Volume 1 • No. 3
April, May, June 2021
The Official Publication of the Missouri Nurses Association with a quarterly circulation of approximately 72,000 to RNs and LPNs
Message from the President
Caryl Goodyear, PhD, RN,
NEA-BC, CCRN-K, FAAN,
March 19 was our day
to celebrate professional
certification. Why March 19?
National Certified Nurses Day
was established on March
19 in honor of Margretta
Madden Styles, a nurse leader
and advocate for certification
who was born on March
19. Dr. Styles advocated for Caryl Goodyear
certification standards and
is widely known to be the inspiration of creating the
American Nurses Credentialing Center (ANCC), part of
the American Nurse Association Enterprise which also
includes the American Nurses Foundation.
We all may have different reasons to become
certified in our area of practice. For me, to obtain
certification meant I was an expert in the field of
critical care nursing practice. Being certified gave me
confidence to care for critically ill patients when their
lives are the most vulnerable. The continued knowledge
and practice experience to keep my certification
meant I was advancing my skills on a continual basis.
Obtaining my CCRN was a significant career event and
one that I’m most proud of.
As I moved into leadership roles, I knew I needed
to validate my knowledge, skills and experience as a
leader – my new area of practice. That’s why I obtained
my certification through ANCC as a Nurse Executive
Advanced, NEA-BC. This certification has given me
the confidence, once again, to lead and maintaining
this certification signifies that I am current on the
best leadership practice within our current healthcare
On every March 19 let’s celebrate all of our
certification achievements with meaningful recognition
for all nurses who have committed themselves to
practice validation. ANA has good ideas to help plan
these celebrations. https://www.nursingworld.org/
education-events/certified-nurses-day/. I would love to
hear what you did this year to celebrate. Please email
me at firstname.lastname@example.org.
Would you like to take the next step of getting
certified? Or if you are certified, who would you tap on
the shoulder to encourage them to get certified?
Missouri Nurses Association is sponsoring anyone
interested in getting certified through the many
certifications from ANCC. For our members, we have
a reduced rate and you only pay if you pass! We
hope this eases the barrier of test-taking anxiety and
financial concerns. Please visit our webpage, www.
missourinurses.org/success-pays for more information.
At the time of this writing,
we are in the middle of the
busiest time of year here at the
Missouri Nurses Association
(MONA). We are past the
midway point of the legislative
session and we are starting to
see the bills that are moving
that have a chance at the finish
line and those that do not. We
have had movement on many
of our priority bills including
ones around workplace
violence, needle exchange, and
APRNs. Members of the Missouri Nurses Association
are sent a weekly legislative report from our lobbyist,
Kyna Iman, that goes into the bills we are following this
year. We also have information available on the MONA
website about all of the bills we are tracking available
to members. We work hard to support nursing
practice and policy at the legislative level and our nurse
members support that work that we do on behalf of
all nursing. Can you imagine what we could accomplish
if all nurses in the state of MO were members of the
Association? Membership is only $15 a month or $174
This is also the time of year when my speaking
engagements pick up! We are still in a bit of limbo
as the world continues to be vaccinated so most
presentations continue to be virtual but hope to be
fully back in person by this summer. If you wish me
to give a presentation to your organization, school,
or hospital, I would love to have that opportunity!
I can speak about advocacy and nursing, the
legislative landscape, association membership, the
social determinates of health, and/or special topics in
nursing. Please reach out to me at my email, director@
missourinurses.org to set up a date and time.
Director’s Letter continued on page 2
current resident or
Inside this Issue
Three Missouri universities earn nursing grant
Ebola Clinical Alert for U.S. Healthcare Personnel.......3
Essential During COVID-19: Learning Lessons
from the Past to Best Utilize Informatics in
Patient Care and Vaccine Distribution................4
MNF License Plates..............................................8
Seeking Staff RNs Working on Inpatient
Hospital Units - Online Survey Research............9
Coming Together in Advanced Practice.............. 10
Advocacy Day 2021........................................... 12
This is an official CDC HEALTH ADVISORY......... 13
MNF 100 for 100............................................... 14
MONA/ANA Membership Application................ 14
Redefining Nursing - Reaffirming Our Practice.... 15
Missouri Nursing News April, May, June 2021
Three Missouri universities earn nursing
Jefferson City - The Missouri State Board of Nursing
recently announced the award of substantial nursing
education program grants to three Missouri universities.
