RN Idaho February 2016

Official publication of ANA Idaho
Volume 38, • No. 4
Quarterly publication direct mailed to approximately 18,000 RNs and LPNs in Idaho.
February, March, April 2016
from the President...
Highlights from the ANA Idaho Nurses
Conference, November 6, 2015
Inside this issue
FEATURE:
To Improve Patient Care, Keep Health Literacy in Mind
Vanessa Potoski, RN, BSN, and Kim Martz, PhD, RN
Page 3
ANA Idaho Conference Highlights-Photos
Update from the Idaho Board of Nursing
Page 6
Sandra Evans, M.A.ED, RN, Executive Director
Page 7
Educating the Idaho Workforce of the Future:
Creating Opportunities for Life-Long Learning Among
Nurses of Traditionally Under-Represented Populations
Andrea Lambe, DNP Student
Page 8
From left: Dr. Marla Weston, CEO ANA; Becky Lambrecht, Idaho Student Nurses Association Liaison;
Tonia Waltson, INA Secretary; Traci Gluch, INA Treasurer; Holly Carlson-Decker,
ANA Idaho president; and Toni Sparks, delegate, at the ANA Idaho Conference in Boise.
ANA Idaho president, Holly Decker-Carlson,
presents Dr. Grace Jacobson, RN, left, with
recognition for her accomplishments at the
ANA Idaho Conference in Boise, Idaho,
November 6, 2015.
current resident or
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371
by Holly Decker-Carlson, MS, CCRN
ANA Idaho President
Email: president@idahonurses.org
A present-day Florence Nightingale may live in Idaho.
At this year’s annual ANA Idaho conference held in
Boise, we had the privilege to recognize and celebrate
Grace Jacobson, PhD, RN. Dr. Jacobson has committed
more than 50 years to the nursing profession. In this time,
she has provided care to people not only within Idaho
communities but also to communities abroad. She has
taught, trained, and mentored hundreds, but more likely
thousands, of nurses who have successfully received their
nursing education at Idaho State University in Pocatello.
In addition to her focus here in Idaho, she has had many
years of service in the U.S. Army Nurse Corps, including
an active duty tour in Desert Storm. To top it all off,
Grace has been an INA/ANA member for 40 years.
Grace is an excellent example of someone who is
fully investing in her career. Thank you Grace!
At the ANA Idaho nurses conference, in addition to
celebrating Grace’s many accomplishments, we had the
great privilege of hearing from four other speakers
including the ANA Idaho Executive Director,
Robin Schaeffer, RN, MSN, CAE, who visually
recapped the Idaho Nurses Association’s past
accomplishments in the presentation, “INA: The
State of the Association.”
Our keynote speaker, Marla Weston, PhD,
RN, FAAN, Chief Executive Officer of the
American Nurses Association, presented “Nurses
Transforming Healthcare.” Dr. Weston shared
a cutting-edge perspective of the professional
nurse trajectory, focusing on the opportunities
that nursing has to become an integral part of
healthcare. As Dr. Weston noted, we have more
When a Family Says “Do Everything,” and We Believe
the Requested Treatment is No Longer Beneficial
R. Alex Chamberlain, Coordinator of Clinical Ethics
Collaborative Testing in Nursing Education
Michelle Critchfield, RNC, BSN
Page 10
Page 11
opportunities within our communities to be present as
board members than ever before. Our current healthcare
model is depending on the increase of advance practice
RN’s and their ability to practice to the fullest of their
licensure. Lastly and most importantly, Dr. Weston
emphasized and reaffirmed that local and national
leaders do hear OUR nursing voices.
At the conference, the remainder of the day included
inspiring words from Alex Chamberlain, Chaplain and
Ethicist, at St. Luke’s Regional Medical Center, on the
ethical dilemmas we as healthcare providers face each
day. Chaplain Chamberlain explained the role and goals
of an ethics committee in ensuring the needs and the
voices of our patients are represented fairly. Following
this presentation, our afternoon was filled with hearing
the very personal experiences of a corporate comedian,
Sharon Lacey, whose mother had recently passed away
and who was touched by the care of her mother’s nurses.
The conference ended with the reunion of our plenary
speaker, Brandon Kelly, with a nurse from St. Alphonsus
Regional Medical Center who had cared for him 20 years
ago after he suffered a life threatening car accident.
Brandon waited a near lifetime to thank his nurse
publicly for having faith in him and for tirelessly working
to heal him through many months of rehabilitation.
Needless to say, we had a great conference! Thank
you to all who participated and/or attended.

Page 2 • RN Idaho February, March, April 2016
Guidelines for Submissions
to RN Idaho
RN Idaho (RNI), the official publication of ANA Idaho, is a peer-reviewed journal that
is published quarterly. Views expressed are solely those of the authors or persons quoted
and do not necessarily reflect ANA Idaho’s views or those of the publisher, Arthur L.
Davis Publishing Agency, Inc. The RNI Editorial Board oversees this publication and
welcomes nursing and health-related news items, original articles, research abstracts
and other pertinent contributions of 200 to 800 words. Authors are not required to be
ANA Idaho members.
For information about manuscript format, submission of photographs, publication
selection and rights, and advertising in RNI, please visit the ANA Idaho website at
http://www.idahonurses.org under “News/Links.” You may also contact the ANA
Idaho at rnidaho@idahonurses.org or by phone 1-888-721-8904.
RN Idaho is published by ANA Idaho
1850 E. Southern Ave., Ste. 1,
Tempe, AZ 85224
Toll-free Phone: 888-721-8904
Direct Dial: 404-760-2803 Extension: 2803
Email: rnidaho@idahonurses.org
FAX: 404-240-0998
Website: www.idahonurses.org
2016
TELEMEDICINE
CONFERENCE
SEATTLE,
WASHINGTON
MARCH 21–23
Telehealth:
Spanning the
Care Continuum
Conference &
Telehealth 101
Workshop – $300
INA Welcomes
New Members
Editorial Board:
Carrie Anstrand, MA, BSN, RN, LCCE, IBCLC
Barbara McNeil, PhD, RN-BC, Editor
Holly Decker-Carlson, MS, RN, CCRN (advisory)
Tracy Flynn, PhD, RN, CNE
Anna Hissong, MSN, RN-BC
Robin Schaeffer, RN, ANA Idaho Executive Director
(advisory)
Kim Watt, BSN, RNC-NIC, CPN
Visit www.nrtrc.org
Call 406-237-8665
for information
September - November 2015
Ammon, Idaho
Luanne Powers
Emmett, Idaho
Lisa Isaksen
RN Idaho welcomes comments, suggestions
and contributions. Articles, editorials and other
submissions may be sent directly to the ANA Idaho
office via mail, fax or e-mail. Please call the ANA
Idaho office if you have any questions.
Searching for the
perfect career?
Find your future here.
• Search job listings in all 50
states, and filter by location
& credentials
• Browse our online database
of articles and content
• Find events for nursing
professionals in your area
Get started now!
www.nursingALD.com
Boise, Idaho
Carrie Anstrand
Mary Barlow
Ann Butt
Kathleen Daniels
Ashlee Dean
Jessicia Emory
Linda Erlandson
Shawn Forseth
Jessica Hadfield
Bobbie Hernke
Cindy Koster
Christine Ludlum
Cynthia Malinowski
Nancy Nadolski
Eve Palmer
Amy Roberts
Anna Rostock
Carmen Salyer
Nichole Santarone
Nicolette Sesek
Erica Yager
Caldwell, Idaho
Jordie Booth
Clarkston, WA
Tracie Freeman
Coeur D Alene, Idaho
Luke Emerson
Cindy Womeldorff
Idaho Falls, Idaho
Sheila Murdock
Juliaetta, Idaho
Janice Hamilton
Kuna, Idaho
Kimberly Braun
Meridian, Idaho
Faith Chennette
Melissa Ward
Moscow, Idaho
Jodi Bice
Nampa, Idaho
Terri Blackburn
Pamela Drake
Brianna Kingsbury
New Plymouth, Idaho
Sara Mahler
Pocatello, Idaho
Marcie Brown
Janice Hammond
M. Michele Pond-Bell
Rathdrum, Idaho
Belinda Childers
Sandpoint. Idaho
Sharon Bistodeau
Seeking Registered Nurses!
Opportunities for Day and Night shift RN’s!
Competitive Wages! Excellent Benefits!
For more information contact Beth Goetz, Nurse Manager and recruiter:
• goetzb@cmccares • (509) 633-6337 office • (509) 449-8109 cell
411 Fortuyn Road Grand Coulee, WA 99133
www.cmccares.org
New Hospital, Great Location
Join ANA Idaho Today
We need you!
Membership application
http://nursingworld.org/joinana.aspx
For advertising rates and information, please
contact Arthur L. Davis Publishing Agency, Inc., 517
Washington Street, PO Box 216, Cedar Falls, Iowa
50613, (800) 626-4081, sales@aldpub.com. ANA
Idaho and the Arthur L. Davis Publishing Agency,
Inc. reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited
to corrections in the next issue or refund of price of
advertisement.
Acceptance of advertising does not imply
endorsement or approval by ANA Idaho of products
advertised, the advertisers, or the claims made.
Rejection of an advertisement does not imply a
product offered for advertising is without merit, or
that the manufacturer lacks integrity, or that this
association disapproves of the product or its use.
ANA Idaho and the Arthur L. Davis Publishing
Agency, Inc. shall not be held liable for any
consequences resulting from purchase or use of
an advertiser’s product. Articles appearing in this
publication express the opinions of the authors; they
do not necessarily reflect views of the staff, board, or
membership of ANA Idaho or those of the national or
local associations.
RN Idaho is published quarterly every February,
May, August and November for ANA Idaho,
a constituent member of the American Nurses
Association.
CARROLL COLLEGE OPENING
Chair,
Department of Nursing
Complete position announcements
can be found at
www.carroll.edu/employment.

February, March, April 2016 RN Idaho • Page 3
from the Editor...
RN Idaho Editorial Board
Member Changes for 2016
At the start of this new year, the RN Editorial Board
wishes everyone good health and happiness. Current
Board members are Dr. Tracy Flynn, Anna Hissong, Kim
Watt, and Dr. Barbara McNeil, editor. In 2016, we will
have changes in membership for the Board but continue to
encourage you to send in your manuscripts or reports.
After publication of this current issue, Kim Watt,
BSN, RNC-NIC, CPNN, will leave the Editorial Board.
