The Pulse - August 2018


August 2018 • Vol. 55 • No. 3


Quarterly publication direct mailed to approximately 18,000 RNs and LPNs in Montana.

Executive Director Report


Page 5

Montana Nurses volunteer to help school

children with health screenings in

the Virgin Islands!!

Page 7

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


Quick reminder: I continue

to get calls from nurses (RNs

and APRNs) assuming that

because they receive the

Pulse that they are members

of their professional

association. Unfortunately,

that is not the case as every

licensed nurse in Montana

receives our Pulse whether

they are members or not, so

unless you have submitted

an application and pay a

monthly or annual dues (as

Vicky Byrd,


with any association) you are not a member of MNA.

Being an MNA member automatically includes an

ANA membership (MNA/ANA joint member), at no

extra cost as we have been long time affiliates of this

national association.

The professional nurses eligible for membership

include any RN who has been issued a license by

the Montana Board of Nursing in any capacity; for


• Managers, Supervisors, Directors, VPs of

Nursing, CEOs

• PRNs, PDRs, Relief

• Staff RNs in non-collective bargaining


• Staff RNs in collective bargaining organizations

• Advanced Practice Registered Nurses

• Nurse Educators

Being an MNA (MNA/ANA) member affords you

many benefits and contributes to our collective voice

as we are the recognized leader and advocate for the

professional nurse in Montana. Applications are online

at and here are some benefit


• We represent all nurses in the state through

numerous activities throughout the year and

engagement in state and national nursing and

healthcare initiatives.

• Continuing Education: Provider and Approver

Accredited – You can enjoy member discounts

for continuing nursing education activities

provided by MNA. Activities include everything

from independent studies to webinars to

3-day conferences. MNA can help you get

contact hours for an individual activity you

would like to offer at your facility or can help

your facility become an approved provider to

offer numerous continuing education activities

at your workplace. MNA members receive

discounts on application fees. Contact

hours earned through the ANCC Accreditation

System help you maintain licensure and attain/

maintain certification.

• Monitor Board of Nursing Activities–MNA

participates in rule development, public policy,

licensure, and legislative planning.

• Political Activity–MNA staff and representatives

monitor and act on state and national policy

and legislation that impacts nurses, healthcare,

patients, workforce issues, child and elder

issues, underserved and unserved populations

(see Legislative Platform under Legislative and

Government Relations Section). MNA contracts

a lobbyist to address nursing and healthcare

issues at the state level.

• Awards–MNA annually recognizes nurses for

outstanding achievement in their professional

and advocacy activities.

• National Involvement for MNA

i. ANA (American Nurses Association)

ii. ANCC-COA (American Nurses Credentialing

Center Commission on Accreditation)

iii. AANP (American Association of Nurse


iv. WEX—“Western States” professional nurses

association’s coalition

• National Involvement (MNA collective bargaining


i. AFTNHP—American Federation of Teachers/

Nurse and Health Professionals

ii. NFN—National Federation of Nurses-coalition

{Staff RNs that have chosen to join their MNA

collective bargaining unit within their facility are MNA/

ANA/AFTNHP members}

MNA 2018 Annual Convention is right around

the corner. This year’s MNA Annual Convention is

October 3rd, 4th, and 5th, 2018. Information and

registration is on the website

The yearly schedule for convention is a full day of

education on day I followed by half day education and

half day House of Delegates on days II and III. Any

nurse can attend the convention as a participant or

as an elected delegate. This year, MNA provides 11

total contact hours (1 is RX) of accredited continuing

education through our Professional Development

Department, which is almost half of what is required

Executive Directors Report continued on page 2

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Page 2 Montana Nurses Association Pulse August, September, October 2018

Executive Directors Report continued from page 1

for our re-licensure requirements due this year (relicensure

required by 12/31/18 with 24 contact hours

over two years). All the district leaders (inclusive of

all nurses whether you are in a collective bargaining

unit or not) have been noticed of the amount of MNA

delegates allotted for their respective districts and

have nominated and elected their MNA delegates.

All of this is done via email so if you haven’t received

correspondence from MNA and you are an MNA

member, be sure to call the office and get an

updated personal email on file. Email is the official

communication tool used to correspond efficiently

with all MNA members. If you have been elected as a

delegate, be sure to register for the convention (www., book a room at the hotel (Best Western

Premier Great Northern Hotel (406) 457-5500), and tap

into your district leadership as most all of the districts

reimburse their delegates for registration and some

districts reimburse for travel and rooms (especially

those traveling long distances). If you are choosing to

attend from your district, not as a delegate, but as a

participant for the continuing education (and amazing

networking!!), reach out to your district leaders or this

Please visit

MNA’s constantly

updated websites!

If you wish to no longer receive

The Pulse please contact Monique:

If your address has changed please

contact Montana Board of Nursing at:


We are gathering articles that are relevant and

appealing to YOU as a nurse. What is happening

in your world today? Is there information we can

provide that would be helpful to you? The Pulse

is YOUR publication, and we want to present you

with content that pertains to your interests.

Please submit your ideas and

suggestions to Jennifer.

office if in need of financial assistance. All MNA nurses

living within the boundaries of their district contribute

a small portion of their dues ($1 per member per

month) to designated secure funds that those

districts are allowed to use for their specific district

members. Don’t let finances deter you from attending

our convention (it is our collective voice of nurses

from across the state) because often times the larger

districts will assist those districts with fewer resources.

You can always call the office for assistance. The

convention continues to be the first Wednesday,

Thursday, and Friday of October annually! So if you

cannot attend this year, keep it on your radar for next


Special Alert for 2018 MNA Convention:

Thursday October 4th, 2018 during convention, MNA

will be hosting a state and national legislative event. All

incumbent and challenging candidates running for the

MT state legislature and our incumbent U.S. Senator

and challenger for the U.S. Senate seat have been

invited to attend. This event begins with a combined

dinner for our nurses and legislators followed by the

legislative event.

Enjoy a user friendly layout and

access to more information, including

membership material, labor resources,

Independent Study Library, a new Career

Center for Job Seekers & Employers,

and more downloadable information.


Circulation 18,000. Provided to every registered nurse, licensed

practical nurse, nursing student and nurse-related employer in

Montana. The Pulse is published quarterly each February, May,

August and November by Arthur L. Davis Publishing Agency, Inc.

for Montana Nurses Association, 20 Old Montana State Highway,

Montana City, MT 59634, a constituent member of the

American Nurses Association.

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. MNA 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 the Montana Nurses Association 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. MNA 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 MNA or

those of the national or local associations.



Montana Nurses Association

20 Old Montana State Highway, Clancy, MT 59634

• Phone (406) 442-6710 • Fax (406) 442-1841

• Email: • Website:

Office Hours: 7:30 a.m.-4:00 p.m. Monday through Friday


MNA is a non-profit, membership organization that advocates for

nurse competency, scope of practice, patient safety, continuing

education, and improved healthcare delivery and access.

MNA members serve on the following Councils and

other committees to achieve our mission:

• Council on Practice & Government Affairs (CPGA)

• Council on Economic & General Welfare (E&GW)

• Council on Continuing Education (CCE)

• Council on Advanced Practice (CAP)


The Montana Nurses Association promotes professional nursing practice,

standards and education; represents professional nurses; and provides

nursing leadership in promoting high quality health care.


Montana Nurses Association is accredited as an approver of continuing

nursing education by the American Nurses Credentialing Center’s

Commission on Accreditation.

Montana Nurses Association is accredited as a provider of continuing

nursing education by the American Nurses Credentialing Center’s

Commission on Accreditation.

MNA Staff:


Vicky Byrd, BA, RN, OCN, Executive Director

Pam Dickerson, PhD, RN-BC, FAAN, Director of Professional Development

Mary Thomas, BA, RN, RN Professional Development Associate

Caroline Baughman, BS, Professional Development Associate

Robin Haux, BS, Labor Program Director

Amy Hauschild, BSN, RN, Labor Representative

Sandi Luckey, Labor Representative

Leslie Shepherd, BSN, RN, Labor Representative

Jill Hindoien, BS, Chief Financial Officer

Jennifer Hamilton, Administrative Assistant

Board of Directors

Executive Committee:

Board of Directors President

Board of Directors Vice President

Board of Directors Secretary

Board of Directors Treasurer

Board of Directors Member at Large

Board of Directors CPGA

Board of Directors PD

Board of Directors CAP

Board of Directors EGW

Lorri Bennett, RN


Chelsee Baker, BSN, RN

Linda Larsen, RN-BC

Jennifer Taylor, BSN, RN, CCRN

Bobbie Cross, RN

Debby Lee, BSN, RN-BC, CCRP

John Honsky, APRN

Jennifer Tanner, BSN, RN, CCRN

Council on Practice & Government Affairs (CPGA)

Jack Preston, BSN, RN

Karen Fairbrother, BSN, RN, DNC, CDE

Abbie Colussi, RN

Anna Ammons, BSN, RN, PCCN

Anita Doherty, RN

MNA welcomes the submission of articles and editorials related

to nursing or about Montana nurses for publication in The PULSE.

Please limit word size between 500–1000 words and provide

resources and references. MNA has the Right to accept, edit or

reject proposed material. Please send articles


Council on Professional Development (PD)

Sandy Sacry, MSN, RN

Cheryl Miller, MSN, RN-BC

Gwyn Palchak, BSN, RN-BC, ACM Sarah Leland, BSN, RN, CMS

Emily Michalski-Weber, MSN, RN-BC

Abbie Colussi, RN

Megan Hamilton, MSN, RN, CFRN, NR-P Janet Smith, MN, MSHS, RN

Cheryl Richards, MS, BSN, RN-BC

Council on Advanced Practice (CAP)

Chairperson Elect-CAP

Deborah Kern, MSN, FNP


Member at Large-CAP

Member at Large-CAP

Nanci Taylor, APRN

Barbara Schaff, FNP-BC

Keven Comer, MN, FNP-BC

Council on Economic & General Welfare (EGW)

Delayne Stahl, RN, OCN

Krystal Frydenlund, RN, CCRN

Rachel Huleatt, BSN, RN

Lisa Ross, RN, CCRN

Questions about your nursing license?

