RN Idaho - May 2021

IDAHO 

May, June, July 2021 

Volume 44, • No. 1 

Official peer reviewed publication of Idaho Alliance of Leaders in Nursing & Idaho Center for Nursing 

Quarterly publication distributed to approximately 32,000 RNs and LPNs in Idaho. 

These organizations are members of the Idaho Center for Nursing. 

ANA-IDAHO PRESIDENTIAL REPORT 

ANA-Idaho Evaluates LPN Membership 

Dori Healey MSN, MBA, RN 

President, ANA-Idaho 

president@idahonurses.org 

I would like to share some of 

Idaho’s nursing history regarding 

the evolution of the Licensed 

Practical Nurse (LPN) in the late 

1940s and how this important 

nursing group has met many 

roles and impacted the 

healthcare of Idahoans. This is 

important because today LPNs 

do not have a collective voice in 

Idaho to impact public policy or 

the LPN workforce needs. Thus, Dori Healey 

ANA-Idaho is considering what 

other states have already accomplished and is evaluating 

how LPNs can become a part of ANA-Idaho. 

Following World War II, Boise, Idaho, per capita in 

the U.S. was one of the hardest hit regions by the Polio 

epidemic. Many trained nurses left the nursing practice 

because they were scared to expose their families to Polio. 

St. Lukes Hospital had to close 10 beds because they 

lacked trained staff to take care of the sick patients. Saint 

Alphonsus Hospital had so many polio patients that they 

converted the parking lot to a hospital tent for 15 patients 

using iron lungs. With the shortage of RNs, practical 

nurses became the backbone nursing staff caring for polio 

patients. 

Hospitals had long used practical nurses in a similar 

manner to the current day certified nurse’s aides, but 

during this epidemic the practical nurses in hospitals 

expanded their skills and had to do many nursing tasks 

because of the registered nurse shortage. It was during 

this time that the idea to license the practical nurse was 

born. After reviewing the needs of hospitals and patients 

a training program was quickly created to educate the 

existing practical nurses to give medications, injections, 

insert catheters, and assist with sterile procedures. At the 

end of the program, there was a state-based test and 

when passed a license was issued, thus resulting in the 

Licensed Practical Nurse. Not all practical nurses took 

advantage of this option, so there remained unlicensed 

practical nurses who worked in the traditional role. 

In 1952, a newly revised Nurse Practice Act 

restructured the Idaho state board of nursing and an LPN 

was added to the board. Parallel to the Idaho Nurses 

Association, the LPNs formed their own Idaho LPN 

association. The association struggled with membership, 

funding was minimal, and it was difficult to incorporate 

rural areas. In the 1990’s the Idaho LPN association 

disassembled. 

The National Federation of LPNs (NFLPN) is a national 

organization that supports LPNs. The American Nurses 

Association (ANA) and NFLPN have long agreed that 

they will keep their organizations separate at a national 

level. However, over the past 25 years most state LPN 

associations ceased to exist, and state RN associations 

have now recognized that this group of nurses is not being 

represented. 

LPN interests and input are important to me as ANA- 

Idaho president. Prior to becoming an RN, I was an LPN 

for almost 10 years. During my LPN career, I was not a 

member of any nursing organization. As I began setting 

my goals for tenure as president, it was very important to 

me that ANA-Idaho consider offering LPNs an opportunity 

to join and for us to evaluate the best and most effective 

method to accomplish this. While LPNs cannot join 

ANA at the national level, I believe it would be a great 

opportunity and benefit to join ANA-Idaho at the state 

level. Many states have begun including LPNs in their 

state organizations as associate members with a reduced 

Presidential Report continued on page 2 

INSIDE 

THIS ISSUE 

FEATURE: 

Vaccinating for a Pandemic 

Amy Gamett, RN PAGE 3 

FEATURE: 

The Roaring 20’s to Salk to Karaoke & Tears 

Sarah Curtright DNP, FNP-ED, LBBP, CLNC, 

Adrianne Paeth, BSN, RN, FNP Student, & 

Jessica Bartlett MSN, RN, FNP Student PAGE 4 

FEATURE: 

Nursing Informatics: 

Use of the Mapping Medicare Disparities 

(MMD) Tool- A Starting Point for Examining 

Health Disparity Data in the United States 

Barbara McNeil PhD, RN-BC PAGE 5 

FEATURE: 

Stop the Bleed® for the Rural Farming Community 

of Oneida County 

Katherine Estep BSN, RN PAGE 6 

Nurses Supporting Nurses: 

The Idaho Nurses’ Education Fund PAGE 8 

IDAHO CENTER FOR NURSING PARTICIPATING 

ORGANIZATION UPDATES: 

Executive Director Report 

Randall Hudspeth, PhD, APRN-CNP/CNS, FAANP PAGE 9 

NLI and IALN Presidential Report 

Joan Agee DNP, RN, CNOR, FACHE PAGE 10 

Board of Nursing Report PAGE 11 

Idaho’s Nurse Refresher Program for 

RNs & LPNs Returning to Practice 

Renae L. Dougal PhD, MSN, RN, CLNC, CCRP, 

& Karin Iuliano BA PAGE 13 

IDAHO NURSING AWARDS AND RECOGNITIONS: 

Daisy Awards 

Daisy Lifetime Achievement Award 

American Association of Nurse Practitioners® Awards PAGE 14 

Idaho Nurse Practitioner to be 

Featured in Johnson & Johnson PAGE 15 

FEATURE: 

The Cures Act: What Nursing Professionals Need to Know 

Georgia Reiner, MS PAGE 16 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

LIKE US ON FACEBOOK 

www.facebook.com/IdahoNursesAssociation/ 

FOLLOW US ON TWITTER 

@IDAHONURSES 

ADVOCACY IN ACTION: 

The 2021 Idaho Legislative Session, 

Michael McGrane MSN, RN PAGE 18 

PRACTICE MATTERS: 

The Power of Healthcare Simulation: Part I 

Michaelyn Muggli MSN, RN, NPD-BC, CCRN-K, CHSE & 

Tammye Erdmann MSEd, BSN, BScIT, RN, CHSE PAGE 21 

PARTING WORDS: 

What Have We Learned? 

Sara F. Hawkins PhD, RN, CPPS PAGE 21 

In Memoriam PAGE 23

Page 2 • RN Idaho May, June, July 2021 

Presidential Report continued from page 1 

dues structure. This has been effective to help LPNs be 

represented as a group and has demonstrated that the 

majority of nursing issues are common to both LPNs and 

RNs. 

Joining together also has an added Idaho benefit 

in terms of meeting license renewal criteria. As we all 

know, the Idaho state board of nursing changed their 

license renewal requirements and made it mandatory 

for all nurses to demonstrate continued competency 

when renewing their license. LPNs renew their licenses 

in even years; most recently August 2020. Many LPNs 

were not prepared to validate that they met two of the 

five continued competency requirements. The easiest of 

these requirements is to have 100 hours of practice and 

15 hours of Continuing Nursing Education, but there are 

also other options. These include publication in a peer 

reviewed journal, precepting, and academic course work. 

Helping LPNs to meet this need and to provide some level 

of statewide representation for LPNs would be beneficial 

to all nurses and to Idahoans in general who depend on a 

sufficient and educated nursing workforce. 

One of the greatest accomplishments of ANA-Idaho 

during 2020 was creating and providing a continuing 

education website. This is a website that hosts our 

conferences and provides the ability to obtain CNE’s 

for a low cost and from the comfort of home. It is an 

ANA Idaho Welcomes New & Returning Members 

Ammon 

Dallin Marston 

Amy Waters 

Boise 

Benjamin Andersen 

Sarah Brauer 

Stephen Dunn 

Jason Elliott 

Adrianne Fisse 

Brenda Jenkins 

Jennifer Kienlen 

Katrina Maginnis 

Abigail Murray 

Rebecca Robbins 

Brooke Torrence 

Steve Wilstead 

Buhl 

Charee Alvey 

Diana Kaminski 

Caldwell 

Ernest Esparza 

Coeur D’Alene 

Dena Payne 

Erin Ferraro 

Dec 08, 2020 – Mar. 09, 2021 

Escondido, CA 

Megan Mauno 

Garden City 

Denice King 

Idaho Falls 

Andrea Resendiz 

Melanie Smith 

Jerome 

Angela Miller 

Meridian 

Leann Johnson 

Kasandra Justus 

Christine Larsen 

Grace Mensah 

Christina Miller 

Marcy Shay 

Marcia Watt 

Mesa 

April Sheen 

opportunity to engage all nurses throughout Idaho and 

support them with their educational needs. Available at: 

https://icn.ce21.com 

The ANA-Idaho board of directors researched how 

other states have accommodated LPN engagement as a 

part of their state organizations. Some have LPNs on their 

boards, others have LPN special interest groups, and all 

offer full access to any state nurse association events and 

benefits. In Idaho we believe there is interest amongst 

LPNs to participate in a nursing organization and to partner 

with ANA-Idaho. 

In order to measure LPN interest, we are asking that 

all LPNs complete a brief survey using the on-line survey 

monkey tool. It is a quick four question survey that will 

help us understand the needs and determine if this is 

something we should create. This is the initial step in 

developing an organizational structure that could meet the 

needs of Idaho’s LPN population. Please visit this website 

and offer your opinion. Our goal is to have the survey 

completed by June 1, 2021. Thank you for completing the 

survey and for helping ANAI to assess the wishes of the 

LPN community in Idaho. 

Middleton 

Cara Hollingsworth 

Moscow 

Katie Stodick 

Nampa 

Megyn Flood 

Oldtown 

Jackie Naccarato 

Pocatello 

Heidi Colson 

Post Falls 

Joylene Grey 

Click Here to Take LPN Survey 

We look forward to your feedback and engagement. 

Rexburg 

Jerusha Hatch 

Rupert 

Eugene Bryan Potter 

Sagle 

Kristen Dirks-Finley 

Saint Maries 

Kara Seigley 

Soda Springs 

Flora Gilmer 

Star 

Rachelle Marema 

Twin Falls 

Brianna Anderson 

Jill Benavidez 

Karen Fiscus 

Farra Knauss 

Weiser 

Erin Emmert-Pond 

= 

IDAHO 

RN Idaho is published by 

Idaho Center for Nursing 

6126 West State St., Suite 406 

Boise, ID 83703 

Direct Dial: 208-367-1171 

Email: rnidaho@idahonurses.org 

Website: www.idahonurses.nursingnetwork.com 

RN Idaho is peer reviewed and published 

by the Idaho Center for Nursing. RN Idaho 

is distributed to every Registered Nurse and 

Licensed Practical Nurse licensed in Idaho, 

state legislators, employer executives, and Idaho 

schools of nursing. The total quarterly circulation 

is over 32,000. RN Idaho is published quarterly 

every February, May, August, and November. 

Editor: 

Sara F. Hawkins, PhD, RN, CPPS 

Editor Emerita: 

Barbara McNeil, PhD, RN-BC 

Executive Director: 

Randall Hudspeth, PhD, MBA, MS, APRN-CNP, 

FAANP 

Editorial Board: 

Michelle Anderson, DNP, APRN, FNP-BC, FAANP 

Sandra Evans, MAEd, RN 

Pamela Gehrke, EdD, RN 

Beverly Kloepfer, MSN, RN, NP-C 

Karen Neill, PhD, RN, SANE-A, PF-IAFN 

Gus Powell, MSN, CRNA 

Katie Roberts, MSN, RN 

Laura J. Tivis, PhD, CCRP 

RN Idaho welcomes comments, suggestions, 

and contributions. Articles, editorials and other 

submissions may be sent directly to the Idaho 

Center for Nursing office via mail or e-mail. Visit our 

website for information on submission guidelines. 

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. ICN 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 advertisement. 

Acceptance of advertising does not imply 

endorsement or approval by the Idaho Center for 

Nursing or by any professional nursing organization 

that is affiliated with the Idaho Center for Nursing, 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 these 

associations disapproved of the product or its use. 

The affiliated nursing organizations 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 affiliated 

nursing organizations, or those of the 

national or local associations. 

JOIN ANA IDAHO TODAY 

WE NEED YOU! 

Membership application 

http://nursingworld.org/joinana.aspx

May, June, July 2021 RN Idaho • Page 3 

FEATURE 

SAVE 

Vaccinating for a Pandemic 

Amy Gamett, RN 

Eastern Idaho Public Health 

agamett@eiph.idaho.gov 

March 13, 2020 became a vital day when Idaho 

announced its first positive result for the virus SARS- 

CoV-2, adding Idaho to the list of states with cases. In 

Governor Brad Little’s press conference he informed 

Idahoans of the first laboratory confirmed case of 

COVID-19. On December 14, 2020, a little over 

nine months later, the first COVID-19 vaccine was 

administered in Idaho, to a health care worker in Madison 

County. The development of the COVID-19 vaccine was 

a welcoming sight for any Public Health staff member 

and giving hope of halting this disease and giving Idaho a 

chance at regaining some sense of normality. 

Prior to the first vaccine being administered, public 

health’s primary role was targeted at interventions to 

slow the transmission of COVID-19. Many staff members 

battled a disease through active investigation, contact 

tracing, surveillance, testing, community mitigation 

strategies, aggressive public education, and stakeholder 

collaboration. “Flattening the Curve” became part of our 

daily vocabulary and was mentioned multiple times at 

every press conference. The goal of slowing transmission 

and protecting Idaho’s health care system was, and still is 

our priority. 

Vaccine planning began early for Idaho, beginning 

in the Spring 2020 as cases were starting to climb 

steadily. The initial planning included the recruitment 

of providers to evaluate the capacity to store and 

administer vaccines. Each provider was asked to 

submit their anticipated estimation of the number of 

individuals they could vaccinate over a set time. State 

and local health districts worked closely together to 

coordinate Idaho’s anticipated vaccination efforts. The 

Idaho COVID-19 Vaccine Advisory Committee was 

established by the governor to help prioritize and assure 

equitable distribution of the vaccine to Idahoans, with 

limited amounts of doses. 

On December 11, 2020, the U.S. Food and Drug 

Administration (FDA) issued the first COVID-19 vaccine 

Emergency Use Authorization (EUA) to Pfizer, a two 

dose COVID-19 vaccine. Infrastructure challenges 

were identified immediately. One of these challenges 

was that the vaccine had to be stored in an ultra-cold 

freezer, set between -80 C and -60 C, and shipped as 

a set that included a minimum of 1,170 doses. Once 

thawed, the doses are only viable for five days and 

once reconstituted, or mixed, it must be administered 

within six hours. 

Due to the requirement of keeping this vaccine at such 

a cold temperature, there was a challenge to find a place 

to store it, because very few ultra-cold freezers were 

identified across the state. The minimum 1,170 doses 

would require the health district or other partners to act 

as a warehouse and distributor of the vaccine weekly. 

For small rural communities, the five-day vaccine viability 

and lack of single dose vials presented its own unique 

challenges. 