The Nursing Education Incentive Program (NEIP)
grants were established in 2011 in order to increase the
physical and educational capacity of professional nursing
programs in Missouri. The funding, through legislative
appropriations, comes from the Missouri State Board of
“We are extremely proud of our Missouri nursing
programs for recognizing solutions to the nursing
shortage need to focus on several strategies, including
increasing the number of nurse educators, developing
a pipeline from nurse aide training to Registered Nurses
and increasing clinical partnerships,” said Lori Scheidt,
Executive Director of the Missouri State Board of Nursing.
In 2021 an additional 13 grant proposals were
received. On March 2, 2021 the Missouri State Board
of Nursing approved three proposals for a total grant
award of $418,864 this year; bringing total NEIP
awards to $7,098,505.74.
The following nursing schools earned 2021 NEIP awards:
Missouri Western University - $120,700
Grant funds will be utilized to open the clinical
simulation lab for greater use and establish a full-
RNs, LPNs and Nurse Practitioner
Lyle Williams, Recruiter
time simulation lab director position. The program will
partner with the Youth Alliance CNA program and area
employers to increase the pipeline of nursing students.
Truman State University - $150,000
Grants will increase seat capacity and expand clinical
partnerships. Utilization of a clinical coordinator position
and technology will aid in clinical scheduling. The
program plans to be able to expand undergraduate
enrollment due to these enhancements.
University of Central Missouri - $148,164
This proposal is geared toward expansion of nursing
faculty resources and the addition of one faculty position
would add 14 seats for the Nurse Educator program.
Three scholarships would add faculty for the Bachelor
of Science in Nursing program with a commitment to
teach for three years at UCM or another undergraduate
program in Missouri.
Director’s Letter continued from page 1
Our regions have also become more active and
have started holding monthly virtual trainings and
events that are free to MONA members. We also offer
some to all nurses for a small fee! We have had a lot
of success with our first few webinars; including our
four-part Cannabis and Nursing webinar series, Yoga
for Nurse Stress Management, and COVID Vaccine
Hesitancy. Look for more events in the coming weeks.
All of these trainings will also be recorded and archived
on the MONA website for viewing at a later date. Look
for the rollout of that page in the near future.
Once again, thank you for your all you do for the
citizens of Missouri, and please consider becoming a
member of the Missouri Nurses Association if you are
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The mission of the Missouri Nurses Association is to
promote, protect and enhance registered professional
nursing practice through advocacy, education, collaboration
MONA’s Official Publication:
The Missouri Nursing News is an official publication of the
Missouri Nurses Association (MONA) (a constituent member
of the American Nurses Association), published quarterly
every January, April, July and October. The MONA provides
education, networking opportunities, publications and
other products and services to its members and extends its
mission to all nurses in Missouri.
Phone: (573) 636-4623
Web site: www.MissouriNurses.org
Mail: c/o Midwest Multistate Division
3340 American Avenue, Suite F
Jefferson City, MO 65109
Questions about your nursing license?
Contact the Missouri State Board of Nursing at:
This newsletter is a service of the Missouri Nurses
Association and your receipt of it does not mean
you are automatically a member. Your membership
in support of this work is encouraged; please visit
• Any topic related to nursing will be considered for
publication in the Missouri Nursing News.
• Authors are not required to be members of the MONA;
however, when space is limited, preference will be given
to MONA members.
• Photos are welcome, digital is preferred. MONA does not
assume responsibility for lost or damaged photos.
• Use current APA formatting for any article requiring
• Provide a brief author biography indicating the author’s
nursing experience and/or expertise with the paper’s
o Limit the author’s biography to 4-sentences.
• Submitted material is due by the 10th of the month in
March, June, September and December of each year.
• The peer-review is blinded; submit the title page
separately from the article
• Submit the title page and article as Word documents to
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626–4081, email@example.com. MONA and the
Arthur L. Davis Publishing Agency, Inc. reserve the right to
reject any advertisement. Responsibility for errors in advertising
is limited to corrections in the next issue or refund of price of
Acceptance of advertising does not imply endorsement
or approval by the Missouri Nurses Association of products
advertised, the advertisers, or the claims made. Rejection of an
advertisement does not imply a product offered for advertising
is without merit, or that the manufacturer lacks integrity, or that
this association disapproves of the product or its use. MONA
and the Arthur L. Davis Publishing Agency, Inc. shall not be held
liable for any consequences resulting from purchase or use of
an advertiser’s product. Articles appearing in this publication
express the opinions of the authors; they do not necessarily
reflect views of the staff, board, or membership of MONA or
those of the national or local associations.
