May 2021 • Vol. 58 • No. 2
THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION FOUNDATION
Quarterly publication distributed to approximately 13,000 RNs and LPNs in Montana.
Executive Director Report
2021 Annual Convention
ESSENCE OF FEAR: RECOGNIZING THE
POWER OF FEAR WITHIN
current resident or
U.S. Postage Paid
Permit No. 14
The 2021 legislative session
ended in April. There were
many bills MNA testified for
and against. To view all MNA
testimony visit our website at
www.mtnurses.org and click
on the Legislative Information
banner. MNA appreciates all
of our nurses that stepped
up and did whatever action
to participate in the legislative
process. Special thank you
to our SWAT team (Special
Workforce Advocacy Team)
being on high alert as some
bills drop literally hours before the hearing. Please check
out our website for all the bills MNA has spoken on.
MNA 2021 Legislative Plan
Vicky Byrd, MSN, RN
OFFENSE plan with potential bill drafts:
• Healthcare Provider definitions correction in statute
• Including in new bills brought forward that APRN’s
are included as Health Care Providers
• Violence against Nurses and Healthcare Workers
• Occupational Disease
• Support Nurse and Healthcare resolution
• Emergent response including PPE
DEFENSE plan to work to halt bad legislation:
• Anti-Public Health
• Nurse and healthcare changes
• Right to Work
• State Pensions/Longevity
• Nurse staffing/trigger staffing
• Infectious disease reporting
• Nurse licensure compact
As 2021 is a legislative year, here is MNA’s
Legislative platform that was approved by the MNA’s
Board of Directors and the memberships House of
Delegates October 2020.
2020-2021 MNA Government
Montana Nurses’ Association (MNA) is the nonprofit
professional association representing the voice of
nearly 18,000 Registered Nurses (RNs) in Montana
including more than 1000 licensed as Advanced
Practice Registered Nurses (APRNs). MNA is the
recognized professional organization, which lobbies
for nursing practice issues to protect the practice of
professional nurses and also protect the public in all
areas of health care.
MNA is the recognized leader and advocate for the
professional nurse in Montana.
1. Improve the quality of nursing practice by:
a. Providing educational opportunities that
contribute to improving practice competency and
quality of patient care.
b. Identifying and pursuing funding sources to
assist in providing continuing nursing education.
Executive Director Report continued on page 3
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Page 2 Montana Nurses Association Pulse May, June, July 2021
& AD RATES
Circulation 13,000. Provided to every registered
nurse, licensed practical nurse, nursing student and
nurse-related employer in Montana. The Pulse is
published quarterly each February, May, August and
November by Arthur L. Davis Publishing Agency, Inc.
for Montana Nurses Association,
20 Old Montana State Highway,
Montana City, MT 59634, a constituent member of
the American Nurses Association.
For advertising rates and information, please
contact Arthur L. Davis Publishing Agency, Inc.,
517 Washington Street, PO Box 216, Cedar Falls,
Iowa 50613, (800) 626-4081, email@example.com.
MNA 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 Montana Nurses
Association of products advertised, the advertisers,
or the claims made. Rejection of an advertisement
does not imply a product offered for advertising
is without merit, or that the manufacturer lacks
integrity, or that this association disapproves of
the product or its use. MNA 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 MNA or those of the national or local
MNA welcomes the submission of articles and
editorials related to nursing or about Montana nurses
for publication in The PULSE. Please limit word size
between 500 – 1000 words and provide resources
and references. MNA has the Right to accept, edit or
reject proposed material. Please send articles to:
If you wish to no longer receive
The Pulse please contact Monique:
If your address has changed please
contact Montana Board of Nursing
We are gathering articles that are relevant
and appealing to YOU as a nurse. What
is happening in your world today? Is there
information we can provide that would be
helpful to you? The Pulse is YOUR publication,
and we want to present you with content that
pertains to your interests.
Please submit your ideas and
suggestions to Jennifer.
Enjoy a user friendly layout and access to more
information, including membership material,
labor resources, Independent Study Library,
a new Career Center for Job Seekers &
Employers, and more downloadable information.
MNA’s constantly updated website!