We wish to thank Kim for her wisdom and outstanding
contributions to our newsletter’s editorial work. For many
years, she has dedicated her time to the Editorial Board
and consistently reviewed manuscripts for publication. Her
critical analysis and keen insights in reviewing submissions
have been valuable assets to RN Idaho. We will miss you,
Kim, and send you good wishes.
On a positive note, we have
gained a new Editorial Board
volunteer, Carrie Anstrand,
MA, BSN, RN, LCCE, IBCLC.
She received her BSN from Boise
State University in 2000 and her
Master of Arts in Communication
in 2006 with emphasis in Health
Communication. Her areas
of nursing specialty began in
pediatrics; she worked for over
10 years at Texas Children’s
Carrie Anstrand
Hospital in the Houston Medical Center. Currently Carrie
is focused on women’s health and has a private practice
as a lactation consultant and Lamaze birth educator. She
also works for St. Luke’s Health System in Women’s
Administration as the Coordinator for Women’s Health
Special Projects. Carrie explained that her reason for
volunteering to serve on the Editorial Board is twofold:
to “sharpen my writing and editorial skills and to grow in
my knowledge and understanding of the nursing culture in
Idaho.” Welcome Carrie!
To Improve Patient Care,
Keep Health Literacy in Mind
by Vanessa Potoski, RN, BSN
St. Alphonsus Medical Group Heart Care Clinic
RN and a Master’s student in the Boise State
University Nursing of Populations Program.
Email: potoskiv@gmail.com
Kim Martz, PhD, RN
Assistant Professor, Boise State University.
Email: KimMartz@boisestate.edu
Case Scenario – Mrs. G.
Mrs. G. is a 71-year-old white woman who says she
went to school through the 9th grade. She has come
to the clinic because she has a complaint of frequent
urination with burning. She says that she thinks she may
have weak kidneys because she found that she has some
of the symptoms listed on a website called Herbcures.
com. She ordered some herbs and has taken them for two
weeks, but her symptoms have not improved. Mrs. G. is
very tentative in her speech and keeps apologizing for
bothering the nurse. She is worried that her son will be
angry that she did not go to the doctor sooner. The nurse
explains to Mrs. G. that she needs to go into the bathroom
and collect a urine sample so that the lab can test it for the
presence of bacteria and leukocytes. Then the nurse gives
her verbal instructions for collecting the sample. Mrs. G.
spends a long time in the bathroom, and when she comes
out, the container is empty. She asks the nurse to repeat the
instructions, and then returns to the bathroom to obtain the
sample. At the end of the visit, the nurse hands Mrs. G. a
patient handout about bladder infections and a prescription
for an antibiotic, and tells her to take 3 tablets per day.
Mrs. G. goes home and takes the tablets at 8 a.m. when she
gets up, at noon when she eats lunch, and at 4 p.m. when
she has a cup of tea and a snack.
Some nurses may complain that Mrs. G. is not very
intelligent or does not “comply” with their instructions for
effective self-care. However, maybe Mrs. G. has a different
challenge – low health literacy. Health literacy (HL) is a
construct that describes the many factors that affect “the
degree to which individuals have the capacity to obtain,
process, and understand basic health information and
services needed to make appropriate health decisions”
(Center for Health Literacy Promotion, n.d).
The Health Literacy Skills framework (Squiers,
Peinado, Berkman, Boudewyns, & McCormack, 2012)
is one model of the interconnectedness of factors that
affect an individual’s HL. It takes into account not only
an individual’s HL skills, but also the family, healthcare
system, community, and media factors that influence HL
and health outcomes. HL and health-related behaviors are
affected by a patient’s print and numerical literacy level,
ability to communicate, information-seeking skills, health
status, emotions, motivation, social support, access to
healthcare, and the quality of the print and verbal messages
they receive from health care providers (HCPs). Mrs. G.’s
story illustrates how some of these factors affect her health
behavior.
Health Literacy and Patient Outcomes
Only 12% of adults in the U.S. have proficient HL
(U.S. Department of Health and Human Services [DHHS],
2012). Low HL can lead to many problems: less favorable
health outcomes; low compliance rates; health disparities;
incorrectly taken medications; worse mental health; less
effective communication with HCPs; seeking out and
using information from inaccurate sources; and increased
medical costs, hospitalizations, ED use, and mortality rates
(Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011;
Bevan & Pecchioni, 2008; Roett & Wessel, 2012; Wynia &
Osborn, 2010).
Patient outcomes affect the financial well-being of
medical institutions. Low HL adds an additional $106 to
$238 billion to healthcare costs in the U.S. per year (Vernon,
Trujillo, Rosenbaum, & DeBuono, 2007). The relationship
between HL and hospital readmissions within 30 days of
hospital discharge is pertinent because Section 3025 of
To Improve Patient Care continued on page 15

Page 4 • RN Idaho February, March, April 2016
Executive Director’s Report
by Robin Schaeffer, MSN, RN, CAE
Executive Director of ANA Idaho
Email: ed@idahonurses.org
Year after year, the member volunteers and staff
of ANA Idaho work tirelessly to meet your statewide
professional needs. Every membership dollar we receive
is invested back into interests that advance the nursing
profession and promote a healthy Idaho. Please take
some time to review our 2015 accomplishments and plans
for 2016. Keep in mind that our work could not be done
without collaboration and partnerships and the amazing
work of our parent organization, the American Nurses
Association (ANA). Be sure to check out the tremendous
resources available to every nurse at http://www.
nursingworld.org
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THE MOST TRUSTED PROFESSION…
WHERE DO YOU FIT IN?
For 14 years in a row, the public has rated nurses’
honesty and ethical standards. This year 85 percent of
Americans rate nurses as very high or high, 17 percentage
points above any other profession! “It’s essential that
we leverage this trust to lead and implement change in
the health care system,” said Pamela F. Cipriano, PhD,
RN, NEA-BC, FAAN, president of the American Nurses
Association (ANA). “Hospitals, health care systems and
other organizations are lacking an important perspective
and can’t make fully competent decisions if they don’t
have registered nurses at the board table or in the C-Suite.
That’s why ANA is a member of the Nurses on Boards
Coalition, working to place 10,000 nurses on boards by
2020.”
EVERY BOARD WOULD BENEFIT
FROM THE UNIQUE PERSPECTIVE
OF A NURSE.
The Nurses on Boards
Coalition (NOBC) represents
national nursing and other
organizations working to
build healthier communities
in America by increasing nurses’ presence on corporate,
health-related, and other boards, panels, and commissions.
The coalition’s goal is to help ensure that at least 10,000
nurses are on boards by 2020, as well as raise awareness
that all boards would benefit from the unique perspective
of nurses to achieve the goals of improved health and
efficient and effective health care systems at the local,
state, and national levels. If you currently sit on a board or
would like to, go to: http://www.nursesonboardscoaltion.org.
NURSING
SHORTAGE: FACT
NOT FICTION!
Robin Schaeffer
With close to 50% of the current workforce (baby
boomers) slated to retire in the next 10 years, health
economists predict a nursing shortage. Job vacancies for
experienced nurses have already started to increase in
Idaho. Keep updated on the latest Idaho nursing workforce
statistics at the Idaho Nursing Action Coalition: http://
www.nurseleaders.org/idaho-nursing-action-coalition/
www.futureofnursingid.com.
WHAT EVERY NURSE NEEDS TO
KNOW
In 2015, ANA released a revision of its Code of Ethics
for Nurses with Interpretive Statements, a cornerstone
document of the nursing profession that reflects many
changes and evolutions in health care. It addresses the
most current ethical challenges nurses face in practice.
The release was just one component of the “Year of
Ethics,” a series of activities emphasizing the importance
of ethics in nursing practice. For more information: http://
www.nursingworld.org. To order a copy of the book: http://
www.nursesbooks.org/

February, March, April 2016 RN Idaho • Page 5
IS YOUR PRACTICE UP TO
STANDARD?
The 2015 3rd edition of the Nursing
Scope and Standards of Practice
contains 17 national standards of
practice and performance that define
the who, what, where, when, why, and
how of nursing practice.
The Nursing Scope and Standards
of Practice informs and guides
nursing practice and is often used as
a reference for quality improvement
initiatives, certification and credentialing, position
descriptions and performance appraisals, classroom
teaching and in-service education programs, boards of
nursing members’ orientation programs, and regulatory
decision-making activities.
It also outlines key aspects of nursing’s professional
role and practice for any level, setting, population focus or
specialty, and more!
STAFFING WHITE PAPER: A MUST
READ
ANA President Cipriano as she kicks off a yearlong drive
into a culture of safety that focuses on patient and nurse
safety: http://www.nursingworld.org. The campaign will
also highlight how patients, communities, and the nursing
profession can benefit from efforts to foster a culture of
safety in health care.
CULTURE OF HEALTH
peers at the only conference for nurses focusing on
quality outcomes!
BENEFITS AND DISCOUNTS
If you are a member of ANA Idaho, you have choices:
Pick one, two, or all: Professional Liability Insurance,
Auto Insurance, Long Term Care Insurance, Term Life
Insurance, Financial Planning: http://www.nursingworld.
org. If you are not a member, please join us and support
the work we do for your profession.
This publication was released in December 2015
and is the first in a series of papers that makes the case
for nursing’s value. The American Nurses Association
(ANA) collaborated with Avalere to explore the clinical
case for using optimal nurse staffing models to achieve
improvements in patient outcomes. Avalere conducted a
targeted review of recent published literature, government
reports, and other publicly available evaluations of
nurse staffing and patient outcomes. Read the findings.
Download a copy: http://www.nursingworld.org.
CULTURE OF SAFETY
It’s been 15 years since the Institute
of Medicine rocked the nation
when it issued the call for a
safer health care system in
its landmark reports, To Err
Is Human: Building a Safer
Health System and Crossing
the Quality Chasm: A New Health
System for the 21st Century. Since
then, nurses have been instrumental in
improving the quality and safety of U.S. health care over
the past decade and a half, but we have to ask whether
we are now truly practicing in a culture of safety. Join
Nurses are key to building a culture of health in
their communities. The theme of the 2015 Campaign
for Action Summit was Leading Change & Building
Healthier Communities. The Robert Wood Johnson
Foundation rolled out their Culture of Health Action
Framework. Look for 2016 updates from our Idaho
Nursing Action Coalition on this important initiative:
http://www.nurseleaders.org/idaho-nursing-actioncoalition/
QUALITY, SAFETY, AND STAFFING
Attend ANA’s premier conference, Connecting
Quality, Safety and Staffing to Improve Outcomes.
