Nevada RNFormation - August 2019

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August 2019 • Volume 28 • Number 3





3 Check it Out!

4 2019 NNA Convention: Inclusivity in


6 Nurse Practitioners at the Nevada


7 Veteran’s Corner

11 Increasing Numbers of Nevada

Nurses Receive Doctoral Degrees

11 Interstitial Lung Disease

12 Is that Coumadin or Cupping?

13 Celebrating the Heart of Nurses

14 Nevada Nursing Students Shine

at the National Students Nurses

Association 2019 Convention

18 Menu Labels: Providing a Key

to Eradicate Obesity and Help


19 An Invitation to: “Thousands of

Reasons to Celebrate Nurses”

regular features

5 Research & EBP Corner

8 NNA Environmental Health


10 Antibiotic Stewardship

15 Nurses in the News

15 NNA Membership Application

16 Nevada Nurses Foundation


The Nevada Nurses Association is a constituent member of the American Nurses Association

Quarterly publication direct mailed to approximately 42,000 Registered Nurses and Licensed Practical Nurses in Nevada

The President’s Message

Mary Bondmass, Ph.D., RN, CNE

President, Nevada Nurses Association

Dear Colleagues,

A big thanks to all who

attended or otherwise

supported the Nevada

Nurses Foundation's (NNF)

Big Hat High Tea at the

Governor’s Mansion in

Carson City on June 1,

2019; all proceeds from

the event go to nursing

scholarships and grants.

It is often difficult for nurses living in the

South to attend activities in the North and vice

versa; however, regardless of our geography,

hopefully several of you from the South and

North will be able to participate in the 2019

Nevada Nurses Association (NNA) convention

in Las Vegas on September 14, 2019 at

the Clinical Simulation Center across from

University Medical Center.

This year the convention’s theme is

Inclusivity in Nursing, and consistent with

that theme, NNA is collaborating with the NNF

and the Nevada Nursing Student Association

(NNSA). The meeting will feature opening

and closing plenary sessions with national

speakers, professionally relevant break-out

and poster sessions, vendors, raffles, plus

breakfast and lunch. The tentative agenda is

published in this issue of RNFormation and on

NNA’s website at; you will

want to visit our website for more information

on the Call for Abstracts and other exciting

nursing activities for professional development

and networking.

In anticipation of the convention, I thought

reflection on the inclusivity theme might be of

value. The Oxford dictionary defines inclusivity

as “the practice or policy of including

people who might otherwise be excluded or

marginalized, such as those who have physical

or mental disabilities and members of minority

groups.” The opening plenary speaker at

the convention is Dr. Lisa Meeks; she is an

expert on supporting learners with disabilities,

and although she has worked primarily with

medical schools and teaching hospitals, her

research captures the insights and lived

experiences of learners with disabilities in

all the health professions. I had previously

heard Dr. Meeks speak and her words and

work made me think that it isn't only persons

with disabilities (PWD) that are slighted by

exclusion; therefore if we talk of inclusivity, we

may need to broaden our perspective a bit.

While we all, as a community of health

care workers, may need to do a better job of

including PWD into our work environments,

I challenge you to apply the concept of

inclusivity for persons who do not necessarily

have disabilities but perhaps may just be

different than us. No doubt we all have been

part of a like-group in our lifetime, and the

sameness of our belonging provided a sense

of security; however, can you reflect on a time

when you felt excluded from a group? Maybe it

was for a geography type-reason issue where

distance excluded you, but what about a time

when you were excluded because of who

The President’s Message continued on page 3

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


Mark Your Calendars

• September 7, 4th Annual Future of Nursing in

Nevada Awards Gala

• September 11, UMC Research Empowerment Day

• September 14, NNA Convention

• October 12, Shining Stars of Nursing in Nevada

Page 2 • Nevada RNformation August, September, October 2019

NNA Mission Statement

Launching the new

NNA Career Center

Where Nevada Nurses and Nevada Employers Connect!

NNA wants to help you find the right nurse for your opening.

Reasonable rates and proceeds benefit nursing through NNA.


For more information, contact Lyle at

Phone: 775-746-0261

Text: 775-224-1270

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


NNA State Board of Directors

Mary D. Bondmass, PhD, RN, CNE ..............President

Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC .......Vice President

Rochelle Walsh, DNP, RN, PCCN ......................Secretary

Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE .........Treasurer

Peggy Lee, BSN, RN ..................Director at Large

Amie Ruckman, MSN, RN ...............Director at Large

Christa Secord, MSN, FNP-BC ................Director at Large

Darlene Bujold, BSN, RN ...............President, District 1

Ruth Politi, PhD, RN ....................President, District 3

Donna Miller, RN ......................Legislative Chair


for poster presentation at the

2019 NNA Convention: Inclusivity in Nursing

in collaboration with the

Nevada Nurses Foundation and Nevada Nurses Student Association

Editorial Board

Managing Editor, Linda Bowman, RN,

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 the NNA website at

Abstracts must be received by July 31, 2019

Are you interested in submitting an article for publication in RNFormation?

Please send it in a Word document to us at 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.

August, September, October 2019 Nevada RNformation • Page 3

Editorial Board

Members Spotlight

Denise Rowe DNP, MSN, APRN, FNP, BC

Dr. Rowe is an

Advanced Practice

Registered Nurse (APRN)

with background in the

private and public health

sectors. She has worked

in rural health medicine

in Tennessee and in

non-profit community

health center in Las

Vegas, Nevada. She provides primary care

and women’s health services at the Veterans

Health Administration in Las Vegas. Dr. Rowe’s

past leadership roles included serving on the

Medical Executive board, and Nurse Executive

council and APRN Council Chairperson at VHA,

secretary of Southern Nevada Black Nurses

Association, and member of the Nevada

Nurses Association nomination committee. Dr.

Rowe is currently serving as secretary of the

Nevada Advanced Practice Nurses Association


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


As a registered

nurse for 30 years,

Dr. Tracey Long has

worked in critical care,

emergency medicine,

IMC and primary care.

She developed health

education and diabetes

programs for hospitals

in Las Vegas, Nevada

where she resides. She earned her Bachelor

in Nursing Science and Spanish from Brigham

Young University, a Masters Degree in

Public Health Education at California College

of Health Sciences and a PhD in Nursing

Education and Leadership from UNLV and

Charisma University. She has served as

faculty and Professor of Nursing at the

College of Southern Nevada, Nevada State

College, Kaplan teaching NCLEX, Chamberlain,

Brightwood College and Arizona College. She

serves with International Service Learning

taking nurses and students internationally

offering free medical clinics to underserved


As a freelance speaker with OnCourse

Learning, Atrain and Pesi, she has earned the

Educator of Excellence Award, and has been

an invited keynote speaker for nursing school

graduations, nursing career fairs, nursing

webinars and genealogy seminars.

As a freelance author she has written

several children’s health books. She married

her college sweetheart and they have their

own Brady Bunch of six kids who teach her

what’s really important in life.


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The President’s Message continued from page 1

or what you are, where you came from, or

maybe your religious or even political beliefs?

Reflect on that latter feeling; how did that

make you feel? Did it make you feel good, or

did it hurt your feelings? Was there any effect

on your self-esteem? What is it that keeps us

from including others? While we don't have to

include everyone in everything we do, nor do

we need always to exclude them either.

Moreover, upon reflection of the definition of

inclusivity, perhaps we can do a better job at

avoiding excluding others when including them

might not be that difficult. Maybe by just being

more mindful of the inclusivity of our actions

towards others, we can affect small changes.

Our closing plenary speaker is Dr. Cindy

Clark; she is an expert in all matters of civility,

mainly focused on work environments. I have

Kathy Ryan, RN

“Organs-on-chips” technology focuses on

understanding the very basis of our lives, the

human cell. Although this technology is in its

infancy, world-wide ongoing research suggests

that science may one day describe, explain,

and predict human cellular behavior so that

health and illness related interventions may

be tailored to individuals for best possible

outcomes. Beyond that, the applications are


Scientists begin by applying living

human cells to microchips. The creation of

membranes and channels allows the recreation

of environmental, mechanical,

and physiological conditions affecting cell

structure, function, and interaction. Flexible

chips can mimic motion such as airflow and

breathing, blood flow, and muscle contraction.

Once developed, chips may be evaluated as

individual units, or as strings of units joined

together as organs. The chips then become

part of a data collection and analysis program

whose results may shed light on the impact

of bacteria and medications, chemicals and

toxins, and more. To date, several cells and

organs have been successfully modeled,

Check It Out!


heard her speak many times, and she makes

the connection between civility and inclusivity,

although one could argue the relationship

is more evident between incivility and

exclusivity. Hopefully, Dr. Clark’s presentation

will close out our convention leaving us with

positive thoughts of civility and inclusivity.

I look forward to seeing many of you

at our upcoming convention. It should be

an excellent opportunity for professional

development and networking.

