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.
Official Newsletter of New Hampshire Nurses Association
March 2021 | Vol. 45 No. 2
Happy National Nurses Day!
Three New Hampshire nurses
were selected by Governor
Sununu to attend the Super
Bowl LV in Tampa, Florida. The
Governor was provided tickets
by the Kraft family, owners of the
New England Patriots for an allexpense
paid trip to recognize
their hard work and sacrifice and
to spread the important message
of getting vaccinated. Facilities
provided the Governor with
the names of those who were
on the front lines of the COVID
pandemic. Nominees were
required to have had both vaccine
doses by January 24, 2021.
The nurses who attended were
Gina Teixeira, Emergency
Department Nurse, Southern
New Hampshire Health, Jenna
Osborn, ICU Nurse, Catholic
Medical Center and Dawn
Chapman, RN, Concord Hospital.
Teizeira was about two-thirds
through a 12 hour shift when
she was asked to report to her
supervisor’s office. “Oh God,
what did I do — or what are
they going to ask me to do?”
she remembered thinking. Her
supervisor brought her to a
conference room, where Sununu
was on the big screen. “Would
you like to go to Super Bowl LV?”
the smiling governor asked her.
current resident or
Nurses Day 2021 – May 6
Super Nurses Go
to Super Bowl
Super Nurses continued on page 2
Nurses in the News
Many New Hampshire nurses were credited by the news
media for being the first to receive COVID vaccinations.
Heid Kukla, an ICU nurse at the Elliot Hospital was the
first person to be vaccinated against the coronavirus
in New Hampshire. She was quickly followed by four of
her ICU colleagues.
“I volunteered to be first to get this vaccine because
I know a lot of people have reservations about getting
the vaccine," she said. “They’re worried about how fast
it was produced, what the long-term effects may be, but
I can assure you that there is absolutely nothing worse
than being a patient on a ventilator in an ICU anywhere
in this country right now with COVID, and the anguish
of the family members that can’t be there. As a nurse,
this is a very emotional moment for me. For the last nine
months we've been collectively searching for a solution
to the COVID-19 pandemic, as a community we now
have our solution.”
The nurses were administered their initial vaccinations
outside in 27-degree weather, prompting one to jokingly
ask whether officials were highlighting the vaccine’s cold
On December 15, 2020 Huggins Hospital Intensive Care
Unit (ICU) nurse Nicole Keirstead, RN, CCRN, was the
first employee to receive the vaccine.
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 firstname.lastname@example.org with
Nursing News in the subject line.
Reflections from the ED................................... 3
President’s Message..................................... 3
Board of Nursing News ................................... 3
The Truth About Vaccination ............................... 4
Coalition Corner .......................................8-9
Humor Me............................................. 9
NCLEX Reconsidered..................................... 9
From the Bookshelf..................................... 10
Nurses on the Move..................................... 10
Extraordinary Nurse Honored...............................11
Nurses Appointed to Board ................................11
Meet the METF! ........................................12
School of Nursing News...................................13
In My Opinion..........................................14
New Hampshire Board of Nursing Guidance....................15
NHNA Organizational Affiliates
Non-Verbal Communication: The Silent Giveaway............. 18-19
Welcome New & Returning Members.........................19
LNAs Learn and Earn ................................... 20
19th Year in a Row!..................................... 20
Hope and Healing for the Addicted Nurse..................... 21
In the News........................................... 21
Save the Date
Annual Student Nurse Virtual Conference
April 8, 2021
Nursing Excellence Awards
May 20, 2021
Nurses in the News continued on page 4
Nurses Night at Fenway
August 10, 2021
Page 2 • New Hampshire Nursing News March, April, May 2021
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Super Nurses continued from page 1
Patriots Plane decked out for healthcare.
Dawn Chapman, R.N., works in Concord Hospital’s 5
North — the respiratory unit. Her floor is an ICU “stepdown”
unit for ventilated patients. Chapman works 7 p.m.
to 7:30 a.m., so she was sound asleep when the call came
about the Super Bowl. Her son banged on the bedroom
door and said she had to come downstairs right away.
“It’s an emergency,” he told her. “Dad needs you
downstairs.” “Now I’m ready to kill my husband,”
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she laughed. “I come down and my husband’s on his
cellphone with this smirk on his face.” It was the hospital
vice president, telling her in a “DJ voice” that she had
been chosen to go to the Super Bowl.
Jenna Osborn, the ICU nurse at Catholic Medical Center,
said before the pandemic, most of her patients were
recovering from surgery at the heart institute. But once
it hit, their unit became a COVID ICU. Osborn was
chosen for the Super Bowl seat because she had logged
the most hours caring for COVID-19 patients in the ICU
since the pandemic began.
The nurses were transported to Gillette Stadium and
spent the night at a Patriot Place hotel in Foxborough,
Mass. The morning of the game they boarded the
Patriots plane at Boston’s Logan Airport. It was from
the very same hangar that received the plane filled
with 1.2 million respirator masks on April 2, 2020.
Patriots Chairman and CEO Robert Kraft greeted them
upon arrival at Tampa International Airport. Once in
Tampa, they attended the NFL TikTok Tailgate concert,
followed by the Super Bowl. They returned to Boston on
the Patriots team plane after the game, arriving back at
Gillette Stadium. Included in the package was a $100.00
VISA gift card for expenses.
Vol. 45 No. 2
Official publication of the New Hampshire Nurses’
Association (NHNA), a constituent member of the
American Nurses Association. Published quarterly
every March, June, September and December. Library
subscription rate is $30. ISSN 0029-6538
New Hampshire Nurses Association, 25 Hall St., Unit
1E, Concord, NH 03301. Ph (877) 810-5972, E-mail
Editor: Susan Fetzer, PhD, RN
Pamela P. DiNapoli, PhD, RN, CNL, Nurse Executive
Paula MacKinnon RN, Executive Assistant/
NURSING NEWS is indexed in the Cumulative Nursing
Index to Nursing and Allied Health Literature (CINAHL)
and International Nursing Index.
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March, April, May 2021 New Hampshire Nursing News • Page 3
REFLECTIONS FROM THE ED
In the December 2020 edition of Nursing News I wrote
about One Word: “mindfulness.” Mindfulness was the
word that I used to guide me through last year. The idea of
One Word is like setting a New Year’s resolution except it
is something that, unlike a resolution, you can accomplish.
One Word gives you focus, a word you select New Year’s
Day and use it to set your intentions every day throughout
the year. Last year’s word, “mindfulness” was much more
introspective than the word I chose for this year which is,
“gratitude.” Gratitude is a more expressive word and more
appropriate for 2021. The idea of One Word is that you
select your word and reflect on ways that you can live that
word and share the word with others.
Pamela P. DiNapoli
In 2021 it is important that we show gratitude. Gratitude for family and friends, many
of whom we have not seen in almost a year. Gratitude for our colleagues and the great
profession to which we all belong. Gratitude for vaccines, masks and handwashing.
And gratitude for the comfort that most of us enjoy in our lives.
No good deed goes unpunished! On Ground Hog day
during the hearing of HB349, Representative Linda Tanner,
a former educator and long-time supporter of nursing gave
testimony in opposition to the bill because it would repeal the
requirement for school nurses to be eligible for school nurse
certification. This was the third year in a row that a similar bill
was proposed. The New Hampshire Nurses Association once
again is opposed to the bill and members were present during
the hearing to share their opinion as to why.
Those speaking in opposition to the bill were trying to
make the point that because of the nature of the role of the
school nurse it is not recommended for new graduates.
The role requires an ability to work independently, with
many competing demands, for a vulnerable and at times large population. Unlike a
nurse who enters a new graduate program to fully achieve competence post-graduation,
school nurses do not have this resource. Sadly, non-nurses jumped into the conversation
rekindling the ADN vs BSN education conversation. This created a firestorm on social
media, diverting the conversation, and resorting to name calling. This unfortunately was
not the intent of the testimony and it missed the point.
It is easy to show gratitude for our fortunes, it is more difficult but very important
to show gratitude for those who do not enjoy as many fortunes. At the start of the
pandemic, it seemed everyone wanted to show gratitude to nurses through food, now
there are very few stories about food being donated to front line workers. At times
nurses said “Don’t give us food give us PPE.” Now with what appears to be a sufficient
supply chain of PPE, we still need to show our gratitude for nurses who are wearing
surgical masks over N95’s twelve hours or more a day. Show gratitude to other
essential workers by wearing masks when we are not able to socially distance. I find
myself always thanking the greeter at Hannaford’s. Grateful that one of the few places
where I can go is the grocery store to buy food. Grateful that unlike many others I am
not experiencing food insecurity. Food is a simple way that we can show gratitude;
many more people in NH are experiencing food insecurity. Donating to food pantries
shows gratitude. The restaurant industry is suffering, show gratitude by supporting their
takeout business or even their limited indoor seating. And yes, even continue to buy
food for those nurses who still bear the burden of the ongoing pandemic.
Several articles in this issue of Nursing News are related to advocacy and the
important role that nurses can play in the legislative process. We live in a
democracy and can use our voices to improve the health and well-being of
the citizens of NH. We show our gratitude for this privilege by using our voices
individually and collectively. It may seem more difficult than the act of buying
and sharing food, but this year it is very easy to be involved in the legislative
process. If you have reliable internet, it is easy as jumping on a ZOOM call.
The legislative schedule is posted daily on the NH General Court website (http://
www.gencourt.state.nh.us/) and the links to all the hearings can be found there.
If you have ever wanted to know what it was like to attend a legislative hearing,
be grateful that you can take advantage of this convenience. The legislative
process does not end after the legislative hearings are over. The process
continues throughout the year, just like One Word. We do not have the fortunes
and comforts, like reliable internet service, that we have without advocacy. The
mission of the NH Nurses Association is to “to promote nursing practice and
the wellbeing of New Hampshire nurses by providing professional development,
fostering nurse innovation and leading in health advocacy to enhance the health
of the people in New Hampshire.” We can show gratitude as members of this
great profession by becoming active and involved members of NHNA. While
2020 was a more introspective year, make 2021 an expressive year. Reflect
on ways that you can show gratitude in your daily life and work. If you are
struggling then seek out gratitude, there is likely someone waiting to share.
The pandemic has certainly raised awareness of the nursing shortage in the state and the
importance of getting all nurses no matter their level of education or experience into the
appropriate role based on education and experience. In NH even our retired nurses have
played a very important part in trying to keep our long-term care population safe. We
know first-hand the importance of including all nurses in the solution.
Let’s not continue the age-old argument about what level of education is best and instead
support our colleagues and teammates to function at the top of their license and start and
finish their education and training as it is comfortable for them. Civility and respect are
what is needed.
This situation was characterized as a teachable moment. The lesson here is that nurses
should be the subject matter experts and we should be steering the conversation. Nurses
and our nurse educators know best what skillset is needed and where specialized
education or training is needed. Now more than ever, your voice is needed to educate
the public about what nurses do. A nurse is a nurse is no longer the case. We are
honored to be chosen as the most trusted profession for the 19th year in a row. The
reason for this honor is our interest is the patient and not the bottom line.
Please join NHNA in our effort to ensure nurses are the voice of nursing! We will find just
the right fit for your talents!
Can LNA perform COVID testing?
It is within the scope of LNA practice to
perform COVID testing.
Can endocrinologist require school
nurses to follow continuous glucose
monitoring from an iPad?
The result of a test is the
responsibility and interpretation of
the provider. The BON suggested the nurse contact the School
Nurse Association for further guidance.
Can an LNA perform ear irrigation?
LNAs can perform ear irrigation when the LNA has received
training and is working under a provider.
Page 4 • New Hampshire Nursing News March, April, May 2021
Nurses in the News continued from page 1
Nurse Practitioner Leslie Gurrissi administers the vaccine
to the First Exeter Hospital employee Mary Ann Liew
Janet Meade RN a school nurse at Simonds Elementary
School in Warner, received her second dose of the
Ned Kershaw, RN, from the Operating Room at Upper
Connecticut Valley Hospital receives his COVID
Vaccine. Kershaw became the first employee within
North Country Healthcare to receive the vaccine.
Home Health (VNA) • Hospice & Palliative Care • Physical Therapies • Aquatics & Fitness
We are a non-profit that provides home health
care, as well as a variety of services in our
Boulder Point facility in Plymouth, NH.
