May 2019 • Volume 28 • Number 2
2 Be Part of an Awesome Team
3 Research & EBP Corner
4 NV Nurses Called to Advocacy
5 What a Great Time to be a Nurse
5 Check it Out!
6 NNA Environmental Health
7 Nevada Nursing Student
8 Cassi Gonzales - A Special Catalyst
9 Veterans Corner
10 Antibiotic Stewardship
11 Bicycle Safety
12 Nurses in the News
13 What the Mirror Doesn’t Tell You
14 Safe Infant Sleep Practices
15 Nevada Nurses Foundation
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 42,000 Registered Nurses and Licensed Practical Nurses in Nevada
The President’s Message
Mary D. Bondmass, PhD, RN, CNE
President, Nevada Nurses Association (2018-2020)
According to the American
Nursing Association (ANA),
advocacy is a pillar of nursing.
Nurses instinctively advocate for
our patients, in our workplaces,
and our communities; but
legislative and political
advocacy is no less critical to
advancing the profession and
On February 26, 2019, the Nevada Nurses
Association (NNA) sponsored Nurses Day at the
Legislature (NDAL) wherein 80 nurses and nursing
students met in Carson City. Discussions on advocacy
and issues affecting nurses as well as health and health
care were the topics of the day. As the day concluded,
I reflected on the concept of advocacy, and I would like
to share some thoughts.
Merriam-Webster defines advocacy as the act or
process of supporting a cause or proposal. Wikipedia,
one of the least scholarly, but most often cited sources
around, proposes that Advocacy is an activity by an
individual or group which aims to influence decisions
within political, economic, and social systems and
institutions. Neither definition mentions the word
patients, but most nursing texts adapt these and other
generic descriptions to our profession such that nurses
advocate for health, health care and individuals who
are unable or cannot advocate for themselves.
No doubt we all learned about advocacy in our
Nursing Fundamentals course; for some of us that
may have been quite a while ago, while others, not so
much. While advocating is probably something we all
do daily, regardless of our practice setting, it may be
helpful to take a few minutes or so to reflect on the
concept and its importance. Often, we get caught up
in the daily tasks that we must accomplish, that I fear
we do not always consider just how vital nurses’ role as
an advocate is. I wonder what a world without nursing
advocacy would be like. Who would, as Merriam-
Webster defines, would act to support causes; who,
as Wikipedia defines, would influence decisions within
political, economic, and social systems and institutions
relating to health and health care? Fortunately, we
don’t have to wonder about a world without nursing
advocacy because as the ANA indicates, it is a pillar of
our profession of which we can all be proud.
If you would like to become more involved with
NNA’s advocacy activities at the State level, I strongly
suggest you visit our webpage at https://nvnurses.org
and browse the content. If you are more interested
in national advocacy issues, view the ANA’s webpage
Colleagues, no matter your level of interest or
involvement, I ask you to take a moment to reflect
upon advocacy as a common thread of our profession
as we go about our daily lives in the workforce and
collectively work to improve health and health care for
the citizens of our state.
Mary Bondmass, PhD, RN, CNE
President, Nevada Nurses Association
Happy Nurses Week!
May 6-12, 2019
current resident or
Mark Your Calendars
• Saturday, June 1, 2019 – Crowns & Tiaras Big Hat
High Tea – Governor’s Mansion
• Saturday, September 14, 2019 – Convention 2019:
Inclusivity in Nursing – Las Vegas
• Saturday, September 14, 2019 - NNA Annual Meeting – Las Vegas
• Saturday, October 12, 2019 – Shining Stars of Nursing in Nevada –
Page 2 • Nevada RNformation May, June, July 2019
NNA Mission Statement
Have you visited the NNA Job Board recently? The Nevada Nurses Association promotes professional nursing practice through
continuing education, community service, nursing leadership, and legislative
activities to advocate for improved health and high quality health care for citizens of
Visit our website www.nvnurses.org and click on the Job Board tab to
view many available Nevada nursing jobs. If you want to receive email
notice when a new job is added, join our Job Board mailing list! Just
send your email address by text message:
Text NNAJOBBOARD to 22828 to get started
or email firstname.lastname@example.org.
If you have a job to advertise, contact Ian at
email@example.com. Our rates are reasonable and
money raised helps to benefit Nevada nursing.
BE PART OF AN AWESOME TEAM!
Do you enjoy learning from your colleagues? Would
you like to be a part of an action-oriented team that
contributes to Nevada nurses? If yes, consider running
for one of NNA’s open offices. The following positions
are now open for candidates:
• State level- seeking candidates for Secretary (2-yr
term) and one director (3-yr term)
• Northern Nevada – District 1: seeking candidates
for President, Vice President and one director (all
• Southern Nevada – District 3: seeking candidates for Treasurer (2-yr
• ANA Membership Assembly in Washington DC: seeking candidates for
one Representative and two alternates (1-yr terms). Candidates should
actively participate in at least one NNA committee. Tentative date for
the Assembly is June 17-June 19, 2020. Expenses are covered.
• Nominations Committee: seeking three candidates (1-yr term)
NNA State Board of Directors
Mary D. Bondmass, PhD, RN, CNE Mary.firstname.lastname@example.org ..............President
Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC email@example.com .......Vice President
Rochelle Walsh, DNP, RN, PCCN firstname.lastname@example.org ......................Secretary
Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE email@example.com .........Treasurer
Peggy Lee, BSN, RN Lee.firstname.lastname@example.org ..................Director at Large
Amie Ruckman, MSN, RN email@example.com ...............Director at Large
Christa Secord, MSN, FNP-BC firstname.lastname@example.org ................Director at Large
Darlene Bujold, BSN, RN email@example.com ...............President, District 1
Ruth Politi, PhD, RN firstname.lastname@example.org ....................President, District 3
Donna Miller, RN Donna.Miller@airmed.com ......................Legislative Chair
Managing Editor, Linda Bowman, RN, email@example.com
Mary D. Bondmass, PhD, RN, CNE
Eliza J. Fountain, RN, BSN
Wallace J. Henkelman, Ed.D, MSN, RN
Tracey Long PhD, RN, MS, CDE, CNE, CCRN
Mary Baker Mackenzie, MSN, RN
John Malek, PhD, MSN, FNP-C
Print Editor, Kathy Ryan, MSN, RN-BC
Lisa Pacheco, MSN, RN
Betty Razor, RN, BSN, CWOCN
Denise Rowe, MSN, RN, FNP-C
Val Wedler, MSN, RN
Bernadette Longo, PhD, RN, FAAN
Visit NNA’s website for nominating form and full description of officers.
Question? Email Linda Bowman at firstname.lastname@example.org. Nominations
close May 15, 2019.
Are you interested in submitting an article for publication in RNFormation?
Please send it in a Word document to us at email@example.com. Our
Editorial Board will review the article and notify you whether it has been
accepted for publication.
If you wish to contact the author of an article published in RNFormation,
please email us and we will be happy to forward your comments.
Arthur L. Davis
Publishing Agency, Inc.
SAVE THE DATE!!!
Convention 2019: Inclusivity in Nursing
September 14, 2019
7:30 a.m. – 5:30 p.m.
Clinical Simulation Center of Las Vegas
Shadow Lane Campus – Bldg. B
1001 Shadow Lane
Las Vegas, NV
The Nevada Nurses Association (NNA) along with the Nevada Nurses
Foundation (NNF) and the Nevada Nursing Student Association (NVNSA)
are planning a collaborative convention. The theme for the convention is
Inclusivity in Nursing and will feature nationally known keynote speakers,
breakout sessions, and poster presentations. Continuing Education hours
will be awarded. Abstract submission and registration information will be
available on the NNA website in early May 2019. More information will also
be available in the June/July RNFormation.
May, June, July 2019 Nevada RNformation • Page 3
Research & EBP Corner
Development of Patient Enrichment Program for Patients with
Psychiatric Behaviors in Acute Care
Submitted by Mary Bondmass, Ph.D., RN, CNE
This feature will present abstracts of research and
evidence-based practice (EBP) completed or spearheaded
by nurses or student nurses in Nevada. The
focus is on new evidence (i.e., research) or on the
translation of evidence (i.e., EBP) in Practice, Education
or Research. Submissions are welcome and will be
reviewed by the RNF editorial board for publication;
send your abstract submission in a similar format used
below to firstname.lastname@example.org.
Danielle C. Craperi DNP, CNML, CNL
University of Nevada Reno
Acute care settings can have
a treatment gap for patients
that exhibit behaviors of a
psychiatric/mental health illness
(PMHI) that have a length of
stay (LOS) greater than 15
days. There may not be proper
knowledge for the clinicians
and/or programs to care for
patients in this population.
Often these patients have
had their acute condition
cared for, they are medically cleared and are awaiting
placement to an outside facility. Barriers to discharge
include needing guardianship, pending approval from
a payer source, or have filled out an application for
health insurance and are waiting for acceptance. The
extended LOS that this population can experience
puts them at a higher risk to experience conflict event.
Conflict events include acts of aggression, verbal abuse,
dependency issues, self-harm, noncompliance with
medication regime, HAI, falls, and elopements. This
population may have a diagnosis of a mental health
illness or they may have medical condition that causes
the patient to exhibit behaviors of a mental illness.
The purpose of this Doctor of Nursing Practice
(DNP) final project was to develop a Patient Enrichment
Program (PEP) to decrease the LOS and number
of conflict events experienced by this population.
Another purpose of this project was to increase the
nurse’s knowledge on how to care for patients that
exhibit PMHI. This population may have a diagnosis
of a mental health illness or they may have medical
condition that causes the patient to exhibit behaviors of
a mental illness.
The PEP provided education for nurses, a daily
routine and therapeutic activities for the patients.
Some therapeutic activities included, daily walks, music
therapy, art therapy, social skills, and pet therapy to
mention a few.
After three months of implementation of PEP there
was a statistically significant decrease in the number
of conflict events seen in this population. Pre and post
nurse evaluations of the education provided regarding
the care of psychiatric patients showed that nurses
gained knowledge and found that information to be
beneficial. LOS increase due to more patients that fit
criteria being transferred to unit.
Dr. Craperi presented her project at the American
December 6 – 7, 2018 in Las Vegas, NV
To see the table containing more information for this article
please view the online version of Nevada RNformation at nursingALD.com.
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Search job listings
in all 50 states, and filter by location and credentials.