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April, May, June 2021 Missouri Nursing News 3
Ebola Clinical Alert for U.S.
Outbreaks of Ebola virus disease (EVD) are ongoing in the Democratic Republic of
the Congo (DRC) and Guinea. The U.S. Centers for Disease Control and Prevention
(CDC) is providing this communication as a reminder to U.S. healthcare personnel
about CDC infection prevention and control guidance for identifying and managing
patients with possible and confirmed EVD.
Please share this information with all personnel who might conduct screening
and triage activities or be responsible for initial clinical management of patients
(e.g., including Emergency Medical Services, outpatient, and emergency department
MONA Partners with NSO
Triage of Patients
Currently, all U.S. healthcare settings are recommended to screen and triage
everyone entering the facility for signs and symptoms of COVID-19.
Additionally, it is recommended that facilities
• Ask about and document international travel histories to alert healthcare
personnel to the possibility of other communicable infections, such as viral
hemorrhagic fevers, that need specific infection control precautions and/or
• Post contact information for infection control personnel and the local public
health jurisdiction for reporting of communicable diseases, including EVD, in
easily visible locations.
Current Infection Prevention and Control Recommendations for EVD in U.S.
Current CDC infection prevention and control guidance for U.S. healthcare
facilities is available on the CDC Ebola website for clinicians. Specific guidance and
tools that may be of interest to facilities include
• Separate personal protective equipment (PPE) guidance remains in place for
the management of Clinically Stable PUIs and Confirmed Ebola Patients or
Clinically Unstable PUIs.
• A PPE Calculator Tool is available to assist healthcare facilities in determining
the appropriate supply of PPE to have on hand to manage a PUI or patient
with confirmed EVD.
A healthcare facility evaluating a PUI or treating a patient with EVD
should consult with public health authorities if they are unable to meet these
recommendations due to PPE shortages caused by the COVID-19 pandemic.
The Regional Treatment Network for Ebola and Other Special Pathogens
Healthcare facilities and public health officials should be familiar with the tiered
U.S. Regional Treatment Network for Ebola and other special pathogens.
• Healthcare facilities should understand their role in the tiered network as a
Frontline facility, State-designated Assessment Hospital, State-designated
Treatment Center, or HHS-designated Regional Treatment Center.
• Healthcare facilities and public health officials should have established plans
for how PUIs or EVD patients are to be managed and referred.
• CDC continues to coordinate with the HHS Office of the Assistant Secretary
for Preparedness and Response, Hospital Preparedness Program and the
National Emerging Special Pathogens Training and Education Center (NETEC)
to increase U.S. capability to safely manage patients with EVD and other
special pathogens. NETEC maintains online resources at the link above, and
remains available to provide consultation to hospitals for managing patients
Nurses need to protect themselves and
their career by maintaining Professional
Liability Insurance, a.k.a. Medical Malpractice
Insurance. Do not assume your employer’s
liability insurance will cover you when a
lawsuit or complaint is filed. Nurses Service
Organization (NSO) has a 45+ year history
of defending nursing professionals from
allegations of medical malpractice and
licensing complaints. With over 500,000
nursing professionals insured and 60+
professional nursing association partners,
they are the premier administrator of nurses’
malpractice insurance in the U.S.
We encourage you to explore NSO’s
website, receive a quick rate quote, and
browse the case studies and articles in NSO’s
Learning Center. In the Learning Center, you will find NSO’s 4th Nurses Claim Report.
It provides statistical data and an analysis of malpractice and licensing claims, as well
as recommendations on how you can avoid potential problems in your practice.
Learn more about NSO and receive an instant quote at www.nso.com/mona
Additional Public Health Resources
• CDC EVD website
• World Health Organization Disease Outbreak News
CDC has also issued an Order for airlines, which you can find here: Order:
Requirement for Airlines to Collect Designated Information for Passengers Destined
for the United States Who are Departing From, or Were Otherwise Present In, the
Democratic Republic of the Congo or the Republic of Guinea | Quarantine | CDC
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Missouri Nursing News April, May, June 2021
Essential During COVID-19: Learning Lessons from the Past to
Best Utilize Informatics in Patient Care and Vaccine Distribution
Bonny Kehm, PhD, RN
Faculty Program Director, Excelsior College
School of Nursing and Vice President of the
Missouri State Board of Nursing
BIO: Bonny Kehm is the faculty program director in
the baccalaureate and Master of Science programs for
the School of Nursing at Excelsior College, where she
designs curriculum and conducts research. Her nursing
career has been dedicated to developing the next
generation of nurses to lead in these ever-changing
In 2017, Kehm was appointed by the governor
of Missouri, and confirmed by the full state senate
to the Missouri State Board of Nursing. The board
governs and regulates the profession of more than
140,377 licensed nurses in the state. She is the board’s
vice president and serves on the Nursing Education
Committee, which regulates and oversees nursing
Kehm’s commitment to improving the nursing
profession includes work to increase awareness of
interprofessional education opportunities that link
nursing, nutrition, pharmacy, and health sciences
education to improve interdisciplinary learning.
