Nevada RNFormation – August 2017

August 2017 • Volume 26 • Number 3
www.nvnurses.org
Nevada
RNFORMATION
Inside
articles
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 37,000 Registered Nurses and Licensed Practical Nurses in Nevada
4 NNA/NONL Convention
4 Call for Posters
5 Legislative Session Summary
6-7 Legislative Update
8-9 Future of Nursing in Nevada
Awards Dinner
10 Check It Out!
10 NNA District 1 Report
11 Antibiotic Stewardship: Focus on
Outpatient Prescriptions
NNA/NONL Convention:
Creating Our Vision
for the Future
Page 4
12-13 State of the Air in Nevada 2017
14 The Stress Burden: Strategies for
Management
regular features
3 Message from President
Dave Tyrell
Page 8
Future of Nursing in Nevada
Awards Dinner
Saturday, October 7th
“Mad Hatter” Big Hat High Tea
State of the Air in Nevada –
Report Card for 2017
Page 12
Details on page 15
current resident or
Presort Standard
US Postage
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Mark Your Calendars
• July 29, 2017, Bleeding Control, Elko
• October 7, 2017, Big Hat High Tea, Governor’s Mansion
• November 30-December 1 NNA/NONL Joint Convention, Reno

Page 2 • Nevada RNformation August, September, October 2017
Have you visited the NNA Job Board recently?
Visit our website www.nvnurses.org and click on the Job Board
tab to view many available Nevada nursing jobs. If you want to
receive email notice when a new job is added, join our Job Board
mailing list! Just send your email address by text message:
Text NNAJOBBOARD to 22828 to get started
or email nnajobs@nvnurses.org.
If you have a job to advertise, contact Ian at
nnajobs@nvnurses.org. Our rates are reasonable and
money raised helps to benefit Nevada nursing.
www.nvnurses.org
Published by:
Arthur L. Davis
Publishing Agency, Inc.
NNA Mission Statement
The Nevada Nurses Association promotes professional nursing
practice through continuing education, community service, nursing
leadership, and legislative activities to advocate for improved health
and high quality health care for citizens of Nevada.
NNA State Board of Directors
Dave Tyrell, BSN, RN davetyrellrn@gmail.com ................President
Donna Miller, RN donnagmiller@flyingicu.com ............ Vice-President
Nicola Aaker, MSN, MPH, RN, CNOR, PHCNS-BC naaker@aol.com ...Treasurer
Bernadette Longo, PhD, RN longo@unr.edu ................. Secretary
Heidi Johnston, MSN, RN, CNE heidi.johnston@gbcnv.edu .. Director at Large
Amy Pang, BSN, RN aepangster@gmail.com ............ Director at Large
Peggy Lee, BSN, RN lee.peggy4423@gmail.com ......... Director at Large
Julie Wagner, PhD, RN Julie.wagner9@gmail.com ...... President, District 1
Carl Bottorf, RN, MPA carlbottorf@flyingicu.com ....... President, District 3
Carol Swanson, DNP, RN swansonc89705@msn.com .......Legislative Chair
Editorial Board
Editor: Margaret Curley, BSN, RN MCurley@nvnurses.org
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Are you interested in submitting an article for publication
in RNFormation? Please send it in a Word document to us at
nvnursesassn@mvqn.net. Our Editorial Board will review the article
and notify you whether it has been accepted for publication. Articles
for our next edition are due by September 1, 2017.
If you wish to contact the author of an article published in
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August, September, October 2017 Nevada RNformation • Page 3
The President’s Corner
Dave Tyrell, BSN, RN
President, Nevada Nurses Association
“They may forget your name, but they will
never forget how you made them feel.”
–Maya Angelou
First of all I would like to once again send
a sincere Thank You and Congratulations to
all of the nurses who were recognized at the
Future of Nevada Nurses and Northern Nevada
Nurses of Achievement events held across the
state in May. Also a HUGE thank you goes out
to all of the people involved in making these
events a reality. It is because of your tireless
commitment to improving nursing in the state
that makes these events possible and so much
appreciated by all.
On some of NNA’s other fronts, the Legislative committee
continues to be an influential force behind bills focused on
improving nursing’s ability to provide exceptional care for all
patients in the state. Also, the Safe Staffing Task Force which
grew out of the Safe Staffing meetings held earlier in the year
has already met a couple of times. The group currently is
focused on analyzing information summarized from the Safe
Staffing meetings and coming up with action plans. We will keep
you posted as the Task Force moves forward.
Finally, please hold the dates of November 30, 2017 and
December 1, 2017 on your busy schedules. This is when NNA
and the Nevada Organization of Nurse Leaders will be holding
our joint conference at the Grand Sierra Resort in Reno. Several
committees are hard at work right now putting together the
event which promises to be a must attend for all. Watch your
email for more information on how to sign up to attend. You will
not be disappointed.
 If you would like to contact NNA or President Tyrell,
please call 775-747-2333 or email nna@hdiss.net
A Special Invitation To NNA
Members: A Call to Serve
We invite you to be a candidate for office on one of the
Boards of Directors in the Nevada Nurses Association. This
is a way to share your ideas, work toward the realization
of your personal and professional goals, and participate in
shaping the future of health care in Nevada.
Most terms of office are two years, and most
business is conducted by email or teleconference.
In Northern Nevada – District One – we are seeking
candidates for Vice-President, Treasurer, and Director at
Large (3).
In Southern Nevada – District Three – we are seeking
candidates for Secretary, Vice-President, and the Director
at Large (1).
At the state level we are seeking candidates for
Secretary, Director at Large (1), and Nominating
Committee.
We need candidates for 2 ANA Member Assembly
Delegates and two alternates. You must be a member of
ANA/NNA and willing to travel to Washington, DC, in 2018.
We will be happy to send you a summary of the office
you’re interested in. If you’d like more information, please
contact Margaret Curley at MCurley@nvnurses.org.
Nominations will close on September 28, so please
begin to think about how you would like to participate. We
welcome self-nominations. And thank you for serving the
nurses and patients of Nevada – you are appreciated!