Browse our online database
of articles and content.
for nursing professionals in your area.
Your always-on resource for
nursing jobs, research, and events.
Page 4 • Nevada RNformation May, June, July 2019
By Darlene Bujold, RN,
On February 26th, 2019
nurses from throughout Nevada
came together in the halls
of the state's Legislature to
represent our proud profession
and to discover what bills are
significant to our patients and
our practices. The theme for the
day was "Advocacy the Power of Nursing."
The agenda for the day was pre-empted by our
state’s “Washoe Zephyrs” which made their presence
known, bringing wind speeds up to 84 mph and
toppling semis. Highways were closed, airlines flights
canceled, delayed or rerouted. Neither our keynote
speaker, Terry Kerns, PhD, RN who was to speak to our
role as advocates in relation to the opioid crisis nor the
NNA state president Mary Bondmass, PhD, RN, CNE
were able to make it from Las Vegas. In addition, the
Senate and Assembly floor sessions, where several
nurses were slated to sit with their legislators, were
canceled. Despite these deterrents, the event was very
well attended by nurses who braved the winds and
showed up to the table to learn and advocate.
Nicola Aaker, MSN, MPH, RN the NNA state Vice
President took up the torch to welcome this proud
group to the day.
Darlene Bujold RN, BSN, MSHI- District 1 President
NNA was honored to act as MC for the day and sang
the National Anthem to the group.
A round table panel of distinguished nurse leaders
shared their experiences of legislative advocacy, how
they found their voices and advocated for legislative
action. This panel consisted of:
David Tyrell, BSN, RN, Past President NNA – Provided
an impassioned call to nursing legislative advocacy and
facilitated rousing discussion.
Nicola Aaker, Director of Carson City Health and
Human Services - Shared her knowledge of pending
bills aimed at increasing Nevada’s public health funding
rate which is currently ranked as second to last in the
nation! Nicki was able to provide us with timely and
crucial pending legislation from the Interim Committee
on Health Care and the Regional Behavioral Health
Cathy Dinaur MSN, RN, Executive Director of the NV
State Board of Nursing – Spoke to the importance of
understanding the state laws that govern our practice
and promoted the re-submission of NV Nursing
Lisa Thomas PhD, RN, CNE, FAAN – Associate
Professor UNR Orvis School of Nursing – Spoke as a
subject expert to legislative policy.
Bernadette Longo PhD, RN, APHN-BC, CNL, FAAN –
Past NNA State Secretary, ANA Clean Air Ambassador,
Nominations Committee Chair NNA – Presented a
NV Nurses Called to Advocacy
heartfelt and encouraging plea, that “Each of us
are experts” in our own unique fields and how our
personal stories can resonate with our representatives
for the change we wish to see enacted.
Donna Miller RN/EMS-RN, CMTE – Told her story
of how a process dysfunction that she recognized as
needing to be fixed propelled her to the halls of the
legislature to change statutes for the better. She had
no clue how to go about this but she moved forward
regardless and “figured it out” as she went. She
also relates how relationships, made possible by her
involvement with the NNA were invaluable in meeting
Jessica Ferrato and Paige Barnes (Crowley & Ferrato
Public Affairs) - Representative Lobbyists for the NNA
– Presented pending current legislation and updates
on clean-up of past bills. Policy highlights included:
APRN Signing Authority (SB134 and AB147) and Public
Health Funding (AB97). The discussion also included:
Assemblyman Sprinkle working to consider various
means to provide access to insurance for a variety of
underserved populations; and consideration of a cleanup
bill to resolve providers concerns with prescription
Melissa Washabaugh, BSN, RN - Spoke to the role
of nurses in advocating for the rural areas of Nevada,
advocating for the Nevada Nursing Compact. She
also discussed how nurses can be instrumental in the
prevention of the rise in current national and state
Anna Anders, MSN, RN, CENP, Chief Nursing Officer
& Vice President at Carson Tahoe Hospital, Inc.- Was
able to add lively discussion by sharing her personal
and professional experiences with such timely items
such as Mental Health legislation, doctor provider
shortages and the advantages of Nevada becoming a
Nursing Compact state.
Norman Wright, MS, BSN, RN provided an
interesting presentation on “Antimicrobial Resistance
Organisms” and how this is a serious health threat.
He explained the importance of communication as it
relates to vaccination history and antibiotic stewardship
and urged all nurses be a part of antibiotic stewardship.
While the topics and the speakers were extremely
interesting and provided oversight of what was on
the horizon for the 80th Legislative session, it was the
personal stories that many speakers shared on how as
nurses, they were able to find their voices and make a
Thank you to Vania Carter, MSN, APRN, FNP-BC with
NAPNA for coordinating the pre-event dinner on February
25, 2019. Many went through closed roads and flight delays
Nurses Day at the Legislature could not have been
successful without the help of some incredible volunteers.
A huge thank you to Pat Fries and Becky Gebhardt for
their help with registration. Dave Tyrell and Donna Miller
jumped in at the last minute when we received information
at 8:00 pm on the night before that the key note speaker
was unable to attend due to cancellation of flights. Dave
and Donna came up with a great plan to save the day. A
big thank you to the presenters who were asked to sit on
a panel 10 minutes before the panel began. This speaks
volumes to the leadership qualities that NNA members
possess. Had these individuals not jumped in at the last
minute, NDAL might not have happened.
Becky Gebhardt and Pat Fries registering nurses
Nevada Nurses Association hopes that “Nurses
Day at the Legislature 2019” was a memorable event
for those who braved the uncooperating weather and
attended. Those who couldn’t attend were missed.
NNA is already looking forward to planning the next
NDAL event in 2021. Many photographs were taken,
however, due to the time constraints of meeting the
deadline of this publication, photos were not available.
Photos will be included in the 2019 NNA Yearbook
which will be sent out in July. NDAL handouts can be
found on NNA’s website under the Legislative section.
And finally, thank you to NDAL’s generous sponsors
– Nevada Nursing Foundation, Nevada Advanced
Practice Nurses Association, Carson Tahoe, University
of Nevada, Reno Orvis – School of Nursing and
University of Las Vegas – School of Nursing.
Heidi Johnston and Karen Bearer near the
Nevada Nurses Foundation sponsor table.
Another huge THANK YOU goes out to Harvey
Dunbar from Grifols and Kane Furey from Respitech
who sponsored the pre-event dinner on Monday,
February 25, 2019.
May, June, July 2019 Nevada RNformation • Page 5
What a Great Time to be a Nurse
Submitted by Susan S. VanBeuge, DNP, APRN, FNP-BC, FAANP
Check It Out!
Some Kind of Wonderful
By Kathy Ryan
Nurse practitioners or advanced practice registered
nurses (APRN) are one of the hottest professions in the
current US job market. According to the US News and
World Report, nurse practitioners rank #5 in Best Health
Care Jobs. With the median salary listed as $103,880 and
an unemployment rate of 1.1%, job security and the ability
to earn a living is achievable (US News, 2018).
Advanced practice nurses have different roles and
populations of foci they may be trained and practice.
The four roles include nurse practitioner, nurse midwife,
nurse anesthetist, and clinical nurse specialist. Population
of foci include family/individual across the lifespan, adult
gerontology, women’s health/gender related, neonatal, pediatrics, and psych/
mental health (NCSBN, 2008). Additional opportunities for APRNs are in specialty
areas such as oncology, nephrology, palliative care, orthopedics, and critical care.
Educational credentials and licensure of the individual advanced practice nurse will
define their scope of practice.
It is a great time to be an advanced practice nurse. There are more than
240,000 APRNs in the United States with just over 2,000 of these licensee’s in
Nevada. APRNs can be found practicing in hospital settings, primary care, specialty
care, outpatient clinics, rural health, palliative care, and higher education.
In Nevada, modernization of laws and regulations governing APRN practice
have changed positively in time since this role was created. The first Nevada nurse
practitioners were established in 1973 and formally granted a “Certificate of
Recognition” in 1979. From the time of initial recognition to current 2019 practice,
46 years after the profession was recognized, APRNs in the state have made great
strides to provide safe, professional, and compassionate patient care. A milestone
reached in 2013 changed practice as APRNs achieved full practice authority.
One of 23 states in the US, Nevada leads the way in providing care to patients
throughout the state. Since gaining full practice authority, the number of APRNs
have more than doubled in five years.
Given the positive practice environment, opportunities are abundant for
APRNs in Nevada and across the US. In Nevada, opportunities for employment,
consulting, building a practice, and providing direct patient care are available. The
winners in this environment are our patients. APRNs provide safe, comprehensive,
and compassionate care across the lifespan in the roles they are trained. Most
APRNs are trained in primary care and offer these services in the care of patients
in acute, chronic, and tertiary care. Training includes treating patients in a
holistic patient-centered model of care to encourage health promotion, provide
education, and evidence-based care.
It’s a good time to be an APRN in Nevada and across the US. Opportunities for
employment, service to others, and an ability to practice independently create an
excellent work environment for our profession.
National Council State Boards of Nursing (2008). Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification, and Education. Downloaded from https://
U.S. News and World Report (2018). 2018 Best Jobs Report. Downloaded from https://
In the United States, most of us are blessed with an abundance of health care
opportunities. Many of us have a doctor for this, a doctor for that, a nutritionist for
this, a physical therapist for that, and high tech specialty services are just a referral
away. But for those less fortunate, health care practitioners and facilities, and the
healing and hope they provide, may be scarce or even absent altogether.
Enter “Some kind of wonderful:” Church Family Missions
In the 1980’s, Bill and Liz Gieg traveled from South Lake Tahoe, California, to
Central America. Liz recalled the world they discovered “was full of dirt streets…
deserted cars…and signs I couldn’t understand. Tons of looped wire hung from
telephone poles…bunches of wire ran from pole to pole to bring electricity to each
cement house…garbage [was] scattered everywhere.” Bill and Liz learned first-hand
of the crushing poverty and overwhelming need of those Guatemalan residents, and
their lives were forever changed.
Returning year after year to Central America, Liz carried a first aid kit “stocked
with more than the ordinary first aid items. In one situation I was able to supply
medicine and treatment to a diabetic man with ulcerated feet.” After serving on
a health care team to Bonete, Liz began to organize health care teams through
Church Family Missions, and that service opportunity continues today. To date, over
300 volunteers have traveled to El Salvador, Guatemala, Honduras, and Nicaragua,
and thousands have received loving health care.