Montana Nurses Association
20 Old Montana State Highway, Clancy, MT 59634
Phone (406) 442-6710 • Fax (406) 442-1841
Email: firstname.lastname@example.org • Website: www.mtnurses.org
Office Hours: 7:30 a.m.-4:00 p.m. Monday through Friday
VOICE OF NURSES IN MONTANA
MNA is a non-profit, membership organization that advocates for nurse
competency, scope of practice, patient safety, continuing education, and
improved healthcare delivery and access. MNA members serve on the
following Councils and other committees to achieve our mission:
• Council on Practice & Government Affairs (CPGA)
• Council on Economic & General Welfare (E&GW)
• Council on Professional Development (CPD)
• Council on Advanced Practice (CAP)
The Montana Nurses Association promotes professional nursing practice,
standards and education; represents professional nurses; and provides
nursing leadership in promoting high quality health care.
Montana Nurses Association is accredited with distinction as an approver
of nursing continuing professional development by the American Nurses
Credentialing Center’s Commission on Accreditation.
Montana Nurses Association is accredited with distinction as a provider
of nursing continuing professional development by the American Nurses
Credentialing Center’s Commission on Accreditation.
Vicky Byrd, MSN, RN, Chief Executive Officer
Sheila Hogan, BS, Director of Outreach Operations
Kristi Anderson, MN, RN, NPD-BC, CNL Director of Professional
Caroline Baughman, BS, Professional Development Associate
Megan Hamilton, MSN, RN CFRN, NR-P, Nurse Planner & Professional
Robin Haux, BS, Labor Program Director
Amy Hauschild, BSN, RN, Labor Representative
Leslie Shepherd, BSN, RN, Labor Representative
Jill Hindoien, BS, Chief Financial Officer
Jennifer Hamilton, Administrative & Marketing Specialist
Board of Directors President
Board of Directors Vice President
Board of Directors Secretary
Board of Directors Treasurer
Board of Directors Member at Large
Board of Directors CPGA
Board of Directors PD
Board of Directors CAP
Board of Directors EGW
MNA Board of Directors
Lorri Bennett, RN
Terry Dutro, MSN, APRN, AGPCNP-BC
Chelsee Baker, BSN, RN
Audrey Dee, RN
Anna Ammons, BSN, RN, PCCN
Tricia Thien, RN, BAN, CGRN
Deborah Lee, BSN, RN-BC, CCRP
Lori Chovanak, DNP, RN, APRN-BC
Brandi Breth, BSN, RN-BC
Council on Practice & Government Affairs (CPGA)
Gwyn Palchak, BSN, RN-BC, ACM Charlotte Skinner, BSN, RN-C
Sally Sluder, DNP, APRN, AGACNP-BC Melissa Anderson, BSN, RN
Paul Lee, CCRN
Council on Professional Development (PD)
Joe Poole, BSN, RN, CHSE
Brenda Donaldson, BA, RN, CAPA
Gwyn Palchak, BSN, RN-BC, ACM Charlotte Skinner, BSN, RN-C
Emily Michalski-Weber, MSN, APRN, Janet Smith, MN, MSHS, RN
Council on Advanced Practice (CAP)
Keven Comer, MN, FNP-BC
Margaret Hammersla, BSN, MS, PhD,
Nanci Taylor, APRN
Member at Large-CAP
Terry Dutro, MSN, APRN, AGPCNP-BC
Member at Large-CAP
Deven Robinson, MSN, FNP, PMHNP
Council on Economic & General Welfare (E&GW)
Delayne Stahl, RN, OCN
Adrianne Harrison, RN
Lorie Van Donsel, BSN, RN, PCCN Charlie Julia Buffo, RN
Questions about your nursing license?
Contact Montana Board of Nursing at: www.nurse.mt.gov
May, June, July 2021 Montana Nurses Association Pulse Page 3
Executive Director Report continued from page 1
c. Identifying and pursuing funding sources that support research/projects to
develop evidence based and innovative nursing practice.
d. Promoting national certification of Registered Nurses.
e. Active representation on local, state and national advisory committees/
f. Supporting the regulatory authority and collaborating with the Montana Board
of Nursing (BON) on nursing practice and regulatory issues.
g. Encouraging transparency and promoting communication from the Montana
Board of Nursing regarding relationship with NCSBN and votes affecting
regulation of registered nurses
h. Providing input into the implementation of NCSBN Nurse Compact Licensure
i. Opposing the NCSBN APRN Nurse Compact Licensure legislation.