With Moderna, the second EUA COVID-19 vaccine, 

some of these challenges were eased. Moderna can be 

stored in a regular freezer and shipped with a minimum 

of 100 doses, but it still requires two doses. As both 

vaccines remain limited, providers may not have a choice 

of vaccine available to them. The logistics of navigating 

between the two vaccines week to week showed to 

be extremely challenging. Second dose scheduling 

and rescheduling has been a challenge reported by all 

providers. 

The most recent EUA vaccine approved, a single dose 

Janssen vaccine. This vaccine does not require a second 

visit. As with all COVID-19 vaccines, the supply is limited. 

Efforts for use of this vaccine may focus on transient 

populations where subsequent visits are difficult. 

Now three months into Idaho’s COVID-19 vaccination 

efforts, both health districts and providers have 

successfully navigated early challenges and are 

vaccinating through Idaho’s priority groups ahead of 

schedule. Ultimately the biggest challenge to date has 

been having a limited amount of vaccines. The demand 

remains higher than supply, which has not allowed 

concerned individuals to get vaccinations. 

As we look forward to supply meeting demand, 

we are anticipating new challenges. Although, some 

questions remain. Will enough of Idaho be vaccinated to 

make an impact? How long will the vaccine last? How do 

we address vaccine hesitancy? 

Public Health will continue its work at addressing 

vaccine hesitancy and achieving herd immunity by 

doing the same things we have done throughout the 

pandemic…hard work, collaboration, and education. 

THE DATES 

National Nurse Recognition Dates 

National Nurses Week 

May 6-12 

International Nurses Day 

May 12 

Nurse Leaders of Idaho 

AONL National Conference 

July 11-14, Washington DC 

Idaho Hospital Association 

Annual Meeting 

Oct 4-7, Sun Valley 

Leap Conference 

Oct 21-22, Boise 

Nurse Recognition Dinner 

October 21, Boise 

Nurse Practitioners of Idaho 

Membership Recruitment Month 

May, 2021 

AANP Annual Virtual Clinical 

Conference 

June 15-August 31 

Idaho Annual Fall NP Conference 

October 1-2 

School Nurses of Idaho 

National School Nurse Day 

May 6 

Idaho Board of Nursing 

July 29-30, Boise 

November 4-5, Boise

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FEATURE 

The Roaring 20’s to Salk to Karaoke & Tears 

Sarah Curtright, DNP, FNP-ED, LBBP, CLNC 

Production Faculty, Family Medicine Residency 

of Idaho; 

Clinical Associate, University of Washington 

sarahc66@uw.edu 

Adrianne Paeth, BSN, RN, FNP(s) 

Family Nurse Practitioner Candidate, Northwest 

Nazarene University 

Apaeth@nnu.edu 

Jessica Bartlett, MSN, RN, FNP(s) 

Family Nurse Practitioner Candidate, Northwest 

Nazarene University 

Jbartlett@nnu.edu 

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The authors report no conflicts of interest. 

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The global pandemic caused by SARS-CoV-2 

(Covid-19) has left graduate students scrambling 

for non-traditional clinical rotations. We were 

fortunate to have the opportunity to work with a 

Covid-19 mass-vaccination clinic held recently in 

Canyon County (Stjepovic, 2021). 

Leading up to this clinical rotation, each of the 

authors had varying degrees of fear. What does 

a mass-vaccination clinic even look like? The last 

time the United States held mass vaccinations to 

help prevent a pandemic was in 1976 (Sencer 

& Millar, 2006). We did not know exactly what 

to expect for challenges. We knew to bring our 

own PPE and lunch. But this would be a new 

site location and questions arose like how long 

the commute would be, where would we park, 

and how would we access the building. At least 

this would be held on a Saturday so if the team 

planning did not go as hoped, we could potentially 

call in a local Chick-fil-A manager to help us (Oyer 

Koyer, 2021). 

Our fears were soon settled. The planning team 

had plans for what seemed like every potential 

possibility. Our patients seemed to be experiencing 

a reawakening as a peer group. One injection 

group had oldies music playing on the radio; the 

injection staff were leading patients (masks in 

place and sitting socially distanced) in singing 

those songs like a karaoke session. One couple 

during their post-vaccination observation time was 

overheard saying, “this is more socialization than 

we’ve had in the past year.” 

As individuals and couples waited through their 

post-vaccination observation period, they remained 

socially distanced, but were heard to be comparing 

their favorite restaurants in Basil, Switzerland and 

Paris, France, commenting on their disappointment 

in the lack of spices in the food in Spain, and 

discussing which “Macdonald’s” [sic] they should 

meet up at for lunch later that day. Our favorite joke 

of the day was: “What do you get when you play 

toggle [sic] war with a pig? Answer: pulled pork.” 

The oldest patient of the day was 97 years old. 

He said, “I’m proud—it took a long time to get it 

[the vaccine]” (J. D. B., personal communication, 

February 5, 2021). Another patient who was 79 

said he had been living outside Philadelphia 

when “Salk’s group” came to their elementary 

school where that team “shot us up then took 

our blood about 20 minutes later” (W.O., personal 

communication, February 5, 2021). 

Another memorable patient was a 67-yearold 

female who had nearly drowned as a child 

and has subsequently suffered from pneumonia 

multiple times over the decades requiring extensive 

hospitalizations. She could not stop crying during 

her check-in, vaccination, and observation period. 

She had been living in strict isolation as she feared 

Covid-19 might kill her. She could not stop telling 

us thank you for helping her obtain the vaccine 

(B. M., personal communication, February 5, 

2021). The clinic, and its second-dose counterpart 

planned in a month, should allow a hint of normalcy 

for these patients. As they told us repeatedly, 

they had missed their kids and grandkids at 

Thanksgiving and Christmas, but now that they 

can be vaccinated, there can be plans for “the 

grandkids to come!” later this summer. 

In the end, we were part of a team who were 

able to vaccinate 244 vulnerable individuals. The 

time we spent with these patients and our fellow 

mass-vaccine site staff not only brought us joy, 

and a sense of accomplishment, but it also was a 

refreshing reminder that what we can do in clinical 

sites can help bring health to a community. 

References 

Oyer Koyer, K. (January 26, 2021). Mount Pleasant 

Chick-fil-A manager called on by mayor to assist 

Covid-19 vaccine line. Retrieved from https://www. 

postandcourier.com/news/mount-pleasant-chick- 

fil-a-manager-called-on-by-mayor-to-assist-covid- 

19-vaccine/article_09b31c7c-5fef-11eb-b92b- 

9b9eff4a1008.html 

Sencer, D. J. & Millar, J. Reflections on the 1976 swine 

flu vaccination program. Emerging Infectious 

Diseases 2006; 12(1): 29-33. https://dx.doi. 

org/10/3201/eid1201.051007 

Stjepovic, K. (February 6, 2021). Boise clinic vaccinates 

over 800 Idahoans in one day. Retrieved from 

https://www.ktvb.com/article/news/health/ 

coronavirus/vaccine/boise-nampa-health-clinic- 

covid-19-coronavirus-vaccine/277-bd848312- 

3852-4cff-92b8-20821c33ad8b


FEATURE 

Nursing Informatics: Use of the Mapping Medicare 

Disparities (MMD) Tool – A Starting Point for Examining 

Health Disparity Data in the United States 

Barbara McNeil PhD, RN-BC 

Adjunct graduate faculty, Gonzaga University 

mcneilb@gonzaga.edu 

The author has disclosed no potential conflicts of 

interest. 

As never before and during this pandemic, citizens and 

healthcare professionals have seen healthcare data upclose 

and embraced and valued it. Through daily analysis 

and visual representation of data and trends, the U.S. 

media and scientists have increased our understanding 

of the spread of COVID-19 across the globe. We are 

seeing how certain populations are more affected by 

COVID-19 and are developing an understanding of how 

social determinants of health influence health outcomes. 

The purpose of this paper is to examine the Centers 

for Medicare and Medicaid Services Office of Minority 

Health’s (CMS OMH) Mapping Medicare Disparities (MMD) 

tool (CMS OMH, 2020) and its usefulness for identifying 

health disparities across populations, informing the need 

for quality of care improvement. 

Health Disparities 

The term “health disparities” is commonly referred 

to as “ differences in health status or health outcomes, 

which may be difficult to attribute to individual 

providers” (Weissman, et al. 2012, p. 5). Examples of 

health disparities include gender, race/ethnicity, income, 

education level, sexual orientation, age, and geography. 

The concept of “health disparities” differs from 

“healthcare disparities” or “health utilization disparities.” 

Weissman et al. (2012, p. 5) utilized a National Institute 

of Health definition to clarify health disparities as “racial 

and ethnic differences in the quality of healthcare that 

are not due to access related factors or clinical needs, 

preferences, and appropriateness of intervention.” A 

research framework and factors influencing health 

disparities are shown in Figure 1. 

The Medicare Medical Disparities (MMD) Tool 

Features 

The MMD instrument is a web-based interactive, nocost, 

user-friendly tool that was first launched in 2016 

(Federal Data Strategy, 2019). Since that time, the tool has 

been modified with added search options based on user 

input and the changing landscape of health. For example, 

users can now compare data from rural and urban 

counties; opioid data were added as a condition within the 

Population View (Federal Data Strategy, 2019). Through 

an interactive search, users can identify geographical 

health disparities for 60 chronic conditions for Medicare 

populations. 

Two Views of the Data: Hospital Versus Population 

There are two possible views of the data: Population 

View and Hospital View. Data parameters (CMS OMS, 

n.d.b) are shown in Table 1 and are used to direct a search. 

Nursing Informatics continued on page 22 

NIMHD Research Framework 

The NIMHD Minority Health and Health Disparities Research Framework reflects an evolving conceptualization of factors relevant to the understanding and promotion of minority health and to the understanding and reduction of health 

disparities. The framework serves as a vehicle for encouraging NIMHD- and NIH-supported research that addresses the complex and multi-faceted nature of minority health and health disparities, including research that spans different 

domains of influence (Biological, Behavioral, Physical/Built Environment, Sociocultural Environment, Healthcare System) as well as different levels of influence (Individual, Interpersonal, Community, Societal) within those domains. The 

framework also provides a classification structure that facilitates analysis of the NIMHD and NIH minority health and health disparities research portfolios to assess progress, gaps, and opportunities. Examples of factors are provided 

within each cell of the framework (e.g., Family Microbiome within the Interpersonal-Biological cell). These factors are not intended to be exhaustive. Health disparity populations, as well as other features of this framework, may be adjusted 

over time. 

Note: This figure and explanation are from: National Institute on Minority Health and Health Disparities. (2017). NIMHD Framework. Retrieved Feb. 9, 20121 from https://www.nimhd.nih.gov/about/overview/ 

research-framework.html.


FEATURE 

Stop the Bleed ® for the Rural Farming Community 

of Oneida County 

Katherine Estep BSN, RN, DNP-FNP Student 

katherineestep@isu.edu 

Melody Weaver PhD, APRN, FNP-BC 

weavmelo@isu.edu 

Idaho State University School of Nursing 

Photo credit: Nell J. Redfield Memorial Hospital 

Photo Credit: Dylan Estep 

As a registered nurse working in a rural Critical 

Access Hospital in Oneida County, Idaho, I have 

witnessed the horrific injuries incurred by our farmers 

and ranchers. Ranked as one of the most dangerous 

occupations, rural farmers experience a high rate of 

fatal farm-related bleeding injuries. In 2017, 416 rural 

farmers died in the United States due to farm-related 

injury, a rate of 20.4 deaths per 100,000 farmers 

(Centers for Disease Control and Prevention, 2019). 

Equipment and livestock accidents that result in blood 

loss from open wounds, damage to internal organs 

and/or blood vessels, and amputation are common 

(Gross, Young, Ramirez, Leinenkugel, & Peek, 2015). 

Photo Credit: Katherine Estep 

Located in southeastern Idaho, Oneida County 

(population 4,531) has 422 farms, 97 of which are 

larger than 1,000 acres (United States Census Bureau, 

2019; 2017 Census of Agriculture, 2017). Out of 

805,100 acres in Oneida County, 319,789 acres are 

farmed acres. Volunteer emergency medical services 

(EMS) are located within the county, however, can take 

up to 45 minutes to arrive on scene. 

As a DNP-FNP student, I found myself drawn to 

a program, Stop the Bleed®, as an intervention to 

decrease morbidity and mortality for farmers and 

ranchers within the community. Although our volunteer 

EMS personnel have been trained in Stop the Bleed®, 

time to arrival on scene puts our farmers and ranchers 

at risk for increased loss of life and limb. Application 

of a tourniquet or bleeding cessation measures in the 

field prior to arrival of EMS or to healthcare can reduce 

mortality by 6-fold (Vu et al., 2018). I became a Stop 

the Bleed® instructor, encouraged and supported by 

a staff physician and the Chief Nursing Officer. 

Photo credit: Stop the Bleed® 

To become a registered Stop the Bleed® instructor, 

one must be a licensed nurse and complete a 

Stop the Bleed® course. This community-based 

intervention was supported by local businesses 

who provided funds and supplies to build Stop the 

Bleed® kits for participants. Prior to implementation, 

human subjects’ protection was obtained through 

Idaho State University Institutional Review Board (IRB- 

FY2020-249). Participant recruitment, using purposive 

snowball sampling, was initiated using a postcard 

mailing to farmers and ranchers in Oneida County. 

Three classes were conducted with an average class 

size of ten participants. The Stop the Bleed® course 

consisted of a PowerPoint presentation followed by 

hands-on exercises of applying tourniquets, applying 

pressure, and packing wounds. 


Participants were taught how to apply direct 

pressure to a wound to control bleeding. 


Wound models were used to demonstrate packing 

a wound. The farmers and ranchers participated in 

hands-on exercises of packing various wounds. 


I constructed four wound models for practicing 

applying pressure and packing a wound. A wound 

model was constructed using a 12”x8” plastic tote 

with a lid and a 12”x8” piece of 3” foam pad. After 

cutting the pad to create the wound openings, white 

Flex Seal® and red paint were used to add realism. 

The community provided funds and supplies for me 

to create the mock open wound models. The cost of 

supplies to build one wound model was $10.59. 

REGISTERED NURSE 

The Walker Center is looking to bring on a Registered 

Nurse to support our Substance Abuse and Mental Health 

Program. You will provide medical knowledge, support, 

and training to the medical technicians, as well as assist the 

Medical Director, Physicians, and Physician Assistants. 

*Health Insurance 

*Retirement 

*Paid Vacation/PTO 

Apply online at www.thewalkercenter.org/careers 

Photo credit: Dylan Estep 

An arm model was used to allow participants to 

practice applying a tourniquet. Allowing the farmers 

and ranchers to practice applying a tourniquet 

provided them with experience prior to emergency use 

in the field. The arm model was provided for each Stop 

the Bleed® course by the local critical access hospital. 

Practice tourniquets were provided by North American 

Rescue. 