Contact Montana Board of Nursing at:

August, September, October 2018 Montana Nurses Association Pulse Page 3

Experience at ANA’s Quality and

Innovation Conference

I would like to thank

you for the opportunity to

go to Orlando on March

21-23, 2018 to attend the

ANA Quality and Innovation

Conference. It was very

inspiring when you look at

what other facilities are doing

around the country to better

their patient safety, quality of

care they give, and creative

staffing techniques they use.

One of my favorite

sessions discussed the fact

Sarah Leland


that we all have an inventor side within us. Every day,

every shift we work, we are always thinking of ways to

accomplish things better and faster, with better quality

and more time directed towards our patients care. We

see that opportunity every day! The question is, do

you have the willingness to turn that into an invention?

The speaker for that session, Nick Webb, encouraged

all facilities to have a space for their employees to

innovate. We as nurses, have the ability to improve

work life. We are smart nurses that want to be on a

mission that matters. So, get out there and become

an inventor to make a difference in your workplace for

your patients.

As health care workers we also must be resilient.

Another great session focused on how we promote

resilience to help prevent negative work environments

from turning into nursing burnout. What is resilience?

Resilience is the ability to cope, recover from and

thrive after a challenging situation. So how do we

promote resilience? We should promote engagement

and prevent burnout by optimizing the experience

of the work environment. This can be achieved by

amplifying inherent rewards, mitigate the impact of

inherent stress through support and resources, which

will prevent or reduce added stress. This will support

the nurse’s ability to cope with the negatives faced

in the work environment, which will increase your

resiliency to continue to overcome the situations you

face every day. You, as an individual, have an equal

responsibility to increase your personal resilience as

well as the facility where you work. It is important to

focus as much on the positives as the negatives, when

promoting resiliency. Remember everyone’s balancing

place is different. We need everyone to realize that

teamwork is a vital component to being resilient. We

need to continue to work together so we are all safe

and healthy while caring for our patients. We must

remember, every patient is everyone’s patient and

we need to work collaboratively with the patient. Our

patients are the center of our care.

Once again, I want to thank you for allowing me

to have this amazing and fun opportunity to meet

and network with nurses from around the country.

I encourage all of you to take advantage of these

conferences as they arise.

Attend MNA Convention and Celebrate

100 years of Public Health in Montana!

October 3rd – 5th, 2018 ~ Helena, MT



Annual Convention

House of Delegates

2018 Convention Proposed Amendments to

the MNA Bylaws submitted by the Professional

Development Department and Council

on Professional Development.

Purpose: Align MNA bylaws with national bestpractice

standard related to terminology by Striking

the words, continuing education and inserting the

words professional development, or the acronym,

CPD in the following:

Article VII Councils, Section 1 Definition, (2);

Article VII Councils Section 2 Composition, (b);

Article VIII Council on Advanced Practice

(CAP), Section 1. Definition b. (5);

Article VIII Council on Advanced Practice

(CAP), Section 4. Responsibilities of CAP (9);

Article IX (title) Council on Continuing

Education CCE to Council on Professional

Development (CPD)

Article IX CCE Section 1 Definition;

Article IX CCE, Section 3 Responsibilities of

the CCE, a., c., and d

Article IX CCE, Section 4 Meetings;

Article XIV Elections, Section 1;

Article XIV Elections Section 3;

Article XIV Elections,

delete entire Section 5 – refers to NFN

Fix spelling of title of Article XIX- from

Amendements to Amendments.

Free asthma

education in your

home on your


Montana Asthma Home Visiting

Program (MAP)

Eligible participants receive comprehensive asthma

control education provided by a RN or RRT over 6 visits.

Who is eligible?

Any child or adult with a current asthma

diagnosis who has had either:

• an emergency department visit,

hospitalization or unscheduled medical office

visit for asthma


• an Asthma Control Test score of less than 20

in the last year

Adults or children who do not meet these

requirements are eligible for MAP with a direct

referral from their healthcare provider.

*Public Health Achievements and Challenges in Montana Session - Sharing the experience

of a current Montana Public Health Nurse’s typical workday*

To find out if a program is available

in your area, please visit or


Page 4 Montana Nurses Association Pulse August, September, October 2018


Unit Rep. Shop Steward. Nurse Steward. Grievance


Each of these titles means Nurse Advocate! Advocacy

is a foundational part of nursing. We advocate for our

patients, their families, and our communities. Just as

advocacy is a core part of nursing, it is a core part of

your unions.

Synonyms for advocate include: supporter, backer,

promoter, spokesperson, campaigner, and fighter. When

you step into a role as a Nurse Advocate you have the

ability to take on each of these rolls. You will stand

with and fight for your fellow nurses to create positive

changes in your working conditions.

Do you need to be an expert about your union? No.

Do you need to be fluent in your contract language? No. The only thing you

need is a willingness to support your peers, everything else can be learned.

MNA is here to promote advocacy at the Local level. You are the experts in your

departments and in your facilities and YOU are the perfect people to become

Nurse Advocates.

If you are interested in learning more about Nurse Advocacy at your Local,

reach out to me and to your Local Leadership. The more we stand together and

support each other, the stronger our unions will become!

Live and work in Beautiful Lewistown, Montana!


for a 25 bed critical access hospital.

Full-time - (working manager)

2 OR Suites and 1 Procedure Room

Wage DOE. Great Benefits.

Healthy work-life balance!

Apply on-line:

Labor Reports and News

Leslie Shepherd,

BSN, RN, Labor


The Benefits of Your

Pre-Bargaining Survey

As our 2018 contract negotiations season is under

way, your MNA Labor staff begins the task of negotiation

preparation. One of our favorite tools is a Pre-Bargaining

Survey which allows your representatives to get their

finger on the pulse of the local unit as a whole. It allows for

each nurse within a bargaining unit to provide input into

the items a negotiating team will present at the bargaining

table. It provides EVERY nurse the opportunity to provide

input and that input is greatly beneficial at the bargaining


How do we create the survey? A Pre-Bargaining

survey is created out of pre-bargaining discussions with a

local unit. As your labor representative begins bargaining

discussions, they listen for the issues the nurses raise

and create survey questions that allow us to gather more

Robin Haux, BS

Labor Program


detailed information on how the majority of the local feels is the best direction to take

at negotiations. Additionally, we review the contract and create questions that give

the nurses the ability to rate what is most important to that nurse and we offer an

area that allows for open comments on most questions. The most important part

of creating a survey is input from the nurses. We encourage every nurse to

participate in the creation, drafting, and participation of the survey. Additionally, peerto-peer

discussions are the best way to encourage your co-workers to participate.

Why is a pre-bargaining survey important? There are many benefits to a

pre-bargaining survey. First, as mentioned above, it allows for the MNA labor staff to

gather a more complete picture of the direction the local unit wants to take at their

negotiations and again, provide every nurse the opportunity to have their thoughts

and ideas heard. Any opportunity your labor representatives and negotiating team

can speak phrases such as: “all the nurses feel…” or “90% percent of the nurses

want …” it helps your team make a better argument at the table. We cannot

underscore the importance of each nurse taking a few minutes to participate in their

survey. A low survey participation rate reduces the effectiveness of the survey at the


When your local unit has upcoming negotiations, remember the importance of

the Pre-Bargaining Survey! Ask your labor representative to help your local develop

the survey and each of you encourage all the nurses to participate! Participation is

crucial towards the effectiveness!

Announcing Career Opportunities

You’ve Been Waiting For!

Crossroads Correctional Facility

Shelby, Montana

Now Hiring:

Clinical Supervisor - RN


New Licensed Graduates Welcome!

Competitive Salary and Pay Based on Experience.

To learn more, please contact:

Cyndy McClimate - Medical Recruiter


Apply online at

CoreCivic is a Drug Free Workplace & EOE - M/F/Vets/Disabled.

August, September, October 2018 Montana Nurses Association Pulse Page 5

Labor Reports and News

Enforce Your Collective Bargaining Agreement

Nurses who work at

facilities where MNA has

a collective bargaining

agreement (CBA) with the

employer enjoy a special

privilege; their terms and

conditions of employment

are clearly outlined in a

binding contract. Working

under a CBA is a huge

benefit that most employees

in Montana do not have;

however, it does come with

huge responsibilities as well.

In order for any contract

Amy Hauschild,

BSN, RN, Labor


to be worth the paper it’s written on, the terms and

conditions of the contract need to be enforced.

Many readers may see the duty of enforcement

of the CBA as one of the jobs of the Union. In part,

they are correct; however, the nurses and elected

leaders on the front line have some of the most

important jobs. They must be ever vigilant and

keeping their eyes and ears open to assure the

terms and conditions of the CBA are being followed

in their facility. For example, recently a nurse came

forward and told a story which had taken place earlier

this summer. It was very clear to both the local unit

president and the MNA labor representative that her

rights under the CBA had been violated. The only

problem was, she waited too long to come forward

and contact her Union leaders, now we are unable

to file a grievance. When we queried her about why

she waited to contact us, she replied “I called Human

Resources and they said I was wrong” (and the CBA

had not been violated).

The long and short of it is, contracts are complex

agreements and often language is dependent on

interpretation, past practice, and bargaining history.