2. Protect the economic and general welfare of nurses by:
a. Actively engaging in legislation and campaigns that positively contribute to
the economic and general welfare of RNs.
b. Ensuring the right of RNs to engage in collective bargaining in Montana.
c. Opposing any “Right to Work” legislation now being referred to as “NO
RIGHTS AT WORK” by MNA.
d. Addressing workplace environment issues including violence against
healthcare workers, safe staffing, infectious disease, and patient safety.
e. Advocating legislation prohibiting mandatory overtime.
3. Improve access to quality, cost effective health care by developing and/or
supporting public policies which:
a. Respond to the needs of the unserved and underserved populations by
promoting access to health care and healthcare coverage.
b. Identify or develop alternative health care delivery systems that are costeffective
and provide quality health care.
c. Mandate third party reimbursements directly to RNs from public and private
d. Remove barriers (financial, governmental, regulatory, and/or institutional) that
deny access to appropriate/qualified health care providers and approved
medical standard of care treatments.
e. Advocate for legislation that is transparent and bipartisan and support
policies that can achieve evidence based real healthcare reform.
f. Promote community and world health by collaborating with other health
professionals to promote health diplomacy and reduce health disparities.
4. Protect human rights by developing and/or supporting public policies which:
a. Promote access to appropriate health services.
b. Preserve individual rights to privacy.
c. Promote, debate and have consideration of ethical dilemmas in health care
d. Protect nurses and healthcare employees and the public at large from public
5. Protect the environmental health of individuals and communities through:
a. Acknowledging, supporting and addressing environmental impacts on the
health of Montanans.
b. Actively engaging with national organizational affiliates in addressing
environmental health issues in our nation.
c. Identify the nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population.
6. Protecting and promoting the future healthcare and nursing practice through:
a. Actively engaging in legislation that supports professional scope of nursing
practice to the full extent of individual education and training.
b. Actively promoting programs and efforts that encourage educational
progression of professional nursing at state and national levels.
c. Representation on boards, committees and advisory groups which influence
the future of the nursing profession and the future of our state and national
d. Engaging with healthcare partners and associations to work collaboratively to
ensure healthcare as a right for all American populations.
e. Actively support science and evidence based data to drive strong investment
in safe quality public health programs at state and national levels.
PLEASE CHECK YOUR
If you fall into any of the below categories, you could
qualify for the ‘Professional Reduced Rate’ $38.65/month.
Your rate will not automatically change. You must let us
• You are a new graduate. You must apply within the first
six months after receiving your initial RN licensure and
this rate is good for one year.
• You are an RN in a full-time study program working
towards a higher degree. You will need to provide
proof of enrollment and you could receive this rate for
up to three years.
• You are an RN 65+ years of age who is licensed and
working. You could receive this rate for the remainder
of your employment.
• If you are a retired RN and are no longer working or
hold an RN licensure you could be eligible for the
retired rate of $13.07/month.
If you are working in a collective bargaining position
and move into a non-collective bargaining position, please
contact the Montana Nurses Association to let us know.
Your membership dues will continue to be paid until YOU
authorize them to be discontinued. Please remember,
only you can cancel your membership and membership
To provide MNA with information on your status or to
receive additional information on MNA membership please
e-mail Jill Hindoien at email@example.com.
Page 4 Montana Nurses Association Pulse May, June, July 2021
Consider a Tax-Deductible Donation to:
Montana Nurses Association
Foundation – (MNAF)
➢ Donations to the MNAF foundation are 100% tax
➢ MNAF mission statement: “The Montana Nurses
Association Foundation (MNAF) is the charitable
and philanthropic branch of the Montana Nurses
Association (MNA), with a mission to preserve the
history of nursing in Montana and contribute, support
and empower the professional nurse in Montana.”
➢ The purposes for which the Corporation is organized
are as follows:
“(a) charitable; (b) educational; (c) to accept healthcare/
nursing research and educational grants; (d) to provide
continuing educational grants to licensed registered
nurses; and (e) to award scholarships to qualifying
May, June, July 2021 Montana Nurses Association Pulse Page 5
2021 Annual Convention
CONGRATULATIONS TO THE FOLLOWING NURSES WHO HAVE
TAKEN ADVANTAGE OF THE SUCCESS PAYS OFFERING BY ANCC
TO MNA MEMBERS!