In April 2019, Church Family Missions will travel once again to Guatemala (April
29 – May 10). These days the health care teams include doctors, nurse practitioners,
nurses, dentists, and volunteers providing services based on their education and
gifts. Chiropractors, massage therapists, occupational and physical therapists: all are
welcome and their essential treatments are so very much appreciated. Regarding
volunteering: if you’re willing, you’re able!
A “typical” day unfolds like this: we walk to a breakfast location, and share the
ground we walk on with cats and chickens. The bus driver may require we walk up
the rocky slope where the road used to be – here’s hoping it doesn’t rain today! We
know we’re approaching our clinic location by all the donkeys and horses “parked”
along the shaded fences.
The crowds of people awaiting us may number between four and five hundred.
Sometimes health care representatives from the national government join us
to perform registration, screening, or immunization surveillance. Our patients
then progress from triage (vital sign and blood sugar measurement, and antiparasite
medication administration), to physical assessment with recommendations
for treatment and medication, to a variety of treatment stations, and finally to
pharmacy. In addition, there are usually several hundred who visit with the dentists.
Thankfully translators assist every step of the way.
Days can be demanding, just as the smoke, heat, and dust are demanding. But
more than once a woman shedding tears of gratitude has said to me “I know you
could take a vacation anywhere, but here you are, with me.” Our eyes locked, our
hands reached for one another… a perfect and magnificent joining of hearts and
If you’re looking for something new, some kind of wonderful, please check
out Church Family Missions. The rewards are endless and eternal, and the life you
change may be your own!
For more information please visit Church Family Missions at www.cfmministries.
org or email email@example.com
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Page 6 • Nevada RNformation May, June, July 2019
NNA Environmental Health Committee
What’s new about Pediatric Lead Poisoning?
Bernadette M. Longo,
PhD, RN, CNL, PHNA-BC,
As nurses we know that
young children are most
vulnerable to the toxic effects
of lead and can suffer profound
and permanent adverse health
effects, particularly on the
development of the brain and
nervous system (WHO, 2018). Over the last 40 years in
the United States there has been a significant reduction
of lead in the environment due to the removal of
lead in gasoline and paint. Typical pediatric screening
asks about living in a home constructed before 1978
for a basis of exposure (thinking of paint sources as
contamination). However, homes and buildings built
between 1982 - 1988 are likely to have lead in pipes,
fixtures and solder resulting in the drinking water as
a source of exposure. In 2011, Congress passed the
Reduction of Lead in Drinking Water Act revising
the definition of lead free by lowering the maximum
lead content of plumbing products from 8% to
0.25% (EPA). In addition to environmental sources
of lead, starting in the 1990’s the FDA, the California
Department of Health Services, and independent
laboratories had identified that certain imported
candies contained hazardous levels of lead. Candies
with elevated lead levels appeared to primarily be
imported from Mexico, Malaysia, China and India. All
these efforts were making progress on reducing the
risk of exposure to children.
Suddenly, lead poisoning was again in the
forefront as the Flint (Michigan) water crisis resulted in
~140,000 individuals being exposed to lead and other
contaminants in their drinking water for 18 months.
Yet, each day in our country children continue to be
exposed to lead and suffer with the adverse effects.
According to Healthy People 2020, no safe blood lead
level has been identified for children. Nearly 500,000
U.S. children ages one to five have blood lead levels ≥ 5
micrograms per deciliter (µg/dL), which is currently the
reference level at which the Centers for Disease Control
recommends public health actions be taken. Even
blood lead exposure levels as low as 2 µg/dL can affect
a child’s cognitive function.
New Considerations on
Exposure to Lead
Exposure to lead occurs from two routes: (1)
inhalation of lead particles (dust, fumes), and (2)
ingestion of lead-contaminated dust/soil, water (leaded
plumbing), and food, materials or contaminated hands.
As you are already aware, young children explore
by touch and hand-to-mouth behaviors potentially
resulting in exposure to lead. Recently, attention has
been given to unexpected new sources of lead exposure
and provide an opportunity for nurses to revise their
screening criteria for which children should be tested.
Lead-contaminated Spices, Herbal Remedies, and
Recent studies found that spices in the homes of
lead-positive children had elevated lead concentrations
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and suggested that these contaminated products
might represent an important source of childhood
lead exposure (Angelon-Gaetz et al., 2018; Hore et
al., 2019). The potentially lead-contaminated spices
included: saffron supplement, turmeric, and paprika. A
study by Hore et al. (2019) found spices and spice mixes
commonly used in South Asian cuisine (curry & masala)
contained elevated lead levels. The researchers further
identified various other seasonings used in different
cuisines, such as bouillon cubes and powders, broth,
or soup spices, as well as hot pepper, chili powder, and
paprika. They concluded that spices purchased abroad
were more likely to have elevated lead concentrations
compared with similar spices purchased locally in the
United States (Hore et al., 2019). The countries included
Georgia, Bangladesh, Nepal, Pakistan, Morocco,
Mexico and Jamaica. In comparison, another study
by Angelon-Gaetz et al. (2018) found some leadcontaminated
products were purchased in the US.
Contamination of spices can occur at any point
along the supply chain due to intentional or inadvertent
addition of lead. Intentional adulteration includes
adding a lead-based coloring agent or adding
weight for products sold by weight. Unintentional
contamination can occur by growing the spice plant
in lead contaminated soils and enters the plant/spice
by contaminated water or dust. Lead can also be
introduced during the grinding process of the spice
from lead-based equipment.
Non-food items can also be sources of lead exposure
to children. These include ceremonial powders and
topical remedies such as kumkum, sindoor, surma,
Balguti Kesaria (an ayurvedic medicine) and turmeric
(Angelon-Gaetz et al., 2018). In 2017, the U.S. FDA
issued a warning about Balguti Kesaria when it
confirmed it contained lead in addition to arsenic, and
mercury. Although ceremonial powders are not food,
they might be accidentally ingested by children.
Shooting for sport and competition requires
commitment to training, discipline and regular practice.
Competitive shooting, from high school teams to
the Olympics, requires shooting excellence in three
positions, including the prone position on the ground.
Training usually begins around 8 to 10 years old.
Exposure to lead is from both inhalation and ingestion
routes and can occur from a variety of shooting-related
activities. Many bullets are made of lead, which is
vaporized at the base of the bullet when it is released
at the muzzle of the gun. Lead is also involved in the
Neurotoxic Effects from
• Executive functions: remaining on task
• Visual-spatial skills
• Speech & language deficits
• Fine & gross motor skills
• Long term: academic performance &
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primer (lead styphnate) to start the combustion of the
gun powder, which propels the bullet down the barrel.
Powder and particles are shed by friction of the bullet
moving through the barrel during firing. The inhalation
exposure primarily occurs when the lead-containing
vapors of shooting blow back into the breathing
zone of the shooter, especially in the prone position.
Secondary exposure also occurs from the environment
of the firing range, especially indoor ranges with
poor ventilation. Lead can collect on finely-sized dust
particles and be inhaled. Ingestion of lead occurs from
handling the bullets, eating or drinking at the shooting
range, contaminated soils or floors, and contaminated
clothing and shoes of the marksman. Furthermore,
if dry sweeping is used for cleaning, this action can
resuspend lead-ladened particles. Goldman et al. (2017)
have been advocates to bring awareness and offer
personal protective and hygiene measures for shooters,
as well as environmental measures to reduce exposure
of lead at firing ranges.
Brain development is a fragile process of
myelinogenesis that continues until about age 25.
Lead exposure is believed to affect the health of
myelin coating on the neurons in the brain. Hence,
adolescents with lead exposure may be facing
associated long-term risks that present in adulthood.
These include a decrease in renal function, blood
pressure and cardiovascular effects, hematological
effects, essential tremor and cognitive effects overtime
(Goldman et al., 2017).
Provider engagement with patients and
community education are successful methods
to increase lead screening rates!
Spices and herbal remedies are a part of
many children’s diets and might be a source
of lead exposure. Therefore, communicate
the risks for lead contamination in spices,
especially those purchased abroad.
Identify children/adolescents involved in
marksmanship activities – add them to your
Nevada’s Low Blood Lead
Alarmingly, only 3% of Nevada's 217,000 children
May, June, July 2019 Nevada RNformation • Page 7
NNA Environmental Health Committee
Fumes from shooting contain lead, a newly
recognized source of exposure.
Spices and herbal remedies may contain lead.
Strategies to Improve Lead Testing
1) Audit your own clinical performance
& that of your team. Time pressures and
simple forgetfulness are common reasons
many children who should be tested are
falling through the cracks. The majority of lead
poisoned children do not exhibit any outward
symptoms of illness, or symptoms so vague as to
be mistaken for any number of minor childhood
illnesses. As nurses, we can do better!
2) Simplify the system to screen for lead. Make
sure screening questions for testing are in an
EMR or form used at annual exams for children.
Offer point-of-service testing by purchasing inclinic
capillary lead screening equipment and use
3) Update your “at risk” profile for who
should be tested. Update according to
current guidelines (see NCLPPP resources).
Add marksmanship and families who may use
imported spices to the screening list. Also,
consider homes built before 1988, instead of
4) Follow-up & case manage lead-positive
children. Develop a system in your clinic to
track and reach out to these patients for longterm
5) Offer Parent Education materials. Obtain
from free websites such as the NCLPPP & CDC.
Place in waiting rooms or a poster on the wall
in treatment rooms. Include in your educational
material packets given out at annual exams.
6) Partner with “The Nevada Childhood Lead
Poisoning Prevention Program” and your
local Nevada Health Department!
References & Resources
Angelon-Gaetz, K.A., Klaus, C., Chaudhry, E.A., & Bean,
D.K. (November 23, 2018). Lead in Spices, Herbal
Remedies, and Ceremonial Powders Sampled from
Home Investigations for Children with Elevated Blood
Lead Levels - North Carolina, 2011-2018. Morbidity and
Mortality Weekly Report, 67(46), 1290-1294.
Goldman, R. H., Woolf, A. D., & Karwowski, M. P. (2017).
Gun Marksmanship and Youth Lead Exposure:
A Practice-Oriented Approach to Prevention.
Clinical Pediatrics, 56(11), 1068–1071. https://doi.