Photo Credit: Katherine Estep


The Stop the Bleed® kits contained instructions on bleeding control, C-A-T® 

tourniquet, QuikClot®, shears, gauze compression bandage, gauze squares, 

permanent marker, gloves, and a mask with a face shield all stored in a red 

weatherproof bag. All participants received a kit at the conclusion of each class. 

Businesses within the community provided funds and supplies for me to prepare 

Stop the Bleed® kits for my participants. 

A quasi-experimental pretest/posttest design was used to collect demographic 

data (see Table 1) and to assess overall knowledge and self-perceived knowledge 

and comfortability of managing a bleeding injury. T-tests for paired two sample 

means were computed in Microsoft Excel to determine the difference in means 

between the pretest and posttest. Statistical significance was set at p ≤ 0.05. 

The mostly young male ranchers who participated in the Stop the Bleed® courses 

demonstrated statistically significant improvement (p < .001) in overall knowledge and 

self-perceived knowledge and comfortability in managing bleeding injury (see Table 2). 

Overall, the project was a success. Anecdotally, I received a call from a participant 

after class completion reporting use of his kit to stop bleeding from a head wound 

while awaiting EMS arrival. Stop the Bleed® courses could continue free of charge 

for members of Oneida County. Even with the challenges of implementing a Stop the 

Bleed® program in Oneida County, it is completely worth it if even one life is saved. 

Conflicts of interest: None 

Commercial affiliation: None 

Acknowledgements: Robert Hodson, DO, Karren Edwards, CNO, Christina Bernal, 

PharmD, Lara Corbridge, RN, Nell J. Redfield Memorial Hospital Foundation and 

Hospital, Malad City Farm Bureau, Allen Drug- Malad City, Malad City Fire Department, 

Z-Medica, North American Rescue. 

References 

Centers for Disease Control and Prevention. (2019). The National Institute for Occupational Safety 

and Health (NIOSH). Retrieved from https://www.cdc.gov/niosh/topics/aginjury/default.html 

Gross, N., Young, T., Ramirez, M., Leinenkugel, K., & Peek, A. C. (2015). Characteristics of workand 

non-work-related farm injuries. Journal of Rural Health, 31(4), 401–409. doi:10.1111/ 

jrh.12121 

United Stated Census Bureau. (2019). Quick facts Oneida County, Idaho. Retrieved from https:// 

www.census.gov/quickfacts/oneidacountyidaho 

Vu, M., Todd, S. R., Rainey, E. E., Allen, L., Agrawal, V., Walker, K., Gandhi, R., Podbielski, J. M., 

Teixeira, P. R., Brown, C. R., Emigh, B., Long, M., Foreman, M., Eastridge, B., Gale, S., 

Truitt, M. S., Dissanaike, S., Duane, T., Holcomb, J., & Regner, J. (2018). Civilian prehospital 

tourniquet use is associated with improved survival in patients with peripheral vascular 

injury. Journal of the American College of Surgeons, 226(5), 769–776. doi:10.1016/j. 

jamcollsurg.2018.01.047 

2017 Census of Agriculture. (2017). Oneida County Idaho. Retrieved from https://www.nass.usda. 

gov/Publications/AgCensus/2017/Online_Resources/County_Profiles/Idaho/cp16071.pdf 

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IDAHO CENTER FOR NURSING 

Nurses Supporting Nurses – The 

Idaho Nurses’ Education Fund 

The Idaho Center for Nursing is pleased to announce two important information 

updates about the Idaho Nurses’ Fund. They are: (1) a report on the 2020 Fund use 

and (2) the 2021 Fund donation campaign. 

The purpose of the Idaho Nurses’ Education Fund is to support academic and 

continuing education opportunities for nurses. This Fund is managed by the Idaho 

Center for Nursing and it is a 501c3 qualified tax-exempt charitable education fund, 

thus any donations are income tax deductible. 

The funding sources in 2020 came from profits and donations made at the 

2018 and 2019 Nursing Recognition Dinners held during the LEAP conferences, 

direct donations to the Fund from nurses and memorials, and investment income 

incorporated into the Fund that resulted from the restructuring of the former Idaho 

Nurses Foundation that had become delinquent. 

In 2020 the Fund had a total balance of $115,650 and $100,000 of that is the 

core balance of a long-term investment account. Funding support to nurses in 

2020 was (1) $1,000 to Idaho doctoral students to complete research or projects in 

their education programs, (2) $5,000 in nursing scholarships, (3) $9,000 to support 

the development and implementation of an Idaho based continuing education 

learning management system so that every Idaho nurse can access cost-effective 

approved CNE on-demand from home that will help them maintain skills and meet 

continued competency requirements for Idaho Board of Nursing license renewal. 

In 2021 we need to continue supporting the Idaho Nurses’ Education Fund 

to maintain supporting the education needs of Idaho nurses. May is designated 

national nurses’ month and the campaign to collect donations will be fully launched 

by then. Please participate by donating $10. 

DONATE NOW 

IF EVERY IDAHO NURSE WOULD DONATE AT LEAST 

$10, THE FUND COULD HAVE ALMOST $200,000 

TO USE FOR SUPPORTING IDAHO NURSES. 

TO DONATE on-line GO TO: 

Make a Donation Form | Idaho Center for Nursing | Nursing Network 

https://idahocfn.nursingnetwork.com/page/95608-make-a-donation-form 

Idaho Supported 

Continuing Education 

Nurses, including Nurse Practitioners, can access Idaho based approved CNE 

using an on-line on-demand CNE catalog to obtain CNE. Go to the website, create 

an account, and select desired programs in the education catalogue, or buy the 

bundled LEAP 2020 packet. 

icn - CE Catalog (ce21.com) | https://icn.ce21.com 

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Make a difference 

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EXECUTIVE DIRECTOR’S REPORT 

The Current State of Nursing in Idaho … Here’s My Take! 

Randall Hudspeth PhD, APRN-CNP, FAANP 

Executive Director, Idaho Center for Nursing 

randhuds@msn.com 

Being in the executive 

director role and being linked 

to all of Idaho’s nursing 

organizations (ANAI, NLI, 

SNOI, IDANA & NPI) through 

the Idaho Center for Nursing 

and its seven operational 

programs affords me the 

ability to keep my finger 

on the pulse of nursing in 

Idaho. My experiences as 

an Idaho native, a former Randall Hudspeth 

Board of Nursing member 

and chairman, a nursing administrator and a nurse 

practitioner have served me well. This has confirmed 

to me what I have believed for many years; that nursing 

as a profession “benefits the many through the hard 

work and financial support of the few.” Nurses come 

and go with varying levels of engagement, but luckily a 

small cohort have been sustained that keeps us moving 

forward, and in general, nursing in Idaho is in good 

shape. I am happy to have the experience of working 

with these programs and here is my take on where 

nursing is today in Idaho. 

Today’s issues facing nursing are not different 

than those experienced in other states, or that 

have been experienced historically in Idaho. Given 

that the Coronavirus Pandemic has caused a 

disruption to the normal way we functioned over 

the past year, there has continued to be positive 

changes for Idaho nursing. The international year 

of the nurse 2020 activities, designed to celebrate 

the 200th birth-year of Florence Nightingale, were 

basically negated due to the pandemic. Thus, the 

celebration year was extended by the International 

Council of Nursing and the ANA through 2021. 

The December 2020 Gallup Poll again identified 

nursing as the most honest and ethical profession 

for the 19th year in a row, with higher scores than 

ever before and significantly outpacing any other 

healthcare profession. This demonstrated how well 

the actions of nurses are viewed by the public (Ref: 

ANA. Available at The American Public Continues 

to Rank Nurses as The Most Honest and Ethical 

Professionals in Annual Gallup Poll (nursingworld. 

org). 

Nursing Workforce: Projected shortages and 

mal-distribution across Idaho continues to be an 

area where nursing has made an impact without 

much support or awareness from non-nursing 

groups. The pandemic provided a temporary 

reprieve that impacted hospital staffing when 

admissions were slowed, but demands in long term 

care, assisted living, home care and public health 

have been sustained or increased. Fortunately, the 

supply of nurses met the need. However, we do 

see an increase in nurses who are retiring earlier 

than planned and we might see a loss of some 

RNs who choose not to re-license in 2021 because 

they are not working and they cannot meet the 

continued competency requirements established 

by the BON (see the BON report in this edition). 

To mitigate a workforce shortage, every nursing 

program in Idaho has plans in place to increase 

student enrollments. Not all programs will be able 

to increase enrollments to their full plan because 

of faculty and clinical placement constraints, but 

schools and faculty are aware of the pending 

shortage and the mitigation strategy. 

Engagement of Nurses in Professional 

Organizations: Membership is an issue in every 

organization. Throughout the years, nurses have reaped 

the benefits achieved by professional organizations 

in terms of practice scope, credentialing, continuing 

education and clinical skill enhancement. It is pitiful that 

in Idaho less than 5% of RNs support the ANA-Idaho 

(Idaho Nurses Association). Even associations like 

Nurse Practitioners of Idaho, that provide a measurable 

benefit to all Idaho NPs in terms of legislation that 

directly impacts NP scope of practice, only see 17% 

of Idaho NPs being dues-paying members. Dues are 

cheap for what a nurse receives (annually: ANA-Idaho 

at $175.00 and NPI at $90). Nurses only need a few 

hours of work to pay their share. Unfortunately, most 

do not easily see the benefits of membership and have 

a difficult time moving past the “what is in it for me” 

conversation and seeing the bigger picture. 

Public Policy Impact: Nurses are getting more 

seats at more tables. Four years ago the National 

Nurses on Boards Coalition set a goal of 10,000 

nurses being on boards of directors by 2020. This 

meant all kinds of boards and was not specific to 

nursing or healthcare boards. Each state was given 

a target based on the number of nurses licensed 

and the state population. In Idaho, the goal was 

to have 60 nurses seated on public boards. We 

started with Idaho having 31 nurses being on 

boards. By the end of 2020 Idaho exceeded its 

goal by 178%. 

Governor Little heard nursing’s concerns about 

the mal-distribution of nurses across Idaho and 

the issues that rural communities, critical access 

hospitals and long-term care facilities experience 

recruiting and retaining nurses. He designated $1M 

in his 2021 budget proposal to address faculty and 

nursing program operational issues. Additionally, 

the Healthcare Transformation Council of Idaho 

(HTCI) approved the development of a Rural Nurse 

Loan Repayment (RNLR) program targeted to 

impact the nursing workforce in rural communities. 

When approved, RNLP will offer new graduate 

nurses education loan repayments based on their 

employment in a designated rural community and 

evidence of loans. The RNLR is currently in the 

final stages of development and is targeted for the 

2022 legislative cycle for funding. 

Meeting the Nursing Action Coalition 

Goals: The work to achieve the 10 goals outlined 

in the 2010 Institute of Medicine Report on the 

Future of Nursing has continued in Idaho with great 

success. This work has been supported by grants 

from the Robert Wood Johnson Foundation and 

the Idaho Board of Nursing. The target timeline 

to attain the goals lasted through 2020. Here is a 

summary of Idaho’s achievements that have not 

already been explained. 

• Achieve an 80% BSN prepared RN 

workforce. Between 2010 and 2020 Idaho 

moved from a 53.5% to a 77.5% BSN 

prepared RN workforce, making Idaho 

one of the top two states in the national to 

achieve this goal. 

• Improve opportunities for RN to BSN 

education. Idaho educators are credited with 

working to insure successful articulation 

between associate degree and BSN 

programs that resulted in our 77.5% BSN 

level. With December 2020 and May 2021 

graduations we expect to see a further 

bump when the 2021 license renewal data is 

reviewed. 

• Enhance transition to practice programs for 

new nurses. Over the past six years, five 

different transition or residency programs 

have been implemented at Idaho hospitals. 

• Increasing opportunity for diversity students 

is a national goal, but Idaho remains 

challenged because there are not large 

numbers of diversity students applying for 

nursing school admission. 

• Continuing Education opportunities for all 

Idaho nurses have been expanded through 

the use of a new learning management 

system that offers approved CNE through 

the professional organization websites to 

both members and non-members at an 

economical cost. 

• Double the number of Doctorate Degree 

prepared nurses in Idaho by supporting DNP 

and PhD student research and scholarship 

endowments at Idaho universities. 

• Help APRNs eliminate barriers to practice. 

Last year nursing supported the global 

signature bill promoted by NPI that was 

passed by the 2020 Idaho legislature. This 

bill replaced the word “physician” with 

“provider” in healthcare related regulations, 

recognizing NPs signatures and thus 

removing an access to care barrier and 

some increased costs for patients. 

• Sponsored a Nurse Refresher Program for 

RNs and LPNs to return to practice. This 

program is BON approved. It has been 

continually updated and today it has a new 

website and is both a paper product and 

electronic. Over 60 nurses have successfully 

completed Idaho’s refresher program. 

I believe that nursing in Idaho will continue to 

exert influence on public policy and politically. 

I am hopeful that Idaho nurses will understand 

the importance of the impacts made by the 

professional associations and recognize that 

support through membership is necessary for 

continued progress. If you are already a member 

of a professional nursing organization in Idaho, 

THANK YOU. If you are not a member, please 

become a part of the solution by joining and 

helping to keep the profession growing and 

progressing in Idaho.


NLI AND IALN PRESIDENTIAL REPORT 

The Profession of Nursing & Leadership 

Joan Agee DNP, RN, CNOR, FACHE 

President NLI and IALN 

ageejo@slhs.org 

As President of the 


(NLI), I have the privilege 

to collaborate with nurse 

colleagues across the state 

of Idaho. These leaders see 

the value of participating in 

professional organizations 

such as NLI and are 

committed to promoting the 

profession of nursing. Being 

a member of professional 

nursing organization such 

as NLI has many benefits. 

Joan Agee 

One of the benefits of a professional 

organization is the provision for the professional 

development of their membership. This aligns 

with the NLI website description and I quote, “NLI 

is a professional membership organization which 

represents the unified voice of nursing leadership 

in Idaho. NLI is recognized for being a leader 

in meeting the continuing education needs of 

nurse leaders statewide, for convening leadership 

colleagues, for making progress on the Institute of 

Medicine report on the Future of Nursing, for being 

the political voice of nursing leadership, and for 

ensuring the reliable reporting of nursing workforce 

supply and demand data” (Nurse Leaders of Idaho, 

n.d.). 

NLI contributes to the professional development 

of its members in many ways including the 

provision of continuing education contact-hour 

credits for a significant discount. This may prove 

beneficial to nurses licensed in Idaho, who will 

be required to attest to practice, education, or 

professional engagement to renew their RN license 

prior to August 31, 2021. One of the options for 

license renewal is 15 education contact hours. 

Therefore, nurses may appreciate the webbased 

educational conference “2020 The year 

of the Nurse-Surviving Change” hosted by NLI in 

collaboration with ANA-Idaho, which offers 20.5 

CNE and can be accessed on the NLI website 

https://nurseleadersidaho.nursingnetwork.com/ 

According to Matthews (2013), another benefit 

of a nursing professional organization is the 

“dissemination of professional knowledge” (p. 