1. Jessica Lukenbill, RN-BC – Medical Surgical Nursing
2. Chelsey Schenavar, RN-BC – Cardiac/Vascular Nurse
3. Laura Senn, RN-BC – Medical Surgical Nursing
4. Riki Emerson, RN-BC – Medical Surgical Nursing
5. Katie Murphy, RN-BC – Cardiac/Vascular Nursing
New Member Benefit: MNA now offers certification
through ANCC’s Success Pays ® Program
> Reduced fee for MNA Members to obtain initial certification
> No cost if you don’t pass the exam; you can also take the
exam a second time at no cost
> Pay only when you pass!
> Identify your specialty practice area
How Success Pays ® Works
> Visit nursingworld.org/our-certifications/ to:
• Make sure you’re eligible to sit for the exam
• Look at the test blueprint and test preparation materials
• Make the decision to move forward
Planning for the 2021 MNA Annual Convention has
begun! MNA has heard our members loud and clear with 65%
of those responding to our recent survey that they would like to
have our convention IN-PERSON as Covid recommendations
will allow. In addition to the IN-PERSON option, we are
preparing for a virtual live-stream option.
Mark your calendars and request the time off now for
October 7th & 8th 2021 for an in person/virtual convention
in Helena at the Delta (Colonial) Hotel. MNA is holding the
convention over two days instead of the typical three with
hopes that those of you (well over 200) who stated you wanted
it in person will attend. Day I will be professional development
with (approx.) seven contact hours and Day II will be half day
of professional development with (approx.) three contact hours
then followed by our business session, the MNA House of
Delegates. Our eight districts (which encompasses all nurse members) across the state
have enough funds to sponsor their delegates that will be allotted to convention and can
cover registration, hotel, and gas. This is typically what each district in the past has done
and is approved by their district members.
Jennifer at the MNA office will help with those communications and the voting
process. On June 1st MNA will allot the Delegates for each district, then assist the
districts with their delegate election process, to include a vote on supporting those
delegates to the convention with district funds. If you would like to participate in the MNA
annual convention, which includes the House of Delegates, come as a delegate, enjoy
the networking, and help MNA move the association forward. MNA will also host a silent
auction (very popular) for the MNA Foundation (MNAF) as we should be ready to launch
the process to support the MNAF mission and goals. We will encourage district delegates
to bring a basket or items for auction as we have in the past!
Please reach out to firstname.lastname@example.org with any questions. To register, visit https://
> Visit www.mtnurses.org and click on Success Pays ® option
to the left and sign up for the program!
> MNA will contact you regarding how to get the benefit.
Page 6 Montana Nurses Association Pulse May, June, July 2021
Majority of young nurses overwhelmed, exhausted
over the last year: Five key survey findings
About 71 percent of young nurses said they felt overwhelmed over the past
year, according to survey results published March 10 — just ahead of the March 11
anniversary of the COVID-19 pandemic’s start.
The American Nurses Foundation, the charitable branch of the American Nurses
Association, collected responses from 22,316 nurses between Jan. 19 and Feb.
Four more findings:
1. Eighty-one percent of nurses aged 34 and younger report feeling exhausted
over the last year and 65 percent said they felt anxious or unable to relax.
2. Among nurses who said they plan to leave the profession, 47 percent cited
work having a negative effect on their health and well-being as a main factor,
followed by insufficient staffing at 45 percent.
3. Among the 30 percent of nurses surveyed who haven’t been vaccinated
against COVID-19, 46 percent identify as Black or African American.
4. While the majority, 73 percent, of respondents said they had adequate
personal protective equipment at the time they were surveyed, 33 percent reported
there was no communication plan regarding PPE inventory at their workplace.
Year One COVID-19 Impact Assessment Survey
Following a series of seven surveys in 2020, the American Nurses Foundation
conducted this comprehensive survey to learn more about the overall mental
health and well-being, financial, and professional impact of the pandemic on U.S.
nurses. 22,316 nurses responded to this survey between January 19 and February
When using this data in media, communications or presentations please
reference as follows: American Nurses Foundation, Pulse on the Nation’s Nurses
COVID-19 Survey Series: Year One COVID-19 Impact Assessment, February 2021.