Kehm has received several honors and awards
throughout her nursing career. She was a speaker at
the Royal College of Nursing Centennial International
Conference in England in 2016 and a speaker at the
Nursing Educational Institute in New York in 2017.
She received the Rising Nurse Leader Award from
the Missouri Organization of Nurse Leaders in 2016;
the International Quality Research Paper Award from
The United States Distance Learning Association in
2018, and was selected as one of the winners in the
inaugural Nabisco 100 Calorie Packs “Celebrating 100
Extraordinary Women” contest for her community
service in 2009, to name a few.
Kehm earned her bachelor’s and master’s degrees
in nursing from Webster University, her doctorate in
nursing education from Capella University, and her
graduate certificate in Health Care Informatics from
Lillian Weiser inspired me to become a nurse. Lillian
was my aunt, but I never knew her. Sadly, she died
from polio as a child, over two decades before I was
born. The last two years of Lillian’s short, tragic life tell
a tale that will ring familiar to anyone who has lost a
loved one during the COVID-19 pandemic. Lessons of
logistics and health management learned during the
polio era could guide efforts for COVID-19 care and
At age 10, Lillian (pictured above) came home
from St. Rose Catholic School in Great Bend, Kansas,
with flu-like symptoms. Within a few hours she was
completely paralyzed and unable to breathe on her
own. Lillian was soon diagnosed with polio, a common
diagnosis in mid-century America. Great Bend, Kansas,
in 1953 offered far from state-of-the-art medical care.
Lillian’s fate relied on treatment in Hutchinson, Kansas,
a 125-mile round trip drive from tiny Great Bend, and
the closest hospital that had the technology that would
keep her alive — an iron lung.
Lillian’s father, my grandfather, lived on a farm and
worked in the grocery business. For two years, he
spent every Wednesday night sleeping on the floor in
Lillian’s hospital room. Every Saturday, he brought her
five siblings to visit. When my mother spoke about
her sister in the iron lung, she always mentioned how
Lillian would smile and never once complained. To
help keep the family together, the small Kansas town
raised money and purchased a brand-new iron lung, so
Lillian could live at home once again. Unfortunately, no
local healthcare professionals were trained on how to
operate the technology. Lillian would be forced to stay
in Hutchinson, and the newly purchased iron lung went
I have often wondered how the application
of nursing informatics could have improved
Lillian’s treatment. Improved data and information
management could have aided in coordination of
her care while keeping her family together in rural
America. Nursing informatics focuses on use of datadriven
information, technology, and communication in
the delivery of health care. Throughout the COVID-19
pandemic, we have seen informatic responses to
social distancing with the expansion of telehealth and
tele-education. Use of technology allows health care
workers to provide care while enabling patients and
health care professionals to remain safe yet connected.
This has been essential for COVID-19 care and is vital
now with the vaccine rollout. However, it remains
underutilized especially in rural America, where we
have seen too many patients die alone.
Lillian died in June of 1955, at age 12. She died
alone in the hospital hours away from her family. The
first mass immunizations against polio began in 1954—
one year after she was diagnosed, and one year before
April, May, June 2021 Missouri Nursing News 5
The COVID-19 vaccine rollout has led to a
surge in the need for logistical coordination and
communication, especially in rural areas. Informatics
will facilitate speedy coordination in vaccine distribution
and administration to millions of Americans to help
gain control of the deadly virus. Vaccine distribution
can be streamlined to track vaccinated patients,
schedule second doses, locate and assign nurses
trained in vaccine administration, and collaborate with
local administrations to identify burdens in distribution.
