Nevada RN - May 2019

May 2019 • Volume 28 • Number 2 

www.nvnurses.org 

Nevada 

RNFORMATION 

Inside 

articles 

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 

Practitioner 

5 Check it Out! 

6 NNA Environmental Health 

Committee 

7 Nevada Nursing Student 

Association 

8 Cassi Gonzales - A Special Catalyst 

for Health 

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 

regular features 

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 

Dear Colleagues, 

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 

patient care. 

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 

at https://www.nursingworld.org/practice-policy/ 

advocacy/ 

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. 

Respectfully yours, 

Mary Bondmass, PhD, RN, CNE 

President, Nevada Nurses Association 

Happy Nurses Week! 

May 6-12, 2019 

current resident or 

Presort Standard 

US Postage 

PAID 

Permit #14 

Princeton, MN 

55371 

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 – 

Las Vegas

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 

Nevada. 

Visit our website www.nvnurses.org and click on the Job Board tab to 

view many available Nevada nursing jobs. If you want to receive email 

notice when a new job is added, join our Job Board mailing list! Just 

send your email address by text message: 

Text NNAJOBBOARD to 22828 to get started 

or email nnajobs@nvnurses.org. 

If you have a job to advertise, contact Ian at 

nnajobs@nvnurses.org. Our rates are reasonable and 

money raised helps to benefit Nevada nursing. 

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 

2-year terms) 

• Southern Nevada – District 3: seeking candidates for Treasurer (2-yr 

term) 

• 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.bondmass@unlv.edu ..............President 

Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC naaker@aol.com .......Vice President 

Rochelle Walsh, DNP, RN, PCCN rochelleh@unr.edu ......................Secretary 

Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE ghagersrom@unr.edu .........Treasurer 

Peggy Lee, BSN, RN Lee.peggy4423@gmail.com ..................Director at Large 

Amie Ruckman, MSN, RN amieruckman@gmail.com ...............Director at Large 

Christa Secord, MSN, FNP-BC cjsecord@gmail.com ................Director at Large 

Darlene Bujold, BSN, RN darlene.cbrn@gmail.com ...............President, District 1 

Ruth Politi, PhD, RN healthccr@icloud.com ....................President, District 3 

Donna Miller, RN Donna.Miller@airmed.com ......................Legislative Chair 

Editorial Board 

Managing Editor, Linda Bowman, RN, lbowman@nvnurses.org 

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 lbowman@nvnurses.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 lbowman@nvnurses.org. 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. 


Published by: 

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 mary.bondmass@unlv.edu. 

Danielle C. Craperi DNP, CNML, CNL 

University of Nevada Reno 

Background: 

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. 

Purpose: 

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. 

Intervention: 

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. 

Results: 

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 

Nursing Conference 

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. 

The Camp Recovery Center 

Scotts Valley California 

West Hills Hospital located in Reno, NV, a leader in 

the treatment of behavioral, mental health care and 

substance abuse treatment is seeking FT/PT/PRN 

Registered Nurses to implement the nursing process 

as it relates to our programs. 

Visit www.westhillshospital.net and click on 

CAREERS to apply. 

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Adult & Adolescent Residential 

Substance Abuse 

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Visit nursingALD.com today! 

Search job listings 

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

Browse our online database 

of articles and content. 

Find events 

for nursing professionals in your area. 

Your always-on resource for 

nursing jobs, research, and events.


By Darlene Bujold, RN, 

MSN, MSHI 

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 

Policy Boards. 

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 

Compact legislation. 

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 

this goal. 

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 

drug abuse. 

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 

suicide rates. 

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 

difference. 

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 

to attend. 

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.


What a Great Time to be a Nurse 

Practitioner! 

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. 

References: 

National Council State Boards of Nursing (2008). Consensus Model for APRN Regulation: 

Licensure, Accreditation, Certification, and Education. Downloaded from https:// 

www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf 

U.S. News and World Report (2018). 2018 Best Jobs Report. Downloaded from https:// 

money.usnews.com/careers/best-jobs/nurse-practitioner 

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 

souls… 

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 churchfamilymissions@charter.net 

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NNA Environmental Health Committee 

What’s new about Pediatric Lead Poisoning? 

Bernadette M. Longo, 

PhD, RN, CNL, PHNA-BC, 

FAAN 

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 

Ceremonial Powders 

Recent studies found that spices in the homes of 

lead-positive children had elevated lead concentrations 

Opening for Part-time or full time licensed and 

certified NP in orthopedics wanted for private 

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practitioner to assist 

orthopedic spine 

surgeon in clinic. 

Please email CV to 

cgreenman@tahoefracture.com 

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. 

Marksmanship 

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 

Lead Poisoning 

• Executive functions: remaining on task 

• Visual-spatial skills 

• Speech & language deficits 

• Fine & gross motor skills 

• IQ 

• 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). 

NURSING INTERVENTIONS 

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 

screening list! 

Nevada’s Low Blood Lead 

Testing Rate 

Alarmingly, only 3% of Nevada's 217,000 children 


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 

it. 