Page 4 • Nevada RNformation August, September, October 2017
2017 Nevada Nurses Association/Nevada
Organization of Nurse Leaders Convention
Creating Our Vision
for the Future
Scheduled sessions
(subject to change):
• Creating a culture of excellence
• Nevada Staffing Initiative and
Exemplars
• Care of LGBT patients
• Corrections Nursing
• Expanding Nevada’s Safe Staffing
Initiative to rural hospital and LTCs
• Hot topics
• Opioid Abuse
• Future of Healthcare in Nevada:
ACA / Medicaid / ???
• SBIRT (Screening, Brief Intervention
and Referral to Treatment)
• Nurse Fatigue
• Antimicrobial Stewardship
• Transition to Practice New Research
• Succession Planning for the Coming
Nursing Shortage
• and more!
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November 30, Dec 1
Conference Title:
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Type and Categories of Posters
- Research Posters
- Case Presentation Poster
- Quality Improvement Poster
- Patient Safety/Satisfaction Poster
Thirty posters will be presented during
the NONL/NNA conference that will be held
November 30 and Dec 1, 2017 in Reno,
Nevada. Abstracts will be used as the basis for
selecting the poster for the presentation.
Dates to be aware of:
Abstract will be due: September 1.
Selection will be made by September 30th.
Final Draft of PowerPoint Slide to committee
for making copies for presentation:
November 6th.
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• Introduction
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• No more than 250 words
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August, September, October 2017 Nevada RNformation • Page 5
Legislative Update
2017 Legislative Session Summary
The 2017 Legislative Session is complete. The session finished, as
expected, Tuesday morning, June 6, at 12:00 a.m. NNA had a very
successful session, helping pass signing authority for the APRNs. Some
of the provisions that passed on staffing can be incorporated into the
work being done through the NNA/NONL Safe Staffing Task Force and
ongoing nurse staffing efforts.
Below is an overview of the important issues for the NNA provided
by our lobbyist, as well as a bill tracking report. As you can see, there
were many healthcare related bills introduced this session, and NNA
had to pick its battles carefully.
Suicide Prevention
AB105, sponsored by Assemblyman Tyrone Thompson, revises
requirements for suicide prevention training for certain providers.
Under this new law, APRNs must complete at least two hours of
evidenced-based suicide prevention training within the first two years
of licensure. The APRNs must complete follow-up training every 4
years. Please reference section 2 of the bill for the portion on APRNs.
From NNA’s perspective, the outcome on this bill was a success. The
original language included RNs and was much more burdensome on
all professions. The original bill required 3 hours of instruction and
we were able to negotiate that number down. Note: NNA strongly
supports the broad goals of this bill – reducing suicide in Nevada. As a
result, we are working with the Nevada Office of Suicide Prevention to
provide safeTalk Train the Trainers classes for Nevada RNs, in order to
provide training to nurses and other HCPs throughout the state.
This bill was signed by the Governor on May 26th. That is its
effective date, but there is a chance regulations will need to be
done, and in that scenario, the effective date for those provisions is
July 1, 2017. Note: NNA will have a 2-hour course which fulfills this
requirement available online soon, which will be free to NNA members
and have a small fee for non-members.
Medicaid Reimbursement Rates
This session, there were four bills that worked to address Medicaid’s
chronic issue of the underfunding of facilities. Each bill had a slightly
different focus but legislators primarily wanted to look at the cost of
health care services compared to the reimbursement rate provided by
Medicaid. These policies resulted from the work by the Interim Study
on Post-acute care. Post-acute care facilities struggle throughout the
state due to their reimbursement rates from Medicaid.
AB108, was the result of all these discussions. Sponsored by
Assemblyman James Oscarson, the bill requires Medicaid to review
reimbursement rates every four years. If the rate doesn’t accurately
reflect the actual cost of care, Medicaid must calculate a rate that
reflects the actual costs. The Department must then recommend this
rate to the Director of the Department for submission under the State
Plan for Medicaid.
This bill was signed by the Governor on May 19th and becomes
effective on July 1, 2017.
APRN Signing Authority
There were four bills that addressed the signing authority for
APRNs. Of those four, two passed. SB227 allows for APRNs to sign
forms that are within their scope of practice. These forms would
include: forms for jury duty, certification of
a
disability, exemption for a child immunization,
authorization for self-administration for a diabetic child, examine
competency in a misdemeanor criminal case, certification of mental
illnesses, birth certificates, death certificates, life sustaining treatment,
POLST, do not resuscitate, release for youth sports, handicapped
placard, worker’s compensation, and a health certificate for a taxi cab
driver. The Governor signed the bill on June 2nd. It becomes effective
upon passage, except the portions that need to be done through
regulation. Those portions become effective on January 1, 2018.
Also, AB199 allows for PA’s and APRNs to sign POLST forms. This
bill also sets forth many of the pieces needed in statute to implement
POLST forms in practice. The Governor signed the bill May 24th. The
bill becomes effective July 1, 2017.
Nurse Staffing
SB482 passed and a portion of it involves nurse staffing. Please
review sections 1.8, 8.3, and 8.5. A portion of this bill requires
the State Department of Health to establish a rating system based
on their staffing plan compliance. The Board also must establish
a procedure where a facility can request a follow-up inspection or
appeal concerning a violation of a staffing plan. This separate state
rating system must also be publicly posted on the Division’s website
and at the facility near the entrance in a conspicuous place. Lastly,
this bill makes the selection of nursing representatives on the staffing
committee more specific and allows for alternate members. It also
requires the signature of all staffing committee members when the
refusal of a work assignment is done.
Nurse Licensure Compact
As we discussed throughout the session, AB18 was introduced
to include Nevada in the Nurse Licensure Compact, as an effort to
address the shortage needs in the state and streamline the process
for licensing across state lines. Unfortunately, this bill did not survive.
The nursing union came out in strong opposition to the bill, and the
bill could not be revived. This bill failed to meet a deadline and died on
April 14th.