While it is easy to look at my Aunt Lillian’s short life
as a tragic “what if” story, it is more important to look
at her life and death as a cautionary tale. The townpurchased
iron lung that was never used due to lack
of expertise has resided in a museum in Kansas for the
past several decades. It has occasionally been displayed
at state fairs to educate the public on the need for
vaccinations. Now, after a year of the COVID-19
pandemic ravaging communities, hope has arrived
in the form of multiple vaccines that can be used to
thwart this deadly virus. But vaccines, like iron lungs,
are only effective when they are used. Stories have
emerged of vaccine doses simply being left on shelves
and in refrigerators or thrown away due to lack of
tracking protocols and shortages of personnel. We can
and must avoid creating another museum relic.
The use of informatics by highly trained nurses
has never been more important or vital, especially
as distribution and administration of the vaccines is
stalled. We have developed the tools to fight this
virus. We must now quickly develop the personnel and
tactics to take up the fight. That starts with nurses
trained in the use of informatics and analytics. Armed
with data and logistics training, nurse informaticists
are learning from history and vital to the future success
of the COVID-19 vaccination plan, distribution, and
Bonny's mother in 2019 visiting the museum in
Kansas that houses Lillian's unused iron long.
Lillian in her Iron Lung at the hospital with
Bonny's mother (the 3-year-old in the picture
holding one of Lillian's dolls), and Lillian's Mom).
We are looking for LPNs
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For more information and to apply visit
Missouri Nursing News April, May, June 2021
Her shoes are worn and dirty
From long hard hours here.
Her hands tough and calloused
Still gently wipe a tear.
Her heart is full of stories,
Some are near and dear.
Some she tries to forget,
But remembers all too clear.
Her walk is purposeful,
Eyes set on a goal.
She still stops to listen,
When people bear their soul.
She is a nurse who cares.
She’ll listen to their fears.
She’ll carry them in her heart.
And she’ll swallow her tears.
She’ll walk on to the next,
And make them feel loved.
Because that’s what nurses do.
Even masked, gowned and gloved.
Ansley Little BSN, RN
What an Honor
What an honor it is
Caring for you like this.
What an honor it is.
Here with ones you hold dear.
Drying their quiet tears.
As your end now draws near.
I know you can hear me,
So I will speak gently
As you soon leave me.
Soon good is all you’ll see.
Ansley Little BSN, RN
Missouri Nursing News April, May, June 2021
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April, May, June 2021 Missouri Nursing News 9
RNs Working on
Units - Online
Hyeonmi Cho, PhD(c), RN, Nursing PhD Student
University of Wisconsin - Madison, School of
If you are a registered nurse (RN) providing
direct bedside patient care on inpatient hospital
units, please consider participating in this study
about hospital nurse fatigue.
This is a nation-wide online survey study recruiting
staff RNs who provide bedside patient care on inpatient
hospital units in the United States. The purpose of
the study is to better understand what leads to nurse
fatigue and its consequences.
Nurse fatigue is common and reduces safety and
impairs health for both nurses and patients. In order to
develop future interventions to address nurse fatigue,
we must learn more about what leads to fatigue and its
It is anticipated the survey will take approximately 20
minutes or less for you to complete. Your responses are
completely confidential, and your responses will not be
linked to your identity.
Responses will be securely stored at UW-Madison.
Only researchers associated with this project will have
access to the information gathered. By participating in
this survey, you are consenting to be a participant in
this research and future analysis of this data.
To say thank you for participating, after
completing the survey you will have the
opportunity to enter a drawing for one of 30, $50
Amazon gift cards.
Here is the link to participate: https://uwmadison.
Thank you ahead of time for participating in this
important work for our patients, coworkers, and
Please feel free to forward this email and share
This study has been determined by a UW-Madison
Institutional Review Board to be exempt research.
This email has been approved by a UW-Madison
Institutional Review Board. If you have questions about
the study, please contact Hyeonmi Cho at hyeonmi.
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Missouri Nursing News April, May, June 2021
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April, May, June 2021 Missouri Nursing News 11
MONA Member Benefit for
Statewide Vaccine Registration
Website and Call Center
The state has set up an online form and call center to help people get registered
to receive the vaccine. The call center phone number is: 877-435-8411 and their
hours are Mon-Fri: 7 am - 7 pm and Saturday: 8 am - 5 pm
The website to sign up is: https://covidvaccine.mo.gov/navigator/
Success Pays is a way to assist healthcare professionals in achieving certification
while eliminating test-taking anxiety and financial barriers. Clinicians are given
two opportunities to test for a certification specialty, and ONLY PAY IF YOU PASS!