May, June, July 2021 Montana Nurses Association Pulse Page 7
Page 8 Montana Nurses Association Pulse May, June, July 2021
Labor Reports and News
No One Ever Asked Me
When union members have been asked why they
have not been involved in their local unit before, the top
two answers are generally “no one ever asked me” (to
do anything) and “I don’t know what to do.”
The beauty of the collective voice is, with lots of
members contributing in small ways the local unit
flourishes without the president or local officers taking
care of most of the tasks. There are lots of ways to be
involved in your local unit ranging from tasks that may
only take moments a month like managing your union
board on your unit or emailing agenda items for PCC
or Labor Management Committee to running for an
officer position. Another easy way to contribute would
to be the eyes and ears of your unit, be on the look
out for contract issues that may need to be addressed
during bargaining and bringing unit problems to the
attention of your local unit leadership.
BSN, RN, Labor
The best way to become familiar with “how” to do work to further your local
unit is to read your collective bargaining agreement, become acquainted with
your local unit officers and simply ask questions and remember, all questions
Now you have “been asked!” Please reach out to your local unit officers or
give your MNA Labor Representative a call and be part of the solution. Your
local unit needs your help! Thank you in advance.
YOUR Oxygen Mask First
I left bedside nursing three years ago. I miss it. I still
remember those long days and cherish the amazing
people I worked with. This year has been hard y’all. I
cannot begin to imagine what you have been going
through over the past year, caring for patients in hospitals
and out in our communities. How are you? Really? Are
you getting enough sleep? Drinking enough water? Taking
care of your mental health?
For me, normally, there are not enough hours in the day
to work on “self-care.” I have a priority list a mile long and
taking care of myself is nowhere near the top. I am sure
this sounds familiar to some of you. I know during periods
of high stress, I find it even harder to take time for myself.
I know this is not the first time you’ve heard this but taking
care of you is important. It is a priority (or at least is should
BSN, RN, Labor
During the safety briefing after boarding an airplane, they tell you in case of an
emergency, put your own oxygen mask on first before turning to help the person
next to you. This is a piece of advice I wish I could practice regularly. Put my own
mask on first. Put me first. As nurses, this is not easy. For me, it goes against my
nature. But this piece of advice is GOLD! If you do not care for yourself first, you will
burn out. We all do if we continue to put ourselves on the bottom of our priority list
that is never reached.
While I may not be a wealth of practical tips on ‘how to fit your yoga in during
your lunch break,’ I do know that when we neglect our own needs, even the little
ones, we are not able to be our best selves for our families or our patients. I would
like to encourage you to really examine where you fall on your list of priorities. Are
you putting your own oxygen mask on before you help the person next to you?
Because, maybe you should be.
Some resources you might find helpful:
If this discussion could in any way lead to my being
disciplined or terminated, or affect my personal
working conditions, I respectfully request that my
Union/Unit Representative or Nurse Advocate be
present at this meeting.
Until my representative arrives, I choose not to
participate in this discussion
When Your Employer Notifies You of a Meeting...
*Immediately ask your Supervisor/Manager/Director:
• “What is the purpose of the meeting?”
• “Is the meeting investigatory?”
• “Will I be asked questions which may possibly lead to discipline?”
• “Will I be asked questions which require me to defend my conduct?”
If the meeting is investigatory or answers may
lead to discipline:
_ #1 – Respectfully inform your employer you are invoking
your Weingarten Rights & will need to have your Union/Unit
Representative or Nurse Advocate present during questioning.
_ #2 – Quickly arrange for your Union/Unit Representative or
Nurses Advocate to attend the meeting.
May, June, July 2021 Montana Nurses Association Pulse Page 9
Labor Reports and News
Understand and Protect Your Collective Bargaining Rights
As many of you may know, Montana’s rights to
collectively bargain were a target at the 2021 legislative
session. Proposed laws were directly attacking the
Blue Eyed Nurses Bill, championed by the late Mary
Munger, RN, perhaps the most prominent nurse in
Montana history (and lifetime MNA member) who won
collective bargaining rights for the professional nurse
with passage of the Blue Eyed Nurses Bill, back in 1967.
At 96 years old and just weeks before her passing in
2019, she spoke to nursing students at Carroll College
and said “You have to be at the (bargaining) table” and
elaborated why the collective voice remains so vital.
MNA, working in collaboration with Montana Unified,
a coalition of labor unions all across Montana, was
successful in defeating these anti-worker bills that would
have directly impacted our communities.