8). As a profession, nursing has its own body of 

knowledge to guide practice and standards of 

care. I challenge nurse leaders to encourage their 

colleagues to participate in their professional 

nursing organizations and commit to expanding 

that body of knowledge. Through professional 

organizations, members may have the opportunity 

to “publish scholarly manuscripts of relevance 

and publish the latest advanced knowledge in a 

specialty area and/or the profession” (Matthews, 

2013). Writing an article for this journal, RN Idaho 

provides such an opportunity to participate in 

scholarly publication and further discourse. 

I encourage nurses to commit to furthering 

the growth and development of the profession. 

Nursing will not sustain its status as a profession 

if its members do not realize that it takes focus 

and commitment to maintain its stature as other 

professions such as medicine and law. For the 

record, it was in 1965 when the “ANA House of 

Delegates and Board of Directors stated that the 

minimum preparation for beginning professional 

nursing practice at the present time should be a 

baccalaureate degree in nursing” (Matthews, 2013). 

Fifty-six years later, NLI along with rest of the 

nursing profession is striving to make progress on 

the Institute of Medicine (IOM) report on the Future 

of Nursing to achieve an 80% BSN rate by 2020. 

I caution nurses to avoid stagnation in their 

vision of the scholarly growth and development of 

the profession of nursing. I urge nurse leaders to 

educate to the value of participating in professional 

organizations such as NLI, to advocate for an 

RN workforce of greater than 80% BSN, and to 

support the goal of nurses working to the full 

extent of their education and training. Kudos to 

the schools of nursing who are collaborating to 

develop articulation agreements to support the 

ADN to BSN journey. In Idaho, the partnerships 

between industry, schools, and healthcare 

institutions are robust. The members of NLI that 

comprise these partnerships is what makes our 

organization thrive with the unified voice of nursing 

leadership in Idaho. Together, we will advance the 

profession of nursing. 

References 

American Nurses Association. (2015). Code of Ethics for 

Nurses with Interpretive Statements. Silver Spring, 

Maryland. ISBN: 978-1-558-10599-7. 

Institute of Medicine. (2010). Institute of Medicine 

report brief: The future of nursing leading 

change, advancing health. https://www.nap.edu/ 

resource/12956/Future-of-Nursing-2010-Report- 

Brief.pdf 

Matthews, J.H., (2013). Role of professional 

organizations in advocating for the nursing 

profession. Online Journal of Issues in Nursing. 

https://www.homeworkgain.com/wp-content/ 

uploads/edd/2020/04/Role-of-Professional- 

Organizations-in-Advocating-for-the-Nursing- 

Profession.pdf 

Nurse Leaders of Idaho. (n.d.). Membership has 

benefits. Retrieved January 23, 2021 from 

https://nurseleadersidaho.nursingnetwork.com/ 

membership/#:~:text=Nurse%20Leaders%20 

of%20Idaho%20is%20a%20professional%20 

membership,reporting%20of%20nursing%20 

workforce%20supply%20and%20demand%20 

data.


IDAHO BOARD OF NURSING UPDATE 

Continued Competence Requirements 

for Renewal of License 

Overview: 

The RN and APRN license renewal period is May 

1st through August 31st of odd-numbered years. The 

renewal application will be available through the Nurse 

Portal starting May 1st. 

To renew an RN license, a licensee must 

accomplish at least two of any of the learning 

activities (in the Practice, Education, or Professional 

engagement sections) within the two (2) year renewal 

period, from the date of renewal to the following 

expiration date. 

Each APRN renewal applicant is required to attest 

to the completion of professional development in the 

areas of Active Practice, Continuing Education, and 

Peer Review and may be audited for compliance with 

these requirements. Each applicant must maintain 

documentation of meeting these requirements for 

the duration of the current two-year renewal period. 

If selected for an audit, a licensee will be contacted 

to submit their documentation to the Idaho Board of 

Nursing within 30 days of the request. Please note the 

renewal application may be delayed, denied, and/or 

result in disciplinary action if the licensee fails to meet 

these requirements. 

Practice: 

• Current nursing specialty certification; or 

• One hundred hours of practice or simulation 

practice, paid or unpaid, in which the nurse 

applies knowledge or clinical judgment in a 

way that influences patients, families, nurses, or 

organizations. 

Education, Continuing Education, E-learning, 

and In-Service: 

• Fifteen contact hours of continuing education, 

e-learning, academic courses, nursing-related 

in-service offered by an accredited educational 

institution, healthcare institution, or organization (a 

contact hour equals not less than fifty minutes); or 

• Completion of a minimum of one semester credit 

hour of post-licensure academic education relevant 

to nursing, offered by a college or university 

accredited by an organization recognized by the 

U.S. Department of Education; or 

• Completion of a Board-recognized nurse refresher 

course or nurse residency program; or 

• Participation in or presentation of a workshop, 

seminar, conference, or course relevant to 

the practice of nursing and approved by an 

organization recognized by the Board to include, 

but not limited to: a nationally recognized nursing 

organization; an accredited academic institution; 

a provider of continuing education recognized by 

another board of nursing; a provider of continuing 

education recognized by a regulatory board of 

another discipline; or 

• A program that meets criteria established by the 

Board. 

Professional Engagement: 

• Acknowledged contributor to a published nursingrelated 

article or manuscript; or 

• Teaching or developing a nursing-related course of 

instruction; or 

• Participation in related professional activities 

including, but not limited to, research, published 

professional materials, nursing-related volunteer 

work, teaching (if not licensee’s primary 

employment), peer reviewing, precepting, 

professional auditing, and service on nursing 

or healthcare related boards, organizations, 

associations, or committees. 

Of note, APRNs who have completed APRN 

renewal requirements are exempt from RN renewal 

requirements. 

Continuing Education Requirements for renewing 

an APRN license include completing 30 contact hours 

of continuing education during the renewal period, 

which shall include 10 contact hours in pharmacology 

if the nurse has prescriptive authority. Contact hours 

will be prorated for APRNs whose initial license was 

issued midway into a renewal period (e.g. a new 

graduate whose initial license is valid for one year is 

required to attest to 15.0 contact hours of continuing 

education and 5.0 contact hours in pharmacologyrelated 

content). 

If you have questions about continued competence 

requirements, please contact our office at 208-577- 

2489 or visit our website. Please follow the Idaho State 

Board of Nursing on Social Media for information on a 

variety of topics. 

Full Time RN’s Wanted 

$7,500 Sign-on Bonus! 

Competitive Wage Scale! 

One (1) year skilled nursing experience 

preferred. Competitive Benefit Packages 

for Full Time Associates. 

Apply online at LifeCareJobs.com

CDC 2020 Gonorrhea Treatment Update: 

Single 500 mg IM Dose of Ceftriaxone Recommended 

This table summarizes the Centers for Disease Control and Prevention (CDC) “Update to CDC’s Treatment Guidelines 

for Gonococcal Infection, 2020” published December 18th, 2020. This guidance updates the 2015 CDC STD Treatment 

Guidelines and reflects changes expected in the forthcoming CDC 2021 STI Treatment Guidelines. 

The new gonorrhea treatment regimens have shifted to monotherapy with a higher dose due to the following reasons: 

1. Increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and 

concurrent pathogens 

2. Continued low incidence of gonorrhea isolate strains with ceftriaxone resistance 

3. Increased incidence of azithromycin resistance 

Disease Recommended Regimen Alternative Regimen Follow-up 

Uncomplicated 

Urogenital and 

Rectal Gonorrhea 

(GC) 

Ceftriaxone 500 mg IM for 

persons weighing


Idaho’s Nurse Refresher Program for 

RNs & LPNs Returning to Practice 

Renae L. Dougal, PhD, MSN, RN, CLNC, CCRP 

Faculty & Clinical Coordinator (Nurse Refresher Program) 


dougrena@isu.edu 

Karin Iuliano, BA, Director of Operations 

Idaho Center for Nursing 

nurserefresher@nurseleaders.org 

The Nurse Refresher Program (NRP) that is offered in Idaho through the Nurse 

Leaders of Idaho organization and the Idaho Center for Nursing is meeting the 

needs of nurses who require a clinical update to re-activate a nursing license. 

This program has a long success history in Idaho, and hundreds of nurses have 

completed the program and returned to active practice in Idaho as well as other 

states. 

The NRP helps many nurses, both RN and LPN, who stepped away from active 

nursing practice for a variety of reasons during their careers. The length of time 

away from practice and whether or not the nurse maintains an active license often 

depends on changes in life circumstances, raising a family, or the inability to find a 

job where the hours and environment meet personal needs. The ability to maintain 

a license can be impacted by practice hour requirements and length of time the 

nurse is out of practice. 

When the decision is made to return to active practice, an assessment of clinical 

competence may be required even if an active license exists. There is a process 

to follow to reinstate a nursing license and return to active practice. First, check 

with the state Board of Nursing (BON) to determine what is needed. An approved 

refresher program option may be needed to fulfill the BON requirements for 

reinstating a nursing license. In addition, some employers may require completion 

of a refresher program even if a nurse has maintained an existing active status 

license because of the duration of time the nurse has been out of active nursing 

practice. Commonly this time limit is five years out of practice. For nurses needing 

to refresh clinical skills, the Idaho based on-line NRP is a good option. 

The Idaho NRP was created in 1983 by Idaho nurse educators as a way to get 

inactive nurses to return to practice with current skills and to help mitigate the 

ongoing nursing shortage issues. The program was originally administered by the 

Idaho Area Health Education Consortium and the BON. Later it was managed by 

the Idaho Commission on Nursing and Nursing Education (ICNNE) which joined 

the Idaho Alliance of Leaders in Nursing in 2004. Today the NRP is owned and 

administered by the Idaho Center for Nursing and the Nurse Leaders of Idaho 

(NLI). The Idaho Council of Nurse Educators and the NLI Education Committee 

provide guidance and direction to the NRP. The NRP is revised every two years for 

content and practice updates. The NRP is approved by the Idaho BON and has 

been accepted by other state BONs based on the Idaho BON approval, including 

Ohio, Nevada, Utah, Wyoming, and Montana. 

The Idaho NRP is a self-study program using a series of modules that 

detail basic skills, assessments, care planning and documentation, diagnostic 

testing and laboratory interpretations, IV therapy and pharmacology, as 

well as scope of practice and standards of practice updates. The focus 

is to provide current knowledge to meet BON requirements or for the 

individual nurse to simply acquire a degree of confidence and security before 

employment. Both RN and LPN refresher programs consist of didactive 

modules composed of pre-tests, learning objectives, narratives, selfassessment 

tests, post-tests, and supplemental readings. A clinical practice 

component designed to accommodate nurses who seek to return to active 

nursing practice is also necessary, and there is assistance for Idaho based 

nurses to meet this need. 

Didactic and post-test components must be completed within a two-year time 

frame from beginning the program and the didactic modules must be completed 

before the clinical component can be arranged. Upon completion of the self-study 

modules and post-tests, the results of the post-tests will be sent to the student 

as well as to the state Board of Nursing where the student is seeking licensure 

reactivation. 

The NPR has a specific website that provides additional information about 

the program and descriptions of the modules. The website is: Nurse Refresher 

Program [https://www.nurserefresher.org] 

Please contact your State Board of Nursing to confirm the necessary 

requirements that you may need to complete for reinstatement of your nursing 

license. If you would like more information about the ICN, NLI, or the NRP, visit 

www.nurseleaders.org or contact Karin Iuliano, Director of Operations, 208- 367- 

1171.


IDAHO NURSING 

AWARDS AND 

RECOGNITIONS 

RN Idaho recognizes nurses who make significant contributions to the advancement of nursing from the 

bedside to the boardroom. We are extremely proud of Idaho Nurses and congratulate you for the positive 

effect you have on patient and professional outcomes! 

AMERICAN ASSOCIATION OF 

NURSE PRACTITIONERS ® AWARDS 

FOR ADVOCACY AND EXCELLENCE 

DAISY AWARD RECIPIENTS 

Ben Bockelman, RN 

St. Luke’s 

Nampa 

Ben defines excellence. 

He provides the highest 

standard of care through 

his organization, attention to 

detail, expertise, and passion 

for patient education. He is 

a very thoughtful coworker 

willing to offer a kind word or gift with no expectations 

in return. Thank you for making a difference in our 

patients’ lives. 

Rebekah Gunter, RN 

St. Luke’s 

Nampa 

Rebekah was recognized 

for her “professional, caring, 

patient centered care.” “She is 

calm and exudes a true sense 

of caring that each patient 

encounter is the only thing 

that is going on.” She “has no 

sense of hurriedness or impatience” and every patient 

feels valued by her. 

Joslyn Dickinson, RN 

Madison Memorial Hospital 

Rexburg 

I am from California 

and was in Island Park to 

snowmobile for four days. At 

the end of the day, I hit some 

ice about a half-mile from 

our house. My sled spun 

around and the ski hit the side 

embankment, throwing me about 15-20 feet onto the 

Royal Plaza Health 

and Rehabilitation 

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Phone: 208-746-2855 fax: 208-746-4994 

www.RoyalPlazaHealthandRehab.com 

frozen paved road. I know pretty darn quickly that 

something was broken so my friends loaded me up 

and brought me to Madison Memorial. 

When I got to Madison, my wait was short and 

Jo was the nurse talking care of me. I had been 

in pain for about 2.5 hours and when I got to the 

back and onto a bed, Jo held my arm in a position 

that relieved all the pain I was experiencing. With 

my gear off and my arm resting in a position that 

allowed me to relax, Jo got the rest of the show 

going. She was very professional, kind, and caring, 

quick and effective, smart, and funny. I felt like I was 

in good hands and trusted what was going on for 

me. 

Now, back in California, I can easily say that Jo 

was the most experienced and professional nurse 

that I had during this whole ordeal. Nurses with 

more years’ experience couldn’t outshine Jo. I 

knew I was in good hands even though I hadn’t a 

clue about what was going on or what was about to 

happen. I thank Jo and all the people who worked 

with me that night. 

DAISY LIFETIME ACHIEVEMENT 

AWARD RECIPIENT 

Cy Gearhard MSN, RN NEA-BC 

St. Luke’s 

Boise 

The DAISY Lifetime 

Achievement Award was 

created to recognize those 

nurses who, over their careers, 

have promoted the positive 

image of the nursing profession. 

Recipients of the DAISY Lifetime 

Achievement Award are nominated for their dedication 

to nursing through active mentoring, role modeling, and 

advocating for their patients. 

St. Luke’s awarded a DAISY Lifetime 

Achievement award to Cy Gearhard MSN, RN 

NEA-BC prior to her retirement in January 2021. Cy 

spent most of her career with St. Luke’s, advancing 

her career from bedside clinician to System VP/ 

CNO. Throughout that time Cy steadfastly role 

modeled outstanding nursing professionalism, 

mentored her colleagues, and advocated 

for clinicians and patients. Her career was a 

demonstration of inclusion of all disciplines to truly 

build better services for our community. 