Respectfully yours,

Mary Bondmass, Ph.D., RN, CNE

President, Nevada Nurses Association

including blood vessels, brain, lung, heart,

kidney, liver, and skin. But the degree of

success varies. For example, lung models

have properly responded to the introduction of

triggers for both inflammation and infection.

Heart models however, continue to present

challenges regarding contractility and


One of the greatest benefits of organson-chips

technology concerns “scientific”

experimentation on animals. I have always

wondered how testing on animals yielded

results even remotely related to humans,

so I look forward to the time when torturing

animals for human “benefit” will cease.

Perhaps organs-on-chips technology will one

day reveal the secrets of the human cell, and

in so doing, make us more human.

For more information, please visit

human-organs-on-chips/ - videos include

“Human organs-on-chips” and “Small airwayon-a-chip” -

images of lung, liver, and intestine chips, and

“thrombosis” on a chip

Picture credits: Bing images

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Page 4 • Nevada RNformation August, September, October 2019

2019 NNA Convention: Inclusivity in Nursing

in collaboration with the

Nevada Nurses Foundation and the Nevada Nurses Students Association

Featuring Continuing Education, Plenary &

Break-out Sessions, Posters, Vendors, Raffle

Prizes and Networking!!

Day/Date: Saturday, September 14, 2019

Time: 07:30–17:30


Clinical Simulation Center of

Las Vegas

1001 Shadow Lane – Building B

Las Vegas, Nevada 89106

Fees: $100 (Non-NNA members)

$90 (NNA members and New RNs

< 3 months as RN

$30 (undergraduate students)


07:30–08:30 Breakfast/Posters/Vendors

08:30–08:45 Welcome

08:45–10:00 Opening Plenary

10:00–10:30 Raffle/Break/Posters/Vendors

10:30–11:45 Breakout sessions

11:45–13:00 Raffle/Lunch/Posters/Vendors

13:00–14:15 Breakout sessions

14:15–15:00 Break/Vendors/Raffle

15:00–16:15 Closing Plenary

16:15–16:30 Closing Remarks/Raffle

16:30–17:30 NNA Meeting

*Agenda is tentative and subject to slight changes

6 Continuing Education Hours will be awarded

for full attendance & completion of program


Visit for registration


NNA Convention: Opening Plenary Speaker

Lisa M. Meeks, Ph.D., M.A.

Assistant Professor

Institute for Health Policy

and Innovation

Department of Family


University of Michigan

Medical School

Dr. Lisa M. Meeks is an expert in disabilities

in education. As an administrative leader and

researcher, Meeks has co-authored several

articles and books on the subject of disability

in medical education, helping to inform policy

and best practice in the area of disability

services. She also consults with leading health

NNA Convention: Closing Plenary Speaker

Cynthia Clark, PhD, RN,


Dr. Cynthia Clark is an

award-winning, tenured

Professor, Professor

Emeritus, and Strategic

Nursing Advisor for ATI

Nursing Education. As a

clinician, she specialized

in adolescent mental health, substance abuse

intervention and recovery, and violence

prevention. She is the Founder of Civility

Matters and a leading expert in fostering

civility and healthy work environments. Her

pioneering work on fostering civility has

brought national and international attention

to the controversial issues of incivility in

academic and work environments. Her theorydriven

interventions, empirical measurements,

theoretical models, and reflective assessments

provide best practices to foster civility and

healthy work environments around the globe.

science programs, colleges, and universities

on a myriad of disability related issues.

Dr. Meeks is the co-founder and current

President of the Coalition for Disability Access

in Health Science and Medical Education, codeveloper

of both the AAMC Disability Webinar

Series and the UCSF Disability Training Series

for Faculty and Administrators, co-editor

and author of the seminal text on disability

in health science The Guide to Assisting

Students With Disabilities: Equal Access in

Health Science and Professional Education and

co-PI and lead author of the AAMC Special

Report: Accessibility, Inclusion, and Action

in Medical Education: Lived Experiences of

Learners and Physicians with Disabilities and

co-creator of the social media campaign


Dr. Clark serves as a fellow in the

American Academy of Nursing, the National

League for Nursing Academy of Nursing

Education, and co-chaired the American

Nurses Association Professional Panel on

Incivility, Bullying, and Workplace Violence.

She is a prolific researcher, presenter,

author; and professional blogger. Her

presentations number in the hundreds and

her publications have appeared in a broad

range of peer-reviewed and open-access

venues. She is the recipient of numerous

teaching, research, and service awards;

including the Most Inspirational Professor

Award, the International Community-Campus

Partnership for Health Award, and the

prestigious Elizabeth Russell Belford Award for

Excellence in Education, awarded by Sigma

Theta Tau International. Her book, Creating

and Sustaining Civility in Nursing Education,”

received 1st place honors as the 2013 AJN

Book of the Year. The 2nd edition is now

available and a must-read for all educators

and health care professionals.

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August, September, October 2019 Nevada RNformation • Page 5

Research & EBP Corner

Implementation of Research into Practice:

A Multifaceted Intervention for Improving Door-to-Needle Times in

Acute Ischemic Stroke

Submitted by Mary Bondmass, Ph.D., RN, CNE

This feature will present abstracts of research

and evidence-based practice (EBP) completed

or spear-headed 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

Vicki L. Walker, DNP, MSN, RN, BS

Purdue University Northwest and

University Medical Center of Southern Nevada

Background and Purpose:

The benefits of rapid thrombolysis in acute

ischemic stroke are time-dependent, and

current guidelines recommend a door-toneedle

of ≤ 60 minutes. At a 564-bed Joint

Commission Certified Primary Stroke Center

the core stroke team conducted a Quality

Improvement Project aimed at improving

door-to-needle times as well as staff

adherence to clinical pathways.


The initial program goal to achieve improved

door-to-needle times involved identified best

practice strategies previously associated

with achieving faster thrombolysis times. A

multifaceted and interactive staff training

program targeting the clinical pathways

associated in the management of acute stroke

patients was utilized. The Translating Research

into Practice model was used to support

implementation of the solution. Variables of

door-to-imaging and door-to-needle were

collected at baseline and following completion

of the training intervention. In addition, a staff

questionnaire on self-reported confidence

was employed following the intervention.

Questionnaire data was analyzed using

Cronbach alpha to provide a measure of

internal consistency of the confidence scale.


The multifaceted training program that

used self-directed and small-group learning

strategies as well as Quick Reference Guides

found that in the two months following

intervention door-to-imaging times had

improved but an improvement in door-toneedle

times was not realized in the same

period. In addition, self-reported confidence by

nurses was rated as high and nurses reported

improved understanding of acute stroke

clinical pathways with each of the training

program approaches.


A multifaceted and interactive staff training

program to improve thrombolysis times

and implemented within the context of the

Translating Research into Practice model

can be successful in addressing ED nurse

confidence and adherence to clinical pathways.

However, success as the intervention relates

to improved thrombolysis was not realized

with this project.

Page 6 • Nevada RNformation August, September, October 2019

By Susan S. VanBeuge,



As the 80th Nevada

Legislature comes to a

close, there is much to

reflect on for nursing.

Nurses celebrated

time being part of the

legislative process to advocate for patient care

and nursing practice issues. One day was a

particular highlight for the advanced practice

nursing community – the first ever Nurse

Practitioner Day at the Legislature on May 13.

This day marked firsts on many accounts:

the first day dedicated to advanced practice

nursing at the Nevada Legislature, a first-time

visit to this historic place for a few attendees,

and some positive changes for nurse

practitioner practice happened in committee

meetings on this day.

The day began with time for networking

and sharing a meal as we met with each

other as professionals and the lawmakers

who came by for a chat. Not only did we meet

lawmakers, but those who support them to

do the serious work of our state. We had

several presentations about the legislative

process, how a bill becomes law, and

ways to participate in making change. One

highlight was a visit to the gift shop where

all things Nevada were available to adorn our

professional attire.

Nurse Practitioners at the Nevada Legislature

As the morning progressed, we prepared to

sit in the Senate with our elected officials for

some and others were in the gallery. All of us

were treated to an introduction and applause

for the work done as advanced practice

registered nurses in the great state of Nevada.

Senators made personal introductions with

some fun stories shared about individuals. We

concluded the time in the Senate with many

photos and more great memories.

This experience is one that should be

repeated in every legislative session.

Attending nurse's day at the legislature can

be an excellent experience to learn, advocate,

and connect with others. It allows nurses to

be part of the legislative process in this citizen

legislature. A citizen legislature means that

our officials are regular citizens who have jobs

outside their elected roles. They are teachers,

lawyers, firefighters, health care providers,

and everything in between. A critical aspect

to remember is that they represent us as

constituents and we should be providing

them input so they can represent our voice

in new statute and revisions to modernize

existing law. In terms of health care, we have

a powerful voice as nurses. Though there are

varying types of licensure (LPN, RN, APRN),

we all have a voice and perspective to share.

Tell your story, share your experience, and

be part of the process to make purposeful,

meaningful change for your practice and

patient population. This experience can all

start at the legislature, so consider the next

time the call for Nurses Day at the Legislature

rolls around in 2021 you make plans to attend.

