The Pulse - August 2018

August 2018 • Vol. 55 • No. 3
THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION
Quarterly publication direct mailed to approximately 18,000 RNs and LPNs in Montana.
Executive Director Report
LABOR REPORTS AND NEWS
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
PAID
Permit #14
Princeton, MN
55371
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,
BA, RN, OCN
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
example:
• Managers, Supervisors, Directors, VPs of
Nursing, CEOs
• PRNs, PDRs, Relief
• Staff RNs in non-collective bargaining
organizations
• 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 www.mtnurses.org and here are some benefit
highlights:
• 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
Practitioners)
iv. WEX—“Western States” professional nurses
association’s coalition
• National Involvement (MNA collective bargaining
only)
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 www.mtnurses.org.
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.
mtnurses.org), 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!
www.mtnurses.org
www.cnebymna.com
If you wish to no longer receive
The Pulse please contact Monique:
mheddens@aldpub.com
If your address has changed please
contact Montana Board of Nursing at:
www.nurse.mt.gov
PULSE SUBMISSIONS
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.
Jennifer@mtnurses.org
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
year.
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.
PUBLISHER INFORMATION & AD RATES
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.
WRITER’S GUIDELINES:
CONTACT MNA
Montana Nurses Association
20 Old Montana State Highway, Clancy, MT 59634
• Phone (406) 442-6710 • Fax (406) 442-1841
• Email: info@mtnurses.org • Website: www.mtnurses.org
Office Hours: 7:30 a.m.-4:00 p.m. Monday through Friday
VOICE OF NURSES IN MONTANA
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)
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.
PROFESSIONAL DEVELOPMENT
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:
MNA
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
Terry Dutro, MSN, APRN, AGPCNP-BC
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
to: jennifer@mtnurses.org
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
Secretary-CAP
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: www.nurse.mt.gov

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
MSCRN BSN RN
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
NOTICE
CALL TO 2018 MNA
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
schedule
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
OR
• 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
https://dhhs.mt.gov/Asthma or
email asthmainfo@mt.gov

Page 4 Montana Nurses Association Pulse August, September, October 2018
Advocacy
Unit Rep. Shop Steward. Nurse Steward. Grievance
Officer.
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!
OR MANAGER
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: cmmc.health
Labor Reports and News
Leslie Shepherd,
BSN, RN, Labor
Representative
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
table.
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
Director
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
table.
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
RN (FT/PRN), LPN (FT/PRN)
New Licensed Graduates Welcome!
Competitive Salary and Pay Based on Experience.
To learn more, please contact:
Cyndy McClimate - Medical Recruiter
615.263.3148
Apply online at jobs.corecivic.com
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
Representative
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
http://www.nursingald.com/publications
in Billings is currently hiring
LPN’s & RN’s
both part-time and full-time
with a Sign on Bonus!
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• Tuition assistance
• Vacation
• 401K
• Onsite child day care
• Health insurance
• Life insurance
• Employee pharmacy
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To apply visit
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or call Kylie at
(406) 655-5920
Full Time RN Needed
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Working between two facilities: Madison Valley Manor,
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Benefits include: paid holidays, vacation,
sick leave, medical, and retirement.
Contact: Darcel Vaughn (406) 682-7271
dvaughn@madisoncountymt.gov
http://madisoncountymt.gov

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,
PhD, RN-BC, FAAN
Director of Professional
Development
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 nursingALD.com today!
Search job listings
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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 www.cnebymna.com 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!
www.cnebymna.com
*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
PRESENTED BY
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
MN, APRN, FNP-BC
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@
gmail.com.
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
learning.
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.
YOUR SOURCE FOR
JOBS IN MONTANA
(OR ANYWHERE)
REGISTERED NURSES
MED/SURG, SURGERY, L&D
Sign On/Relocation Bonus for experienced nurses
CHA is a 25-bed critical access hospital located in scenic
Southwestern Montana.
http://www.fmdh.org
FMDH is an Equal Opportunity/Affirmative Action Employer
For details, contact Amber Benes,
Director of Human Resources, at (406) 563-8647
or abenes@chofa.net

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
www.prairietravelers.com
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
BUILD A CAREER -
MAKE A DIFFERENCE
Undergraduate Degree Options
www.montana.edu/nursing
406-994-3783
• 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 dphhs.mt.gov/publichealth/diabetes
or email chronicdiseaseprevention@mt.gov 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://
d3ms3kxrsap50t.cloudfront.net/uploads/publication/
pdf/1645/Vermont_Nurse_4_18_.pdf
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
care.
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 info.nursingworld.org/
staffingwp.
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
specialists
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
maintenance
• Information technology investments and
upgrades
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.
Conclusion
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.
info.nursingworld.org/staffingwp