Haboush-Deloye, A., Marquez, E., Marshall, M., &
Gerstenberger, S.L. (2019). Evaluation of the blood
lead screening component of the Southern Nevada
Childhood Lead Poisoning Prevention Program. Journal
of Public Health Management and Practice, 25,
S37-S43. doi: 10.1097/PHH.0000000000000882
Haboush-Deloye A, Marquez E, Gerstenberger S. (2017).
Determining childhood blood lead level screening
compliance among physicians. Journal of Community
Health, 42(4), 779-784.
Look on page 11 of RNFormation for answer!
Hore, P., Alex-Oni, K., Sedlar, S., Nagin, D.A. (2019).
A spoonful of lead: A 10-Year look at spices as a
potential source of lead exposure. Journal of Public
Health Management and Practice, 25, S63-S70. doi:
The Nevada Childhood Lead Poisoning Prevention Program.
EPA Drinking Water Contaminants – Standards and
Regulations & The Federal Lead and Copper Rule.
World Health Organization. (2018). Lead poisoning and
Household interventions for preventing domestic lead
exposure in children. Cochrane Systematic Review –
Intervention, 2016. https://www.cochranelibrary.com/
Bernadette M. Longo, Ph.D., RN, APHN-BC, CNL,
Chair of NNA’s Environmental Health Committee
Emerita Professor at the Orvis School of Nursing,
University of Nevada Reno
By Camille Catelo
UNLV Student Nurse
Vice President, Nevada
The Nevada Nursing Student
Association (NVNSA) is the
first state student nurses’
association chapter for Nevada.
It was recently founded last April 2018 to allow all
nursing schools in Nevada to come together and
work towards common goals. NVNSA’s mission is to
bring together various student nurses’ associations
in Nevada to create a network that will ensure the
proper education of nursing students and result in the
highest quality professional healthcare. Its goals include
promoting community engagement through outreach
opportunities, becoming involved in the Nevada
legislature by advocating for bills that will affect the
future of nursing practice, the creation of scholarships
to advance nursing education, and provide leadership
opportunities for nursing students. Additionally,
NVNSA plans events to allow nursing students to
network, hone their leadership skills, and help them
transition from undergraduate nursing students to
NVNSA helped organize the Future of Nursing in
Nevada (FONN) awards gala and the Shining Stars of
Nursing event in Nevada last October 6th, 2018. The
FONN awards gala is a fundraising event to support the
work of the Nevada Action Coalition (NAC) which is
the driving force for transforming health care through
Nevada Nursing Student Association
nursing in our state. The NAC’s goal is to improve
the health of Nevada residents, remove scope-ofpractice
barriers, prepare nurses to lead in the changes
to advance health, and expand opportunities for
nursing students by providing scholarships and grants.
This event aimed to honor nurses in Nevada and all
proceeds went to nursing scholarships and grants.
NVNSA is currently leading the Vegas Roots Project
which helps low-income Nevada residents eat fresh
fruit and vegetables while supporting family farmers
and growing economies. This volunteer opportunity
happens on the first day of every month, and interested
individuals can contact firstname.lastname@example.org.
My name is Camille Catelo, and it has been a
wonderful experience to serve as the first Vice
President of NVNSA, I am delighted to have this
opportunity to invite you to our exciting event:
“Meet and Greet” with our board of directors and
first annual convention to elect our next officers.
The NVNSA 1st annual convention will be held on
Saturday, May 11, 2019, at 12pm-4 p.m. at the Nevada
System of Higher Education (NSHE) building located
at 4300 S. Maryland Parkway in Las Vegas. Please
join us if you want to learn about what we do, or
have interest on how to get involved with community
health events, breakthrough nursing events, and
leadership opportunities. RSVP by May 3, 2019 at
email@example.com to assist with planning
this exciting event.
Additionally, we are also co-organizing the Nevada
Nurses Association convention on September 14th,
2019. Please plan to attend this event if you would
like to support NVNSA, the first state student nurses’
association chapter for Nevada. There will be keynote
speakers, poster presentations, opportunities to get
Continuing Education (CE) credits, and fundraising
silent auctions with raffles. There will be more
information available soon. We look forward to seeing
you all at our future events.
Thank you all for your support!
Full-time positions available for:
ICU, EMS/Flight RN, Nursing Home/
Memory Care, Surgical Nurse
Nevada license required. We offer competitive
salary DOE; excellent benefits including Public
Employees Retirement, group insurance
benefits, accrued PTO & Sick Leave.
Contact: HR Director
Humboldt General Hospital
118 E. Haskell Street, Winnemucca, NV 89445
firstname.lastname@example.org • Fax (775) 623-5904
EOE Employer • Non-smoking facility, non-smoker preferred.
Page 8 • Nevada RNformation May, June, July 2019
Cassi Gonzales - A Special Catalyst for Health
By Tracey Long PhD, RN, MS
Three years ago, Cassi Gonzales, RN and a few friends created a Healthy Athletes
program for Special Olympics in Nevada. Nevada was one of the few states that
didn't have a Healthy Athletes program in conjunction with the National Special
Olympics program. Their goal was to have a health fair twice a year in northern
and southern Nevada where special needs athletes could get physicals, meet with
healthcare professionals for education, referrals, and various services. The services
now offer screenings and education to the athletes to help promote a healthy
lifestyle. The five programs are:
• Health promotion: a nurse-run program that offers education on nutrition,
healthy living and exercise
• Med fest: offers physical exams for the athletes and provides referrals to
specialists as needed
• Fun fitness: physical therapists teach stretches, balance and exercises
• Strong minds: provides education on relaxation and stress control techniques
• Special smiles: provides dental screenings, referrals and education on oral
All of the clinical directors volunteer their time and have been trained by Special
Olympics International on how to run their discipline. The growth in the programs
have grown exponentially. In addition to the biannual health fair, they have started
a fitness class where athletes can work with a fitness instructor weekly. Fitness
challenges throughout the year are offered for athletes who may not be able to
Gonzales humbly stated “When I first started volunteering for Special Olympics,
my first thoughts were “I’m going to make such a difference in the lives of these
athletes. I’m going to help them get healthier; I’m going to help educate them
and I’m going to improve the quality of life.” It didn’t take me long to realize that
while I was trying to change their lives, the athletes were changing mine. They have
taught me to always do my best, to always be positive and encouraging to others,
and to do my best to enjoy the moment that I’m in.” Bringing in new volunteers
and showing them just how rewarding volunteering with Special Olympics can be
is a special joy for Gonzales. They are always looking for new volunteers to serve as
program directors and volunteers in any capacity to help the athletes and programs in
For more information about this program and to become a volunteer contact Cassi
Gonzales @ email@example.com or visit the website for Special Olympics of
Southern Nevada at https://www.sonv.org/
Dementia Word Search
ANSWERS on page 13
May, June, July 2019 Nevada RNformation • Page 9
Mental Health Services for Veterans with Post Traumatic Stress Disorder (PTSD)
Denise Rowe DNP, MSN, APRN, FNP, BC
Post traumatic stress disorder (PTSD) is a debilitating mental disorder with
a significant public health burden in the United States (US). 1-2 Veterans are at
heightened risk for PTSD due to military combat and exposure to other traumatic
events. 3 The prevalence of PTSD among US Veterans is estimated to vary between
5% and 32% compared to the annual prevalence of 3.5% among the general US
adult population. 4-9
The diagnostic criteria for PTSD includes an exposure to an actual or threatened
death, serious injury, or sexual violence through: direct experience, witnessing,
learning about traumatic events that occurred to others, or experiencing repeated
or extreme exposure to the unpleasant details of the traumatic events. 10 Several
weeks or months after the events, individuals may experience intrusive symptoms
(including flashbacks, nightmares and intrusive thoughts of the incident), avoidant
behaviors (such as avoiding situations, people, stimuli that remind them of the
traumatic event), negative mood including self-blame for the traumatic incident,
isolation and detachment), and alterations in arousal (including hypervigilance,
exaggerated startle response, poor sleep and concentration). 10 People with PTSD
can have other mental health problems - like depression, anxiety, alcohol and drug
abuse. Consequently, these individuals are at risk for harming themselves or others. 11
VA Southern Nevada Healthcare System provides a wide array of mental health
services to Veterans with PTSD. These services include psychotherapies, medications
and classes / support groups. Psychotherapies focus on techniques to address the
underlying symptoms from traumatic events and are proven to treat PTSD. 11
Psychotherapies are available to treat the symptoms of PTSD. Psychotherapies
• Prolonged Exposure Therapy (PE) – PE exposes individuals to the traumatic
thoughts, feelings and situations they are avoiding while helping them to
manage their thoughts and feelings more effectively
• Cognitive Processing Therapy (CPT) - CPT teaches individuals how to identify
traumatic thoughts and feelings and utilize techniques to change them
• Eye Movement Desensitization and Reprocessing (EMDR) – EMDR utilizes a
specific sound or movement to trigger traumatic memories and work through
the process of eliminating the associated negative thoughts, emotions, and
In addition to psychotherapy, a variety of medications are available to treat PTSD.
While they are not the only pharmacotherapy available, SSRIs (selective serotonin
reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are
types of antidepressant medications commonly used in treating depression and
anxiety associated with PTSD. 11 SSRI and SNRI control neurotransmitters (serotonin
and norepinephrine) in the brain to relieve the symptoms of depression and anxiety
by elevating mood and promoting a sense of well-being. Four SSRIs/SNRIs that are
recommended for PTSD include Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine
(Prozac) and Venlafaxine (Effexor).
VA Southern Nevada Healthcare System offers many support groups and classes
to veterans with PTSD.