Anesthesiologist Assistants
SB210 was a bill that would allow for the practice and licensing
of AA’s in the state. NNA, in conjunction with the CRNA’s and
their lobbyist, opposed this bill. As you will recall, the AA’s and
anesthesiologists had a very strong hearing in the Senate policy
committee but a weaker one in the Assembly. The union also brought
their opposition to the bill. The bill missed the May 20th deadline.
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Page 6 • Nevada RNformation August, September, October 2017
Legislative Update
Nevada Nurses Association Report
Bill # Sponsor Description Status Position Notes
AB105
Tyrone
Thompson
Revises continuing education
requirements relating to suicide
prevention and awareness for certain
providers of health care. (BDR 54-32)
Status: Approved
by the Governor.
Chapter 176.
Last Action:
Mentioned no
jurisdiction
Monitor
This bill requires 3 hours of continuing
education in suicide prevention for ARPNs.
AB108
James
Oscarson
Provides for the periodic review of
Medicaid reimbursement rates. (BDR
38-209)
Status: Approved
by the Governor.
Chapter 44.
Last Action: Do pass
Monitor
This bill requires Medicaid to review
reimbursement rates every 4 years and if the
rate doesn’t reflect the actual cost of care,
Medicaid must calculate a rate that reflects the
actual costs.
AB165 John Hambrick Provides for the licensure of health
services executives. (BDR 54-566)
Status: Approved
by the Governor.
Chapter 130.
Last Action: Do pass
Related to long-term care, authorizing holder
of executive license to perform functions of an
administrator of a residential facility for groups
and a nursing facility administrator.
AB199
Melissa
Woodbury
Robin Titus
Cresent Hardy
Revises provisions relating to end-oflife
care. (BDR 40-813)
Status: Approved
by the Governor.
Chapter 104.
Last Action: Do pass
Support
Authorizes PA or APRN to take actions pertain
to a Physician Order on Life-Sustaining
Treatment.
AB424
Michael
Sprinkle
Revises provisions governing the
determination of death. (BDR 40-1025)
Status: Approved
by the Governor.
Chapter 315.
Last Action: Amend,
and do pass as
amended
Monitor
Life-sustaining treatment for person who’s
been determined brain-dead.
AB474
Health and
Human
Services
Makes various changes relating to drug
overdoses and prescribing and using
drugs. (BDR 40-1102)
Status: Enrolled
and delivered to
Governor.
Last Action: Do pass
Support
Governor’s Rx Drug Abuse Bill.
SB28
Health and
Human
Services
Requires an annual review of certain
rates paid by Medicaid in this State.
(BDR 38-373)
Status: (No further
action taken.)
Last Action: Heard,
No Action
Support
This bill requires Medicaid to do an annual
review of Medicaid reimbursement rates. A
report would be submitted to the Legislature
on proposed rates that would cover costs.
SB95
Health and
Human
Services
Requires an analysis of the adequacy
of Medicaid reimbursement rates for
personal care services. (BDR S-368)
Status: (No further
action taken.)
Last Action: Heard,
No Action
Support
Study on Post Acute Care: Requires a study
on Medicaid to evaluate reimbursement rates
for personal services; If the study shows
that rates do not meet the cost, they should
recommend an appropriate rate that does.
SB96
Health and
Human
Services
Requires a comparative analysis of
the rates of reimbursement paid by
Medicaid for certain services. (BDR
S-369)
Status: (No further
action taken.)
Last Action: Heard,
No Action
Support
Study on Post Acute Care Bill: Requires
Medicaid to do an analysis of reimbursement
rates and to do a comparative analysis of rates
for personal care services, community-based
services, and home-based services.
SB227
Joyce
Woodhouse
Mark Manendo
David Parks ...
Revises provisions relating to nurses.
(BDR 54-213)
Status: Approved
by the Governor.
Chapter 318.
Last Action: Do pass
Support
APRN signing authority bill.
SB482
Health and
Human
Services
Revises provisions relating to health
care facilities. (BDR 40-605)
Status: In Senate.
To enrollment.
Last Action: Heard
Do pass
Requiring the State Board of Health to
establish a system for rating medical facilities
and facilities for the dependent using letter
grades; requiring the posting of the letter
grade assigned to such a facility in certain
places.
** Reports on staffing rations

August, September, October 2017 Nevada RNformation • Page 7
Legislative Update
Bills That Missed Deadline
Bill # Sponsor Description Status Position Notes
AB18
Commerce and
Labor
Ratifies the Nurse Licensure Compact.
(BDR 54-182)
Status: (Pursuant
to Joint Standing
Rule No. 14.3.1,
no further action
allowed.)
Last Action:
Mentioned No
Jurisdiction
Support
Ratifying Nurse Licensure Compact
AB115 Robin Titus Authorizes a physician assistant or
advanced practice registered nurse to
perform certain services. (BDR 40-98)
Status: (Pursuant
to Joint Standing
Rule No. 14.3.1,
no further action
allowed.)
Last Action: Not
considered
Support
Allows for PA’s and APRNs to sign POLST
forms, head injury forms for children,
handicapped placards, order in home health
care, and taxi cab health exam.
AB265
Health and
Human
Services
Revises provisions relating to nursing.
(BDR 40-352)
Status: (Pursuant
to Joint Standing
Rule No. 14.3.1,
no further action
allowed.)
Last Action: Heard
Monitor
APRN signing authority.
SB210
Ben Kieckhefer
Aaron Ford
Heidi Gansert
Provides for the licensure and
regulation of anesthesiologist
assistants. (BDR 54-155)
Status: (Pursuant
to Joint Standing
Rule No. 14.3.3,
no further action
allowed.)
Last Action: Heard
Oppose
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Page 8 • Nevada RNformation August, September, October 2017
Future of Nursing in N
On May 20th, 2017, Nevada Nurses
Foundation, Nevada Action Coalition, Nevada
State Board of Nursing, Southern Nevada
Black Nurses Association, Nevada Advanced
Practice Nurses Association, Pilipino
Nurses Association, Chamberlain College,
WestPac Wealth Partners, Dignity Health St.