Members of the Missouri Nurses Association also receive a reduced rate
of $260. Certification renewals with ANCC are also available through MONA at a
reduced price of $250.
For a list of qualifying certifications and full details, please visit: https://
Missouri Nursing News April, May, June 2021
PhD, RN, NEA-BC, CCRN-K, FAAN
Using our personal power to advocate for our patients
is one of the most important duties of being a nurse.
It’s the individual connection – nurse to patient – that is
foundational for the broader perspective of caring and
advocacy. Going beyond our nurse to patient advocacy,
one of our necessary skills is in actualizing our political
power and influence by being involved in policy – as the
ANA’s Code of Ethics states, it is our duty as a nurse to be
involved in policy that shapes and impacts our profession,
our patients, and our society.
This year Missouri Nurses Association hosted on March
3 an online (via Zoom webinar) Advocacy Day where
over 200 joined our efforts in learning more about the
advocacy efforts with our Missouri’s General Assembly.
We heard from our lobbyist, Kyna Iman, about the many
bills MONA is supporting or not supporting in our efforts to
support nurses like you in removing barriers to our practice.
Advocacy Day 2021
We heard from the MONA Vice President of Advocacy,
Sarah Oerther, about why it was important to establish a
relationship with your state representatives and senators.
Also, legislators who support nurses joined us online
and we learned about their efforts at the State Capitol.
Together, online, we completed an advocacy ‘call to action’
which is a communication to legislators to clarify the issues
and bills we support. The legislators’ emails I’m sure were
overloaded with messages from nurses!
I hope you will consider joining us in the efforts to
support and advocate not only for nurses but for our
patients and families. It is vital that we hear your voice.
Come Join Our Team!
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We offer career opportunities in both our inpatient and
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• Doctorate in nursing practice
degree with NP preparation
• Four or more years of experience
as a professional nurse.
Director of Nursing
Resource and SIM Lab
• Ability to establish or advance an extramurally
funded program of research.
• Earned doctorate in nursing or related field with a graduate
degree in nursing.
For further information call
1-888-NURSEUM (1-888-687-7386) or visit our website at
Dear Missouri Nurses:
COVID-19 has brought unprecedented challenges to our
profession. We understand.
That’s why we are writing to you directly to introduce a new
statewide initiative, RNconnect 2 Well-being, a free resource from
the Missouri Nurses Association to easily integrate well-being
into your day. Text RNconnectMO to 60298 to receive twiceweekly
tips on how to de-stress, strengthen your mind and body,
and take care of yourself. We’ve simplified finding support like
counseling, resources, and opportunities to connect with other
nurses facing the same challenges as you.
Sign up by texting RNconnectMO to 60298 today!
LEARN MORE: American Nurses Foundation Well-Being Initiative
Msg&data rates may apply. Terms & privacy: slkt.io/7YfV
April, May, June 2021 Missouri Nursing News 13
This is an official
CDC HEALTH ADVISORY
Distributed via the CDC Health Alert Network
March 31, 2021, 4:00 PM ET
***Missouri healthcare providers and public health
practitioners: Please contact your local public health
agency or the Missouri Department of Health and
Senior Services’ (DHSS’) Bureau of Environmental
Health Services at 573-751-6095 or 800-392-0272
(24/7) with questions regarding this Advisory or to
report a case of acute non-viral hepatitis of unknown
etiology potentially associated with an alkaline water
Additionally, consumers who may have recalled
products are advised to discard it immediately and
to not drink the water. Consumers with questions,
or to obtain a refund, may contact the company at
1-702-310-5437 or by email at customerservice@
Acute Non-Viral Hepatitis of
Unknown Etiology Potentially
Associated with an Alkaline
Five cases of acute non-viral hepatitis of unknown
etiology in children were reported to the Southern
Nevada Health District (SNHD) between November and
December 2020. The Centers for Disease Control and
Prevention (CDC) is assisting the SNHD in investigating
a potential link between these illnesses and the
consumption of an alkaline water product called “Real
Water” and other possible etiologies. The purpose of
this Health Alert Network (HAN) Advisory is to advise
clinicians and health departments to have a high index
of suspicion for cases of acute non-viral hepatitis and to
report any cases to their local health authority.