Dunbarton school nurse Emily Kotkowski gets her
COVID vaccine from Master Sgt. John McDowell from
the Air National Guard.
Lorraine Paris, RN at the Elliot Hospital, administered
the vaccine to Jennifer O’Neill, RN at the Southern New
Hampshire Medical Center.
Concord, New Hampshire
Are you looking for an exciting new opportunity? Do you
love working with a great team and helping others? If so,
we want to talk to you.
We have a competitive wage scale and we offer the best
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• County paid Short Term Disability and Life Insurance
• $2700 annual tuition reimbursement
• Employee meals provided daily
• Complimentary Medicine Benefit
For more information:
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All grade levels
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Give us a call, let us give you a tour and chat about what
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The Truth about Vaccination:
Vaccinated with HOPE
Distribution of the COVID
vaccine to Group 1A to
workers began in interest
in early January, 2021.
It was reported that
even healthcare workers were skeptical about
being the first recipients. NHNA conducted a
survey of members in December 2020. Of the 626
Respondents, 55% reported they would definitely
get the vaccine, 26% probably would and 19%
would definitely not.
But the truth about vaccines from one “vaccine
scheduler” in the intensive care unit at a seacoast
hospital was that when approached staff gathered
around and patiently waited their turn. “I don’t care
what time, any opening," “I will come in on my day
off," “first available." There were many thank you’s
After nearly a year of feeling overwhelmed and
consumed by grief and anxiety nurses are beginning
to experience a sense of hope. Hope that we will
STOP this disease, hope that people believe in
the science and hope that one day we will return
to some sense of normalcy. When asked about
being vaccinated nurses used the words hope and
strength. Nurses are ready to move on!
How can we move forward to continue building
a sense of HOPE. The answer is to continue
vaccinations, continue social distancing and
continue to mask. Believe in the science and
support it. Learn the truth about the COVID
1. The vaccine allocation process is equitable.
2. The U.S. vaccine safety system ensures that
all vaccines, including the FDA-authorized
Pfizer-BioNTech (95% efficacy) & Moderna
(94.1% efficacy) COVID vaccines, are as safe as
3. Side effects are normal responses showing that
your body’s immune system is working.
Undoubtedly COVID has changed the fabric of
nursing. The pandemic has been both devastating
and “profoundly heartwarming” said one nurse.
The pandemic has given nurses and all healthcare
workers greater resiliency with which to carry into
patient care. “It FINALLY feels like the fog is lifting
and hope has arrived. Get vaccinated for both
COVID and hope!”
Megan Gray, DNP, RN, CNL practices at
Portsmouth Hospital as the Neuroscience Service
March, April, May 2021 New Hampshire Nursing News • Page 5
2021 Town Hall Forum Draws Record Crowd
In a typical year, the planners of the New Hampshire Nurses Association
Legislative Town Hall Forum worry about the weather. In this, the year of
nothing typical, we worried if Zoom was going to handle an event with well
over 250 participants registered. Technology did not fail and on January 26 the
event was held and by all indications a very successful evening. The event was
facilitated by the new Chairperson of the Commission on Government Affairs,
Marcy Doyle. In her remarks Doyle described the process for selecting the 31
bills presented (see box below). Compared to previous years a greater number
of bills, 31, were presented at the forum this year. Doyle described the important
role that the NHNA Legislative Advocacy Councils played in this year’s process.
There were 4 working groups consistent with the legislative priorities of NHNA:
Public Health, Maternal Child/School Health, Nursing Practice and Behavioral
Doyle directed the audience to consider
the testimony and the position taken by
the members of each Legislative Advocacy
Council. The participants were asked
to vote in support or opposition to that
position. Doyle then introduced a panel
made up of NHNA Executive Director
Pamela DiNapoli, Former legislator Polly
Campion, Board of Nursing President
Tracey Collins, and NHNA President
Carlene Ferrier. Each panelist offered brief
DiNapoli described NHNA’s approach to advocacy this year which in addition
to individual advocacy efforts, the focus will be on coordinated advocacy
strategies. Coordinating our advocacy strategies with affiliate organizations,
coalitions and advocacy groups has the potential to amplify our voices
resulting in sustained change. Attendees were encouraged to take a “seat at the
Campion described how this legislative session will look differently than those
sessions in the past and noted it will be much easier to listen to testimony and vote
for or against legislation. Both the House and the Senate sessions will be conducted
via Zoom. She discussed how the Senate is streamlining the process by combining
bills into what are called Omnibus bills. Campion stressed that this is a budget year,
and it may be very difficult to have legislation enacted if it has significant budget
Collins explained to the audience the makeup of BON and that it is one of 54
professional boards that falls under the umbrella of the Office of Professional
Licensure and Certification (OPLC). OPLC administers the licensing process
while the BON continues to protect the public’s health by reviewing matters of
nursing practice. The BON and NHNA are often confused with one another. The
BON is a regulatory body and NHNA is a professional organization.
Ferrier spent her time with a 3-pronged message. Policy work takes time. She
cited how efforts to prohibit drunk driving began in 1906, the same year NHNA
was established. The law was not enacted until 2003. She talked about how
timing is everything for policy change. We expected last year to finally pass a
Seat Belts For All Bill. COVID-19 drastically changed legislative efforts last year
and the bill was “laid on the table.” Finally she called the legislative process
DiNapoli continued the introduction with a definition of Omnibus Bill. An omnibus
bill is a proposed law that covers several diverse or unrelated topics. On 1/19/2021
the NH Senate released a list of combined LSR’s to create a series of 30 omnibus
bills covering many topics NHNA has taken a position on including licensure,
HHS Appropriations, Commissions and Committees, and HHS for the purpose of
simplifying the process and limiting the number of hearings.
Included in this Omnibus Bill are:
Licensure: Sponsor Sen. Carson LSR 964 includes
Appropriations: Sponsor Sen Rosenwald LSR 961 includes
The evening proceeded with the presentation and discussion of bills. The intent of the
process was to pare down the number of bills that NHNA can effectively follow with
limited resources. The goal is to follow 8-10 bills at different levels of advocacy from
simply watching and reporting on the bills to submitting written or verbal testimony at
Overall, the very well organized and informative
event garnered praise for those Zooming in. For more
information or to get involved in NHNA contact the
office at NHNA.NED@gmail.com or email@example.com.
Members are directed to the advocacy toolkit on the
NHNA webpage for valuable resources. (https://nhnurses.
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Psychiatric Specialty Areas:
Young Adult, Adult, Geriatric & Crisis Stabilization
Legislative Update continued on page 6
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Human Resources 603-271-5855
Page 6 • New Hampshire Nursing News March, April, May 2021
Legislative Update continued from page 5
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March, April, May 2021 New Hampshire Nursing News • Page 7
Page 8 • New Hampshire Nursing News March, April, May 2021
Ed Note: In 2021 NHNA’s advocacy efforts will be
directed at amplifying advocacy efforts by working
to support and promote associations, coalitions and
advocacy groups with similar legislative agendas.
Strategic relationships have the potential to create greater
sustained change than individual efforts alone. This
new feature in the Nursing News will feature coalitions
and their work across the state and encourage NHNA
members to consider adding their voices to these efforts.
HB 103 requires Medicaid to add dental benefits to
adults. The bill was of great interest to the participants
of the town hall forum. Gail Brown, Coalition
Director and Regina Blaney, Administrative and Data
Coordinator provided information about the NH Oral
Does your coalition have a mission and vision? If not,
what is the purpose of your group?
Our mission is to advance and promote oral health for
the people of New Hampshire.
Our vision is that through improved oral health, the
people of New Hampshire will have enhanced quality
of life and opportunity.
We use an equity lens to
• Help remove barriers that exist between people
and oral health services.
• Promote the use of the best available scientific
evidence to improve oral health for everyone.
• Use public-private partnerships to improve oral
health in New Hampshire, especially for the
underserved and those at greater risk of oral
• Change perceptions about oral health and
• Promote an effective health infrastructure that
integrates oral health into overall health, so that
oral health is recognized as a component of
• Advocate for oral health in all health-related
What is the history of your coalition?
Coalition Corner: NH Oral Health
The New Hampshire Oral Health Coalition is a diverse
group of organizations, agencies, and individuals,
concerned about the impact of oral health issues facing
New Hampshire. This group is broadly representative
of those involved in oral health provision, planning,
policymaking, and funding including the dental and
medical communities, the legislature, educational
programs, advocacy groups, insurance providers, state
agency leaders, and private funders.
Established in 2002, this critical public initiative
convened by the Endowment for Health and the New
Hampshire Department of Health and Human Services
NHS, Vershire Center
$750.00 Sign On Bonus
Position available for RN with interest in and or background in
Developmental Disabilities. The RN will work closely with the
agency and the state to oversee medications, update records and
oversee healthcare of clients in accordance with state regulations.
A strong teaching interest in infection control, med administration
and illness/conditions is needed. Candidate will enjoy a busy, varied
work routine, both inside and outside of the office, advocating for
needed health care, providing basic first aid, and working as a team
player. Excellent communication and listening skills are essential. We
offer flexible week-day hours within a supportive multi-disciplinary
work environment, competitive wages and an excellent benefit
package. Please submit a cover letter and resume to:
Northern Human Services, Vershire Center
24 Depot Street, Colebrook, NH 03576
Attn: Lynn Johnson or email firstname.lastname@example.org
This position requires a valid driver’s license, proof of Current RN License
and the ability to pass the nurse trainer course, an adequate auto
insurance, completion of driver’s and criminal background checks. This
agency is an equal opportunity provider and employer.
as the Coalition for New Hampshire Oral Health Action
published the “New Hampshire Oral Health Plan: A
Framework for Action” to provide structure and vision
for oral health advancement within New Hampshire.
Maintaining the spirit of the plan as a “living document”
the Coalition continues to work toward its vision of
optimal oral health for the residents of New Hampshire.
In 2012, the Coalition accepted the role of hub organization
for the development of the New Hampshire oral health
stakeholder network within the nationally recognized
DentaQuest Foundation Oral Health 2014 initiative,
continuing that role into the subsequent Oral Health 2020
and now with OPEN - the Oral Health Progress and Equity
Network – a national network of over 2,200 members
taking on America’s oral health challenges so that everyone
has an equitable chance to thrive.
In 2015, the Coalition engaged with state and national
stakeholders in developing the updated 2015 NH
Oral Health Plan. The Coalition is now engaged
in updating the NH Oral Health Plan for 2021 and
beyond. Additionally, in 2015, the Coalition completed
a statewide survey to identify dental programs. This
document, the “NH Oral Health Baseline Survey
I: Identifying Oral Health Resources and Promising
Practices for Community-based, Non-traditional
Settings” and a related interactive map are available on
our website at: www.nhoralhealth.org.
What is the governance structure of your coalition?
Currently organized under a fiscal sponsorship with the
NH Public Health Association, the Coalition is planning
to file as an independent 501c3 not-for-profit.
The organization consists of individuals and
organizations representing various community
segments and populations who are committed to
promoting optimal oral health for the people of New
The Coalition is comprised of these groups
– The Steering Committee that includes elected
– The Nominating Committee
– The Public Policy Committee
– General Membership
– Staff including a Director, Administrative and
Data Coordinator, and Project Coordinators as
The Steering Committee is currently made up
of designated representatives from the following
– Bi-State Primary Care Association
– NH Dental Society
– NH Academy of Pediatric Dentists
– NH Dental Hygienists’ Association
– NH Nurse Practitioners’ Association
– NH Department of Health and Human Services
Medicaid and Public Health
– NH Public Health Association
– NH Medical Society
– NH Pediatrics Society
– NH Technical Institute
– NH Area Health Education Centers
– NH-Based Non-profit Dental Benefits
– NH-Based Philanthropic Foundation which
targets oral health
– Community-based Oral Health Program
– Plus two Community-at-large Members
General Coalition Membership is open to any
organization or individual any time subject to the
review of the Steering Committee.
What three priority advocacy issues have you
In collaboration with our community, state, and national
partners, we work to achieve optimal oral health
throughout the state by operationalizing our key objectives.