Rose Dominican, Academic Partnerships,
University Medical Center, Optum Health
Southwest Medical, College of Southern
Nevada, Mountain View Hospital, Life Guard
International Flying ICU, Centennial Hills
Hospital, Sigma Theta Tau Zeta Kappa
Chapter (Las Vegas), workforce Connections,
Desert View, Nevada Nurses Association,
University of Nevada, Las Vegas and other
affiliates honored and recognized exceptional
Nevada Nurses and student nurses at the
2nd annual Future of Nursing in Nevada
Awards dinner! The exquisite Green Valley
Ranch Hotel & Casino, in Henderson, Nevada
accommodated nearly 300 guests.
The 2017 Distinguished Nurse Leader
with Lifetime Achievement award was given
to two highly acclaimed Nevada leaders,
Dean Patsy Ruchala, of Orvis School of
Nursing at the University of Nevada, Reno
and Dean Carolyn Yucha, of the University
of Nevada, Las Vegas School of Nursing.
Orvis School of Nursing recently celebrated
60 years and the recovery of their
deanship.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
One hundred and twenty-two Nevada nurses
were recognized for advancing their nursing
degree and/or pursuing certification in their
practice. Linda Paulic and Debra Collins from
the Nevada Action Coalition awarded the nurses
in attendance.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Please see the Nevada Nurses Foundation
website for the list of nurses names for the
Professional Progression awards.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Cathy Dinauer, Nevada State Board of
Nursing, Executive Director, celebrated nine
outstanding Nevada Student Nurse Leaders with
certificates as Nevada’s future nurse leaders.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Congratulations to the Nevada student
nurse leaders recognized at the event; David
Alvarez (College of Southern Nevada), Duyen
(Yenny) Hua (Chamberlain), Sheryl Kaboud
(Chamberlain), Mary Kuan (Nevada State
College), Erik Nunez (Nevada State College),
Olivia Sircroff (University of Nevada, Reno),
Brandee Speece (Chamberlain), Kate Tretheway
(University of Nevada, Reno), and Amber
Wojciechowicz (Chamberlain).
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Dr. Pat Farmer the guest speaker representing
the Robert Wood Johnson Foundation for the
Campaign for Action, enthralled the audience
with her statistical data and motivated nurses
to be engaged and get involved. Although, the
report Dr. Farmer shared from the Campaign for
Reverend Dr. Denise
Ogletree McGuinn
Dean Patsy Ruchala
Dean Carolyn Yucha

August, September, October 2017 Nevada RNformation • Page 9
evada Awards Dinner
Nurses on Boards identified 19 Nevada nurses
on a boards, the event recognized 56 nurses.
There are many nurses who did not complete
the online recognition form therefore, Nevada
Nurses Foundation continues to make an effort
to capture the missing nurses and add them to
their website at nvnursesfoundation.org.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Congratulations to the Nurses on Boards
recipients. Get involved, make a difference, and
be the change you wish to see in the world.
Please see the Nevada Nurses Foundation
for the growing list of Nurses on Boards. If
your name is not on it, PLEASE let us know.
775.50.1118.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
The Nurses Choice Chief Nursing Officer
(CNO) awarded by Dr. Glenn Hagerstrom, was
graciously accepted by the Centennial Hills
Hospital CNO, Dr. John Coldsmith, who by the
way, received his Doctor of Nursing Practice
degree on Thursday, May 18th.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
The following 50 Nevada nurse leaders,
under the age of 50 were honored for
demonstrating a commitment to learning,
practice, community, and health care. These
nurses are being the change they wish to see
in nursing and health care. Congratulations
to the following 50 Under 50 winners:
Kristi Abbott, Allison Anderson, Alona
Angosta, Julie Aoun, Karen Bearer, Olga
Boronzinski, Andrew Brown, Michael Chave,
Heather Davis, Kasey Dean, Rhone D’Errico,
Kari Eaton, Willard Erickson, Lauren Edgar,
Jackie Ferdowsali, Mitzy Flores, Jenjira
Hendrix, Valarie Jakubos, Heidi Johnston,
Jennifer Kawi, Matthew Khan, Peggy Lee,
Kevin Lemus, Ludy Llasus, Eden Machado,
Suzette Matoto, Jeremy Marinez, Jennifer
McCarthy, Wendy Merchant, Donna Miller,
Sandy Olguin, Arvin Operario, LaTricia Perry,
Mariana Petterson, Cindy Pitlock, Neal
Rosenburg, Amie Ruckman, Flora Sayson,
Julia Sbragia, Jennifer Stevens, Tracy Stewart,
Jeanine Swygman, Bre Taylor, Lisa Thomas,
Wei-Chen Tung, Christine Wahinehookae,
Jennifer Warren, Melissa Washabaugh, Shonda
Williams, and Lisa Woodall.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you to all of the sponsors, donors,
attendees, volunteers, and honored nurses
and student nurses for supporting the Nevada
Nurses Foundation’s Future of nursing in
Nevada Awards dinner.
In 2018, the Future of Nursing in Nevada
Gala needs your help! Please let us know if
you are interested in planning, sponsoring or
sharing your talents to help create an even
more spectacular event next year in the fall!
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you and have great days,
Sandy Olguin, DNP, MSN, RN
Nevada Nurses Foundation President/
Chief Executive Officer
solguin@nvnurses.org
Linda Paulic & Debra Collins
Dr. Glenn Hagerstrom
Dr. Glenn Hagerstrom & Dr. John Goldsmith

Page 10 • Nevada RNformation August, September, October 2017
Infectious diseases present continuing
challenges for those working in hospitals and
national and international public health care
settings. Although science and technology
advance health care at turbo speed, infectious
diseases persist as a leading cause of death.
The National Institute of Allergy and
Infectious Diseases categorizes infectious
diseases as emerging, re-emerging, and
persistent intractable.
• Emerging infectious diseases “include
outbreaks of previously unknown
diseases or known diseases whose
incidence in humans has significantly
increased in the past two decades.”
