New Hampshire - June 2020

New Hampshire Nursing News
Year of the Nurse 2020
Official Newsletter of New Hampshire Nurses Association
Quarterly publication direct mailed to approximately 1,250 Registered Nurses and LPNs and delivered
electronically via email to 16,500 Registered Nurses and LPNs in New Hampshire.
June 2020 | Vol. 44 No. 3
www.NHNurses.org
Florence Nightingale (1820-1910)
2020 STUDENT NURSE
OF THE YEAR
The student nurse of the year award
is given to a student nurse in a prelicensure
entry program who embodies
the finest qualities of nursing. Unable to
celebrate nursing students in the state
of New Hampshire with our Annual
Student Nursing Conference in the midst
of the COVID-19 closure, NHNA felt it
was important to recognize excellence.
Graduating students were unable to
celebrate traditional graduations but
will soon be on the front lines caring
for New Hampshire citizens and
communities.
The Student Nurse Award was bestowed
virtually. Five deserving students were
nominated and judged by the NHNA
Commission on Nursing Practice based
on qualities include caring, professionalism, advocacy,
leadership and involvement. 2020 nominees were:
Shadane Davis, St. Joseph School of Nursing
Devon Fortier, University of New Hampshire
Emily Galasyn, Rivier University
Laura Howard, University of New Hampshire
current resident or
Laura Howard with her
senior capstone preceptor at
Littleton Regional Hospital,
Riley Vashaw RN
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371
Adam Therrien, Manchester Community
College
The recipient of the 2020 Award is
Laura Howard from the University of
New Hampshire. Laura was described
by her professors as mature, curious,
responsible, patient, and focused.
Early in her schooling Laura began to
define her philosophy of nursing which
expressed an understanding that nursing
was more than just treating an illness
but involved, “treating the entirety of
a person in body, mind, and spirit.” In
addition to her majoring in nursing,
Laura is minoring in Gerontology to
improve her readiness to care for this
complex population. During her time at
UNH, Laura served as both a Student
Nurse Ambassador and Student Nurse Mentor. Laura’s
peers have described her as compassionate, professional,
always on time, and a leader.
NHNA, the Commission on Clinical Practice and the
nurses of New Hampshire offer their congratulations to
Laura Howard and the excellent nominees.
2020 NURSE PRACTITIONER
OF THE YEAR
The New Hampshire Nurse Practitioner
of the Year Award is typically announced
during the Annual Spring meeting and
banquet. This year, the NP Association
joined many others in education, religion,
and business by celebrating the honoree
virtually in an online ceremony on April 9.
The recipient of the 2020 honors is Mary
Vigeant MSN APRN. Vigeant has practiced
in the Emergency Department of Memorial
Hospital in North Conway for almost 20
years.
Memorial Hospital Chief Medical Office Dr. Matthew
Dunn noted that Mary “serves as a role model to us
all for what it means to be dedicated to
your profession, your organization, and
community. She is tireless in her efforts to
continuously improve all of what we do.
Mary is an excellent clinician and it is a
pleasure to work with her.”
Vigeant was recently elected President
of the Medical staff by her colleagues,
a responsibility that recognizes the role
nurse practitioners play at Memorial and
honors her ability to lead and represent her
medical colleagues. “Years ago, Memorial
recognized we needed everybody if we were going to
move forward,” she says. “The medical staff bylaws were
changed to fit that culture. We were the first in the
state to recognize everyone who was practicing
within their capabilities. We made everyone equal.”
The former college English major began her nursing
career working as a nurse’s aide during summer
vacation. “I thoroughly enjoyed it.” Vigeant was an
LPN while she attended Salve Regina College for her
BSN. She obtained her Masters at Simmons College.
She established her focus in emergency care at St.
Luke’s Hospital, near Boston, while preparing for her
NP exam. “I always knew that emergency medicine
was in my heart.” At that time, she says most NP
programs prepared graduates for primary care
roles. She was the first NP hired in the St. Luke’s
Please be sure to notify us with address
changes/corrections. We have a very large list
to keep updated. If the nurse listed no longer
lives at this address – please notify us to
discontinue delivery. Thank You!
Please call 877-810-5972, extension 701 or
email to office@nhnurses.org with
Nursing News in the subject line.
Index
President’s Message............................... 2
From the ED’s Desk................................ 3
2020 Graduating Student Conference Cancelled........... 4
Management Minute............................... 4
Littleton Hospital Acquires New Sim Lab................. 4
In My Opinion .................................... 5
Board of Nursing Responds to State of Emergency......... 6
NHNA in Alliance to Support Senior Facilities ............. 7
APRN Column.................................... 8
KUDOS......................................... 8
Loon Chocolates Deliver Joy to Nurses.................. 8
Family Centered Maternity Care and COVID-19............ 9
Past, Present and Future of Nurse Anesthetists............10
Home Care Nurses Caring for Recovering Patients .........11
Board of Nursing News .............................11
Nurses on the Web ................................12
From the Bookshelf................................13
Humor Me.......................................13
Welcome New and Returning NHNA Members!............14
Nurse in Key Role in New Geriatric Program..............14
NCLEX Reconsidered...............................15
NH Nurses Make It Happen ..........................15
Be Part of Research................................15
School of Nursing News.............................16
Florence Nightingale – Lamp of Scutari .................17
In Memory of Our Colleagues...................... 18-19
emergency department where one of her research projects
was exploring the medical and financial benefits of using
nurse practitioners in emergency medicine. St. Luke’s today,
she says, has an emergency staff of half medical doctors
and half nurse practitioners.
By the late 1990s, Vigeant and her husband had a second
home in the Conway area. She inquired at Memorial about
working as a per diem but Memorial was not interested in
hiring nurse practitioners at the time. A few years later a fulltime
job was worked out.
In accepting the award Vigeant noted “This really is an
award to be accepted on behalf of my medical staff. It’s a
culture that is warm and welcoming. I’ve been blessed and
fortunate to work with wonderful clinicians on medical
staffs my entire career.”
In the Next Issue:
• Winners of the 2020 Excellence in Nursing Awards
• Florence Nightingale: The Later Years