First through improving and
knowledge and service integration in communities
including such projects as local and statewide
convenings and projects that include local programs
and national experts on topics such as oral health
assessment and implementation of fluoride varnish
into medical settings; community water fluoridation;
the use of telehealth teams in local communities;
training with care managers and community health
workers on #WhyOralHealthMatters; collaboration
with Amerihealth Caritas on developing a dental
provider network; the use of less intrusive, lower
cost atraumatic dental interventions such as
silver diamine fluoride and atraumatic restoration
that can done by certified public health dental
hygienists; and dissemination of information on
the known associations between oral health and
chronic, acute, and substance misuse diagnoses and
Also, through leading change strategies to educate,
convene and sustain high quality, integrated health
practices through interprofessional local and statewide
trainings; continuing dental and nursing education
programs, presentations at our Annual Oral Health
Fall Forum; topic webinars and summits for providers,
program managers, and legislators; and dissemination
of newly released information on medical-dental
integration and evolving dental practice.
And finally, by promoting access to affordable and
accessible oral health programs that are available for
prevention and restoration across the lifespan through
public and private resources and programs. This
work includes the identification of nontraditional,
community-based oral health programs and providers
that take dental and oral health outside the box of
the private dental office and move it to locations at
which individuals and families naturally congregate
such as schools, community centers, senior centers,
WIC and Head Start programs, and others. Specific
advocacy campaigns focus on the development
and implementation of a comprehensive NH Adult
Medicaid Dental Benefit; we are active in the
interdisciplinary DHHS HB4 Working Team that is
meeting with the department of health to define a
benefit for NH. The benefit has been authorized
through HB 4 and is strongly supported by the
Governor, Legislature, and the Department of Health
and Human Services. This benefit creates the potential
for coverage of adults covered through Medicaid and
Medicaid Expansion, including new coverage for
eligible pregnant women over 21. On the national
level, we are working with our Congressional
Delegation to include an Adult Dental benefit into the
Medicare program. This coverage would provide a
dental benefit to over 235,000 NH seniors.
Our members and partners serve as trainers, advisors,
advocates, and innovators to achieve our common
vision through work focused on research, education,
linkage creation, service provision, convening and
facilitating re: integrated oral health, equity, community
engagement, and advocacy.
Specifically, what can NHNA members do to become
Nurses, individually and as an association, are critical
partners in the advancement of good oral health for
NH residents statewide and across the lifespan. There
are several simple ways to engage.
Check out our website at www.nhoralhealth.org.
Identify a nursing member to sit on our Steering
Committee as a nursing representative. Let your
voice be heard.
Contact email@example.com to be added to
our Constant Contact list for new information
and upcoming events.
Check out the “NH Oral Health Baseline
Survey I: Identifying Oral Health Resources and
Promising Practices in Community-based, Nontraditional
Settings” available on our website at:
Invite us to speak at member meetings or
Consider co-sponsoring or co-endorsing an
event with our Coalition. This can be done at
low- or no-cost including helping us obtain
CNEs and promote the programs.
March, April, May 2021 New Hampshire Nursing News • Page 9
Check out “Smiles for Life” the national oral curriculum that is free online.
Check out the Oral Health Nursing Education and Practice (OHNEP) website
http://ohnep.org/. We have worked closely with the Executive Director,
Judy Haber and the Project Director, Erin Hartnett for years. This is a great
How do you see your coalition as part of an integrated strategy to sustain system
Our theory of change states that we advance oral health statewide and across the
lifespan though coordination, facilitation, and data development/dissemination. We
do this through a model of convening and training in collaboration with local, state,
regional, and national partners.
We work on a state and national level to support and advocate for system change.
The Coalition supports oral health care system transformation where the provision of
care is changed from a siloed model toward an integrated whole-health approach.
For the oral health care to shift from a surgical (drill and fill) model toward one of
prevention and disease management. Currently, providers are compensated based
on procedures through a fee-for-service model rather than outcomes. Alternative
payment models are being explored that would provide reimbursement based on
improved access to care, quality, outcomes, and cost savings. Advancement on
medical-dental integration is “putting the mouth back into the body.”
Dental data needs to be interoperable and coordinated to allow sharing of electronic
health records and data collection in support of value-based care. Quality measures
need to be established and data collection mechanisms developed to support a
value-based system of care.
If you are interested in sitting on the Steering Committee please complete an intent
to serve found on the NH Nursing Network website or contact the NHNA office at
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. Submissions are welcome. In
this issue one liners about 2020 and COVID.
Focus on Stroke
Ed Note: Where it has been a year or years since you took the NCLEX how
well would you do now?
1. A 59 year old man arrives in the emergency department with an
ischemic stroke and receives tissue plasminogen activator (t-PA)
administration. Which is the priority nursing action?
A. Obtain list of current medications
B. Obtain complete history
C. Obtain time of onset of current stroke
D. Obtain information on health care proxy
2. What is a priority nursing assessment in the first 24 hours after admission of a
patient with a thrombotic stroke?
A. Baseline INR
B. Pupil size and pupillary response
D. Lung sounds
3. Which patient has the greatest risk for a CVA?
A. 55 yo African American male
B. 84 yo Asian female
C. 67 yo Caucasian male
D. 39 yo Hispanic female
4. Which assessment data places a patient at risk for a hemorrhagic stroke?
A. A1C = 7.0
B. Presence of a right sided carotid bruit
C. BP = 220/100
D. History of bronchogenic carcinoma
5. Following a stroke with right sided brain damage which signs and symptoms
would be expected? (Select all that apply)
A. Right sided hemiplegia
B. Confusion on date, time or place
D. Unilateral neglect
F. Impulsive behavior
G. Limited attention span
H. Agraphia Answers on page 10
• Everyday COVID Check: At 5 PM open a bottle
of wine, smell it, pour it in a glass. If you can
smell and taste it, you are good. Celebrate by
finishing the bottle!
• You know what they’re saying about 2020? It
went viral faster than anyone thought it would.
• What did the man say to the bartender? I’ll have a corona, hold the virus.
• I never thought the comment “I wouldn’t touch them with a six-foot
pole” would become a national policy.
• If I tell you a coronavirus joke now, you’ll have to wait two weeks to
see if you got it.
• Today's weather? Room temperature.
• The nose and mouth are the new “private parts” …keep them covered
when in public.
• I used to spin the toilet paper roll like I was on the Wheel of Fortune…
now I turn it like I’m cracking a safe!
• Just by seeing how some folks wear their masks … it is understandable
why contraception fails.
• If the schools are closed for too long, the parents are going to find a
vaccine before the scientists.
• Never in a million years could I have imagined going to a bank teller
with a mask on and asking for money.
• The dumbest thing ever purchased – a 2020 planner.
• I’m not adding the year 2020 to my age, I did not use it.
• When this quarantine is over, let’s not tell some people.
• It is very clear why the 1918 pandemic was followed by the roaring 20’s…
people were dressing up just to go out.
• Fencing is the perfect COVID sport; masks, gloves and if anybody gets
closer than six feet you stab them.
• I just landed a small supporting role in an upcoming movie about
the COVID-19 pandemic. I guess you could say I'm going to be a
• The quarantine has turned us into dogs. We roam the house all day
looking for food. We are told "no" if we get too close to strangers. And
we get really excited about car rides.
• Never in my life would I imagine that my hands would someday
consume more alcohol than my mouth.
• Airlines have been sending me a lot of "we're in this together" emails.
But when my suitcase weighed 52 pounds, I was on my own.
• It looks like Las Vegas in my house: We're losing money by the minute.
Cocktails are acceptable at any hour. And nobody knows what time it is.
• Home Schooling Update: My child just said “I hope I don’t have the
same teacher next year.”
• From the Psychiatric Association: During the quarantine it is considered
normal to talk to your walls, plants and pets. Kindly contact us only if
Page 10 • New Hampshire Nursing News March, April, May 2021
From the Bookshelf
Podcasts, What is Everybody Talking About??
Anita Pavlidis, RN, MSN
For those unfamiliar with the term; podcast is “a
program (of music or talk) made available in digital
format for automatic download over the Internet” and
can be listened to on multiple devices (iphones, ipads,
computer, etc.). Podcasts are a series of episodes,
and refers to the program as a whole. Then, a podcast
episode is just one recording from that entire Podcast.
It's just like TV. A TV show is made up of a whole series
of episodes. So, think of ‘NCIS’ as the series and “ Ziva
Returns” as the episode.
With a similar format to talk radio, podcasts usually
include a host or hosts discussing all kinds of material,
from news to cooking, interviewing special guests or
each other, sharing stories, performing an audio play,
or a combination of all of the above. The length of
podcasts can vary with some of the shortest podcasts
lasting just five minutes, while others for hours. And
because they come in such a range of styles and
subjects, you can tune in to keep your mind occupied
while doing chores, prepping dinner, working out or
Podcasts are now part of our culture and are beginning
to win awards for their information. The American
Life, a podcast of a popular news radio series won
a Pultizer Prize. After reviewing a variety of sites on
the internet, favorite podcasts of 2020 ranged from
comedy to storytelling, cooking shows, true crime,
music, and more. Podcasts seem to be everywhere
and can be accessed (most of them for free!) from a
variety of sources on the internet including Amazon,
Google, iTunes, and Spotify to mention a few. Many
health organizations such as the CDC, American Heart
Association, and the American Diabetic Association
publish free podcasts on a variety of topics.
So choose your favorite topic of interest and enjoy
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
• Inpatient Medical Surgical Unit
• Charge RN- Emergency Room
• Primary Care Office Nurse
• Flex Pool RN
• Maternal Child Health
ON THE MOVE
Tiffany Haynes-Hicks, MSN,
has been named President of
North Country Home Health &
Hospice Agency. Tiffany, who
most recently served as the
organization’s Vice President of
Operations, also served three
years as Director of Hospice.
Tiffany received her Master
of Science in Nursing with a
concentration in Health Care
Administration in 2012 from Norwich University and
her Bachelor of Science in Nursing from St. Anselm
College in 2007. She also received her National
Hospice and Palliative Care Certificate (CHPN) in 2018.
Previous leadership roles including Clinical Supervisor,
Charge Nurse, Educational Preceptor, Chair of Shared
Governance and Infection Prevention Team Champion.
Littleton-native K a i t l y n
(Considine) Red Elk has joined
the Oncology, Hematology,
and Infusion Center at Littleton
Regional Hospital as the new
She earned her Bachelor of
Science in Nursing from St.
Anselm College. Kaitlyn's
nursing career began in 2010
at nearby Cottage Hospital in Woodsville. She then
practiced at Catholic Medical Center and became
a traveling nurse, working in hospitals throughout
Answers to NCLEX Reconsidered from page 9
1. C 2. B 3. A 4. C 5. B-D-F-G
March, April, May 2021 New Hampshire Nursing News • Page 11
Extraordinary Nurse Honored
In October, 2020 the
Keene Sentinel honored
the achievements of 10
local women, presenting
them with Extraordinary
Women awards. It was
the The Sentinel’s eighth
of women who are
making a difference in
the Monadnock Region
community. One of the
recipients was Amy Matthews, the Chief Nursing Officer
and Vice President for Patient Care Services at Cheshire
Medical Center in Keene. A profile of her career was
provided by Keene Sentinel reporter Olivia Belanger.
When Amy Matthews decided to go to college
for nursing, she had no idea what she was getting
into. Today, with over 30 years of experience in the
nursing field, she oversees the implementation of
patient care at the Dartmouth-Hitchcock Health
affiliate, and is constantly finding new ways to
improve the experience for patients and nurses alike.
A native of Portland, Maine, Matthews said she
always loved science, and wanted to find a career
that was centered around it. She was ultimately torn
between forestry and health care, but said being able
to help others drew her into nursing.
“I can remember being 17, figuring out what I am
supposed to go to school for and what I want to be,”
the Peterborough resident said. “I had no idea really
what nursing was when I was 17, and neither did my
guidance counselor who advised me against it.”
Before arriving in the Monadnock Region, Matthews
practiced in 10 different locations across the country,
as her husband and high-school sweetheart, Keith,
was a military intelligence officer in the Army.
She started her career in Atlanta as a medicalsurgical
nurse, and from there held various nursing
roles in several states, including as a nurse in the
neonatal intensive care unit and emergency care, as
well as administrative positions.
“Through those experiences I found I loved two
things: I loved the complexity of health care and
I loved seeing all the different roles and how they
come together,” she said.