Robin Haux, BS
What do Right to Work (RTW) Laws Mean for You (or NO RIGHTS at Work)?
Despite its misleading name, this type of law does not guarantee anyone a job
and it does NOT protect against wrongful termination. It WEAKENS your union,
your collective voice, and your collective bargaining rights. It limits your ability to
advocate for you, your patients, and your ability to bargain fair wages, respect,
safe working conditions, and benefits. RTW actually means ‘Right to Work FOR
LESS”! Currently, laws allow private facilities and nurses to freely negotiate to make
sure everyone who benefits from their union contract pay their fair share as it is
CURRENTLY (and always has been) illegal to force anyone to join a union. RTW
laws allow the government to interfere unfairly in the free choice of the nurses and
will DIRECTLY impact the Blue Eyed Nurses Bill.
What you NEED to Know about RTW Laws:
Q: Without RTW laws, can a worker be forced to join a union?
A: NO. RTW laws are unnecessary because the US Supreme Court ruled
long ago that no one can be forced to join a union or to pay fees NOT
directly related to the cost of representation.
Q: Is my union required to represent all employees covered by our
contract (members and non-members)?
A: YES. Under federal labor law, all unions have the duty to represent all
nurses covered by the contract, whether they pay or not. RTW WILL create
inequity within your nurses union!
Q: Currently in MT, are nonmembers required to pay full union dues if
they chose to not join their local union?
A: NO. Nurses who receive the benefits of their contract, but choose
not to join are only required to pay their fair share of the costs related to
bargaining and representation.
Q: Who benefits from RTW laws?
A: Employers think they do. Some employers believe RTW laws will weaken
unions’ strength at the bargaining table, therefore a weak union will equal
lower wage increases. Union members earn an overall 28.7 percent more
Q: How would a Montana RTW law impact my family?
A: It would put our families’ safety at risk. It would make it even HARDER
(and we know how hard this is already) for nurses to negotiate safe staffing
levels, staffing matrixes, staffing committees, retention/recruitment plans,
safe orientation plans, cross training, and weaken your ability to use an
Assignment Despite Objection (ADO) form, which is a document YOU can
use to document an unsafe assignment. (For a short educational video on
ADO forms and how they can protect you and your license, follow this link:
For Healthcare Workers, the Pandemic is Fueling Renewed Interest in Unions:
Across the country, union membership and organizing is improving. According to a
study from the Roosevelt Institute this past year, they found union members reported
better COVID-19 workplace practices and outcomes than from nonmembers.
Additionally, the study reported that union members were more likely to report
receiving appropriate PPE, other disinfecting/sanitizing resources, receive paid sick/
COVID leave, and reported being tested more. We, together, need to protect this
right for all Montana workers into the future. By protecting collective bargaining, you
will be protecting (just to show a few) of the following bargaining HIGHLIGHTS nurses
achieved over that past year:
• Stopped Health Insurance increases
• Created the first UNLIMITED wage scale and improved wage progressions
• Added steps to wage scales
• Staffing committees
• Extra shift bonuses and creative voluntary call incentives
• STOPPED take-a-ways related to PTO, sick leave, vacation.
• Bargained Short Term disability plans
• RN Exhaustion language
• New staffing language
• Workplace Violence Prevention
• Improving RN experience levels and wage placement
• In our six larger facilities, over past three years, we have bargained an
average 16% in wage increases
Would you want to lose protections or the ability to bargain any of the above??
WHAT YOU CAN DO to PROTECT
the BLUE EYED NURSE BILL??
• Stay UP-TO-DATE on all legislative issues by visiting www.mtnurses.org
• Join the MNA SWAT Team by contacting email@example.com
• Be ready to VOTE for candidates that support the Blue Eyed Nurse Bill and
protect your right to collectively bargain for better wages/benefits.
For more information visit
RN – Inpatient Nursing
Full Time or Part Time
Competitive salary, great benefit package,
student loan repayment and relocation expenses available.
Please contact the HR department at (406) 228.3662 for more information.
FMDH is an Equal Opportunity/Affirmative Action Employer
RNs & LPNs
FT/PT/PRN – All shifts available
Sign On Bonus Available!
Big Sandy Medical Center, Inc
Critical Access Hospital, Longterm
Care Facility and Rural Health Clinic.