Epidemiologists investigate the first
confusing constellation of signs and
symptoms to define and describe
previously unknown diseases. But they
are also attuned to the evolution of
known diseases resulting from changes
in human interactions with animals
and the environment. This alteration in
“transmission dynamics” often increases
both the ease and frequency of human
exposure to pathogens, and the
incidence and prevalence of illness. For
example, the import of exotic animals as
food sources and as pets links to recent
monkey pox and SARS outbreaks
• Re-emerging infectious diseases “are
known diseases that have reappeared
after a significant decline in incidence.”
Pathogenic survival mechanisms such as
adaptation and recombination present
new strains of old diseases that elude
human immune systems and produce
new illness. Additional concerns include
the inappropriate use and overuse of
medications and pesticides (producing
pathogens and illness resistant to
chemical intervention), and an increasing
noncompliance with immunization
guidelines (allowing the re-emergence of
previously controlled illness)
• Persistent intractable infectious diseases
“have never been adequately controlled
on either the national or international
level” (such as HIV/AIDS, malaria,
Check It Out
and tuberculosis). Given the ease of
international travel, illness common in
the third world may now manifest in
the first world and be initially difficult to
diagnose
A final consideration is the intentional use
of pathogens in bioterrorism. Widespread
exposure to anthrax, smallpox, or other
pathogens producing mass casualties may
severely impair U.S. health care systems’
response, with catastrophic results.
The National Institute of Allergy
and Infectious Diseases maintains a
commitment to education and research with a
focus on HIV/AIDS, malaria, and tuberculosis.
Selected goals include understanding the
relationships of host, environment, and
pathogen in predicting and preventing illness,
and developing diagnosis and treatment
options (including vaccines).
Please visit the National Institute of
Allergy and Infectious Diseases website
at www.niaid.nih.gov/topics/emerging/Pages/
introduction.aspx
NNA D1 President Report
1. WELCOME to NEW
BOARD members: Carrie
Hintz – President elect
(from Reno) & Melissa –
at Large (from Lovelock,
NV)
2. NNA D1 District
board reviewed the State
Board meeting held
January 16, 2017. The
NNA D1 board then discussed the following
issues:
• Reviewed 2017 goals for both State
and D1 to make sure they reflect
current bylaws
• Membership report - Melissa stated
they are trying to appeal to the new
nurses/floor level; need to advertise
more. Julie thanked Kristina, Hayley
That research paper isn’t going to write itself.
Visit www.nursingALD.com
to gain access to 1200+ issues of official state nurses publications,
all to make your research easier!
The Infectious Diseases Society of America
coordinates the Emerging Infections
Network of over 1100 infectious diseases
specialists to assist public health entities
with surveillance. Their website links include
surveys, projects, and resources.
Please visit the Emerging Infections
Network website at http://ein.idsociety.org
The International Conference on
Emerging Infectious Diseases serves as
a forum for public health professionals to
share scientific information on national and
international infectious diseases. Discussion
topics for the August 2015 conference include
• Antimicrobial resistance
• Bioterrorism and preparedness
• Foodborne, waterborne, vectorborne,
and zoonotic diseases
• Global heath
• Nosocomial infections
Please visit the International Conference
on Emerging Infectious Diseases website at
www.iceid.org
and Jeremy for their efforts on
increasing membership through use of
social media and word of mouth.
• Rural Nursing: Melissa discussed the
need to get 18 nurses trained across
the state as “Trainers” for Safe Talk.
Discussed methods of reaching rural
areas to provide training as to allow
for networking. Still working on
options. If Zoom is used may want
to purchase the product to allow for
longer sessions. Rural Health Advisory
Committee will be setting up trainings.
• NNA D1 voted to SUPPORT a NURSING
SCHOLARSHIP of $1,000 for 2017
• NNA D1 – Held another breakfast
and CEU event on April 4, 2017; Dr.
Felicia Lowenstein-Moffett presented
“Antimicrobial Stewardship.” Very
successful event!
• NNA D1 will 100% support the joint
2017 NONL/NNA Conference this year,
using their time and talents to help
make it a success (to be held in the
North this year). Julie asked that each
board member help on the various
committees that Margaret will be
sending out.
Respectfully submitted,
Julie Wagner, President NNA D1
JOIN OUR TEAM!
William Bee Ririe Hospital
located in Ely, NV
A friendly rural community in mountainous Eastern Nevada
RN Positions Available
Sign On/Relocation Bonus Offered
We offer generous benefits; State retirement (PERS); salaries
range from $63,000 to $105,000. Eligible site for HRSA
Nursing Education Loan Repayment Program.
Contact: Maggie Whitehead, mwhitehead@wbrhely.org
775-289-3467 Ext. 299 or apply online at www.wbrhely.org

August, September, October 2017 Nevada RNformation • Page 11
Antibiotic Stewardship: A Call to Action #5
Focus on Outpatient Prescriptions
By Norman Wright, RN, BSN, MS
Having worked in the
Long Term Care and LTAC
facilities my antibiotic
stewardship concerns and
focus has been directed
at the institutional setting.
However, according
to the CDC in 2014
there were 266 million
antibiotics dispensed to
outpatients in the USA which equals more
than 5 prescriptions for every 6 people living
in the USA. Of those 266 million antibiotic
prescriptions at least 30% were prescribed
unnecessarily. Most of this unnecessary use is
for acute respiratory conditions, such as colds,
bronchitis, sore throats caused by viruses, and
even some sinus and ear infections. Doing the
math, each year almost 80 million antibiotic
treatments are totally unnecessary and
another 20% either had the wrong antibiotic,
dose, or duration, prescribed in the outpatient
setting.
Antibiotic misuse is the most important
modifiable driver of antibiotic resistance, and
antibiotic-resistant infections lead to higher
healthcare costs, poor health outcomes, and
more toxic treatments.
Total inappropriate antibiotic use in the
outpatient setting includes unnecessary
antibiotic use plus inappropriate antibiotic
selection, dosing, and duration may approach
50% of all outpatient antibiotic use.
Antibiotics are the most common cause
of adverse drug events (ADEs) in children,
accounting for 7 of the top 10 drugs leading to
pediatric ADE-related emergency room visits.
