New Hampshire - March 2021


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.

New Hampshire

Nursing News

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

Gina Teixeira

Jenna Osborn

Dawn Chapman

Super Nurses continued on page 2

Presort Standard

US Postage


Permit #14

Princeton, MN


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

storage requirements.

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 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

Legislative Update......................................5-7

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

Management Minute.....................................14

New Hampshire Board of Nursing Guidance....................15

KUDOS.............................................. 16

NHNA Organizational Affiliates

AWHONN.......................................... 16


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

In Memoriam........................................22-23

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,” with NN Submission

in the subject line.

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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.

New Hampshire


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

Editorial Offices

New Hampshire Nurses Association, 25 Hall St., Unit

1E, Concord, NH 03301. Ph (877) 810-5972, E-mail

Editor: Susan Fetzer, PhD, RN

NHNA Staff

Pamela P. DiNapoli, PhD, RN, CNL, Nurse Executive


Paula MacKinnon RN, Executive Assistant/

Communications Specialist

NURSING NEWS is indexed in the Cumulative Nursing

Index to Nursing and Allied Health Literature (CINAHL)

and International Nursing Index.

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Empower New Hampshire nurses as leaders in

advancing the profession of nursing and the health of

New Hampshire.


NHNA, as a constituent member of the American

Nurses Association, exists to promote the practice,

development and well being of NH nurses through

education, empowerment and healthcare advocacy.

Adopted 10-20-2010. can point you

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Three NH nurses were among the photo of 76 healthcare workers photographed at Gillette Stadium

before leaving for Boston’s Logan Airport for Super Bowl LV.

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March, April, May 2021 New Hampshire Nursing News • Page 3


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.

Carlene Ferrier

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:// 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.

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The Truth about Vaccination:

Vaccinated with HOPE

Distribution of the COVID

vaccine to Group 1A to

vulnerable healthcare

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


Megan Gray

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

Line Director.

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

LSR 207

LSR 838

LSR 899

Appropriations: Sponsor Sen Rosenwald LSR 961 includes

LSR 1046

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

committee hearings.

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 or

Members are directed to the advocacy toolkit on the

NHNA webpage for valuable resources. (https://nhnurses.

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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

Health Coalition.

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

general health.

• 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

Registered Nurse/

Nurse Trainer

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

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:

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

promoting medical-dental

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

Identify a nursing member to sit on our Steering

Committee as a nursing representative. Let your

voice be heard.

Contact 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

educational programs.

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 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.

NCLEX Reconsidered

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

C. Echocardiogram

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

C. Aphasia

D. Unilateral neglect

E. Hemiopsia

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

Corona Extra.

• 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

they reply.

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



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

annual recognition

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

more comfortable.

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

of that.”

Reprinted with permission.



Mary Bidgood-Wilson

Pamlea DiNapoli

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:


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, 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!

Joan Widmer

Kaitlynn Liset

Cheryl Abbott

Pamela Kallmerten

Photo Not Available

Pat Lazare

Anthony McLean

Dansir Minster

Austin Ritter

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 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. ‘

—Arnold Glagow

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


On Problem Solving

Susan Fetzer

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

to communicate.

• 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

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Page 16 • New Hampshire Nursing News March, April, May 2021


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

this victory.

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

team indefinitely.


Mirchandani, P. (2020). Health care supply chains: COVID-19

challenges and pressing actions. Annals of Internal

Medicine, 173(4), 300-301.


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


APRN who was honored

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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


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).

Rae Ritter

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

autonomously providing

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

receive care.

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.


Published 2020.

2. Appeal of New Hampshire Association of Nurse

Anesthetists, (State of New Hampshire Supreme

Court 2020).




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)

researched silent/non-verbal

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?

Carolyn Taylor

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

work space.

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.


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

formal discussion.

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

wearing black.

(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 Types—

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


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 where joining is easy and one of the best professional values

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Jean Francis


Amanda Livernois


Alexandria Noble


Larissa Tinkham


Barbara Pires-Lynch


Kari Smith

Cornish Flat

Brandon Kuhre


Chloe Shapiro-Barnard


Dawn Guilbeault

Lindsey Parker


Michelle Ferry


Teresa Broyer


Thomas Kretz


Paige Tuttle

Julie Hounchell

Diane Ketchum

Melissa Taylor


Kris Frank


Lisa Cassidy


Carly Kissane

New Castle

Danielle Ades


Kathleen Nunes


Terry Malec


Sherri Perry


Rudolph Pavelesich


Erica Goroshko


Ase Hauge


Sarah O’Hara


Lisa Wunderlich

Coreen Toussaint

Nicole Speidel


Ilyssa Sherman


Michelle Thomas


Vicki Mellon


Lise Dehart


Maria Scholz

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


Body Height—

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

dangerous neighborhood.

3. Men often lie about their height on dating

profiles—a tendency to exaggerate. Females

frequently minimize (lie) about their weight on

dating profiles.

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

less fertile.

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


Personality Traits—

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


Romantic Relationships—

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


Suggested Reading:


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

LNAs Learn

and Earn

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





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

PLUS 15%



(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 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

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,

professional practice.

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

actual concerns.

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 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

October 2020.

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Page 22 • New Hampshire Nursing News March, April, May 2021


Elliot Grad

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-


Monadnock Nurse

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.

Frisbie LPN

Psych Nurse

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

Mental Health.

Portsmouth Nurse

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

her retirement.

Manchester Nurse

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


ED Nurse

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.

Office Nurse

CMC Nurse

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


Concord Nurse

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

Family Medicine.

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


CMC Nurse

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

Nurses Association.

Pedi Nurse

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.


Janet (Meinhart)

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

practical nurse.

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.

Elliot Grad

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.

Army Nurse

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.

Hospice Nurse

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



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

Nursing Home.

Rivier Grad

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.

Elliot Nurse

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

Gero Nurse

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.

Elliot Grad

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.

Elliot Grad

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,

psychiatric nursing.

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.

Pedi Nurse

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.

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