Page 10 Montana Nurses Association Pulse August, September, October 2018
Statewide
Nursing News
*ALL Nurses Welcome
*Members and
Non-Members
*11 Contact Hours
(1 Rx) Offered
*Accredited Continuing
Education
Visit our websites at
www.mtnurses.org or
www.cnebymna.com
to register and for more
information
*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 jennifer@mtnurses.org 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 | www.bsmc.org
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,
CMSRN,
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...
CARROLL COLLEGE OPENINGS
Nursing Faculty
Complete position
announcements can be
found at www.carroll.edu/
employment.

August, September, October 2018 Montana Nurses Association Pulse Page 11
Legislative and Government Relations
2017-2018 MNA Government Relations Platform
Montana
Nurses’
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,
BA, RN, OCN
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
nurses.
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
MNA.
d. Addressing workplace environment issues
including violence against healthcare workers, safe
staffing, and patient safety.
e. Advocating legislation prohibiting mandatory
overtime.
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
disparities.
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
(stopbullyingtoolkit.org).
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
workplaces?
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
silence.
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).
HISTORY AND DEFINITION
“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.
BALANCED BUDGET ACT
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.
MEMBERSHIP
MATTERS!
Montana Nurses Association would like to
invite you to join us today!
SAVE THE DATE
* 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:
jill@mtnurses.org or 406-442-6710
BENEFITS INCLUDE:
• EMPOWERING RNs TO USE THEIR VOICES IN
THE WORKPLACE
• IMPROVING PATIENT CARE
• HAVING INPUT REGARDING
WAGES & BENEFITS
• CONTINUING EDUCATION OPPORTUNITIES
• LEGISLATIVE REPRESENTATION
Call or email today • jill@mtnurses.org
(406) 442-6710
Applications also available on our website.
mtnurses.org

August, September, October 2018 Montana Nurses Association Pulse Page 13
GENERAL LICENSING/CERTIFICATION
CRITERIA
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
requirements.)
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.
STATE RECERTIFICATION
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.
CAPITAL IMPROVEMENT FUNDING—
GRANTS AND LOANS
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.
PAYMENT FOR SERVICES
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
FCHIP).
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
pressure
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.
ELECTRONIC HEALTH RECORDS (EHRs)
Incentive payments (like other hospitals) are
available for EHRs; however, with a limit period of four
years of incentive payment.
FINANCIAL VIABILITY
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.
SUGGESTED READING
RHI hub (Rural Health Information Hub)
CONTRIBUTORS:
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 (leadershippoweronline.com)
carolynrtaylor21@yahoo.com
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.
Takeaways:
• 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 Nursys.com, 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.
Mission
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,
MONTANA NURSES
ASSOCIATION FOUNDATION
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.
Sincerely,
Vicky Byrd RN, BA, OCN
President/Executive Director
406-442-6710
Vicky@mtnurses.org
• 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 Jill@mtnurses.org. 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. Nurse.org. 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.
EveryNurse.org. 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
professions.
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,
BA, RN, OCN
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
walls.”
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
Association.
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
Nurse.com home page https://www.nurse.com/
Home Care
Nurses
Partners in Home Care is
a nationally accredited,
not-for-profit, fullservice
home care agency
located in spectacular
Missoula, Montana.
We recruit registered
nurses for our Hospice
and Home Health
programs to serve clients
in their homes.
Additional information
can be found at:
www.PartnersIn
HomeCare.org

JOIN MONTANA NURSES
ASSOCIATION TODAY!
VISIT MTNURSES.ORG
FREE Online CE Activity
Nurses:
parents trust you.
You can help reduce the risk of Sudden Infant Death Syndrome (SIDS),
the leading cause of death among infants between 1 month and 1 year of age.
Take our free continuing education (CE) activity to stay up to date on the latest
safe infant sleep recommendations. Approved for 1.5 contact hours.
Learn more about the free online activity at https://www.nichd.nih.gov/cbt/sids/nursececourse/.
The CE activity explains safe infant sleep recommendations from the
American Academy of Pediatrics and is approved by the Maryland
Nurses Association, an accredited approver of the American Nurses
Credentialing Center’s Commission on Accreditation.