Improving antibiotic prescribing can reduce
harm. A 10% decrease in inappropriate
prescribing in the community can result in a
17% reduction in Clostridium difficile infection,
a severe form of diarrhea usually caused by
antibiotic exposure.
At the risk of being accused of plagiarism
anyone who does their own research will see
that much of the above is directly quoted
from the CDC. Paraphrasing the CDC would
only serve to water down the message and I
encourage you to do your own research. (1) (2)
What are the reasons why up to 50%
of outpatient antibiotics are prescribed
inappropriately and what can be done to
reduce this number?
The NC Medical Journal lists these reasons
why antibiotics are inappropriately prescribed
in the outpatient setting.
1) Unreasonable expectations or demands
for antibiotics by patients – or their
parents.
2) Inadequate time available to physicians
to provide an explanation to patients/
parents about why antibiotics are not
required.
3) Misdiagnosis of non-bacterial infections
by providers.
4) Providers have inadequate knowledge or
fail to act on knowledge they have.
5) Providers honoring a patients request
for an antibiotic prescription to maintain
a good relationship even when a viral
infection is suspected.
6) Concerns of litigation. (3)
One tactic to counteract these barriers
is “delayed prescriptions” for infections
which antibiotics are not effective against.
In essence delayed prescribing encourages
patients/parents to allow their - or their
children’s - immune system to fight off viral
infections for a few days after the physician
visit without using antibiotics. Patients are
instructed to delay filling the prescription and
are educated to observe if symptoms such
as fever and congestion resolve over what
would be the normal course of the infection
with, or without, the use of an antibiotic.
According to research published in JAMA,
delayed antibiotic prescriptions achieves a
40% reduction in antibiotic use. (4)
The National Institute of Health states:
“Patient-based intervention, particularly the
use of delayed prescriptions for infections
for which antibiotics were not immediately
indicated effectively reduced antibiotic use
by patients and did not result in excess
morbidity.” (5) (6)
One way The Nevada Antimicrobial
Stewardship Program – www.NVASP.
net – in conjunction with the Nevada
State Office of Public Health Informatics
and Epidemiology (OPHIE), is working
to reverse this trend is by initiating an
educational program via a cell phone
advertising campaign using slogans that
will appear on phones in and around
hospitals and physician office complexes.
This educational campaign is designed
to enlighten both patients and providers
about the dangers of inappropriate
antibiotic use.
Additionally NVASP and OPHIE is sponsoring
the third annual infection prevention
symposium designed to educate health care
workers about the latest infection prevention
initiatives and antibiotic stewardship. The
tentative conference date is August 15th and
one focus is to encourage outpatient antibiotic
stewardship and to promote communication
between the various health care providers
via use of the Inter-facility Transfer Form
which provides a means to communicate prior
antibiotic use along with MDRO infection and
colonization history to health care providers.
REGISTERED NURSES
Full-time positions available for:
ICU, Emergency Room,
Med/Surg, EMS/Flight RN
Nursing Home/Memory Care
Nevada license required. We offer competitive
salary DOE; excellent benefits including Public
Employees Retirement, group insurance
benefits, accrued PTO & Sick Leave.
Contact: HR Director
Humboldt General Hospital
118 E. Haskell Street, Winnemucca, NV 89445
rose@hghospital.org • Fax (775) 623-5904
EOE Employer • Non-smoking facility, non-smoker preferred.
Which brings us to the question – What
can I (meaning you) do to stem the rising tide
of Antibiotic Resistance, a question that can
only be answered by you. It is my hope that
you make the decision to do something in the
setting you work in, and in your daily lives.
Antibiotic Resistance is a growing threat that
will create havoc unless it is reversed. Make a
commitment to do something today, tomorrow
and in the future. Join our team and promote
sane and sensible antibiotic use.
Citations
1 https://www.cdc.gov/getsmart/community/
programs-measurement/measuring-antibioticprescribing.html
2 https://www.cdc.gov/getsmart/community/
pdfs/annual-reportsummary_2014.pdf
3 http://www.ncmedicaljournal.com/
content/77/5/346/T2.expansion.html
4 http://jamanetwork.com/journals/
jamainternalmedicine/article-abstract/2475018
5 https://www.ncbi.nlm.nih.gov/
pubmed/16235325
6 https://www.cdc.gov/getsmart/community/
improving-prescribing/evidence/education.html
Norman Wright is the Infection Preventionist
at Kindred Health Care – Sahara.
TIP # 6: Document in real time...
If an error occurs, you may be
fired before charting at the end of
your shift, so don’t wait!

Page 12 • Nevada RNformation August, September, October 2017
NNA Environmental Health Committee
State of the Air in Nevada – Report Card for 2017
Bernadette Mae Longo, Ph.D., RN, PHNA-BC, FAAN; ANA’s Clean Air Ambassador for Nevada
Associate Professor, Orvis School of Nursing at the University of Nevada Reno
How bad does it have
to get? Over the last few
years Nevada’s air quality
has not improved. This
year’s report card depicts
a continuing trend of high
ozone and fine particle
exposure to the nearly
2.9 million residents of
the Silver State. Despite
the world-wide attraction and glamour, Las
Vegas-Henderson remained ranked in the top
10 most polluted U.S. cities for ozone! For the
2nd year in a row, our two major population
centers in the north and south failed in their
air quality.
Nurses Care about Nevada’s Air
What would you do if these were your
own college grades or your child’s grades
in school? You would take action. As nurses
we have the knowledge, ability and desire
to advocate for vulnerable populations. The
Environmental Health Committee urges you
to work in your local communities, to write
to your state and national legislators urging
them to support clean air initiatives, and to
teach your patients how to protect themselves
Carson
City
High
Ozone
Particle
Pullution
Total
Population
(est. 2014)
Pediatric
Asthma
Vulnerable Populations
Adult
Asthma
COPD
CVD
B F 54,521 651 3,491 3,226 3,912
Churchill B No data 24,200 328 1,491 1,341 1,612
Clark F D 2,114,801 29,146 130,553 103,810 121,423
Douglas No data F 47,710 496 3,145 3,276 4,072
Lyon C No data 52,585 680 3,293 3,135 3,827
Washoe F F 446,903 5,803 28,100 23,194 27,430
White
Pine
D No data 9,811 122 624 518 613
Figure 1. Nevada’s Air Quality Report Card for 2017
Some counties in Nevada do not have air quality monitors.