Page 2 • New Hampshire Nursing News June, July, August 2020
Guidelines for Submissions to NH Nursing News
NH Nursing News (NHNN) is the official publication
of the NH Nurses’ Association (NHNA), published
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submission of nursing and health related news items,
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and contact information. Authors should state any
potential conflict of interest and identify any applicable
Nurses, once again, are
asserting their place in
history. The past weeks
have challenged you and
yet, you have remained
strong and dedicated,
committed to facing the
COVID-19 pandemic
head-on and with sleeves
rolled up. In my role as
NHNA president, I’ve had
the privilege of seeing the
global New Hampshire
nursing response to the
commercial affiliation. Email as
attachments to office@nhnurses.
org with NN Submission in the
subject line.
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PRESIDENT’S MESSAGE
Janice Deziel
call to duty and the advocacy of patients and peers.
Here is but a snapshot of what the NHNA has seen
and heard about what nurses are doing throughout
the state:
• Working on the frontlines in Emergency
Departments, ICUs, and COVID-19 dedicated
units, accepting the risks to themselves and
their families.
Faculty Positions in Nursing
School of Nursing & Health Sciences
We celebrate diverse undergraduate and graduate academic
programs, outstanding faculty and a strong community partnership
with Dartmouth-Hitchcock Health.
We are seeking multiple innovative, energetic nurse educators
to teach in both the classroom and clinical setting. Applications
for tenure-track and non-tenure track, full-time faculty positions
beginning September 1, 2020 are now being requested.
Qualifications:
1. A doctoral degree is preferred; a Master of Science in Nursing
is required.
2. Demonstrate and possess a strong record of collegiate teaching.
3. A philosophy of education consistent with Colby-Sawyer’s
programs and mission is required.
4. Expert-clinician who has a strong desire for an academic
appointment focused on advancing knowledge through
integrating teaching, clinical practice, scholarship and service.
5. Strong interest in mentoring and advising undergraduate and
graduate students.
To Apply
To apply, submit a current CV, letter of application, statement
of teaching philosophy, sample syllabi if available, and names
and telephone numbers/e-mail addresses of three references to
CSCjobs@colby-sawyer.edu.
• Taking care of and protecting the most
vulnerable in our population: the elderly and
those with special needs.
• Signing up, in large numbers, for volunteer
opportunities.
• Coming out of retirement to contribute to the
need for nursing expertise.
• Thanking first responders, recognizing that
healthcare truly is a team sport.
• Cross-training, learning new skills to take on
roles needed to address this novel pandemic.
• Innovating to provide much needed supplies.
• Supporting one another, keeping each other
strong.
Witnessing this level of dedication has been
awe-inspiring and I thank you for all that you are
doing. Information regarding the NHNA activities
of the past several weeks is readily available on
the website. There is a lot behind the scenes
that the NHNA is doing to advocate for the
nursing profession. Please read the Executive
Director’s column for all the details, activities and
accomplishments.
On a national level, the ANA and Johnson &
Johnson created a series of podcasts on the
nursing profession for 2020, the Year of the Nurse
called See You Now. They have since paused their
regularly scheduled programming to produce and
broadcast stories from nurses serving in various
roles during the pandemic. Storytelling conveys
important information, concepts, and cultural mores
in a way that no written word can. The stories in
these podcasts will leave you feeling inspired,
humbled, and proud. I encourage you to listen –
they are brief yet powerful.
As difficult as the past several weeks have been,
never have I seen greater respect for the nursing
profession. The collective power that you wield has
consistently been used wisely and for the greater
good of all people and our world is responding in
kind, turning to you for care and guidance. When
called upon during the most challenging of times,
you have answered without hesitation. You are
honorable people with a solid foundation of ethics
and a love of mankind that serves as your moral
compass.
With gratitude for the privilege of being a nurse
among you,
Janice Deziel
President, NHNA
New Hampshire
NURSING NEWS
Vol. 44 No. 3
Official publication of the New Hampshire Nurses’
Association (NHNA), a constituent member of the
American Nurses Association. Published quarterly
every December, March, June, and September. Library
subscription rate is $30. ISSN 0029-6538
Editorial Offices
New Hampshire Nurses Association, 25 Hall St., Unit
1E, Concord, NH 03301. Ph (877) 810-5972, E-mail
office@NHNurses.org
Editor: Susan Fetzer, RN, PhD
NHNA Staff
Joan Widmer, RN, Nurse Executive Director
Paula MacKinnon RN, Executive Assistant/
Communications Specialist
Beth Dow RN, Event Coordinator
NURSING NEWS is indexed in the Cumulative Nursing
Index to Nursing and Allied Health Literature (CINAHL)
and International Nursing Index.
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VISION STATEMENT
Empower New Hampshire nurses as leaders in
advancing the profession of nursing and the health of
New Hampshire.
MISSION STATEMENT
NHNA, as a constituent member of the American
Nurses Association, exists to promote the practice,
development and well being of NH nurses through
education, empowerment and healthcare advocacy.
Adopted 10-20-2010.
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June, July, August 2020 New Hampshire Nursing News • Page 3
FROM THE ED’S DESK
The world has changed dramatically. How we work, how we
learn, how we live has changed markedly over the past three
months. And the work of New Hampshire Nurses Association
(NHNA) has changed as well.
NHNA’s single largest fund raising event of the year, the
Graduating Student Conference & Career Fair, was cancelled
in late March due to campus closures and social distancing
directives. Meetings of the NHNA Board of Directors and the
various Commissions were cancelled between mid-March and
mid-April and then transitioned to teleconferencing platforms
as the new norm is established.
Joan Widmer
The day-to-day work of the NHNA staff focuses on addressing
issues and concerns related to the COVID-19 pandemic. The number of daily calls to the
NHNA office and email outreaches through the Contact Us on the NHNA website has
increased significantly. Nurses call with concerns regarding personal protection equipment
and spreading the virus to their families; retired nurses seek ways to volunteer to help and
media outlets contact NHNA with questions.
During March and April you may have seen or heard NHNA representing the nurses of
New Hampshire. NHNA representatives were interviewed and featured on WMUR (March
24, March 25), NHPR (April 3, April 9, April 27), Valley News (March 28), Union Leader
(April 2, April 13) and the Keene Sentinel (April 4). These represent more media outreaches
that I’ve encountered during my four year tenure with NHNA!
NHNA has developed a series of webpages to keep New Hampshire nurses informed
about the COVID-19 pandemic with vetted resources from the New Hampshire
Department of Health and Human Services, the Centers for Disease Control & Prevention
(CDC) and the American Nurses Association (ANA). NHNA developed guidance for nurses
on steps to take after their shift to minimize risks associated with transmitting COVID-19
which is posted on the NHNA website.
As the weeks wore on, with no signs of the abatement of the healthcare crisis, we
developed a webpage of self-care resources to help nurses cope with the prolonged stress
of caring for patients during this crisis and coping with the major societal changes impacting
their daily lives. As nurses started to experience reduced hours, reduced pay, furloughs
and/or layoffs, we developed a webpage featuring resources to help nurses cope with the
financial stressors necessitated by COVID-19 healthcare crisis.
NHNA created a 30-second public service announcement regarding social distancing and
handwashing.
“You trusted us when your baby was born. You trusted us when your loved one was
sick. You trusted us when your child was at school. Please trust us now. We ask you to
please stay at home. We ask you to practice social distancing and stay at least six feet
apart. We ask you to please wash your hands. We ask you this to protect the vulnerable.
Trust New Hampshire nurses to help us through this difficult time.”
We sought and received the support of the New Hampshire Association of Nurse
Anesthetists, the New Hampshire Nurse Practitioner Association, the New Hampshire
chapter of the American Association of Women’s Health and Neonatal Nurses, Southern
New Hampshire Oncology Nurses and the New Hampshire School Nurses Association
for this Public Service Announcement (PSA). The PSA aired ten times on WMUR (between
April 10 and April 17). It has over 3,100 views on YouTube (https://www.youtube.com/
watch?v=sAbovjqsZ7c).
After receiving numerous calls from nurses seeking to volunteer, we asked DHHS if they
would find a list of potential volunteers helpful. We were encouraged to proceed so we
sent a survey to our members and followers list serve (about 10,000 names) and received
over 600 responses in a week. This information was shared with DHHS and with 10
nursing organizations around the state, as well as the Nashua Department of Public Health.
When state Senator Tom Sherman reached out looking for volunteers to help with a
project emanating from MIT to provide a daily check-in with New Hampshire nursing
homes, we reached out to these potential volunteers again. Over 120 potential volunteers
responded to this request and the Covid Alliance Senior Support Team was founded
(https://covidalliance.com/sst). Past President of NHNA, Dr. Judy A. Joy, assumed the role of
Statewide Volunteer Coordinator. Paula MacKinnon developed the online data collection
tool and set-up a website for the project. Traci Fairbanks, Carla Smith and Susan Smith are
a few of the volunteers serving as Regional Liaison Coordinators.
When the Red Cross reached out seeking volunteers to help with their blood drives, we
sent a follow up email to these 600 survey respondents sharing information regarding how
to volunteer with the Red Cross.
NHNA has responded to numerous outreaches from New Hampshire’s Congressional
delegation, including Senator Jeanne Shaheen, Congresswoman Annie Kuster and
Congressman Chris Pappas. We worked with Senator Shaheen’s office to understand the
issues of fingerprinting to register to sit for NCLEX and how to address the closure of the
state police office after the stay at home order. The National Council of State Boards of
Nursing (NCSBN), which requires an FBI background check to register for NCLEX, issued a
waiver for this requirement during the current healthcare crisis.
We spoke with Congresswomen Kuster regarding the issue of hazard pay for frontline
workers, particularly nursing staff working in long term care. Congresswoman Kuster
indicated she would look into this and shortly after this discussion, Governor Sununu
announced his program for a $300 weekly stipend for health care workers in Medicaid
approved long term care facilities. The Congress is also considering additional legislation,
the Heroes Act, to support essential, frontline workers. We have regularly touched base
with Congressman Pappas’s office regarding the ongoing need for PPE.
We have worked with the Board of Nursing and the Office of Professional Licensure and
Occupations to address emergent needs related to the COVID-19 pandemic. We discussed
issues related to streamlining re-entry into licensure for nurses with retired and lapsed
licensees. We discussed the transition of senior nursing students through the licensure
process, and encouraging nursing students to seek their LNA license for work in long term
care facilities. Nursing students working as LNAs will help ease the dangerous staffing
shortages occurring when COVID-19 infections arise in a facility, while giving the students
increased experience providing patient care. We worked with a group of stakeholders to
develop the Temporary Health Partner role, an unlicensed care aide to work in long term
care in nursing teams with license nursing assistants (LNA), to help provide activities of
daily living care.
All of us at NHNA are working to support you, our members, during this challenging time.
We are all in this together and together we are strong. Together we have a voice.
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Page 4 • New Hampshire Nursing News June, July, August 2020
2020 GRADUATING STUDENT
CONFERENCE CANCELLED
Graduating Student
Conference & Career Fair
Co-Sponsor:
Southern New Hampshire University
Gold Sponsors
Dartmouth-Hitchcock
Encompass Health
Granite State College
Southern New Hampshire Health
Wentworth-Douglass Hospital
Silver Sponsors
Cheshire Medical Center
Concord Hospital
North Country Health
NSO
River Woods
VNA Health Systems of No New England
Exhibitors
Brattleboro Retreat
Catholic Medical Center
Chamberlain University
Elliot Hospital
Franklin VNA
Genesis
Littleton Regional Hospital
LRGHealthcare
New Hampshire Hospital
New Hampshire Veterans Home
Northern Light
Rivier University
Saint Joseph College of Maine
Speare Memorial Hospital
United States Army
University of New Hampshire
University of Rhode Island
University of Vermont Medical Ctr.
Western Governor’s University
Everyone has been touched in many ways by the
COVID-19 pandemic, but the Class of 2020 has been
particularly challenged. Both from the aspects of
completing the academic requirements remotely to
enable them to graduate, and from the loss of all the
traditional programs that help graduating students
celebrate their transition from student to a working
member of society. Each year the New Hampshire
Nurses Association (NHNA) hosts the Graduating
Student Conference and Career Fair for nursing students
across the state who are in the final year of their nursing
program. This year’s Conference was scheduled to be
held on March 29th on the campus of Southern New
Hampshire University, our co-host for this wonderful
event. Sadly, the event was cancelled and the planned
site for this Conference was reconfigured into one of
thirteen flex hospitals designed to care for patients
during the anticipated surge of COVID-19 patients.
New Hampshire Nurses Association fully refunded all
registration fees. However, we received permission
MANAGEMENT MINUTE
The new normal is likely to include more virtual and
fewer face-to-face meetings. With technology allowing
for many participants, seeing 10 or more faces at the
same time can get distracting. When your mind starts
to wander, you have no idea what the last person said.
Perhaps you pretend to listen while checking your inbox
and answer emails. By the end of the meeting, does it
seems like a waste of time?
A recent article in the Harvard Review, Gershman (2020)
provides five suggestions for more effective virtual
meetings.
1. Before the meeting, determine the purpose of the
meeting and what you can contribute. If you do not
have a critical role, determine what you hope to
learn.
2. Before you raise a new topic, reiterate what you
just heard or the previous point you are addressing.
from planned speakers to post their presentations and
handouts on the NHNA website. We worked with the
planned sponsors and exhibitors to create a Graduating
Student Nurse Career Resource Guidebook. The
Guidebook lists each of the sponsors and exhibitors
with contact information for their human resource
department and an information pitch, prepared by the
organization, sharing the benefits of working at their
organization. Available links to the organization’s online
career resource webpages are included. The Guidebook
was emailed to every registrant of the Graduating Student
Conference & Career Fair and posted to the NHNA
website on a specially created webpage: Graduating
Student Nurse Conference.
NHNA wishes to extend a thank you to all the planned
sponsors and exhibitors for the Graduating Student
Conference & Career Fair. We look forward to meeting
the Class of 2021 in person!
People are more likely
to listen if they first feel
they have been heard.
3. Summarize frequently
stated comments to
guide the conversation.
4. Write down wandering thoughts
during the meeting allowing you to be more present
and ready to listen.
5. Don’t be afraid to ask a clarifying question “I
apologize, I lost track of the conversation for a
moment. Could someone help me understand why
we are focusing on ……”
Gerhman notes that the bigger the group, the less
responsibility each person feels to ensure success. One
of the best ways to be heard in a virtual meeting is to be
an active listener.
Littleton Hospital Acquires New Sim Lab
Glencliff Home
is accepting applications for
Registered Nurses I-III
Salary Range: $50,835.20 - $71,052.80
Licensed Practical Nurses I-II
Salary Range: $45,177.60 - $57,408.00
Additional 15% Enhancement on Salary Base (Not Included)
40 hours/week – All Shifts and Part-time Available
Direct Care an additional $1,040.00
Add additional 2nd shift diff. at $4,160.00
Add additional 3rd shift diff. at $7,280.00
To provide professional nursing care to residents within an
assigned unit and provide and support medical care as directed
by medical staff and pursuant to objectives and policies of the
nursing department and Glencliff Home. Must possess and
maintain a current license as a RN/LPN in NH. Salary and Position
determined by years of experience and certifications.
State of New Hampshire Benefit Package!
Health/Dental/Vision/Prescription plan
Single $22/ 2-Person $44/ Family $66 (Bi-Weekly)
L. Todd Bickford, Administrator
393 High Street, PO Box 76, Glencliff, NH 03238
(603) 989-5203 | Louis.Bickford@dhhs.nh.gov
Applications can be completed and benefits reviewed online at
https://das.nh.gov/hr/index.aspx
Equal Opportunity Employer
The Littleton Regional Healthcare (LRH) Fundraising
Committee approved the purchase of high-fidelity
training manikins, and investment of $100,000 for
a state of the art Simulation Lab. The funding was
supported by large and small donors who had
not designated their donation other than an area
of greatest need. The Sim Lab will be available to
new graduate nurses, nursing assistants (LNAs),
medical assistants (MAs), respiratory therapists, and
physicians.
Full-Time Nurse Trainer Opportunity at
One Sky Community Services!
Office-based position at a non-profit agency in
Portsmouth, NH, supporting individuals with DD, ABD/ABI,
and their families. Must be an RN licensed to practice in NH
and will be required to become a Nurse Trainer through the
NH Bureau of Developmental Services. Job responsibilities
include trainings and monitoring the quality of services
and supports provided through One Sky and our service
provider partners. Prior experience working with
individuals with DD or ABD/ABI is ideal, but not required.
Email HR@oneskyservices.org for more information.
From Left to right: Calyn Brown, LNA; Crystal
Kimball, LNA; Susie; Heather Newfield, RN, BSN,
CEN, CPAN - Manager of Education and Tammy
Ladd, RNC, BSN, CLC - Clinical Coordinator
An adult manikin named "Susie" can be set up to mimic the
various stages of pregnancy. The option will be invaluable
not only to maternity staff, but to EMTs in the community.
Likewise, clinical staff are able to maintain competencies
necessary to care for babies born at LRH. Sim Lab staff can
program "Tory," the newborn baby manikin, for any number
of conditions arising in a newborn.
Heather Newfield, RN, BSN, CEN, CPAN and Manager
of Education and Staff Development states, "We are so
pleased to have the Simulation Training Lab available to
our staff and local emergency medical service providers. It
allows LRH to provide ongoing training to clinical support
staff, nurses, and physicians so we can continue to provide
quality healthcare to the community."

June, July, August 2020 New Hampshire Nursing News • Page 5
IN MY OPINION
The 2020 Irony
It is ironic. The 2020 outbreak
of COVID-19 parallels the Year
of the Nurse commemorating
the 200th birthday of Florence
Nightingale. Nightingale’s
experience during the Crimean
War has been repeated exactly
200 years later. Florence
felt overwhelmed by the
seemingly impossible situation
of having only 38 nurses to
care for over 2,500 injured
and sick men. Florence
was frustrated with the lack
Susan Fetzer
and inability to obtain needed supplies. Florence felt
sorrow at the inability of medical care to cure disease
or prevent a death. Florence felt discouraged when
necessary medications were not available and men had
to undergo amputations without chloroform anesthesia.
Florence had to be resourceful to create areas that were
safe and clean for her patients. Florence demonstrated
quiet heroism, she did not feel the need to exploit her
successes. She left a legacy which we commemorate
today and still learn about nursing from her writings.
While the celebration of Florence Nightingale’s
birthday marks the end of National Nurses Week,
this year, National Nurses Month continued with
the theme “Nurses Make a Difference.” Even
the public service announcements on radio and
television have acknowledged nurses’ contributions
and the difference we are making. I have never seen
as many nurses profiled on media as I have in 2020.
Two hundred years ago Florence used her letters to
generate interest about the contributions of nurses.
Today, it is technology. Even the use of technology
during the past three months has provided a new
normal for how individuals communicate. We
would have never thought 12 months ago of having
a virtual birthday party, a virtual wedding, or a
virtual hospital visit. The amount of information
available on the internet has exploded, from videos,
interviews, opinions and scientific research. I would
predict that 2020 will be regarded as the Year of
Virtual Communication.
As I do before every issue of the New Hampshire
Nursing News, I virtually scan hospital, long term
care, school of nursing and specialty organization
websites for ‘news’ about nurses and nursing.
The results are typically very disappointing. Few
organizations have a section of their website
dedicated to the nursing department that is
available to the public. It is as though nurses are
invisible. While press releases are put out about
new providers at an institution, there is no press
release about new nurse employees and what they
will bring to the organization. Websites post newly
developed programs or technology, but fail to even
mention that nurses will be managing the program
or learning and operating the new equipment. In
my opinion, this failure to demonstrate how we
make a difference reflects on both institutional
administrations and the willingness of nurses to
allow for virtual invisibility. Nursing departments
should invite their Public Relations Department to
key meetings and expect a monthly ‘profile’ article.
Nurses must step up and inform others of their
accomplishments.
The accomplishments in sports, school or nonhealth
care news over the past three months has
been replaced by front page health care news.
Seemingly to fill newspaper space and television
time a few nursing stories related to how the public
has honored nurses have been publicized. But
nurses in masks and scrubs outside facilities waving
to cars or planes going by is not how we make a
difference. It only makes one wonder who is left
inside to care for patients.
Nurses have demonstrated a Nightingale brand of
heroism. While Florence did not accept accolades
easily, she did use her accomplishments to further
her mission. Heroism is in your story that must be
shared. We need to take a lesson from Florence’s
play book. She wrote to the politicians, army
generals and even the Queen to explain the positive
impact of her actions. It is time for nursing to have
virtual visibility, and not just on the back page.

