RN Idaho - May 2021

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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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Page 4 • RN Idaho May, June, July 2021

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


May, June, July 2021 RN Idaho • Page 5

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.


Page 6 • RN Idaho May, June, July 2021

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.

Photo Credit: Katherine Estep

Participants were taught how to apply direct

pressure to a wound to control bleeding.

Photo Credit: Katherine Estep

Wound models were used to demonstrate packing

a wound. The farmers and ranchers participated in

hands-on exercises of packing various wounds.

Photo Credit: Katherine Estep

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


May, June, July 2021 RN Idaho • Page 7

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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Page 8 • RN Idaho May, June, July 2021

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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JOIN OUR TEAM

Make a difference

in the lives of our patients.

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May, June, July 2021 RN Idaho • Page 9

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.


Page 10 • RN Idaho May, June, July 2021

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

Nurse Leaders of Idaho

(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.


May, June, July 2021 RN Idaho • Page 11

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


May, June, July 2021 RN Idaho • Page 13

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)

Nurse Leaders of Idaho

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.


Page 14 • RN Idaho May, June, July 2021

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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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.


May, June, July 2021 RN Idaho • Page 15

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


Page 16 • RN Idaho May, June, July 2021

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/


May, June, July 2021 RN Idaho • Page 17

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)


Page 18 • RN Idaho May, June, July 2021

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.


May, June, July 2021 RN Idaho • Page 19

ADVOCACY IN ACTION

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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Page 20 • RN Idaho May, June, July 2021

ADVOCACY IN ACTION

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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May, June, July 2021 RN Idaho • Page 21

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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Page 22 • RN Idaho May, June, July 2021

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


May, June, July 2021 RN Idaho • Page 23

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

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