Classes / Groups
(ACT Orientation) Introduction to
Acceptance and Commitment Therapy
ACT for Depression and Anxiety
ACT for PTSD
Mantra Repetition for Veterans:
Meditation Techniques for Veterans
Pathways to Recovery Group
PTSD support Group
HU Meditation and Guided Imagery for
Healing and Peaceful Energy
Anger Management Group
Managing Your Anger
Anger Management Series for Women
Women’s Mind Body Group
Winning Against Depression
Tai Chi & Chi Gung Class
Yoga for PTSD-Mind Body Group
Bass Guitar Group
Classes / Groups
PTSD Phase I – Combat PTSD Group
PTSD Phase I – Non-Combat Group
PTSD Phase I – Military Sexual Trauma
PTSD Phase II – Military Sexual Trauma
Evidenced Based Therapy preparation
Imagery Rehearsal Therapy for
Cognitive Behavioral Therapy for
Vet to Vet Peer Support Group
Recharge Group for Improving Sleep
Pathways to Recovery – Women’s Peer
Post Traumatic Growth Group
Brief Cognitive Behavioral Therapy for
Mindfulness Based Stress Reduction
PTSD Stress Management Group
Acoustic Guitar Group
Veterans may schedule appointment for classes/groups at VA Southern Nevada
Healthcare System by contacting:
• VA Medical Center PTSD Program: 702-791-9062
• Veterans Recovery Center: 702-791-9060
• Women’s Health Center: 702-791-9176
• Northwest Clinic Mental Health: 702-791-9020
• Northeast Clinic Mental Health: 702-791-9050
• Southwest Clinic Mental Health: 702-791-9040
• Southeast Clinic Mental Health: 702-791-9030
• VA Medical Center Call Center: 702-791-9024
1. Alonso J, Petukhova M, Vilagut G, et al. Days out of role due to common physical
and mental conditions: results from the WHO World Mental Health surveys. Mol
Psychiatry. 2011;16 (12):1234 –1246 . doi:10.1038/mp. 2010.101 PubMed
2. Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders:
an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr
Soc.2009;18(1):23–33. doi:10.1017/S1121189X00001421 PubMed
3. Wisco BE, Marx BP, Wolf EJ, et al. Posttraumatic stress disorder in the US veteran
population: results from the National Health and Resilience in Veterans Study. J Clin
Psychiatry. 2014;75(12):1338 –13 46 .
4. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health
services, and attrition from military service after returning from deployment to Iraq or
Afghanistan. JAMA. 2006;295(9):1023–1032. doi:10.1001/jama. 295.9.1023-1032.
5. Kulka RA, Schlenger WE, Fairbank JA, et al. Trauma and the Vietnam war generation:
Report of findings from the National Vietnam Veterans Readjustment Study. Vol 18:
Brunner/Mazel New York; 1990.
6. Dohrenwend BP, Turner JB, Turse NA, et al. The psychological risks of Vietnam for US
veterans: a revisit with new data and methods. Science. 2006;313(5789):979–982.
7 Kok BC, Herrell RK, Thomas JL, et al. Posttraumatic stress disorder associated with
combat service in Iraq or Afghanistan: reconciling prevalence differences between
studies. J Nerv Ment Dis. 2012;200(5):444–450.
8. Kessler RC, Berglund P, Delmer O, Jin R, Merikangas KR, Walters EE. Lifetime
prevalence and age-of-onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry. 2005; 62(6):593–602.
9. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, Severity,
and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey
Replication. Arch Gen Psychiatry. 2005; 62:617–627. [PubMed: 15939839
10. Diagnostic and Statistical Manual of Mental Disorders. (DSM-5®). Arlington, VA:
American Psychiatric Association; 2013.
11. US Department of Veterans Affairs. Understanding PTSD and PTSD treatment. https://
November 14, 2018.
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Page 10 • Nevada RNformation May, June, July 2019
Many nurses who read
RNformation are not members
of the Nevada Nurses
Association (NNA) or the
nationwide American Nurses
Association (ANA) and, before I
continue, the question at hand
“What is your responsibility
to prevent antimicrobial
ANA’s periodical, The American Nurse, published
the article: “Strengthening nurses’ role in antibiotic
stewardship” in October 2017. It begins; “The recent
worldwide outbreak of Candida auris, a multidrugresistant
fungus, underscores the criticality of
robust institutional and community-based antibiotic
stewardship programs. Improving antibiotic use is a
patient safety issue.” The article focuses on what nurses
can do to halt antimicrobial resistance. 1
The January 2019 edition of The American Nurse
updated the ANA’s 2017 concerns and the cover photo/
text defines Candida auris as an emerging threat.
The accompanying article: “Nurses’ response to an
emerging threat” emphasizes the potential dangers
of multidrug-resistant (MDR) Candida auris as a new
world-wide peril. 2
Also, in January 2019 Lei Chen, Ph.D. Sr.
Epidemiologist at the Washoe County Health District
sent out a bulletin instructing: “If your healthcare
facility is located in Washoe County, should you have
any suspected case of Candida auris, please call us
immediately at 775-328-2447.”
A Nurse’s Responsibility
By Norman Wright, RN, BSN, MS
Anyone who has followed this column since 2016
knows the problem of Antimicrobial Resistance (AR) is
more extensive than the recent concerns with Candida
auris, which is fungal not bacterial. Fungal Candida
auris alarms go way beyond MRSA, VRE or other
familiar MDR pathogens. Likewise, MDR organisms
(meaning resistant to just three classes of antimicrobial
agents) are now overshadowed by Carbapenemresistant
Enterobacteriaceae (CRE) that can be PDRO
(Pan Drug Resistant) meaning resistant to all classes of
Recognizing AR is an ever-expanding global threat
you may ask yourself - “What can one nurse do to
avoid AR?” After all, you are a single person in a vast
network of health care providers and, unless you are an
APN, you cannot write an antibiotic order. You may feel
powerless, so why try? Which brings us to one of the
basic mandates of nursing – do no harm.
The May, 2016 edition of ANA’s The American Nurse
includes the article “Antibiotic stewardship for staff
nurses” 3 which, under the heading of: “Role of the
staff nurse” highlights these five actions:
1. Ensure pertinent information about antibiotics is
available at the point of care
2. Question the antibiotic administration route
3. Reassess antibiotic therapy in two to three days
4. Review antibiotic therapy when your patient
develops a new C. difficile infection
5. Reconcile antibiotics during all patient-care
To rephrase, the first action is: Obtain and
communicate accurate information about your patient’s
symptoms to the prescriber. I recommend using SBAR.
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The second step, you must re-evaluate and question
the prescribers’ initial antibiotic order, then three review
subsequent C&S reports to determine if the antibiotic/
antifungal is appropriate, or needed at all. Number 4
asks you to determine if an allergic reaction, or C-diff,
develops. Finally, if the C&S report shows an antibiotic
is not needed, or the bacteria is resistant, you must
communicate this information to the prescriber and get
the initial order changed.
Let’s get real
Reality is some prescribers do not want to be
questioned and any nurse who questions them gets
bullied. When confronted by this type of behavior you
have a decision to make, do you say, “I am sorry I will
never question your order again,” or do you stand up
and continue questioning?
If you adhere to the premise of “Do No Harm” it
is your responsibility to continue questioning, which
admittedly may be difficult. Depending on the politics
of the institution you work at, raising concerns have
been known to place a nurse’s job in jeopardy. But this
is a topic for another day.
Back to basics
Each time you neglect to perform proper hand
hygiene you potentially cause harm. Likewise, if you
observe someone failing to use proper transmissionbased
precautions (isolation), it does not matter if they
are a nurse, visitor, RT, PT, CNA, or a physician, call them
out because they place your patient at risk for infection.
Preventing an infection achieves two goals. Your
patient was not harmed, and, if there is no infection
there is no need to order an antibiotic.
Be observant, explore your environment and find
items harboring germs. For example, let’s look at
privacy curtains. The American Journal of Infection
Prevention published a study on how quickly a bedside
curtain gets contaminated. The study found that 14
days after freshly laundered hospital curtains were
hung five of eight curtains were contaminated with
Now ask yourself - during patient care, did you ever
realize the curtain was not providing enough privacy
and you quickly close it with your soiled gloved hand?
If yes you just contaminated the curtain. Later, before
tending to the patient in the next bed you wash your
hands, put new gloves on and again close the curtain!
You have just contaminated your clean gloves with
pathogens from the patient you previously cared for!!!
Cross-contamination happens that quickly. Explore
your environment for other similar scenarios to resolve.
For additional information on preventing
antimicrobial resistance go to www.nvasp.net – The
website of the Nevada Antimicrobial Stewardship
Program. We must preserve the power of antibiotics
for future generations.
Become involved and join the American Nurses
Association, which enrolls you in Nevada Nurses
Association. These organizations provide resources that
will promote your nursing career, and antimicrobial
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May, June, July 2019 Nevada RNformation • Page 11
CDC RECOMMENDS HELMETS
The CDC recommends the use of a properly fitted
helmet, when riding a bicycle, for all ages, to prevent
head and brain injury in case of a crash (2017). Helmets
not only protect against head and brain (TBI) injuries,
which are the leading cause of morbidity and mortality,
but other facial, ocular and dental injuries as well.
Those wearing helmets during a wreck were found to
have a 51% lower risk of TBI, 31% lower risk of facial
fracture and 27% decrease in facial contusions and
lacerations (Joseph et al. 2017).
Lisa McKinney, BSN, RN
Cycling can be a fun form of recreation, exercise and
transportation for the whole family to enjoy. However,
cycling is not without risks. There were 840 bicyclists
killed, in the United States, in 2016, (National Highway
Traffic Safety Administration, NHTSA). Seven of these
fatalities were in Nevada and accounted for 1.8%
of total traffic fatalities (NHTSA, 2018). The Nevada
Department of Transportation shows 58% of these
accidents were in the roadway, 13% on sidewalks
and another 13% in intersections (2017). The majority
of bicycle related deaths and one-third of non-fatal
injuries are related to traumatic brain injuries (TBIs). TBIs
tripled when injuries happened to riders not wearing
helmets. In 2012, over 80,000 bicycle related head
injuries were treated in emergency departments across
the US. Helmets have been shown to decrease the risk
of severe head and brain injury by 63-88% (Graves et
AGE & GENDER RELATED STATISTICS
While one might think children are the ones to
most benefit from helmet use, children accounted for
only 7% of bicyclists killed in traffic collisions in 2016.
In this same time frame, men accounted for 84% of
bicycle fatalities. The largest group of men were 50
to 54 years old and 12% were 55 to 59. Men’s bicycle
fatalities were 5.6 times higher than women’s (NHTSA,
2018). A study conducted between 1997-2013 reported
3.8 million bicycle injuries not ending in death. These
numbers are thought to be just an estimate as only a
fraction of accidents causing injuries are ever reported.
The costs to society related to these statistics include
medical costs, loss of work as well as life or quality of
life. This study found the cost of non-fatal injuries to
be $209 billion and fatalities $28 billion (Science Daily,
2017). Joseph et al. (2017) found that over $2 billion US
healthcare dollars are spent on TBI’s annually.