Page 6 • New Hampshire Nursing News June, July, August 2020
Board of Nursing Responds to State of Emergency
On Friday, March 13, 2020, Governor Chris Sununu
signed Executive Order 2020-04 declaring a state of
emergency in response to COVID-19. Section 3 of the
Executive Order stated:
Beginning at 11:59 p.m. on Sunday, March 15,
2020 all assisted living facilities, long term care
facilities, nursing facilities, residential care facilities,
as those terms are defined in RSAs 151-151-H,
or any other similar facilities providing residential
care to elderly or infirm patients, shall prohibit
visitor access to reduce facility based transmission
of COVID-19. This prohibition shall not apply to
medically necessary personnel, visitors for residents
receiving end of life care, or visitors necessary
to provide for a residents psychosocial needs
as determined by a licensed medical care provider.
In effect, the governor's executive order caused nursing
assisted living facilities, long term care facilities, nursing
facilities, residential care facilities, and any other similar
facilities to be "locked down" to all visitors. Visitors
included nursing students. The Board of Nursing Rules
require that programs that prepare LNAs must require that
each LNA student obtain 60 hours of clinical experience
in a skilled nursing facility (Nur 704.09(i)). Yet, the majority
of locations that provide such clinical experience are
closed to all visitors, including nursing students, for the
duration of the state of emergency. For pre-licensure
LPN and RN programs, the rules currently require that
the program's curriculum be approved by the Board of
Nursing, and that any changes to the curriculum also need
to be approved, including any changes to requirements for
clinical experience (Nur 602.16).
The Board of Nursing’s Chair, Vice-Chair, Administrator
along with the Director of the Office of Professional
Licensure requested an emergency rule to address the
concerns related to the current state of emergency in New
Hampshire. A rule related to clinical experience during
a state of emergency was drafted (see Box Nur 101.04).
In an emergency meeting on March 16, 2020 the Board
of Nursing passed the rule, which was submitted and
accepted by the State of NH, and is now in effect until
September 12, 2020.
Nur 101.04 "Clinical Experience" means practice in
an inpatient, ambulatory care, or community setting
where the student provides care to patients under
the guidance of a nursing instructor or preceptor.
(a.) Clinical Experience may be substituted with
simulation and lab work during a State of
Emergency Declared by the Governor that
impacts clinical site availability; provided,
however, the Board of Nursing is notified
within twenty-four (24) hours of such
substitution. "Simulation" means a technique,
not a technology, to replace or amplify real
experiences with guided experiences that evoke
or replicate substantial aspects of the real world
in a fully interactive manner.
The rule relaxes the requirement for clinical experience
during the course of a declared state of emergency,
and allows the 60 hours of clinical experience to be
substituted with 60 hours of simulation and lab work
during the state of emergency. Nursing programs may
substitute in-person clinical with virtual simulation. The
Board must be given 24 hours’ notice of such substitution.
RN and LPN programs needing to affect changes in
curriculum delivery as a result of the transition from
in-person to online learning are also impacted by Nur
602.16. The rule relates to notification requirements for
curriculum changes, which requires three months prior
written notice when changes occur in more than 10%
of [entire program] credit hours. However as most of the
curriculum revisions necessitated by transition from inperson
to online learning relate to the last six weeks of
the Spring 2020 term the rule is less likely to be applied.
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For example a two-year
nursing program, with
two 16-week terms for
each of two years and
one 8-week summer
term has a total of 72
weeks in the program. If
this program changes from
in-person instruction to online
instruction for six weeks (of the
72 weeks) only 8.33% of the total curriculum hours are
affected. Only a Board of Nursing notification is required
if the 10% threshold is not met.
The relaxation of in-person clinical experiences have
implications for potential employers of Board of Nursing
licensees. Licensed Nursing Assistants that were trained
during the state of emergency may not have received a
comprehensive clinical experience with direct patient
care. They may require extended orientations specifically
in care needs of patients with dementia or cognitive
impairment.
The Board of Nurses has also enacted an amendment to
Nur 303.02 (d) pursuant to Emergency Rule on March
23, 2020, to extend the time period for taking the NCLEX
exam.
Nur 303.02 (d) Registered and Practical Nurse
Examinations. (d) For graduates of programs
within the US or Canadian Provinces where
the NCLEX is required, the NCLEX shall be
taken within six months of graduation from an
approved school of nursing. Notwithstanding,
during a State of Emergency declared by the
Governor, the Board shall allow Registered
and Practical Examinations to be completed
within 90 days of the Expiration of the State of
Emergency to complete this requirement.
The Governor’s Executive Order called for the temporary
authorization for out of state medical providers to provide
medically necessary services and provide services
through telehealth. The temporary licenses authorized
under this emergency order are issued to any healthcare
provider who can demonstrate a license in good standing
in another State jurisdiction. The temporary licenses are
being provided at no charge and remain valid during the
declared state of emergency. As of May 1, 2002, 1633
temporary licenses were issued to APRNs, 39 to RNs, four
to LPNs and one to an LNA.
The Executive Order declaring a state of emergency
concerns meetings of public bodies. Therefore public
sessions of the meetings of the New Hampshire Board
of Nursing are being conducted by teleconference and/
or video teleconference. Information on how to connect
and listen to the Board of Nursing meeting is posted on
the website (nhbon.org) under Board Meetings.
Staffing of nursing homes and assisted living facilities has
been dramatically impacted by COVID-19 transmission.
Senator Tom Sherman, Representative Polly Campion
RN, Lindsey Courtney, Interim Director of the Office of
Professional Licensure and Board of Nursing Administrator
Bonnie Crumley-Aybar met to develop a streamlined
process to encourage LNAs with licenses that had lapsed
within the past three years to reenter the workforce.
An outreach to nursing students who had passed
Fundamentals of Nursing was created to secure an LNA
license and practice in long term care facilities. The
$35.00 licensing fee is being waived to encourage nursing
students to become LNAs.
Bonnie Crumley-Aybar, RN, MSN is the Administrator of
the New Hampshire Board of Nursing.
For more information contact:
Dayle.Sharp@unh.edu
chhs.unh.edu/graduate-nursing

June, July, August 2020 New Hampshire Nursing News • Page 7
NHNA in Alliance to Support Senior Facilities
A newly formed statewide network of volunteers has
now been working for three weeks to provide help
and guidance to senior residential facilities in New
Hampshire, including assisted living and nursing homes,
to enable them to better handle the health crisis caused by
COVID-19.
As of May 4, the network, known as the COVID Alliance
Senior Support Team (SST), had more than 60 volunteer
COVID Response Liaisons serving 65 facilities. The
Liaisons are available daily to gather information about the
facilities’ needs and connect them with state, federal, and
private resources that can help them. The most common
issues Liaisons discuss with facility staff are personal
protective equipment (PPE), staffing and testing needs.
The effort launched on April 13, after having consulted
with residential industry associations, state government
officials, university leaders, medical experts and the
New Hampshire Nurses Association. The impetus
for the program came from the COVID-19 Policy
Alliance, founded by faculty at the MIT Sloan School
of Management to help reduce the impact of the virus,
particularly on the elderly.
SST Chairman and NH State Senator Tom Sherman, who
is also a practicing physician, points out that the age,
comorbidities and close proximity of the residents of
senior residential facilities put them at especially high
risk of COVID-19 outbreaks. “Experience in Italy, Spain,
Washington State, and a growing list of locations around
the world, shows that COVID-19 can spread quickly
among the residents and staff of senior residential facilities,
and the evidence is clear that older COVID-19 patients are
more likely to require hospitalization or die. This makes
senior care facilities a critical front line in the fight against
COVID-19. The volunteers of the Senior Support Team
intend to do everything they can as remote volunteers to
support senior care facilities through this crisis.”
Each participating facility began by filling out a survey to
evaluate its potential exposure to COVID-19 and to inform
the facility’s Liasons on its risks and needs. The SST also
operates an automatic text messaging tool, developed by
MIT graduate student Jackie Baek, to quickly and easily
document new cases and new needs at each participating
facility each day. This has become a critical technical tool
for the SST and its partners.
The SST first contacted residential facilities to see if they
were interested in participating through a number of
associations, including the New Hampshire Association of
Residential Care Homes (NHARCH), the New Hampshire
Healthcare Association (NHHCA), LeadingAge ME &
NH, and the NH Association of County Nursing Homes.
The SST collaborates with these associations to share
knowledge and resources, advocating for the needs of
participating senior living and long-term care providers.
With the consent of participating facilities, the SST
provides data on facility status to the associations each day.
“Given the nature of this pandemic, our usual support
systems have been stretched beyond their capacity. The
importance of collaboration with other associations and
organizations has increased a great deal. We welcome the
Alliance’s expertise in data collection, as well as volunteer
coordination, to help our members, and the members of
our industry partners,” said Kelly Adams, Vice President
of the New Hampshire Association of Residential Care
Homes (NHARCH).
Lisa Henderson, Executive Director of LeadingAge Maine
& New Hampshire, says “LeadingAge Maine & New
Hampshire is grateful for our partnership with the COVID
Alliance. Their rapid development and deployment of
a daily texting program to help us check in with our
members on the frontline is helping us direct resources to
them and continue to advocate for their most urgent needs
including PPE, staffing and testing.”
The New Hampshire Nurses Association (NHNA) was
a critical partner for the SST on volunteer recruitment
and organization. “We are proud that NHNA Past
President, Dr. Judith Joy, has been appointed the Statewide
Coordinator for the COVID Response Liaison volunteers.
Paula MacKinnon (President-Elect, School Nurses
Association) has also played a critical role developing the
team’s data collection tools,” said NHNA Nurse Executive
Director Joan Widmer. Nearly all of the volunteer Liaisons
of the SST have some level of healthcare training, and
a majority are current school nurses or retired nurses
recruited by the NHNA. Also represented on the allvolunteer
SST team are MIT student EMTs and graduate
students, professors and physician assistant students from
MCPHS, Dartmouth medical students, political campaign
operations and data experts, and volunteers from the NH
business and nonprofit sectors.
The SST has developed a menu of resources to ensure the
volunteer liaisons are always aware of the latest guidance
for their calls. “I’ve worked closely with nurse educators
from around New Hampshire to create a searchable FAQ/
reference site where SST liaisons and senior care facilities
alike can quickly find answers to their questions and links
to authoritative public health information,” Deb Baker,
Library Director at Manchester Community College, who
also serves as the Chief Librarian for the SST.
The Medical Advisory Group vetting the materials used
by the SST includes State Rep. Dr. Jerry Knirk, Dr. Paul
Friedrichs, Dr. Karl Singer, Dr. Apara Dave, SST Chairman
and NH State Senator Dr. Tom Sherman, Dr. Daniel
Stadler, Dr. Bruce Bartolini, Dr. Kim Perez, and Prof. Linda
Martino.
“We intend to be ready to serve all of the over 200
licensed senior care facilities in New Hampshire,” said SST
Executive Director Daniel Curtis. “We have the structure
and the amazing volunteers to do it, and we’ve already
made a big impact to help get the senior care facilities of
New Hampshire the support they need.” To learn more
about the SST, visit our website at covidalliance.com/sst.