Nurse Practitioner Day at the Legislature is

in the books. It was a historic first for Nevada

Advanced Practice Registered Nurses but not

the last as we continue to advocate for access

to care across the state. See you in 2021 in

Carson City!

Assemblywoman Titus with Nevada nurse practitioners.

Senator Wheeler with Nevada nurse practitioners.

Visit today!

Search job listings

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

Find events

for nursing professionals in your area.

Your always-on resource for nursing jobs, research, and events.

Browse our online database

of articles and content.

August, September, October 2019 Nevada RNformation • Page 7

Veteran’s Corner

Increasing Access to Care with VA Video Connect

Hedian Swanson, DNP, MSN, APRN, FNP-BC

Denise Rowe DNP, MSN, APRN, FNP-BC

Lowryanne Vick, DNP, APN, ACNP-BC, CMC

The Department of Veterans Affairs (VA)

is increasing access to healthcare by using

telehealth technologies to deliver healthcare

services when Veterans and clinicians

are separated geographically. Telehealth

technology provides healthcare access for

Veterans in remote, rural locations and in

areas with scarce healthcare resources.

Common telehealth technologies utilized at the

VA include Clinical Video Telehealth, Store and

Forward, Home Telehealth, TeleMental Health,

and Telephone care.

VA telehealth services recently expanded

to include VA Video Connect (VVC). VVC

is a secure web-based service that allows

Veterans to schedule appointments with VA

clinicians (physician, nurse practitioner, nurse,

psychologist, psychiatrist, or other healthcare

staff) by utilizing a virtual medical room. VVC

allows clinicians to provide care to Veterans

who are conveniently located at home, work,

or other chosen location. Using this new

modality of care, Veterans can discuss their

health concerns with clinicians from anywhere

within the United States, thus making

appointments convenient by eliminating travel

to a VA facility.

A personal computer, laptop, iOS (Apple) or

Android mobile device (smart phone, tablet,

iPad) is required to use VVC. Additionally,

the Veteran and clinician must have an

active email account, internet access, and

an internet browser such as Google Chrome,

Microsoft Internet Explorer, or Edge. Webcameras

and microphones are also necessary;

however, many devices have integrated

cameras and microphones in place. If an iOS

device (iPhone, iPad) is used, a free, easy to

download VA Video Connect App is needed to

automatically launch a VVC session.

VVC is an effective and simple way to

address medical needs when a hands-on

physical exam is not required (although

a limited examination is possible with

additional technologies). This modality of

care is particularly useful when Veterans

are unable to leave home or work due to

time, health conditions, or transportation

difficulties. It is used by many healthcare

disciplines for counseling, education,

wound/skin assessment, blood pressure

monitoring, review of diagnostic test results,

and medication reconciliation. VA nurses

can observe if a Veteran is measuring their

blood pressure correctly; witnessed blood

pressure measurements can be entered into

the VA electronic medical record by the nurse

eliminating the need for the Veteran to bring

a blood pressure log to in-person medical

appointments. VVC is also a great option to

makeup missed clinic appointments.

Veterans can forward their VVC email

invitations so that family members and/

or caregivers can be more involved in the

Veteran’s care. Clinicians can also invite other

healthcare providers to participate in VVC

visits when a multidisciplinary approach is

necessary. There is no cost to Veterans for

VVC, co-pays are not required. VVC sessions

can be scheduled up to 90 days in advance.

However, clinicians can also invite a Veteran to

an on-demand VVC visit at any time.

The VVC appointment process is straight

forward. Once the VA clinician determines that

a VVC appointment is appropriate, Veteran

consent is obtained. Afterwards, an email

invitation is sent, and all invited participants

meet in the virtual medical room at the

mutually agreed upon time. At the beginning

of the encounter, the clinician confirms the

Veteran’s phone number, physical location,

and emergency contact information. This

information is gathered so that emergency

medical services can be sent to the Veteran

if a medical and/or psychiatric emergency

occurs during the VVC visit. Since the virtual

visit is between a VA clinician and a Veteran

located at a non-VA site, it is important to

ensure that the Veteran is in a private and

safe environment. It is not acceptable for

the Veteran to initiate a VVC session while

driving or while located in an area with loud

background noise. The Veteran’s undivided

attention is required to promote optimal

participation during the VVC encounter.

Since widespread VVC marketing is

underway, the word is spreading quickly

among the Veteran community. VA clinicians

can stay ahead of the increasing demand by

conducting practice VVC visits, completing

online VVC training, and reviewing current

information on the VHA Telehealth Services

website. VVC is still in the early stages of

implementation, however, clinicians are

gradually offering more VVC visits as they

become increasingly familiar with this modality

of care. Program evaluation is ongoing to

ensure that VVC care is effective and Veterans

are satisfied with the care received while using

this technology.

In select cases, telehealth technology

can be loaned to Veterans free of charge. If

multiple VVC visits are needed for a Veteran

who lacks the necessary equipment, a consult

to dispense a VA-issued iPad with a data plan

can be placed. If necessary, other peripherals

such as a blood pressure cuff, pulse oximeter,

digital stethoscope, digital thermometer, and

scale can be provided. Loaned VVC technology

usage is closely monitored. If minimal usage

requirements are not met, a request will be

made for the Veteran to return the loaned


The VHA Telehealth Technology Help Desk

(NTTHD) is available for Veterans and VA

clinicians at: 866-651-3180 or 703-234-4483,

Monday through Saturday, 7 a.m. – 11 p.m.

Eastern Time.


• VA Video Connect App information and test visit for


• VA Video Connect





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Page 8 • Nevada RNformation August, September, October 2019

NNA Environmental Health Committee

State of Nevada’s Air - 2019

The Report Card

The grades are in for 2019 and we can’t

ignore the data. Our state continues to

be challenged with poor air quality from

toxic ozone gas and fine particle pollution.

Therefore, it is essential that we actively

educate our patients on how to protect

themselves during poor air quality events.

For two decades the American Lung

Association has analyzed data from air quality

monitors to compile the "State of the Air"

report. This year's report examines monitoring

data collected during 2015, 2016, and 2017.

According to the 2019 State of the Air Report,

“increased heat played a major role in the

higher number of unhealthy air days. This

year’s report covers the three warmest years

on record in the U.S. According to the National

Oceanic and Atmospheric Administration,

2017 was the second warmest year on record,

following 2016, which was the warmest year,

and just ahead of 2015, which was the third

warmest. Warmer weather makes ozone more

likely to form.”

Our state’s poor report card (Figure 1)

shows that 60% of Nevada’s nearly three

million residents are a member of a vulnerable

population potentially affected by poor air

quality. Las Vegas-Henderson is ranked the

13th most polluted city for ozone in the USA.

In addition, the Reno-Carson City-Fernley

area ranked 23rd in the nation for short-term

particle pollution.

about air quality and the associated adverse

effects. We can then collaborate with them

to personalize clinical recommendations that

can reduce their exposure or treat symptoms

caused from air pollution during poor air

quality days.

Here are some suggestions:

1. Learn about EPA’s AirNow site:

download the App to your phone, and

computers at home, in your clinic or

hospital. Have the site available to show

your patients and teach them how to use


2. Learn how to interpret the Air Quality

Index shown on the AirNow site (see

Figure 2).

3. Emphasize helpful actions to

reduce exposure to the air pollution

as recommended by EPA, your local

health departments, and tailor to your

individual patient and their health

condition (Figure 3). Hang up in your

clinic/exam rooms EPA’s AirNow free

poster describing health effects from air

pollution and explains the AQI.

4. School nurses in Nevada can advocate

for school children, especially those

with respiratory diseases. Check the air

quality daily from the AirNow site for

the closest air monitor to your school.

Request to be involved with decisions

regarding outdoor recess and athletic

events. Follow EPA’s Air Quality and

Outdoor Activity Guidance for Schools

developed in 2014. Work with the

American Lung Association of Nevada

for resources and support training for

educators/coaches at your school (see

section below).

A Message from the American Lung

Association in Nevada

“Las Vegas residents should be aware that

they are breathing unhealthy air, placing

health and lives at risk,” said American Lung

Association Manager of Health Promotions

Kimberly Rogers. “In addition to challenges in

Las Vegas, the 20th-anniversary ‘State of the

Air’ report highlights that more than 4 in 10

Americans are living with unhealthy air, and

we’re heading in the wrong direction when it

comes to protecting public health.”

This year’s report covers the most recent

quality-assured data available collected by

states, cities, counties, tribes and federal

agencies in 2015-2017. Notably, those three

years were the hottest recorded in global


Compared to the 2018 report, Las Vegas

experienced more unhealthy days of high

ozone in this year’s report. “Ozone especially

harms children, older adults and those with

asthma and other lung diseases,” said Rogers.