• Wear a Proper Fit Helmet
• Wear Light Reflective Clothing
• Be Aware of Your Surroundings
• Know the Law (NRS 484B.760-783)
Bicyclists have the same rights and
responsibilities as other drivers.
HELMET SAFETY & FIT
For helmets to be effective in protection, they must
be a Consumer Product Safety Commission (CPSC)
approved helmet. The CPSC is the standard required
by law, in the United States, for bicycle helmets. This
standard was put in place by the government in 1994
and covers all helmets produced for the US, since 1999
(Bicycle Helmets, 2017).
The CPSC helmet must be properly fit and adjusted.
If the helmet is not properly adjusted it is unstable and
may wobble or rotate. Helmets are made with adjustable
straps, many with an adjustment at the nape of the neck
as well as under the chin affecting stability. Poor stability
compromises the efficacy of the helmet on impact. In one
particular study, children and adolescents were found to
more often wear helmets incorrectly. The correct size,
adjustments, angle or tilt and width of the helmet worn,
was found to be detrimental in its effectiveness. The
helmet should be adjusted to take out the instability, with
straps fastened securely under the jaw.
It is worth seeking fit guidance from a bicycle
technician, in one of the many sports or bicycle shops
in the area. Sufficient helmet fitting was found in less
than half of retail stores (Thai, McIntosh & Pang, 2015).
NURSES GET INVOLVED
Nurses may get involved in one of the many school
bicycle programs or create bicycle safety programs
where they do not exist. Nurses have a wide range
of outreach to educate patients, families and schools
within our communities. For example, one trauma
center was instrumental in developing a program to
keep kids healthy and safe in their community. The
program consists of bicycle safety books, DVD’s,
video games, classroom educational programs as
well as organizing an interactive bicycle safety rodeo.
The safety program provided patients presenting to
the emergency department after crashing, safety
awards for wearing helmets. The positive recognition
reinforces safe behavior (Elwell, Kulp & McCue, 2014).
Nurses may provide printable education brochures
available at Nevada’s Source for Bicycling Information,
Kids Bicycling Guide
Kids Bicycling Guide in Spanish
A Guide to Frequently Asked Questions
A Guide to Frequently Asked Questions
Grab your helmet, friends and family and get out
there and ride Nevada!
Bicycle Helmet Standards. (2017). Retrieved from https://
BicycleNevada.com (n.d.). Nevada’s Source for Bicycling
Information. Retrieved from https://www.nevadadot.
Centers for Disease Control and Prevention. (2017).
Bicycle safety. Retrieved from https://www.cdc.gov/
Elwell, S., Kulp, H. & McCue, J. (2014). Creating a
comprehensive bicycle safety program. Journal of
Trauma Nursing, 21(6), 309-313.
Graves, J., Pless, B., Moore, L., Nathens, A., Hunte, G., &
Rivara,F. (2014). Public bicycle share programs and
head injuries. American Journal of Public Health,
Joseph, B., Azim, A., Haider, A., Kulvatunyou, N., O’Keefe,
T. Hassan, A., Gries. L. Tran, E., Latifi, R. & Rhee, P.
(2017). Bicycle helmets work when it matters the most.
The American Journal of Surgery, 213(2), 413-417.
National Highway Traffic Safety Administration. (2018).
Bicyclists and other cyclists (DOT HS 812 507).
Retrieved from https://crashstats.nhtsa.dot.gov
Nevada Department of Transportation. (2016). Public safety.
Retrieved from https://www.nhtsa.gov/sites/nhtsa.dot.
Science Daily. (2017). Soaring medical costs from bicycle
accidents. Retrieved from https:www.sciencedaily.com/
Thai, K., McIntosh, A. & Pang, T. (2015). Bicycle helmet size,
adjustment and stability. Traffic Injury Prevention,16,
NNA EHC Answers
puzzle on page 7
Page 12 • Nevada RNformation May, June, July 2019
Nurses in the News
Tracey Long PhD, RN, MS, MSN, CDE, CNE, CCRN
Nevada Nurses in the News
Joyce Malaskovitz has been named the new CNO for
Desert Springs Hospital in Las Vegas, Nevada. She brings
to the position a long legacy of leadership with the
Diabetes Treatment Center at the hospital, which due to
her leadership is the only accredited diabetes education
program in Nevada. Her leadership in the Valley Health
system will continue to promote the hospital’s accredited
programs of CHF, Diabetes, Bariatrics, and Stroke care,
which she also created. Desert Springs Hospital sent five
members from the emergency department to Alabama
this past summer for disaster training. Participants
included (pictured) Travis Legrand, RN, ER manager,
David Barrett, RN Clinical Supervisor, Brooke Backer, RN
Joanne McCready, RN, and John Kay, EMT-P. After the
Las Vegas October 1 shooting, emergency department
personnel have received advanced training in triage tools
to hazmat suit decontamination. “Personally, this was
one of the most memorable educational experience I’ve
had in my 13-year nursing career,” Backer stated.
National Nurses in the News
Leading articles of nurses in the news nationwide
have featured stories of male nurses sexually assaulting
patients in nursing homes. One disabled patient in
a vegetative state in an Arizona nursing home facility
gave birth, to the surprise of the nursing staff who
were unaware she was pregnant as they responded
to her labor. The father of the baby was confirmed
by DNA tests to be a male nurse who worked with
her. The Arizona Governor has called for severe
investigation of such conduct. This issues a strong call
to all nurses nationwide to honor the legal and ethical
duty to honorably respect those entrusted to our care.
New York nurses won a hallmark legislation to
be eligible for retirement benefits in a $20.8 million
settlement. Male dominated professions described as
“physically taxing,” such as plumbers and construction
workers entitled them to early retirement after working
K’ima:w Medical Center (an ambulatory, rural clinic), an entity of the
Hoopa Valley Tribe, is seeking applicants for the following positions:
Director of Nurses DON, FT/Regular ($83,688-108,678 per yr
DOE) – 8-hr shifts, M-F; no weekends; signing bonus available; loan
repayment available. Responsible for setting the standards for clinical
nursing care; providing care; and, supervises the Nursing Department.
Minimum Requirements: RN Licensure; driver license; Bachelor degree
preferred; two years supervisory experience preferred.
Open until filled.
Registered Nurse Care Manager, FT/Regular ($69,264-90,043 per yr
DOE) – 8-hr shifts, M-F; no weekends; signing bonus available; loan
repayment available. Acts as patient care coordinator for outpatient
clinical services and participates in patient and family education.
Minimum Requirements: RN Licensure; driver license; Bachelor degree
preferred; 1-2 years case management experience preferred.
Open until filled.
For an application, job description, and additional information, contact:
K’ima:w Medical Center, Human Resources,
PO Box 1288, Hoopa, CA, 95546
or call 530-625-4261, ext. 211 or 226,
or email: email@example.com
for a job description and application.
Resume and CV are not accepted without
a signed application.
Nurses in Albany, NY demonstrating this past
summer to pass a minimum staffing law, which
passed. Source: Mike Groll/Associated Press
25 years by age 50. Nurses lobbied to be qualified
equally as a profession for benefits and won triumphantly
recognizing the very physical demands of nursing.
National nurse shortages still estimate thousands of
nurses are still needed in all areas of nursing as the baby
boomer generation ages and requires medical attention
and more patients have access to health care due to the
Affordable Care Act. Community and mental health
are put at risk due to the shortage. An estimated 92%
of emergency rooms report patient overcrowding and
often hold patients in hallways on gurneys waiting for
available rooms. Additionally, efforts are being made in
multiple states to recruit more minority nursing students
to better serve the nation’s growing diverse populations.
Scholarships and grants are available through various
organizations and nurses are encouraged to promote
the nursing profession to the younger generation.
Celebrating Nurses in Nevada
David Barrett and Arlene Blanco were nominated
by Desert Springs Hospital as exemplary in their fields
and worthy of celebration. Getting to know these
nurses will give you a sense of pride in nursing as our
colleagues demonstrate excellence in their corners of
our nursing world.
David Barrett: ER Charge Nurse
What is your background in nursing?
I began as a CNA, then LPN, RN and now BSN RN
for the past eight years. It’s been a long journey and I
have learned so much.
How do you maintain positivity while working in the
challenging setting of an ER?
I think if you remember that most people make the
best decision at the time with the information they
have, helps you not to judge, but just to help them
when the decisions produce negative outcomes.
How do you help your ER team to be effective and
I will always remember my ER charge nurse mentor
who had significant things stolen from his home the
day before. He would have been justified coming
to work angry, but he came to work and moved on
positively through the work day, because people
needed him to be at his best. That really impacted me.
Join Our Team!
The Clark County School District located in
Las Vegas, Nevada is currently hiring School Nurses.
Interested candidates should visit our website
www.teach.vegas or call us at 702-799-5427 to learn more.
In CCSD, more than 320,000 students are served in a unique
combination of urban and rural schools. We are searching
the globe for individuals who have extraordinary passion,
the keen ability to connect with students, and a relentless
drive to achieve life-changing results.
#1 for Kids
School Nurse Positions Available
What are you doing now that energizes you in
nursing? (At this question, he physically got excited and
his demeanor was full of energetic passion)
I started a non-profit called $5 for Change and our
goal is to give back essentials of housing and food
to our homeless youth in Southern Nevada. We have
coordinated community food and clothing drives with
many volunteers who served Noah’s animal house,
the Ronald McDonald House, Three Square, Whitney
Elementary School, Shade Tree, Well Care clinic and
hospital children’s drives for several years. If everyone
in Las Vegas donated just $5/month that could support
the funding to help end youth homelessness in our city.
We’re offering them a hand-up not a hand-out.
To learn more how you can volunteer or donate go
Arlene Blanco: In-patient wound care coordinator
Why did you want to become a nurse?
I want to make a difference in people's lives. I
was inspired by the nurses that took care of my
grandmother when she was hospitalized. I admired
how they touched my grandma's life, and how those
nurses look fulfilled in what they're doing - serving sick
What is your current nursing position?
In-Patient Wound Care Coordinator. I went To
Emory University in Atlanta, Georgia for my Wound,
Ostomy, Continence Nursing Program. I specialized in
Wound care and I'm board certified in Wound Care
and a member of the WOCN Society.
What do you love about nursing?
It allows me to enjoy the rewards of serving people
while growing professionally and personally.