Learn new innovations in nursing and examine the
variables that affect nurses’ ability to deliver highquality
care. Conference sessions will bring you the
latest strategies, research, and best practices to improve
outcomes through quality, safety, and staffing. Attendees
will learn from evidence-based research and discover
innovations they can start using immediately. Join your
Join our high caliber staff
of RN’s and live in the beautiful high desert
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$29.56-$45.13 DOE, night and weekend differentials.
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IDAHO NURSES
Help us spread the word about
Women’s Health Check
Women’s Health Check
offers
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For more information, or to find a screening
location, call the Idaho CareLine at 2-1-1
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Program Faculty:
Laura Holyoke, Ph.D
Associate Professor, Moscow
Jean Henscheid, Ph.D
Clinical Asst. Professor, Boise
Michael Kroth, Ph.D
Associate Professor, Boise
Adult, Organizational Learning
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The Adult, Organizational Learning and
Leadership (AOLL) program prepares
leaders in a wide range of careers including
higher education, business, government
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You will be able to attain skills to become
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This program is designed for working
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including adult learning, organizational
learning, leadership, and human resource
development.
For more information:
Web: http://www.uidaho.edu/ed/leadershipcounseling/aoll
Call: 208-364-4047 • Email: lead@uidaho.edu

Page 6 • RN Idaho February, March, April 2016
Conference
Highlights
COMPLETING YOUR
PROFESSIONAL PUZZLE:
WHERE DO YOU FIT IN?
Idaho Nurses Association, Friday, November 6, 2015
St. Alphonsus Regional Medical Center Boise, Idaho
Board of Director members meet prior to the ANA INA Annual Conference: Sitting around
the table from the left: Holly Carlson, President; Kim Froelich, VP, Pres-Elect; Tonia Walston,
Secretary; Becky Lambrecht, Liaison, Idaho Student Nurses Association; Margaret Henbest,
Executive Director, Nurse Leaders of Idaho (guest); Toni Sparks, Membership Assembly
Representative; Debby Wood, ANA Idaho Staff and Traci Gluch, Treasurer.
Closing speaker Brandon Kelly presented
Elevating Your Efforts so That You Can
Elevate Your Excellence. Brandon is a master
at triumphing against all odds. He fought
and won a battle against cancer twice. In
this picture Brandon is re-united with one of
the St. Alphonsus nurses that cared for him
during a prolonged hospitalization when he
was just 2-years old and just barely survived
a car accident caused by a drunk driver. You
can see 2-year-old Brandon in the picture
behind the speaker.
American Nurses Association’s
CEO Marla Weston, PhD, RN,
FAAN, immediately captured the
interest of the audience during
her keynote address: Nurses
Transforming Healthcare.
Her presentation was
followed by audience
questions and discussion.
Alex Chamberlain, Ethicist,
presented the audience with
many ethical scenarios
during his presentation: When
Family Says ‘Do Everything’ and
We Believe That the Requested
Treatment Is Futile.
Comedian Sharon
Lacey presented
Life Should be an
Adventure: How to
Overcome Change
and Beat Stress.
Weaving in real
nursing experiences
along with audience
participation,
Sharon was the
perfect after lunch
speaker! Here
she is with Gary
Dokter, conference
participant.
Waiting for the next session to start. Glad to have a day off
from work and down-time with their friends and colleagues.
Mentoring our future nurses: Grace Jacobsen
(right) sits with Jessica Daugharty-Sterner
(left). Jessica is the current president of the
Idaho Student Nurses Association.
Anna Rostock and Brienne Sandow
take a moment to pose for the camera.
Heather Healy, MS, APRN,
FNP-BC, NEA-BC, was a
member of INA until she moved
to Spokane, Washington to
become Chief Nursing Officer
for Deaconess Hospital,
Rockwood Health System.
Heather gave an excellent
update of the ANA’s Nursing
Scope and Standard of
Practice, 3rd edition. For more
information about this updated
publication see page 5.
We had many nurses join ANA Idaho on conference day.
Here are the 3 lucky winners of our new member raffle.

February, March, April 2016 RN Idaho • Page 7
Update from the Idaho Board of Nursing
by Sandra Evans, M.A.Ed, RN, Executive Director
Email: sandra.evans@ibn.idaho.gov
Second Regular Session of the 63rd Idaho
Legislature
The second Regular Session of the 63rd Idaho
Legislature will be in full swing by the time you receive
this issue of RN Idaho, and, as in previous years, the Idaho
Board of Nursing will be enthusiastically engaged during
the Session. This year, the Board will be:
• Introducing three pieces of legislation, each amending
the Nursing Practice Act;
• Presenting two administrative rule dockets;
• Presenting the Board’s FY2017 budget request;
• Monitoring bills that impact the Board as an agency
of state government and also the safety, health and
welfare of patients and the public; and
• Responding to requests from policymakers for
information and bill analysis as they maneuver
through the complex task of lawmaking in the brief
period of time they are in Boise doing “the work of
the people.”
Proposed Legislation
The Board’s three proposed bills, when adopted, will:
1) Enact the “enhanced” Nurse Licensure Compact
(NLC), which will replace the current NLC, of which
Idaho has been a member since 2001 and which
is currently in effect in 25 states. The “enhanced”
NLC is an amended version of the current NLC,
an interstate compact modeled after the Driver’s
License Compact that provides the mechanism for
member states to recognize nurse licenses mutually,
thereby alleviating the need for licensed practical
nurses and licensed registered nurses to hold
multiple licenses. The “enhanced” Nurse Licensure
Compact incorporates language agreed to by the 50
states and four U. S. territories, addressing concerns
about public protection as well as operational and
governance issues with the current Compact.
2) Enact the Advanced Practice Registered Nurse
(APRN) Compact, modeled after and complementary
to the NLC, that will allow APRNs to hold one
license issued by the primary state of residence that
grants the privilege to practice as an APRN in other
APRN Compact member states, both physically
and via technology. Adoption of the Compact will
increase patient access to qualified APRNs licensed
in another state who choose to practice, either
physically or electronically, in another Compactmember
state.
3) Amend the current definition of “practice of nursing”
to more accurately reflect the functions nurses
perform and what the practice of nursing means in
Idaho. Practice of nursing, as amended, will mean
“the autonomous and collaborative performance of
acts and services requiring specialized knowledge,
judgment, and skill that assist individuals, groups,
communities or populations to promote, maintain, or
restore optimal health and wellbeing throughout the
life process. Nursing practice encompasses a broad
continuum of services delivered in, but not limited to,
areas of clinical practice, education, administration,
research, and public and volunteer service. Nursing
practice occurs at the physical location of the
recipient.”
Pending Rules
The Board is presenting two separate administrative
rule dockets that were introduced for comments in July,
revised as necessary based on comments received, and are
now pending approval by the Legislature as the last step
toward becoming final.
1) Pending Rule Docket 23-0101-1501 requires RNs and
LPNs seeking to renew their licenses to demonstrate
their continued competence to practice nursing in
Idaho. The rule establishes methods and criteria to
comply with this obligation.
2) Pending Rule Docket 23-0101-1503 amends Board
of Nursing Rule 402 (IDAPA 23.01.01.402) to update
and clarify provisions regarding registered nurses
functioning in a specialty area of nursing.
The Board especially appreciates the Idaho Nurses
Association’s careful review and input on the proposed
legislative bills and administrative rules as well as the
organization’s indicated support for each document.
These exciting initiatives will maintain the currency
and relevance of the Idaho Nursing Practice Act and
Administrative Rules of the Board, the primary structural
elements that support the Board’s mission to protect the
public.
Other Updates
The nine-member, governor-appointed Board of
Nursing meets quarterly for the conduct of regular
business. At their October 1-2, 2015, meeting, Board
members Susan Odom, RN, Moscow, Chair; Vicki Allen,
RN, Pocatello, Vice Chair; Whitney Hunter, consumer
member, Boise; Christopher Jenkins, RN, Homedale; Jan
Moseley, RN, Coeur d’Alene; Carrie Nutsch, LPN, Jerome;
Rebecca Reese, LPN, Post Falls; Clay Sanders, APRN,
CRNA, Boise; and Merrilee Stevenson, RN, Wendell:
— Adopted new/revised internal policies related to 1)
practice remediation for nurses who have been absent
from practice and are seeking initial or reinstatement
licensure and 2) Board member and staff in- and outof-state
travel;
— Granted continued approval to nursing assistant
training programs at the College of Southern Idaho;
College of Western Idaho; Eastern Idaho Technical
College; Idaho State University; Lewis-Clark State
College; North Idaho College; and Stevens-Henager
College/Idaho Falls;
— Approved a major curriculum change to the AD/
RN program presented by Eastern Idaho Technical
College;
— Granted continued approval to currently recognized
APRN credentialing bodies;
— Revoked three RN and two LPN licenses based on
substantiated violations of the Idaho Nursing Practice
Act;
— Continued their discussion of Board member
qualifications and set this as the primary topic for the
Board’s 2016 Business Retreat in May;
— Received an update report on the Idaho Nursing
Action Coalition’s (INAC) initiative to “Position
Idaho to Best Meet the Future of Nursing Workforce
Needs,” presented by Dr. Randy Hudspeth, Project
Director;
— Discussed the potential impact of the recent U.S.
Supreme Court decision on North Carolina Board of
Dental Examiners vs. Federal Trade Commission;
— Received an informative report on Idaho’s State
Health Innovation Plan (SHIP) from representatives
of the Idaho Department of Health and Welfare;
— Continued work on revision of the Board’s Vision
statement;
— Engaged in robust dialogue on emerging treatment
modalities for substance use disorder, including
agonist therapy, and implications for participation in
the Board’s Program for Recovering Nurses as well
as Board decisions related to licensure eligibility.
In addition, the Board discussed the evolving role
and educational preparation of LPNs, lifelong learning
and continued competence requirements for nurses, and
training needs for unlicensed assistive personnel in various
settings, with several members of the public in attendance
at the October meeting during the scheduled Open Forum
on October 2.
Next Board of Nursing Meeting
The Board invites the public to attend scheduled
Board meetings and participate in the Open Forum held
on the second day of each meeting. The Forum provides
an opportunity to dialogue with the Board on issues of
interest that are not necessarily included on the published
agenda. The Board will not take action on issues
introduced during the Forum, but may choose to address
them at a later scheduled Board meeting.
Future meetings of the Board are tentatively scheduled
for April 21-22, July 21-22, and October 20-21, 2016,
in Boise at locations to be determined. For further
information, visit the Board’s website at www.ibn.idaho.
gov or contact Lyn Moore at lyn.moore@ibn.idaho.gov or
208.577.2500.