“When older adults or children with asthma

breathe ozone-polluted air, too often they end

Nurses as Community Health Advocates

As stated in ANA’s Principles of

Environmental Health for Nursing Practice

(2007) “it is important for communities to

have access to information about the amount,

type, and source of potential hazards that are

released into their environment.” As nurses,

we can be facilitators to help patients achieve

their own health goals. We can educate them




Figure 1. Nevada’s 2019 Air Quality Report Card









Vulnerable Populations





B C 54,745 858 4,515 3,386 4,170

Churchill C No data 24,230 429 1,936 1,412 1,732

Clark F F 2,204,079 39,891 176,845 115,545 139,163

Douglas No data F 48,309 646 4,072 3,517 4,418

Lyon D No data 54,122 910 4,367 3,372 4,172

Washoe F C 460,587 7,810 37,551 25,463 30,860



B No data 9,592 148 798 555 676

Note: Some counties in Nevada do not have air quality monitors.


Figure 2. Understanding the Air Quality Index

Levels of Health


AQI Color Code

8-hour Ozone


24-hour PM 2.5


Good Green 0 – 54 ppb 0.0 mg/m 3 to 12.0 mg/m 3

Moderate Yellow 55 – 70 ppb 12.1 mg/m 3 to 35.4 mg/m 3

Unhealthy for

Sensitive Groups


71 – 85 ppb 35.5 mg/m 3 to 55.4 mg/m 3

Unhealthy Red 86 – 105 ppb 55.5 mg/m 3 to 150.4 mg/m 3

Very Unhealthy Purple 106 – 200 ppb 150.5 mg/m 3 to 250.4 mg/m 3

Hazardous Maroon >200 ppb ≥ 250.5 mg/m 3

Note: The higher the AQI value, the greater the level of air pollution and the greater the

health concern. The concentration of a gas is measured as “parts per billion” or ppb, whereas

particles are measured as micrograms per cubic meter of air or mg/m 3

Reference: The U.S. EPA’s AirNow site

August, September, October 2019 Nevada RNformation • Page 9

NNA Environmental Health Committee

up in the doctor’s office, the hospital or the

emergency room. Ozone can even shorten life


The 2019 report also found year-round

particle pollution levels lower than the 2018

report. Nationwide, the best progress in this

year’s report came in reducing year-round

levels of particle pollution.

Particle pollution is made of soot or tiny

particles that come from coal-fired power

plants, diesel emissions, wildfires and woodburning

devices. These particles are so small

that they can lodge deep in the lungs and

trigger asthma attacks, heart attacks and

strokes, and can even be lethal. Year-round

particle pollution levels have dropped thanks

to the cleanup of coal-fired power plants and

the retirement of old, dirty diesel engines.

State of the Air 2019 tracked short-term

spikes in particle pollution, as these can be

extremely dangerous and even lethal. Many of

these spikes in Nevada were directly linked to

weather patterns like drought or to events like

wildfires, which are increasing in frequency

and intensity in many areas due to climate


The American Lung Association is a Vital


American Lung Association programs such

as Asthma Basics, Open Airways for Schools,

and Better Breathers Clubs can help support

individuals with Asthma, COPD and other lung

diseases that impact breathing. Additionally,

the Lung HelpLine is available Monday-Friday

5 AM-7 PM and weekends from 7:00 AM to

3 PM (Pacific Time). If you are interested in

more information about these volunteer-led

programs, and how to start a program in your

area, please call Kimberly Rogers at (702) 431-


References & Resources

The American Lung Association’s 2019 “State of the Air



American Lung Association in Nevada: https://www.lung.


American Lung Association:

EPA’s AirNow:


Washoe County Air Quality Management Division: https://


Clark County Department of Air Quality: http://www.


Bernadette M. Longo,



Chair, NNA’s

Environmental Health


Air Quality Index



(0 to 50)


(51 to 100)

Unhealthy for

Sensitive Groups

(101 to 150)


(151 to 200)

Very Unhealthy

(201 to 300)


(301 to 500)

Figure 3. Public Health Implications

Who Needs to be


It’s a great day to be active outside.

Some people who may

be unusually sensitive

to ozone and/or particle


Sensitive groups include:

• people with heart or

lung disease

• older adults

• children & teenagers

• outdoor workers




Actions: What Should I Do?

Unusually sensitive people: Consider

reducing prolonged or heavy outdoor

exertion. Watch for symptoms such as

coughing or shortness of breath. These are

signs to take it a little easier.

Everyone else: It’s a good day to be

active outside.

Sensitive groups: Reduce prolonged or

heavy exertion outside. Take more breaks

and do less intense activities. Watch for

symptoms such as coughing or shortness

of breath. Consider staying indoors.

Schedule outdoor activities in the morning

when ozone is lower.

People with asthma: should follow their

asthma action plans and keep quick relief

medicine handy.

If you have heart disease: Symptoms

such as palpitations, shortness of breath,

or unusual fatigue may indicate a serious

problem. If you have any of these, contact

your health care provider.

Everyone: Reduce prolonged or heavy

outdoor exertion. Take more breaks, do

less intense activities. Schedule outdoor

activities in the morning when ozone is


Sensitive groups: Avoid prolonged or

heavy exertion. Move activities indoors or

reschedule to a time when the air quality is


People with asthma: keep quick-relief

medicine handy.

Everyone: Avoid prolonged or heavy

outdoor exertion. Schedule outdoor

activities in the morning when ozone is

lower. Consider moving activities indoors.

Sensitive groups: Avoid all physical

activity outdoors. Move activities indoors

or reschedule to a time when air quality is


People with asthma: keep quick-relief

medicine handy.

Everyone: Avoid all physical activity


Sensitive groups: Remain indoors and

keep activity levels low. Follow tips for

keeping particle levels low indoors.

• Use the Air Quality Index (AQI) to plan outdoor activities. To keep the AQI handy, sign up

for EnviroFlash emails, get the free AirNow app, or install the free widget on your website.

Find all of these tools at

• If you don't have an air conditioner, staying inside with the windows closed may be

dangerous in extremely hot weather. In these cases, seek alternative shelter.

Reference: AirNow “Activity Guides” for Ozone & Particle Pollution

Kimberly Rogers, GPC

Manager | Health


American Lung Association

in Nevada

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Page 10 • Nevada RNformation August, September, October 2019

Antibiotic Stewardship

By Norman Wright, RN,


The first “Call to Action”

article RNformation was

published in August

2016. Perhaps it is time

to move on beyond

continually reviewing the

fundamentals of infection

prevention – So, let’s get the first “basic” of

infection prevention out of the way.

Florence Nightingale is quoted to have

said, “True nursing ignores infection, except

to prevent it”, and "Every nurse ought to be

careful to wash her hands very frequently

during the day." Nightingale understood

that, in the 1840’s, Semmelweis discovered

that mothers who used midwifes, (midwifes

washed their hands) to deliver babies, were

more likely to survive than mothers who used

doctors, (who did not wash their hands).

By now one would assume that the crux

of what Semmelweis and Nightingale taught

us over 160 years ago are implemented, but

sadly this is not the case. According to the

Joint Commission’s Sustaining and Spreading

Improvement in Hand Hygiene Compliance

hand hygiene compliance in hospitals prior to

interventions to improve it ranged from under

50 to about 60 percent, with improvement to

the 80 percent range after interventions called

“Robust Process Improvement® (RPI®)” to

increase compliance were initiated. (1)

These reported improvements in hand

hygiene are impressive however, this is still

under the 90+ percent compliance rate

that the Joint Commission strives for and

is unacceptable during a survey when 100

percent compliance is required.

Having personally taught hand hygiene

for decades I have witnessed many quality

improvement programs attempt to increase

compliance and there usually is a brief time

when compliance improves. Unfortunately

old habits die hard and after a few months

many digress, returning to pre-intervention

behaviors. This is not to say that Robust

Process Improvement, Continuous Quality

Improvement (CQI), Quality Assurance

(QA), which morphed into QAPI (Quality

Assurance Performance Improvement) or

any other quality improvement programs

are not beneficial, at least in the short term.

The challenge is to change the behavior

permanently, not just have a temporary

“bump” in compliance.

Direct observation by the infection

preventionist who monitors and tracks

compliance has been shown to be effective.

However, the Hawthorne effect, which

essentially holds that when someone

knows they are being watched, consciously

complies. Thus, compliance rates just shows a

statistical improvement while the monitoring

occurs. Designated “secret shoppers,” which

enlists other staff to surreptitiously evaluate

compliance is one method used to minimize

the Hawthorne effect. There also are the

expensive technological systems where

hospital workers wear badges that change

color and others that measure how frequently

the soap and alcohol dispensers are used. (2)

All of these monitoring systems have

advantages and disadvantages but the

question is why are they even needed? The

most effective hand hygiene monitoring

system is you and your fellow workers.