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 

1978. 

4) Follow-up & case manage lead-positive 

children. Develop a system in your clinic to 

track and reach out to these patients for longterm 

health maintenance. 

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. 

org/10.1177/0009922817701177 

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: 

10.1097/PHH.0000000000000876 

The Nevada Childhood Lead Poisoning Prevention Program. 

https://nvclppp.org/ 

EPA Drinking Water Contaminants – Standards and 

Regulations & The Federal Lead and Copper Rule. 

https://www.epa.gov/dwstandardsregulations 

World Health Organization. (2018). Lead poisoning and 

health. https://www.who.int/en/news-room/factsheets/detail/lead-poisoning-and-health 

Household interventions for preventing domestic lead 

exposure in children. Cochrane Systematic Review – 

Intervention, 2016. https://www.cochranelibrary.com/ 

cdsr/doi/10.1002/14651858.CD006047.pub5/full 

Bernadette M. Longo, Ph.D., RN, APHN-BC, CNL, 

FAAN 

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 

Nursing Student 

Association 

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 

professional nurses. 

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 nevadansaofficial@gmail.com. 

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 

nevadansaofficial@gmail.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. 

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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 

hygiene 

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 

attend classes. 

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 

Southern Nevada. 

For more information about this program and to become a volunteer contact Cassi 

Gonzales @ caasicgonzales@gmail.com or visit the website for Special Olympics of 

Southern Nevada at https://www.sonv.org/ 

Dementia Word Search 

Puzzle 

BINGO 

BLANKETS 

CANDY 

COMFORT 

COMPASSION 

DIGNITY 

FAMILY 

FEEL 

HOLD 

HUGS 

LISTEN 

MEMORIES 

MUSIC 

PLAY 

RESPECT 

SLEEP 

SLOWER 

SMILE 

TEARS 

TIME 

TOUCH 

WARMTH 

ANSWERS on page 13


VETERANS CORNER 

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 

Psychotherapies are available to treat the symptoms of PTSD. Psychotherapies 

include: 

• 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 

feelings 

Medications 

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). 

Support Groups 

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 

with PTSD 

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 

Veterans 

Women’s Mind Body Group 

Winning Against Depression 

Tai Chi & Chi Gung Class 

Yoga for PTSD-Mind Body Group 

Therapy 

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 

Nightmares 

Cognitive Behavioral Therapy for 

Insomnia 

Vet to Vet Peer Support Group 

Recharge Group for Improving Sleep 

Pathways to Recovery – Women’s Peer 

Support Group 

Post Traumatic Growth Group 

Brief Cognitive Behavioral Therapy for 

Depression 

Mindfulness Based Stress Reduction 

Group 

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 

References: 

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. 

doi:10.1126/science.1128944 PubMed 

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. 

[PubMed: 15939837] 

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:// 

www.ptsd.va.gov/publications/print/understandingptsd_booklet.pdf. Accessed 

November 14, 2018. 

Join NNA Today! 

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Antibiotic Stewardship 

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 

is: 

“What is your responsibility 

to prevent antimicrobial 

resistance?” 

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 

History 

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 

antibiotics. 

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 

transitions 

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 

MRSA. 4 

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 

stewardship. 

Citations: 

1) https://www.americannursetoday.com/nurse-roleantibiotic-stewardship/ 

2) https://www.americannursetoday.com/candida-aurisemerging-threat/ 

3) https://www.americannursetoday.com/antibioticstewardship-staff-nurses/ 

4) https://www.ajicjournal.org/article/S0196- 

6553(18)30155-X/fulltext 

PERSHING GENERAL HOSPITAL 

Lovelock, NV 

Career Opportunities for Nurses 

FULL TIME / PART TIME POSITIONS- 

ED/ACUTE RN & LTC RN/LPN 

Per Diem RNs needed in the ER/Acute – must have 

experience. RNs or LPNs needed in Long Term Care. 

Application and information for all opportunities 

available: www.pershinghospital.org 

855 6th St., Lovelock NV 89419 • 775-273-2621 x202 

EOE/Drug & Alcohol Free Workplace


Bicycle Safety 

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 

al. 2014). 

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. 

BE SAFE 

• 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, 

BicycleNevada.com (n.d.): 

Kids Bicycling Guide 

https://www.nevadadot.com/home/ 

showdocument?id=3684 

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! 

Reference 

Bicycle Helmet Standards. (2017). Retrieved from https:// 

helmets.org/standard.htm#CPSC 

BicycleNevada.com (n.d.). Nevada’s Source for Bicycling 

Information. Retrieved from https://www.nevadadot. 

com/mobility/bicycle 

Centers for Disease Control and Prevention. (2017). 

Bicycle safety. Retrieved from https://www.cdc.gov/ 

motorvehiclesafety/bicycle/index.html 

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, 

104(8), 106-111. 

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. 

gov/files/documents/nevada_fy2017_ar.pdf 

Science Daily. (2017). Soaring medical costs from bicycle 

accidents. Retrieved from https:www.sciencedaily.com/ 

releases/2017/06/170601082236.htm 

Thai, K., McIntosh, A. & Pang, T. (2015). Bicycle helmet size, 

adjustment and stability. Traffic Injury Prevention,16, 

268-275. 