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Page 8 • RN Idaho February, March, April 2016
Educating the Idaho Nursing Workforce of the Future:
Creating Opportunities for Life-long Learning Among Nurses of
Traditionally Under-Represented Populations
by Andrea Lambe, Boise State University,
DNP Student
Email: andrealambe@u.boisestate.edu
A landmark report, published by the prestigious
Institute of Medicine [IOM] (2010), recommends that
80% of nurses be baccalaureate prepared by the year
2020. Additionally, the report calls for the provision of
strategically aligned pathways to facilitate academic
progression from recruitment to admission, graduation,
and licensure of a culturally diverse nursing workforce.
State-based implementation (SIP) grants funded by
the Robert Wood Johnson Foundation (RWJF) and
the American Association of Retired Persons (AARP)
awarded grants to 31 states, including Idaho.
The purpose of this paper is 1) to introduce the fourth
objective of Idaho’s SIP grant, which is the creation of
opportunities for life-long learning among nurses of
traditionally under-represented populations and 2) to give
a preliminary status report of this objective.
Current Status of Diversity Among Idaho’s Nurses
By 2043, minority populations are projected to
become the majority, necessitating a diversified nursing
workforce to narrow the gap of healthcare disparities
nationwide (American Academy of Colleges of Nursing
[AACN], 2013a). Current data indicate that Idaho falls
short of achieving a diversified nursing workforce based
on the percentage of licensed practical (13.4%), licensed
registered (11.6%), and advanced practice nurses (10.5%)
with minority backgrounds practicing in the state (Idaho
Department of Labor, 2015, p.56). Ethnic or racial
minorities account for 37% of the general U.S. and 17%
of Idaho’s population (Idaho Department of Labor, 2015).
Approximately 13% of Idaho’s nursing workforce stems
from traditionally under-represented populations and,
therefore, reflects Idaho’s diversity demographics more
closely than those of the United States (Idaho Department
of Labor, 2015).
National data suggest that 30.1% of undergraduate
and 31.9% of graduate nursing students have a minority
background (AACN, 2013b), indicating a 4%-7% rise in
minority baccalaureate and graduate nursing students
over the last decade (AACN, 2015). A snapshot of Idaho’s
four AACN member academic institutions 1 points to the
fact that only 10% of baccalaureate students come from
traditionally under-represented populations while an
additional 15% are male nursing students, who, due to
low enrollment, are often considered a minority group
(AACN, 2015).
Faculty positions, nationwide, appear to equally lack
diversity as minority nurses hold only 13.1% of positions
available (AACN, 2013a, 2013b; National Advisory
Council on Nurse Education and Practice (NACNEP),
2013). Diversity statistics for Idaho’s nursing faculty
are unknown. Because of the aforementioned data,
Idaho must continue to strive for a nursing student and
faculty demographic that meets the nation’s demands
of a diversified, baccalaureate healthcare and nursing
workforce by 2020.
Proposed Action Items
Structured Pipeline Program
Admission into Idaho’s schools of nursing (SON)
remains highly competitive due to a shortage of clinical
sites and faculty in the face of existing funding cuts
for public institutions of higher education. Creating a
diversified nursing workforce and student population must
include targeted recruitment strategies for minorities to
ensure a diversified student body and future workforce.
Research indicates that students from under-represented
populations often face science and math preparation
gaps, are less likely to enroll in a health science major,
experience a lack of paternal guidance during the college
application process, and experience language difficulties
leading to avoidance of degree seeking (Brooks Carthon,
Nguyen, Pancir, & Chittams, 2015). Despite significant
interest in diversification, these authors found that only
a small number of nursing programs had implemented a
structured pipeline program to increase minority student
representation.
Pipeline programs focus on the provision of financial,
academic, and psychosocial support, which includes
diversity workshops, career development, research
opportunities, and community partnerships between
distance learning, counseling and mentoring. Carthon
et al. (2015) note that every minority group requires
different support systems. Hence, a “one size fits all”
approach is not appropriate and nursing as well as
other healthcare professional programs are encouraged
to explore and engage in diversity pipeline programs
that appreciate the swath of experiences and cultural
nuances of minority students and their contribution to the
institution, student body, and community.
Holistic Review Admission Process
Historically, admission processes provided advantages
for Caucasian students with a focus on grade point
average and standardized testing results (Hassouneh

February, March, April 2016 RN Idaho • Page 9
& Lutz, 2013). However, today’s healthcare employers prefer a nursing workforce that
displays independent attributes such as resourcefulness, resilience, relationship capacity
for service to others, patient centricity, positivity and achievement orientation to name a
few (Talent Plus, Inc., 2010). The Sullivan Commission report decided that
…diversity in higher education was seen as critical for the development of skills
necessary to participate and compete in the global economy, in order to foster such
skills as the ability to understand, learn from, and work and build consensus with
individuals from different backgrounds and cultures. (Sullivan Commission, 2004, p. 25)
The challenge amidst a growing, diversified population is for healthcare workers to
provide the type of culturally-competent patient care that has been directly linked to
organizational effectiveness and safe patient outcomes. Hence, the American Nurses
Association (ANA) and the Idaho Nurses Association advocate for “culturally congruent
practice” as part of the revised ANA Scope and Standards of Practice (2015) for nurses.
In 2007, the Association of American Medical Colleges (AAMC) endorsed a holistic
review initiative, and recently published the Roadmap to Diversity and Educational
Excellence delineating holistic admission processes for Schools of Medicine (AAMC,
2014). A holistic review process incorporates four principles that allow for a broad
selection criteria other than standard admission processes. These criteria include (a)
a candidate’s fit with an institution’s mission and goals, (b) his/her life experiences,
personal attributes and academic metrics (“EAM”), (c) the consideration of the
applicant’s race and ethnicity as well as (d) each candidate’s contributions to the
academic institution and profession (Glazer, Bankston, & Clark, 2015).
SON that have implemented this holistic review in their admission processes have
seen the number of attempts by students to pass licensing exams either improve or
remain unchanged (Glazer, Bankston, & Clark, 2015). Additionally, holistic admission
practices improved student engagement within the community, cooperation and
teamwork among students, and increased the students’ openness to ideas or perspectives
other than their own. Therefore, Idaho’s healthcare employers and SON face a great
opportunity to dialogue on the integration of holistic review processes and the creation
of a diversified influx of baccalaureate-prepared nursing students.
Bleich, M., MacWilliams, B., & Schmidt, B.J. (2015). Advancing diversity through
inclusive excellence in nursing education. Journal of Professional Nursing, 31(2), 89-94.
Brooks Carthon, J.M., Nguyen, T.H., Pancir, D. & Chittams, J. (2015). Enrollment of
underrepresented minorities in nursing majors: A cross sectional analysis of U.S.
nursing schools. Nurse Education Today, 35, 1102-1107.
Campaign for Action. (2015). Promoting diversity. Retrieved from http://
campaignforaction.org/campaign-progress/promoting-diversity
Glazer, G., Bankston, K., & Clark, A. (2015). Holistic admissions in nursing: Moving
forward. Retrieved from http://www.aacn.nche.edu/networks/gnap/membersonly/2015/Bankston.pdf
Hassouneh, D. & Lutz, K. (2013). Faculty of color having influence in schools of
nursing. Nursing Outlook, 61(3), 153-163.
Idaho Department of Labor. (2015). Idaho nursing overview. Retrieved from http://labor.
idaho.gov/publications/NursingOverview2015.pdf
Institute of Medicine. Committee on the Robert Wood Johnson Foundation Initiative
on the Future of Nursing. (2010). The future of nursing: Leading change, advancing
health. Washington, DC: The National Academy Press.
National Advisory Council on Nurse Education and Practice. (2013). Achieving health
equity through nursing workforce diversity. Retrieved from http://www.hrsa.gov/
advisorycommittees/bhpradvisory/nacnep /Reports/eleventhreport.pdf
Sullivan Commission on Diversity in the Healthcare Workforce. (2004). Missing
persons: Minorities in the health professions. Retrieved from http://www.aacn.nche.
edu/media-relations/SullivanReport.pdf
Talent Plus, Inc. (2010). Clinical health care professional talent online assessment.
Lincoln, NE: Talent Plus, Inc.
Diversity Measurement
The Sullivan Commission (2004) charged schools to set measureable goals and
promote the training in diversity and cultural competence for students, faculty, and
healthcare professionals. Bleich, MacWilliams and Schmidt (2015) ask that SON
advance diversity through inclusive excellence by creating partnerships with minority
groups and organizations. Diversity measurements, for example in the form of race or
ethnicity specific data, can be utilized to support such inclusive excellence to institute
evidence-based recruitment, retention and holistic review practices. Transparent data
assists in mitigating diversity engagement strategies between stakeholders through the
statistical analysis of race, ethnicity, gender, socio-economic status, and educational
background among nursing students. Idaho can benefit from data-driven analysis and
data-based actions to ensure the appropriate allocation of resources and facilitation of
life-long learning opportunities among all nurses in the state.
Idaho Nursing Action Coalition’s Contribution
To answer the call for a diversified nursing workforce based on migration and
population projections as well as anticipated and identified gaps in healthcare,
national attention has been given to the development of diversity engagement practices
in healthcare education programs. Accrediting agencies, educational institutions,
professional organizations, and employers agree to close this gap and Idaho is making
significant strides towards this goal.
Thus far, the Idaho Nursing Action Coalition (INAC) has assessed Idaho’s progress
towards attaining an 80% baccalaureate prepared nursing workforce by 2020 and
continues to support inclusive practices to promote diversity in our state in accordance
with the Campaign for Action (2015). The design and implementation of diversity
engagement practices is no small feat, but INAC is dedicated to continue an open
dialogue between stakeholders on the development of mitigation strategies that will
include and respect state-based, as well as school-based, variables. For Idaho, healthcare
employers and regional differences will play an important role in defining the healthcare
sector’s particular needs for a diversified nursing workforce.
What Is Next?
In 2015, the Idaho Board of Nursing implemented a new licensure database and
diversity-specific data should become available in January of 2016. Thereafter, Idaho
nurse leaders and educators as well as healthcare employers are called upon to denote
Idaho’s status as it stands in terms of diversity engagement and formulate specific
implementation strategies for a culturally diverse nursing workforce for Idaho. The new
data and potential diversity engagement strategies will be presented and opened up for
discussion at the June 2016 INAC regional meeting in Boise, Idaho.
1.