Page 8 • New Hampshire Nursing News June, July, August 2020
APRN COLUMN
Post-Graduate Advanced Practice
Training Programs
Jillian Bellmont,
New Hampshire Nurse Practitioner Association
Advanced practice providers (APP) are qualified medically
licensed health care providers, who can function
independently or alongside a physician, in population
centered care models, disease management, care
coordination, and direct patient care. This professional
umbrella term includes nurse practitioners (NP) and
physician assistants (PA) among several other subgroups of
non-physician health care providers. In the United States,
there are very few APPs who have undergone formal
postgraduate training. Post-graduate APP educational
programs are becoming more popular and are typically
designed for new graduates and experienced clinicians
interested in change of practice specialty.
The Institute Of Medicine (IOM) has recommended that
“state boards of nursing, accrediting bodies, the federal
government, and healthcare organizations should take
actions to support nurses’ completion of a transition-topractice
program (residency) after they have completed
a prelicensure or advanced practice degree program or
when they are transitioned into new clinical practice areas.”
Many APPs have limited orientation programs as they enter
practice and are expected as new graduates to perform
at an advanced level with minimal support. Fellowships
and residencies are not required for NPs or PAs as these
professionals have met all training requirements needed for
licensure during their graduate programs.
Programs to facilitate APP transition-to-practice programs
have been developed with continued growing numbers
of public and private institutions across the US. Added
support and mentoring after graduation is fundamental to
an effective transition from new grad to expert. Bush and
Lowery (2016) opined that postgraduate education has
demonstrated statistically significant positive influence
on NP job satisfaction. Influence on professional growth,
autonomy and more valuable collegiality in early years of
career development are key factors identified. Post-graduate
programs should complement formal education with a goal
to promote autonomy, aid with adjustment of role transition
and support productivity within a rapidly changing and
demanding healthcare system. Leading programs provide
learning environments that stimulate professional growth
and include mentorship, lectures, supervision, assigned
readings, online courses, active critiques on performance
and case presentations.
100 Saint Anselm Drive
Manchester, NH 03102
(603) 641-7086
www.anselm.edu/cne
Committed to Promoting Excellence
in the Practice of Nursing
Saint Anselm College is approved as a provider of nursing
continuing professional development by the Northeast
Multistate Division, an accredited approver by the American
Nurses Credentialing Center’s Commission on Accreditation
Residency and Fellowship programs for APP can also
have drawbacks and may not be the right path for
everyone. Most post-graduate APP programs are not
widely standardized. However, there are several notable
accrediting bodies who have developed guidelines
and formal standards which are becoming increasingly
appreciated and used. There are no dual-accreditation
options available to include both NPs and PAs. The value
of accreditation for individual programs is still being
evaluated and uniquely dependent on each organization.
Supplemental education is expensive and there is no
published evidence supporting improved patient outcomes
related to these programs. Post-graduate training programs
can cost organizations up to $100,000 per trainee including
support needed to supplement lost preceptor productivity.
Post-graduate training programs typically offer decreased
salaries and have one or two year employment agreement.
There are also inconsistencies among titles of programs (i.e.
residency vs fellowship) which may obscure trainee choices
and contributes to confusion.
As leaders, educators and clinicians, we have a professional
obligation to guide our nurse practitioner and physician
assistant colleagues with the ongoing development of postgraduate
education and training. It is important we avoid
terminology that may indicate or promote downstream
regulatory implications or mandatory requirements, or
suggest APPs are not prepared to enter the workforce upon
completion of formal graduate education. Post-graduate
training programs help promote creative models to bridge
gaps in our rapidly changing health system and add
leadership opportunities for NPs and PAs. It is important to
be aware of novel and growing programs which may help
provide the support and structure a colleague, a graduating
student or even yourself, may need for a successful and
supported transition in clinical practice.
References:
American Association of Nurse Practitioners. The NP roundtable’s
discussion paper on NP education and postgraduate training.
Updated 2013. Retrieved at http://www.aanp.org/component/
content/article/82-legislation-regulation/policy-toolbox/nppolicy-essentials/445-aanp-and-the-np-roundtable-jointstatements/.
Accessed Feb 13, 2020.
Bush, C. & Lowery, B. (2016). Postgraduate Nurse Practitioner
Education: Impact on Job Satisfaction. The Journal for Nurse
Practitioners. 12(4). April 2016.
Institute of Medicine. The future of nursing: leading
change, advancing health. 2011. Retrieved at http://iom.
nationalacademies.org/Reports/2010/The-Future-of-Nursing-
Leading-Change-Advancing-Health.aspx. Accessed Feb 13,
2020.
We’re Looking For The Best.
Come Join Our Team!
We have many opportunities available at
Memorial Hospital’s Merriman House
• RNs, LPNs, and LNAs
• $1,000 sign-on bonus* (for qualified candidates)
• Exceptional MaineHealth benefit package
• Generous shift differential
• Work with a friendly and collaborative team
providing compassionate care to residents
We offer excellent pay, wonderful benefits, paid vacation,
tuition reimbursement, retirement and all in a warm, exciting
and compassionate team setting!
Candidates can apply online at www.memorialhospitalnh.org
An Equal Opportunity Employer
“To every nurse throughout our state and beyond, our
gratitude is as deep as your courage, and we thank you
for your dedication to keeping your community healthy,
and for the bravery, compassion and empathy you
provide to your patients every day.”
Steve Ahern, President of the New Hampshire Hospital
Association, May 2020
Congratulations to UNH Graduate student Susan
Gonya RN and faculty mentor Pam DiNapoli, RN,
PhD awarded 3 rd place for Student Poster by the Eastern
Nursing Research Society. The poster was titled: Do
We Really Know What's in Our Food? The Connection
between Dietary Mycotoxin Exposure and Pediatric
Crohn's Disease. Unfortunately, the Annual meeting of
ENRS, March 26-7, to be held in Boston was cancelled
though posters were judged virtually.
Dr. Jillian Belmont was recently
elected President of the New
Hampshire Nurse Practitioners
Association. Belmont received
her BSN from St. Anselm’s, MSN
from UNH and DNP from
Northeastern University. Her
focus is neurology which she
practices as an assistant
professor and associate provider
at DHMC. Belmont is also
serving as President of the Green and White Mt. Chapter
for American Academy of Neuroscience Nursing.
Loon Chocolates
Deliver Joy to
Nurses
Loon Chocolates, the small local chocolate maker in
New Hampshire, located at seven different locations in
the state is delivering chocolate to health care workers
on the front lines of the Covid-19 pandemic. The
company has delivered over 500 of their Hero Bars to
Healthcare Heroes in the state with a goal of 800 Hero
Bars by June 1, 2020.
Loon’s goal is to provide some joy to Healthcare
Heroes while fighting the battle for all of us. They have
donated chocolate bars at Catholic Medical Center,
Parkland Medical Center, Dartmouth Hitchcock Medical
Center, Exeter Hospital, Concord Hospital, NH State
Hospital, Primary Care of Milford and several retirement
communities in southern New Hampshire. Their website
provides an avenue for public support of the project.
Nurses always appreciate a little chocolate to sweeten
their day.
Jennifer Pitre receives Loon chocolates for
Catholic Medical Center Healthcare Heroes

June, July, August 2020 New Hampshire Nursing News • Page 9
Family centered maternity care and COVID-19
Since the model of family centered maternity care (FCMC) was first
recommended in the late 1970’s, hospitals and birthing centers have moved
toward a model of care that focuses on the needs of the family unit as whole
during an important life transition. While not always a perfect model, FCMC
techniques have been linked to positive outcomes across the spectrum of
perinatal and infant care. Supportive family interventions such as the roomingin
of infants with their parents on postpartum care units reduces hospital
costs, decreases infant infections, supports early initiation of breastfeeding,
encourages bonding, and increases patient satisfaction. Although the motherinfant
couplet is often the focus of the provision of inpatient care, maternity
nurses are experts at supporting mothers, their partners, and extended family
on obstetric and neonatal care units, in the community setting, and in patient’s
homes.
Until recently, the FCMC framework was actualized in many ways in New
Hampshire hospitals. Family waiting rooms allow supportive friends and
family to gather in anticipation and support expectant parents before and after
their deliveries. Whenever possible, patient rooms are single rooms, warmly
lit and decorated to appear more like a welcoming home environment, with
a place for supporting partners to stay overnight. Childbirth preparation
classes welcome pregnant patients and their partners to the hospital in the
weeks before delivery to tour the unit and learn about their options from
nurse childbirth educators. Partners are admitted into the OR for C-section
deliveries, a practice not usually seen in surgical settings. Hospitals offer
sibling and grandparent preparation classes, recognizing that the family unit
extends beyond the parents and provide postpartum care home visits to
continue to support families after discharge. Nurses bring infants to bond
with their mothers through skin-to-skin on adult ICU units, or help mothers
separated due to maternal illness to pump their breastmilk and bring it to the
NICU to give to premature or ill neonates. These recommended practices were
all flourishing before COVID-19 changed the face of obstetrical care.
Tenants of family centered maternity care (JOGNN, 1978, p. 55)
• The family is the basic unit of society.
• The family is viewed as a whole unit within which each member is an
individual enjoying recognition and entitled to consideration.
• That childbearing and childrearing are unique and important functions of the
family.
• The childbearing experience is an experience that is appropriate and beneficial
for the family to share as a unit.
• That childbearing is a developmental opportunity and/or a situational crisis,
during which the family members benefit from the supporting solidarity of the
family unit. (p. 55)
Alyssa O’Brien, PhD, RN is an Assistant Professor of nursing at UNH and member of the
NH AWHONN Steering Committee.
Family Center
nurses at Exeter
Hospital in April
2020 (Photo
courtesy Michelle
Savoie)
Women and
Children’s Center
nursing staff
at Wentworth-
Douglass Hospital
(Photo courtesy
Diane Proulx)
The CDC, WHO, and professional organizations have been quick to establish
guidelines for safely providing care to patients and families in the time of
COVID-19. Family care units and providers across New Hampshire have
swiftly put in place protocols to reduce risk to staff and patients. Of primary
concern is the transmission of the virus, but also to find ways to provide safe,
supportive, and affirming care across the perinatal year. Recommendations
include spacing out prenatal visits for low risk pregnant patients and increasing
exposure screenings at prenatal visits and hospital intake, as well as increasing
testing for women who are symptomatic. Under some circumstances an infant
may be separated from their mother, if the birth mother has tested positive for
COVID-19 and the status of the infant is unknown. Pregnant women have been
encouraged to avoid gatherings and remain physically distanced whenever
possible. Other recommendations impact everything from C-section protocols
to hospital visitors.
Precautionary measures have resulted in the provision of perinatal and infant
care in NH that looks very different than just a few months ago. In many
cases, nurses and other care providers are making phone calls or using telepractice
visits to provide additional assessments, education, and support.
Group prenatal exercise and education classes have been canceled with
some organizations recommending online resources or offering virtual
classes.
During their hospital stay pregnant patients are limited to one support person,
support groups have gone virtual. Support partners may not be permitted in
the operating room or in other areas of the hospital. These restrictions have
required nurses providing perinatal care and education to adapt.
Nurses at Monadnock Community Hospital created a virtual hospital tour and
make personal phone calls to all expectant families to establish support and
trusting relationships one-on-one with families. Perinatal education at Catholic
Medical Center has gone virtual, with overwhelmingly positive responses to
Zoom and virtual classes developed by their perinatal education coordinator.
Although the use of popular labor support techniques like nitrous oxide are
not currently allowed due to guidelines, nurses at Wentworth-Douglass
Hospital created shared decision-making documents to use with COVID
positive moms and their support partners. They are also using virtual platforms
for postpartum support groups.
Patients report that this time feels stressful and uncertain, but they are being
well supported by their nurses and providers. For some, the time to bond
alone with their newborns without expectations to entertain numerous
hospital visitors has been a welcome side-effect of changes to family visiting
policies. How COVID-19 will change FCMC practices in the long term is still
unknown, but for now all across New Hampshire perinatal nurses continue
to deliver high-quality FCMC to their pregnant and postpartum patients,
newborns, and their families.

Page 10 • New Hampshire Nursing News June, July, August 2020
Past, Present and Future of Nurse Anesthetists
Janelle Pickering
In this time of extreme uncertainty, the ingenuity and versatility of the nursing
profession has never been more important. As COVID-19 ransacks not only
our supply lines, but our healthcare staff, nurses have consistently risen to the
challenges associated with working during a pandemic. These challenges do
not solely revolve around patient care, in fact, some of the greatest challenges
have surrounded the uncertainty of personal protective equipment (PPE)
and appropriate utilization. PPE shortages, combined with frequent changes
in protocols regarding the appropriate level of PPE, have left all healthcare
providers nervous. Despite this concern, nurses everywhere have shown their
ability to adapt to these rapidly changing circumstances, and selflessly share
information on current best practices when treating COVID-19 patients. Social
media has allowed for the quick dissemination of information and has brought
into focus the immense value we bring to the healthcare team. This truly is the
‘Year of the Nurse’!
“Patients come to the hospital and stay the night, not because they need a
doctor, but because they need a nurse. If they only needed a doctor, they could
go to a doctor’s office. They come to the hospital and spend the night because
they needed a nurse.” This quote, by Carol Rauen MS, RN-BC, highlights the
value of nurses. During the COVID-19 pandemic, nurses have been on the
frontlines in many capacities. As units attempt to limit contact with COVID-19
positive patients, bedside nursing assessments have become even more critical
in directing patient care. Nursing intuition takes years to develop. It is acquired
not by rote memorization, but by countless interactions with patients and their
families. This hard to define nursing intuition is often described as the “art of
nursing,” and nothing is more alarming than a nurse saying she has a “bad gut
feeling” about a patient’s condition. In a time when all medical providers are
inundated by data, nursing intuition provides an additional tool for decision
making. This reflexive thought is what allows a nurse to meet the constant,
sometimes unexpected needs of the patient.
The vast majority of the public are aware of the advance role of the Nurse
Practitioner, but the role of the certified registered nurse anesthesiologist (CRNA)
is not well understood. This lack of knowledge has created a situation in which
some hospitals do not utilize the CRNA to their fullest potential at a time when
every member of the nursing community is greatly needed.
To understand a specialty, it is important to review its history. The first successful
demonstration of an anesthetic was performed by William T.G. Morton on
October 16, 1846, however, due to poor aseptic practices in the operating room
(OR), lack of antibiotics, and high anesthetic mortality rates, anesthesia did
not gain instant success (Ray & Desai, 2016). During the Civil War, 1861-1865,
Catherine S. Lawrence is credited as the first ‘nurse’ to administer anesthesia in
the form of chloroform to wounded soldiers needing emergent operations on
the battlefield (Ray & Desai, 2016). Due to its characterization as a “subordinate
role,” anesthesia was often delegated to medical students or younger physicians
more eager to observe the surgical
technique than administer the anesthetic.
Despite its “subordinate role,” surgeons
recognized the need for highly trained
professionals to monitor and administer
anesthesia to the patient, and were the
earliest supporters of additional training
for nurses to fulfill this role (Ray & Desai,
2016).
Catherine Lawrence, Civil War
In 1877, Sister Mary Bernard was the first nurse
to rise to the challenge of specializing in the
delivery of anesthesia (Ray & Desai, 2016).
Catholic nuns played an important role in
training nurses to administer anesthesia, but
Alice Magaw is credited as the true “Mother of
Anesthesia.” In 1906, Alice Magaw published
“A Review of Over Fourteen Thousand Surgical
Anesthesias” which highlighted the benefits of
a trained anesthesia provider (Ray & Desai, 2016). Her
innovation and dedication to providing anesthesia safely,
led to the Mayo Clinic being regarded as the best place for nurses to train in
the delivery of anesthesia. With the beginning of World War I, the educational
requirements and demand for trained anesthesia providers increased. Mayo
Clinic and Pennsylvania Hospital responded to this increase by developing a sixweek
course focused on safely administering anesthesia.
Alice Magaw providing anesthesia
circa 1906
It was not until 1931 that a professional
organization for nurse anesthesiologists
was founded by Agatha Hodgins
(Ray & Desai, 2016). The National
Association of Nurse Anesthetist’s
(NANA) name was changed to the
American Association for Nurse
Anesthetists (AANA) in 1939 which
coincided with World War II, and another increase in educational requirements for
nurse anesthesiologists (Ray & Desai, 2016). This brief overview of the anesthesia
specialty shows not only the importance of nurses in its evolution, but also
highlights that during times of chaos, nurses have continued to innovate and adapt
to provide the safest care possible.
The proud history of nursing innovation and versatility may be practiced to its
fullest extent in New Hampshire where advanced practice nurses can provide
exemplary care to their patients independently, without physician supervision. This
is important as 37% of NH residents live in rural and underserved areas (2(Hub,
2020). Historically, it has been difficult to recruit and retain healthcare providers
in rural areas, and APRNs are more likely to provide care for underserved
populations (Patel, Petermann, & Mark, 2018).
Like their Nurse Practitioner counterparts, NH CRNAs licenses are not restricted,
and CRNAs can practice independently, without physician supervision.
Unfortunately, not all hospitals recognize the full scope of practice of the CRNA,
not to mention the versatility, efficiency, accountability and high level of care that
the CRNA provides.
The AANA (2020) issued a statement at the beginning of the COVID-19 pandemic
stating that “CRNAs should be given full authority to practice to their highest
level of education and training…and their roles should reflect their high degree
of clinical skill and expertise.” Across the country, individual hospitals’ responses
to this statement have varied. CRNAs have found themselves furloughed or laid
off, as elective case numbers significantly decreased. Some institutions decided to
utilize their CRNAs as critical care nurses, but this approach diminishes the ability
of the hospital to efficiently react to COVID-19. A CRNA working as an ICU nurse
provides care to a single patient. In NH, CRNAs are recognized as APRNs, and this
distinction makes it far easier to utilize CRNAs in the ICU. As APRNs, CRNAs can
rapidly assess patients, provide advanced airway management, oversee ventilator
management, place central lines, and order and assist in the titration of vasoactive
medications and volume resuscitation. This list is far from inclusive, and shows the
utility in the CRNA as part of the healthcare team, not simply as a one on one
provider.
Times of crisis are also times of great innovation, and COVID-19 is no exception.
The value of nurses has never been more appreciated, and once again we have
shown our versatility. We do not yet know what the new “normal” will be for us
in the community and in the hospital. We have seen a crisis that has changed the
very fabric of society and day to day functioning of our nation. Moreover, it has
redefined what is meant by “essential” in both service and providers. Although we
were able to “flatten the curve” we cannot be fooled into believing we are safe. It
is my hope that we, as a nursing community, will use the lessons learned during
this pandemic to forge a larger role in our communities, hospitals, and legislation.
Our unique perspective will be invaluable, and it is important that we advocate
not only to improve patient care, but to secure a future that values all nurses, in
every specialty.
References
AANA (2020). CRNAs as advanced practice providers in critical care settings. https://www.
aana.com/, accessed 05/01 2020.
Hub, R. (2020). https://www.ruralhealthinfo.org/states/new-hampshire, accessed
05/01/2020.
Patel, E., Petermann, V., & Mark, B. (2018). Does state-level nurse practitioner scope-ofpractice
policy affect access to care? Western Journal of Nursing Research, 41, 488-518.
Ray, W. T., & Desai, S. P. (2016). The history of the nurse anesthesia profession. Journal of
Clinical Anesthesia, 30, 51–58. https://doi-orrg.unh.idm.oclc.org/10.1016
Janelle Pickering, DNP, CRNA is a nurse anesthetist at Dartmouth Hitchcock in
Lebanon, New Hampshire.
Ed Note: The News welcomes NHANA as a NHNA Organizational Affiliate and
looks forward to their future contributions to the News.