Changing the behavior of an individual

involves changing the person’s habits, but

personal habits are difficult to change if the

culture continues to be lackadaisical about

ensuring compliance. Systematic culture

change only occurs if a large number of

individuals change their behavior. When

a preponderance of nurses’ practice hand

hygiene consistently - peer pressure influences

those who are out of compliance to conform

and sustainable culture change occurs. If

anyone is unsure when hand hygiene is

required the World Health Organization’s “My

5 Moments of Hand Hygiene” provides simple,

yet comprehensive, guidelines. (3)

Florence Nightingale taught us about the

importance of hand hygiene over 160 years

ago and the question is: – Why do nurses,

doctors, and other care providers continue to

disregard proven science showing that hand

hygiene is the most effective way to prevent

infection? Something so simple as washing

your hands prevents infection and stops the

spread of antimicrobial resistance. It is time

for you to commit to take action, comply with

hand hygiene regulations and call out coworkers

who fail to comply.

New Regulations

In January 2018 the Joint Commission

recognized that a facility must not only have

a hand hygiene compliance program but that

it must be effective and this standard was

initiated: “Any observation by surveyors of

individual failure to perform hand hygiene in

the process of direct patient care will be cited

as a deficiency resulting in a Requirement

For Improvement (RFI) under the Infection

Prevention and Control (IC) chapter for all

accreditation programs.” (4)

Beyond the Joint Commission’s 2018

initiatives, effective November 28, 2019,

nursing homes will be required to comply with

phase 3 of new LTC regulations. In part these


“Staff must perform hand hygiene (even if

gloves are used):

• Before and after contact with the


• Before performing an aseptic task;

• After contact with blood, body fluids,

visibly contaminated surfaces or after

contact with objects in the resident’s


• After removing personal protective

equipment (e.g., gloves, gown,


• After using the restroom; and

• Before meals.” (5)

These new regulations require a nursing

home to ensure hand hygiene compliance

or potentially receive poor survey results,

monetary penalties and/or negative publicity

by placing patients at risk for infection.

It is time we all take action to combat

antimicrobial resistance and prevent

infections. Perhaps the first action to take is

to put into practice what Florence Nightingale

tried to teach us over 160 years ago.













August, September, October 2019 Nevada RNformation • Page 11

Increasing Numbers of Nevada Nurses Receive

Doctoral Degrees

Submitted by Mary Bondmass, PhD, RN, CNE

In 2010, the Institute of Medicine (now

known as the National Academy of Medicine)

indicated the need for more nurses to be

prepared at the doctoral level. Nurses with

doctoral degrees may alleviate shortages of

nurse faculty, primary care providers, and

researchers; therefore a cadre of qualified

nurses needs to be ready to advance to the

doctoral level.

Below are the names of the known Nevada

nurses who obtained a doctoral degree

thus far in 2019. Congratulations to these

exceptional nurses!!!

Purdue University Northwest:

Abbie Purney, DNP

Vicki L. Walker, DNP

Touro University Nevada:

Beth Elaine Carter, DNP

Kaylinne Allison Chang, DNP

Leah Elaine Elliott, DNP

Alex Joseph Durante Francisco, DNP

Debra Jean Gillen, DNP

Cameron Lee Grant, DNP

Megan Ferris Kirschner, DNP

Debra Mayers, DNP

My Phuong Nguyen, DNP

Jennifer Niduaza, DNP

Amenaghawon Osaghae, DNP

Maria Lisa Rubolino-Gallego, DNP

Marta Sales, DNP

Jesse Santoyo, DNP

Joann Siapno, DNP

Michael William Steffan, DNP

Jose Rafael Valdez, DNP

Nhia Yang, DNP

Karen Natalie Wolaridge, DNP

University of Nevada, Las Vegas

Noelle Cerdan, DNP

Maulah Halley, DNP

Laura Larson, DNP

Lydia Lefchuck, DNP

David Morrow, DNP

Anne-Marie Schenk, DNP

Lauren Scott, DNP

Janet Wright, DNP

Karen de la Cruz, Ph.D.

Christina Pepin, Ph.D.

Megan Smith, Ph.D.

University of Nevada, Reno

Candee Copeland, DNP

Candie R. Cuneo, DNP

Amber M. Federizo, DNP

Jordan Forman, DNP

Rebecca Gebhardt, DNP

Jasmine N. Lewis, DNP

Jennifer McCarthy, DNP

Okechuwu Olisa, DNP

Valerie A. Porter, DNP

Leighanne Shirey, DNP

Ashley Szmania, DNP

"Responding to

Anaphylaxis: Know

the Universal Sign for


By Tracy Stewart, DNP, MBA, RN-BC, NE-BC, CENP

Anaphylaxis may make it difficult to speak,

or people may be too far away to hear a call

for help. If a person is having an anaphylactic

reaction and can’t be heard, FIST to THIGH

is the universal sign to show they need

epinephrine. The person is to:

• Make the motion FIST to THIGH

• Wait a second

• Repeat again FIST to THIGH

If you see this sign ask the person if they

have an epinephrine pen. If they do not have

one, immediately call 911. If they do have an

epinephrine pen, ask them to point to where

it is. Retrieve it and ask the person if they

can inject it them self. If they cannot or have

become unconscious, grasp it with the orange

tip pointing downward, remove the blue cap

by pulling straight up, and swing and push the

auto-injector firmly into the thigh until it clicks.

Hold it firmly in place for three seconds, then

call 911. Remember, Blue to the Sky, Orange

to the Thigh.


Food Allergy & Anaphylaxis Connection Team. (2019).

Food Allergy & Anaphylaxis. Retrieved from https://

Interstitial Lung Disease

By Aubree Carlson, MSN, RN

Interstitial Lung Disease

(ILD) is a group of lung

diseases affecting the

interstitium resulting in

scarring and thickening

of the tissue. Unlike

Chronic Obstructive

Pulmonary Disease, ILD is

a restrictive lung disease.

ILD is an umbrella term

encompassing more than 200 lung disorders,

including pulmonary fibrosis and idiopathic

pulmonary fibrosis, which are the most

commonly diagnosed disorders under the

ILD umbrella. While only 35% of patients

make up the known etiology of pulmonary

fibrosis, a staggering 65% of patients fall

into the idiopathic category (Oldham & Noth,

2014). Known etiology causes of pulmonary

fibrosis include connective tissue disease

such as Rheumatoid Arthritis, occupational

exposures such as Asbestosis, and druginduced

secondary to pulmonary toxicity from

medications such as Amiodarone (Oldham,

2018). A suspected cause of idiopathic

pulmonary fibrosis is Gastroesophageal Reflux

Disease due to the potential silent aspiration

of gastric contents into the lungs.

A chronic, non-productive intractable cough

is reported in 80% of patients with pulmonary

fibrosis, along with other symptoms such as

dyspnea and fatigue. One of the key signs of

pulmonary fibrosis is inspiratory Velcro-like

crackles, which is reported in 90% of patients.

These discernable crackles are referred to

as “Velcro-like” because of their uncanny

resemblance to the sound of Velcro being

ripped apart and are best at identifying early

disease due to their excellent sensitivity and

specificity for the disease (Oldham & Noth,


Accurate diagnosis of the disease is

complex. On average, patients report waiting

over a year and seeing multiple physicians

before receiving the correct diagnosis. Once

the diagnosis is made treatment options

include supplemental oxygen, oral medications

such as Esbriet or OFEV, and pulmonary

rehabilitation to build endurance and educate

patients on proper breathing techniques.

However, lung transplant remains the sole

therapy proven to prolong life expectancy

as the median survival rate in this patient

population is three years (Oldham & Noth,

2014). Ultimately, early detection and referral

is key in these patients in order to ensure a

prompt and accurate diagnosis.


Oldham, J.M. (2018). Interstitial Lung Disease: An Overview.

[PowerPoint Presentation]. Retrieved from https://


Oldham J.M., Noth, I (2014). Idiopathic pulmonary fibrosis:

early detection and referral. Respiratory Medicine,

108(6), 819-829.


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Page 12 • Nevada RNformation August, September, October 2019

Is that Coumadin or Cupping?

By Tracey Long PhD, RN, APRN

You are working in a hospital and see

large circular bruising on the back of your

adult patient. Could this be physical abuse,

a skin disorder or bruising from excessive

coumadin? None of the above. It may be from

a Traditional Chinese Medicine practice called

cupping that is used to stimulate deep energy

flow across meridians for pain, inflammation

or illness. Many times, patients have been

referred to social services for alleged abuse,

when the bruising was caused as a curative

therapy, with often very positive outcomes for

the patient. Cupping was brought to American

attention when Olympic champion Michael

Phelps was seen with the classic cupping

bruises on his shoulders.

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Seeking Adventurous, Compassionate Nurses

With the increasing population diversity in

the United States, nurses need to be more

educated about integrative and alternative

therapies. The National Institutes of Health

have developed the National Center for

Complementary and Integrative Health to

examine alternative medicines being used in

the United States. For more information about

research, training and news go to: https://

Many of these treatments are brought

by other cultures including Traditional

Chinese Medicine (TCM), Ayurvedic Medicine,

Curandismos from Latin America and Native

American holistic medicine. Understanding

the philosophical definitions of health, disease,

balance and healing by other cultures is

the beginning to working more effectively

with patients who are using non-western

approaches to health. It is estimated that as

many as 63% of Americans are using health

practices not endorsed by allopathic Western

medicine. Such approaches include herbal

remedies and aromatherapy, but also include

biomedicine, supplements, and even yoga

and meditation. The lack of endorsement of

these modalities is not for lack of efficacy but

of the sparsity of evidence-based research

to confirm their effectiveness. There are not

a lot of pharmaceutical companies willing to

invest in the power of prayer and nutritional

supplements to help cancer patients.

