Missouri Nurse - April 2021




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

Celebrating Certification

Caryl Goodyear, PhD, RN,


MONA President

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 carylgoodyear@gmail.com.

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.

Director’s Letter

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

Heidi Lucas

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

a year.

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

Presort Standard

US Postage


Permit #14

Princeton, MN


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

grant awards

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

Nursing funds.

“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

not already!

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MONA’s Mission:

The mission of the Missouri Nurses Association is to

promote, protect and enhance registered professional

nursing practice through advocacy, education, collaboration

and partnership.

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

Email: director@missourinursess.org

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:

(573) 751-0681.

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


Writer’s Guidelines:

• 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, sales@aldpub.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.

Healthcare Personnel

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


Liability Insurance:

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.

Healthcare Facilities

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

with EVD.

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

education programs.

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

Excelsior College.

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

she died.

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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Missouri Nursing News April, May, June 2021


A Nurse

A Nurse

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.

Go on.

It’s ok.

You’re safe.

Pass gracefully.

Ansley Little BSN, RN


Missouri Nursing News April, May, June 2021

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April, May, June 2021 Missouri Nursing News 9

Seeking Staff

RNs Working on

Inpatient Hospital

Units - Online

Survey Research

Hyeonmi Cho, PhD(c), RN, Nursing PhD Student

University of Wisconsin - Madison, School of

Nursing, hyeonmi.cho@wisc.edu

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

with others!

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

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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

ANCC Certification

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

Caryl Goodyear,


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.

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Dietary Aides, Housekeepers

For more information about these positions and others,

please visit our website at:


or contact Human Resources at 636-441-7300.


RN’s and LPN’s needed

• Assistant Director of Nursing • Day Supervisor

• MDS Coordinator • FT and PT floor nurses all shifts

Apply in person or check us out at


711 S. Kirkwood, Kirkwood MO 63122 Phone: 314-965-0864

Registered Nurses

Join our Team and “Changes Lives”

Generous shift differential & benefit package

available for FT positions

FT & PRN positions - 12 hour shifts

Apply at www.heartlandbehavioral.com

Heartland BHS - 1500 W. Ashland Nevada, MO 64772


University of Missouri – St. Louis

The Next Step in Your


Faculty in the

School of Nursing

• 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


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

Water Product


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.


For Clinicians

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

applications NOW! Compare between the 3 NHSC

Loan Repayment Programs and apply today. A

comparison of the programs is also attached.

Please share this widely. NHSC has a historical

amount of money to award. Let’s bring as much of it as

we can to the Show-Me State!

Visit: https://bit.ly/3s3AGKG for more information.

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 MedWatch

• Online

• Paper

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

international organizations.

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.

Thank you,

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

Privacy Assured

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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

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Nursing Instructor

Apply online:


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.



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 cbm.hr@dmh.mo.gov.

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

of their insurance status.

Check out our website at


for our current listing of career


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