Every human resources employee or even your

manager may not be an expert in your CBA. The take

home message is… whenever you have a question

about the terms and conditions of employment or

a contract question please contact your local unit

leaders or your MNA labor representative. Often we

field questions from nurses who are reporting “this just

doesn’t seem right.” The nurse very well may not even

be aware the CBA has been violated or even worse,

their rights under the National Labor Relations Act may

have been violated.

Nurses working under a CBA are the gatekeepers

of the agreement. MNA cannot assure your rights are

protected unless we are aware of potential violations

or things that just don’t seem right. Remember, no

question is stupid!

Riki Ross, RN Local # 12 Wins 2013

Economic and General Welfare Award

Local unit leader, Riki Ross from Havre was

awarded the 2013 MNA E&GW Eileen Robbins

award. This award recognizes nurses at the local unit

level who have influenced their work setting through

collective bargaining activities. Recipients of this

award have demonstrated commitment to professional

nursing via individual practice competency and

continuing educational growth.

Riki has led her bargaining unit through some very

trying times this year and has shown tremendous

leadership and strength. She is also in the process of

mentoring new local leaders as they transition into their

leadership positions. Fantastic job, Riki!

Montana Nurses Association Districts

Rev (08/2000)

To access electronic copies of

The Montana Pulse, please visit

in Billings is currently hiring

LPN’s & RN’s

both part-time and full-time

with a Sign on Bonus!

• Loan repayment

• Tuition assistance

• Vacation

• 401K

• Onsite child day care

• Health insurance

• Life insurance

• Employee pharmacy

• Set Schedules

To apply visit

or call Kylie at

(406) 655-5920

Full Time RN Needed

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Working between two facilities: Madison Valley Manor,

Ennis and Tobacco Roots Mountains Care, Sheridan.

Benefits include: paid holidays, vacation,

sick leave, medical, and retirement.

Contact: Darcel Vaughn (406) 682-7271

Page 6 Montana Nurses Association Pulse August, September, October 2018

Professional Development Department

MNA’s Approved Providers for Continuing Nursing Education

Montana Nurses

Association is accredited with

distinction as an approver

of continuing nursing

education by the American

Nurses Credentialing

Center’s Commission on

Accreditation. Maintaining

ANCC accreditation is

evidence that we adhere to

international evidence-based

standards in evaluating

applicants who wish to plan,

implement, and evaluate

activities for you – and

award contact hours to you

when you successfully complete those activities.

Pam A. Dickerson,


Director of Professional


We approve two types of applications: individual

applications and approved providers. Individual

applicants are organizations wishing to get approval

to award contact hours for one activity. The applicant

must provide evidence of meeting all educational

design criteria before we are able to authorize the

awarding of contact hours for learners who complete

that activity.

Approved providers are organizations that

have an infrastructure supportive of developing

and maintaining quality continuing education

programming over time. These organizations must

be operational, using ANCC accreditation criteria,

for at least six months before they can apply to

be approved providers. Further, they must not be

organizations that make, sell, distribute, or market

products consumed by or used on patients, and

they must offer their educational activities to target

audiences within a specified geographic range. The

application for approved provider status is extensive,

and requires evidence of meeting criteria in three

domains: structural capacity, educational design, and

quality outcomes. An approved provider must have a

person accountable for the overall functioning of the

provider unit (called a primary nurse planner). The

primary nurse planner then educates and supports

nurse planners within the provider unit in their efforts

to design professional development activities to meet

your needs as learners. Nurse planners develop skills

in assessing problems in practice or opportunities for

improvement, analyzing evidence to determine the

extent of a problem and the appropriate educational

Visit today!

Search job listings

in all 50 states, and filter by location and credentials.

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research, and events.

intervention, planning education purposefully to enable

learners to close those practice gaps or reduce the

identified problems, and evaluating the success

of the activity in improving knowledge, skills, and

practices of nurses. In other words, nurse planners

use critical thinking and clinical judgment to implement

the nursing process – only their focus is on you, the

learner, rather than on a patient.

MNA currently has 42 organizations that are

approved providers for continuing nursing education.

Our most recent additions are the Montana VA

Health Care System and Caring for Hawai’i Neonates.

Congratulations to these organizations on achieving

initial approved provider status! We currently have

approved providers in Alaska, Florida, Hawai’i, Idaho,

Montana, North Dakota, South Dakota, Washington,

Wisconsin, and Wyoming.

In April, May, and June, 2018, Caroline and I

provided educational workshops for nurse planners in

MNA’s approved provider units. Combined attendance

was over 70 nurse planners at locations in Anchorage,

Alaska; Helena, Montana; and Vancouver, Washington.

Thanks to all who attended! We had enlightening

Montana Nurses Association Approved Providers

MNA thanks all of the Approved Provider Units we work with for their commitment to advancing and

promoting quality nursing practice through continuing nursing education.

Acute Care Education

Vancouver, WA

Alaska Division of Public Health

Anchorage, AK

Alaska Native Tribal Health Consortium

Anchorage, AK

Alaska Nurses Association

Anchorage, AK

Alaska Regional Hospital

Anchorage, AK

Alzheimer’s Resource of Alaska

Anchorage, AK

Bartlett Regional Hospital

Juneau, AK With Distinction

Benefis Healthcare Systems

Great Falls, MT With Distinction

Billings Clinic

Billings, MT

Bozeman Deaconess Hospital

Bozeman, MT

Cardea Services

Seattle, WA

Caring for Hawai’i Neonates

Honolulu, HI

Central Peninsula General Hospital

Soldatna, AK With Distinction

Cheyenne Regional Medical Center

Cheyenne, WY

Community Medical Center

Missoula, MT

Evergreen Health

Kirkland, WA

Fairbanks Memorial Hospital

Fairbanks, AK

Kadlec Regional Medical Center

Richland, WA

Kalispell Regional Healthcare System

Kalispell, MT

Kootenai Health

Coeur d’Alene, ID

Mat-Su Regional Medical Center

Palmer, AK

Kootenai Health

Coeur d’Alene, ID

conversations at each location and learned from, with,

and about each other to improve our work in the field

of nursing professional development.

Is your organization an approved provider? If so,

do you know your primary nurse planner and the

nurse planners? Do you know who to approach with

questions or suggestions for educational activities to

improve your practice or help you learn and grow as a

professional nurse? We hope so! If you have questions

about whether or not your organization is an approved

provider, please email – we can let you know that,

and give you the name of the contact person for your

approved provider unit. If your organization is not an

approved provider, we can assist you in beginning that

journey so you can be assured of “at home” quality

professional development opportunities to support you

and your colleagues.

Don’t forget, too, that MNA is also an accredited

provider, in addition to being an accredited approver.

That means we can (and we do) provide lots of

opportunities for you to learn and earn contact hours.

Visit to learn about both “real

time” and “on your own” activities currently available.

Let us know how we can help you!

Mat-Su Regional Medical Center

Palmer, AK

Montana Geriatric Education Center of UM

Missoula, MT With Distinction

Montana Health Network

Miles City, MT

Montana VA Health Care System

Helena, MT With Distinction

Mountain Pacific Quality Health

Helena, MT

North Valley Hospital

Whitefish, MT With Distinction

Pacific Lutheran University

Tacoma, WA

Partnership Health Center

Missoula, MT

Planned Parenthood of the Great Northwest

and the Hawaiian Islands

Seattle, WA

Providence Alaska Learning Institute

Anchorage, AK

Providence Healthcare

Spokane, WA

Providence St. Patrick Hospital

Missoula, MT With Distinction

South Dakota Nurses Association

Pierre, SD

South Peninsula Hospital

Homer, AK

St. Alphonsus Health System

Boise, ID

St. James Healthcare

Butte, MT

St. Luke’s Health System

Boise, ID

St. Peter’s Health

Helena, MT

St. Vincent Healthcare

Billings, MT

UF Health Shands Hospital

Gainesville, FL

Wisconsin Nurses Association

Madison, WI With Distinction

Wrangell Medical Center

Wrangell, AK With Distinction

August, September, October 2018 Montana Nurses Association Pulse Page 7

Don’t forget to check out our CNEbyMNA

Website for Continuing Education opportunities.

It is constantly updated with new Webinars and

Courses for your continued learning!

*Montana Nurses Association is accredited with

distinction as a provider of continuing nursing

education by the American Nurses Credentialing

Center’s Commission on Accreditation*

Workplace Wellness

Cardiac Considerations for Nurses

Nutrition for Nurses

Is Your Compassion for Nursing

Stressing You Out?

Women’s Health and Fitness

Prostate Cancer: Education and Outreach

Sleep Like a Baby

Happiness as a Contributor to Health

Recovery/Work Life Balance

Infection Control/Immunizations

Mindful Practice for Nurse Mental Health

Holiday Health: Dashing Through the Days

Patient Care Topics

Creativity and Innovation in Decision-Making:

From Bedside Nursing to C-Suite

Developing Critical Thinking and Clinical

Judgment Skills

The Fine Art of Care Coordination

Managing Symptoms & Side Effects of Long

Term Treatments for Cancer

Professional Practice Topics

Moral Distress: Addressing the Challenge

in Health Care Practice

Multigenerational Challenges:

Working Together in Health Care

Whose Job Is It, Anyway? The Nurses’s Role

in Advocacy and Accountability

Developing Your Professional Image

For CE Providers


Webinar Series

Outcomes and Objectives: When, What, and How

The Quest for Quality – Outcomes Webinar 1:

Strategies for Learning Activities

The Quest for Quality – Outcomes Webinar 2:

Selecting Provider Unit Outcome Measures

The Quest for Quality – Outcomes Webinar 3:

Provider Unit Outcomes: Data Collection

and Analysis

Nurse Planner Webinar: Educating to

Achieve Quality Outcomes

Happy summer days. Can I

say that summer is my favorite

season? Probably when warm

nights bring back memories

of my youth playing outside

till it was long past dark and

falling into bed so tired but

fighting sleep and wanting

to keep playing but wishing

for morning so I could start

all again. When I am in each

season it seems to be my

favorite, until winter won’t

leave and spring has trouble

remembering how to wake up. I often feel a renewal

as summer days fill me with warmth and memories.