A group of nurses and nursing students

from Las Vegas, Nevada learned about

Traditional Chinese Medicine in April in

Shanghai and Hangzhou China, headed by

Professor Tracey Long, who takes nurses and

nursing students internationally on medical

trips each year to learn about global health

and world culture related to nursing. In

addition to teaching over 1000 Middle and

High School students first aid and CPR, this

group studied at the Zhejiang Chinese Medical

University with other international students.

They learned about the core principals of yin

and yang and chi, and how it is implemented

in the modalities of cupping, auricular

acupressure, acupuncture, moxibustion,

Tuina massage, and biological herbal teas for

healing. All Chinese modalities are focused on

restoring the natural energy flow, known as

chi. A foundational concept in TCM is that the

body is a garden and how we feed it with light,

food, rest and chemicals determines what

grows, for good or bad.

Team member RN learning first-hand about

cupping for lower back pain.

TCM also teaches practitioners how to

diagnose the internal energy balance by

identifying 22 different levels of the pulse

and examining the color, thickness, coating

and health of the tongue. Perhaps American

nurses can learn to improve our own physical

assessment skills by observing more closely

what the body is showing us.

Nursing students Victoria Church-Gandy and

Briana Puentes teaching CPR to students.

Learning about different approaches to

medicine, wellness and healing from other

cultures can open our minds and eyes to

the power of the body to heal and how to

promote better health for ourselves and

our patients. To learn more about future

international medical trips contact Dr. Long at


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Nursing team (left to right): Katie Anderson, Joshua LoMonaco, Victoria Church-Gandy, Briana

Puentes, Chief Nurse, Dr. Tracey Long, Cindy Reedy, Paris Gonzales and Barbara Stenstrom

August, September, October 2019 Nevada RNformation • Page 13

Celebrating the Heart of Nurses

By Tracey Long PhD, RN, APRN

Nurses have great hearts and care for the

hearts of others. Nurses are very familiar

with the national statistics that the leading

cause of death is heart disease in America.

According to the Centers for Disease Control

and Prevention, about 610,000 people die

of heart disease annually, which is about 1

in every 4 deaths. Unlike previous decades

where men lead the nation in cardiac disease,

both women and men are now equal in cardiac

diseases. Coronary artery disease is the most

common type of heart disease, which is fatal

for 370,000 people each year. 735,000 people

have a heart attack each year, with 210,000 of

those who have already had a previous heart


Knowing the signs of heart disease and a

heart attack are part of the skills of nurses.

Most nurses are in a position to provide direct

patient teaching on how to decrease heart

disease risks and how to help the public

recognize and respond to a heart attack.

Most nurses have to be certified in Basic

Life Support (BLS) and cardiopulmonary

resuscitation (CPR) for their job in any

capacity. Keeping your skills sharp is a

benefit of the required recertification every

two years. Additional skills many nurses

have are Advanced Cardiac Life Support

(ACLS) or Pediatric Advance Life Support

(PALS) depending on the job requirements,

critical care training and the population

they serve. Classes and certification are

offered throughout the State of Nevada

through hospitals, community colleges

and individual companies. Prices vary, and

classes are offered through the Red Cross

or through the American Heart Association,

(which is generally preferred for healthcare


One Nevada nurse with true heart has gone

the extra mile. She is not only ACLS/PALS

certified but volunteers to speak at women’s

groups about heart disease and women.

Lizbeth Hamilton, a neurosurgery ICU nurse at

Mountain View Hospital in Las Vegas sees the

consequences of uncontrolled hypertension,

coronary atherosclerosis and poor health


She has chosen to become an advocate

and voice in the mission to educate the public

about our precious heart health. She has

served as the honored “mascot wrangler” for

the 2018 heart walk in Las Vegas, Nevada

and serves in the logistics for annual heart

walk events. She has served at local health

fairs as a representative for the American

Heart Association (AHA) and been involved

in the annual Go Red for women event. The

month of June is known as CPR month by the

AHA and February is heart awareness month

for the Heart Foundation, so throughout the

year, nurses have an opportunity to be “heart

conscious” and increase public awareness

about heart health. This next February heart

month kicks off by wearing red on the first

Friday to show support for women’s heart

health. Because of the annual event, there is

improved awareness, with the help of a red

dress fashion show, often by celebrities, to

share information and support for women

taking charge of their own health choices to

improve their own health. The American Heart

Association recommends four simple tips for

improving your own health including: eating

a healthy diet with low sodium and low trans

fats, managing health conditions, knowing

about the possible use of a baby aspirin for

those at risk and knowing the signs of a heart


To volunteer or serve in AHA events, contact

Lizbeth Hamilton at or and look for a

volunteer opportunity near you.

Have a heart - save a heart and be an American

hero by learning CPR.

Lizbeth Hamilton volunteering for the AHA to teach the public about “hands only” CPR. Annual Go

Red AHA event in Las Vegas, NV. Hands-only CPR has been shown to be as effective as conventional

CPR for cardiac arrest at home, work or in public. Only about 46% of people who experience an

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Page 14 • Nevada RNformation August, September, October 2019

Nevada Nursing Students Shine at the National Student Nurses

Association 2019 Convention

Nevada delegate, Matt Mastalski voting at

the National Student Nurses Association’s


Submitted by Matt Mastalski, Student Nurse

Nursing, as we all know, is a profession

as well as a calling. A field where each one

of us gets to fulfill our dreams of helping

restore wellbeing to a sick individual. As a

student it is an exciting but nerve wracking

experience going through school, taking care

of patients, and worrying about our futures in

a profession that is routinely one of the most

trusted professions in the nation. While we

are students, we are continually questioning

our impact on the profession and one way



• Training and Technical Assistance

• Implementation

• Workflow

• Educational Materials

• Screening Forms

• Video Demonstrations

• Online Courses

• Other Resources


Visit our website and click

Resources to learn more

about free NSBN Approved

CEU online courses.

“SBIRT is a comprehensive,

integrated, public health approach

to delivering early intervention for

individuals with risky alcohol & drug


“SBIRT provides a timely referral

to more intensive substance use

treatment for those with substance

use disorders.”

“Primary care centers, ERs, trauma

centers, and community health

settings provide opportunities

for early intervention with at-risk

substance users before more severe

consequences occur.”

of making a direct impact is to participate in

the local, state, and National Student Nurses

Association (NSNA).

The state chapters of the NSNA are

constituents of the American Nurses

Association (ANA). This last spring, I had the

honor to represent both the University of

Nevada, Las Vegas (UNLV) and the Nevada

Nursing Students Association (NVNSA) at the

annual National Student Nurses Association

(NSNA) conference in Salt Lake City, UT, as

a delegate to the House of Delegates from

UNLV's SNA. As delegates, I and my student

colleagues were tasked with voting on

direction of the NSNA through resolutions of

support, and the election of the new board of

directors for the organization.

One of the primary duties of a delegate

to the House of Delegates is to debate on

resolutions put forth by student nurses that

go to support health care policy and advocate

for significant initiatives through the NSNA. In

total, there were approximately 59 resolutions

that were proposed by various chapters

across the country. Many of these resolutions

addressed the core meaning of what it is to

become a nurse and show that nurses wish to

have an impact not just on the hospital floor,

but on the entire community at large. Topics

included advocating for education about the

high cost of insulin, improving nursing faculty

education about LGBTQ health, screening,

and identification of Adverse Childhood

Experiences (ACE), and many more. The

resolutions were debated on the floor in the

house of over 500 delegates from every state.

This kind of involvement by students, who

are just getting their feet wet in the waters

of their career, shows just how dedicated

and passionate we are about our chosen


The other duty set to the delegates is to

elect the Board of Directors for NSNA for the

2019 – 2020 year. I am exceptionally proud of

Nevada as this year we ran three candidates in

the election and succeeded in getting all three

elected to positions with NSNA. What is most

exciting is that the state of Nevada has only

had its constituency for one year and is still

in its infancy as a chapter. However, we now

are proud to occupy the following positions on

Nevada Nursing Students...continued on page 19

Nevada nursing students with voting signs at the

National Student Nurse Association

Visit our website to learn more about how we can assist your organization

to promote, prepare, adopt and implement SBIRT.


This publication was supported in whole or in part by the Nevada Division of Public and Behavioral Health Bureau of

Behavioral Health, Prevention, and Wellness through funding provided by the Nevada State Targeted Response to the

Opioid Crisis Grant (1H79TI080265-02) awarded by the Substance Abuse and Mental Health Services Administration

(SAMSHA). The opinions, findings conclusions and recommendations expressed in this publication/program/exhibit are

those of the author(s) and do not necessarily represent the official views of the United States Department of Health and

Human Services, SAMSHA or the State of Nevada.

