RN Idaho - May 2018

Page 4 • RN Idaho May, June, July 2018
Advocacy in Action
Every Mother Has the Freedom
to Feed Her Baby
Adrean Cavener, BS, Lobbyist
adreancavener@gmail.com
After a lot of hard work from advocates from across
the state, H.B. 448 became law this legislative session.
This bill gives protection to breastfeeding mothers from
the indecent exposure statute. H.B. 448 worked its way
from the House to the Senate without a single “nay” vote,
and the Governor signed it into law shortly after. It was
truly incredible to see mothers with their sweet children
in committee rooms during hearings to lend their support
for the bill. (Many legislators even commented that it
was an unfair advantage…) So, after years of work on the
issue and countless hours from volunteers and supporters
since 2003, mothers across the state can finally rest easy
that they can now nurse in public without the threat of
legal action. A special thanks to Representative Paul
Amador for his leadership in moving this bill forward to
a successful signing! We would also like to thank ANA
Idaho for their support of this important bill for Idahoans.
For specific language and session activity, you can find
H.B. 448 at https://legislature.idaho.gov/sessioninfo/2018/
legislation/. Also, do not hesitate to contact your local
legislator and thank him/her for their support of this
monumental legislation.
Representative Amador with his son Peter.
Many mothers, families, community members,
lactation consultants and nurses came in
support of the bill.
Photo credit: Senator PattiAnne Lodge
Representative Paul Amador (R) testifying in the
Senate Committee Hearing on H.B. 448 while
holding his 6 month old son, Peter.
Nurses for Idaho! continued from page 1
Senator Maryanne Jordan and Representative Sue
Chew to the full body of the Senate and the House. The
Day at the Capitol not only engaged legislators to learn
about nursing, but also provided an opportunity for nurses
to learn the workings of the legislature and the difficult
process for a bill to become a law. Thank you to everyone
who participated, especially those who braved the heavy
snow so early to help set-up!
To learn more and get involved making a difference
for nursing in our state, consider joining the Legislative
Affairs Committee with ANA-Idaho! Contact Anna
Rostock at rostocka@slhs.org or Michael McGrane at
mcgraneconsulting@gmail.com. We look forward to
hearing from you!
Bundled Payments for Care
Improvement (BPCI) Initiative:
The role of nurse navigators and how
they fit in with the initiative
Nurses come from around the state to
participate in “Nurses for Idaho!”
Nurses Day at the Capitol 2018
Teresa L. Coiner, RN, BSN, MHS
Nurse Navigator, Saint Alphonsus-Nampa
Teresa.coiner@saintalphonsus.org
All nurses are navigators. When we first step into a
patient room, we literally become their navigator. Managing
a patient’s course of care right from the very beginning is a
positive step that directly impacts his clinical outcome. The
Bundled Payments for Care Improvement (BPCI) initiative
was implemented at both Saint Alphonsus Boise and Nampa
locations in 2015. This initiative is a patient-centered
strategy: the navigator facilitates efficient health care access
by using their nursing skills to manage a patient’s course of
care (Centers for Medicare & Medicaid Services, 2018).
As navigators in a hospital setting, we meet with patients
to set collaborative goals of care with the patient and their
family/support system. The ultimate goal is nearly always
to get patients back home after hospitalization, however,
occasionally the next best site of care may be a skilled
nursing facility or their condition may require setting up
home health services. In general, as nurse navigators,
we provide the following services: a) education to guide
patients through the disease process, b) education on
treatment options and understanding the recovery process,
c) access to community resources and medical equipment,
d) medication review, e) access to psychological and clinical
support, f) coordination with primary care providers
and other specialists, and g) home visits. As BPCI nurse
navigators, we make important contributions to improve the
quality of life, quality of care, and efficiency of resource use
for our medically complex patients.
The following is a case study that demonstrates the
importance of the BPCI nurse navigator role. 82 year-old
Mrs. Smith was admitted to the hospital for congestive heart
failure (CHF) and pneumonia. During her stay, she was
assigned a nurse navigator due to her medical complexity
and because she lives alone, has limited family support and
doesn’t drive. At the time of discharge, Mrs. Smith was given
orders for a home health agency to provide physical therapy,
nursing care, and a bath aide. The assigned nurse navigator
called Mrs. Smith post discharge and discovered that home
health had not yet been initiated, prompting the navigator to
provide a home visit that afternoon. Mrs. Smith was pleased
not only that she had met the nurse navigator during her
hospital stay but that her complex needs were being met and
she was not “falling through the cracks” of the system.
At the home visit, the navigator discovered multiple
medication discrepancies, one being that the patient was
taking over 1000 mg of aspirin a day. Additional observations
revealed that the CHF patient had a “bag full” of medications,
lots of chips and nuts within reach, and the patient did
not have a scale to weigh herself daily. The Navigator
called the patient’s PCP (primary care provider) and had
medications clarified, set up an office visit, and then arranged
transportation through the Saint Alphonsus Express van. At
the time of the scheduled PCP appointment, the navigator
attended the appointment with the patient. In addition, the
navigator provided the patient with a scale so she could weigh
herself daily and then taught Mrs. Smith to use a daily log
called the Zones to Manage Heart Failure-Green-Yellow-
Red; which is a daily log for tracking weight, heart rate, blood
pressure and shows what “zone” they are in for the day.
After weekly calls and several home visits, the
navigator was not only able to keep the patient from
being readmitted to the hospital, but also helped her to
better manage her congestive heart failure. The impact of
the Bundled Payments for Care Improvement Initiative
Nurse Navigator role is an exciting and critical one for
maximizing the health of patients as they navigate the
complexities of our health care system.
Reference:
Centers for Medicare & Medicaid Services. (2018). Bundled
Payments for Care Improvement Initiative (BPCI) Fact
Sheet Retreived: https://www.cms.gov/Newsroom/
MediaReleaseDatabase/Fact-sheets/2015-Fact-sheetsitems/2015-08-13-2.html
Left to right: Anna Rostock, Barbara Hocking,
Brie Sandow, and Kim Popa
Participants visit the House and Senate floor