If you could improve the nursing profession what
would you do?
My message is for nurses to uphold their profession
and increase their awareness of their significant part in
the health care team.
What is your advice to new nurses?
Don't give up easily. The first few months may be
overwhelming but give yourself time to adjust to your
new role. Respect the knowledge and long years of
experience of the experienced nurses. Be a team player
and always establish rapport with your patients and
families and other health care team members.
What is your advice to experienced nurses of how to
stay in love with nursing?
Always go back to the time how enthusiastic they
were to become nurses. Never forget that they were
once a new nurse, so be supportive with the new
nurses. You can also learn from them. Keep yourself
abreast in the new trends of nursing by attending
conferences, trainings and classes. It is helpful in
updating and improving your knowledge and skills.
Share with us an uplifting story about how you
made a difference for good in a patient's life.
There's actually a lot of them. I took care of a
non-English speaking patient who had a dehisced
abdominal surgical wound. I've been managing the
wound vacs for several months, so I established a good
relationship with her and her family. The wound was
healing slowly as she had other comorbidities and a
nutritional deficit. I remember the first time I met her,
she was extremely terrified. I was able to lessen her
fears and she and her family trusted me. She always
thanked me every time I change her vac dressing and
that kindness from her touched me.
May, June, July 2019 Nevada RNformation • Page 13
Tracey Long, PhD, RN, MS, MSN, CDE, CNE,
“I hate my body.” “Where did all these ugly gray
hairs and wrinkles come from?” “How could anyone
find me attractive when I look like this?” “My body is
such a burden.”
If you’re like 97% of the American population, you’ve
probably said something like this to yourself. According
to a repeat survey done by Glamour magazine 30
years ago and updated in 2014, 54% of women are
unhappy with their body and 80% claim the mirror
makes them feel bad about themselves. Even men admit
to body image angst; from 1997 to 2001, the number
of men who had cosmetic surgery increased 256%.
Unhappiness about body image has been reported
among girls as young as age six. Clearly, we need to
evaluate the messages the mirror is sending to us.
Mirror, mirror, on the wall
Although many of us rely on mirror messages as the
absolute truth, we need to be aware of the inherent
distortions the mirror may hold. Ever since 8,000 B.C.,
when the mirror made its first appearance, people
have been evaluating their personal worth based on
their physical appearance. Two opposite attitudes exist:
Some people are fixated by their own faces, as shown
by an obsession with “selfies.” Others declare their
body hatred throughout the day as we often see on
social media. We have a love-hate relationship with the
mirror—but the mirror may not always tell the truth.
People with anorexia nervosa see a distorted view in
the mirror; some view themselves as fat even though
they’re dangerously thin. The mere act of focusing
on something, such as a nose or a mole, may make it
look larger in the mirror. Even your mood may affect
the way you see yourself. When you’re tired, angry, or
anxious, the mirror may reflect your emotions more
than your true physical image.
What the mirror tells you
Relying on the mirror to tell you “who is the fairest
of them all” may not give you the whole truth. Despite
potentially negative messages people get from the
mirror, it can provide helpful information. It can tell
you a lot about both the outside and the inside of
your body. Although we focus on our exterior image,
the mirror can provide information about the internal
health of your body.
Using your nursing assessment skills, take an objective
look at your skin and hair. The skin, the body’s largest
organ, can provide a lot of feedback on your sleep (or
lack thereof) and nutrition. Without adequate vitamin
intake or sun, your skin may be pale and flaccid; without
adequate essential fatty acids, it may be dull or dry.
Stress, overwork, and lack of purpose in your life may
reflect in the empty eyes that stare back at you.
What the mirror doesn’t tell you
Shakespeare’s Hamlet exclaimed, “What a
piece of work is man! How noble in reason, how
infinite in faculty! In form and moving how express
and admirable! In action how like an angel! In
apprehension how like a god!”
The mirror doesn’t tell you about the amazing functions
of your body systems, or that you and your body are the
most brilliant creations in the universe. For instance, your
endocrine system is an amazing creation of numerous
Dementia Word Search Answers
puzzle on page 8
What the Mirror Doesn’t Tell You
autonomic functions working through feedback loops of
chemicals to regulate many systems. It also balances your
energy levels through the thyroid gland. When is the last
time you thanked your adrenal glands for helping regulate
your blood pressure via cortisol and aldosterone?
Thanks to auto-regulation, your body can maintain
its temperature within the same general range even
when the environment around it changes constantly.
Breathing is controlled by tissues in your carotid arteries
that track carbon dioxide (CO2) concentration and send
messages to the brain’s respiratory center. Your body
breathes faster or slower to eliminate CO2 as needed,
all without your conscious awareness.
Your pancreas produces both insulin and glucagon,
which naturally oppose each other, but work in
harmony to balance blood glucose levels. These
levels affect the function of all three trillion cells in
your body. Your glucose level rises in the morning to
awaken you and give your cells energy to start the day
automatically. Somatostatin regulates the endocrine
system, balancing insulin and glucagon to work in
complete balance without your attention. When is the
last time you thanked your pancreas?
The mirror also doesn’t tell you how well your liver
detoxifies drugs and chemicals and maintains your
blood glucose level when you’re asleep. Nor does it
reveal that your immune system constantly monitors
and patrols your blood for foreign pathogens, which
it then kills through a complex chemical cascade. Does
the mirror tell you that your spleen has been working
hard to store white blood cells and recycle red blood
cells? When did you last thank your spleen?
What the mirror doesn’t tell you about your
magnificent self is far more interesting and exciting than
the cellulite you may glimpse in the mirror. It doesn’t
let on that your body has innate abilities, such as autoregulation,
self-defense, and self-healing. Your body has
the ability to detect injury and immediately goes into
repair. Your natural self-healing includes the inflammatory
process and movement of white blood cells to the site of
damage to destroy pathogens that may have caused or
entered the injury. Your body moves gracefully through
tissue repair and healing autonomically, usually. We
often treat our bodies so poorly and then expect them
to perform without our support. An example is giving
our bodies Styrofoam (such as poor food choices) and
expecting it to repair like steel.
The nursing reflection
Ironically, some nurses who care for sick patients
and help promote health and healing are unhealthy
themselves. Research shows that occupational stress,
poor coping behaviors, and lack of support create
anxiety and depression in nurses. The longitudinal
Nurses’ Health Study, which began in 1988, examines
relationships among hormone replacement therapy,
diet, exercise, and other lifestyle practices and chronic
illnesses. It found female nurses’ health was no better
than that of the general populace. Ideally, a nurse’s
health should reflect their education and knowledge
Ready for a change? Want to try
something different? Come to
beautiful rural Nevada.
RNs needed for:
Director of Nursing
49 bed attached to hospital
Contact Administration at
All RNs, LPNs, and New Grads welcome to apply
of the human body. Unfortunately, knowledge alone
doesn’t create vibrant health. We should sing along
with the Disney character Mulan, who asks, “When
will my reflection show who I truly am?”
You’re invited to join the American Nurses
Association campaign for action improving nurses’
health and wellness. For more information please
visit http://www.healthynursehealthynation.org/ and
view the free webinar on the grand health challenge
for nurses at https://campaignforaction.org/webinar/
As nurses, we can do better to reflect the true inner
beauty of our bodies—and project that beauty in our
lifestyles. Balancing the mirror’s messages is the key.
What the mirror doesn’t tell you can inspire you to
honor your body. What it does tell you can motivate
you to care for yourself, so you can better model
healthy behaviors for patients.
Fixing the mirror’s reflection
In our society of quick fixes and limited warranties,
it’s easy—and often necessary—to replace just about
everything. Most material objects can be replaced
when they’re worn out.
The only thing that can’t be replaced is the human
body. We can misuse and abuse it or treat it with
loving care. Despite the amazing advances of medical
science (and plastic surgery), your body is still your
physical essence. Although it comes with a lifetime
warranty, its quality isn’t guaranteed; that’s up to you.
Our decisions can determine our destiny with health.
Saying you don’t have time for your health today may
leave you with no health for your tomorrow.
What does your mirror say to you? Will you listen?
Tracey Long is a Professor of nursing in Las Vegas,
Nevada for Chamberlain and Arizona College. As an
identical twin, she regards her twin sister as her better
Coditz GA, Manson JE, Hankinson SE. The Nurses’ Health
Study: 20-year contribution to the understanding of health
among women. J Women Health. 2009;6(1):49-62.
Dove® Campaign for Real Beauty. www.dove.us/Social-
Enoch JM. History of mirrors dating back 8000 years.
Optom Vis Sci. 2006;83(10):775-781.
Mark G, Smith AP. Occupational stress, job characteristics,
coping, and the mental health of nurses. Br J Health
Cleveland Clinic. Fostering a better self-image. Retrieve
American Nurses Association health nurses campaign.
Retrieved from http://www.nursingworld.org/
Song, M. and Iovannucci, E. Nurses Health Study. JAMA
Retrieved from http://oncology.jamanetwork.com/
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For more information, please call Leah Webb at
775-356-4085 or visit www.nnmc.com/careers.
Page 14 • Nevada RNformation May, June, July 2019
Submitted by Rebecca Gebhardt, APRN FNE
Forensic Nurse Practitioner & DNP student
Washoe County Human Services Agency
As a nurse participating in the Infant Fatality Review
Board for Sudden Unexpected Infant Death (SUID), the
tragedy is close to my heart. The Washoe County Infant
Fatality Review has two sections including community
response to sentinel events and public health
improvements and the internal investigation of the
specific factors of the SUID; both contribute to defining
areas to affect positive change.
Nevada, not unlike the rest of the nation, has
experienced a tragic increase in infant mortality related
to unsafe sleep practices. In July 2018, the Clark County
Coroner’s office reported that, across all demographics,
"unsafe sleeping conditions kills a baby every two
weeks." The 2016 records confirm this sad reality
with 31 deaths due to modifiable risk factors. Washoe
County is not far behind averaging one per month in
2018. Providers that have experienced the tragedy of an
Safe Infant Sleep Practices
infant loss in their practice setting or personally could
not express how painful this is to a family. The pain is
compounded when modifiable risk factors, grounded in
good intention, led to the infant’s death (Mejia, 2018).