Nevada students with ANA President,

Ernest J. Grant, PhD, RN, FAAN.

August, September, October 2019 Nevada RNformation • Page 15

Nurses in the News

By Tracey Long PhD, RN, APRN

Nursing is a bitter-sweet profession. It’s a human profession where

life and death are met frequently by nurses. Nurses hold the gift of

life in their delicate hands and can often make the difference between

healing and harm. Several recent studies in the news featured this


An international news story that featured the power for harm by

a nurse is that of German male nurse Niels Hogel from Oldenburg,

Germany who is now serving life in prison after admitting to dozens

of murders of patients while working as an ICU nurse. Officials now

suspect and are investigating potentially 300 patient murders since

2000. Staff noticed there were more deaths during his shift in the

ICU, yet there was “a culture of looking away and keeping your head

down” stated a nurse colleague. Prosecutors said he ironically created

the very life-and-death situations that he would respond to in order to

appear a hero for which he was earlier awarded. He would administer

lethal doses of cardiac drugs that caused cardiac arrest and was

known as “Resuscitation Rambo” when he would heroically respond

to the code. Many patients didn’t recover. If this news story is deeply

unsettling to you, that’s good. It should bother you at your core for his

inhumane actions to those in his care who trusted him. It should also

bother you about those nurses who looked the other way and didn’t

speak up about suspicious activity. Nursing is a team sport and as

Florence Nightingale said, “the noblest of professions.”

Nursing should be the purest form of patient advocacy and a

fierce defense for human life. May we all be better committed

through this story to work with each other as we serve and protect

our patients. For more on this story go to:




Nurses are often the first to see new life. A polar opposite to the

above news story is about nine maternity ward nurses who are


From left: Tara Randazzo, Clare Perkins, Melissa Souza, Pam Tarr, Katelyn

Berry, Kristen Doane, Vanessa Amato, Lauren Buchan and Ruth Lucien. –

Courtesy of Beverly Hospital, Boston, MA.

working hard to bring in new precious life. They have all been pregnant

at the same time and work on the same maternity ward in Boston,

Massachusetts. They walk the talk of caring for pregnant women

and teach mothers how to care for their own bodies, which directly

strengthens the health of their baby. All nurses who never work in a

maternity ward also have that privilege to teach patients to better

honor their own body by daily choices towards healthy behavior.

The New York Times featured nurses in the news as attention

has focused on recent statistics that as many as one in four nurses

experience post-traumatic stress disorder at some time during their

career. Those at highest risk are working in critical care units or organ

transplant care. Nurses have difficult discussions with family members

and patients about life and death decisions, and work with patients

with narcotic addiction, abuse, mental health disorders, disheartening

living situations, violence, despair, fatal diseases and are often

subjects of ungrateful and even violent patients in return. The stressful

working environment of nurses can trigger the same distress as posttraumatic

disorder. Current studies about the resilience of nurses have

identified that humor, optimism and social support can help nurses

cope with the stresses of the job and find satisfaction and even joy in

our profession.

For more on this story go to:


Nurses in the news help us remember the privilege it is to be a

nurse and the importance of self-care as our profession requires your

best self. Effective nursing isn’t just for the patient in the bed- but

giving healing nursing care extends to each other.

The Research and Evidence Based Practice Council at UMC would

like to invite all healthcare professionals (including students) to

participate in a poster session.

2019 UMC Research Empowerment Day

Poster Session

When: September 11, 2019 (7am to 5pm)

Where: The Cafeteria at UMC 1800 W Charleston Blvd

There is still time to submit a Poster abstracts -

the deadline is July 21st!!

Please request full abstract/poster information by emailing

Page 16 • Nevada RNformation August, September, October 2019

Nevada Nurses Foundation EST 2014

On behalf of the Nevada Nurses Foundation,

congratulations to the 2019 Nevada Nurses

Foundation spring scholarship and grant

recipients. There were 80 scholarship

applications this spring and the following

recipients each received $1,000.00 to offset

the cost of their tuition, books, and other

educational expenses which may prevent

someone from seeking an advanced degree.

Thank you to our wonderful judges this

spring, including: Dr. Mary Bemker, Dr. Mary

Bondmass, Dr. Judi Carrion, Vicky Lang Catlin,

Maria D’Errico, Caren Jaggers, Dr. Heidi

Johnston, Dr. Jennifer McCarthy, Debra Scott,

Dawn Taylor, Dr. Wei-Chen Tung, Dave Tyrell

and Julie Wagner.

The Nevada Nurses Foundation offers eight

scholarships in the spring and the fall annually.

The categories are; Certified Nursing Assistant

(CNA), Licensed Practical Nurse (LPN), Prelicensure

to Nursing, CNA to Registered

Nursing (RN), LPN to RN, RN to Bachelors of

Science in Nursing (BSN), and Masters and

Doctorate degrees. Congratulations 2019


Many thanks to the Legacy Scholarship

Sponsors for giving students an opportunity

to worry less about their finances and thrive

more in their educational journey. Thank

you, to the 2018 Shining Stars scholarship

sponsors, including: Optum Health, for

sponsoring two $1,000 scholarships, Teresa

Praus, APRN and Dr. Ian Choe for gifting

legacy scholarships since 2016, and Dr.

Debera Thomas, Dean at Orvis School of

Nursing University of Nevada, Reno, who

created the Orvis School of Nursing Family

Nurse Practitioner Scholarship in the amount

of $1,000. Carson Tahoe Health has sponsored

the Jesse J. Valentine Legacy Scholarship

since 2016 and has been a Big Hat High Tea

Ruby Sponsors since 2016! Thank you to

everyone who has believed in the Nevada

Nurses Foundation and contributed to helping

us in awarding over $91,500 in scholarships,

and $3,908.16 in grants since our fruition.

The grant application is open from October

to February and located on our website. Nora

Lusk, BSN, RN, CEN, the 2018 Nevada Nurses

Foundation grant recipient and an emergency

nurse at Northeastern Nevada Regional

Hospital, is building a healthier tomorrow

for rural Nevada because of the grant she

received in 2018. She reports using the grant

money to pay for two Nevada nurses from

Elko, Nevada to receive extensive training on

sexual assault nurse examination. Victims of

sexual assault have been able to be seen in

their home town, rather than driving several

hours to be examined. Although Nora and her

committee’s efforts are making a difference,

they seek support and funding from the

community and hospital in Elko, Nevada to

increase access of quality healthcare for the

victims of assault.

Dawn Taylor, MSN, RN,

an Assistant Professor

at the Nevada State

College received a 2019

grant. She is a previous

Nevada Nurses Foundation

scholarship recipient and

current grant recipient

pursuing her PhD at the

University of Colorado and


How do you express yourself? Therapists

like to encourage individuals to journal and

“write it down,” but I’m not a therapist, and

find that many people do not naturally journal

as a method of reflection. In a busy world of

movement and demands on our personhood,

it is easy to leave behind feelings of hurt and

never return to them or reflect on them. The

research I propose, asks sex/gender diverse

females who have past experience of intimate

partner violence from another female, to

do just that – reflect on where they have

been and the journey that has led them to a

better place, or a place of healing. To explore

what the meaning of that journey has meant

to them, I plan to co-create the research

with them. Aesthetic means are fantastic at

encouraging reflection and a starting point for

an interview, where the subject matter is hard

and a relationship between the researcher

and the participant is still untested and new.

Developing trust can be augmented through

the use of technology, such as disposable

cameras to take pictures, and provide a

tentative look back on where the journey

began and how it has changed over time.

As human beings, we are more comfortable

where many similarities exist between

ourselves and others. We find that we are

increasingly divisive as soon as we label

ourselves by gender. Arguments have been

made that females are considered to be

oppressed and secondary to males. Moreover,

when we consider gender with sexual

diversity, the vulnerability and disparity gap

becomes increasingly wider. A storyboard

is considered as a way of visualizing that

photographic journey along a time line, and

consistent with a phenomenological approach,

permits a deeper reflection on healing for

sex/gender diverse females after having

experienced intimate partner violence from

another female. During the interview the

meaning of this journey towards a healing

environment is explored existentially and in

its ability to help that person express what

healing looks like in the future chapters of

their lives.

Live in Las Vegas!

We offer outstanding career opportunities for qualified people who

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customer service.

We are currently recruiting full-time and per diem

Registered Nurses and other Clinical Support

Come Join the Family! Apply online.

Our employees enjoy opportunities for professional development and

career advancement, as well as a competitive compensation and

benefits package. We offer:

* Growth Opportunities * Vacation, Sick, Holiday Pay

* Generous 401k * Medical/Dental/Vision

* Education Reimbursement

Recruiter: (702) 657-5580


August, September, October 2019 Nevada RNformation • Page 17

Nevada Nurses Foundation EST 2014






The Foundation recognizes students, nurses and partners at all

events funded by the Nevada Nurses Foundation. Two events we hold

annually are the “Crowns and Tiaras” Big Hat High Tea and Shining

Stars of Nursing in Nevada. On June 1st the Foundation hosted the

5th annual Big Hat High Tea at the Governor’s Mansion. The ambiance,

food, entertainment, raffle prizes, and silent auction gifts are all

exquisite! Many dress up according to the theme. Thank you to the

many wonderful volunteers including: Nicki Aaker, Karen Bearer, Dr.