Enough reminiscing.

The MNA annual nurses convention will be coming

up October 3 rd – 5 th ! It is just around the corner. It is

a time to connect with fellow nurses from around the

state and I always look forward to seeing old friends

and meeting new nurses committed to the growth of

the organization and to their own personal growth as

nurses. If you are a delegate you know that your voice

is important to help guide MNA regarding decisions

Montana Nurses volunteer to help school

children with health screenings in

the Virgin Islands!!

Four Montana nurses, BreAnn Hebel, Samantha

“Sam” Northrup, Julie Anderson, and Jennifer Taylor

volunteered to deploy to the Virgin Islands to help

with much needed school screenings. This initiative

came to be because our union members in the Virgin

Islands mentioned the need for school nurses to do

screenings that were not getting done this school year.

At the Clinton Global Initiative (CGI) meeting in January

2018, representatives from the government identified

this need also. The American Federation of Teachers/

Nurses and Healthcare Professionals (AFTNHP)

launched into action and put together a commitment

that was announced at this meeting. This was about

helping the families, students, and the community of

people who are suffering from a national disaster. The

opportunity presented itself through our professional

nurses association, the Montana Nurses Association

(MNA), because of our affiliation with our national

union of professionals, the AFTNHP.

MNA stepped up and helped because these

Americans have been left behind. While the public

schools have been open, it was unclear what

conditions the students and educators were facing

and was hard to imagine. Our mission was to

determine the conditions that students and educators

are learning and teaching in and make sure that they

are safe, and hoped to assist with their much needed

health screenings, focusing on hearing and vision.

As nurses, our mission is to protect, heal, and

advocate for their immediate healthcare needs and

APRN Corner

Keven Comer


that impact its legislative agenda. This year, APRNs

will be taking the concept of global signature to the

legislature. If you are interested in testifying about any

items that have been difficult for you to get carried

out for patients – on a state level – please let me or

the staff know. Personal, patient experiences are very

important to let legislators know how these barriers

impact real lives.

I just returned from the annual AANP conference.

This year it was held in Denver. Not often that it is

west of the Mississippi river. Over 7000 NPs attended.

AANP has over 185,000 members and is reaching for

200,000. MNA is an affiliate of AANP and has your

voice in keeping full practice authority intact.

Find your passion, grow and rekindle your love of

nursing and the joy it brings to you and each of your

patients. The mind-body connection is the important

link that nursing has known for centuries. This is why

we understand and know the importance of each and

every person as the key to their health and well-being.

Enjoy the rest of summer into fall.

As always, if you have any questions, comments or

concerns, don’t hesitate to contact me keven.comer@

that is what these volunteers did. They ensured any

health-related issues, illnesses or diseases processes

were identified to the best of their abilities and were

handled properly. In addition to checking the safety

of schools, all the volunteers wanted families to send

their children into environments that are conducive to


This was a volunteer opportunity that really had a

meaningful impact on people’s lives and we appreciate

these nurses’ volunteer efforts.

Jennifer Taylor, one of the nurse volunteers (pictured

below) was one of your AFT delegates to the national

convention and they honored her as a nurse hero who

participated in AFT’s volunteer efforts.

Thank you Jennifer!!

We are looking for

passionate and

caring nurses to

join our team.

RN – Inpatient Nursing

Full Time or Part Time

Competitive salary, great benefit package,

student loan repayment and relocation expenses available.

Please contact the HR department at (406) 228.3662 for more information.






Sign On/Relocation Bonus for experienced nurses

CHA is a 25-bed critical access hospital located in scenic

Southwestern Montana.

FMDH is an Equal Opportunity/Affirmative Action Employer

For details, contact Amber Benes,

Director of Human Resources, at (406) 563-8647


Page 8 Montana Nurses Association Pulse August, September, October 2018

Excerpts from ANA

Everyone Deserves A Job They Love!!

Let Us Help Today, Call 406.228.9541

Prairie Travelers is recruiting Traveling

Healthcare Staff in Montana,

North & South Dakota

• Registered Nurses (Hospital, ER, ICU, OB and LTC)

• Licensed Practical Nurses

• Certified Medication Aides

• Certified Nurse Aides

• Full-Time and Part-Time

Prairie Traveler’s Commitment

to our Staff

• Excellent Wages • Health Care Benefits

• Travel Reimbursement • Annual Bonus

• Paid Lodging

• Zero Assignment

• Flexible Work Schedules Cancellations

• 24/7 Staff Support • Varied Work Settings

APPLY TODAY 406.228.9541

Prairie Travelers Recruitment Department

130 3rd Street South, Suite 2 • Glasgow, MT 59230

For an application or more information, visit

Talk with your patients,

they are listening.

A 12-month program with

weekly and monthly sessions.

Weekly sessions focus on

lifestyle change strategies to

improve nutrition and exercise

habits. Monthly sessions are

designed to support and guide

the nutrition and exercise goals

met during the program.

“Going through the program I was able to

reduce my cholesterol from 200 to 120 and

cut my blood pressure medication in half.”

- Dan



Undergraduate Degree Options


• Bachelor of Science in Nursing (BSN) degree

• Accelerated BSN degree for post-baccalaureate students

Graduate Degree Options

• Master’s Degree (Focused on Clinical Leadership)

- ADRN to MN option

- BSN to MN option

• Doctor of Nursing Practice (DNP)

- Family Nurse Practitioner (FNP)

- Psych Mental Health Nurse Practitioner (PMHNP)

Please visit

or email for

program eligibility, requirements and locations.

August, September, October 2018 Montana Nurses Association Pulse Page 9

Excerpts from ANA

ANA’s Case for Evidence-Based Nursing Staffing

Essential for cost-effective, high-quality hospital-based care and patient safety

This article can be found on page 11 of the https://


Registered nurse (RN) staffing makes a critical

difference for patients and the quality of their care.

ANA champions the role of direct-care nurses

and nurse managers in working with their hospital

leadership to define the best skill mix for each hospital

unit, recognizing the role of nurses in managing each

patient’s treatment plan and continuously assessing

each patient’s health status. Our work demonstrates

that patients, nurses, and health care systems thrive

with appropriate and flexible nurse staffing. For

hospitals to succeed, tools and processes must

support evidence-based staffing decisions driven by

nurses who understand the dynamic nature of patient


ANA bases its advocacy on research. ANA

commissioned a comprehensive evaluation of nurse

staffing practices as they influence patient outcomes

and health care costs. A white paper, authored

by consulting firm Avalere, evaluated a review of

published literature, government reports, and other

publicly available sources, along with information

gathered from a series of panels of nurse researchers,

health care thought leaders, and hospital managers.

To read ANA’s first staffing white paper Optimal

Nurse Staffing to Improve Quality of Care and

Patient Outcomes, visit


Key Findings

Best practices consider many variables when

determining the appropriate care team on each

hospital unit:

• Patients: Ongoing assessment of patients’

conditions, their ability to communicate, their

emotional or mental states, family dynamics,

and the amount of patient turnover (admission

and discharges) on the unit

• Care teams: Each nurse’s experience,

education, and training; technological support

and requirements; and the skill mix of other

care team members, including nurse aides,

social workers, and transport and environmental


Nurse staffing models affect patient care, which

also drives health care costs. Safe staffing affects a

range of hospital-based care issues, including:

• Medical and medication errors

• Length of stay

• Patient mortality

• Readmissions

• Preventable adverse events, including falls,

pressure ulcers, health care-associated

infections, and other complications

• Nurse injury, fatigue, and low retention

Findings point to the importance and costeffectiveness

of nurse staffing decisions that are

based on evidence rather than traditional formulas and

grids. To foster innovation and transparency in staffing

models, it is essential to capture and disseminate

outcomes-based best practices.

Staffing and Cost Containment

Nurse salaries and benefits are among the

largest components of a hospital’s expenses and

thus are an easy target when balancing budgets.

However, decisions to cut labor costs are sometimes

shortsighted when the long-term impacts on cost and

patient care quality are not considered.

Other variables to consider in addressing hospitalbased

care costs include:

• High-tech devices and procedures

• Prescribed drugs and other medicine

• Clinician and system practice insurance

• Facility construction, renovation, and


• Information technology investments and


Well-managed hospitals/health systems

continuously balance competing needs to keep

organizations fiscally sound.

Legislated nurse-patient ratios versus flexible,

nurse-driven staffing

Some organizations advocate for legislated

nurse-patient ratios, believing that strict ratios will

ensure patient safety. Based on our experience with

unintended consequences, ANA does not support

numeric, fixed ratios. In many cases, to meet these

ratios, hospital administrators have eliminated other

care team positions and then shifted noncore patient

care work to nurses. This leaves nurses overextended

and distracted from their core responsibilities

of continuously monitoring patient status and

implementing clinical treatment plans.


ANA supports direct-care nurses and nurse

managers in working with hospital clinical and

management teams to address pressures to control

costs while providing high-quality care in a safe

environment. Outcomes-based staffing models

require partnerships between nurses and hospital/

health system leadership, including those in finance,

operations, and clinical areas. Together, we can find

pragmatic solutions to complex and pressing issues.

Page 10 Montana Nurses Association Pulse August, September, October 2018


Nursing News

*ALL Nurses Welcome

*Members and


*11 Contact Hours

(1 Rx) Offered

*Accredited Continuing


Visit our websites at or

to register and for more


*8 Districts with Elected Delegates

*Delegates participate and vote on

MNA business

*District funds available to

Delegates for Convention fees

*Networking with Nurses from

across Montana

If you have any questions about the 2018 MNA Convention please

email or call Jennifer at or (406) 442-6710

RNs & LPNs

FT/PT/PRN – All shifts available

Sign On Bonus Available!