Boise State University, Idaho State University, Lewis-Clark State College, and
Northwest Nazarene University
References
American Association of Colleges of Nursing. (2013a). Enhancing diversity in the
workforce. Retrieved from http://www.aacn.nche.edu/media-relations/diversityFS.pdf
American Association of Colleges of Nursing. (2013b). New AACN data show an
enrollment survey in baccalaureate and graduate programs amid calls for more highly
educated nurses. Retrieved from http://www.aacn.nche.edu/news /articles/2012/
enrollment-data
American Association of Colleges of Nursing. (2015). Policy brief: The changing
landscape: Nursing student diversity on the rise. Retrieved from http://www.aacn.
nche.edu/government-affairs/Student-Diversity-FS.pdf
Association of American Medical Colleges. (2014). Roadmap to diversity and
educational excellence: Key legal and educational policy foundations for medical
schools (2nd ed.). Washington, D.C.: Association of American Medical Colleges.

Page 10 • RN Idaho February, March, April 2016
Strategies for Nurses Encountering Patients at Risk for
Addiction or Substance Use Disorder
by Deborah A. Thomas, M.Ed., LPC, CADC,
Chief Executive Officer
The Walker Center, Gooding, Idaho
Email: debbie@thewalkercenter.org
Addiction is a chronic, progressive, primary disease
that if left untreated will lead to an early death. According
to the American Society of Addiction Medicine [ASAM]
(2011, Definition of Addiction, para 1), addiction “is
characterized by an inability to consistently abstain,
impairment in behavioral control, craving, diminished
recognition of significant problems with one’s behaviors
and interpersonal relationships, and a dysfunctional
emotional response.”
As the first step in helping a person at risk for an
addiction or with a substance use disorder (SUD), the
nurse must recognize that there is an addiction problem.
When encountering these adolescents and/or adults, a
nurse may feel manipulated and experience an active
addict’s playing on the nurse’s emotions with lies,
complaints, or even appealing to the nurse’s sympathies
in order to continue to obtain the reward the addict may
be actively seeking. Oftentimes a nurse will not know how
to interact with these patients. Even worse is that those
persons at risk for addiction or with a SUD will not know
what to do with themselves. It’s a frustrating situation. It
can seem hopeless at times for the patient, the patient’s
family, and the nurse.
How Nurses Can Intervene
In interactions with persons at risk for addiction or
SUD, nurses may not know the words that will help these
individuals or their family. From a nurse’s perspective, it
may be challenging to determine whether a patient at risk
for addiction or with SUD needs inpatient or outpatient
treatment. The expectation is not that the nurse would
assess or treat these patients, but instead should make a
referral to an addiction treatment center. Nurses should
be aware however that this might lead to upset patients
and/or family members. The person at risk for addiction
or with SUD needs to hear that there is hope, that there
is someone that can provide options, and that life can get
better.
At the addiction treatment center, the addiction
specialist will conduct a multidimensional assessment of
the individual using the American Society of Addiction
Medicine Criteria (see Figure 1). According to ASAM
(2011. ASAM Criteria, para 1), these criteria are a
“comprehensive set of guidelines for placement, continued
stay and transfer/discharge of patients with addiction and
co-occurring conditions.”
Nurses play a pivotal role in ensuring the patient
receives the best treatment. By facilitating the referral,
nurses plant the seed to initiate change, which may turn
around the life of these individuals and assist them toward
sobriety and ultimately to become a productive, motivated
contributor to society. Residential facilities such as The
Walker Center in Gooding, Idaho, can help treat adults
over 18 who are at risk for addiction and/or who abuse
drugs and alcohol. The underlying emotional or behavioral
issues are addressed through gender-specific and genderseparate
treatment such as cognitive behavioral group
therapy.
Figure 1. ASAM’s Six Dimensions of
Multidimensional Assessment
If you are concerned about someone who has a
substance abuse problem, facilitate the addiction specialist
consult.
References
American Society of Addiction Medicine. (2011).
ASAM criteria. Retrieved from http://www.asam.org/
publications/the-asam-criteria
When a Family Says, “Do Everything,”
And We Believe That the Requested
Treatment Is No Longer Beneficial
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Drug Free Employer/EOE
by R. Alex Chamberlain,
Coordinator of Clinical Ethics
St. Luke’s Regional Medical Center, Boise, Idaho
Email: chambera@slhs.org
One of the greatest challenges in health care arises
when we believe that we are doing something “to” a
patient rather than “for” them. This surfaces when we face
the age-old ethical dilemma of noticing when we can do
something, but are wondering if we should do it in the face
of diminishing returns in terms of patient benefit.
One Approach
Some states, Texas for example, have formulated a legal
algorithm when the patient or his/her surrogate decision
makers want to continue treatment that the medical team
has deemed no longer medically beneficial (e.g., futile,
to use a traditional term.) After a diligent search for an
alternate provider, and with concurrence of an ethics
committee, the medical team is allowed to remove nonbeneficial
treatment over the surrogate’s objections. This
is similar to a process that is built into the policies of
many individual hospitals as well. The solution is largely
unsatisfactory, because most hospital ethics committees
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September 22, 2016: Celebrate Nursing Dinner
The LEAP conference and the Celebrate Nursing Dinner will be
held at the Courtyard Marriott, 1789 S. Eagle Rd., Meridian.
Go to www.nurseleaders.org for more information and to get
registered! Contact Karin Iuliano at kiuliano@nurseleaders.org
with any questions or concerns.
consist of members who appear indistinguishable from
the clinicians themselves…rendering the perception that
ethic committee members are not impartial. Knowing that
our fallback position is to overrule the family sets up an
adversarial relationship.
Maintaining Heartfelt Presence
Alongside the Family
As difficult as it will be for us, a more ethically sound
approach can be to make it clear that we will struggle
with the family amid these decisions rather than make
a unilateral pronouncement that “we are done” and
proceed to treatment withdrawal, make a patient DNR,
or otherwise move away from an aggressive plan of
care. We don’t have to “fix” the clash between us and
the surrogate decision makers. In fact, we should not
be surprised that the patient’s family may be slow to
recognize treatment failure due to their long-standing
relationship with the patient, their limited sampling of
similar medical disappointments, and their exposure to the
media’s portrayal of the “miraculous” cures and surprising
outcomes if a medical team persists in treatment.
If we maintain a heartfelt presence alongside family,
a bond can be formed. As our working relationship with
family members is developed and trust grows, we may
find that a solution arises more quickly than if battle lines
are drawn. Each individual patient story that involves an
ethical dilemma may benefit from an ethics consultation
and many hospitals have an ethics committee with
trained members who will come alongside to offer their
perspective.
Nursing’s Role
By turning on its head the standard maxim “the
patient comes first,” it is my conviction that the first
priority of the nurse facing ethical dilemmas should
be the survival of the nurse. If we don’t recognize our
moral distress and seek the support of our peers and the
interdisciplinary team, we will become depleted and no
longer be able to continue to serve our patients and one
another. One way to avoid this involves joining with the
family in expressing dismay and looking forward to a sigh
of relief with them…rather than in spite of them.

February, March, April 2016 RN Idaho • Page 11
Collaborative Testing in Nursing Education
by Michelle Critchfield, RNC, BSN
Assistant Professor Registered Nursing, College of Southern Idaho
Idaho State University Doctoral Student
Email: mcritchfield@csi.edu
The author reports no potential financial or
other conflicts of interest and no commercial affiliation.
In keeping pace with changes in health care and following the call by the Institute
of Medicine [IOM] (IOM, 2011) and the American Association of Colleges of Nursing
[ACCN] (AACN, 2011) for collaboration, a primary goal of nursing education must
be preparing future nurses to work in collaborative teams (Sandahl, 2010). Nursing
education must also meet the needs and learning styles of the students enrolled in nursing
programs. Nurse educators must recognize that today’s college-age students utilize a
unique approach to learning, drastically different from that of current nurse faculty. This
younger generation of future nurses has grown up in a technologically-rich society and
prefers teamwork, innovative learning strategies, the use of technology, and experiential
activities (Hanson & Carpenter, 2011, p. 270). The purpose of this paper is to analyze the
collaborative testing strategy, and describe the benefits and potential drawback of this
educational strategy for use in nursing education.
Collaborative Learning
In collaborative learning, students work together to achieve learning goals. This
type of learning strategy is active and student-centered (Sandahl, 2009) and allows
the learner to interact with other individuals while developing skills like creativity,
flexibility, and problem solving (Bloom, 2009). Collaborative learning allows students
to work in small groups and promote each other’s learning by explaining, sharing, and
discussing (Hanson & Carpenter, 2011). Collaborative learning activities are varied and
can include discussions, group case studies, research teams, peer-teaching activities, and
testing (Sandahl, 2009). Five key components have been identified to make collaborative
learning a successful learning strategy: face-to-face interaction, individual and group
accountability, interpersonal and small group skills, positive interdependence, and group
processing (Hanson & Carpenter, 2011).
Collaborative Testing
Collaborative testing is an educational strategy that utilizes the five key components
of collaborative learning. This educational strategy gives student nurses the opportunity
to reinforce nursing knowledge and theory while practicing teamwork and collaboration
skills (Sandahl, 2010). Collaborative testing consists of small groups of students working
together to come to a consensus on examination questions. Collaborative groups can be
chosen by the instructor or be student-selected; students can remain in the same groups
over the course of many exams or groups may change with each assessment (Pandey &
Kapitanoff, 2011).
The type of exam utilized in collaborative testing can also be varied; unit exams,
final exams, or both types of exams may be offered. Collaborative exams may be used
exclusively or may be utilized after an exam has been taken on an individual basis. The
variety of options allows the learning strategy to be tailored by the instructor to meet the
students’ learning needs (Bloom, 2009).
Positive Benefits of Collaborative Testing
Retention of Knowledge
One benefit of collaborative testing is retention of content. When students collaborate
to answer exam questions, they discuss and reason with another, becoming more skillful
in critical thinking through communication. Knowledge, in general, is social, and
constructed from cooperative efforts to learn, understand and solve problems. “Group
members exchange information and insights, discover weak points in each other’s
reasoning strategies, correct one another, and adjust their understanding on the basis of
others’ understanding” (Bloom, 2009, p. 219).
2009). Research also showed that when collaborative testing was utilized in the course,
individual exam scores also increased (Bloom, 2009). Researchers cited decreased
anxiety, more positive learning environment, and increased preparation that collaborative
learning environments provide as reasons for the individual exam improvements (Bloom,
2009).