As the years went by and their family began to grow,
Matthews said she and Keith had two criteria for
their final destination: more snow, fewer people. This
led them to Peterborough, where they raised their
three now-grown children.
Matthews has worked at Cheshire Medical ever
since, starting 20 years ago as night shift emergency
department nurse, and working her way to chief
nursing officer two years ago.
In addition to her post at the Keene hospital,
Matthews is also actively involved in her community.
She serves on the Monadnock Regional Healthcare
Workforce Group, the N.H. Nurses Association and
on the Monadnock United Way. She has previously
volunteered with the American Red Cross, Girl
Scouts and the N.H. Trauma Medical Review Board.
Before dedicating her career to the hospital setting,
Matthews said she wasn’t sure which avenue of
nursing she wanted to pursue. She has four nursing
degrees — an associate in nursing, a bachelor’s
of nursing, a master’s in nursing education and a
doctorate of nursing practice.
“I took the phrase 'lifelong learning' seriously,”
she joked. “The guy I married says four degrees is
Matthews said when she first graduated with her
bachelor’s degree, she thought she would work in
hospice care for a few years before going back to
school to teach.
“It was a community hospital that changed my
mind on that,” she said. “I was so impressed by the
complexity of health care and also the knowledge
and tenacity of keeping health care local and
maintaining a presence in the local community.”
While she did end up pursuing a teaching degree, it
was her newfound love for community health care
that kept her in the hospital.
As to why she has stayed at Cheshire Medical for so
long, Matthews said it comes down to its mission.
“We serve our community, and that passion and notfor-profit
tie to a community means a lot to me,” she
said. “I think about how do I connect people and
programs and resources in a way that helps serve our
In her time at the Keene hospital, Matthews has worn
many hats: emergency department nurse, trauma
program coordinator, director of critical care and
emergency services and senior director of patient care
She also serves as the operations chief for Cheshire
Medical's incident command team, which has
overseen the hospital's response to the COVID-19
pandemic, from visitor limitations to how staff
addressed the public health crisis.
"We moved quickly to be ready, and as we are very
fortunate that we didn't go steeply into a high peak
[of COVID-19 cases], the decisions made in our
area did help flatten that curve," Matthews
One of her largest projects, while she was director
of critical care and emergency services, was about
eight years ago, when the hospital’s emergency
department was renovated.
The department used to be one large open room,
with only curtains dividing the patients. To provide
more privacy, the hospital initiated a five-phase
construction process to create private rooms
that were “much more efficient,” according to
Matthews. Other small changes such as more
natural lighting were intended to make patients
Katherine Richardson – director of leadership giving
at Cheshire Medical’s Health Foundation who
nominated Matthews for the Extraordinary Women
award – said Matthews was “instrumental” in
making this renovation run smoothly.
“Her goal was to involve all staff in the process —
from physicians to receptionists – so they could
proudly take ownership,” Richardson said in an
email. Matthews said that involvement is what the
job is all about.
“I get to come to work every day surrounded by
amazing people who are committed to making a
difference,” she said. “I am pretty lucky to be part
Reprinted with permission.
The New Hampshire Children’s Health Foundation
appointed has appointed Mary Bidgood-Wilson
and Pamela DiNapoli to their Board of Directors.
The foundation is one of the leading private funders
for children’s health in the state. Bidgood-Wilson
is a nurse practitioner and principal of Meredith
Bay Consulting. DiNapoli is the executive director
of the New Hampshire Nurses Association and
previously taught pediatric nursing as an Assistant
Professor at the University of New Hampshire.
Page 12 • New Hampshire Nursing News March, April, May 2021
Meet the METF!
The strength of any membership association is its
members. NHNA is not simply an office in Concord,
it is the arena in which nurses come together
to support their profession. The Membership
Engagement Task Force (METF) is designed to really
LISTEN to nurses, provide opportunities to expand
their connections, and advance their career among
other professionals in their field.
The METF was born out the participation of
NHNA in the High Impact Volunteer Engagement
(HIVE) training program offered through the New
Hampshire Center for Non-Profits. The HIVE
workshops offered staff and volunteer leaders the
opportunity to explore the latest trends and best
practices in volunteer engagement along with
support to pilot one strategic innovation in volunteer
Participants on NHNA’s HIVE Team included Cheryl
Abbott, Pat Lazare, Julie Taylor, Cathy Cuchetti,
Paula MacKinnon and Joan Widmer. A yearlong
project, NHNA had the opportunity to network with
other non-profits in New Hampshire. The series
of workshops was led by experts in the field and
included two full day trainings, along with group
and individualized coaching calls.
The team’s vision was to create a membership
engagement team which would identify and plan
new membership engagement opportunities for our
members. HIVE team’s project included the following
• Develop a position description for a Membership
Engagement Task Force (METF).
• Recruit and screen for a Chair/Champion of the
• Work with Chair/Champion to recruit and screen
for other Task Force members.
• Design, implement and analyze a member needs
assessment (conducted in Spring 2020).
• Create Member Tool Kit/Onboarding information
for Task Force members.
NHNA’s Membership Engagement Task Force is the
product of the HIVE program. The METF uses data and
trends from New Hampshire Nurses Association (NHNA)
and other sources to collaboratively create enhanced
opportunities for membership engagement. The METF
desires to increase the ability of NHNA to impact the
lives of NH nurses and the health of the citizens of NH.
To better inform the METF members of the needs of
NHNA members, the HIVE team conducted a survey
of members regarding how they engage with the
organizations. The results of this survey are helping to
shape the work of the METF.
The goal of the METF is increase the number of NHNA
members who volunteer with the organization at various
levels, which will increase membership satisfaction and
retention. The METF plans to design and implement
activities that help inspire New Hampshire nurses to
expand the impact of the nursing profession and to improve
the health of the people of New Hampshire. The METF
seeks to increase community awareness of NHNA and the
important role nurses play in improving the health of New
Hampshire residents by increasing NHNA’s presence on
social media. The METF hopes to increase membership
engagement by developing new member activities across
the state. The current METF members include:
• Chair: Joan Widmer
• Vice Chair: Kaitlynn Liset
• Cheryl Abbott
• Pamela Kallmerten
• Pat Lazare
• Anthony McLean
• Dansir Minster
• Austin Ritter
New members are always invited! If you are interested
in joining the METF and helping us with our member
outreach, submit an intent-to-serve form on the NHNA
website at this link: https://nhnurses.nursingnetwork.com/
Currently, the METF members are working with New
Hampshire health care organizations to develop 1-2
minute videos showcasing the great work being done by
nurses around the state. If you are interested in helping
with this project by sharing the work of nurses at your
facility, please let us know by contacting NHNA via email
at firstname.lastname@example.org, add METF in the subject line of the
The team is also developing a list of Tips and Tricks to help
nurses new to the profession, such as:
• Be confident. Patients assume you are awesome.
Prove them right.
• Treat your nursing assistants like the gold they are
and watch your practice flourish in every way.
• Advocate for yourself and your goals, and make
time for your wellness.
The team plans to develop short, 30 second video clips
to demonstrate these Tips and Tricks and share these via
Instagram and possibly TikTok in the future. Finally, the
METF is drafting a short survey for nurses, both members
and non-members, to gain a better understanding of what
nurses need during these challenging times. The survey
will be shared via social media when it is ready. Watch for
it and let us know what you think!
Photo Not Available
March, April, May 2021 New Hampshire Nursing News • Page 13
The University of New Hampshire in Durham and Rivier University in Nashua
were recognized in the top 100 rankings for 2020 issued by the Nursing Schools
Almanac. Rivier University is ranked 98th, and UNH is ranked 80th. Nursing Schools
Almanac assessed schools in three areas — academic prestige and perceived value,
breadth and depth of nursing programs offered, and students’ success, including
the National Council Licensure Exam.
“This is a real honor for us, and we are very proud, especially our faculty who works so
hard with students who desperately want to become nurses. It is a big, serious decision
to become a nurse right now, especially while dealing with COVID-19. These individuals
are out there working on the front lines,” said Dr. Paula Williams, Dean of the Division of
Nursing and Health Professions at Rivier University.
At its October 16, 2020 meeting the New Hampshire Board of
Nursing emergently suspended the Board’s approval of the nursing
education program offered and provided by the American School
of Nursing and Medical Studies in Manchester, New Hampshire.
An emergency suspension generally means there was an allegation
that, if true, could impact the public safety, welfare or health of
constituents, In December the New Hampshire Department of
Education-Office of Career School Licensing revoked the license of
the for-profit organization. The department had been investigating
the school since 2019 and received several complaints about its
Previously known as the Salter School of Practical Nursing the
program was run by Trigram Education Partners, LLC of New Haven,
Connecticut. More than a dozen nursing instructors and about 90
students were affected, with some weeks away from graduation.
Excelsior College of Albany, New York which offers distance learning programs has
lost their accreditation for the associate’s degree nursing program. The Accreditation
Commission for Education in Nursing (ACEN) which reviews associate degree
programs will recognize students graduating before May 11, 2020. As a result,
the NH Board of Nursing has removed the ability of graduates after May 11 to be
licensed in New Hampshire.
ED Note: News from nursing schools, faculty,
students or alumni are welcome. Please direct
submissions to email@example.com with
NHNN in the subject line.
In January 2021 the New Hampshire Attorney General's Office filed a
civil enforcement action in Merrimack County Superior Court against
the school due to consumer protection act violations. The attorney
general's office said between August and December 2020, Trigram
"repeatedly deceived students about the school's loss of accreditation,
loss of higher education bond, and eviction from its campus for failure
to pay rent." State investigators also accused the company of telling
students they would receive refunds if they chose to withdraw from
the program. Instead, the state said, "Trigram issued a bill for payment
to at least one student rather than the promised refund." The company
reportedly told another student it did not have the "financial ability
to pay refunds." Investigators are seeking restitution for students,
injunctive relief, civil penalties, and attorney's fees in this civil action.
Page 14 • New Hampshire Nursing News March, April, May 2021
‘One of the tests of leadership is the ability to recognize a
problem before it becomes and emergency. ‘
No doubt COVID has required unique and innovative
approaches to health care and societal care. Overall, I have
thought that Governor Sununu had done a good job in guiding
New Hampshire’s approach and seeking resources to meet the
added burden. However, on December 10, 2020, he blew it.
With his emergency political powers he sought to quickly solve
a problem that we have been expressing for many, many years.
In my opinion Emergency Order #75 was a poor attempt at
addressing the nursing shortage, particularly in long term care.
Emergency Order #75 For the duration of the State of Emergency, senior nursing
students who are scheduled to graduate on or before May 31, 2021, from a
Board of Nursing approved registered nursing or practical nursing program are
authorized to practice nursing.
Several statements justified the order including
“Whereas, permitting nursing students to work alongside licensed staff in long-term care
facilities will increase the number of qualified long-term care workers in New Hampshire.”
Consider the key word: ‘qualified.’ The Executive Order, not previously reviewed by
the New Hampshire Board of Nursing, was passed to them to provide guidance on
implementation. The BON provided guidance in a four page document posted on their
website (see page 15).
The ramifications of the Executive Order and the BON Guidance are far reaching. Nursing
students in their final semester are now temporarily licensed and authorized to practice
nursing. These are the same students who have been attending many classes virtually over
the past year and have used simulation for practice experience in hours never imagined.
Associate degree students will have completed three of four of their nursing courses and
2/3s of their clinical experience with BSN students completing a bit more. Temporarily
IN MY OPINION
On Problem Solving
licensed students can practice in any facility, and like newly licensed graduates, will likely
prefer acute care.
Key to the BON Guidance is the requirement for direct supervision. Employed nurses
will be responsible for the ongoing education of the temporarily licensed senior
student. This includes being ‘physically present on the same unit’ and reviewing
all documentation and med administration. The employed nurse must be present
when IV meds are administered. The employed nurse is both the educator and the
supervisor, in essence replacing the faculty. The effort, experience and time in preparing
employed nurses to be familiar with the ‘individual student academic preparation and
competencies’ will add to the burden. Licensed students will not be working full time as
they are still required to complete the nursing program curriculum. What will happen if
the licensed student does not pass the NCLEX at the completion of their program? Does
not pass the nursing program? Can the facility be held libel for not doing a good enough
job teaching? Is the employed nurse qualified to supervise? The BON requires one year
of experience and three months in the facility for nurses who are supervising. Yet the
BON requires nurse educators to have a minimum of two years of experience in the
clinical area for which they are teaching.