Big Sandy Medical Center, Inc

Critical Access Hospital, Longterm

Care Facility and Rural Health Clinic.

166 Montana Ave. East | Big Sandy, MT 59520

(406) 378-2188 |

The Benefits of

Drinking Coffee and

Union Membership

I am finding it harder and

harder to pretend that I am

simply a nurse that advocates

for wellness. I believe I

better fit the description of

an Underground Fitness

Dedicated Activist or UFDA!

To that end, I would offer

suggest that you do a little

research on the overwhelming

research that suggests

coffee is good for you. In fact,

according to the most recent

study in the JAMA Internal

Joey Traywick,


BS Kinesiology

Medicine publication, coffee may help you live longer

AND be considered part of a HEALTHY DIET! Wow! I

was told it would stunt my growth, cause yellow teeth

and give me nervous twitches - and while that has all

indeed happened to me - you will be glad to know

that I will be around a bit longer to write this article for

years to come.

The question is, why? Why does coffee potentially

extend life? The journal article states that the coffee

may be decaf or regular. You can drink anywhere from

one to eight cups a day. Is it the beans? Are there

magic properties in coffee beans that extend life?

Perhaps, but the authors of the study do not try to

answer the WHY question, they simply point out that

data suggests those who drink coffee, live longer than

those that do not.

I have a theory.

Maybe those who drink coffee are taking a moment

to do something for themselves. Maybe they are

socializing with people and conversing over a steaming

cup of joe. Maybe the benefit isn’t in the beans at all.

Maybe the benefit is in the lowered stress of enjoying

something every once in a while and perhaps doing that

with people with whom one enjoys. Hmmmm.

Here’s the UFDA part.

This month, the Supreme Court dealt a blow to union

membership across our country. It isn’t as if the agenda

is hidden. Strong business interests do not want to have

to negotiate with employees or be under the burden of

regulatory pressures that ensure safe or fair working

conditions. That is pretty clear. But what happens when

employees belong to a union? Did you know they report

being in BETTER HEALTH overall? According to a 2012

study published by Duke University, union members

reported being in better health than workers that were

not union members. Interesting.

Maybe it’s because the union environment

helps relieve stress associated with poor working

environments or unequal pay. Maybe union members

don’t have to live with the worry that they can be

unfairly or arbitrarily mistreated on the job without

representation to back them up. Maybe strong union

membership and participation gives employees hope

that their condition can improve rather than merely

exist. Or, maybe it’s just the magic in the beans.

You want a longer life? Have a cup of coffee!

You want a longer life worth living? Become a

dues-paying member of YOUR union, I’m sure they’d

buy you your next cup! Take care of yourself, we need

you more than ever...


Nursing Faculty

Complete position

announcements can be

found at


August, September, October 2018 Montana Nurses Association Pulse Page 11

Legislative and Government Relations

2017-2018 MNA Government Relations Platform



Association (MNA) is the

nonprofit professional

association representing

the voice of nearly 18,000

Registered Nurses (RNs)

in Montana including more

than 1000 licensed as

Advanced Practice Registered

Nurses (APRNs). MNA is

the recognized professional

organization, which lobbies

for nursing practice issues

to protect the practice of

Vicky Byrd,


professional nurses and also protect the public in all

areas of health care.

MNA is the recognized leader and advocate for the

professional nurse in Montana.

MNA Mission Statement: The Montana Nurses

Association promotes professional nursing practice,

standards and education; represents professional

nurses; and provides nursing leadership in promoting

high quality health care.

1. Improve the quality of nursing practice by:

a. Providing educational opportunities that contribute

to improving practice competency and quality of

patient care.

b. Identifying and pursuing funding sources to assist

in providing continuing nursing education.

c. Identifying and pursuing funding sources that

support research/projects to develop evidence

based and innovative nursing practice.

d. Promoting national certification of registered


e. Active representation on local, state and national

advisory committees/boards.

f. Supporting the regulatory authority and

collaborating with the Montana Board of Nursing

(BON) on nursing practice and regulatory issues.

g. Input into the implementation of NCSBN Nurse

Compact Licensure legislation.

h. Oppose the NCSBN eAPRN Nurse Compact

Licensure legislation.

2. Protect the economic and general

welfare of nurses by:

a. Actively engaging in legislation and campaigns that

positively contribute to the economic and general

welfare of RNs.

b. Ensuring the right of RNs to engage in collective

bargaining in Montana.

c. Opposing any “Right to Work” legislation now

being referred to as “NO RIGHTS AT WORK” by


d. Addressing workplace environment issues

including violence against healthcare workers, safe

staffing, and patient safety.

e. Advocating legislation prohibiting mandatory


3. Improve access to quality, cost effective health

care by developing and/or supporting public

policies which:

a. Respond to the needs of the unserved and

underserved populations by promoting access to

health care and healthcare coverage.

b. Identify or develop alternative health care delivery

systems that are cost-effective and provide quality

health care.

c. Mandate third party reimbursements directly to

RNs from public and private payers.

d. Remove barriers (financial, governmental,

regulatory, and/or institutional) that deny access

to appropriate/qualified health care providers and

approved medical standard of care treatments.

e. Advocate for legislation that is transparent and

bipartisan and support policies that can achieve

evidence based real healthcare reform.

f. Promote community and world health by

collaborating with other health professionals to

promote health diplomacy and reduce health


4. Protect human rights by developing and/or

supporting public policies which:

a. Promote access to appropriate health services.

b. Preserve individual rights to privacy.

c. Promote, debate and have consideration of ethical

dilemmas in health care

5. Protect the environmental health of individuals

and communities through:

a. Acknowledging, supporting and addressing

environmental impacts on the health of Montanans.

b. Actively engaging with national organizational

affiliates in addressing environmental health issues

in our nation.

c. Identify the nurse’s primary commitment is to

the patient, whether an individual, family, group,

community, or population.

6. Protecting and promoting the future healthcare

and nursing practice through:

a. Actively engaging in legislation that supports

professional scope of nursing practice to the full

extent of individual education and training.

b. Actively promoting programs and efforts that

encourage educational progression of professional

nursing at state and national levels.

c. Representation on boards, committees and

advisory groups which influence the future of the

nursing profession and the future of our state and

national healthcare system.

d. Engaging with healthcare partners and

associations to work collaboratively to ensure

healthcare as a right for all American populations.

Leading the Way

Nurse leader talks about respectful, healthy work environments

Find an opportunity to address workplace civility.

Reprinted with permission from the American

Nurses Association

American Nurse Today April 2018 Vol. 13 No. 4

Ric Cuming, EdD, RN, NEA-BC, FAAN, is senior

vice president and chief nurse executive at the twice

Magnet®-recognized Christiana Care Health System

in Wilmington, Delaware, and a Delaware Nurses

Association member.

Among his passions is promoting respectful, healthy

work environments. An alumnus of the prestigious

Robert Wood Johnson Foundation (RWJF) Nurse

Executive Fellows program, he codeveloped the Civility

Tool-kit: Resources to Empower Healthcare Leaders to

Identify, Intervene, and Prevent Workplace Bullying


As a nurse leader, do you face

consistent challenges?

Challenges are really opportunities in disguise. One of

the biggest is the pace of change in healthcare, which

is exponential. Another is having sufficient resources

— staff and supplies — so we can provide the safest,

highest quality patient care. What really keeps me up

at night is recruitment. We have nurses who have been

with us for decades who are retiring. I can replace the

individual, but I can’t replace all that knowledge and

depth of clinical experience. We place high value on our

clinical ladder and nursing tuition-assistance program

to advance our nurses and continue to develop our

extraordinary nursing workforce.

Can you describe your work around the Civility

Tool-kit and its importance?

We wanted to provide a resource for nursing and

health-care leaders that focused on creating and

sustaining healthy work environments that staff,

educators, and others can access free online.

The American Nurses Association also has done

important work addressing workplace incivility,

bullying, and violence, which has become a national

epidemic in healthcare. For the tool-kit (with tip sheets,

assessments, and strategies), we defined workplace

incivility broadly to include any negative behavior

that demonstrates a lack of regard for other workers.

We’ve reached a very wide audience locally, nationally,

and internationally through ongoing presentations.

Healthcare is a team sport. At Christiana Care,

our values statement supports this from the top: “We

serve together, guided by our values of excellence and

love.” We continue to implement and innovate with the

full support of our leadership.

We’ve started using aspects of the tool-kit and

established a task force to promote a healthy, respectful

workplace. Our “Heavenly Seven” survey assesses the

experiences of our float pool and nurses required to

float from their units — whether they felt welcomed on

the unit, if they were offered help when needed.

What are key strategies to build civil


Healthcare leaders need to shine a light on the

importance of a healthy, respectful workplace and

model those behaviors,

including the following:

• Empower staff to safely

respond to uncivil behavior

when they see or hear it.

• Train supervisors, managers,

and faculty to recognize

the signs of bullying and

emotional distress.

• Refuse to be a silent

bystander; take a stand. Ric Cuming

• Create a mechanism for

staff to confidentially report issues in the workplace

without fear of retaliation. What’s happened recently

in Hollywood and the political world is extremely

empowering to others who may be suffering in


What are pressing issues that nurses should

be leading on or advocating for?

Appropriate nurse staffing is the number-one issue.

Advocating for healthy work environments, governance

structures, patient safety, quality indicators, and the

ability for nurses to practice to the top of their license in

all settings leads to appropriate staffing.

Final comments?