The Center for Disease Control and Prevention (CDC)
divides SUID into seven different categories including
sudden infant death syndrome (SIDS), accidental
suffocation, neglect or homicide, hypothermia and
hyperthermia, metabolic disorders, poisoning, and the
unknown or undetermined. Unlike the broad category
of SUID, SIDS became a diagnosis in 1969 and to
the present day, is recognized only as a diagnosis
of exclusion. The criteria for SIDS is that an infant is
less than one year of age, all of the modifiable risk
factors eliminated, thorough autopsy and genetic
testing yielding no other cause, and the clinical and
death scene is devoid of suspicion. Only then can
the diagnosis of SIDS be used. For those particular
cases, there may be potentially applied scientific
research relating to the serotonin levels in the medulla
oblongata or hippocampus associated temporal lobe
epilepsy (CDC, 2014).
Unsafe sleep practice is often passed down
generationally or culturally misinformed by individuals
that don't know or understand the risk factors. Often
healthcare colleagues are among the misinformed
due to the age of their children or lack of knowledge
regarding the actual number of healthy infant
deaths related to SUID. The acronym SIDS has been
familiar for generations; unfortunately, there are
multiple inaccurate interpretations. Recently, the
National Association of Medical Examiners, American
Academy of Pediatrics, the American Academy
of Nurse Practitioners, and many other pediatric
healthcare stakeholders, have taken a closer look at
the differentiation and standardization of diagnosis
between accidental smothering or mechanical
suffocation and the thymic causes (Haynes et al., 2016).
This author plans a study that will examine suffocation
related to unsafe sleep practices as this number is on
the rise as the SIDS rate decreases. Common factors
and scene findings include prone or side position, soft
bedding, pillows of all shapes, water beds, couches, missfitting
mattresses, bed frame distance to the wall, larger
person rolling over onto the infant, and creating a wedge
with a body part. Anything that decreases or restricts
the oxygenated environment in or around the infant’s
face can play a role. There is also a risk of strangulation
between bed rails and pumper pads. Fortunately, there
is a hopeful movement in Nevada to create legislation
banning the sale of bumper pads.
Bairoliya and Fink (2018) identified that over 7,000
full-term infants died in the U.S .between 2010 and
2012. SUID was the leading cause of full-term infant
death. These authors concluded that lower maternal
education regarding unsafe sleep was associated with a
higher risk of dying from SUID and quoted "a substantial
proportion of these deaths are preventable" (p. 2).
This author has developed a survey to identify gaps
and bias of education delivery by role models such as
nurses and social workers. The identification of these
issues may help focus future efforts in Nevada on
the education of providers, adjusting the present inplace
systems, and shift collectively in awareness. The
information gathered may add to the body of knowledge
in classification and reporting; it may also improve trend
monitoring and lead to design interventions ending
healthy infant mortality related to unsafe sleep.
Center for Disease Control (2014). Sudden Infant Death.
Bairoliya, N. & Fink, N. (2018). Causes of death and infant
mortality rates among full-term births in the United
States between 2010 and 2012: An observational
study. Journal of Pediatric Medicine 15(3) 1-14. https://
Haynes, R., Folkerth, R., Paterson, D., Broadbelt, K.,
Zaharie, D., Hewlett, J., … Kinney, H. (2016). Serotonin
receptors in the medulla oblongata of the human fetus
and infant: The analytic approach of the international
safe passage study. Journal of Neuropathology &
Experimental Neurology 75(11) 1048-1057. https://doi.
Mejia, H. (2018, July 24). Clark County Coroner: Unsafe
sleeping conditions kill a baby nearly every 2
May, June, July 2019 Nevada RNformation • Page 15
Nevada Nurses Foundation EST 2014
The Nevada Nurses Foundation (NNF) is grateful for establishing a professional
and charitable presence in Nevada, collaborating with individuals, educational and
health care institutions, and community organizations as well as carrying out its
mission. With the federal recognition as a 501(c)(3) non-profit organization status
in October 2014, the NNF has since awarded $80,526.00 dollars to Nevada nurses,
certified nursing assistants, licensed practice nurses, and pre-nursing students.
Because of the generous and charitable donations from people like you, the NNF
will award over $100,000.00 in awards by the end of this year.
Maria D’Errico, APRN, RN, NNF Advisory Board member; Community Outreach
Coordinator and previous two-time scholarship recipient and Dave Tyrell, BSN, RN,
NNF Executive Board member, previous NNA President share ways to support the
Nevada Nurses Foundation (NNF). Through the generous support of our donors,
the NNF has granted scholarships to more than 80 nurses and nursing students
across the state. By becoming a scholarship donor you have an important role
in supporting the professional development of nurses and increasing access to
quality healthcare for Nevadans. You can also sponsor grants that support nursing
professional projects, and recognize the achievements of your nursing colleagues by
nominating them for one of the many awards that NNF offers.
If you are a previous NNF scholarship recipient there are many ways to show your
gratitude and foster a culture of giving back to the Foundation. You can volunteer to
serve on the NNF Advisory Board, where members collaborate on ways to advance
the mission and vision of the Foundation. You can also help to increase awareness
of the NNF by sharing our scholarship opportunities with nursing students, and
identifying potential community partners to support the Foundation. There is no
effort too small, and the NNF appreciates all of your support. Together we can work
to support the professional development of our nursing community so that we can
increase access to quality care for all Nevadans.
“The Nevada Nurses Foundation had a very productive year in 2018” asserts
Dr. Glenn Hagerstrom, NNF Chief Financial Officer. According to Dr. Hagerstrom,
the NNF received approximately $11,000 in donations specifically for scholarships
and $1,670 in other donations in 2018. Approximately $44,800 was earned from
fundraising events such as the Big Hat High Tea and the Shining Stars of Nursing
dinner. These amounts demonstrate that only 22% of our revenue for the year
came from donations whereas 78% of our revenue came from our own fundraising
efforts. The Foundation awarded a total of $18,908 in scholarships and grants in
2018, which represented 73% of the total expenses for the year. The remainder of
our expenses were for operational and fundraising event costs. With your support,
we look forward to another successful year in 2019.
Please consider attending the Crowns and Tiaras Big Hat High Tea on Saturday,
June 1st, 2019 at the Nevada Governor’s Mansion catered by Yerington’s The Bakery
Gallery. Entertainment by the University of Nevada, Reno Music Therapy Foundation
and pianist Landon Flournoy, BSN, RN. Tickets are on sale NOW for $50.00 per
ticket, $500 per table, and an additional $10.00 for gluten-free. Last year, we sold
out, so purchase your tickets ASAP. Doors open at 1:00 PM! Silent auction, raffle,
fun times with friends and family, delicious food, wonderful entertainment, and
supporting three Nevada Foundations!
The Shining Stars of Nursing in Nevada will be held on Saturday, October
12th, 2019 at the exquisite Blind Center of Las Vegas, Nevada. If you would like
to participate in the planning of this one of a kind state-wide Nevada nursing
and student nursing awards and recognition event, please contact SSON@
NVNursesFoundation.org. The Shining Stars of Nursing in Nevada Student Nurse
Event, is a free student event held in the morning of October 12, 2019. Vendor and
Exhibitor opportunities are available to support student nurses in Nevada.
The NNF is the charitable and philanthropic arm of the Nevada Nurses
Association and our mission is to increase access of quality health care for Nevada
citizens by promoting the professional development of nurses through scholarships,
grants, and recognition. Please help us increase quality health care and visit us on
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When shopping on Amazon Smile, please select the Nevada Nurses Foundation
as your charitable organization and Amazon will make a donation to NNF on your
On behalf of the Nevada Nurses Foundation, thank you for your support and
Thank you and have great days,
Sandra M. Olguin, DNP, MSN, RN
President/Chief Executive Officer
Nevada Nurses Foundation
“Success has nothing to do with what you gain in life or accomplish
for yourself, it’s what you do for others.” ~ Danny Thomas
Development of Patient Enrichment Program (PEP) for Patients with
Psychiatric Behaviors in Acute Care
Danielle C. Craperi, DNP, RN, CNML, CNL
University of Nevada, Reno
Dr. Stephanie DeBoor/DNP Project Advisor
Introduction and Problem
Acute care settings often have a treatment gap for patients
that exhibit behaviors of a psychiatric/mental health illness
(PMHI). This treatment gap is related to lack of proper
knowledge and/or programs to care for patients with
PMHI. Due to limited community-based resources,
patients with PMHI have extended length of stay (LOS)
compared to those without a PMHI. 7.74% of hospitalized
patients will experience an undesirable event.
Increased LOS causes higher risk to experience conflict
Conflict events: Aggression, verbal abuse, dependency
issues, self-harm, noncompliance with medication regime,
HAI, Falls, elopements.
Project, Goals and Intervention
Develop a Patient Enrichment Program (PEP) for acute care can
help bridge the gap. PEP will offer education for nurses, a daily
routine and therapeutic activities for the patients, since these
things have all shown to help with the care of this population.
The population includes adults that exhibit mental health
behaviors that are caused by a mental or medical illness.
Diagnosis's may include anything from bipolar or schizophrenia
to Huntington's or frontal lobe trauma
Arts & Crafts
Art & Movement
Family style meals
Individual Music Therapy
Social Skills Activities
Pre-Implementation Conflict Events
Jul-17 25 19 (19/25) 76%
Aug-17 24 16 (16/24) 66%
Pre-Implementation Types of Events
Aug-17 8 (8/16) 50% 8- Falls (8/16) 50%
Post Implementation Conflict Events
Sep-17 18 15 (15/18) 83%
Oct-17 22 17 (17/22) 77%
Nov-17 18 15 (15/18) 83%
Post Implementation Types of Events
3-Falls (3/15) 20%
5-Falls (5/17) 29%
There was a statically significant decrease in the number of conflict
events after the implementation of PEP
Average LOS at
Time of Event
Jul-17 64 6.48
Aug-17 80 6.8
Length of Stay
at Time of
Length of Stay
Sep-17 41 6.94
Oct-17 50 6.20
Nov-17 104 7.44
Pre and post nurse evaluations
showed that staff gained
knowledge from provided
LOS increase due to more patients that fit criteria being
transferred to unit, from 8 to 15 patients. This occurred because
the PEP programs promotion throughout the hospital.
• PEP was presented to Nursing Leadership
• Fliers were distributed
• Formal and informal communication about PEP was
developed to many nurses, CNA’s, hospitalists and
To request references email Danielle Craperi at DCraperi@gmail.com