CDC and the U.S. Food and Drug Administration
(FDA) were notified of five cases of acute non-viral
hepatitis of unknown etiology in children by the SNHD
in Nevada on March 13, 2021. The cases occurred
in children ranging in ages from seven months to
five years who presented to a hospital between
November 10, 2020, and December 3, 2020, with
signs and symptoms of vomiting, poor intake, and
fatigue. Laboratory testing on the patients showed
elevated hepatic transaminases, hyperbilirubinemia,
coagulopathy, and a negative viral hepatitis serology
panel. All patients required transfers to a pediatric
tertiary-care specialty liver unit because of concerns
for acute liver failure and the possible need for liver
transplantations. All children recovered and were
discharged home. In addition to these cases, several
adults and other children living in the cases’ households
reported similar but mostly less severe symptoms
including nausea, vomiting, anorexia, and fatigue.
Information to date from the preliminary
epidemiologic investigation supports that there is a
strong link between these cases of acute non-viral
hepatitis and Real Water alkaline water. Real Water, Inc.
owns this brand of alkaline water and has headquarters
in Mesa, Arizona. This product is available in 5-gallon,
3-gallon, 1 gallon, 1.5 liters, 1 liter, and 500 ml bottles,
and “Real Water” concentrate. Bottles and concentrate
products are available for purchase online and in stores
nationwide. Real Water has issued a recall on their
products. The FDA advises consumers, restaurants,
and retailers not to drink, cook with, sell, or serve Real
Water alkaline water until more information is known
about the cause of the illnesses. Further, FDA advises
that Real Water not be given to pets.
1) Counsel your patients (or their caregivers and
guardians) to stop drinking, cooking with, or
using Real Water until more is known about the
cause of the illnesses per FDA recommendations.
NHSC Loan Repayment
NHSC Loan Repayment Programs are accepting
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2) Educate your patients on the signs and
symptoms of acute hepatitis due to any cause,
which may include fever, fatigue, loss of appetite,
nausea, vomiting, abdominal pain, dark urine,
light-colored stools, joint pain, and yellow skin
or eyes; and the importance of seeking medical
3) Maintain a high index of suspicion for non-viral
hepatitis in your differential diagnosis of acute
hepatitis in adults and children presenting with
compatible clinical findings.
4) Obtain a more detailed exposure history in
patients when you suspect acute non-viral
hepatitis. Possible etiologies associated with
acute non-viral hepatitis include exposure to
medications, contaminated water or food,
dietary and herbal supplements, traditional or
home remedies, wild-growing mushrooms and
plants, and chemicals such as metals, solvents,
paint thinners, or pesticides.
5) Obtain early consultation with and/or referral
to a gastroenterologist or infectious disease
specialist for medical workup and management
of patients with signs and symptoms of acute
6) Contact your local health authority to report
cases of acute non-viral hepatitis of unknown
7) Contact your local poison center (1-800-222-
1222) for information on chemical or druginduced
liver toxicity and report any cases.
For Public Health
1) Please contact CDC via email (NCEHOutbreak@
cdc.gov) for case classification criteria, suggested
reporting guidelines, case investigation forms,
and other questions. Acute non-viral hepatitis is
currently not a nationally notifiable disease. Case
findings may be mainly from clinicians reporting
who may recognize these illnesses in their
patients. The forms provided by CDC will help
prepare public health agencies to receive these
reports from clinicians.
2) Consider conducting case-finding activities that
leverage existing data sources such as hospital
discharge data, electronic syndromic surveillance
systems, your local poison center, and other
applicable surveillance systems. Contact CDC at
NCEHOutbreak@cdc.gov for guidance on search
For More Information
• FDA Investigation
• FDA Case Reporting:
o FDA Consumer Complaints
• Southern Nevada Health District FAQ
• American Association of Poison Control Centers
The Centers for Disease Control and Prevention
(CDC) protects people's health and safety by preventing
and controlling diseases and injuries; enhances
health decisions by providing credible information
on critical health issues; and promotes healthy living
through strong partnerships with local, national, and
Categories of Health Alert Network messages:
Health Alert Requires immediate action or
attention, highest level of importance
Health Advisory May not require immediate
action; provides important information for a specific
incident or situation
Health Update Unlikely to require immediate
action; provides updated information regarding an
incident or situation
HAN Info Service Does not require immediate
action; provides general public health information
##This message was distributed to state and
local health officers, state and local epidemiologists,
state and local laboratory directors, public
information officers, HAN coordinators, and clinician
Missouri Nursing News April, May, June 2021
MNF 100 for 100
Victor Hugo is credited with the observation that
there is nothing so powerful as an idea whose time
has come. Unfortunately, until their time arrives, the
best ideas can repeatedly fail to launch for decades.