I encourage nurses to embrace lifelong learning,

become certified in their specialty, lean in to new

opportunities, and get involved in professional practice

issues. I also believe we must be courageous, perhaps

even more today, to speak truth to power.

Page 12 Montana Nurses Association Pulse August, September, October 2018

Critical Access Hospitals:

History, Criteria, & Reimbursement

This information has

been carefully compiled

through collaboration to

be relevant to a nurse’s

understanding of the Critical

Access Hospitals (CAHs)

in Montana. It should, also,

provide an appreciation and

increased knowledge of the

convoluted regulations.

Throughout the United

States there are 1,332 certified

Critical Access Hospitals

(CAH)-approximately 3.5%

Carolyn Taylor

Ed.D, MN, RN

are located in Montana. There are 46 CAHs that are

licensed by the State of Montana and two federal CAHs

(Fort Belknap Service Unit in Harlem and Crow/Northern

Cheyenne Indian Hospital at the Crow Agency).


“Critical Access Hospital” (CAH) is a designation

given to eligible rural hospitals, or those grandfathered

as a “necessary provider” rural hospital by the Centers

for Medicare and Medicaid Services (CMS). Congress

created the (CAH) designation through the Balanced

Budget Act of 1997 in response to a string of rural

hospital closures during 1980’s and early 1990’s.

To determine the CAH model attributes, two

existing programs were considered. These models

were known as the highly successful Montana’s

Medical Assistance Facility (MAF) project and the

Essential Access Community Hospital/Rural Primary

Care Hospital (EACH/RPCH) Project. These two

“stopgap” measures were set up as demonstration

projects involving a handful of small, struggling

hospitals to determine a successful model to keep

hospitals from permanently closing. The model

determine is now known as a CAH.


From 1990 through 1996, 140 rural hospitals closed

in the United States. These hospitals were generally

smaller and treated fewer patients than the national

average. Small rural hospitals faced growing difficulty

in meeting the full certification requirements for a

hospital and were facing growing financial pressures

due mainly to inadequate payments from Medicare

and other government programs.

In 1997, the Balanced Budget Act enacted by the

U.S. Congress included a response to many of the

closed hospitals. The purpose of the rural hospital

provisions contained in the Balanced Budget Act was

to provide regulatory relief to rural facilities, address

financial vulnerability, and to improve access to

essential health care services in rural areas.

Financial support then became possible through

cost-based reimbursement by the Centers for

Medicare and Medicaid Services (CMS) to hospitals

that qualified for the CAH designation and who were

determined to be at risk for financial stress. This

support was very timely in its delivery. For instance,

year 2008 added to the widespread decrease in

profitability of the hospital industry possibly due to

the worsening recessionary economy. The significant

long-term event would undoubtedly result in many

more small hospital closures.

The Balanced Budget Act also established a

Medicare Rural Hospital Flexibility Program (Flex

Program) encouraging states to strengthen their rural

healthcare initiatives that would add the most value to

CAHs in each specific state, support CAH health system

development and improvement, and support community

continued engagement in the CAH health system.



Montana Nurses Association would like to

invite you to join us today!


* MNA Convention *

Helena, MT ~ October 3 rd ,4 th & 5 th 2018

* Seamless Health Care for Our Veterans*

Helena, MT ~ November 7th, 2018

*Transition To Practice*

Helena, MT ~ January 27 th & 28 th , 2019

*Legislative Day*

Helena, MT ~ January 31 st , 2019

*2019 APRN Pharmacology Conference*

Helena, MT ~ March 1 st & 2 nd , 2019

*Labor Retreat*

Chico, MT ~ April 7 th , 8 th & 9 th , 2019

Has your contact

information changed?

New name? New address?

New phone number?

New email address?

To update your contact information,

please email or call

Montana Nurses Association: or 406-442-6710









Call or email today •

(406) 442-6710

Applications also available on our website.

August, September, October 2018 Montana Nurses Association Pulse Page 13



1. Twenty-five (25) or fewer acute care inpatient

beds. The beds (some or all) can be used for

either inpatient acute care or long-term (swing bed)

care services. A “swing bed” provides flexibility in

meeting unpredictable demands for acute care

and long-term care. Swing beds are an alternative

to both a skilled and intermediate long-term care

facility in a rural setting where, usually, there is an

older patient population. Swing beds are common

in rural hospitals with a CAH status. The most

common use of a swing bed is for aging patients

needing rehabilitation.

Excluded from this bed count are

examination, observation, emergency room or

procedure beds, operating room tables, stretchers,

and similar surfaces.

2. Location must be thirty-five (35) miles or

more from another hospital or fifteen (15)

miles from another hospital in mountainous

terrain or areas with only secondary roads.

(Hospitals designated as a “necessary provider”

by their state and approved by CMS prior to

January 1, 2006 are exempt from these distance


3. An agreement must be developed and

maintained with one or more other hospitals

regarding patient referral, transfer,

communication, and emergency or nonemergency

patient transportation. The

receiving hospital can also be a CAH, but it must

offer services at a higher level of care, such that

the sending facility isn’t “dumping” patients.

The agreement ensures that patients always

have at least one place to go. Under the transfer

agreement, the receiving facility cannot refuse to

accept the sending facility’s patients at any time.

4. Acute care patients can only be kept for an

annual average length of stay of ninety-six

(96) hours or less; although, case-by-case

exceptions may be granted under special

circumstances, such as a transfer putting a

patient’s well-being at risk.

Non-Medicare/Medicaid long-term care (swing

bed) bed patients have no length of stay limit.

However, in Montana, patients on Medicaid

must be transferred to a Skilled Nursing Facility

(SNF) within a twenty-five (25) mile radius that has

an open bed. If there is no SNF within 25 miles,

there is no limit on a patient’s swing bed length

of stay. (Transfer swing-bed policy is a Medicaid

policy, only.)

5. Emergency services must be provided 24/7.

Medical staff must be on-site or on-call and

available on-site within 60 minutes, although many

CAHs choose to require a shorter time frame in

their Medical Staff By-Laws to ensure a higher

standard of care. Coverage can be provided by a

Medical Doctor (M.D.), Doctor of Osteopathy (D.O.),

Physician Assistant (P.A.), Nurse Practitioner (N.P.),

or a Clinical Nurse Specialist with experience and

training in emergency care. In frontier areas, if no

physician or mid-level practitioner is available, a

Registered Nurse (R.N.) can provide temporary

coverage in the form of a screen examination,

patient stabilization, and arrangement of transfer to

another facility.

6. There must be at least one physician on the

medical staff, but he/she is not required

to be onsite. A physician is required, however,

to be accessible, such as by phone. Mid-level

practitioners can be an independent part of the

medical staff and can provide direct services to

patients, including emergency services and voting

on medical staff issues.

7. There must be a registered nurse (R.N.)

on site 24/7. Federal requirements do allow

temporary hospital closure if the facility has no

patients, no providers, and/or no nursing staff.

Some state licensure requirements may vary.

8. According to the services provided, the same

requirements of a general acute hospital

must be met by a CAH. This doesn’t mean that

all CAHs must offer the same services as a larger

hospital, but if they do, they will be held to the

same operating standards. Some variance in state

licensure laws could exist.

9. State hospital licensure law(s) must be met if

the state law(s) are stricter than the Medicare

Conditions of Participation (CoP) required for

a CAH. Most often, state laws simply refer to the

Medicare CoPs or replicate them.

10. Quality assurance (QA) must occur as a part

of a network or through a credentialing body.

(e.g. Joint Commission or Healthcare Facilities

Accreditation Program).

Generally, each state’s Flex Program includes

an element of QA that meets the criteria.

11. Each CAH must undertake quality

improvement through the Medicare

Beneficiary Quality Improvement Project

(MBQIP) by encouraging self-reported quality

data used to improve facility activities as a

part of the Flex Program.


Recertification occurs according to the consistent

accreditation interval of the accrediting organization.

For instance, those with JCAHO certification are

usually surveyed every 12 months and at least every

15 months. Those who choose not to be JCAHO

will be surveyed under state licensure laws (which

are every three years in Montana) as well as being

subjected to federal oversight surveys. Decertification

of the CAH occurs if something presents an immediate

jeopardy to patients and/or the public and if concern(s)

are not fixed quickly.



Two federal programs are available to CAHs to

assist with capital improvements. Those programs are:

A) U.S. Department of Agriculture (USDA)

Community Facilities Loan and Grant Program for

construction, expansion, and facility improvement, and,

B) U.S. Department of Housing and Urban

Development (HUD), Section 242: Hospital Mortgage

Insurance Program (Funding/95) for new construction,

refinancing debt, or purchasing of new equipment, e.g.

hospital beds and office machines.


Hospitals, in general, are paid, licensed, and meet

related certification requirements in either ONE OF

TWO categories:

1. Inpatient Prospective Payment System (IPPS

or PPS)—Medicare system.

A certain amount of IPPS reimbursement

is influenced by hospital costs; however, most

reimbursement involves defined, fixed payment

mechanisms, such as Diagnosis Related Groups

(DRGs). Under this program, hospitals are paid a fixed

amount for each of its services, regardless of how

much it costs to deliver those services. There are a

variety of payment exceptions related to the IPPS/PPS

payment system. The payment exceptions are different

as to the following IPPS/PPS hospitals/center/project.

The three payment exceptions are as follows:

A) Sole Community Hospital (SCH) under the IPPS/

PPS system receives the greater of the reimbursement

made under pure IPPS/PPS methodology or the

cost-based reimbursement rate indexed for inflation.

Furthermore, even though CAH’s do not fall under

this category of reimbursement, a CAH can be a

SCH. This designation is often used to allow access

to certain programs that benefit a hospital’s patient

population—e.g. 340B Drug Pricing Program.

B) Medicare Dependent Hospital (MDH) under the

IPPS/PPS system, a hospital receives an upward cost

adjustment to the purely-acquired IPPS program.