Over the past two years, senior students participating in Dedicated Education Units, have
been placed with employed nurses who have volunteered to precept and been through
a preceptor course. Identifying these preceptors has been problematic and these clinical
placements have been further exacerbated by COVID-induced staffing problems.
Long term care has seen dramatic changes in their population of residents. Patients
who would have been hospitalized twenty years ago are now cared for in their ‘home.’
Reimbursement has not kept up with acuity and neither have salaries. Newly licensed
graduates flock to acute care to get a variety of experiences and a better pay scale. They
leave for salary and benefits. A nurse with 14 months of experience recently shared that
she had resigned and obtained a similar position just over the New Hampshire line in
Lowell, Massachusetts. She would garner $10.00 more per hour or over $20K per year.
No executive order will solve the shortage of long-term care providers by cutting corners
in nursing education. The Governor’s emergency solution will create more problems. It is
time to put more effort into a solution. The nursing shortage has been, and will continue to
be, a long term problem which COVID has made transparent.
Leader Charisma and Zoom
Never more important in the current health care
environment is leader charisma which helps inspire trust
and confidence. In a virtual world, it is difficult to read body
language and nonverbal messages. Nurse leaders who communicate clearly and
effectively must adjust their voice, pace, tone and posture when meeting online.
Consider these ten tips to improve your Zoom charisma:
• Relax and open your upper body posture, try not to fold your arms.
• Use your eyes. Look into the camera rather than at yourself on screen. This
feels odd to start with but gets easier with practice
• Use your facial expressions and hand gestures to support what you are trying
• Avoid fidgeting. When people touch their face, hair or fidget when answering
questions, they can be perceived as being dishonest or covering something up.
• Nothing beats a smile. Smiling is the easiest way to help others to feel
accepted and relaxed
• A webcam saps charisma, so you need to be bigger and more expressive in
your performance. If you are chairing a meeting or presenting an idea, change
your setup so you can stand up – this immediately improves your energy level.
• Make sure you are well-lit and fill the screen with your head and shoulders.
• Try and add humor. Your team will engage with what you’re saying more
• Give your full attention to whoever you are speaking to. Turn off your email,
social networking sites and phone. Silent mode isn’t good enough: Very few
people can resist looking at the phone when a text notification appears.
• Focus before and during the conversation. Show up and start being present
five minutes before the online meeting. Don’t let the dog or the kids interrupt.
Having charisma is not about the way you look, particularly in
a virtual world. It’s about the way you make others feel. Focus
on making people feel confident and cared about, and inspire
them to want to make a positive impact, and you will gain their
trust and willingness to follow – vital traits in these times of
uncertainty and change.
Adapted from Karlin Sloan “How to develop charisma in a virtual world” available at
March, April, May 2021 New Hampshire Nursing News • Page 15
Full-time, part-time and per diem
Day and night shift
For more information or to apply online,
go to www.cottagehospital.org and
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Page 16 • New Hampshire Nursing News March, April, May 2021
NHNA ORGANIZATIONAL AFFILIATES
The Hidden Supply Chain
Alyssa J. O’Brien
Beginning in the spring
of 2020 and continuing
through last summer it
felt like there was not a
single news cycle that
did not talk about supply
chain and manufacturing
issues regarding personal
protective equipment (PPE)
for healthcare workers.
If you just turned on the
local news or looked at
the headlines you would
Alyssa J. O’Brien
have seen everyone from
hospital CEOs, politicians, even NFL teams trying
to help supply frontline healthcare workers with
the protection they needed to provide safe care.
Supply chain issues can spread to the shelves of our
favorite local businesses or big box stores, as people
rushed out to find the staples that they needed in
their homes. Even the supply chain for US currency
has been impacted, as stores across the country
offered incentives for their customers to pay with
change due to concerns regarding a nationwide
circulation issue related to our coin supply. Now,
at this stage in the game we aren’t hearing as much.
Likely because over time, some of these issues have
smoothed out as demand and production stabilized
or because the news outlets have moved onto other
stories to highlight. But it is important to recognize
that there are ongoing issues. A hidden network of
nurses are supporting each other and the patients of
NH by identifying issues in the supply chain. Nurses
are finding creative ways to overcome supply chain
problems and still care for patients with the highest
level of quality care and safety in place.
As a nurse and an AWHONN member I was inspired
by the poem “Chorus of the Captains” read by the
amazingly talented Amanda Gorman before the
coin toss at the Super Bowl. She honored those who
are continuing to pull us through this pandemic,
community volunteers, teachers, and nurses. I am
not ashamed to say that I was moved to tears as I
listened to Gorman’s words. But then I thought of
how quick we celebrate the visual part of nursing
in this pandemic. The moments we see spread
across the evening news and on the front pages of
major newspapers. Nurses donning their layers of
PPE, tirelessly working to care for patients that are
on their last option for care and treatment. We hear
stories of nurses and midwives stepping up and
creating innovative ways to care for patients. And we
should honor and celebrate their selfless sacrifices.
But what we don’t hear about are the online email
chains or brainstorming sessions at professional
organization meetings. The messages sent out from
nurse managers or materials and supply departments
to their local professional networks to say “Hey
everyone, we only have two boxes of fetal scalp
electrodes left. Can anyone spare a box while we
wait for our backordered shipment?” or “Our supplier
just changed and it will take us a while to get this
all figured out, does anyone have any delivery packs
we can borrow?” What we don’t see are nurses
meeting in parking lots to exchange boxes of needed
equipment. We don’t see them driving hours to
hospitals outside their regions to get needed supplies
and bring them to work. What we don’t see are
university nursing programs hearing about shortages
and emptying the shelves of their simulation centers
to send supplies to their local health partners. But it
is happening. They are the unsung captains leading
However, these are not new issues. In August of 2020
an idea and opinion brief in the Annals of Internal
Medicine highlighted five categories in the healthcare
supply chain. While we keep hearing a lot about
PPE, the national supply of pharmaceuticals, medical
devices, medical supplies, and blood products have
all had “glitches” during the COVID-19 pandemic
(Mirchandani, 2020). The issues highlighted in
the brief are obvious to many of us now and have
existed long before COVID-19. Solving the issues
will prove to be more complex and include problems
regarding production, distribution, storage, and a
lack of standardization across brands and products.
Just consider that most of our medical devices have
supplies that only work for that device and something
as simple as one closed factory that produces IV
tubing for one brand of IV pumps can create a
shortage that impacts entire healthcare organizations.
For now we can be assured that our professional
organizations and personal networks have created a
hidden supply chain in NH. The chain is filled with
nurses working to ensure that those supply chain issues
never impact patient care. We all need to start the harder
work of figuring out how to solve these other glitches to
ensure that our nursing “captains” don’t have to carry the
Mirchandani, P. (2020). Health care supply chains: COVID-19
challenges and pressing actions. Annals of Internal
Medicine, 173(4), 300-301. https://doi.org/10.7326/M20-
Alyssa O’Brien, PhD, RN is an Assistant Professor
of nursing at UNH and a member of the
NH AWHONN Steering Committee.
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Congratulations to Steven
Ball MBA, MS, CRNA,
APRN who was honored
as CRNA of the month for
January 2021. Ball
obtained a BSN from
UMass Amherst, a MSN
from Central Connecticut
State University and the
New Britain School of
Nurse Anesthesia in 2006
and an MBA in Healthcare Administration from
Plymouth State. He practiced in Connecticut until
relocating to Plymouth, NH. From 2010 to 2019,
Steve was on staff at Speare Memorial Hospital
(SMH) and appointed as the Chief of Anesthesiology
in 2018 after changing the practice from a physician
led department to a CRNA led practice. In 2020 he
accepted a position as a Staff Nurse Anesthesiologist
at Cottage Hospital in Woodsville.
least 50% of eligible perioperative nursing staff must
be CNOR-certified and the facility must consistently
recognize and reward nurses who become CNORcertified
or complete recertification. At LRH 88% of
their eligible perioperative nursing staff are CNORcertified.
Despite the restrictions in place due to
COVID-19, Littleton Regional Healthcare performed
a total of 2,837 surgical procedures in 2020,
including 284 joint replacements.
The perioperative nursing operating room team
of Littleton Regional Healthcare earned the
Certified Nurse Operating Room (CNOR) Strong
designation for 2021. This is the fifth year the group
has received this designation. The CNOR Strong
designation demonstrates continued dedication to
perioperative excellence, through achievement of a
high percentage of certified perioperative nurses. At
From left to right: Sharon Larson, RN, CGRN,
CNOR; Chris Morancie, RN, MSN, CNOR;
Heidi Chauvin, RN, CNOR; Michael Stone,
RN, CNOR; Lorelee Wetherbee, RN, CNOR;
Katherine LeHoskey, RN, BSN, CNOR, Director
of Perioperative Services at LRH. Missing from
photo is Sonya Morse, ARNP, RNFA, CNOR
March, April, May 2021 New Hampshire Nursing News • Page 17
NHNA ORGANIZATIONAL AFFILIATES
Celebrating CRNA Week: A Day in the Life of a CRNA
Rae Ritter & Janelle Pickering
The week of January 24,
2021 was CRNA week. In
honor of that week, NHANA
shares a glimpse into the
life and work of a CRNA.
The story is based on real
call shifts at a critical access
hospital in New Hampshire.
I awake at 5 am and ease
into a bit of gentle yoga,
centering my mind for the
day ahead. After a quick
breakfast and coffee, I arrive
at work at 6:30. I reviewed
my charts and entered
orders before leaving work
yesterday, so I feel prepared
for the scheduled cases in
the operating room (OR).
Like a pilot, I start my
day with many safety
checks, beginning with the
anesthesia machine. I ensure
the machine can create the
pressure needed to help a
patient breathe, that enough Janelle Pickering
oxygen is available, and that
there is sufficient anesthesia gas to keep my patient in
a state of unconsciousness we call anesthesia meaning
“without sensation” in Greek. I prepare a breathing
tube along with emergency airway supplies and then
methodically draw up IV medications which induce
unconsciousness and keep the patient comfortable.
At 7 am, I meet my first patient, Bill, in the preoperative
area. I take a moment to get to know him, meet his
companion, and set his mind at ease. We only have a
few moments to create a relationship with our patients
before surgery, and each one is critical. As nurse
anesthesiologists, we know the importance of this bond
and the impact it can have on the patient experience.
We discuss his health history and then I perform
a physical assessment. We discuss the risks &
benefits of anesthesia, and the plan for his care
today. Bill is having shoulder surgery and he would
like to receive a nerve block, an injection of local
anesthetic (like “Novocaine”) near the nerves that
give his arm sensation. After working with the
preoperative RN to monitor and sedate Bill, I use an
ultrasound to visualize his nerves, blood vessels, and
muscles. Then I inject medication that will stop the
nerve from sending pain signals to Bill’s brain.
I roll the stretcher into the OR, chatting with Bill,
joking about the movie marathon he’s planning
while he recovers from surgery. The conversation
continues as I methodically check his vital signs.
He takes deep breaths of oxygen while I make preinduction
preparations, ensuring his safety. I inject
propofol and watch his breathing become slow and
gradually fade into apnea. I confirm that he is not
consciously aware, then use a special mask with
oxygen to inflate his lungs. I administer a muscle
relaxant, a medication that makes his muscles still,
so that I can place a breathing tube into his lungs.
During the surgery, I am vigilant at the head of the
bed, watching each heartbeat and each breath,
responding as needed to make sure Bill stays safe.
At the end of surgery, I wake Bill up, remove the
breathing tube, and transfer Bill to the recovery
room, where he will be cared for by our wonderful
postoperative nurses. I’ve written orders for pain,
nausea, and blood pressure medicines for the nurses to
give and I am available if they encounter any issues.
The second case of the day is similar to the first
and proceeds without incident. When it’s done, I
check on Bill, who is leaving for home, pain free. I
sit down to grab a few bites to eat. A few minutes
later, the Emergency Department (ED) pages me
and asks me to help sedate a child with a broken
leg. I gladly oblige, providing comfort and amnesia
to a young girl who fell while playing on the jungle
gym at school.