June, July, August 2020 New Hampshire Nursing News • Page 11
Home Care Nurses Caring for Recovering Patients
Home Healthcare, Hospice and Community Services nurse
Kristina McGuirk visits patients who have returned from the
hospital after battling COVID-19. Staff photo by Ben Conant
(reprinted with permission from Monadnock Ledger-Transcript)
TIM GOODWIN
Originally published by Monadnock Ledger-Transcript on 5/4/2020.
Reprinted here with permission from Monadnock Ledger-Transcript
When patients infected with coronavirus first made an appearance
on Kristina McGuirk’s case load, it was hard not to be concerned.
As a nurse with Home Healthcare, Hospice and Community
Services, McGuirk’s job is to go into people’s homes to provide
care for those dealing with a variety of conditions and medical concerns. But the addition
of COVID-19 brought on that question of “what if?”
“You have to assume everyone has it and that’s really the best way,” McGuirk said. “I
obviously don’t know what I was expecting. It’s something we’ve never seen before.”
She’s worried about being infected herself or bringing it home to her fiance. For those on
her weekly caseload who had contracted coronavirus, her visits have so far come after
the patient returned home from hospitalization.
“The acute phase has already passed,” McGuirk said. She said that some patients’
symptoms still remain like a cough and shortness of breath.
“Little things like holding a conversation can be difficult,” she said. “They’re feeling
shortness of breath just talking.”
But as the weeks have gone by, McGuirk said she has seen progress from those patients
who tested positive for the disease, like being able to walk up stairs and go outside.
“It’s been really nice to see the recovery phase,” she said. “But the weekly progress I’ve
seen was pretty gradual.”
Each trip into someone’s home that has been diagnosed with COVID-19 – as well as
everyone else – comes with a heightened sense of precaution. For patients who have
tested positive for the virus, that means an N95 mask with a secondary cloth mask on
top, double gloves, gowns and extra sterilization of the equipment.
“Sure you think about it when you’re at work and on the way to their house for a visit,”
she said.
The New Hampshire Board of Nursing
considered the following practice questions
posed by licensees.
News
Question: Is an LPN able to administer
cosmetic injectable (dermal fillers, Botox)
under an APRN who is authorized to
practice in New Hampshire.
BON Response: Yes, an LPN may administer the cosmetic injectable
medication with a valid written order from a provider Physician APRN, or
DDS who is authorized to practice in NH.
McGuirk said that HCS was unable to supply her with booties or a
hair covering due to shortages, but that if they were available, she
would wear those too.
Prior to a visit, HCS conducts screening calls, McGuirk said, and a
lot of what she has done since the pandemic changed the way of
life in New Hampshire has been to answer questions and educate.
“Just doing our best relaying the information,” McGuirk said.
While there is concern, McGuirk knows she has a job to do and
can’t let fear or reluctance creep in.
“I’m a nurse and I like helping regardless of their diagnosis,”
McGuirk said. “At the end of the day they’re still a patient and need care.”
McGuirk said early on the nurses at HCS were asked if and when they got patients with
COVID-19 who would be willing to add them to their case loads.
“I volunteered because they’re patients that need a nurse, they need care,” she said.
She did so because she considers herself young and healthy at the age of 27, and knows
there are some older nurses on staff that have conditions or are immunocompromised.
When McGuirk goes home for the day, she changes into clothes she leaves in the garage
before heading out for her shift, uses hand sanitizer, and washes her hands thoroughly
once inside.
Branden Howe spends two or three days a week going into homes in his role as
residential supervisor for Monadnock Worksource. He used to conduct in home visits
every day before transitioning into a managerial role.
While the threat of COVID-19 is on Howe’s mind, he’s more concerned with the
individuals he and the staff work with on a weekly basis. After the pandemic, Monadnock
Worksource reduced the number of hours it spends with individuals, which ranges from
11 to 30 hours each week, executive director Janis King said.
They put a stop to transportation because “we can’t provide that safe distance,” King said,
and a number of the places where individuals held jobs or volunteered were suspended
for the time being. And that kind of disruption to the routine is concerning for Howe –
even more so than the looming threat of coronavirus.
But at the top of his priority list is making sure he takes the proper precautions to keep
from getting sick.
“I’m doing everything I can to maintain my health,” Howe said. “Because keeping myself
healthy is part of this.”
Howe said in certain instances they would use PPE during in home care, but now it is
used with every visit.
“It’s been working, but every day is different and has challenges,” Howe said.
But for Howe, it’s just the nature of the job.
“Our job is challenging, but people who do direct care are really invested in the
individuals they support,” Howe said.
Question: Can an RN remove a spinal catheter?
BON Response: Yes, an RN can remove spinal catheters under the
direct order of a physician or APRN, after training and demonstration of
competency.
Question: Can an LNA apply a tourniquet?
BON Response: Yes, an LNA can apply a tourniquet based on training and
demonstration of competency.
Question: Is it within nurse’s scope of practice to calculate a
CMADVASC Score?
BON Response: Yes, it is within the scope of practice of registered nurses
to calculate screening exam scores.
Question: Can a school nurse provide over-the-counter medications without
a provider’s order?
BOD Response: Yes, the school nurse does so in accordance with nursing
knowledge, judgment, and skill and 2. The school nurse in public schools
must follow the NH DOE administrative rule, Ed 311 which states “nonprescription
medication shall be given only with the written request and
permission of the parent and/or guardian” and must follow local policy and
procedures.
Question: Is it within the scope of practice of a RN to remove pins postoperatively
from a patient with a ligament construction?
BOD Response: No, the Board found no research to support the removal of
pins from a site status post ligament reconstruction and tendon interposition
skill as part of the RN scope of practice.
Join a dynamic, caring organization and grow your career
while making a difference in the lives of our residents.
• Resident focused with higher than average
staff-to-resident ratios
• Tuition reimbursement
• Growth opportunities for RNs, LPNs, MNAs and LNAs
Call RiverWoods Exeter at 603.658.1541
or visit RiverWoodsExeter.org/careers
The Board of Nursing is now requiring nursing programs to provide an
analysis of student retention rates and steps to improve retention rate in their
annual reports to the Board.

Page 12 • New Hampshire Nursing News June, July, August 2020
Nurses on the Web
Cheshire Nurses
Interviewed
Ashley Thompson, RN
and Chastity Hodgson,
RN in Cheshire’s
Emergency Department
were interviewed for
the Cheshire Medical
Centers magazine
Health and Wellness.
Elliot Nurse Interviewed
Mary Seigle RN, a
Resource Nurse, in the
CICU at Elliot Health
System was interviewed
for the Elliot Hospital
website. Regarding
caring for COVID-19
patients she noted “It’s
extremely hard and wonderful all at the same time. I will
now forever cry when I hear ‘Here Comes the Sun’ by the
Beatles. That song is played when a COVID-19 patient is
discharged from the hospital and nurses line the hallway to
say goodbye.
Memorial Hospital Pins New Graduates
While the COVID-19 pandemic has caused many school
graduations to be cancelled, the nursing staff at Memorial
Hospital made sure to honor their graduating student
nurses with a traditional ceremony welcoming these
new nurses to their profession. “A pinning ceremony is
an invitation to graduates to join the nursing profession,”
said Shauna Ross, RN, a member of the Memorial staff.
“These students have all done their clinical rotations here
and have worked hard.” Each of the students was awarded
a pin. Usually, the nursing pin represents the student’s
nursing school. Since their school pins were not available,
Memorial awarded pins usually presented to recognize
outstanding service by employees. Students also recited the
Nightingale Pledge, promising to “practice my profession
faithfully.” Joining them were a dozen or so other hospital
nurses gathered to congratulate these new professionals
and also reflect on their own service as nurses. Memorial
Hospital Chief Nursing Officer Kris Dascoulias noted
“Nursing is a profession that requires extreme knowledge
and a willingness to put others above yourself. As you start
your journey, remember you are not alone. As a nursing
graduate, you have earned the right to wear a nursing pin.”
Memorial has extended job offers to all of their graduating
student nurses, an acknowledgement of the quality of this
class and the way they have handled the extraordinary
circumstances of their final semester.
Graduates from White Mountains Community College
included Natalie Harmon, Paige Lautenschlager, Emily
Fournier, Nicholas Dukehart, David Frankowski, Amy
Lindgren, Chelsea Schribner and Michael Kane. Elizabeth
Hockmuth was a student at the University of Southern
Maine:
SNHMC Nurse
Irene Arevalo BSN RN was recently highlighted on the
Rivier University website. An alumnus, she practices at
Southern NewHampshire Medical Center. “Never would
I have thought I would be part of a pandemic let alone
working on the very front line. But here we are. I must say
we are doing a decent job in New Hampshire flattening
White River Junction, VT VA Medical Center
is seeking experienced Registered Nurses for the following clinical areas:
Nurse Manager OR • Asst. Nurse Manager Addiction Treatment
• Asst. Nurse Manager Mental Health • Night/Weekend Hospital Nursing Supervisor
• ED • Primary Care • Med/Surg • OR • Occupational Health
Other vacancies include: NP/PA (Float positions)
• LPN (Dermatology, TeleHealth) • Nursing Assistants
To learn more contact Regina.Radikas@va.gov OR look on USAJOBS.GOV
RNs who join our team receive excellent benefits including:
• 26 annual and accruable paid vacation days
• 13 annual and accruable sick days
• 10 paid Federal holidays
• Retirement thrift savings plan with matching dollars
• Tuition reimbursement after one year of
employment for qualified employees
I'm not just a nurse.
I'm inventing a new
model of health care.
the line. The only thing we
as healthcare providers
can ask is for people to
hang tight, continue staying
home, and please pray
and support your front line
workers because although
now called heroes, we
are people just like you.
Working directly with
COVID patients has been
challenging in many ways, but also rewarding in many
others. I feel that nursing care has become more essential
than ever in the care of patients, as things change quickly
and unexpectedly. It brings me so much joy when a
patient finally begins to improve, especially when we can
celebrate the little things such as going for a short walk
or taking a much-needed shower on their own. But the
biggest cheers come with the discharge paperwork and the
wheelchair ride to the car.”
Maternity Nurse
Hollyann DeCarteret,
BSN, RN, a maternity
nurse at Elliott Hospital,
was profiled on the River
University website. “It’s an
ever-evolving situation
and we are all trying to
roll with the punches. I
am a nurse and I
absolutely love what I do.
It’s a scary and emotional time, but in healthcare, we all
have each other’s back and we are helping to rally each
other. We are a family. We smile with our eyes (because
you can’t see our mouths) and continue to care with every
bit of our hearts.”
Public Health Nurse on
the Front Line
Rivier University alumna
Bobbie Bagley, RN is the
Director of Public Health
and Community Services
in Nashua. In her profile
on the school’s website
they note that Bagley has
been on the front line of
the COVID-19 pandemic
for weeks, working with
City officials and others to keep the community informed,
prepared, and safe. “My job is to promote, preserve,
and protect the health of our community and to lead the
community response to emergent public health issues.
The joint response to COVID-19 has been absolutely
phenomenal. Everyone is working together including the
City of Nashua, the Office of Emergency Management,
hospitals, schools, and faith-based organizations. Together,
as a community, we can stop the spread of COVID-19.”
NHNA Nurse
NHNA’s own Executive
Director Joan Widmer,
RN was profiled on
the Rivier website.
Joan has been keeping
New Hampshire nurses
informed regarding the
COVID-19 pandemic.
“The NHNA is
addressing concerns raised from nurses around the state,
staying informed on COVID-19 updates from the CDC,
NH Department of Health and Human Services and the
American Nurses Association and communicating this
information through e-flashes and our website.”
DHMC Nurse
Danielle Finn, RN of
DHMC was interviewed
by ABC news. She
speaks Portuguese and
recently translated
for a patient in the
COVID-19 unit in
addition to preparing
language signs to assist
Danielle Finn and
DHMC co-workers.
in communication.
Fenn, who is originally
from Brazil, was living in Germany before she came to the
United States in 2004 to be with her late husband. Now,
her international roots are playing an instrumental role in
caring for her patients.