You may be familiar with the case of James Lancaster,
an English sea captain who suspected that citrus juices
prevented scurvy in his sailors (this idea occurred to him
at a time when scurvy killed more sailors than warfare
or sea accidents). Today, we know he was correct. As
early as 1601, he proved his theory with real sailors and
a control group. Even so, his innovation failed to catch
Finally, in 1747 (150 years later), a British Navy
physician, James Lind, read about Lancaster’s
experiments & began some of his own. Lind’s
experiments also proved the theory. It was so
undeniable, the British Navy ultimately required
oranges, lemons & limes for sailors on its entire fleet
of ships, to prevent scurvy among its sailors… in
1795, nearly 50 years after this re-discovery of James
Lancaster’s original experiments.
You may wonder why, in the face of so many
deaths, when the answer was so simple, it took two
centuries for this medical innovation to catch on. In
short, bureaucratic inertia was a major barrier. There
was evidence that citrus prevented scurvy, but not
everyone agreed it was a cure. Further, Dr. Lind may
have been correct, but he was not a prominent figure
in Navy medicine, so his message was slow to gain
traction. One thing we know for sure: During the
intervening 200 years, the Navy adopted numerous
innovations in shipbuilding & weaponry. It was simply
not the case that the Navy was averse to innovation in
In his seminal work, Diffusion of Innovations,
Everett Rogers found that for a new idea to be widely
adopted, it has to meet four basic criteria:
1. It has to be innovative.
2. It has to be communicated through certain
3. It has to occur over time.
4. It has to happen among the members of a social
One of the most important roles of the Missouri
Nurses Association is our promotion of innovation in
the field of Nursing. One way we do this is by offering
an Early Career Nurse Innovator Award – an annual
cash prize for a creative new nurse, who looks at the
profession with fresh eyes, whose innovative approach
accomplishes something noteworthy & respectable that
advances the profession of Nursing & the health of
This year, we are using a somewhat innovative
approach to fundraising for the grant. We are asking
100 people to donate $100 to support the Early Career
Nurse Innovator Award. As leaders in the social system
of Nursing, we believe that by communicating these
innovative acts to & through our members & our
colleagues over time, we’re well-positioned to help
these innovations diffuse in the time-tested manner
supported by research. We are asking you to visit our
website & make a $100 donation to our effort, and to
send this letter to a couple of your friends, encouraging
them to consider doing the same.
To give, please visit: https://
With your help, as always, we hope to connect the
past, improve the present & anticipate the future of
Nursing in Missouri.
Matt Younger, M.S., LNHA
President, Missouri Nurses Foundation
Striking a balance between work and life is something we
all want. Visit us online at lakeregional.com/careers/ourcommunity
to learn more about the Lake of the Ozarks,
the Midwest’s premier lake resort destination
Lake Regional Health System is a growing and
collaborative health system with a supporting, dynamic
learning environment. Improving lives is at the center of
all we do, and we proudly make our days about serving
others. Learn more at lakeregional.com/careers.
April, May, June 2021 Missouri Nursing News 15
can point you right to that perfect
Free to Nurses
Easy to Use
E-mailed Job Leads
Redefining Nursing —
Reaffirming Our Practice
Register today for our free Nurses Month webinar,
Redefining Nursing — Reaffirming Our Practice.
Introducing the Nursing: Scope and Standards of
Practice, Fourth Edition, you'll be able to identify
innovations in nursing and future opportunities, and
explore changes in select standards and accompanying
Clinical Nursing Instructor
Center for Behavioral Medicine
Center for Behavioral Medicine (CBM) formerly
Western Missouri Mental Health Center is an agency
for the Department of Mental Health. The facility
is located on Hospital Hill in the heart of Kansas
City and provides comprehensive psychiatric care to
patients from Kansas City and the seven surrounding
counties. CBM currently operates 65 adult acute
beds and 25 adult residential beds.
NOW RECRUITING for
Current MO licensure required. Psychiatric/Mental
health experience a plus but not required.
You may fax or email your résumé to (816) 512-7415
or email firstname.lastname@example.org.
Applications are accepted in Human Resources at:
Center for Behavioral Medicine
1000 East 24th Street | Kansas City, MO 64108
A Drug-Free/Smoke-Free Workplace | EOE
Central Ozarks Medical Centers
has been providing quality healthcare since 1979.
COMC believes that everyone deserves
access to high quality healthcare regardless
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Check out our website at
for our current listing of career