Reference: http://www.lung.org/our-initiatives/healthy-air/sota/city-rankings/states/nevada/
Correctional Nursing,
the best kept secret in Nursing.
At CoreCivic, we do more than manage inmates,
we care for people.
CoreCivic is currently seeking F/T and PRN Registered Nurses
and Licensed Practical Nurses (P/T and PRN) at Nevada
Southern Detention Center who have a passion for providing the
highest quality care in an institutional setting.
This is your opportunity to make a satisfying career even more
rewarding. We have a passion for providing the highest quality
care. So, we take care of our people with competitive wages and
great benefits!
• Medical, Dental, Vision, Life, & Disability
• 401(k) Retirement Savings Plan
• Paid Training
• 9 Paid Holidays
• Free CEUs
• Free Uniforms
Newly licensed graduates welcome!
To start your meaningful career in correctional healthcare, visit us
online today and explore our open opportunities.
Apply today at jobs.corecivic.com
or contact Cyndy at 615.263.3148
CoreCivic is a Drug Free Workplace and EOE
OR Training for RN’s is Here!
during pollution events such as inversions
that cause a build up of pollutants or wildfire
smoke events. Together, Nevada’s nurses
can create awareness to prompt changes
– otherwise those failing grades will likely
continue!
Tips to Protect Yourself & Your Patients
from Unhealthy Air
The American Lung Association & NNA’s
Environmental Health Committee encourages
everyone to get involved in the fight for
cleaner, healthier air. Here are some simple,
effective tips for protecting you, your family
and your patients from the hazardous effects
of air pollution exposure:
1. Check daily air pollution forecasts in
your area. Download the American Lung
Association’s State of the Air app on
your mobile device through the Google
Now Hiring NP/PA-C
Expand your practice at
Renewed Health & Wellness!
We are seeking a dedicated Nurse
Practitioner or Physician Asst. to
join our team.
Interested Applicants
submit resume/cv to
applicant@renewed-health.org
For more information
about our practice
visit us online!
renewed-health.org
Play Store or the iPhone iTunes store.
Other sources include local radio and TV
weather reports, newspapers and online
at airnow.gov.
2. Avoid exercising outdoors when pollution
levels are high.
3. Always avoid exercising near high-traffic
areas.
4. Use less energy in your home.
5. Encourage your child’s school to reduce
school bus emissions and establish “idlefree”
zones. Tell the school board in your
community.
6. Turn your car off when waiting or idling.
7. Walk, bike or carpool. Check out Washoe
County’s program “Rack Em up”
8. Don’t burn wood or trash.
9. Use battery-powered or electric lawn
care equipment rather than gasolinepowered.
Psychiatric Nurse Opportunities
Southern Nevada Adult Mental Health Services
Rawson Neal Hospital, Stein Forensic Hospital and
Community Outpatient clinics. Req. NV license.
Psych exp preferred. Training available for new
grads. Variety of schedules including set 8 and 12
hr shifts. No call-offs! EXCELLENT benefits -
health/dental/vision. Public
Employees Retirement
System. THREE weeks
annual and sick leave, paid
holidays, on-site CEU’s.
NO social security, state,
county or city tax! Email
CV to marniwhalen@
health.nv.gov

August, September, October 2017 Nevada RNformation • Page 13
NNA Environmental Health Committee
10. Don’t allow indoor smoking and support
measures to make all public places
tobacco free.
11. Report smoking vehicles – be a
smog spotter. Take down the license
plate and vehicle make & type. Call:
844-END-SMOG (844-363-7664) or
report on web: Nevada’s DMV Smog
Spotter Program
12. Contact your national representatives
(Senators Dean Heller & Catherine
Cortez-Masto; or congressman), the
Governor, and your state legislators.
Please see NNA’s Legislative Committee
website for guidance.
Resources
American Lung Association: http://www.lung.
org/our-initiatives/healthy-air/outdoor/airpollution/10-tips-to-protect-yourself.html
Washoe County Air Quality Management Division:
https://www.washoecounty.us/health/
programs-and-services/air-quality/index.php
Washoe County’s Rack Em Up Program: https://
www.washoecounty.us/health/programs-andservices/air-quality/rack-em-up.php
Clark County Department of Air Quality: http://
www.clarkcountynv.gov/airquality/Pages/
default.aspx
State of Nevada Division of Environmental
Protection – Bureau of Air Pollution Control:
http://ndep.nv.gov/bapc/index.htm
Nevada DMV Smog Spotter: http://www.
smogspotter.com/
Figure 2. Health Risks of Ozone & Particle Pollution.
Source: American Lung Association.

Page 14 • Nevada RNformation August, September, October 2017
The Stress Burden: Strategies for Management
Denise S. Rowe, MSN, APRN, FNP, BC
Stress is the body’s natural psychological, physical and social
response to the changes and demands of everyday life. In 2011,
forty four percent of Americans said their stress level had increased
over the past 5 years. 1 Common causes of stress include: money,
job and job security, relationships and family responsibilities, and
health problems.
Employee stress and burnout cost approximately $250 to $300
billion annually. 2 One in five nurses leaves a job because of stress
and burnout. 3 The cost for each nurse turnover ranges from $62,100
to $67,000). For every 15 nurse positions left vacant from turnovers,
it can cost up to an additional $1million to an organization. 4
Stress can be either acute or chronic. While acute stress is normal
and helpful in preparing the body to react quickly in response to a
challenge or threat, chronic stress of ongoing compounded acute
stressors for long periods of time, can be problematic.
Prolonged stress creates tension, nervousness and leaves the
body’s stress response system turned on long term. This disrupts
normal body processes and can result in health problems if not
corrected. Common symptoms of stress include: headaches, fatigue,
digestive problems, irritability, chest pain, anxiety, anger, sleep
problems, overeating, depression, decreased sex drive, and drug or
alcohol abuse.