As I prepare to leave, I’m paged again, this time
by OB. A patient, Mollie, is requesting a labor
epidural. Her nurse, Rhonda, and I prepare for
the epidural. Proper positioning, medications at
hand, vital signs checked and recorded. We work
together, Rhonda and I, in a carefully orchestrated
dance. I narrate so Mollie knows what to expect;
Rhonda coaches Mollie on her breathing and
provides comfort. I set up efficiently, brain and
hands moving smoothly through an oft practiced
sequence. Clean the skin and place a sterile drape
to prevent infection, draw up and verify the correct
medications, numb the skin to make the procedure
tolerable. Slowly, slowly, advance the epidural
needle until the right spot is identified, thread the
epidural catheter to its proper position, and inject
medication to confirm we are in the right place.
Over the next few contractions, I can see her
discomfort easing, the elation of relief giving way to
the drooping eyelids of exhaustion.
I exercise, eat dinner, meditate, chat with family.
Bedtime by 9 pm—an early start on sleep is helpful
when a night on call becomes busy. When my pager
goes off again at 11 pm, I’m glad that I’ve had time
to nourish my body and soul and rest for a bit.
Mollie needs to have a cesarean section. In the
OR, I administer a stronger medication through
her epidural and it makes her body numb for the
surgery while keeping her mind awake. I monitor
her vital signs and administer medications to ensure
adequate blood pressure. Mollie is nervous, baby’s
dad sits beside her. In minutes, we meet a squalling
little girl, pink and lively. The OR is a flurry of
smiles, tears, and activity. Baby girl is brought to
mum’s arms for skin-to-skin contact and dad gives
me his phone camera when I offer to take pictures
for them. The photo is captured in my memory as
permanently as on the camera roll.
Like many other call nights, I fall into bed at 2 am,
tired, the image of baby girl with mum and dad in
my mind, the memory of Bill, happy with the block
that rendered his shoulder pain-free, and of every
patient whose life I touch each day.
There are many other stories that can be written
about CRNA practice in New Hampshire. CRNAs
work in all places anesthesia is administered, from
hospitals to surgical-centers, outpatient clinics
and more. CRNAs care for patients of all ages,
from birth to death, and all acuity levels. We
care for people undergoing all types of surgeries,
including cardiothoracic, transplant, orthopedic,
major abdominal surgery, outpatient surgery, and
endoscopy. New Hampshire’s CRNAs provide
anesthesia for cardiac surgery such as valve
replacement and coronary artery bypass graft
surgery (CABG). In the outpatient or clinic setting,
CRNAs provide anesthesia ranging from sedation
to general anesthesia for all types of procedures,
including plastic surgery and dental anesthesia.
CRNAs work independently or as a member
of a collaborative team of providers caring for
patients undergoing all types of surgeries. In June
of 2002, Jeanne Shaheen, NH Governor, “optedout”
of the federal supervision requirement,
exempting NH from the requirement of physician
supervision over CRNAs 1 . She noted in her letter
that if CRNAs could not practice independently,
it “may severely limit the ability of rural hospitals
to treat emergencies and provide other services
that require anesthesia care.” 2 Indeed, CRNAs
work independently at 43% of New Hampshire’s
In addition to perioperative
anesthesia services, CRNAs
in New Hampshire work
chronic pain services to
our rural communities.
Residents of northern New
Hampshire depend on these
providers for procedures such
as epidural steroid injections, nerve
ablations, and more. Without them, it would be an
onerous journey to another geographic location to
During the COVID pandemic, CRNAs have
courageously stepped into new roles on airway
teams, where providers intubate patients during
the height of the COVID-19 pandemic. As airway
experts, CRNAs are an important part of this
invaluable team. We have used our ICU background
and experience managing acutely ill patients
during COVID-19 by working as advanced practice
providers in intensive care units.
No matter the practice setting, CRNAs in New
Hampshire provide top-notch, cost-effective care.
We are responsible for the vital life functions of
our patients during vulnerable times. We place
breathing tubes, support the heart, lungs, kidneys,
and other vital organs, manage acute or chronic
pain, perform epidurals and other procedures for
obstetric care, place intravenous lines and nerve
blocks, and more. CRNAs are able to provide the
full spectrum of care for patients across the lifespan.
CRNAs are fully board certified, have been giving
anesthesia for over 150 years, and we have an
excellent safety record. If you have had anesthesia,
odds are high that a CRNA stayed by your side,
keeping you safe in every breath, every beat, and
every moment of your surgery.
Thank you to every CRNA in the Granite State for
the work you do each day to support & care for our
communities. When New Hampshire needs expert
anesthesia care, #WEARETHERE.
1. American Association of Nurse Anesthetists. Fact
Sheet Concerning State Opt Outs and November 13,
2001 CMS Rule. https://www.aana.com/advocacy/
2. Appeal of New Hampshire Association of Nurse
Anesthetists, (State of New Hampshire Supreme
Court 2020). https://www.aana.com/docs/
Rae Ritter, MSN, APRN-CRNA practices as a selfemployed
Locum Tenens in New Hampshire.
Janelle Pickering, DNP, APRN-CRNA practices
at Dartmouth Hitchcock Medical Center
in Lebanon, New Hampshire.
Page 18 • New Hampshire Nursing News March, April, May 2021
Non-Verbal Communication: The Silent Giveaway
Carolyn Taylor, Ed.D. M.N. R.N.
Reprinted with permission from Montana The Pulse,
November 2018 Issue
Of all the communication
that a person witnesses
(verbal or non-verbal)
the non-verbal silence
is the most interesting
and informative, by far.
Albert Mehrabian (1960)
communication and found it
to be more believable than
verbal communication. It is
an independent messaging
system that is used differently
by every person. How good
are you at reading people?
Ed.D, MN, RN
We are all constantly sending messages, whether we
realize it or not!
The content of this article is to encourage thoughtful
and accurate consideration of unspoken attributes
of mankind. By increasing our personal and
researched knowledge about unspoken body
language, we increase our potential understanding
and appreciation of human physical and behavioral
Not intentionally learned, but so very revealing
is blushing, shaking, sweating, smiling, laughing,
crying, and similar behaviors that show nervousness.
Think of “The Look!” (whatever that is!), a pat on
the back, a pat on the “rear,” and even a drop (or
no drop or elevation) in the voice at the end of a
sentence. Add to these examples just a very few of
the many non-verbal behaviors—voice tone while
moving the hands, shrugging the shoulders, wearing
a certain color, decorating a home in a certain color,
listening to a specific type of music, or even having
a scented candle in the room. Our unspoken silence
makes up our non-verbal communication.
Non-verbal (silent) communication has been, also,
called the “transparency effect.” This says that we are
all more transparent than we realize! However, the key
in recognizing the “transparency effect” in others is to
correctly interpret the non-verbal communication we
Territoriality (Primary, Secondary, Public)
Humans have a sense of territoriality. This enables
us to invite or disinvite social interaction. We have
all sorts of signs, signals, and effects to establish our
territory without saying a word. This comes from
two types of learning—biological and social. For
instance, in regard to biology, male animals often fight
off other males to defend females. Socially, humans
declare possessions and spaces of their own and set
boundaries on possessions and spaces within the
environment. Our social spaces and possessions might
include our side of the bed, our desk, our wallet, our
closet space, our car, etc.
The expression of PRIMARY territoriality can be
represented as non-verbal and verbal. We use nonverbal
“markers” to remind others as to what is
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“ours.” For instance, we place a sign of our name on
the desk, put numbers on our house, and we often
put our initials on items. Oh yes, we all say, “This is
SECONDARY territoriality involves belongings we
have for a limited time. We borrow books, have
special food items for a snack, put your name
on a pencil, etc. They are actually or figuratively
borrowed or soon to be used up. They usually
require a marker of some kind that allows for a
temporary access to the item.
PUBLIC territoriality involves items that are shared by
the public. That is, buses, roads, park benches, grass
and trees in the park, etc.
“Territorial Invasion” is when someone else takes
over a part or all of our territory. “Contamination”
occurs when someone destructively takes over your
territory—and that often becomes a legal matter.
Remember when you were in a crowded room and
someone keeps staring at you? If you were led to
believe that the person doing the staring is a “difficult
person” the invasion becomes a “Psychological
Territorial Threat” that causes stress—therefore, this
nonverbal threat causes stress and an increase in
blood cortisol excreted by the adrenal glands. Our
body, in that type of situation, can become stiff, we
pull in our elbows, and turn our bodies so that our
back faces the threat in an attempt to reestablish our
Determine another’s comfortable space by watching
their behavior (e.g. a hand shake or a hug) and allow
that person to nonverbally tell you their personal
acceptable closeness. The amount of extension of
the arm to your extended hand for a hand shake, the
closeness (or not) of a hug, or even the desire for a
private desk or cubicle are a few of the “little things”
that tell “big stories.”
As a leader in a work setting, it is best to encourage,
when you can, the flow of group conversation
between people in an open non-curtailing
environment rather than in a cubicle or confined
Proxemics is the study of personal space, as a part
of territoriality. It determines what we do, think, and
how we react. Such as—
INTIMATE ZONE is for our family, close friends, and
spouse. It is about 18 inches from us.
CASUAL-PERSONAL ZONE is for normal
conversation. It is about 18 inches to 4 feet from us.
CIVIL INATTENTION is for the person with whom
you have eye contact for a fraction of a second, then
avert your eyes/gaze away from that person.
SOCIAL CONSULTATIVE is for most day-to-day
activities while recognizing personal autonomy and
privacy while conducting discussion. This ranges
from 4 to 12 feet from us—known as an area of
PUBLIC is from about 12 feet from us to what you
can see or hear. This includes observable activities.
Differences in Cultures and Subcultures
Some cultures require distancing the person from
strangers; whereas, other cultures value closeness.
For example, in Tanzania being too far away from
another person as a matter of personal choice means
the given message is that you reject that person;
therefore, it is best to sit close to another person.
Other cultures, such as the Arab culture, desire to be
as close as possible when conversing—close enough
to feel a person’s breath (bad breath or otherwise).
Space, Colors, and Mood
Research shows that we shape our own environment
through determining our space, color, and mood.
The physical management of these factors in our
environment help to determine our personal behavior
and the behavior of other people. The environment,
in general, also triggers conscious and unconscious
perceptions. Our personal perceptions, in turn,
determine our behavior.
There are three factors that determine the non-verbal
spaces created by people. They are—
1. The flow of traffic: The requirements of personal
movement within buildings are an example.
Studies have shown that in an apartment house,
the people living near the stairwells are more
likely to boost the interpersonal interactions with
others. (MIT 1950 study) Another example are the
exits within certain buildings that are somewhat
hidden—take as an example, the casinos that are
laid out in a manner that often discourages finding
your way out until you become aware of the
2. The direction people face: Obviously when
people face each other there is an increase in
the possibility of social interaction. The family
table usually requires people to face each other,
which increases the opportunity for verbal
and nonverbal communication. The bar stool,
in comparison, does not face another person,
thereby, decreasing verbal and nonverbal
3. The location of the leader: The “leader” (or
someone in charge) is usually at the head of the
table— and is the person more likely to be in
charge. If this person is not at the head of the
table, he/she is located somewhere in a central
location of the involved persons. (Remember that
leadership means the encouragement and active
involvement of others; so, where do you currently
sit, as the leader, to encourage the nonverbal
participation and involvement of others?)
All colors have meaning and cause an influence a
person’s impressions and behaviors. When different
colors are studied, some colors have consistencies
in their interpretations, and some do not. Even color
brightness has significant meaning.
The color of white seems to impart a feeling of
goodness; whereas, black seems to give a negative
feeling. Bright colors give a feeling of intenseness.
Whereas, passive feelings can be related to black,
white, blue, and pink. In the sports world, research
tends to show that white uniforms or uniforms with
white seem to be more positively responded to by
referees than totally black uniforms. According to
some studies, more penalties for teams wearing
all black were reported to have occurred. Physical
aggressiveness was reported to increase by merely
(The question for you is related to how do people see
you if you wear black? Do you see yourself as more
aggressive—or not? In this case, more likely, the way
YOU FEEL when you wear a certain color usually
results in you acting the way you feel. Your behavior
related to how you feel most often identifies your
degree of aggressiveness, or lack thereof.)