In situations where students were administered a collaborative exam after completion
of an individual exam, the collaborative exam served as a posttest review. This double
testing method provided answers to lingering questions from the initial individual
exam, corrected erroneous thinking, and provided an additional learning opportunity
of the course content (Peck, Stehle-Werner, & Raleigh, 2013). Posttest reviews in this
format were positive, constructive, and educational, whereas some faculty will describe
traditional posttest reviews as negative and argumentative. The students were reinforced
in their correct thinking or corrected in their erroneous thinking by peers in a learning
environment (Centrella-Nigro, 2012). This also eliminated the need to utilize subsequent
class periods reviewing exam items and allowed more time to focus on new content
(Bloom, 2009).
Drawbacks to Collaborative Testing
Beneficial to Selected Students Only
Collaborative testing is not an effective learning strategy for all learners, despite
the improved test scores for most participants. Some students describe themselves as
introverts and prefer to do all course work alone; other students cite a lack of trust and
friendship within the cohort group as a reason to shy away from group learning activities
(Peck, et al., 2013). Solitary and high achieving learners often prefer to rely on their own
preparation and knowledge for exam strategies (Haberyan & Barnett, 2010).
Possible Grade Inflation
Collaborative learning may result in individual grade inflation. While both high and
low achieving students reported collaborative testing as a positive experience, lower
achieving students benefited the most from the group testing experience (Centrella-
Nigro, 2012). This is not surprising as low performers have more to learn from high
performers than vice versa (Dahlstrom, 2012). Less prepared and lower achieving
students can rely on the efforts of more prepared and higher achieving students and the
collaborative exam grade may not reflect the individual learner’s actual knowledge of the
content (Giuliodori et al., 2009).
Non-Acceptance by Educators
Some educators are unfamiliar with collaborative testing strategies and see the
strategy as less sound than traditional forms of assessment (Shindler, 2004). Others
Collaborative Testing continued on page 12
Student Perceptions
Student perceptions of collaborative testing are consistently positive (Sandahl, 2010).
Students believe they learn more with collaborative testing when compared to individual
examinations (Woody, Woody, & Bromley, 2008) and collaborative testing has been
shown to reduce learner test anxiety. Collaborative learning activities result in a more
positive relationship among students and create healthier psychological regulations than
do competitive or individualistic learning practices (Bloom, 2009). Students prefer group
discussion; it was ranked first on a list of 11 possible teaching approaches (Woody et al.,
2008) and the group format has been shown to enhance the learners’ satisfaction with the
overall learning process (Bloom, 2009).
Individual Student Preparation and Motivation to Learn
Research shows that when collaborative testing is utilized, individual student
preparation is increased (Shindler, 2004). Students reported increased motivation to
prepare in collaborative conditions than they might have in an individual exam context.
They related their increased preparation to the fear of letting down their group mates
(Shindler, 2004). In this lower anxiety, positive, collaborative testing environment,
students are more likely to study and retain information being reviewed prior to the
exam. This positive attitude towards course work and peers can be a motivating force to
improve study habits and exam preparation (Sandahl, 2009).
Improved Exam Scores
One benefit from collaborative testing that has been supported overwhelmingly in
research is the improvement of exam scores. Students working together and utilizing
a collective knowledge base perform significantly better than when being tested
individually (Bloom, 2009). In the collaborative format, students were more likely to
change wrong answers to correct answers than the reverse (Giuliodori, Lujan, & DiCarlo,
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Page 12 • RN Idaho February, March, April 2016
Collaborative Testing continued from page 11
argue that collaborative testing does not prepare students
to be successful on national certification exams (Peck et
al., 2013). Many nursing curricula are designed towards
successful attainment of a passing grade on the NCLEX-
RN. In these circumstances, collaborative testing is seen
as contrary or non-preparatory for this goal (Centrella-
Nigro, 2012).
Preconceptions of Students
A barrier to collaborative learning and collaborative
testing is the students’ pre-conceived notions about
traditional education and learning strategies. Even
though teaching-learning strategies for younger students’
learning utilize cohort groups and collaborative learning,
the students may be unfamiliar with these strategies in
formal education. They may be uncomfortable to try an
unfamiliar tool like collaborative testing, when they have
no previous experience with the strategy. Instructors
may utilize class time creating “buy-in” or encouraging
students to utilize collaboration for learning, instead of
focusing on the learning objectives. Students can also
have expectations that instructors will provide all the
learning and information and they may hesitate to listen
to classmates’ ideas and perspectives and may continually
seek support and reassurance from the instructor (Smith-
Stoner & Molle, 2010).
Application to Nursing
As cited in Giuliodori et al (2009, p. 24), the American
Association for the Advancement of Science strongly
recommends, “science be taught as science is practiced.”
This means that teaching strategies must be consistent
with methods utilized in scientific inquiry; one crucial
part of that is collaboration (Giuliodori et al., 2009,
p. 24). Most teachers will default to the pedagogical
strategies that they were exposed to as students. As
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faculty prepare the nurse educators of tomorrow, there
arises the important need to model educational methods
that are sound, research based, and utilized in health care
practice (Shindler, 2004). Johnson, Johnson, and Smith
(1998) evaluated 305 studies comparing collaborative and
cooperative learning with individualist or competitive
learning. Their findings overwhelmingly concluded that
cooperative learning is more effective than any other
approach.
Adult learners entering the nursing profession
must master the skills of listening to others’ opinions,
discussing possibilities, and cooperating with their peers.
They must practice these attributes if they wish to thrive
in the health care profession. Learning to cooperate in
order to achieve success is a valuable life and professional
skill that nursing education can demonstrate, teach, and
promote. Collaborative testing accomplishes these aims
by preparing future nurses to be competent listeners and
contributing members in multicultural and diverse health
care teams (Dallmer, 2010). Utilizing collaboration as
an assessment tool in nursing education mirrors what
happens in the “real world” of health care: “groups of
people working together to complete a task, using problem
solving to determine the best method for success.”
(Dallmer, 2010, p. 7).
Conclusion
Collaborative learning is a useful educational strategy,
based in scientific research and learning domains, with
many positive benefits to nursing education. Nurse
educators can utilize collaboration to prepare future nurses
to seamlessly transition into inter-disciplinary health care
teams while strengthening their nursing knowledge by
utilizing a student’s preferred learning strategy (Smith-
Stoner & Molle, 2010). It can be taught, modeled, and
practiced in nursing education to prepare student nurses
to function on interdisciplinary teams and meet the
challenging needs of diverse health care patients. Nurse
educators can facilitate collaboration in nursing education
by utilizing collaborative testing.
References
American Association of Colleges of Nursing [AACN].
(2011). Core competencies for interprofessional
Long Term Care:
• MDS Coordinator • Registered Nurses
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The UW PTC provides
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collaborative practice. Retrieved from http://www.aacn.
nche.edu/education-resources/ipecreport.pdf
Bloom, D. (2009). Collaborative test taking: Benefits for
learning and retention. College Teaching, 57(4), 216–220.
Centrella-Nigro, A., M. (2012). Collaborative testing as
posttest review. Nursing Education Perspectives, 33(5),
340–341.
Dahlstrom, O. (2012). Learning during a collaborative
final exam. Educational Research and Evaluation,
18(4), 321-332.
Dallmer, D. (2004). Collaborative test taking with adult
learners. Adult Learning, 15(3/4), 4-7.
Giuliodori, M. J., Lujan, H. L., & DiCarlo, S. E. (2009). Student
interaction characteristics during collaborative group testing.
Advances in Physiology Education, 33(1), 24-29.
Haberyan, A., & Barnett, J. (2010). Collaborative testing
and achievement: Are two heads really better than one?
Journal of Instructional Psychology, 37(1), 32–41.
Hanson, M. S., & Carpenter, D. R. (2011). Integrating
cooperative learning into classroom testing:
Implications for nursing education and practice.
Nursing Education Perspectives, 32(4), 270–273.
doi:10.5480/1536-5026-32.4.270
Institute of Medicine [IOM]. (2010). The future of nursing:
Leading change, advancing health. Washington, DC:
The National Academies Press.
Johnson, D. W., Johnson, R. T., & Smith, K. A. (1998).
Cooperative learning returns to college: What evidence
is there that it works? Change, 30, 26-35.
Pandey, C., & Kapitanoff, S. (2011). The influence of
anxiety and quality of interaction on collaborative
test performance. Active Learning in Higher Education,
12(3), 163-174.
Peck, S. D., Stehle-Werner, J. L., & Raleigh, D. M. (2013).
Improved class preparation and learning through
immediate feedback in group testing for undergraduate
nursing students. Nursing Education Perspectives,
34(6), 400–404. doi:10.5480/11-507
Sandahl, S. (2009). Collaborative testing as a learning
strategy in nursing education: A review of the literature.
Nursing Education Perspectives, 30(3), 171–175.
Sandahl, S. (2010). Collaborative testing as a learning
strategy in nursing education. Nursing Education
Perspectives, 31(3), 142–147.
Shindler, J. V. (2004). “Greater than the sum of the
parts?” Examining the soundness of collaborative
exams in teacher education courses. Innovative Higher
Education, 28(4), 273-283.
Smith-Stoner, M., & Molle, M. (2010). Collaborative
action research: Implementation of cooperative
learning. Journal of Nursing Education, 49(6), 312–318.
doi:10.3928/01484834-20100224-06
Woody, W. D., Woody, L. K., & Bromley, S. (2008).
Anticipated group versus individual examinations:
A classroom comparison. Teaching in Psychology 35(1),
13-17. doi:10.1080/00986280701818540
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February, March, April 2016 RN Idaho • Page 13
by Peggy L. Farnworth, CPA, CFP, CSA,
Securities and advisory services through
KMS Financial Services, Inc.
Email: peggy.farnworth@kmsfinancial.com
We have all have felt the pinch of the rising costs of
health care. According to the Centers for Medicare and
Medicaid Services (CMS, 2015) and national health
expenditure projections for 2012-2022, our health care
costs are on a path to $4.8 trillion by 2021, up from $2.76
trillion in 2010 and $75 billion in 1970. Health care is fast
approaching 20% of the U.S. economy. What does that
mean to you personally and to your patients? Accelerating
health care costs leave families with considerably less
cash to spend. But what are the options? What can we do
differently?
PricewaterhouseCoopers (2010) calculated that up to
half of all health care spending results from waste. That
waste can be divided into 2 areas. One area of waste
is excessive, defensive medicine that orders redundant,
inappropriate or unnecessary tests. What can you do to
prevent this? We can ask questions, challenge the “why,”
get second opinions, and look for less expensive options
for the same procedure.
We can also control the other major area of waste—
our own health behaviors. We can take medication as
prescribed. We can stop smoking and drink alcohol
moderately or not at all. We can eat healthy whole foods
Finances 101:
Impact of Your Health on Your Wealth
and stay physically active to maintain a healthy weight.