June, July, August 2020 New Hampshire Nursing News • Page 13
From the Bookshelf
CURE COTTAGES OF SARANAC LAKE:
Architecture and History of a Pioneer Health Resort
by Philip L. Gallos, 1985
Reviewed by Anita Pavlidis RN MSN
For seventy years the name Saranac Lake was
synonymous with tuberculosis. It meant mortal
dread and at the same time transcendent hope. The
only treatment available for the disease was both
researched and dispensed in the isolated village in
New York State’s Adirondack Mountains.
Between 1873 and 1945, Saranac Lake, New York
became a world-renowned center for the treatment
of tuberculosis, using a treatment that involved
exposing patients to as much fresh air as possible
under conditions of complete bed-rest. In the
process, a specific building type, the "Cure Cottage"
was created.
As a young man Dr. Edward Livingston Trudeau
(1848–1915), watched his elder brother die of
tuberculosis over a period of three months– at the
time, the disease was incurable. He subsequently
trained as a doctor, and, three years after
completing his studies, was himself diagnosed with
tuberculosis. Conventional thinking of the time
called for a change of climate, and he went to live
in the Adirondack Mountains, spending as much
time as possible in the open, and he subsequently
regained his health. In 1876 he moved to Saranac
Lake and established a medical practice. In 1882,
Trudeau read about success in treating tuberculosis
with the "rest cure" in cold, clear mountain air.
Following this example, Trudeau founded the
Adirondack Cottage Sanitarium in February, 1885.
With the fresh air treatment a whole technology
developed and a building type known locally as a
“cure cottage” developed. The requirement for fresh
air lead Trudeau to avoid large institutional settings,
feeling that a cottage-like structure would maximize
the patient's exposure to light and air, and avoid the
sanitation difficulties of a large institutional setting.
Consequently, as the town's increasing fame drew
more and more invalids, "cure cottages" began to
spring up throughout the town. Many were created
by simply adding glassed-in porches to existing
houses. Others were built as cure cottages and/or
apartment buildings, but all had "cure porches" with
sliding glass windows, in which patients spent at
least eight hours a day resting on special day beds
or reclining chairs.
The discovery that tuberculosis was contagious
further contributed to Saranac Lake's importance
as a cure center, as many other venues in the
Adirondacks began to turn "consumptives" away. As
a result, the village grew rapidly, from 533 in 1880
to 1,582 in 1890 to a peak of more than 6,000 by
1920. A number of different types of institutions
developed: boarding houses and cottages, for
relatively ambulatory patients; cottages that did
not provide board, in which case meals would be
provided by a nearby boarding cottage; "nursing
cottages" for patients too weak to get around.
Tuberculosis did not respect wealth or position;
all levels of society were represented, from the
first factory girls to scions of nationally prominent
families.
World War I caused another major increase in
patients— the stress of war and the damage caused
by mustard gas provided fertile ground for the
tuberculosis bacillus. In 1944, an effective drug,
streptomycin, was developed, and by the mid-
1950s, sanatorium treatment of tuberculosis was
nearly entirely supplanted by drug treatment. Many
of the cure cottages were converted into apartment
houses, and some were torn down; some have been
lovingly restored, and some badly renovated.
Christy Mathewson "Cure Cottage" in Saranac
Lake, New York. Taken by Mwanner.
This book is of interest to history buffs, researchers
wishing to understand the outdoor life once lived at
Saranac Lake, and to architectural historians tracing the
influence of that life on buildings all over the United
States. The book was an interesting read however, the
writing was methodical and detailed. Considerable space
was devoted to the architecture and history of many
of the cottages. It is a book that you can pick up and
read and put down over a period of time, reflecting on
the dark thread of tuberculosis throughout the fabric of
American Life.
The exploits of Saranac Lake parallel those of New
Hampshire. The Glencliff Home for the Elderly, located
in the White Mountains, was formerly the Glencliff
Sanatorium, which opened in the summer of 1909 for
New Hampshire residents infected with tuberculosis
seeking respite and cure in the fresh mountain air.
The New Hampshire State Sanatorium was located at
Glencliff because the site's elevation of 1,650 feet would
provide the fresh mountain air that was then thought to
be therapeutic for tuberculosis patients. Glencliff was
a self-sufficient community, designed to maintain the
isolation that was part of the sanatorium concept. Its
medical facilities included a hospital unit, an open ward,
an x-ray facility, an operating room, and a microbiology
laboratory. The campus encompassed 500 acres and
included a farm with pigs and cows and a vast vegetable
garden. Electricity, water, and sewage disposal were
all provided by the nearby town of Glencliff. Coal was
brought to the base of the mountain by train until the
HUMOR ME
Regularly exercising our sense of humor improves
resiliency, positivity and balances anti-negatively.
Laughter may not solve problems but can change
your chemistry allowing you to face them anew. In this
issue we present one-liners related to the COVID-19
pandemic.
• What should you do if you don’t understand a
coronavirus joke? Be patient.
• If you need 144 rolls of toilet paper for a 14 day
quarantine you probably should have seen a doctor
long before COVID-19.
• With hair salons, nail salons, waxing centers, tanning
places and barbershops closed, it’s about to get ugly
out there.
• What’s the best way to avoid touching your face? A
glass of wine in each hand.
• Sign on a dating site: Single man w/TP seeks single
woman w/Purell for good clean fun.
• Grocery shopping has become a real life version of
PAC-Man. Avoid everyone, get the fruit, and take
any route to avoid contact.
• Man looking at his calendar: Can’t wait until
tomorrow. I have another big day of hand washing
and looking out the window planned.
railroad was discontinued in 1952. The sanatorium even
had its own shortwave radio station. The sanatorium
treated more than 4,000 TB patients during its first 50
years. When the outlook for patients with tuberculosis
changed due to drug therapy Glencliff sent its last active
tuberculosis patient to the Mary Hitchcock Hospital
in Hanover, ending the sanatorium movement in New
Hampshire.
In 1970, the Glencliff Sanatorium was converted into
the Glencliff Home for the Elderly. Many of the unique
architectural features of the original facility have been
preserved. The main patient building still has its floorto-ceiling
windows that admit ample light. The sturdy
columns that used to support the screened porches
which were used for the open-air treatments have now
been framed in to create patient rooms.
Fresh air porch at Glencliff Sanatorium
The themes of both the book and story of Glencliff
Sanatorium are much the same as the COVID-19 world
we live in today. Patients experienced isolation, sickness,
loneliness, separation from family and friends, fear of
never recovering, and loss of income/jobs. For many
years, there was no effective treatment and worry about
the patients returning to society as their health improved
but were not cured of tuberculosis. But this period did
end and although there was a tremendous loss of lives,
people survived this time and met the challenges of that
terrible time. We shall too.
Anita Pavlidis, RN MSN was the former Director of
Nursing at the NHTI, Concord’s Community College
and Program Specialist at the New Hampshire Board of
Nursing.
• Nobody thought I’d amount to anything. But here I
am lying on the couch, saving the world.
• In 2021: Human Resources: I see a gap in your
resume. What were you doing in 2020? Job hunter:
Looking for toilet paper.
• We are about three weeks away from finding out
what everyone’s real hair color is.
• Thinking a mask is going to stop COVID-19 is the
same as thinking that your underpants will protect
everyone from a fart.
• Half of us are going to come out of the quarantine as
amazing cooks. The other half will come out with a
drinking problem.
• Some of us need to practice social-distancing from
the refrigerator.
• Public Service Announcement: Every few days try
your jeans on, just to make sure they fit. Pajamas will
have you believe all is well in the kingdom.
• Day five of homeschooling: Which one of you
called in a bomb threat?
• A dog owner: Now I know why dogs are so excited
to go for walks.
• A cat owner: My cat is still trying to figure out why
I’m in his house after 8 AM.

Page 14 • New Hampshire Nursing News June, July, August 2020
WELCOME NEW and RETURNING NHNA MEMBERS!
NHNA welcomes these new and returning members. Thank you!!! What do these 67 nurses and over 1,100 NHNA members know that you don’t?
If you are not a member ask your neighbor on this list why they joined! Go to nhnurses.org where joining is easy and one of the best professional values
for your money! We want to see your name here in the next issue of the NH Nursing NEWS!
Allenstown, NH
Tiffany Hutchins
Atkinson, NH
Charlotte Dimaggio
Auburn, NH
Angela Diorio
Bedford, NH
Julia Duquette
Boscawen, NH
Brooke McLain
Bow, NH
Sally J. Jenkins
Brentwood, NH
Sarah Dinneen
Claremont, NH
Odalie Bernash
Concord, NH
Susan Bryant
Mary Elizabeth Cahan
Dorothy Michelle
DeLisa
Derry, NH
Dawn LaPorte
Stephanie Russo
Barbara Sullivan
Dover, NH
Jeanne Spurlin
Laura Willett
Elkins, NH
Shari Goldberg
Goffstown, NH
Julianne M. Ashton
Hampton, NH
Nicole Susan
Leibundgut
Hooksett, NH
Sabrina Bolianites
Hudson, NH
Elizabeth Duffy
Elizabeth Martell
Intervale, NH
Jennifer Leigh Grise
Keene, NH
Margo Helen Banks
Rachel Hough
Laconia, NH
Deborah E. Bossey
Lebanon, NH
Nadine Nicola Brown
Dayhna Pamela Marti
Ojeda
Janice E. Morton
Lee, NH
Suellen Olson Drake
Lisbon, NH
Sean Destephanis
Littleton, NH
Bailey Dammen
Manchester, NH
Melinda Daigle Bennet
Martha Derkach
Mirline Estiverne
Kathleen Fantozzi
Kathleen Bridget
Forbush
Jessica Gluek
Pamela Lee Gomes
Cindy T. Louxay
Jessica McCardell
Claude Mua
Kim Ozuna
Hannah Pirozzoli
Melissa Vitagliano
Merrimack, NH
Julie Brady
Nashua, NH
Tammi Boudreau
Mellony Cude
Alana Evans
Emily Madison
Lily Roselin Raja
New Boston, NH
Emma Angeline Pinard
New Hampton, NH
Jaimie N. Walton
Newton, NH
Tina Greenwood
Northfield, NH
Michele Ann Murphy
Taylor Thompson
Penacook, NH
Cynthia Bergeron
Peterborough, NH
Brittany Stokes
Plainfield, NH
Sunshyne June Rice
Plymouth, NH
Paula Michelle Hurvit
Moulton
Rindge, NH
Donna J. Babb
Salem, NH
Brittany Burke
Bethany A. Pelletier
Stratham, NH
Ericka J. McCarron
Sunapee, NH
Arlene M. Halsted
Thornton, NH
Kimberly Ann Thibault
Wolfeboro, NH
Dara St. Sauveur
Woodsville, NH
Dina Quinn
Nurse in Key Role in New Geriatric Program
Dartmouth-Hitchcock Medical
Center (DHMC), in partnership
with West Health of Lebanon,
has launched a three-year
effort to build a hub and spoke
model Geriatric Emergency
Department (GED) aimed at
keeping most geriatric patients
in their communities through
telemedicine. A key player
in the development of this
innovative approach to caring
for geriatric patients in northern
New Hampshire is Hilary
Hawkins, BSN, RN, Geriatric
Emergency Department
Manager at DHMC. Hawkins
is responsible for developing
Hilary Hawkins,
BSN, RN, Geriatric
Emergency
Department Manager
at DHMC.
care protocols and implementing screening tools to assess
the needs of the geriatric patient. “The idea behind [the
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GED] is DHMC (the hub) has many resources such as case
managers, social workers, pharmacists and geriatricians that
can help community hospitals (spokes) with the geriatric
population, to keep them in their community hospitals or
their homes,” states Hawkins. Research has demonstrated
that admitting geriatric patients can often lead to additional
risks versus maintain them in their home or community. Of
course, if these patients need to be at DHMC they will be
welcomed.
Hilary Hawkins, BSN, MBA, RN, CEN, CPEN, TNRN
always knew she wanted to be in health care. Her father
was a nursing home administrator and she spent time there
growing up. “I first started in healthcare in EMS and then
obtained my BSN. As a nurse, I have worked in the adult
intensive care unit, the emergency department, trauma
performance improvement and then running trauma
programs. Statics show that trauma in NH is predominantly
65 years and older which led me to work closely with
palliative care, hospice and ethics committees,” remarks
Hawkins. Hawkins is certified in Geriatric Emergency
Nursing Education (GENE), as designated by the Emergency
Nursing Association, the leading professional organization
for emergency nurses.
“We’re delighted to have Hilary’s insight, experience
and expertise so tightly woven into the development of
our GED,” says Karen Clements, RN, FACHE, D-H Chief
Nursing Officer. “This investment will have a lasting
positive impact on our patients and our communities,
and for that reason it’s absolutely imperative that we have
qualified nurses, like Hilary, so closely engage in what we’re
creating.”
GED nurses are aware of the nuances in care required
by geriatric patients, including the need for additional
assessments to detect underlying issues with mental
health, physical health or in need of additional resources.
“They work closely with care management to ensure that
the patient has the appropriate resources or equipment at
home and that they understand their discharge plans or
follow up,” notes Hawkins. GED nurses also ensure that the
patient is receiving the care that matters most to them. Most
often that care is at home.
The goal of the GED is to recognize those patients who will
benefit from inpatient care, and to effectively implement
outpatient care to those who do not require inpatient
resources. The GED utilizes additional staffing, equipment,
education, policies and procedures, follow-up care, and
performance improvement measures. When implemented
collectively, the GED hopes to see improvements in patient
care, customer service, and staff satisfaction. Improved
attention to the needs of this challenging population has
the opportunity to more effectively allocate health care
resources, optimize admission and readmission rates,
while simultaneously decreasing iatrogenic complications
and the resultant increased length-of-stay and decreased
reimbursement.
Developing the care protocols the GED will use has been a
multidisciplinary team approach based on evidence. These
disciplines include and are not limited to pharmacists,
nurses, physicians, care managers, social workers, physical
therapists, occupation therapists, as well as community
resources and experts in the area of aging. Additionally, the
team is developing a robust data analysis process that will
guide much of the work going forward and help to identify
quality measures and understand related outcomes.
“The Geriatric Team at DHMC is still working on
developing and refining their processes and the
application,” comments Hawkins. The spoke and hub
implementation has slowed down as resources are needed
to focus on COVID -19. The Geriatric Team continues to be
a presence in the ED during the pandemic and is live-time
providing support to our older families. The Geriatric Team
is also adding their collective experience to the Nursing
Home Collaborative which is meeting to discuss how
nursing facilities can maximize the use of their resources
in the best interest of all patients, and still protect their
residents who are some of our most vulnerable.