Cy was fond of referencing that it takes a 

team to move the dial, but we knew that it took a 

great leader to help motivate and guide the team 

to achieve superior outcomes. Cy was a key 

driver in expanding and maturing the Heart and 

Vascular service line at St. Luke’s, which served 

as a framework for the other growing St. Luke’s 

service lines. Cy was often asked jump in when a 

structure or process needed stabilization, her key 

competencies included building high functioning 

teams and structures. Many of those people and 

structures are now the backbone supporting 

nursing and patient care throughout the St. Luke’s 

system. 

Most important to her long career in nursing 

was her ability to build relationships, see the 

big picture, and maintain a gracious manner. 

Acknowledging Cy’s contribution to nursing, her 

40 years of commitment to the elevation of nursing 

practice and care of those in need, with a Lifetime 

DAISY was St. Luke’s honor and a reflection of an 

outstanding career in nursing. 

Each year the Nurse Practitioners of Idaho (NPI), 

as an affiliate of the American Association of Nurse 

Practitioners® (AANP) awards the recognition for 

Advocacy of the Nurse Practitioner (NP) role. The 2021 

recognition goes to Cynthia Dalsing, MSN, APRN-CNP, 

of Sandpoint. 

Ms. Dalsing has worked in 

multiple clinical settings 

including Universities, private 

practice, and ultimately starting 

the first independent Nurse 

Practitioner Practice in 

Sandpoint, Idaho. Creating a 

visible and vocal NP presence 

in Sandpoint has been a focal 

point of Cynthia’s role as Region 

1 Rep for NPI. She has done 

this through gathering voices to educate her community 

about NP’s, NP practice and barriers to care. With 

COVID-19 and a ground swell of support from local NP’s 

she spear-headed a program to hand out masks, 

posters, and hand sanitizers to educate and keep the 

community safe. 

She has been active on the board of NPI as well as 

the Legislative Committee. Health policy has been a 

necessary aspect of Cynthia’s career. She had excellent 

role models as a master’s student at the University of 

Utah and has continued this throughout her career. 

Cynthia believes being involved in bringing NP’s together, 

and keeping them educated about the legislative 

landscape, enhances their personal practice, and 

ultimately benefits health care for our community. 

Being retired has given Cynthia more opportunities 

to continue to advocate for NP’s. She especially wants 

to partner the northern part of Idaho with NP colleagues 

in southern Idaho, increase participation in NPI, and 

educate NP’s about how legislative actions that impact 

health care policy and NP practice. 

AANP also announced Bradley 

Bigford, MSN, APRN, NP-C, 

CCHP as the 2021 recipient for 

Idaho’s 2021 American 

Association of Nurse 

Practitioners (AANP) Nurse 

Practitioner State Award for 

Excellence. This prestigious 

award recognizes outstanding 

achievements by nurse 

practitioners (NPs) yearly with 

one recognition in each state. 

Brad has been a RN for 14 years and NP for seven. 

He has worked in corrections for the Ada County 

Sheriff’s Office for the past six years working with people 

who traditionally struggle with access to affordable 

healthcare. 

In 2016 Brad wanted another way of increasing 

people’s access to healthcare. He started his own 

house call company, Table Rock Mobile Medicine, 

a mobile urgent care servicing Boise and the 

surrounding areas. Table Rock brings healthcare 

to the people and accepts almost every insurance 

company at no additional cost. In 2020 Brad, along 

with others, started a non-profit, Access COVID 

Testing Idaho, to increase access to COVID testing 

at a time when testing was extremely limited. This 

resulted in affordably helping to identify those who 

were COVID-19 contagious and helped to decrease 

community spread. 

To help promote nursing and nurse practitioners, 

Brad interacts directly with the public via social media 

making unique content. He routinely precepts NP 

students to help the next generation become ready for 

practice.


Idaho Nurse Practitioner Brad Bigford To Be Featured in Johnson 

& Johnson Nursing Recognition Public Service Announcement 

Johnson & Johnson Nursing (J&J), that has 

promoted nursing through national advertisements 

and public service announcements over the 

past decade, has announced a new nursing 

recognition program launch for 2021. This is a part 

of celebrating the international year of the nurse 

that has been expanded from 2020 to include 

2021. J&J searched nationally for nurses who have 

been creative and who have impacted the health of 

people in their communities to be featured in this 

national program. Brad Bigford, MSN, APRN-FNP, 

was nominated by Idaho nurses to be a part of 

this national campaign based on his presentation 

at the November LEAP 2020 conference about his 

home visit practice. The selection was rigorous and 

Brad was selected to be featured in the national 

program. Here was what Idaho submitted to 

nominate him. 

Brad Bigford front yard house call 

Brad Bigford FNP at COVID testing site 

Brad has been a nurse since 2006 and a family 

nurse practitioner since 2012. In 2016 he started 

a small mobile urgent care practice to treat kids 

and adults in their homes for any reason that they 

would use a walk-in clinic, UTIs, strep throat, ear 

infections, rashes, lacerations, etc. The mission 

was to increase peoples’ access to healthcare. The 

service is named Table Rock Mobile Medicine. 

Things were going fine before COVID. When 

COVID-19 hit Idaho in March 2020, all of the 

Personal Protective Equipment (PPE) was suddenly 

gone. Table Rock Mobile Medicine had over 5,500 

followers on Facebook so they put out a call for 

help. Anyone with cleaning supplies, PPEs such 

as gloves, eye protection, masks, etc., was asked 

to consider donating them. Brad started having 

clinics reach out stating they were also having PPE 

access problems. An ER nurse who works at a 

small rural hospital called saying she was sharing 

a N95 with another ER nurse and they were 

seeking mask supplies. There were also home 

health and hospice providers and family practice 

clinics requesting supplies. In the first month of the 

pandemic Table Rock had received and distributed 

over 300 masks, 50 goggles, dozens of 3D printed 

face shields and other items at a time when you 

could not buy hand sanitizer. 

At the start of the pandemic Table Rock Mobile 

Medicine only had 2 providers and by September 

it had grown to five NPs because of the volume 

of patients and people being afraid to leave 

their homes to go to a clinic. During the first few 

months the NPs did many visits on people’s 

front doorsteps. They masked up from the very 

beginning but some people still didn’t want them 

in the homes. They gave people IV fluids on their 

front porch, diagnosed pneumonia in the front 

yard of a man who was sick with COVID and 

occasionally needed to call 911 for people who had 

put off seeking treatment because they were afraid 

of going to the hospital. 

In April Table Rock partnered with a local lab 

who had access to COVID-19 tests at a time when 

getting any kind of test outside of an emergency 

room was extremely difficult. Brad participated in 

establishing a non-profit called ACT Idaho (ACT = 

Access COVID Testing) to make it as affordable as 

possible. ACT operated from April to August and 

tested thousands of people. Brad would call any of 

the positive patients and notify them of their result 

and how to quarantine. Brad worked in a pop-up 

tent in the lab parking lot where he would screen 

patients and discuss the test with them. 

Finally, Table Rock is a very pro-science/ 

evidence based treatment clinic. NPs advocate 

for vaccines on social media and do a yearly flu 

shot clinic going to people’s homes to vaccine 

families. Last year they vaccinated 1,500 people 

in their homes, often in people’s yards. Idaho 

has quite a vocal anti-vaccine group and one 

social media post about an upcoming flu shot 

clinic at a men’s barbershop that was focused on 

increasing men’s access to healthcare and influenza 

vaccines resulted in hundreds to thousands of 

harassing texts messages, insulting comments 

and threatening phone calls. This incident was 

reported in the Idaho Statesman newspaper, https:// 

www.idahostatesman.com/living/health-fitness/ 

Brad Bigford FNP believe nurses 

article235680912.html. That article led to a follow-up 

article published in the New York Times last March, 

https://www.nytimes.com/2020/03/10/health/ 

vaccines-protest-doctors.html. These events did not 

negatively impact the work that Brad has done to 

promote access for both men and women in Idaho. 

Like most nurses, Brad is a supporter of 

vaccinations. He tries to be proactive & positive in 

promoting vaccines because of their importance 

in saving the lives of children all over the world. 

He even came up with a version of Mr. Roger’s 

“Won’t You Be My Neighbor” that he call, “Let Us 

Be Caring Neighbors,” https://www.youtube.com/ 

watch?v=DaSSd7hif1E. 

Idaho nurses are incredibly happy that Brad has 

been selected by J&J to be featured in a national 

recognition public service program. His efforts 

to coordinate PPE distribution, promote access 

to COVID testing through ACT, provide followup 

education for COVID positive patients through 

ACT, and for increasing at-home provider care 

throughout the pandemic demonstrates what a 

creative entrepreneurial nurse can accomplish. For 

updates on when these PSAs featuring Brad will be 

released check the nursing association websites 

for announcements and be on the look-out for the 

J&J PSAs on regular television. 

Brad Bigford outside COVID clinic


The Cures Act: What Nursing Professionals Need to Know 

Georgia Reiner, MS, Senior Risk Specialist, 

Nurses Service Organization (NSO) 

Editor’s note: In April, ANA-Idaho entered into an agreement with the ANA, 

along with many other ANA state affiliate organizations, to participate in 

the newly re-designed comprehensive Member Benefits Program. One of 

the benefit offerings is an updated and discounted malpractice coverage 

program through NSO Liability Insurance. NSO also participates in a topical 

education program designed to inform nurses about the impacts of current 

legislation and practice developments. This article is provided as a benefit of 

participating in the ANA Benefit Program. 

In December 2016, President Obama signed the 21st Century Cures Act 

(“Cures Act”) into law, and the US Department of Health and Human Services 

published the final rule on May 1, 2020. The act has several elements of 

interest to healthcare providers, including regulations designed to facilitate 

sharing of data for research purposes, thereby accelerating drug and device 

development, and those designed to improve interoperability so that patients 

have easier access to their health information. 

However, the act has the potential to create difficulties for both patients 

and healthcare providers. Nurse practitioners, registered nurses, and other 

nursing professionals need to understand the act, its benefits and potential 

risks, and how to protect themselves against legal action. 

What is the Cures Act? 

One of the Cures Act’s goals is to speed development of new treatments 

through a variety of methods, including data sharing. The act also promotes 

patients’ ready access to information in their electronic health record. 

Although patients already have the right to access their information under 

the Health Insurance Portability and Accountability Act (HIPAA), the Cures 

Act focuses on quick, free access to electronic health information (EHI), 

including consultation notes, discharge and summary notes, history and 

physical, imaging narratives, lab report narratives, pathology report narratives, 

procedure notes, and progress notes. The act requires organizations to have 

a secure “application programming interface” so patients can access this 

information via apps on their personal devices. 

Failure to provide patients with access can result in penalties related to 

“information blocking.” The act defines information blocking as practices 

“likely to interfere with, prevent, or materially discourage access, exchange, or 

use of electronic health information,” which includes delays in giving access. 

The Office of the National Coordinator for Health Information Technology 

has issued eight exceptions that will not result in penalties for information 

blocking: 

• preventing harm 

• privacy 

• security 

• infeasibility 

• health information technology (IT) performance 

• content and manner 

• fees 

• licensing. 

The “preventing harm” exception is of particular interest to healthcare 

providers and states: “It will not be information blocking for an actor 

[healthcare provider] to engage in practices that are reasonable and 

necessary to prevent harm to a patient or another person, provided certain 

conditions are met.” It’s beyond the scope of this article to review each 

exception and its associated conditions; more information can be found at 

www.healthit.gov/topic/information-blocking. 

The deadline for compliance with most of the act’s parameters that 

directly impact healthcare providers was April 5, 2021; full compliance with all 

information-blocking provisions will be required on October 6, 2022. 

What are the potential risks? 

Although providing patients with access to information is a worthy goal, 

that access can create problems. For example, a patient with slight chest 

discomfort who is waiting in the ED to see a provider may access their lab 

results via their smartphone app and incorrectly assume they don’t have a 

problem because no test is marked “abnormal.” The patient may then leave 

without seeing the provider, but later return with serious heart damage. Or 

a patient accessing their health record could object to terms or labels used, 

such as seeing that a nurse listed “male-to-female transgender” as a “health 

issue” in their record. Issues such as these can affect the clinician-patient 

relationship between nurses and their patients, and even result in lawsuits. 

Another challenge is balancing access with privacy protection. There has 

been confusion as to what is meant by EHI and how it relates to electronic 

“protected health information (PHI)” listed under HIPAA. The definition of EHI 

in the final rule is aligned with the information in HIPAA, so it’s important that 

nurses review what falls under PHI (see Protected health information). 

How can nurses protect themselves? 

Nurses, other healthcare providers, administrators, and IT personnel 

should understand the act’s requirements, particularly as they relate to 

information blocking, including the eight exceptions that will not result in 

penalties for information blocking, listed above. Before proceeding with acting 

under an exception, nurses should consult with a risk manager. 

It’s also important to know nurses still need to adhere to state 

requirements for sharing EHI. If, for example, a state law prohibits sharing 

certain EHI, nurses should follow the law. And, of course, nurses need to 

adhere to HIPAA requirements, which include PHI in paper, electronic, and 

verbal formats. 

More data may prompt patients to ask more questions. Therefore, it’s a 

good time for nurses to remember to document patient counseling fully in the 

health record so they are protected in case of legal action. 

Meeting information needs 

As awareness of the act increases, more patients are demanding access 

to their EHI. Nurses need to ensure that this access is available, while 

remembering that it’s up to them to help patients interpret that information 

correctly and to document education and counseling efforts completely in the 

health record to protect themselves from liability. 

Joining Your Professional Organization 

“The rising tide raises all ships…” Engaging with your professional organization 

has many benefits for both you and the profession as a whole. No one is expected to join 

every organization but choose the one that best meets your professional needs and join 

it. Membership is important and it sustains the organizations which in turn benefits every 

professional nurse and helps promote and benefit the profession as a whole. 

Joining is easy! It can be accomplished on the organization website. Visit the website 

HOME PAGE of the association you want to support and follow the instructions how to join. All of 

the nursing organizations listed below participate in the Idaho Center for Nursing. 

RNs: 

idahonurses.nursingnetwork.com/ 

Nurse Practitioners: 

npidaho.enpnetwork.com/ 

Program for Recovering Nurses 

Addiction Intervention and Recovery 

Services for Nursing Professionals 

Do you know a nurse or a colleague who needs help for 

drugs/alcohol or mental health problems? 

Please contact us for assistance. This program is an 

alternative to disciplinary action offered by the BON. 

For immediate assistance, please call us at 800-386-1695 

www.southworthassociates.net 

CRNAs: 

idahoana.org/ 

Nurse Leaders of Idaho: 

nurseleadersidaho.nursingnetwork.com/


Protected health information 

HIPAA specifies that PHI is “individually 

identifiable health information” that relates to the 

person’s past, present, or future physical or mental 

health or condition; the provision of healthcare to 

the person; or the past, present, or future payment 

for the provision of healthcare to the individual. 

It refers to information transmitted in any form 

(verbal, paper, electronic). 