C) Rural Referral Center (RRC) under the IPPS/

PPS system is a specialty designation reserved

for reimbursement of high-volume acute care rural

hospitals that treat a large number of diagnosis-related

groups (DRGs). It is not technically cost-based under

the RRC guidelines; rather, it is based on federal rates.

2. Cost-Based Reimbursement—(CAH and


A CAH cost report is required from every CAH by the

Centers for Medicare and Medicaid Services (CMS) for

the purpose of comparing and reimbursing the CAH

at the lowest rate and making adjustments for difficult

populations, such as Medicaid Disproportionate Share

Hospital (DSH) program which provides additional

funding to hospitals who treat a disproportionate share

of indigent patients. The outcome of the DSH rate can

greatly affect CAH care rates.

Interim rates are established at the CAH’s start of a

fiscal year, and a settlement is made at the end of the

fiscal year according to the CAH cost report. Currently,

a CAH is reimbursed at 101% to help provide a source

for hospital/facility improvements.

The National Rural Health Resource Center is

associated with providing federal grants to each state that

has a CAH program. A Technical Assistance and Services

Center within the National Rural Health Resource Center

provides information and technical assistance.

A study was performed by the National Rural

Health Research Policy Analysis Center in 2010 that

determined the following benefits about CAH hospitals

in comparison to the other hospital classifications:

1. Experienced a higher amount of financial


2. More revenue came from outpatient business

3. Fewer allowances and discounts

4. Profitability was one of the lowest of the

classifications, possibly due to low volumes,

private insurance, Medicaid, and self-pay

5. Lowest fixed assets, possibly resulting in ability

to attract patients and retain physicians

6. Within two years post conversion to a CAH

classification, the average total profit margin

increased from -2.5% to 3.7%.

In addition, small hospitals participating in a current

CMS demonstration project, Frontier Community

Integration Project (FCHIP), also receive cost-based

reimbursement. FCHIP is a three-year demonstration

project authorized under the Affordable Care Act (ACA)

and is technically an off-shoot of the CAH program.

It was designed to test new models for healthcare

delivery in frontier designated areas and was originally

developed and proposed in Montana. Participants in

this project are limited in quantity—three in Montana,

three in North Dakota, and four in Nevada. These 10

participants (Montana, North Dakota, and Nevada)

are some of the smallest CAHs in the nation, and as

such, continue to receive cost-based reimbursement.

Montana’s three FCHIP health care programs are

McCone County Medical Center in Circle, Roosevelt

Medical Center in Culbertson, and Dahl Memorial

Healthcare Association in Ekalaka.


Incentive payments (like other hospitals) are

available for EHRs; however, with a limit period of four

years of incentive payment.


Conversion to a CAH hospital has been found to

improve financial viability in small rural hospitals. Yet,

in some hospitals, being a CAH was shown to cause

significant financial distress and loss.

The measurement of financial distress is measured over

the long-run, not over a short-run of time. For example,

extraordinary expenses could result in a negative cash flow

margin for one year only, which is considered by financial

measurement to be a short-run of time.

Some newly converted CAHs tend to believe their

generated income will increase significantly every

year, so they overextend themselves building a new

hospital. The reality is that cost-based reimbursement

is still a delicate mechanism that needs to be carefully

managed, since CAHs can still become extended.

Generally, hospitals hire a consultant to determine if

they have the potential to be in a financial bind before

converting to a CAH status.


RHI hub (Rural Health Information Hub)


Bob Olsen, Sr. Vice President, Montana Hospital

Association (MHA)

David Espeland, CEO, Fallon Medical Center (FMC)

Carolyn R. Taylor, Ed.D. M.N. R.N., President,

Leadership Power (

Copyright 2018

Page 14 Montana Nurses Association Pulse August, September, October 2018

Social media missteps could

put your nursing license at risk

Reprinted with permission from the American Nurses Association

American Nurse Today March 2018 Vol. 13 No.3

Learn the rules and what to do if you make a mistake.


• For nurses, social media use has daily applications in their personal and

professional lives, facilitating conversations with colleagues about best

practices and advancing healthcare.

• Inappropriate use of social media can create legal problems for nurses, including

job termination, malpractice claims, and disciplinary action from boards of

nursing (BON), which could negatively impact their nursing license and career.

By Melanie L. Balestra, NP, Esq

Without a doubt, social media has become an integral part of modern life.

Today, seven in 10 Americans use social media to get news, connect with

others, and share information. Facebook leads the way with more than 2 billion

users worldwide, followed by other popular platforms such as Twitter, Instagram,

LinkedIn, and YouTube. For nurses, social media use has daily applications in their

personal and professional lives, facilitating conversations with colleagues about

best practices and advancing healthcare.

Although social media offers many benefits, inappropriate use can create legal problems

for nurses, including job termination, malpractice claims, and disciplinary action from

boards of nursing (BON), which could negatively impact their nursing license and career.

What to avoid when posting

Remember that professional standards are the same online as in any other

circumstance. And although you should approach all social media posts with

caution, several high-risk areas deserve closer examination.

Breaches of patient privacy and confidentiality

Whether intentional or inadvertent, social media posts that breach patient

privacy and confidentially are the most egregious. They include patient photos,

negative comments about patients, or details that might identify them, the

healthcare setting, or specific departments. Even when posted with the best

intentions, such as trying to get professional advice from colleagues about patient

care, these posts are discoverable and can lead to legal problems, with potential

fines and jail time for Health Insurance Portability and Accountability Act (HIPAA)

violations, termination or other discipline from your employer, action taken against

your license by a BON, civil litigation, or professional liability claims.

According to the 2015 nurse professional liability exposures claim report update

from the Nurses Service Organization, examples of civil litigation and closed claims

in connection with inappropriate electronic and social media use include:

• An RN who took a picture of a man getting an electrocardiogram and posted

it on Facebook.

• An RN who sent text messages to another nurse and physician describing a

sick child and his mother in an unfavorable light.

• Staff members at a long-term-care facility who videotaped and photographed

a certified nursing assistant colleague who was in labor. They allegedly

mocked the woman, posting photos, including of her vaginal area, on various

social media sites.

Unprofessional behavior

A second high-risk area are posts that could be considered unprofessional or

reflect unethical conduct—anything defined as unbecoming of the nursing profession.

For example, negative comments about your workplace, complaints about coworkers

and employers, or threatening or harassing comments fall into this category.

The highly publicized firing in 2013 of an emergency department nurse at

New York–Presbyterian Hospital demonstrates the risks connected with posting

workplace photos. The nurse shared a photo on Instagram depicting an empty

trauma room where a patient had been treated after getting hit by a subway train.

Although the post didn’t violate HIPAA rules or the hospital’s social media policy,

she was terminated for being insensitive.

Posts about your personal life also can negatively affect your professional life.

Posting photos or comments about alcohol or drug use, domestic violence (even

comments about arguing with a spouse) and use of profanity, or sexually explicit

or racially derogatory comments could lead to charges of unprofessional behavior

by a BON. And keep in mind that complaints can come from anywhere, including

employers and coworkers, family and friends, and intimate partners, so the privacy

setting on the social media platform won’t protect you.

Court rulings have supported disciplinary actions by BONs against nurses for

unprofessional behavior in their personal lives. A key example is the 2012 decision

by the California Supreme Court, which left intact an appellate ruling (Sulla v Board of

Registered Nursing) that allowed a state board to discipline a nurse who was caught

driving drunk, even though his arrest had nothing to do with his job. The BON placed

the nurse on 3 years’ probation after his arrest. The appeals court ruled that state

laws authorize disciplinary action against a nurse who uses alcohol, on or off the

job, in a way that endangers others. The result is that nurses in California who are

convicted of driving under the influence will have their nursing license suspended by

the BON. This has clear implications for social media posting about alcohol use (or

any high-risk topic) in your personal life. (See How to avoid social media pitfalls.)

If you hear from the BON

If you receive a letter from the BON about an investigation, don’t represent

yourself. Hire an attorney who specializes in administrative law and procedure—

ideally one who’s familiar with your state BON. Decisions about a complaint can

take from several months to more than a year, and outcomes can range from case

dismissal for lack of merit or insufficient evidence to referral to the state’s attorney

general office for prosecution. If no settlement is reached, you and your attorney will

argue the case at a hearing with potential outcomes that include public admonition/

reprimand, restriction, probation, suspension, or revocation of your nursing license.

Other serious repercussions are possible. Decisions made by BONs are

communicated via, a national database for verification of nurse

licensure, discipline, and practice privilege administered by the National Council of

State Boards of Nursing. If disciplined, you also could receive a letter from the U.S.

Montana Nurses Association

Foundation (MNAF) 501c3

The Montana Nurses Association Foundation (MNAF) was launched at our

annual convention October 2017 hosting a silent auction with great success. Many

nurses donated to our foundation and the foundation has recently invested those

donations to begin meeting our mission and purposes. MNAF is excited to spread

the word across the state of Montana that donations (100% tax deductible) can

now be accepted and used to support our mission below. MNAF will leverage the

strength of our organization and our MNA members to drive excellence in practice

and education, and ensure that the history, voice and vision of professional nurses in

Montana thrives. MNAF helps our communities through charitable grants and helps

nurses improve the lives of patients and their families locally and throughout the state.


The Montana Nurses Association Foundation (MNAF) is the charitable and

philanthropic branch of the Montana Nurses Association (MNA), with a mission to

preserve the history of nursing in Montana and contribute, support and empower

the professional nurse in Montana.