June, July, August 2020 New Hampshire Nursing News • Page 15
NCLEX
Reconsidered
Focus on IV
Therapy
Ed Note: Where it has been a year or
years since you took the NCLEX (AKA
“Boards”), how well would you do
now?
1. A patient is receiving an infusion of lactated ringer’s
solution at 100 ml/hr. The IV site appears red with
moderate swelling. The infusion is sluggish as the pump
keeps alarming. The nurse recognizes these findings as:
A. Extravasation
B. Infiltration
C. Phlebitis
D. Occluded catheter
2. The nurse reports a patient’s central venous pressure
as 1mmHG. Which provider order for fluids should be
questioned by the nurse? (Select all that apply).
A. 0.9% NaCl
B. 0.45% NaCl
C. 3% NaCl
D. Lactated Ringers
E. D5LR
3. For which patient would a colloid be administered?
A. A patient with chronic heart failure with slight JVD
and BP 96/50
B. A patient with chronic anemia and Hg/Hct report of
9/31
C. A patient with cirrhosis and pitting edema of the
extremities
D. A patient requiring volume replacement for chronic
diarrhea
4. A home care nurse is conducting a follow-up home visit
to a patient who has been discharged with a parenteral
nutrition (PN). Which of the following should the nurse
most closely monitor in this kind of therapy?
A. Blood pressure and temperature.
B. Blood pressure and pulse rate.
C. Height and weight.
D. Temperature and weight.
5. A patient that has been receiving parenteral nutrition at
80 ml/hr has been cleared to begin a liquid diet. The
nurse expects that which of the following orders?
A. Decrease parenteral nutrition to 40ml/hr.
B. Start 0.9% normal saline at 30 ml/hr.
C. Maintain the present infusion rate.
D. Discontinue the parenteral nutrition.
Answers on page 17
NH Nurses Make It Happen
Elliot ICU nurse Heidi Kukla, right, decided to take
the need for vital PPE into her own hands. She and
other volunteers were working around the clock
in a making-marathon of protective gowns she
designed. (Photo courtesy Elliot Hospital)
Personal protective equipment or PPE has been in
been in short supply in New Hampshire and across
the country. While Elliot Hospital and Southern New
Hampshire Medical Center, both part of Solution Health,
have been managing supplies and orders in advance
of the surge, isolation gowns have been of particular
concern. With a mix of talent and innovative spirit, some
inspired nurses at Elliot Hospital took on the challenge of
enhancing supplies.
Heidi Kukla, RN, who practices in the Intensive Care
Unit at Elliot developed a pattern for a disposable,
detachable gown. Working with colleagues who
volunteered their time, Kukla developed prototypes that
went to Infection Prevention staff for testing and review.
A socially-distant but unified volunteer crew has
taken over AR Workshop on Elm Street to make
the gowns. (Photo courtesy Elliot Hospital)
Once the teams landed on a design and material that
met the necessary clinical standards, Kukla reached
out to fellow ICU nurse, Stephanie Joyce who had a
strong connection at AR Workshop on Elm Street in
Manchester. Joyce helped AR owner Laura McKelligan
set up the shop, which has been closed because of
the “stay at home” order. McKelligan was more than
happy to open her doors and transformed the crafting
workshop into a gown-making shop. SolutionHealth
purchased materials for the group to create more
gowns to be used at Elliot Hospital and Southern New
Hampshire Health, and McKelligan was able to bring
back some of her staff to help.
“Stephanie asked if the space was being used, and I told
her they were more than welcome. One day turned into
a weekend, and now we are planning for the whole
week,” McKelligan said on Monday.
Kukla says the disposable gowns will cost less than 25
cents/each and the washable gowns will cost about $10/
each. She says volunteer labor was key to keeping costs
down. The group spent the weekend cranking out gowns
at the AR Workshop.
Be Part of
Research
Ed Note: The Nursing News receives requests
from researchers to solicit study subjects or
participants. All studies must demonstrate
evidence of Institutional Review Board approval.
Cynthia Horton Dias RN, a PhD Candidate
at the University of South Carolina is seeking
participants for a research study to understanding
of the experiences of hospital nurses with free
food in the workplace. Qualified participants for
this study are registered nurses (RN), working
at least 50% of the time inside a U.S. hospital
and participation will involve filling out a survey
taking no more than 15 minutes. Participants will
be entered into a raffle for one of two US $100
Amazon gift cards. Once the drawings for the
raffles are completed, email address collected for
the drawing will be deleted. No other personally
identifiable information will be collected in this
study, other than certain demographic measures.
Nurses who meet the study criteria can take
the research survey at this link: https://is.gd/
RNfreefood

Page 16 • New Hampshire Nursing News June, July, August 2020
Due to the coronavirus pandemic, Plymouth State
University (PSU) senior nursing students quickly adjusted
to virtual simulations and other alternative methods to
complete their final semester of clinical training. The nursing
students graduated early – a full month ahead of schedule.
The combination of earlier graduation and the New
Hampshire Board of Nursing issuing temporary licenses to
new graduate nurses allowed healthcare facilities to start
the onboarding process weeks earlier than usual. “This is
especially important now,” said Kim Force, Clinical Director
of Inpatient Services at Littleton Regional Hospital. Seventy
percent of PSU’s nursing graduates expect to become
licensed in New Hampshire, and many will begin working
at the hospitals where they completed their senior capstone
semesters.
St. Joseph School of Nursing, with approval of the NH
Board of Nursing, has added an evening cohort of 24
students to their associate degree nursing program.
Shannon Murdock a graduating senior nursing
student at the University of New Hampshire was
honored as a 2019-20 America East Winter Scholar-
Athletes. This was Murdock’s second year as a
Scholar-Athlete. She earned her BSN with a 4.0
GPA in nursing and 3.72 GPA overall. Murdock won
the 5,000 meter track event at the America East
Championship and also placed second in the mile.
The Salter School which offers a program to prepare practice
nurses among other non-licensed health careers was renamed
the American School of Nursing and Medical Careers.
The campus remains in Manchester, New Hampshire. The
American School of Nursing and Medical Careers is owned by
Premier Education Group, L.P.; registered limited partnership
in the Commonwealth of Pennsylvania.
ED Note: News from nursing schools, faculty,
students or alumni are welcome. Please direct
submissions to office@nhnurses.org with NHNN
in the subject line.