Left unchecked, chronic stress can lead to significant health
problems including high blood pressure, heart disease, obesity,
diabetes, and memory loss.
Stress management begins with identifying the sources and
triggers of stress and developing strategies to manage them.
Effective strategies include the following:
• Set limits for yourself. Be assertive. Say no to requests that
create excessive stress
• Remember that events will occur that you cannot control.
Develop healthy coping skills
• Make time for hobbies and other interests
• Seek social support from those you enjoy
• Eat a healthy well balanced diet
• Get adequate rest and sleep to restore the body and mind
• Start an exercise routine. Almost any kind of exercise,
such as aerobic or weight lifting can relieve stress. Regular
exercise increases energy, self-confidence and elevates
mood. Set specific goals such as committing to walk
time three times a week. Work out with a friend to stay
committed. Change the workout routine to stay motivated,
such as alternating between walking, yoga or Pilates. Always
remember to consult a healthcare provider before starting
a new fitness program, especially if there are pre-existing
medical conditions
• Relaxation involves different techniques that decrease the
effect of stress on the body. Meditation is a relaxation
technique between the mind and body which promotes a
sense of calm, peace and balance. It focuses on increasing
self-awareness and reducing negative emotions. Meditation
is often conducted in quiet settings, focusing the mind
away from distractions using relaxed breathing techniques.
Common relaxation techniques include: hypnosis, massage,
and meditation (guided imagery, mantra, Qi-gong, Tai Chi
and Yoga)
Lastly, keep a positive attitude. Recognize that stress is a normal
occurrence in life. How you manage stressors will determine if you
successfully triumph over them or collapse from the pressures they
create.
References
1. American Psychological Association. The impact of stress. Available
at: http://www.apa.org/news/press/releases/stress/2011/impact.aspx.
Accessibility verified March 4,2012
2. Jones, D., Tanigawa, T., & Weisse, S. (2003). Stress management
and workplace disability in the U.S., Europe, and Japan. Journal of
Occupational Health, 45, 1-7.
3. Aiken, L.H., Clarke, S.P., Sloan, D.M., Sochalski, J., & Silber, J. (2002).
Hospital nurse staffing and patient mortality, nurse burnout, and job
dissatisfaction. Journal of the American Medical Association, 288(16),
1987-1993.
4. Jones, C. (2005). The cost of nurse turnover: Applications of the
nursing turnover cost methodology. Journal of Nursing Administration,
35(1), 41-49.
5. MayoClinic. Stress management. Available at: http://www.mayoclinic.
com/health/stress-management/MY00435. Accesibility verified March
4, 2012
6. WebMD. Stress management health center. Available at: http://www.
webmd.com/balance/stress-management/default.htm. Accessibility
verified March 4,2012

August, September, October 2017 Nevada RNformation • Page 15
Nevada Nurses Foundation
Nevada Nurses Foundation
Presents
Nevada Nurses have Talent!!!
Calling all Nevada licensed nurses (C.N.A, LPN, RN, & APRN) and student
nurses with talent to share. On Thursday, November 30, 2017, let the
Nevada Nurses Foundation give you a platform to showcase your talent at a
benefit event held during the Nevada Nurses Association (NNA) and Nevada
Organization of Nurse Leaders (NONL) two day joint conference at
GRAND SIERRA RESORT in the SILVER PAVILLION BALLROOM.
Nurses Talent Showcase
Thursday Evening, November 30, 2017
6:30 P.M. – 9:30 P.M.
Prizes awarded to contestants based on attendee and online polling “People’s
Choice” award and judges choice. Performances will be live streamed on
Facebook and open for voting by your friends, family, and affiliates.
Please join the Nevada Nurses Foundation for the 3rd Annual
“Mad Hatter” Big Hat High Tea at the Nevada Governor’s
Mansion on Saturday, October 7th from 12:00 pm – 3:00
pm! Of course, the amazing Bakery Gallery is catering the
event again and Through a Child’s Eyes Foundation will be
creating a wonderful Wonderland! The raffle prizes, partially
donated by Cedric Williams, include a 60” Flat screen TV,
$500 Visa gift card, Laptop computer, Blue Ray DVD player,
and a Notebook (do not need to be present to win). Raffle
tickets: 1-$10.00, 5-$20.00, and 25-$100.00. The beautiful
Rev. Dr. Denise Ogletree McGuinn will MC the event. Our
headliner, Mike Furlong, a local Tom Petty impersonator who
once appeared on the American Bandstand in his youth,
is preparing to take us through the looking glass to a Mad
Hatter Tea. Ticket sales available online beginning July 15th
with $50/guest, add $10 for gluten-free and no
additional charge for sugar-free.
To be eligible, participants must be at least 18 years of age with a valid
Nevada nursing license (CNA-LPN-RN-APRN) or enrolled in a
Nevada nursing program. Send a 2 minute video feed to
NursesHaveTalent@nvnursesfoundation.org.
Sponsorships available: Name an award after YOUR organization!!
Online Silent Auction. Appetizers & Cash Bar!
Nevada Nurses Foundation | P.O. Box 34047, Reno, Nevada 89533
775-335-9554 | NVnursesfoundation.org | Tax exempt 501(c)(3)
Foundation and Big Hat High Tea Event Sponsorships
and souvenir program advertisements available.
Seating is limited to 160 guests and will surely sell out fast.
Hats and wonderland wardrobe is optional.
We look forward to seeing you there!
Please visit nvnursefoundation.org or call
775-560-1118 for more information.

Page 16 • Nevada RNformation August, September, October 2017
• B.S. in Nursing
• RN to BSN
• M.S. in Nursing
o Clinical Nurse Leader
o Nurse Educator
o Adult Gerontology Acute Care Nurse Practitioner
o Family Nurse Practitioner
o Psychiatric Mental Health Nurse Practitioner
• DNP (Doctor of Nursing Practice)
o BSN to DNP:
• Nurse Practitioner Tracks
o Post-MSN DNP:
• Advanced Practice
• Nurse Executive
www.unr.edu/nursing