NNA EHC Answers 

puzzle on page 7


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: hr.kmc@kimaw.org 

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 

positive? 

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 

to: https://fivedollarsforchange.com/ 

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 

people. 

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.


Tracey Long, PhD, RN, MS, MSN, CDE, CNE, 

CHUC, CCRN 

“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: 

Long-Term Care 

Director of Nursing 

49 bed attached to hospital 

Acute ER 

Supervisor 

slmcnv.org 

Contact Administration at 

775-463-6401 

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/ 

improving-nurses-health-wellness/ 

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? 

AUTHOR BIO 

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 

reflection. 

Selected references 

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- 

Mission/campaign-for-real-beauty.aspx 

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 

Psychol. 2012;17(3):505-21. 

Cleveland Clinic. Fostering a better self-image. Retrieve 

from http://my.clevelandclinic.org/health/healthy_ 

living/hic_Stress_Management_and_Emotional_ 

Health/hic_Fostering_a_Positive_Self-Image 

American Nurses Association health nurses campaign. 

Retrieved from http://www.nursingworld.org/ 

healthynurse 

Song, M. and Iovannucci, E. Nurses Health Study. JAMA 

Retrieved from http://oncology.jamanetwork.com/ 

article.aspx?doi=10.1001/jamaoncol.2016.0843 

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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. 

References 

Center for Disease Control (2014). Sudden Infant Death. 

https://www.cdc.gov/sids/data.htm 

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:// 

doi.org/10.1371/journal.pmed.1002531 

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. 

org/10.1093/jnen/nlw080 

Mejia, H. (2018, July 24). Clark County Coroner: Unsafe 

sleeping conditions kill a baby nearly every 2 

weeks. https://www.lasvegasnow.com/...coroner... 

baby.../1320163673


Nevada Nurses Foundation EST 2014 

Hello Everyone! 

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 

social media; like and follow us on Facebook, Twitter, Instagram, and LinkedIn. 

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 

behalf. 

On behalf of the Nevada Nurses Foundation, thank you for your support and 

collaboration! 

Thank you and have great days, 

Sandy 

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 

event 

Conflict events: Aggression, verbal abuse, dependency 

issues, self-harm, noncompliance with medication regime, 

HAI, Falls, elopements. 

e 

Project, Goals and Intervention 

Project 

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 

Tai Chi 

Daily Walks 

Movie Nights 

Arts & Crafts 

Pet Therapy 

PEP Activities 

Music Therapy 

Art & Movement 

Therapy 

Chair Yoga 

Meditation 

Goals 

Family style meals 

Daily Routines 

Floral arranging 

Individual Music Therapy 

Social Skills Activities 

Results Continued 

Month 

Pre-Implementation Conflict Events 

Number 

of Events 

with 

Greater 

Than 14 

Days LOS 

Number of 

Events 

Involving 

Population 

of Interest 

Percentage of 

Events 

Involving 

Population of 

Interest 

Jul-17 25 19 (19/25) 76% 

Aug-17 24 16 (16/24) 66% 

Pre-Implementation Types of Events 

Month Number 

of 

Security 

Events 

Jul-17 17 

Percentage 

of Security 

Events 

(17/19) 

89% 

Other 

Types 

of 

Events 

2- Skin 

breakdown 

Percentage 

of Other 

Events 

(2/19) 11% 

Aug-17 8 (8/16) 50% 8- Falls (8/16) 50% 

Post Implementation Conflict Events 

Month 

Number of 

Events with 

Greater 

Than 14 

Days Length 

of Stay 

Number of 

Events 

involving 

population 

of interest 

Percentage 

of Events 

involving 

population 

of interest 

Sep-17 18 15 (15/18) 83% 

Oct-17 22 17 (17/22) 77% 

Nov-17 18 15 (15/18) 83% 

Month 

Post Implementation Types of Events 

Number 

of 

Security 

Events 

Sep-17 12 

Oct-17 12 

Nov-17 12 

Percentage 

of Security 

Events 

(12/15) 

80% 

(12/17) 

71% 

(12/18) 

80% 

Other 

Types 

of 

Events 

Percentage 

of Other 

Events 

3-Falls (3/15) 20% 

5-Falls (5/17) 29% 

3- 

Falls 

(3/15) 20% 

There was a statically significant decrease in the number of conflict 

events after the implementation of PEP 

Results 

Month 

Pre-Implementation LOS 

Patients 

Average LOS at 

Time of Event 

(Days) 

Units Overall 

Average LOS 

(Days) 

Jul-17 64 6.48 

Aug-17 80 6.8 

Month 

Post-Implementation LOS 

Average 

Length of Stay 

at Time of 

Event (Days) 

Units Overall 

Average 

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 

education. 

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 

psychiatrists. 

References 

To request references email Danielle Craperi at DCraperi@gmail.com

Nevada RN - May 2019

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