Purposes: from our articles of incorporation

• Charitable

• Educational

• Grants to licensed

registered nurses

• Awards scholarships

Areas of Interest

• Elevating the image of nursing

• Improving health

• Strengthening leadership

July 10, 2018

Dear Mr and Mrs xxx,



20 Old Montana State Highway ~

Clancy, MT 59634

Phone (406)442-6710 ~ Fax (406)442-1841

FEIN: 81-3002564

The Montana Nurses Association Foundation (MNAF) was established in 2016 and is

the charitable and philanthropic branch of the Montana Nurses Association (MNA), with

a mission to preserve the history of nursing in Montana and contribute, support, and

empower the professional nurse in Montana.

The Montana Nurses Association Foundation has received a generous monetary

donation from Mr and Mrs xxx in memory of your loved one, xxxx. Through this

generous donation, MNAF is able to provide continuing educational grants to Montana

registered nurses, award scholarships to Montana nurses pursuing advanced degrees

in nursing, and preserve Montana nursing history.


Vicky Byrd RN, BA, OCN

President/Executive Director


• Provide continuing education grants

• Historical record preservation

• Stimulate and promote the professional

development of nurses

• Generating new knowledge and policy

• Fostering philanthropy

To give to the Montana Nurses Association Foundation contact Jill Hindoien at

406-442-6710 or email You can also donate in honor of, or in

memory of someone. If you wish to do this, please be sure to include the name

and address of the family members you want notified of your donation. The family

will receive an acknowledgement letter from MNA with the donation information.

Department of Justice restricting your ability to work in any facility that receives

reimbursement from Medicare and Medicaid. In addition, disciplinary action in one

state may affect your license in another. After you’ve been disciplined, each state in

which you hold a license can review or open the case.

To protect yourself, carry your own malpractice/disciplinary insurance (don’t

rely on the insurance carrier for your hospital or private practice). This is especially

important with the anticipated increase in medical professional liability claims

associated with social media use.

Think twice

Social media is a great way to connect personally and professionally. But

remember that online posts live forever and that social media misfires could

negatively affect your license and ability to practice. To protect yourself, think twice

before you post content that could be judged as unprofessional.

Melanie L. Balestra is nurse practitioner and has her own law office in Irvine

and Newport Beach, California. She focuses on legal and business issues that

affect physicians, nurses, nurse practitioners, and other healthcare providers and

represents them before their respective boards.

Selected references

Brous E. How to avoid the pitfalls of social media. Am Nurse Today. 2013;8(5).

Brown CG. Must-read social media advice for nurses. June 9, 2016.

Nurses Service Organization. Nurse professional liability exposures: 2015 claim report update.

Egelko B. High court lets nurse’s probation stand. SF Gate. August 8, 2012. How nurses should be using social media.

Jackson J, Fraser R, Ash P. Social media and nurses: Insights for promoting health for

individual and professional use. Online J Issues Nurs. 2014;19(3):2.

National Council of State Boards of Nursing. A Nurse’s Guide to the Use of Social Media.

November 2011.

National Council of State Boards of Nursing. Welcome to Nursys.

Pew Research Center: Internet & Technology. Social media fact sheet. January 12, 2017.

Ramisetti K. ‘NY Med’ star Katie Duke speaks out on getting fired from NYC hospital for

posting Instagram photo of trauma room. New York Daily News. July 8, 2014.

August, September, October 2018 Montana Nurses Association Pulse Page 15

National Nursing News

Take a stand against workplace violence

Nurses back legislation that enforces higher penalties on perpetrators

Carole Jakucs, BSN, RN, PHN

Suddenly you hear it — the yelling, the

crashing of equipment hitting a wall, then the

sounds of someone being struck — is it the TV?

You know you’re at work, and not at a wrestling

match. You realize these are the sounds of your

coworker under attack.

Tragically, this scene is very real and happening

more to nurses in the U.S. nearly every day. From

verbal abuse and being spit on to having their hair

pulled and being brutally raped and beaten, violence

against nurses is becoming an epidemic. According

to the U.S. Bureau of Labor Statistics, there were

16,890 workers in 2016 who were intentionally injured

by another person in the workplace — of these,

70% worked in the healthcare and social services


States enact protection legislation

Several states have enacted legislation to protect

nurses and other healthcare workers against violence

in the workplace. Illinois is one of them. Alice Johnson,

esquire, executive director of the Illinois Nurses

Association in Chicago, was one of several people

involved with the creation of a bill that recently passed

the Illinois state legislature.

Known as HB 4100 and called the Health Care

Violence Protection Act, the bill is awaiting final

approval by Illinois Gov. Bruce Rauner. Johnson said

the governor is expected to sign the bill and there

has been no opposition to it. Once signed by the

governor, the new law takes effect in January 2019,

she said.

The INA lobbied for the passage of HB 4100

Johnson said.

“This bill was drafted in the summer of 2017, in

response to violence that occurred against two nurses

in Illinois in May 2017,” she said. “They were held

hostage at gunpoint by a prisoner who was receiving

medical care at their hospital. One of the nurses was

raped, beaten and shot over the course of several

hours while being held prisoner in a dark room, until

the SWAT team came and killed the perpetrator.”

Alaska recently passed legislation known as HB

312, to protect nurses and other healthcare workers.

The bill includes stiffer penalties for assaulting a

medical worker, according to the Juneau Empire.

“We had seen an uptick in the amount and extent

of violence in healthcare, and in ERs especially over

the past two years, from 2016 through 2017,” said

Dennis Murray, vice president of long-term care at the

Alaska State Hospital and Nursing Home Association

in Anchorage. “We suspect some of this may be

attributable to the opioid epidemic. The violence

prompted one hospital to bring in K9s (security dogs)

to accompany their security personnel when they

make their rounds. We have found that this has a

significant deterrence effect.”

Murray pointed out members of ASHNA had been

raising concerns about the increase in violence for the

past few years with some healthcare providers tracking

data, along with various government agencies. Even

though the use of K9s is effective, the cost to bring in

trained K9s (security dogs), as well as other possible

security measures can be cost prohibitive for many

health care providers, prompting more action at the

legislative level to be taken, Murray said.

Alaska’s bill received bipartisan support — drafted

by both a republican and a democrat, Murray said.

“I think both lawmakers felt this was a serious

problem that needed to be addressed,” Murray said.

“One of the two is a former police chief in Kenai, Alaska,

so he had an awareness from that prospective too.”

The bill passed both the Alaska house and senate

and was signed into law by Alaska’s governor on June

14, 2018. The new law will take effect 30 days later.

Two states fight for legal protection

On the flip side, some

states are struggling to

get legislation passed that

protects nurses and other

healthcare workers against

workplace violence. The

Montana Nurses Association

has been advocating for a

law that would make it an

automatic felony to assault a

nurse, first responder or other

healthcare worker while they

are on duty said Vicky Byrd,

BA, RN, OCN, executive

director of the Montana Nurses Association.

Vicky Byrd,


The Montana bill, HB 268 was introduced to a

legislative committee in January 2017 and was shelved

in that same committee in April 2017, Byrd said.

“Some of our nurses have experienced horrific acts

of violence in the workplace,” Byrd said. “We’ve had

nurses who were sexually assaulted and others who

have publicly shared their stories to raise awareness

of the problem who were kicked and slammed against


Many times, nurses are reluctant to report to

local police agencies for various reasons, Byrd said.

Some fear retaliation from their employers, don’t feel

supported by their employer after the assault or have

more concern for their patient’s well-being over their

own, while others feel they were discouraged to make

a formal report by some of the police agencies with

which they interacted.

The Montana Nurses Association will continue

to work at getting this legislation passed to protect

nurses,” Byrd said. “We had one nurse who was

sexually assaulted, the police came and took the

perpetrator [who was a patient]. But due to the jail

being full and this crime is not a felony, they had

to kick him loose. If these assaults were automatic

felonies, these crimes would go through the legal

channels for district attorneys to review and the courts

to decide.”

Massachusetts is another state whose nurses

are seeking workplace safety legislation but also

experiencing the frustration of their bill going nowhere.

HB 1007 would require healthcare employers conduct

annual risk assessments regarding safety and

implement programs to reduce workplace violence

which includes staff training, monitoring of events and

having reporting processes in place.

“HB 1007 was introduced

in the Massachusetts

House in 2017 and is still on

hold,” said Donna Kelly-

Williams, RN, president of

the Massachusetts Nursing


Seeing an increase in

violent acts against their

nurses and other healthcare

workers, the Massachusetts

Nurses Association has been

working on efforts to improve

workplace safety for nurses

Donna Kelly-

Williams, RN

and other healthcare workers for nearly 10 years,

Kelly-Williams said.

“Nurses in Massachusetts are attacked on the job

more than police and correctional officers combined,”

she said. “When a nurse named Elise Wilson suffered

a violent knife attack by a patient while on duty, it

confirmed what we already knew – that more needs to

be done to stop the violence against nurses and other

healthcare workers.”

Dubbed “Elise’s Law,” the measure would require

hospitals and other healthcare employers take the

initiative to prevent workplace violence, not just

respond to it when it happens, Kelly-Williams said.

One example of a law requiring hospitals take a

proactive stance to reduce violence in healthcare

is AB 508 — in existence in California for more than

20 years, said Yalanda Comeaux, MSN, MJ, RN,

CMSRN, a legislative team coordinator with the

Academy of Medical-Surgical Nurses. The law requires

hospitals to conduct annual education and training to

workers who provide direct care to patients in how

to reduce the risk of violence and how to respond to

violence when it occurs, she said.

In addition to some employers needing to do more

to protect their nurses and other workers, Comeaux

recommends nurses be encouraged to familiarize

themselves with safety training and become active

in workplace committees involved with developing

policies and procedures to protect themselves from

workplace violence.

EDITOR’S NOTE: Carole Jakucs, BSN, RN, PHN,

is a freelance writer.

Published with one-time permission. © OnCourse

Learning Corporation 2018 home page

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