The color of black is not always associated with death
in some cultures. Blue and white in Asia are often the
colors of a funeral. In Ghana, red is often combined
with black for this occasion.
Red is a lucky color in Asia. International research has
found that ovulating women will unpredictably often
wear red. Red, being a bright color, is an attention seeking
color. The color has been found to attract a male’s
attention toward females. Research has determined that
men have the same effect on women if they (males) wear
red—and women found that men wearing red were more
sexually desirable and of higher social status.
A nice warm cup of “something” or a hand warmer
helps to promote a personal feeling of warmth and
trust toward another person. If you provide a cold
drink or cold pack to another person, there is reported
to be an increase in the recipient’s loneliness.
(Perhaps this knowledge can be used by safe houses
and disaster shelters in times of community stress and
should be an example of the fact that, “all behavior
has meaning” as a universal concept!!
Body and faces can send many different messages.
In regard to the static features of the body and face,
research tells us that:
March, April, May 2021 New Hampshire Nursing News • Page 19
WELCOME NEW and RETURNING NHNA MEMBERS!
NHNA welcomes these new and returning members. Thank you!!! What do these 36 nurses and over 1,200 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!
Body Shapes (Identified by William Sheldon)—
1. Endomorph is a heavier (fat) body type. He claimed
that the digestive system probably works slowly. This
person, usually, is known to be relaxed and sociable.
2. Ectomorph is a skinny body type. He claimed
that the nervous system of this person probably
3. Mesomorph is a more muscular body type. He
claimed that the muscular system probably is
1. The world-wide income for males is two percent
more per one inch of height than females. Females
over 5’ 8” earn about 15% more than shorter
2. In romantic relationships, women seem to prefer
taller men—especially if the female lives in a
3. Men often lie about their height on dating
profiles—a tendency to exaggerate. Females
frequently minimize (lie) about their weight on
Why has height become important? It has been
speculated that, maybe, it is because in the animal
kingdom height is a dominant factor and they tend to
be bigger and stronger. The dominant animals lead the
pack, the herd, or the group.
Waist-To-Hip Ratio in Women—
1. Men appear to be more attracted to women that
have a waist to hip ratio of 0.70. Fertility seems to be
increased with, at least, this ratio.
2. If the waist to hip ratio gets to 0.85 or higher, health
issues are more likely to occur—diabetes and heart
disease. These diseases often cause women to be
3. It appears that men are more attracted to women
who have a hip-ratio that signals fertility— and
maybe the fact that they are, also, more attractive.
1. The shift to an approval of increased weight has
increased in the past 125 years in the U.S. There
could be a connotation that heavier means more
wealth and the availability to food.
2. In some Arabic cultures the fathers like to boast
about their “heavier” daughters as evidence of the
father’s ability to provide food.
1. The neutral face (without expression) is determined
by others to identify the personality of the person.
2. In 1950, there was an agreement that a
personality can be identified by the neutral
face. Research findings indicated that people
who wore glasses were seen as smarter because
it suggests, to some, that a person reads a lot.
Broad-set eyes became a metaphor for broad
mindedness. Conversely, narrow set eyes
became a metaphor for narrow-mindedness.
If the corners of your mouth turn up, it was
thought that you must be a happy person.
Where some of the neutral face research findings
appear, sometimes to be true, it is also true that
health conditions could be the reason for what is
Social scientists assume that we all have varying
amounts of five personality traits. These are
conscientiousness, agreeableness, neuroticism,
openness to experience, and extroversion.
Assessments of photos show a significant correlation
between the person’s photo personality assessment
and the person’s formal/actual personality
John Gottman, a psychologist, noted a pattern
of behavior in couples. He called them the four
horsemen of the apocalypse: criticism, contempt,
defensiveness, and withdrawal. Criticism and
defensiveness are verbal signs that relate to sarcasm.
Contempt is a nonverbal sign expressed in the face.
Withdrawal occurs when the couple no longer talks
to each other—and that is extremely toxic. Staying
happy in a marriage requires a couple to do the
little non-verbal “things.” They include, gentle
squeezes, smiles, showing attentiveness—OFTEN!
Silent Signs of Pain—
One of the many responsibilities of a nurse is
the recognition of pain. Nurses are expected to
recognize pain just by looking at a patient. The
grimace, tenseness, moaning, being combative, and
many other non-verbal symptoms and vital sign
changes can reveal pain intensity. Some patients
will deny pain while their non-verbal says, without
doubt, they are in pain.
It has been widely reported that nurses often do
not assess non-verbal evidence of pain correctly.
We need to remember that every person/patient is
different and their diagnosis (medical or psychiatric)
can cloud the accurate recognition of pain. Some
patients think they “deserve pain” as if it were a
redemption quality for their stated personal sins.
The message, here, is to increase awareness of the
many unspoken behaviors that require an astute
nurse to pay attention to the suffering patient. Do
not ignore the symptoms. Narcotics are not known
to addict when a person needs true pain relief. How
many times have many of us ignored the silent signs
of obvious pain and reported that the patient is
resting without pain?
Your challenge—watch for the numerous and
individual signs of non-verbal pain, treat that pain
in an appropriate manner, evaluate the intervention,
and teach other nurses the individualized reaction
to the patient’s existing pain. Treat it as such,
because you are the nurse! And—we know that
no one deserves (and need not be) in unspeakable
COMMUNICATION” (Great Courses Course
By Mark G. Frank, Ph.D.
Professor and Department Chair,
Department of Communication;
Director, Communication Science Center
University of Buffalo,
The State University of New York
Behavioral Pain Scale (/behavioral-pain-scale-bpspain-assessment-intubated-patients)
CPOT Pain Scale (/critical-care-pain-observationtool-cpot)
Page 20 • New Hampshire Nursing News March, April, May 2021
With the demand for licensed nursing assistants soaring,
two New Hampshire hospitals have created in-house
education programs. Portsmouth Regional Hospital
launched a free Licensed Nursing Assistant (LNA) course
in January 2021. The course was approved by the
Board of Nursing and includes seven weeks of classes
using the curriculum from the American Red Cross.
Each seven-week course is open to eight students. The
hospital-based LNA training program is administered by
Portsmouth Regional Hospital registered nurses serving
as instructors for the program. Students are paid $13 per
hour for their classes and after they finish the course and
obtain their license will be paid $15 per hour. Students
are asked to sign a one-year commitment to work at
19th Year in a Row!
A Gallup poll conducted the first week of December 2020
reported nurses topped the Honesty and Ethics list. Nurses have
topped the list in all but one year since they were added in 1999.
The exception is 2001, when firefighters were measured on a onetime
basis shortly after the Sept. 11 terrorist attacks, and earned
the highest score to date for any profession, 90%. This year, nurses
fell one point shy of that mark.
Americans have become more likely to laud the honesty and ethics of nurses, medical doctors and
pharmacists during the COVID pandemic. Still, nurses remain the undisputed leader, as they have been for
nearly two decades.
• Nurses earn a record 89% very high/high score for their honesty and ethics in 2020, four
percentage points greater than their prior high, last recorded in 2019.
• Medical doctors' rating has improved even more in the past year, rising 12 points to 77% and
exceeding the previous high of 70% found in 2011 and 2012.
• Pharmacists' honesty and ethics rating is up seven points to 71%. While not their highest rating, it is
the highest since 2012, when 75% rated them this positively.
Concord Hospital entered into a partnership with NHTI
and Manchester Community College (MCC), with MCC
offering the instruction and NHTI serving as a local
training site for the program. The program includes five
weeks of full-time instruction, both online and in-person
training, with 60 hours of soft skills training, 60 hours
of online theory, 24 hours of lab work and 60 hours of
clinical practicum at Concord Hospital. The hospital
pay 100 percent of the tuition costs and participants
are full-time, benefitted employees from the start of
the program. The first class of eight students began in
NEW HAMPSHIRE DEPARTMENT OF
CORRECTIONS IS LOOKING FOR:
Northern NH Correctional Facility in Berlin, Secure
Psychiatric Unit in Concord, NH State Prison for Men in
Concord, NH Correctional Facility for Women in Concord
RN I: $50,835.20-$71,052.80
RN II: $55,182.40-$77,438.40
RN III: $59,862.40-$84,427.20
INCREASE ON TOP
OF BASE SALARY
(Salary does not reflect Hazard Duty, applicable Shift differential, and/or Weekend pay)
Provides general nursing care and treatment in an adult ambulatory setting, inpatient
infirmary unit, and/or in an inpatient psychiatric forensic unit under the direction of the
nurse coordinator. Correctional nursing requires ongoing close and immediate contact
with prisoners and/or civilly committed residents while maintaining safety and security.
Locations are secure facilities managed by the NH Department of Corrections.
Please apply on line at www.nh.gov. Click on the job opportunities icon
and follow the instructions to Register; create a complete profile and save.
Log In and apply. Questions may be directed to Linda McDonald at
603-271-5645 or via e-mail at Linda.J.McDonald@doc.nh.gov.
Percentages of Americans rating pharmacists, medical doctors and nurses as having very
high or high honesty and ethical standards.
To access electronic copies of New
Hampshire Nursing News, please visit
March, April, May 2021 New Hampshire Nursing News • Page 21
Hope and Healing for the Addicted Nurse
There is nothing as heart-stopping to the professional
nurse as the sudden realization that an error in
judgement or nursing practice has led to an outcome
that injures a patient. We panic, we bargain, we
rationalize, perhaps even try to cover up our mistake
or blame others. Our first instinct is not always to
seek help but may be to deny culpability and hope
that our error will not be discovered. We project a
future scenario of disgrace and isolation from our
colleagues, along with the loss of our license and
livelihood. We may fervently wish for an “if only”
moment, just one chance to take us back to the time
before tumbling down the rabbit hole of shame and
Now imagine experiencing this tortuous cycle of
emotions daily, sometimes hourly. You the addicted
nurse, can find no relief, beyond another drug or
drink. You are of the delusion that you are not really
hurting anyone but yourself, that you can handle it,
stop anytime, and all the other lies you tell yourself
but don’t really believe. It is the ceaseless self-talk
of addiction. All the sacrifices you made to graduate
from nursing school and advance in your career
become meaningless. You have acquired new skills
in lying, manipulation, and diversion. The new skills
bring you closer to the embrace of your new best
friend, the substance. The substance has lead you to
destroy the dreams that first called you to the nursing
profession. But what if that nurse, that colleague or
that employer could really stop time. If they could
stop time and find that “if only” moment to intervene
early they might halt the addicted nurse’s fatal
For guidance, look to the Joint Position Statement
by the Emergency Nurses Association (ENA) and the
International Nurses Society on Addictions (IntNSA)
issued in 2015 and approved by the American Nurses
Association (ANA) in 2016:
1. Health care facilities provide education to nurses
and other employees regarding alcohol and other
drug use, and establish policies, procedures, and
practices to promote safe, supportive, drug-free
2. Health care facilities and schools of nursing
adopt alternative-to-discipline (ATD) approaches
to treating nurses and nursing students with
substance use disorders, with stated goals of
retention, rehabilitation, and re-entry into safe,
3. Drug diversion, in the context of personal use, is
viewed primarily as a symptom of a serious and
treatable disease, and not exclusively as a crime.
4. Nurses and nursing students are aware of the
risks associated with substance use, impaired
practice, and drug diversion, and have the
responsibility and means to report suspected or
The statement concludes that ATD programs
have been shown to identify and enroll more
nurses with substance use disorders, with
potentially greater impact on protecting the
public than disciplinary programs.
New Hampshire offers such a program for nurses,
the New Hampshire Professionals Health Program
(NHPHP). The NHPHP is a non-profit organization,
independent of other professional organizations
and the State of New Hampshire. The NHPHP
is contracted by the New Hampshire Office of
Professional Licensure and Certification (OPLC)
to provide assistance to NH licensed nurses and
other NH licensed health professionals. They offer
help to those who are experiencing difficulties with
substance abuse and addiction, psychiatric and/
or behavioral health concerns, stress/burnout,
work-related conflicts or professionalism. The
concerns may be self-recognized or have come to
the attention of an employer or the licensing board.