Here are items that could be used to identify a 

person, so they are included under PHI: 

• Names (full or last name and initial) 

• Geographical identifiers smaller than a state, 

except for the initial three digits of a zip code 

(but only under specific conditions) 

• Dates (other than year) directly related to an 

individual 

• Email addresses 

• Phone, fax, medical records, account, 

certificate/license, and Social Security 

numbers 

• Health insurance beneficiary numbers 

• Device identifiers and serial numbers 

• Vehicle identifiers 

• Web Uniform Resource Locators (URLs) 

• Internet Protocol (IP) address numbers 

• Biometric identifiers, including finger, retinal, 

and voice prints 

• Full-face photographic images and any 

comparable images 

• Any other unique identifying number, 

characteristic, or code except the unique 

code assigned by the investigator to code 

the data. 

Nurses should keep PHI information confidential 

and only share with the patient’s authorization. 

Failing to adhere to privacy standards may result in 

significant penalties, as well as legal action. 

References 

Aebel E.S., Newlon A.J. 2020. Increased patient access 

under the 21st Century Cures Act: what it means 

for providers. Trennan Law. www.trenam.com/ 

trenam-news/increased-patient-access-underthe-21st-century-cures-act-what-it-means-forproviders. 

Ambulatory Surgery Center Association. 2020. Cures 

Act final rule. www.ascassociation.org/asca/ 

federalregulations/overview/cures-act. Federal 

Register. 2020;85(85). 45 CFR Parts 170-71. 

Majumder M.A., Guerrini C.J., Bollinger J.M., Cook- 

Deegan, R., McGuire A.L. 2017. Sharing data 

under the 21st Century Cures Act. Genet Med. 

19(12):1289-1294. 

Posnack S., 2020. Pssst…information blocking 

practices, your days are numbered…pass it on. 

HealthIT Buzz. www.healthit.gov/buzz-blog/ 

information-blocking/pssst-information-blockingpractices-your-days-are-numberedpass-it-on. 

Primeau D., James J., 2020. Game planning the 

information blocking final rule. J AHIMA. https:// 

journal.ahima.org/game-planning-the-informationblocking-final-rule. 

Office of the National 

Coordinator for Health Information Technology. 

Cures Act final rule. Information blocking 

exceptions. www.healthit.gov/topic/informationblocking. 

US Department of Health and Human Services. 

2020. 21st Century Cures Act: interoperability, 

information blocking, and the ONC Health IT 

Certification Program. www.federalregister.gov/ 

documents/2020/05/01/2020-07419/21st-centurycures-act-interoperability-information-blockingand-the-onc-health-it-certification. 

US Department of Health and Human Services. 

Summary of the HIPAA privacy rule. OCR Privacy 

Brief. 2013. www.hhs.gov/hipaa/for-professionals/ 

privacy/laws-regulations/index.html. What is 

protected health information? HIPAA J. 2018. 

www.hipaajournal.com/what-is-protected-healthinformation. 

U.S. Department of Health and Human Services. 

Summary of the HIPAA Privacy Rule. OCR Privacy 

Brief. 2013. www.hhs.gov/hipaa/for-professionals/ 

privacy/laws-regulations/index.html; What is 

protected health information? HIPAA J. 2018. 

www.hipaajournal.com/what-is-protected-healthinformation. 

Disclaimer: The information offered within this 

article reflects general principles only and does 

not constitute legal advice by Nurses Service 

Organization (NSO) or establish appropriate or 

acceptable standards of professional conduct. 

Readers should consult with an attorney if they 

have specific concerns. Neither Affinity Insurance 

Services, Inc. nor NSO assumes any liability for 

how this information is applied in practice or for the 

accuracy of this information. 

This risk management information was provided 

by Nurses Service Organization (NSO), the nation’s 

largest provider of nurses’ professional liability 

insurance coverage for over 550,000 nurses since 

1976. The individual professional liability insurance 

policy administered through NSO is underwritten by 

American Casualty Company of Reading, Pennsylvania, 

a CNA company. Reproduction without permission of the 

publisher is prohibited. For questions, send an e-mail to 

service@nso.com or call 1-800-247-1500. www.nso.com. 

Nursing News Updates for Idaho 

National Institute of Medicine Report, The 

Future of Nursing 2020-2030: Charting a Path 

to Achieve Health Equity — The new report is 

a follow-on to the famous 2010 report titled The 

Future of Nursing: Leading Change, Advancing 

Health. The new report will be released at a national 

teleconference on Tuesday, May 11, 2021, at 1PM 

MDT. Pre-registration is needed to access the 

teleconference. You can register at: The Future of 

Nursing 2020-2030 - National Academy of Medicine 

(nam.edu). 

Dori Healey, MSN-RN, MBA-HA, CPPS, 

ANA-Idaho President — was featured in the ANA 

Leadership Insights column of the American Nurse 

magazine in December 2020, as a change maker. 

In addition to being the ANA-Idaho president for 

2021-2022, Dori is also a member of the ANA-PAC 

(Political Action Committee) and serves as ANA-PAC 

treasurer. 

ANA-Idaho Offers New Member Benefits — 

ANA-Idaho has entered into a new benefit package 

whereby members can access discounted benefit. 

The new benefits include (1) a Home and Auto 

Insurance program with Liberty Mutual that will be 

launching in May 2021, (2) the recent launches of 

the NSO Liability Insurance, (3) Laurel Road Student 

Loan Refinancing, and (4) Prudential Term Life and 

AD&D insurance programs, (5) Long Term Care 

insurance program via Anchor/Mutual of Omaha 

and, (6) Travel discounts via Booking Community 

programs. Additionally, the Prudential Financial 

Wellness program is being reclassified as an ANA 

Member Benefit program (not a Personal Benefit 

program which has the optional programs that 

members may utilize). More information about 

personal benefits is available on the ANA-Idaho 

website at Personal Benefits | ANA Idaho | Nursing 

Network. 

Idaho Nursing Education Fund (Formerly 

the Idaho Nurses Foundation) Now Offering 

Charting Idaho Nursing History book — This 

landmark book about the history of Idaho nursing 

from before the Civil War to present day was first 

published in 2009. In the past 10 years thousands of 

copies of this book have been purchased, received 

as gifts, and added to libraries. The authors 

dissolved their publishing LLC and have donated all 

remaining copies to the Idaho Nursing Education 

Fund, with the intent that all income from future 

book sales will be used by the Fund to support 

Idaho based nursing education. To read about the 

book or to buy a copy go to: Purchase Order Form 

| Idaho Center for Nursing | Nursing Network. All 

purchases and Fund Donations are tax deductible 

as a donation to an educational 501c3 nursing 

philanthropy. 

Idaho Nursing Student Association Elects 

New State Officers for 2021 — INSA has 

chapters at almost every school in Idaho and has 

maintained sufficient membership and school 

participation to maintain Idaho being a state affiliate 

of the National Student Nurse Association. Last year 

INSA affiliated with the Idaho Center for Nursing for 

management assistance to sustain the organization 

on a year to year basis when student officers 

graduate and there is significant membership turn 

over. For 2021, the newly elected state officers are 

Nikita Gonzalez, President, from College of Eastern 

Idaho, Dane Larson, Vice-President from Boise 

State University and Hayley Brown, Secretary/ 

Treasurer from Boise State University. 

Idaho Board of Nursing Announces RN and 

APRN License Renewal opens May 1 and ends 

August 31. Access the renewal application through 

the nurse portal. https://ibn.boardsofnursing.org/ibn 

This year nurses are required to attest to completing 

Continued Competence Requirements (CCR) on the 

renewal application. Please note that the license 

renewal application may be delayed, denied, and/or 

result in disciplinary action if nurses fail to attest to 

completion of CCR requirements. Board staff will 

not be pre-approving CCRs prior to submitting 

the renewal application. 

In addition, nurses may be audited at a later 

date for compliance with these CCR requirements. 

If nurses are selected for an audit, they will be 

contacted to submit documentation proof of 

CCR completion to the Idaho Board of Nursing. 

Newly graduated RNs are exempt from Continued 

Competence Requirements for the first renewal 

cycle after initial licensure. If nurses do not renew 

their license within the renewal period, they will 

be required to submit a reinstatement application 

including a new fingerprint-based background 

check. For additional information about the 

application process, including the Continued 

Competence Requirements please contact our 

office using the below options: 

Continuing Education Available on-line at icn - 

CE Catalog (ce21.com) (https://icn.ce21.com) This 

is approved CNE that can be accessed on-demand 

and is sponsored by ANA-Idaho, focused on Idaho 

programs and economical to meet Idaho nurses’ 

CNE needs. 

— Governor Little’s office has posted 3 

vacancies for the Idaho Board of Nursing, 2 RNs 

and 1 Public non-nurse member. To apply go to 

the Governor’s Office website or access the link at: 

Appointments | Office of the Governor (idaho.gov)


ADVOCACY IN ACTION 

The 2021 Idaho Legislative Session 

Michael McGrane, RN, MSN 

Senior Lobbyist 

Benn Brocksome & Associates 

mcgraneconsulting@gmail.com 

As 2020 is the year that never ends, the 2020-2021 Legislative Session never 

ends. The 2021 session formally began on January 11th, however this year’s 

session really began March 16, 2020, when Governor Little announced restrictions 

as COVID-19 emerged in Idaho. That initial round of restrictions identified 

“essential” and “non-essential” businesses and workers. The 2020 Legislature was 

in its final week with some senators and representatives leaving early to avoid the 

contagious spread. Enough lingered to push-back on the Governor’s order. At the 

time Blaine County was a national COVID-19 hotspot. There was still little known 

about the virus and how it spread. But the idea of blanket shutdowns across 

the state riled many of the more rural and conservative legislators from districts 

unaffected by the virus. Recognizing the diversity in those areas affected, and 

those so far unaffected, the Governor allowed the regional health districts, cities, 

and counties to initiate health orders rather than closing the entire state. This riled 

those who could see the infectious impact of the pandemic who felt the Governor 

was failing to act. 

During the summer of 2020, a group of right-wing legislators held a mock 

legislative session at the capitol to decry the Governor’s restrictions and hail 

personal freedoms that included the right to work, the right not to wear masks, 

and general resistance to any health orders. Under the Idaho Constitution, only 

the Governor can call a special session of the Legislature, but must specify the 

issues the legislature can consider. So, in August, Governor Little called a special 

session to consider two topics, legislation to allow for safe and smooth elections 

in November, and liability protection for businesses during the pandemic. Nonethe-less, 

the legislature, while limited by the Constitution, took the August Special 

Session as an opportunity to attack the Governor and health restrictions. Along 

with the health concerns, Idaho received $1.25B in federal CARES Act economic 

stimulus funding. In April, Governor Little created the Coronavirus Financial 

Advisory Committee to allocate those federal funds. The Governor’s committee 

included Senator Steve Bair and Representative Rick Youngblood who both chair 

the Joint Finance Appropriations Committee (JFAC) of the Legislature. JFAC is 

the committee that approves all state budgets. The constitutional power of the 

Legislature is the “power of the purse,” or the authority to allocate state funds. Even 

with representation on the Governor’s advisory committee, legislators were up in 

arms that they were not consulted nor the ones who allocated those extra federal 

funds. 

In advance of the 2021 Legislative Session, legislators began drafting bills 

to restrict the Governor’s authority to call an emergency, restrain the Director of 

the Department of Health and Welfare and health districts’ authority to issue 

mask, quarantine or isolation orders, and allow the legislature to call themselves 

into special session and declare or limit emergency declarations. Along with the 

funding authority, these topics pitted the legislative branch against the executive 

branch and propelled the 2021 Legislative Session. 

Typically, there is a flow to the session where agency rules are heard during 

the first few weeks of the session, then there is a limited period for introduction 

of “personal bills” followed by more formal committee bills and hearings and 

ending with the budget bills that must be completed by the end of the session and 

the “going home” bills which are the big political items that define the session’s 

success. This year, however, the Session opened in a scramble, as leadership 

allowed personal bills to be introduced immediately. With all the attention on health 

restrictions and the Governor’s emergency authority, a plethora of “freedom” bills 

flooded the first few weeks of the session, creating a lot of public attention and 

internal confusion on what process was being followed. Many legislators used the 

opportunity to run pet or politically advantageous issues while at the same time, 

state agencies tried to navigate their rule approvals and necessary bills. Despite 

constitutional concerns, the legislature attempted to take power away from the 

Governor, defund the Governor’s projects, defund the Attorney General’s office in 

retaliation for advice they considered unsupportive of the legislature’s goals, and 

assert their authority to control the budget. Idaho is the only state to have run a 

surplus and add jobs during the pandemic. 

Fortunately, for health care, the 2021 Session was tame. Representative Fred 

Wood, a retired physician from Burley, and the eldest member of the legislature, 

is Chairman of the House Health and Welfare Committee. He stayed back during 

the initial days of the session and made it clear that his committee would only hear 

necessary legislation. The number of bills considered by the House Committee 

were filtered through a sense of reasonableness and necessity and were way 

fewer in number than past years. The Senate Health and Welfare Committee, 

chaired by Senator Fred Martin, also fielded few bills, mostly in response to the 

House committee’s actions. Accommodations were made for social distancing and 

remote testimony for committee hearings. 

Here is a rundown of nursing and healthcare rules and bills. Administrative Rules 

become effective upon adjournment of the Legislature. Bills become effective on 

July 1st unless there is an emergency provision which then become effective upon 

the Governor’s signature.



Board of Nursing Rule Changes 

• The $10 Nurse Apprentice application fee is eliminated. 

• A temporary license awaiting exam results may now be issued 30 days prior 

to graduation. 

• Temporary licenses issued to examination candidates are issued for a 

period not to exceed ninety days. 

Board of Nursing 

House Bill 37 – Nursing Disciplinary Action - Signed by the Governor, 

becomes Law 

This bill extends license action under the Nurse Practice Act to include “guilty 

pleas” for a criminal conviction. This is related to a 2019 case. In that case, the 

Board of Nursing could only act once the individual was convicted despite having 

made a guilty plea. 

Telehealth 

Despite an exponential increase in the use of telehealth during the pandemic 

and the work of the Telehealth Task Force, none of the three telehealth bills that 

were introduced passed. 

Senate Bill 1126 – Virtual Care Access - Passed Senate (30–5–0) – Held in 

House Health and Welfare Committee 

Senate Bill 1126 was introduced in the Senate Health and Welfare Committee, 

which would implement the Telehealth Task Force’s recommendations and create 

the Virtual Care Access Board. Senate Bill 1126 passed the Senate but was pulled 

from the House Health and Welfare Committee. 

Senate Bill 1127 – Telehealth – Held by the Chairman in Senate Health and 

Welfare Committee 

Senate Bill 1127 would have expanded telehealth to include new technology. 

This is in line with the Telehealth Task Force Recommendation to include 

asynchronous communication. 