Mary Bondmass, Vicky Lang Catlin, Rocio Cruz, Dr. Glenn Hagerstrom,

Caren Jaggers, Dr. Heidi Johnston (2015 scholarship recipient), Sandy

Kinser, Cassidy Knight, Emily Koestner, Madelon Lawson, Mariah Miles

(2019 scholarship recipient), Alyx Olguin, Dave Owens, Carolyn and

Lyle Pritchett, Dawn Taylor (2017 scholarship & 2019 grant recipient),

Dave Tyrell, Dr. Julie Wagner, Val Wedler.

Val Wedler and Dr. Glenn Hagerstrom

helping at the Crowns & Tiaras Big

Hat High Tea.

The Shining Stars of Nursing in

Nevada Gala information may be

accessed through the Nevada Nurses

Foundation’s website at https:// The

Foundation honors and recognizes

Shining Stars throughout Nevada.

Last year, the Gala was at the Nugget

Casino inside the Celebrity Showroom

and in 2019, The Shining Stars will be

held at The Blind Center of Nevada, in

Las Vegas, Nevada. Serving our Battle

Born State and increasing access to

quality healthcare takes a village.

Please consider being a volunteer,

attending, sponsoring a ticket for a

recipient, donating raffle prizes, silent

auction gifts or your time, service and

resources, or being a judge. No gift is

too small! Everything helps! Contact us


The Foundation is a non-profit organization and the charitable and

philanthropic arm of the Nevada Nurses Association (NNA). Because

the NNA was instrumental to our existence by giving seed money to

the Foundation in 2014 and sharing resources, staff, and invaluable

time and expertise, the Foundation awards extra points to any NNA

member who applies for a scholarship or grant.

Thank you and have great days,

Sandra M. Olguin, DNP, MSN, RN

President and Chief Executive Officer

Nevada Nurses Foundation

Page 18 • Nevada RNformation August, September, October 2019

Menu Labels: Providing a Key to Eradicate Obesity and Help Diabetes

By Daniris L Hill, BSN, RN

Eating out has increased in the past

few decades. Individuals, for convenience,

social or lifestyle reasons, either chose to

pick something fast or eat out with family

and friends. Eating out may be one of the

reasons that for the past few decades the

United States has been battling obesity and

its complications such as diabetes. Obesity

continues to increase gradually and it will

take different approaches applied gradually to

eradicate it. One approach could be the use of

menu labels.

In an effort to address the obesity

epidemic and minimize its complications,

Healthy People 2020 has a Leading Health

Indicator, “Nutrition, Physical Activity, and

Obesity,” and a goal to reduce the prevalence

of adult obesity from 35.9% in 2005-2008

to 20.5% in 2020 (United Nations, 2015).

One regulation that can help reduce obesity

and its complications, such as diabetes is

section 4205 of the Affordable Care Act

which has been enforced by the Food & Drug

Administration (FDA) since May 7, 2018 (U.S.

Food & Drug Administration [FDA], n.d.). It’s

mandatory menu labeling requires that food

establishments display information for the

foods or the portions of foods they serve, such

as total calories, total fat, saturated and trans

fat, cholesterol, sodium and carbohydrates

(Federal Register: The Daily Journal of the

United States Government, 2014).

Examples of food establishments required

to apply this ruling are sit-down/quick service

restaurants, bakeries, grocery/convenience

stores and movie theaters (FDA, n.d.).

On the other hand, examples of foods or

establishments that are not required to

comply with this ruling are foods sold by

weight intended for more than one person,

foods sold in transport vehicles, foods sold in

schools pertaining to the national school lunch

and school breakfast program, foods that can

be eaten on several occasions, foods sold in

bulk, foods requiring additional preparation

prior to consumption, and establishments with

less than 20 locations (FDA, n.d.).

In the United States, Americans spent

more than $700 billion dollars in restaurants

in 2016, or more than $1.9 billion daily (Tod

Marks, 2016). Reale & Flint (2016) argued that

modern ways of living such as households in

which both parents work leads to eating out

expenditures and less time for preparation of

meals at home. Restaurants’ foods have a high

energy density or high calories and portions

are usually larger contributing to weight gain

(Reale & Flint, 2016). This has led to the

importance of providing nutritional information

at restaurants and food establishments.

In addition, there is an underestimation of

nutritional content when eating out. One

solution is to make an “intervention at a

national level” (Reale & Flint, 2016, para. 3)

such as section 4205, so consumers can make

informed nutritional choices.

One hundred million transactions from

purchases made at Starbucks in New York City

prior to and after implementation of menu

labels were analyzed. These transactions

showed a 6% reduction in energy content

foods ordered including drinks and solids. This

study was compared with “control” Starbucks

in Boston and Philadelphia that did not adhere

to menu labels at the time of this study

(VanEpps, Roberto, Park, Economos, & Bleich,

2016). A comparison of 884 card-holders

from the 100 million transactions was done.

The card-holders purchased at nearby food

establishments without menu labels and these

transactions showed that the same individuals

purchased food with less energy density

after exposure to menu labels (VanEpps et

al., 2016). This shows that menu labels may

lead to sustainability of benefits in which

consumers adopt and then continue to make

healthy choices when eating out.

Studies shows that obesity is linked to

the development of other conditions such as

diabetes (Bleich et al., 2017; Block & Roberto,

2014; Burton et al., 2006; Chobot et al., 2018;

Reale & Flint, 2016; VanEpps et al., 2016).

Utilizing menu labels offers communities

the opportunity to make healthy informed

choices when eating out (Vanderlee et al.,

2016). By making healthy choices health

care professionals and communities can

gradually contribute to eradicating the obesity

epidemic and benefiting individuals who also

have diabetes. Menu labels can also motivate

the population to eat healthier even when

not eating out and lead the food industry

to modify menus and offer better choices

that meets recommended nutritional daily


References Available on Request

August, September, October 2019 Nevada RNformation • Page 19

An Invitation to: “Thousands of Reasons to Celebrate Nurses”

In Jeans, Jackets and Jewels

By Elizabeth Fildes and the

2019 Future of Nursing in Nevada (FONN) Committee

The Nevada Action Coalition (NAC) remains one of the driving forces

engaged in transforming healthcare through nursing in our state. To

support NAC’s important work and to honor nurses in Nevada, the

4th Annual Future of Nursing in Nevada will be on Saturday,

September 7, 2019, at the Red Rock Country Club. All funds raised

from “Future of Nursing Awards Celebration” will support both nursing

scholarships and the work of the Nevada Action Coalition.

Quick synopsis of the event is as follows:

Fifteen NAC Scholarship recipients will be announced;

Nurses who completed their BSN, MSN, DNP, PhD, and other

advanced degrees (2018-2019) will be honored;

Nurses who attained specialty certifications (2018 – 2019) will be


Outstanding RNs, LPNs and CNAs will be honored in the following


• Diversity Nurse Champion

• NAC Nightingale Award

• Rising Star-Student Nurse

• Nurse Educator of the Year

• Nurse Innovator of the Year

• Nurse Entrepreneur of the Year

• Researcher of the Year

• LPN of the Year

• CNA of the Year

• Nurse Advocate of the Year

• Case Management Nurse of the Year

• Future Nurse Leader

• 3 Under 30

• 4 Under 40

• 5 Under 50

• 6 Under 60

• 7 Under 70

• Nurses Choice, Chief Nursing Officer

• Outstanding Retired Nurse

• Nurses on Boards

• NV FAANs 2018/2019 Batch.

Doors will open at 5 pm and Registration will begin at 5:30 pm.

Cocktails and Silent Auction will be from 5:30 pm – 7 pm. Dinner will

be served at 7:15 pm and the program will be underway by 8 pm.

Please go to the for:

Nomination Forms

Sponsorship/Souvenir Program Advertisement Forms

NAC Scholarship Application Forms

If you have any questions, concerns or need additional information,

please email us at

Nevada Nursing Students...continued from page 14

the board of NSNA: Aaron “AJ” Cook – Vice-President, Stephanie Bell

– Director, and Lauren Shipton – Nominating and Elections Committee

West. All three officers are current nursing students at UNLV. For a

fledgling organization, the NVNSA is making our state known at the

national level.

Overall the experience at the national convention was amazing and

inspiring for me. I was able to network with students from across

the country, explore career paths with different organizations, and

expand my horizons. In addition to all of the wonderful things at the

convention, it also made me want to get more involved in the local and

state level. My experience at Nationals inspired me to run for, and get

elected to, a state position with NVNSA. I am excited about the future

and look forward to what tomorrow holds.

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