The NHPHP provides intake assessments, treatment
referrals, monitoring when indicated, as well as
documentation of recovery, education, advocacy and
support. NHPHP believes that early intervention and
treatment offers the best opportunity for a successful
outcome. Early intervention can prevent a health
issue from becoming a work issue.
The assistance of NHPHP is free and confidential
as required by law or regulation. The program is
clinical, not disciplinary. Voluntary options for
treatment exist! The NHPHP offers a confidential
pathway for those nurses who recognize the need to
self-report and enter into treatment and monitoring
without any perceived penalty or licensing board
Up to 10-12% of the general population will
succumb to addiction, nurses are not immune to this
statistic. Covid-19 is increasing rates of alcohol use
and a mental health crisis, in the patients nurses care
for, as well as in nurses themselves.
For more information about NHPHP services,
visit www.nhphp.org or contact:
PHONE: (603) 491-5036
On December 23, 2020, the U.S. Bankruptcy
Court, District of New Hampshire issued a
final order approving Concord Hospital’s
acquisition of Lakes Region General Hospital,
Franklin Hospital and their ambulatory sites.
Lakes Region Healthcare filed for bankruptcy in
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Page 22 • New Hampshire Nursing News March, April, May 2021
IN MEMORY OF OUR COLLEAGUES
Norene Susan (Holmes) Sauls, 84,
passed away November 1, 2020 in South
Carolina. A Manchester native she was a
1958 graduate of the Elliot Hospital
School of Nursing in Manchester and
went on to graduate from New England
College in 1993. She was the school
nurse at the Northwood Elementary School from 1986-
Debra Jean Locastro Cilley, 67, passed
away on November 2, 2020. She
obtained her nursing diploma in New
York. After arriving in New Hampshire in
1983 she practiced at Crotched Mountain
and Monadnock Community Hospital.
Deb helped launch the Occupational
Health program at MCH connecting the hospital to
many local employers. She founded the MCH Fall
Foliage Benefit Golf Tournament and volunteered for
years to oversee this annual event. She spent numerous
years on the Greenfield Fire and Rescue as well as the
Peterborough Ambulance Crew as her way to use her
nursing skills and give back to the community.
Dora Jean (Carll) Spedding, 88, died
November 6, 2020 in Maine. She
graduated in 1967 from the Practical
Nursing School of Portsmouth, New
Hampshire and worked at Frisbie
Memorial Hospital for 20 years.
Brenda A. (Mitchell) LaPointe, 70, died
November 13, 2020. A Manchester native
she obtained her nursing diploma in
Massachusetts. She practiced as a
registered nurse with Greater Manchester
Alice Varotsis Buchanan, 94, passed
away on November 14, 2020 in Maine.
Born in Greece she obtained her nursing
diploma from the Laconia School of
Nursing. She practiced in maternity and
pediatrics throughout her long career at
the Portsmouth Hospital.
St. A’s Grad
Joyce Roberts Smith, 70, passed away on
November 16, 2020. She attended Saint
Anselm College Nursing School for a BSN
and earned her Master's Degree in
Gerontological Nursing from University of
Lowell. She practiced in California before
Pauline L. (Geoffrion) Sullivan, 80, died
November 17, 2020. She was a 1961
graduate of the Sacred Heart School of
Nursing and then obtained a bachelor's
degree in psychology from New England
College. She practiced at Sacred Heart
Hospital and then Catholic Medical
Center. Until her retirement in 2001, she was at the Elliot
Virginia (McCarron) L’Heureux passed
away November 23, 2020. She obtained
her AD from North Shore Community
College with her nursing degree in 1972.
She practiced as an emergency room
nurse, working in Massachusetts and then
at Elliot Hospital and St. Joseph’s Hospital
before she transitioned working for Dr. Arthur
Fitzmaurice as his office nurse for almost 20 years prior
to her retirement.
Susanne Murray Wenninger, 79, died on
November 25, 2020. She practiced
nursing at Exeter Family Medicine
Lorraine L. (LaPlante) Simon, 83, passed
away November 27, 2020. She was a
graduate of the Notre Dame School of
Nursing and practiced at hospitals around
New England, including Catholic Medical
Gertrude Marie (Violette) Murphy, 91,
passed away on December 1, 2020.
Born in New Brunswick, Canada she
graduated from the New Hampshire State
Hospital School of Nursing in 1951. She
practiced at Concord Hospital for 27
years and spent the last years of her
career at New Hampshire Hospital, from where she
retired in 1992.
Roberta M (Martin) Mathews, 71, passed
away December 6, 2020. A Concord
native she obtained her AD from NHTI
and practiced at the Concord Clinic
(which later became Dartmouth
Hitchcock Clinic) and at Pleasant Street
Dian Johnson (Foster) Schwartz, 74,
passed away December 6, 2020. A North
Carolina native she practiced as a nurse
anesthetist at Concord Hospital, before
retiring in 2015 after a nearly 50-year
Carolyn "Carrie" V. (Prisby)
O'Malley, 82, died on
December 9, 2020. She
obtained her nursing diploma
from the Sacred Heart School of
Nursing and practiced at the
Sacred Heart Hospital and
Catholic Medical Center until her retirement. She served
as a parish nurse and was a member of the Catholic
Eleanor Hamor Wells,
94, passed away on
December 10, 2020. A
Maine native, she was a
1947 graduate of the US Cadet Nurse
Corps. She practiced at Concord Hospital
in pediatrics from 1963 to 1989.
Jacqueline L. (Carter) Sullivan, 81,
passed away December 11, 2020. She
received her nursing degree from NHTI in
1983 at the age of 43. She helped deliver
babies and ran the Outpatient Clinic at
Franklin Hospital for most of her career.
She briefly relocated to Florida where she
practiced as a community hospice nurse. Moving back
to New Hampshire she retired from nursing at the New
Hampshire Veterans Home.
Paglierani, 88, died
December 11, 2020.
During the 1950's, she
served in the U.S. Marine Corps. She
worked with the Visiting Nurse
Association in Freedom as a licensed
Veterans Home Director
Helen K. (Soltys) Proulx, 98, died
December 5, 2020. A native of Franklin,
from the time she was a young girl she
wanted to be a nurse. Helen began her
training at Nashua Memorial Hospital and
later worked at Hale Hospital in
Haverhill, MA where she receiving her
cap. She practiced for 25 years as a nurse at Franklin
Hospital. Helen later retired in 1986 as Director of
Nurses at the New Hampshire Veterans Home in Tilton
after 18 years of service.
Bertha H. Stritch, 81, died December 9,
2020. A Keene native she was a graduate
of the Thompson School of Practical
Catherine Lee (Derdock)
Speidel, 61, died on
December 13, 2020. She
served in the US Air
Force and in her fifties
attended school to become an LPN at the
Edgewood Centre in Portsmouth.
Audrey M. (Marcotte)
Castle, 89, died on
December 16, 2020. A
graduate of the Elliot
Hospital School of
Nursing in Manchester
she practiced in the
Exeter area for many years. She was the
Director of the Exeter Area Visiting Nurse Association for
18 years before establishing and managing PRN Home
Health Service. Audrey was a member of the American
Nurses Association and the New Hampshire Nurses
Mt. Saint Mary Grad
Patricia ‘Patsy’ Francis (Healy) Prescott,
94, died of COVID-19 pneumonia on
December 18, 2020. Along with her twin
Polly, she graduated from Mount Saint
Mary's nursing school in Hooksett.
Harold Montague Chase
Jr, 82, passed away
December 19, 2020. An
Illinois native he was in
the Army Reserves from
1956 - 1965, then going active duty from
1965 - 1983. He did a tour in Vietnam
and retired as a Lt. Colonel in 1983. He obtained his
Bachelors' Degree in Nursing from Mt Sinai University.
He practiced OR nursing from 1983-2003 at Dartmouth
Hitchcock Medical Center.
Betty McKiever-Lowell, 78, died
December 23, 2020 after a 10-day battle
with COVID. Born in Georgia she
obtained a nursing degree from River
Valley Community College. She practiced
at Cheshire Medical Center, Langdon
Place, Beacon Hospice, Hospice at HCS
in Keene, and for Genesis Healthcare at the Elms in
Milford. She was a First Aid and CPR instructor for the
American Red Cross for 15 years. As a Hospice Nurse
she was exposed daily to Covid-19 patients, a risk she
voluntarily took, in spite of her own health issues.
March, April, May 2021 New Hampshire Nursing News • Page 23
IN MEMORY OF OUR COLLEAGUES
Miriam J. (Welch) Pelletier, 89, passed
away on December 31, 2020. She was an
LPN and employed by Notre Dame
Hospital as a pediatric nurse and
eventually moved on to nursing homes.
She finished her career at McKerley's
Mary Elizabeth ‘Marybeth’ (Duffy)
Florczak, 75, passed away on January 3,
2021 after battling cancer for eight years.
A New Jersey native she obtained her AS
in nursing from Rivier College. She
practiced at the Hitchcock Clinic, Nashua
NH for 11 years and moved from Adult
Medicine to Occupational Health, where she supervised
their drug Consortium. Her true love was volunteering
for Home Health & Hospice of Merrimack, NH for 10
years, where she participated in maintaining their
gardens, home and nursing home visits, patient
transportation and a member of their vigil team.
Leona Edith (Zajkowski) Benson, 90,
passed away on January 4, 2021. A
Connecticut native she graduated from
the Elliot Hospital School of Nursing in
Manchester in 1951. She practiced as a
surgical nurse at Concord Hospital until
her retirement after 41 years.
Pillsbury Hospital Grad
Edna Kinne Woodman,
93, passed away on
January 5, 2021. She
went into nursing under
the US Cadet Nurse
Corps program and was able to attend
the Margaret Pillsbury Hospital School of
Nursing in Concord. During that time Margaret Pillsbury
Hospital and Concord Memorial Hospital merged and
became Concord Hospital. While she graduated from
Concord Hospital she was proud to wear her Margaret
Pillsbury cap at graduation.
North Country Nurse
Betty "Buffi" Christie Smith, 80, died
January 12, 2021. She obtained her
nursing diploma from Mass General
Hospital School of Nursing. For 29 years
she practiced as an office nurse for Dr.
David Bishop in Littleton.
St. A’s Grad
Ursula "Dolly" B. (Taylor) Classon, 87,
passed away on January 13, 2021. She
received her Bachelor's degree in Nursing
from Saint Anselm College.
Lois M. (Weldon) Duhamel, 84, died
January 20, 2021. A Goffstown native she
obtained her nursing diploma at the
Sacred Heart School of Nursing. She
dedicated 35 years of her life serving and
caring for the residents of Hillsborough
County Nursing Home.
New London Nurse
Judith (Schucker) Walker, 89, passed
away on January 23, 2021. She followed
in her mother's footsteps obtaining a
diploma in nursing in 1953. She practiced
for many years at New London Hospital.
In 1971 she joined the infirmary staff at
Colby-Sawyer College from which she
retired in 1997. She also did private in-home care and
was an American National Red Cross Nurse.
Dawn P. (Broderick) Barrett, 81, passed
away on January 26, 2021 in Florida.
was born March 15, 1939, in Boston,
Mass., to Laurence and Marguerite
Broderick. An alumna of the Elliot
Hospital School of Nursing and Saint
Anselm College she practiced for many
years at the Elliot Hospital.
Priscilla (Gingras) Jean, 79, passed away
in Maine on January 28, 2021. She
obtained her nursing diploma at the Eliot
Hospital School of Nursing and practiced
at Eliot Hospital in the role of supervisor.
She was also a nurse for the Manchester
Red Cross, and the Manchester Mental
Health Center. She practiced in several areas of nursing
in her long career, and eventually settled on her favorite,
Wentworth Douglas Nurse
Helen (McKay) Merrill, 92, passed away
January 29, 2021 in Nova Scotia, Canada.
She obtained her nursing diploma at the
Grace Maternity Hospital in Halifax,
Nova Scotia and practiced nursing at
Wentworth Douglass Hospital.
Elizabeth “Boo” (Stevener) Zotto, 62,
passed away January 30, 2021. She
obtained her BSN from New York and in
1983 practiced as a pediatric nurse at
Dartmouth Hitchcock for many years.
She transitioned as a school nurse in
Bedford at McKelvie Middle School and
Ross A. Lurgio Middle School. She was a school nurse
for 20 years until she retired.