We can very significantly reduce our chances of suffering
from chronic diseases such as diabetes and heart/lung
problems. The growing burden of chronic diseases adds
significantly to escalating health care costs. Researchers
predict a 42% increase in chronic disease cases by 2023
(Partnership to Fight Chronic Disease, 2009); this adds
$4.2 trillion in treatment costs. Much of this cost is
preventable, since many chronic conditions are linked to
unhealthy lifestyles.
We need to become more responsible consumers of
health care if for no other reason than poor health is a
huge opportunity cost. Poor health makes us miss work,
possibly miss promotions. Poor health costs us money that
we could spend elsewhere and poor health makes it harder
to save money.
Olivia Mitchell, the head of Pension Research Council
at the Wharton School of Business at the University of
Pennsylvania, said in a 2007 Money Magazine interview
that if a couple in their 50s and 60s with an average
income develop chronic health problems, it will slow
their savings by half the rate of their healthy counterparts.
She adds that a healthy 65-year-old couple would need
$295,000 to cover insurance premiums and out of pocket
medical expenses over an average life span (or about
20 years). Add an additional $150,000 for a couple with
chronic illnesses.
One more way to reduce health care waste is to take
advantage of high deductible health insurance policies
offered by employers. These encourage conservative use of
health care. When paired with Health Savings Accounts,
they can increase savings for medical expenses.
But perhaps the biggest shift needs to be in our attitude
as a society. Allison Ferguson (2014) sums it up well: “Too
many people sacrifice their health to earn their wealth.
Then, [they] turn around and spend their wealth getting
back their health.”
References
Centers for Medicare and Medicaid Services [CMS].
(2015). National health expenditure projections: 2012-
2022. Retrieved from https://www.cms.gov/researchstatistics-data-and-systems/statistics-trends-and-reports/
nationalhealthexpenddata/downloads/proj2012.pdf
Ferguson, A. (Sept. 1, 2014). Health is wealth [Blog post].
Retrieved from http://healthimpactswealth.com/healthis-wealth/
Partnership to Fight Chronic Disease. (2009). The 2009
almanac of chronic disease: The impact of chronic
disease on U.S. health and prosperity. Retrieved from
http://www.fightchronicdisease.org/sites/default/files/do
cs/2009AlmanacofChronicDisease_updated81009.pdf
PricewaterhouseCoopers. (2010). The price of excess:
Identifying waste in healthcare spending. Retrieved
from http://pwchealth.com/cgi-local/hregister.cgi/reg/
waste.pd
Idaho Nurse Residency Program (INRP): A Pilot Project With
Critical Access Hospitals
by Val Greenspan, PhD, RN
Project Director, Robert Wood Johnson
Foundation’s State Implementation Program
grant, Nurse Residency Component,
Idaho Alliance of Nurse Leaders
Email: vgreenspan@cableone.net
Development of the Idaho Nurse Residency Program’s
(INRP) pilot project was described in a previous issue
of RN Idaho (Henbest, 2015). For 2013-2015, the IRNP
was funded with two Robert Woods Johnson Foundation
(RWJF) State Implementation Program grants (SIP1 and
SIP3) and with matching Idaho funds. The purpose of this
current paper is to report the initial evaluative findings
from the INRP pilot project.
Use of Critical Access Hospitals
The INRP targeted Critical Access Hospitals (CAH).
This is the Centers for Medicare and Medicaid (CMS)
designation created in 1997 for certain rural hospitals
that meet criteria such as having 25 or fewer acute care
inpatient beds or providing emergency services on a 24/7
basis (Rural Health Information Hub, (2002-2016). In
addition, for the INRP pilot project, CAHs were selected
that were not connected to a health system already
having, or in the process of establishing, a nurse residency
program. Of the 27 CAH’s in Idaho, 20 met this criterion,
and of these, four geographically distributed facilities
participated with five Nurse Residents (NR) who were
recent graduates of Associate Degree in Nursing (ADN)
and Baccalaureate in Nursing (BSN) programs. These new
graduates had minimal registered nurse experience (from
zero to eight months) prior to starting the IRNP project.
Evaluation of the INRP
Data were collected quantitatively at baseline, six
months, and 12 months via a voluntary, self-report Casey-
Fink postgraduate survey from both the Iowa and Idaho
online nurse residency enrollees. The “n” at baseline was
16, at 6 months n=10, and at one year, n=13 with six NRs
completing all three surveys (Idaho NRs in all three).
Of the initial 22 nurse residents in the first cohort, six
were from a rural hospital and 16 worked at a designated
CAH. By March, the cohort decreased to 18 due to Iowa
dropouts.
At 12 months, more than 90% of the 13 respondents
achieved eight of nine items in the survey’s “support”
category, achieved three of five items in the “patient
safety” category, all six items in the survey’s
“communication/ leadership” category, and all three items
in the survey’s “professional satisfaction” category.
Insights from Structured Interviews
with Idaho Nurse Residents
Structured interviews of the Idaho Nurse Residents
were conducted at six and 12 months and resulted in the
following insights:
1) The real practice world Iowa modules were both a
review from, and complementary to, their nursing
program, but different from the facility’s orientation and
daily work foci.
2) At 12 months, NRs reported feeling more confidence,
competence, and readiness for independent practice.
Improvement in communication (e.g., with difficult
providers, health care team members, and patient
education) was cited as the greatest INRP benefit.
3) Through non-institutional discussions, Nurse Residents
reported gaining tips and ideas for greater efficiency
and error reduction. They reported finding an outlet for
practical guidance, for talking about issues or problems
they were avoiding at work, and for reflecting on
monthly professional growth. Nurse Residents reported
gaining insights on not being alone in experiencing
certain feelings or issues. They reported more
confidence overall and greater independent practice.
4) The required, facility-valued Quality Improvement/
Evidence-Based project (during the last six months
of the INRP) promoted more focus on safety, quality
care, implementing change, and leadership growth
than might otherwise have occurred in the first year of
practice.
5) The work effort of four to 10 hours/month connected
to benefits of increased confidence, competence,
professional growth, and either satisfaction with the
time spent or a greater benefit than the time invested in
the IRNP.
6) Nurse Residents reported that all parts of the Idaho
Nurse Residency Program worked together and that all
features of the Program were essential.
Overall INRP Evaluation
When preceptors and Nurse Residents were paired on
the same shift, there was more mutual satisfaction and a
positive working relationship. However, those pairs that
worked different shifts had decreased satisfaction and a
less positive working relationship. Although simulations
are highly valued with this program, they are on hold at
this time. The overall recommendation, with NR and
preceptor suggestions and concurrence by the facility
CNO/DNS, was to continue the Idaho Nurse Residency
Program. Subsequently, a 2015-2016 cohort of NRs have
enrolled from a hospital of

Page 14 • RN Idaho February, March, April 2016
In Memoriam
ANA Idaho is pleased to honor deceased registered
nurses who graduated from Idaho nursing programs and/
or served in Idaho during their nursing careers. Included,
when known or when space allows, will be the date when
deceased and the Idaho nursing program. The names
will be submitted to the American Nurses Association
for inclusion in a memoriam held in conjunction with
the ANA House of Delegates. Please enable the list’s
inclusiveness by submitting information to rnidaho@
idahonurses.org.
Barott, Agnes Pearthree. July 10, 2015. Agnes
earned an associate degree in nursing from the University
of Minnesota in Duluth in 1950. Because she highly
valued education, she later attended Lewis-Clark State
College in the 1980’s and earned a Bachelor’s degree,
one of her proudest accomplishments. Agnes worked in
the pediatric office of Dr. Mannschreck and Dr. Olson in
Lewiston, caring for hundreds of children over the years.
Bayer, Judith Mary Coppage. August 29, 2015. Jude
completed her nursing education at Troy State University
in Alabama and worked 30 years for the University of
California-Los Angeles Medical Center neuropsychiatric
unit as a certified psychiatric nurse. She later moved to
Lewiston, where she worked in the psychiatric unit at St.
Joseph Regional Medical Center. Jude’s lifelong passion
was nursing. She loved mentoring younger co-workers to
help them embrace the nursing profession.
Childers, Lorraine Lycklama, December 21, 2015.
Lorraine lived in Meridian, Idaho, and worked as an RN
at a Kaiser hospital in Oakland, CA, and at the Lawrence
Livermore General Electric Lab in Livermore, CA. before
continuing her nursing career at hospitals in Boise, Sun
Valley, and the U.S. Virgin Islands. Her dedication to
nursing was stellar.
Correll, Rebecca Evelyn. September 18, 2015. While
raising a young family in Spokane, Rebecca earned a
bachelor of arts in nursing from Whitworth College
and a master’s degree in guidance and counseling from
Gonzaga University. During this time, she also provided
care for several foster children. After moving to Lewiston
she opened the Home Health Care Agency, the first of its
kind. She later sold her business to St. Joseph’s Hospital.
Rebecca was active in private, anonymous charity work,
which touched many lives. She was loved greatly by all
who knew her.
Davis, Marjorie Aileen Dizer. August 23, 2015.
Marjorie was trained as an RN at Deaconess Hospital in
Boston and used her talents as a school nurse in Illinois
and, later, as a clinic nurse in her son’s practice. She was
a woman of great courage and faith who lovingly blessed
all of those around her.
Holy Apostles Shawl Ministry, with whom she crocheted
shawls for many years.
Giampedraglia, Charlotte Lee. September 1, 2015.
Charlotte graduated from Lewis-Clark State College as
a registered nurse in 1972 while raising her children. She
was a charge nurse at Clarkston Care Center until retiring
in 1995. As a young girl, Charlotte played clarinet with the
Los Angeles Orchestra for background music in newsreels.
Charlotte was a mother to many and would take in any in
need. She worked from sunup to sundown and laughed and
played in between.
Heiskari, Carol Irene. August 15, 2015. Carol trained
as a registered nurse at Ricks College and the LDS
Hospital in Idaho Falls, going on to achieve her Bachelor’s
Degree in nursing at the University of Utah. She entered
into public health nursing in Lewiston, where she was
assigned to the Nez Perce Indian reservation. She was then
recruited by a former instructor to teach at the Odessa Jr.
College in Odessa, Texas. She later returned to the Public
Health Department in Lewiston and Moscow. While Carol
always put family first, she made time for community
service and worked with pregnant and parenting teens
until she retired in 2000.
Howorth, Jodelle Ann McCracken. October 22, 2015.