House Bill 179 – Interstate Health – Held by Chairman in House Health and 

Welfare Committee 

House Bill 179 - This bill would have allowed out-of-state telehealth providers, 

licensed in other states, to practice in Idaho without an Idaho license. The 

telehealth license waiver was part of the Governor’s executive order related to 

the COVID-19 public health emergency. This bill would have made that waiver 

permanent. ANA Idaho and NLI actively opposed this bill as it could significantly 

impact license fees paid to the Board of Nursing and impact activities to support 

nurses in Idaho. 

Limits to Public Health Orders 

Senate Bill 1060 – Public Health Orders - Signed by the Governor, 

becomes Law 

Health orders issued by a Health District become effective immediately but must 

be approved or denied by the County Commissioners of the affected counties. It 

also reduces public health order violations from a misdemeanor to an infraction 

with a third violation becoming a misdemeanor. 

Senate Bill 1139 – Health and Welfare Director Duties - Passed Senate, 

Awaiting House Floor Vote 

The bill defines “quarantine” into law and would limit the powers of the Director of 

Health and Welfare to order isolation or quarantine during a public health emergency. It 

also sets a three-day court challenge to a quarantine or isolation order. 

Medical Marijuana 

In April, Kind Idaho received permission from the Secretary of State to begin 

collecting signatures for a voter initiative to place medical marijuana on the November 

2022 ballot. Under current law, signatures from 6% of those who voted in the previous 

election from 18 of Idaho’s 35 legislative districts are required to get an initiative on the 

ballot. This would require 65,000 valid signatures to get the medical marijuana initiative 

on the ballot. An effort to further restrict voter initiatives along with a more restrictive 

medical marijuana bill than the one proposed by Kind Idaho and a constitutional 

amendment that would prohibit any illicit drugs from ever being approved were efforts 

this session to block medical marijuana. SJR101, the constitutional amendment only 

requires legislative approval, not voter signatures nor the Governor’s signature to 

appear on the November 2022 ballot. 

Senate Bill 1110 – Voter Initiatives – Passed Senate – Awaiting House Floor 

Vote 

This bill would further increase the requirements to place any voter initiative on the 

ballot. It would require signatures from 6% of voters in the past election from all of 

35 legislative districts from the current law that requires signatures from 18 legislative 

districts. 

Senate Joint Resolution 101 – Anti-legalization Constitutional Amendment – 

Passed Senate – Awaiting House Floor Vote 

S101 would add a new section to the Idaho Constitution to prohibit any future law 

that would allow the production, distribution, possession or use of psychoactive drugs, 

any schedule I or II drugs, not approved for medical use, lawfully prescribed, and 

lawfully dispensed. A constitutional amendment would supersede any voter initiative or 

legislative action to approve medical marijuana. 

The 2021 Idaho Legislative Session continued on page 20 

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The 2021 Idaho Legislative Session continued from page 19 

House Bill 108 – Medical Cannabis Act – Held by the Chairman in House Health 

and Welfare Committee 

This bill would have regulated medical marijuana under the Board of Pharmacy, 

moving it from a schedule I to a schedule II classification for specific conditions. It 

would have required dispensing from licensed pharmacies with limited concentration 

and prescribing, and require the source to be from licensed manufacturers and 

distributors, prohibiting the production of marijuana, even for personal use. 

Healthcare 

House Concurrent Resolution 11 – 988 Suicide Prevention Hotline - Passed 

House – Awaiting Senate Floor Vote 

Idaho has 40% more suicide cases than the national average, and 2020 had 

a substantially higher number of cases than previous years. Federal legislation in 

2020 established the universal 988 phone number for mental health and suicide 

crisis. The law left it to the states to implement and fund the 988 effort. Idaho 

currently uses the national 800 suicide hotline that routes calls from the 208-area 

code to the Idaho center. The new 988 number will ensure that anyone located 

in Idaho can access the Idaho hotline without regard to their originating phone 

number. This resolution will allow Health and Welfare to come back next session 

for funding and other resources to support the hotline. 

House Bill 315 – Opioid Judgement Settlements – Passed House to Senate 

Health and Welfare Committee 

The state has received $2.3M in one settlement and has joined other states 

in another lawsuit with a $20M settlement in the opioid crisis. This bill establishes a 

settlement fund to deposit this money. It authorizes the legislature to appropriate these 

funds for drug treatment and behavioral health to be overseen by the Idaho Behavioral 

Health Council. H315 is on the committee agenda for when they return in April. 

House Bill 316 – County Public Health Districts – Passed House – Under 

Consideration by Senate Health and Welfare Committee 

Thursday, the Senate Health and Welfare Committee heard testimony on H316. 

The hearing was to be continued to Monday, March 22nd, however with the 

legislature now in recess, the hearing will be continued Wednesday, April 7th. 

Under existing law, the counties cover the first $11,000 of indigent claims, and 

the state Catastrophic Health Care (CAT) fund covers the remainder for those who 

qualify. With Medicaid Expansion, most of those who would be covered under 

indigent care are now eligible for Medicaid. In aggregate the counties pay $9.8M 

and the state CAT fund pays $19M for indigent care. This bill would limit county 

liability in providing indigent services now that Medicaid Expansion has passed. 

The bill says that those who qualify for Medicaid, including Expanded Medicaid, 

or those who are eligible for private insurance, even if they do not seek insurance 

coverage, are not eligible for county indigent fund coverage. It precludes individuals 

who refuse to obtain any coverage from being covered by the counties. 

A second piece of this bill would move $9.8M from the state’s general fund 

designated for the Public Health Districts to the counties to operate the Health 

Districts. The counties will save because they are no longer paying for indigent 

care, so with this the counties pick up the cost of operating the health districts. The 

state’s savings from the CAT fund will be used to help fund Medicaid Expansion. 

House Bill 209 – Medicaid Budget Stabilization Fund - Failed House Floor 

Vote (25 – 42 – 3) 

This piece of legislation would have created a Medicaid Stabilization Fund. FY 

2020 there was $65M left over that was lost somewhere in the general fund. A 

budget stabilization fund creates dedicated Medicaid funding placed in an interestbearing 

account funded through General Fund dollars that could only be expended 

on appropriation by the legislature. 

House Concurrent Resolution 14 – Forced Vaccinations – Passed House 

(66-0-4) – to Senate Health and Welfare Committee 

This is a resolution that the Idaho Legislature affirms the protection of the human 

right that no mandate would ever justify or permit the use of forced immunizations, 

vaccinations, inoculations, or genetic modifications against a person’s will, even 

during a health emergency. The legislature will oppose any effort, including federal 

law, that would force a person to receive a vaccination. This is unlikely to get a 

hearing on the Senate side. 

House Bill 249 – Human Sexuality, Instruction - Passed House Education 

Committee – Passed the House (56 – 12 – 2) – Awaiting Hearing in Senate 

Education Committee 

House Bill 249 is presented as a parental rights bill. It distinguishes between 

“Sex Education” which teaches anatomy and human reproductive physiology 

and “Instruction in Human Sexuality” that teaches sexual activity, gender identity 

and sexual pleasure. Under current law, a parent can opt-out of sex education. 

This bill would require parents to opt-in to human sexuality instruction for their 

children. 

School nurses are concerned that this could limit their ability to provide honest 

education and support for students and place them, and their schools, at risk of 

legal liability. 

H249 was repeatedly scheduled for a hearing in the Education Committee but 

pushed back as other bills had extensive testimony. It was rescheduled for next 

Monday, March 22nd, but with the suspension of all committee hearings until April, 

it will now likely get a hearing when the session resumes. 

House Bill 233 – Child Custody – Removal – Passed House, Filed for Senate 

Floor Vote 

For families seeking mental health support for their children with serious mental 

health disturbances, sometimes as a last effort of hope, in seeking help, they 

would often encounter threats or actions of child protection to separate the child 

from their parents. This bill adds a section to the Children’s Mental Services Act to 

protect children from being separated from their parents when seeking crisis care. 

As of this writing, the Legislature has taken a two-week recess until April 6th 

in response to the increased coronavirus cases at the capitol. Several legislators 

have contracted coronavirus. With another $1.9B, the state’s share of the American 

Rescue Plan Act, when they return, the Legislature may well stay in session even 

longer to retain control over those funds, address the two “going home” items, 

Transportation Funding and Tax Relief, and further grab emergency powers from 

the Governor. This is the Session that never ends. 

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PRACTICE MATTERS 

Part 1: Embracing the Power of Simulation 

Michaelyn Muggli, MSN, RN, NPD-BC, CCRN-K, 

CHSE, Clinical Educator, Simulation Program, 

St. Luke’s Health System 

mugglim@slhs.org 

Tammye Erdmann, MSEd, BSN, BScIT, RN, 

CHSE, Director, Simulation Program, 

St. Luke’s Health System 

erdmannt@slhs.org 

The authors have no conflicts of issue including 

financial or commercial affiliations. 

Editor’s Note: 

This article is the first in a four-part series on 

The Power of Healthcare Simulation. The second 

article will explore how fidelity in simulation evokes 

emotions. 

Simulation has disrupted the status quo of healthcare 

education. Traditional pedagogy of teacher-centered 

lecture and testing is being replaced by interactive 

scenarios, team-based performance, and reflectionon-action 

strategies. Simulation-based education (SBE) 

creates realistic learning events that evoke emotion, involve 

the senses, and allow learners to make decisions based 

on their frame of references and previous experience. 

Technological developments of tactile devices and hightechnology 

manikins support the learning environment. 

St. Luke’s Health System (SLHS) began using 

simulation as a teaching modality in 2007 offering 

simulated events to emergency medical responders 

and critical access hospital staff. Through this learning 

modality, the SLHS Simulation Program has been 

developed, holding a variety of clinical and team 

performance simulations across our health system 

allowing us to interact with thousands of learners. The 

system staff has witnessed the power of simulation and 

are pleased to share this experience with you in this fourpart 

series. This article will highlight the power of simulation 

as an innovation in learning, describe why fidelity evokes 

emotion, explain the neuroscience of simulated learning, 

and explore how debriefing provides the opportunity to 

reflect on one’s experience and promote practice change. 

Simulation provides an opportunity to view delivery 

of healthcare through a lens we’ve never had by gaining 

insight from a different perspective about how healthcare 

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teams perform. Through the application of simulated 

learning, organizational processes can be effectively 

evaluated, as well as individual and team performance 

in a safe and controlled environment. Examples include 

determining readiness of a new hospital for opening day, 

evaluating team performance in response to post-partum 

hemorrhage, and identifying improvement opportunities in 

code blue events. 

What is it about SBE that leads to learning long after 

the experience has ended? Key learning happens when 

things go wrong, not necessarily when things go right. The 

associated emotions and reflection on actions after the 

event become the lessons learned. This helps learners see 

fallibility as part of professional practice facilitating insight 

PARTING WORDS 

Sara F. Hawkins PhD, RN, CPPS 

Feeling nostalgic, I recently flipped through the 

pages of old American Journal of Nursing magazines 

in our medical library. The first one I pulled was dated 

December 2014. The editorial caught my attention: 

“Our Ebola Wake-Up Call: What have we learned from 

this crisis?” For historical context, Ebola escalated 

as an epidemic in West Africa in March 2014. The 

first patient in the United States was identified in 

September followed by two nurses who cared for the 

patient diagnosed in late October. Ebola engendered 

a high level of fear among the public and providers. 

Kennedy (2014) writes about the circumstances of 

into themselves and their practice and subsequently 

promoting practice change. There is a strong sense that 

making mistakes and the associated unpleasant emotions 

are a key part of learning and has often been described as 

one of the key benefits of simulation. 

There exists the potential to produce better learning 

outcomes using SBE emphasizing deliberate practice and 

mastery learning, giving learners an opportunity to think 

differently about their performance. Working in a simulated 

environment allows learners to make mistakes without 

the need for intervention by experts to stop patient harm. 

By seeing the outcome of their mistakes, learners gain 

powerful insight into the consequences of their actions 

and the need to “get it right.” 

What Have We Learned? 

the time – the reassurances from hospital and public 

officials that the US healthcare system was fully 

equipped to deal with such a virulent disease, the 

public confusion and concern about a new deadly 

disease, and the frequent mixed messaging and 

changing policies and rules. Kennedy asked, “I can’t 

help but wonder why we weren’t better prepared, not 

only with equipment but with an action plan and a 

communication strategy…” (p. 7). 

Oh, the irony! 

Reference 

Kennedy, M. S. (2014, Dec). Our Ebola wake-up call: What 

have we learned from this crisis? American Journal of 

Nursing 114(12), 7. 

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Nursing Informatics continued from page 5 of the Medicare enrollment and fee-for-service claims data (CMS OMH, n.d.a, p. 5). 

Table 1. 

Examples of Parameters for Conducting a Search With the MMD Tool 

chronic disease prevalence 

readmissions 

average inpatient days per 

admission 

inpatient admission discharge 

destination with various chronic 

conditions, a disability, or end 

stage renal disease 

Medicare 

spending 

mortality rates 

PSI (Patient 

Safety Indicators) 

admissions 

hospital and emergency 

department utilization 

potentially disabling 

conditions 

average Medicare 

reimbursement 

Hospital View Searching 

preventable 

hospitalization 

preventive services 

for Medicare 

beneficiaries 

inpatient admission 

type 

In Hospital View, different searches can be conducted for examining 50 quality of 

care measures and the cost of care (Medicare spending). Data for specific hospitals 

and/or comparisons by hospital type, location, and hospital size can be made. Data 

are derived from the CMS Hospital Compare database (CMS OMH, n.d.a). 

Figure 2. 

MMD Tool Population View: Search Parameters and Idaho’s Average Diabetes 

Mellitus Prevalence for All Races of Medicare Recipients in 2018 

Other sources of socioeconomic data are extracted from the American Community 

Survey provided by the U. S. Census Bureau for years 2012-2018 (CMS OMH, n.d.a, 

p. 5). 

Note that the population in the MMD Tool includes Medicare recipients only; but if 

“dual eligibility” is selected for the eligibility parameter for the population, it means that 

the Medicare recipient has been receiving full or partial Medicaid benefits at some 

point during the specific year. 

Figure 2 shows a typical search strategy in Population View using parameters to 

determine how the average prevalence data in 2018 across U.S. states/territories for 

diabetes mellitus Medicare recipients compares to the average national prevalence 

data for all races/ethnicities with this chronic condition. Once the search is run with 

these parameters, we can click on the map to review the results e.g. Idaho’s average 

prevalence data for all races/ethnicities (see results in Figure 2). Or, we have the 

option to run the search and download an Excel® spreadsheet containing average 

prevalence data for every U.S. state and territory compared to the national average 

prevalence. We can then extract data to compare Idaho’s average prevalence data 

for diabetes mellitus with data from one or more US. states/territories. By changing 

the race/ethnicity parameter to Hispanic, we can run another search to see 

prevalence data for the Black population. 

Implications for Nursing 

Costs associated with racial health disparities and poor health include lives lost 

and fewer weeks worked due to illness (Nanney et al., 2019). The National Academies 

of Sciences, Engineering, and Medicine [NASEM] (2017, p.39) also note that health 

disparities significantly add to the financial waste in the U.S. healthcare system. 