June, July, August 2020 New Hampshire Nursing News • Page 17
Florence Nightingale – Lamp of Scutari
Ed Note: This is the third in a four part series celebrating
the 200th birthday of Florence Nightingale and the Year
of the Nurse
Sue Fetzer
In March 1854, England, France and Turkey declared
war on Russia to protect themselves against the Russian
expansion, marking the beginning of the Crimean War.
England had not been in a foreign war for 40 years and
the 27,000 English troops had gone to Turkey with little
support from a Medical Department.
After accepting, Sidney Hebert’s request, Florence
recruited nurses from the Irish Catholic Sisters of Mercy
(10), Anglican Sisters of Mercy (8), St. John’s House
of the Church of England (6) and 14 lay nurses from
hospitals around London. Together with Florence and
her housekeeper from Upper Harley Street and Mr. and
Mrs. Bracebridge, 41 members of her group departed
London on October 21, 1854. The travelled to Paris then
to Marseilles where they boarded the cargo ship Vectis.
Despite nearly all developing seasickness, they arrived at
Constantinople (today known as Istanbul) on November
4. Constantinople is divided by the Bosporus, a strait of
water connecting the Black Sea to the Mediterranean
and Atlantic Oceans. The French Hospitals were on the
west side, while the British wounded had been taken to
Scutari, on the Asiatic, or east side of the Bosporus.
Florence was given the nursing responsibility of
Superintendent of Hospitals in the East of eight hospitals,
but she spent most of her time at the Barracks Hospital
on the hill overlooking the town of Scutari. The hospital
had been created out of a Turkish army barracks, and the
large square building was nearly a mile in circumference,
three stories tall with towers on each corner. In the
central court up to 12,000 men could exercise. There
was over four miles of corridors for wounded and sick
men to inhabit, up to 2,500 men at a time. The Hospital
was located over a network of cesspools, the sewer
lines were blocked and overflowing into the hallways.
Windows were closed against the cold.
The reception provided to Nightingale and her nurses
was nonexistent. Soon after her arrival Florence
approached the medical officers to offer her services.
Dr. Hall, Inspector General of the Hospital declined.
Most of the medical staff believed the intruders would
be a hindrance. The environment, rats, vermin, the lack
of bedding, clothing, no kitchens, provision for washing,
or medical supplies, they believed was not appropriate
for women. The Nightingale party was quartered in two
floors of one of the Towers.
Twenty-four hours after their arrival, more wounded
arrived from the Battle of Inkerman, across the Black Sea
Answers to NCLEX Reconsidered from page 15
1. C 2. B,C 3. C 4. D 5. A
from Scutari. Wounded men would have to be carried
to the docks, transported by boat, unloaded onto the
docks and transported to the Barrack Hospital. The
ordeal could take up to two weeks. There was little
nourishment during the trip, and little upon arriving at
the hospital. Nightingale’s nurses first set up a kitchen,
and the smell of soup was enough to prompt the
medical officers to allow the group to feed the wounded.
Obtaining and storing supplies was one of Nightingale’s
ongoing efforts. Medical supplies were often rerouted,
not unloaded or stolen. Three different government
agencies were responsible for supplies with little
communication. Food preparation was primitive, boiled
in huge copper pots. Vegetables were rare. There were
no laundry facilities as the boiler had broken. She
wrote home, to the English newspaper Times and to
the officials that had sent her, proclaiming the lack of
supplies and conditions. Soon, supplies were sent to her
directly, and she maintained a ‘warehouse’ in the tower.
Sash worn by one of
the Nightingale
nurses.
From the beginning,
Florence kept track of
the wounded, those
suffering from disease,
and the dead. She hunted
down cleaning supplies,
created kitchens, got
the boilers fixed and
created a laundry. An
oft repeated story relates
that one night, the surgeons triaged five soldiers aside to
die, deeming their condition hopeless. Nightingale got
‘permission’ to care for the men through the night and by
morning they were fit for surgery. She would reply ‘we
must’ to medical officers who would say ‘we can’t.’
The winter of 1855 recorded temperatures at Scutari of
–10 degrees C. The hospital was full of cases of frostbite,
gangrene, and dysentery. Nightingale calculated the
mortality rate of 1,000 per 1,174 men. Nightingale’s
letters to her benefactor in England, Sidney Herbert,
were shared with Queen Victoria who responded.
Nightingale would administer the hospital during the
day and make rounds after the surgeons had retired for
the night. She would carry a small lamp in her hand and
would pause for anyone in need. The practice would
be responsible for her reputation as the “Lady with the
Lamp.”
Turkish lamp of style
used by Nightingale
Cholera, a bacterial
infection from water
or food contaminated
by human waste,
was rampant during
the Crimean War.
Diagnosed by watery
diarrhea, vomiting,
and muscle cramps,
the dehydration and
electrolyte imbalance
resulted in a blueish
tinge to the skin. There
was no cure, only care. Throughout 1855, typhus
fever also ran rampant. Typhus, caused by bacteria
transmitted by flea, mite, louse, or tick bites, results in a
severe headache, fever over 102, rash, hypotension and
photosensitivity. Unfortunately the medical staff and
Florence’s nurses were not immune.
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On May 1855, Florence set out across the Black Sea
for Balaclava to determine how the sick and wounded
were cared for near the fighting front and to inspect
the hospitals. Arriving at the dock was a much different
scene than when she arrived in Scutari six months
previously. Her successes at the Barracks Hospital were
well known, and some of the men she had cared for had
returned to the front lines. While on this trip, Florence
is stricken with Crimean fever. While historians have
debated the cause, it was most likely brucellosis, a
bacterial infection transmitted from animals by ingestion
of raw milk, infected food or contact with an infected
animal. Symptoms include fever, sweats, headaches,
back pains, and physical weakness. One form of the
illness may also cause long-lasting symptoms, including
recurrent fevers, joint pain, and fatigue, complaints that
Florence would manifest for the rest of her life.
After a month being cared for by her own nurses,
Nightingale returned to Scutari for additional
recuperation, by August she was back administering the
Barracks Hospital. Her recovery was heralded in England
as a heroic. In November, Florence received a letter and
gift from Queen Victoria. Designed by Prince Albert, the
brooch with the inscription “Blessed are the merciful,”
the word “Crimea” and a St. George cross surmounted
by a crown of diamonds. A Crimean Peace was declared
in March, 1856, but the hospitals did not close until the
summer. Florence left Turkey late in July traveling as
‘Miss Smith;’ she arrived at Lea Hurst unnoticed.
The Florence
Nightingale brooch
bestowed by Queen
Victoria in 1855
served as the
inspiration for the
current nursing pin
bestowed on nursing
schools graduates.
Despite her success
during 20 months in
Scutari, Nightingale felt
she had failed to reform the Medical Department of the
Army. Although, she was comforted in the thought that
she met her calling to do “God’s work.” At 36 years old,
she saw her achievements as starting point for her future
work.
Upon returning from
the Crimea,
Nightingale’s hair has
started to grow back
after being cropped
short during her
experience with
Crimean Fever.
Next Issue: Florence Nightingale – Shaping the Profession
RN 2nd Shift Supervisor Needed – Charge Nurse Role
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Page 18 • New Hampshire Nursing News June, July, August 2020
IN MEMORY OF OUR COLLEAGUES
The New Hampshire Nurses Association honors the
memory of and acknowledges the work of deceased
nurses who have graduated from New Hampshire
nursing schools or who have actively practiced in
New Hampshire during their career. Sharing the
names and information about these nurses is one way
we honor their contribution to the profession. Brief
submissions are welcome.
Navy Nurse
Barbara A. Cirincione, 86, formerly of
Manchester and Holderness, died on
Februrary 14, 2020. She proudly served
in the U.S. Navy as a nurse. Before
retiring, Barbara worked as an APRN
for Elliot Hospital. She was especially
proud to serve as the parish nurse at
her local church for many years. Barbara was also a
camp nurse for the American Diabetes Association
Insurance Nurse
Louise C. Marchand, passed away
February 14, 2020, After high school
she was a manager of dental offices
and at age 40 decided to change her
career path. She graduated from NHTI
with her AD degree and practiced in
Manchester area hospitals. Later, after
earning her National Case Management Certification,
Louise became an administrative insurance nurse first
for Cigna and later for Alicare Medical Management,
where she worked at the national level managing
complex cases.
Sacred Heart Grad
Marlene Eudora (Cilley) Eddy, 72, died
February 19th, 2020. She was a native
of Concord, graduating from Sacred
Heart Nursing School. With a 40+ year
career as an RN, she retired from
Havenwood Heritage Heights in 2011.
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36 Clinton Street Concord, NH 03301
Human Resources 603-271-5855
LPN
Rachel M. (Snow) Crane, 82, of
Hillsborough, passed away on February
22, 2020. As an LPN she worked for
Hillsboro House Nursing Home and
Hillsboro Visiting Nurses Association.
Gero Nurse
Rita A. Latham, 91, died on February
22, 2020. She obtained her nursing
diploma in Massachusetts and as a
Concord native practiced at Concord
Hospital. For many years she was a
nursing supervisor at McKerly’s Nursing
Home, and in 1992 opened the first
Adult Medical Day Care center in NH where she
practiced for nearly 20 years.
Public Health Expert
Kathleen A. (Katie) Dunn 61, died on
February 20, 2020 after a courageous
three year battle with brain cancer. She
obtained her nursing diploma at the
Concord Hospital School of Nursing
where she graduated as valedictorian.
She earned a BS from New England
College in Psychology and Sociology and a MPH from
Boston University School of Medicine, School of
Public Health. She practiced at Concord Hospital for
twenty years as an ICU/CCU, PACU RN. She
supervised ER Admitting. She opened the New
Hampshire office of the New England Organ Bank.
She spent 23 years employed by the State of New
Hampshire. Beginning in Maternal and Child Health as
a nurse consultant, bureau Chief of Communicable
Disease, and Director of Public Health. She was
Associate Commissioner of Health and Human
Services. One of her career highlights was writing the
CHIP (Children’s Health Insurance Program), a pilot
program for the country, under then Governor Jeanne
Shaheen. She was a compassionate advocate for the
disabled and their families. Her career concluded as
Senior Program Director for the National Academy of
State Health Policy in Portland, Maine and
Washington, DC. She was a Robert Wood Johnson
Medicaid Leadership Fellow.
Gero Nurse
Rita P. Annicchiarico died peacefully
on March 8, 2020 She earned a nursing
diploma in 1951 and practiced in
private duty as well as a nurse at the
former Centennial Home.
Mary Hitchcock Grad
Ethel Amy (Norcross) Crane, 86, died
on March 11, 2020 after a long hardfought
battle with dementia. She
received her nursing diploma in 1955
from Mary Hitchcock Memorial School
of Nursing. She practiced at the State
Hospital and Concord Hospital in
Concord, the Newport Hospital in Newport, NH,
Hillsboro House Nursing Home and the Office of Dr.
Richard Douglass in Hillsboro, NH.
Sacred Heart Grad
Maryanna (Casey) Commerford, 85,
died March 12, 2020 at the CRVNA
Hospice House in Concord surrounded
by her children. She obtained her
nursing diploma from Sacred Heart
Hospital School of Nursing. She had a
long career as a Registered Nurse, practicing at
Concord Hospital and St. Paul’s School.
Founding Nursing Educator
Barbara “Ann” Manchester Kelley, 85,
died on March 14, 2020. Ann received
her nursing diploma in 1955 from Peter
Bent Brigham Hospital School of Nursing
in Boston and her master’s degree in
nursing education from Boston
University. She moved to the University
of New Hampshire in 1964 to help develop a new
baccalaureate nursing program. As a founding nursing
faculty member, she remained on the faculty until her
retirement in 1998. Ann was a highly esteemed
colleague serving terms as Interim and elected
Department Chair. In recognition of her contributions,
the Department of Nursing established the Ann
Manchester Kelley Nursing Inquiry Day, a research
presentation day for UNH undergraduate and graduate
nursing students. She served as President of the New
Hampshire Nurses’ Association and founding member
of Eta Iota Chapter, Sigma Theta Tau International
Honor Society of Nursing. Ann received the Joseph D.
Vaughn Award in 2011 for 29 years as a founding
volunteer of the NH Long Term Care Ombudsman
Program. A fond memory was the summer she crossed
the US in a camping trailer with her
husband, visiting schools of nursing to
study their nursing simulation
laboratories. After returning to UNH,
she wrote and received a federally
funded grant to develop and direct the
first nursing simulation laboratory at
UNH.
A Tribute to Ann Kelley
My fondest memories of Ann Kelley were from
the time that I served on the leadership team for
New Hampshire Nurses’ Association (NHNA).
This was back in the late 80’s and through
the 90’s. During this time, I served as a board
member, then an officer, and eventually from
1994-1996, as the Association’s president. I
recall that Ann was a constant presence in
the NHNA leadership, having herself been the
NHNA president in a prior decade. She was
a constant source of wisdom, support and
guidance, not only for me, but for the many
NHNA presidents that would come after me.
Well after her formal retirement, I would always
see Anne at NH nursing gatherings......always
invested and interested in what was happening
with nurses in our state and how the work of
the profession was evolving. Never without
an opinion, she was one of nursing’s greatest
advocates.
This said, I believe the pivotal role she played
was as the steward of NH nursing’s and the
Association’s history. She meticulously archived
materials, documents and artifacts that she
personally collected over the many years of her
nursing career spent in NH. It would always
amaze me when Ann could produce a sentinel
document from years past that would actually
help to inform a current dilemma. Preserving
our history was truly a passion for Ann.
Ann reigns among the many unsung heroes
of New Hampshire nursing for her perpetual
efforts to help us preserve our history. She will
be greatly missed. – Susan Reeves, EdD, RN,
CENP, Chief Nurse Executive, Dartmouth-
Hitchcock Health
School Nurse
Diane Brown McClintock, 79, died on
March 18, 2020. She was a diploma
graduate of the Elliot Hospital School of
Nursing in Keene, obtained a BSN from
Saint Anselm College, a degree in
Psychology at New England College
and earned a Masters in Education from
Antioch University. She practiced as a
school nurse for 28 years at ConVal High School in
Peterborough, NH.
Home Health Nurse
Nancy A. (Perry) Leppanen, 84, passed
away March 19, 2020. She practiced at
Home Health and Hospice, Merrimack,
N.H., for over 30 years.
Keene Nurse
Joyce Winnette Sawyer, 83, passed
away on March 19, 2020. A Keene
native she obtained her nursing diploma
from the Elliott Community Hospital

June, July, August 2020 New Hampshire Nursing News • Page 19
IN MEMORY OF OUR COLLEAGUES
School of Nursing in Keene. She practiced as a head
nurse in the Emergency Department at Cheshire
Medical Center.
Day Surgery Pioneer
Joan (Jamrog) McCann, 85, died on
March 27, 2020, after a period of
declining health. She received her
nursing diploma from the Elliot Hospital
School of Nursing in Manchester and
practiced as a registered nurse at the
New Hampshire State Hospital and Concord Hospital.
Joan also provided private duty nursing care and in
the mid-1970s, she was asked to open the Day Surgery
Unit at Concord Hospital. Joan successfully took on
the challenge ran the unit with another nurse. Upon
her retirement, Joan worked for the Department of
Health and Human Services for the State of New
Hampshire, using her nursing skills to oversee the
Katie Beckett Medicaid program and the Children’s
Prosthetics Program.
Concord Hospital Nurse
Brian J. Trombly Sr., 68, passed away
on April 26, 2020. Brian’s first career
included participating in the
construction of the Seabrook Nuclear
Power Plant in Seabrook, NH. Brian
changed careers and as a RN practiced
at Concord Hospital where he was a
member of the staff for over ten years.
Gero Nurse
Claire D. (Ouelette) Provencher, 85,
passed away April 30, 2020. After
obtaining her nursing diploma she
practiced at Notre Dame Hospital as
well as several nursing homes.
Seacoast Nurse
Nancy Jean (Collopy) Ferris, 76,
passed away March 29, 2020 at home
surrounded by family. After obtaining a
nursing diploma in 1964 she practiced
in Connecticut and New Hampshire.
Mary Hitchcock Grad
Hazel Howe McNamara, 95, passed
away on April 1, 2020. She graduated
from Green Mountain College in
Vermont and went on to pursue her
nursing degree at Mary Hitchcock
School of Nursing, graduating in 1947.
She had a long nursing career, finishing
it as a visiting nurse for the town of Hanover.
Nurse Educator
Nancy Bradley Chandler, 85, died May
5, 2020. She obtained her BSN and
MSN from Boston College. She
practiced in Boston, and New York and
taught nursing in Massachusetts
including as the Director of Lawrence
General Hospital School of Nursing.
Relocating to New Hampshire she taught nursing at St.
Anselm College and NHTI. She was a pioneer in
childbirth education, teaching classess in Laconia, and
Franklin, NH. She established Prenatal Programs at
Concord and Franklin Hospitals. Later in life she found
great joy as a school nurse in Winnisquam and
Warren schools and then as a camp nurse at Camp
Walt Whitman and Camp Moosilauke.
Nurse Educator
Marjorie Lillian Allen, 87, passed away
April 2, 2020. She obtained a BA from
Fitchburg State University and then her
nursing diploma. She taught nursing at
St. Joseph Hospital in Nashua. She also
practiced at the Derry Medical Center
for nearly eight years and coordinated
the community’s visiting nurse and
home-makers program.
North Country Nurse
Cynthia L. (Brown) Griffin, 61, of Berlin,
died on April 10, 2020. She was a
diploma graduate of the Concord
Hospital School of Nursing. She practiced
for many years at Littleton Hospital, North
Country Home Health and Coos County
Family Health Services.
• Emergency Room
• Maternal Child Health
• Inpatient Medical Surgical Unit
• Office RN
• PACU
UNH Grad
Rhonda Irene (Knapp) Hebert, 69,
passed away in Texas April 29, 2020.
She graduated Cum Laude from the
University of New Hampshire with a
Bachelor of Science degree in Nursing.