Jody received her nursing degree from Lewis-Clark State
College, then spent the majority of her working years
in Alaska. She worked for the State of Alaska Pioneer
Home and later became the administrator for Providence
Extended Care in Anchorage. She eventually formed her
own consulting firm for long-term care education and
worked on many projects around the state. Jody was a
woman of incredible faith.
Laidlaw, Candace Kaye. June 20, 2015. Candace
achieved her nursing degree at Boise State University and
worked 31 years as a licensed practical nurse. She had a
natural talent for making people laugh, and her humor was
contagious. Caring for her loved ones was what she did best.
Locklear, Louise L. July 18, 2015. When her children
were well along in school, Louise elected to join the
work force. She began as a nurse’s aide forZ Boise’s
St. Alphonsus Hospital. Louise graduated to the St.
Alphonsus Hospital surgical teams before retiring in the
mid 1970’s. She loved working with the patients she served
so well.
Nagle, Lori Brantner. June 20, 2015. Lori received
her degree in nursing from Spokane Community College
in 1985 and worked at hospitals in Pullman, Cottonwood,
Lewiston, and Colfax. She truly lived her life to the fullest,
and enjoyed the company of friends who became family,
and co-workers who became friends.
grandparents, neighbors, and her husband as well as in
her professional career as a nurse. She often looked over
and took care of those who were chronically ill or needed
long-term care, and enjoyed serving those who were sick
or needed help.
Patterson, Doris Elaine. October 14, 2015. Dee
joined the Air National Guard in 1976 and began a
career that would take her to every state and a dozen
countries. She became a licensed practical nurse and
EMT, and served in the 124th Medical Clinic. She also
worked at the Pentagon for a time. After retiring from the
Air National Guard, Dee worked for the State of Idaho
Departments of Health and Welfare and Medicaid. She
said many times that she lived a full and fantastic life.
Shuldberg, Ramona Shipp. October 5, 2015. Ramona
completed the registered nursing program at the Idaho
Falls Nursing School in 1958. Her nursing career spanned
50 years and several continents, including stints as
Head Nurse of the ICU at Lakeview Hospital, Lakeview
Hospital Emergency Room, InstaCare, and medical
missions for Operation Smile to China, Honduras, and
the Philippines. Ramona was an active member of the
LDS church where she served faithfully in many callings.
Stenberg, Shirley Geraldine. September 23, 2015.
Shirley studied nursing at Fairview Nursing School in
Minneapolis from 1939 to 1942, then moved to Seattle
where she worked as the right hand for a urologic surgeon.
Although she retired from nursing when she married in
1948, she never stopped volunteering her time and energy.
Shirley was a loving, faith-filled example to her friends,
children and grandchildren who she loved so dearly.
Van Manen, Trudy. November 12, 2015. Trudy was
born and raised in Holland. After immigrating to the
United States she attended Mercy Medical Center and
received her licensed practical nursing license. For many
years she worked at the Idaho State School and Hospital,
where she greatly enjoyed caring for the residents. Trudy
wrote the book “Under the Shadow of His Wings” and
continued working on her computer until just before her
death.
Voegtly, Dorothy Anne. October 22, 2015. Dorothy
attended St. Alphonsus Nursing School and graduated
in 1942, then served as the community health resource
in Fields, Oregon. Later she attended Albany Medical
School to become a nurse anesthetist, graduating in 1967
and retiring after a long and successful career in 1991.
Many from the community remember her affectionately
as “Nannie D.” Dorothy had an insatiable zest for
learning and life, and was honored in 1990 as the Harney
County Woman of the Year for her many outstanding
accomplishments.
Fish, Roxiena Mae. May 26, 2015. Roxiena became
a licensed vocational nurse in 1971. She nourished
her patients, friends and family with her love, witty
personality, and faith. Very dear to her heart was the
Osborne, Patsy Lou Pollard. December 5, 2015. Patsy
was widowed at a young age and put herself through
nursing school as a young mother. She gave of herself
throughout her life nursing those who were sick including
Wickel, Eloise Hedges. October 23, 2015. Eloise
attended a three-year nursing program in Boise and
received certification as a registered nurse. She spent
most of her nursing career at St. Alphonsus Hospital and
was devoted to her patients.
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February, March, April 2016 RN Idaho • Page 15
To Improve Patient Care continued from page 3
the Affordable Care Act mandates decreased Medicare
payments to hospitals with high readmission rates (Stevens,
2014). HL is an independent predictor of readmissions at
both the individual and the population level, and patients
with low HL are 1.46 times more likely than patients with
adequate HL to return to the emergency department (ED)
or be readmitted to the hospital within 30 days of discharge
(Bailey et al., 2015; Mitchell, Sadikova, Jack, & Paasche-
Orlow, 2012).
American Nurses Association/ ANA Idaho Membership –
It’s Your Choice! It’s Your Privilege!
Just Because You Received This Publication,
Doesn’t Mean You Are an ANA Idaho Member
Many Nurses Lack Knowledge About Health Literacy
There are over two million nurses in the U.S. who
can help prevent these costly readmissions by educating
themselves about HL and intervening appropriately.
Unfortunately, researchers have found that nurses frequently
are not trained to understand and address the HL of their
patients. Many nurses overestimate their patients’ HL levels,
view HL as a low-priority problem for their patients, and do
not know how to implement low HL interventions (Cafiero,
2013; Macabasco-O’Connell & Fry-Bowers, 2011).
In an era when patients and their family members
are asked to perform medical/nursing tasks (Reinhard,
Levine, & Samis, 2013); to manage complicated medication
regimens; and to navigate a complex healthcare system with
shortened office visits, fragmented care, and an increasing
amount of insurance paperwork (Ferguson & Pawlak, 2011),
it is imperative that nurses know how to assist patients who
have limited HL.
The Nurse’s Role and Interventions
Nurses should play a leading role in improving HL.
The National Action Plan to Improve Health Literacy
(U.S. DHHS, 2010) strives to connect HL to public
health, clinical care and education and calls for pilot
tests and demonstration projects to be expanded for use in
organizations, population groups, and geographic regions.
Nurses should assume that all patients have low HL until
proven otherwise because HL does not always correspond
to educational attainment, and adults often mask their HL
problems. Also, the complex healthcare system and the
stress of illness can put anyone at risk for HL challenges.
Nurses should be aware that cognitive impairment, poor
vision, age, lower education, low acculturation, and less
frequent use of English might signal low HL.
Nursing interventions should address these areas:
spoken and written communication, self-management and
empowerment, and support systems. The AHRQ Health
Literacy Universal Precautions Toolkit (AHRQ, 2015)
addresses each of these areas and provides specific tools
and resources for HCPs (available at http://www.ahrq.gov/
professionals/quality-patient-safety/quality-resources/tools/
literacy-toolkit/index.html).
Health Literacy From the Patient’s Perspective
HCPs have a tendency to view healthcare from their
own perspective. A 2009 study (Shaw et al., 2009) of 321
cardiac patients found the majority of patients, regardless
of their level of HL, wanted the doctors to use simpler
language and to use verbal communication to build trust in
the relationship. Many patients stated that they either did not
read the patient education materials or became confused and
anxious when they did.
In a study of readmitted diabetes patients, although not
one patient possessed adequate knowledge of their diabetes
or of the discharge instructions they received, almost all of
the patients stated that they did not have any questions while
being discharged, and that they understood the discharge
instructions.
These studies and the personal and financial costs of low
HL provide evidence that all nurses have an obligation to
learn about HL, to make HL a priority in their practices, and
to take a leadership role in their organizations with regard to
improving HL interventions.
References
Agency for Healthcare Research and Quality. (2015). Health
literacy universal precautions toolkit. Retrieved from
http://www.ahrq.gov/professionals/quality-patient-safety/
quality-resources/tools/literacy-toolkit/index.html
Bailey, S. C., Fang, G., Annis, I. E., O’Conor, R., Paasche-
Orlow, M. K., & Wolf, M. S. (2015). Health literacy and
30-day hospital readmission after acute myocardial
infarction. BMJ Open, 5:e006975. doi:10.1136/
bmjopen-2014-006975
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern,
D. J., & Crotty, K. (2011). Low health literacy and health
outcomes: An updated systematic review. Annals of
Internal Medicine, 155(2), 97-107.
Bevan, J. L., & Pecchioni, L. L. (2008). Understanding the
impact of family caregiver cancer literacy on patient
health outcomes. Patient Education and Counseling,
71(3), 356-364. doi:10.1016/j.pec.2008.02.022
Cafiero, M. (2013). Nurse practitioners’ knowledge,
experience, and intention to use health literacy strategies
in clinical practice. Journal of Health Communication,
18, 70-81. doi:10.1080/10810730.2013.825665
Center for Health Literacy Promotion (n.d.). Health
literacy definitions. Retrieved from http://www.
healthliteracypromotion.com/Health-Literacy-
Definitions.html
Mitchell, S. E., Sadikova, E., Jack, B. W., & Paasche-Orlow,
M. K. (2012). Health literacy and 3-day postdischarge
hospital utilization. Journal of Health Communication,
17, 325-338. doi:10.1080/10810730.2012.715233
Roett, M. A., & Wessel, L. (2012). Help your patient “get”
what you just said: A health literacy guide. Journal of
Family Practice, 61(4), 190-196.
Shaw, A., Ibrahim, S., Reid, F., Ussher, M., & Rowlands,
G. (2009). Patients’ perspectives of the doctor-patient
relationship and information giving across a range of
literacy levels. Patient Education and Counseling, 75,
114-120. doi:10.1016/j.pec.2008.09.026
Squiers, L., Peinado, S., Berkman, N., Boudewyns, V.,
& McCormack, L. (2012). The health literacy skills
framework. Journal of Health Communication, 17, 30-54.
doi:10.1080/10810730.2012.713442
Stevens, S. (2014). Preventing 30-day readmissions. Nursing
Clinics of North America, 50, 123-137. doi:http://dx.doi.
org/10.1016/j.cnur.2014.10.010
U.S. Department of Health & Human Services [DHHS],
Agency for Healthcare Research and Quality (AHRQ).
(2012). About the CAHPS item set for addressing health
literacy. Retrieved from https://cahps.ahrq.gov/surveysguidance/item-sets/literacy/index.html
Vernon, J., Trujillo, A., Rosenbaum, S., & DeBuono, B.
(2007). Low health literacy: Implications for national
health policy. Retrieved from http://publichealth.gwu.
edu/departments/healthpolicy/CHPR/downloads/
LowHealthLiteracyReport10_4_07.pdf
Wynia, M. K., & Osborn, C. Y. (2010). Health literacy and
communication quality in health care organizations.
Journal of Health Communication, 15, 102-115.
doi:10.1080/108

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