Healthcare spending in 2028 is expected to reach 19.7% of the gross domestic 

product, climbing from 17.7% in 2018 (Advisory Board, 2020). The NASEM (2017) 

further conclude that addressing health disparities and health inequities must be a 

national priority. Beyond economics, there are moral, political, and ethical factors to 

consider as an impetus for eliminating health disparities. 

Nurses at all levels and in any role have an opportunity to utilize the MMD Tool 

as a starting point for gaining knowledge about their community’s health disparities 

according to race/ethnicity or other variables for chronic health conditions. Of 

significant importance, the use of the MMD Tool can increase nurses’ understanding 

of health disparities and quality performance differences in order to plan for 

interventions of care (CMS OMH, n.d.b). Nurse leaders may choose to examine 

MMD data to compare hospital performance data for quality improvement purposes. 

Nurse researchers could use the tool to monitor health disparities or as a stepping 

stone to plan research studies to assess the effectiveness of interventions or better 

understand the influence of patient factors on the healthcare system. 

Population View Searching 

Population View will result in displaying disparities according to parameters such as 

geographic area, race/ethnicity, and others. Data for the Population View are derived 

from the CMS Chronic Condition Data Warehouse (CCW) that contains 100 percent 

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Conclusion 

To ensure that health disparities are addressed in our communities, health 

care professionals, researchers, and the public must first be aware of the existing 

interconnections between health, the environment, and socioeconomic and 

demographic data. The Medicare Mapping Disparities Tool is one resource to 

begin to examine health disparities. There are many available resources and case 

studies involving nurses that address dealing with health disparities (Fauteux, 

2021; IOM,2003; NASEM, 2017). Nurses are taking on new roles and making a 

“measurable difference” in addressing social determinants of health (Fauteux, 2019, 

p. 53). Before implementing nursing interventions, we must be knowledgeable about 

where and what those health disparities are. According to Fauteux (2021, p. 55), “… 

nurses should expect their work to entail an even greater effort to track and share 

patient data.” The MMD Tool can help nurses and the public in accessing health 

data to support an understanding of health disparities at the local, state, and national 

levels. 

References 

Advisory Board. (2020). CMS: U.S. healthcare spending will reach $4T in 2020. http://www. 

advisory.com/daily-briefing/2020/04/03/healthspending. 

Centers for Medicare & Medicaid Services Office of Minority Health [CMS OMH]. (n.d.-a) The 

Mapping Medicare Disparities Tool: Frequently asked questions. https://www.cms.gov/ 

About-CMS/Agency-Information/OMH/Downloads/MappingPublicFAQs.pdf 

Centers for Medicare & Medicaid Services Office of Minority Health [CMS OMH]. (n.d.-b) The 

Mapping Medicare Disparities Tool quick start guide. Retrieved 2/12/21 from https:// 

www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/MMDT-Quick-Start- 

Guide.pdf 

Centers for Medicare & Medicaid Services Office of Minority Health [CMS OMH]. (Dec. 20, 

2020). The Medicare Mapping Disparities Tool. [Data set]. Retrieved February 10, 2021, 

from https://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Mapping- 

Medicare-Disparities 

Fauteux, N. (2021). Beyond screening: Health systems invest in social determinants of health. 

AJN: American Journal of Nursing, 121(2), 53-55. 

Federal Data Strategy. (May 3, 2019). The Medicare Mapping Disparities Tool. https://strategy. 

data.gov/proof-points/2019/05/03/the-mapping-medicare-disparities-tools/ 

Institute of Medicine [IOM]. (2003). Unequal treatment: Confronting racial and ethnic 

disparities in health care. National Academies Press. http://www.nap.edu/openbook. 

php?isbn=030908265X. 

Nanney, M.S., Myers, S.L., Xu, M. Kent, K., Durfee, T.S., & Allen, M.L. (2019). Economic 

benefits of reducing racial disparities: the case of Minnesota. International Journal 

of Environmental Research and Public Health, 16(5). doi: http://doi.org/10.3390/ 

ijerph16050742 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427451/ 

National Academies of Sciences, Engineering, and Medicine [NASEM]. (2017). Communities 

in action: Pathways to health equity. The National Academies Press. http://doi. 

org/10.17226/24624 https://www.nap.edu/download/24624 

National Institute on Minority Health and Health Disparities. (2021). NIMHD Minority Health 

and Health Disparities Research Framework. Retrieved Feb. 9, 2021 from https://www. 

nimhd.nih.gov/about/overview/research-framework/ 

Weissman, J.S., Betancourt, J.R., Green, A.R., Meyer, G.S., Tan-McGrory, A., Nudel, J.D., 

Zeidma, J.A., & Carrillo, J.E. (2012). Commissioned paper: Healthcare disparities 

measurement. http://www.qualityforum.org/Publications/2012/02/Commissioned_ 

Paper__Healthcare_Disparities_Measurement.aspx


RN Idaho is pleased to honor Registered Nurses 

and Licensed Practical Nurses, who served the 

profession and are now deceased. The names are 

also submitted annually for inclusion in the Idaho 

section of the nursing memorial of the American 

Nurses Association. A nursing school graduation 

photograph is included when available. 

Editor’s Note: During the pandemic, we are 

attempting to identify any COVID related deaths if 

they are known. 

Adkins, Betty, 1927-2021, Monteview & 

Idaho Falls. After graduation from high school 

in Roberts in 1944, she attended the St. Anthony 

Mercy Hospital as a Cadet Corp student, 

graduating as a RN in 1947. She was a full time 

RN at Sacred Heart Hospital in Idaho Falls before 

working 25 years as a RN for the INL. 

Idaho Honors the Passing of Another 

Idaho Nursing Legend, Bee Biggs 

Bee Biggs RN, BSN, MPA came to Idaho in 1974 as a nurse 

with Mountain States Regional Medical Program (MSRMP). In her 

position with MSRMP, Bee secured federal funding to help nurses 

become Family Nurse Practitioners and even helped place new 

graduates from that program in needy rural areas around Idaho. 

During those years, Bee decided to augment the degrees she had 

by earning a Master’s degree in Public Administration from Boise 

State University in 1981. She then became the Assistant State 

Health Officer for the State of Idaho (at that time the Health Officer 

had to be a physician). She was an effective advocate for nursing 

and held one of the highest state jobs by a nurse until she retired. 

Bee was honored as an Idaho Nursing Legend for her 

contributions in promoting the profession. She joins several other 

Idaho nursing legends who have passed in the recent years: Sister 

Mary Agnes Richelin OSB, Alyce Sato, Dorothy Whitmer, and Sister 

Patricia Mulvaney CSC. 

Arrington, Helen Louise 

Gault, 1936-2020, Twin Falls. 

She attended the College of 

Southern Idaho and graduated 

at age 49. She then worked at 

St. Luke’s Magic Valley for 25 

years, until her retirement in 

2013 at age 76. 

Bailey-Sigler, Mary, 1929-2021, Boise. Mary 

worked as a nurse until she was 78 years old. She 

will be greatly missed by her patients and family 

members. 

Benzschawel, Mary Ziebarth, 1946-2021, 

Boise & McCall (complications of COVID-19). 

She graduated as valedictorian from Southwestern 

Community College in California. After moving to 

Idaho, she worked as an RN at St. Luke’s Boise 

Internal Medicine. 

Bruck, Mary Alice, 1933-2021, Boise. 

She grew up in Wyoming and after high school 

attended Carroll College in Helena, Montana. 

She graduated the nursing program in 1954. Her 

husband opened a dental practice in Boise in 

1973. 

Burke, Verda Lee, 1943-2021, 

Pocatello. She was raised in 

American Falls and graduated 

from the LPN program at Idaho 

State University. She worked at 

Power County Hospital and later 

at Lamb Weston as an employee 

health nurse. She was active in community nursing 

events and was chairman of the Power County Red 

Cross and taught CPR, First Aid and Advanced First 

Aid. 

Ennis, Evangeline, 1934-2021, Paul. She grew 

up in Iowa and later moved to Idaho. She graduated 

from St. Anthony Hospital School of Nursing in 

1955. 

Erramouspe, Betty, 1926-2021, Blackfoot. 

After graduation from high school in Preston in 

1943, she joined the Cadet Nursing Corps and 

attended the University of Utah. She graduated 

in 1947 from the LDS Hospital SON in Salt Lake 

City. She later became the Director of Nursing at 

Oneida Hospital in Malad. 

Gallagher, JoAnn Osborne, 1937-2021, 

Idaho Falls. She grew up in Ashton and later 

attended Idaho State College, graduating from 

the LPN program. She worked in Ashton and 

Rexburg and retired from Madison Memorial. 

Gebhards, Maria, 1935-2020, Boise & McCall. 

She grew up in Germany and married an American 

soldier and came to the U.S. She graduated from 

Boise State University and worked for many years as a 

RN on the cardiology unit at St. Luke’s in Boise. 

Herrick, Julie Lynn, 1948-2021, Boise. She was 

a nurse at St. Luke’s in Boise for 35 years before being 

diagnosed with cancer in 2007. 

Jones, Martha, 1945-2021, Nampa. Martha 

was born in Wendell, Idaho, and lived in Hagerman, 

Dietrich. and New Plymouth where she began her 

nursing career. She worked for many years at the 

Idaho State School and Hospital. She was passionate 

about her work, gardening, and family that included 12 

grandchildren. 

Johnson, Annette, 1941-2021, Bancroft 

& Victor. She was born in the Teton Valley and 

graduated from Ricks College SON. She worked as 

a RN at Teton Valley and Rigby, and in Wyoming at 

Jackson Home Health. 

Lindgren, Ruth Brose, 1919-2020 (age 101), 

Kimberly. She was born and raised in Twin Falls by 

early Magic Valley pioneers. After graduation from 

high school, she graduated from the Good Samaritan 

Hospital School of Nursing in Portland, Oregon 

and later she obtained a BSN from the University of 

Washington. During World War II she served in the 

Army Nurse Corps and attained the rank of Captain. 

She was stationed in Hawaii from 1944-1946. Ruth 

had a long career in nursing supervision and operating 

room supervision through the Western U.S. and in the 

military. 

Lyons, Mary Carolyn, 1943-2021, Boise. She 

grew up in Boise and graduated from Saint Teresa’s 

Academy in 1962. She then graduated from the Holy 

Cross Hospital School of Nursing in 1965 and returned 

to Boise. She was a RN at Saint Alphonsus. She later 

became the Principal Officer for the Red Cross Blood 

Services for 20 years. The final job of her nursing 

career was teaching CNA courses through the College 

of Western Idaho. 

Marsden, Verna Gaye, 1935-2020, Idaho Falls. 

After high school graduation she attended the LDS 

Hospital SON in Idaho Falls. She worked as a RN in the 

1950’s but left nursing after the birth of the second of 

nine children. 

McPherson, Jennifer Lee, 1957-2021, 

Rigby. Jenn graduated in May 1996 from Miles 

Community College, Montana, with an Associate 

Degree in Nursing. She worked in the community 

hospital and clinic setting for five years as an 

RN. After moving to Idaho, she was an Assistant 

Director of Nursing at Rexburg Nursing and 

Rehab for a year before becoming the Director 

of Nursing at Idaho Falls Care Center in 2003. 

Jenn’s love for nursing started at a young age 

as a candy striper. She enjoyed taking care 

of everyone, especially the elderly. Jenn had 

a special place in her heart for the staff at 

Promontory Point in Idaho Falls, Idaho where 

she was employed leading up to the time of her 

passing. 

Pack, Lova, 1929-2021, Meridian. She 

graduated from Eagle High School and then 

graduated from St. Luke’s Hospital SON in 1949. 

She was a RN in the operating room at St. Luke’s. 

She was active in the community and volunteered 

as a nurse for the Pine Acres Church Camp. 

Quaarez, George, 1927- 

2021, Rexburg. George came 

to the U.S. with his mother and 

sister as war refugees from 

Europe. George then entered 

the School of Nursing at 

University of Utah. After George 

graduated from the University of Utah, he pursued 

a Master’s degree in psychiatric nursing in San 

Francisco. That would be his chosen field for the 

rest of his career. He worked in hospitals in San 

Diego, San Francisco, Napa and Sacramento, 

California. In 1980, George and his family came to 

Rexburg, Idaho, where he taught psychiatric 

nursing at Ricks College (now BYUI) for 22 years 

before his retirement. 

Silva, Juanita, 1952-2020, Nampa. Juanita 

worked as an LPN 35 years and retired from Terry 

Reilley Health Services in Nampa. 

Simpson, Elva Niccolls, 1933-2020, 

Emmett. She went to nursing school and 

graduated as an LPN. She loved being a nurse 

and caring for others while working in doctor’s 

offices, hospitals and nursing homes. 

Swainston, Carol Park, 1932-2020, Preston. 

After graduation from high school in 1951, she 

graduated from the LDS Hospital SON in Idaho 

Falls in 1954.

Sexually Transmitted Diseases (STDs) 

During Pregnancy 

STD Prevention During Pregnancy 

STDs can complicate pregnancy and may have serious consequences for both the woman and her developing baby. 

As a healthcare provider, you play a key role in safeguarding their health. 

To reduce complications from STDs during pregnancy: 

• Take a sexual history from your patient. 

• Test your pregnant patients for STDs early in their pregnancy and repeat close to delivery as 

needed (see back side for screening recommendations). 

• Encourage risk reduction by providing prevention counseling and emphasizing the importance of 

using latex male condoms. 

• Explain that when used consistently and correctly, condoms can reduce the risk of transmitting or 

acquiring STDs and human immunodeficiency virus (HIV). 

STD Treatment During Pregnancy 

STDs such as chlamydia, gonorrhea, syphilis, and trichomoniasis can all be treated and cured with antibiotics that are safe to take during pregnancy. 

Viral STDs, including genital herpes (HSV), hepatitis B (HBV), and HIV cannot be cured. However, in some cases these infections can be 

treated with antiviral medications or other preventive measures to reduce the risk of passing the infection to the baby. 

Detailed information on the management of specific STDs during pregnancy can be found in the Centers for Disease Control (CDC)’s 2015 STD 

Treatment Guidelines https://www.cdc.gov/std/tg2015/default.htm. 

Local health departments are also available to assist with diagnosis and treatment information: 

Panhandle Health District – Hayden - (208) 415-5100 

Idaho North Central District– Lewiston - (208) 799-3100 

Southwest District Health – Caldwell - (208) 455-5300 

Central District Health Department – Boise - (208) 375-5211 

South Central Public Health District – Twin Falls - (208) 737-5900 

Southeastern Idaho Public Health – Pocatello - (208) 233-9080 

Eastern Idaho Public Health – Idaho Falls - (208) 522-0310 

Centers for Disease Control (CDC)’s Screening Recommendations 

Disease 

Chlamydia 

Gonorrhea 

Syphilis 

Human 

Immunodeficiency 

Virus (HIV) 

Hepatitis B (HBV) 

Hepatitis C (HCV) 

CDC Recommendation 

First prenatal visit: Screen all pregnant women

RN Idaho - May 2021

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