166 Montana Ave. East | Big Sandy, MT 59520
(406) 378-2188 | www.bsmc.org
NOW HIRING RN’s & LPN’s
Full- Time positions, Competitive Salary,
403b, Great Benefits
To discuss our current opportunities
call (406) 683-3009 or
Visit us at
Page 10 Montana Nurses Association Pulse May, June, July 2021
Professional Development Department
What’s the difference between individual activity submission
and becoming an approved provider?
Association is accredited with
distinction as an approver of
nursing continuing professional
development by the American
Nurses Credentialing Center’s
Commission on Accreditation.
If you are interested in
obtaining approval to award
nursing contact hours for any
educational programs, MNA
offers two options to obtain
approval: approving individual Kristi Anderson,
activities and approving MN, RN, NPD-BC, CNL
independently operating Director of Professional
providers of nursing continuing Development
professional development. The table (left) outlines each of
• Award nursing contact hours for
a single or a few activities
• If you’re interested in offering just
a few activities each year, then
individual activity application
approval may be more appropriate
for your group
• Nurse Planner
• Build an infrastructure within their organizations for
delivery of quality nursing professional development
activities that support the mission and vision of their
• If you have a plan to have a robust program of multiple
educational offerings each year (generally more than
8-10), then you may want to consider working towards
becoming what we would call an Approved Provider Unit
• Primary Nurse Planner
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by location and credentials.
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Your always-on resource for nursing jobs, research, and events.
• Individual activities may be
repeated during a two-year
• Application fee is based on the
number of contact hours.
• A late fee applies for applications
submitted less than 20 business
days prior to the scheduled start of
• Your organization would have the ability to plan, implement,
and evaluate your own activities after you’ve submitted
documentation and evidence that you’re equipped
structurally and have competency among your team to
execute this work without direct approval for each activity for
a three-year period of time
• New approved provider applicants and renewing
applicants pay an application fee for a period of time
(i.e., current approval period is three years)
• Applicant must not be a
commercial interest entity/
ineligible company (an entity that
produces, markets, resells, or
distributes healthcare goods or
services consumed by or used
on patients or an entity that is
owned or controlled by an entity
that produces, markets, resells,
or distributes healthcare goods or
services consumed by or used on
• Applicant organization must have been operational for
at least six months as a provider of nursing continuing
• Planned, implemented, and evaluated at least three activities
that adhere to accreditation criteria within the past six
months (each at least one hour in length)
• Designated primary nurse planner who is accountable for
adherence to the accreditation criteria
• Target audience for at least 51% of the provider unit’s
learning activities must be learners within the provider unit’s
geographic region or states contiguous to the region (see
www.hhs.gov/about/regions for map)
• Activity file requirements need to
be retained in your activity files
for six years
Summative evaluation is sent to
MNA following the program
• Activity file requirements need to be retained in your activity
files for six years
• Annual reporting requirements through Nursing Activity
Reporting System (NARS), other requirements as requested
• The primary nurse planner is responsibility to notify MNA of
any changes to provider unit
• Three-year renewal application requirements
• Refer to the information on our
• Email Caroline:
• Email Kristi: firstname.lastname@example.org
Please let us know if you have any question related to options for contact hours for nursing continuing
$46.00/hr for RN | $36.00/hr for LPN
.55¢ per mile for travel. Contracts are negotiable.
Please call Deb: 406-207-9614
May, June, July 2021 Montana Nurses Association Pulse Page 11
Montana Nurses Association
MNA thanks all of the Approved Provider Units we work with for their
commitment to advancing and promoting quality nursing practice through
continuing nursing education.
Acute Care Education
Alaska Native Tribal Health Consortium
Alaska Nurses Association
Alzheimer’s Resource of Alaska
Bartlett Regional Hospital
Benefis Healthcare Systems
Great Falls, MT
Boise State School of Nursing
Caring for Hawai’i Neonates
Central Montana Medical Center
Central Peninsula General Hospital
Community Medical Center
East Wenatchee, WA
Foundation Health Partners
Kalispell Regional Healthcare System
Coeur d’Alene, ID
Midland Memorial Hospital
Montana Geriatric Education Center of UM
Montana Health Network
Miles City, MT
Montana VA Health Care System
Mountain Pacific Quality Health
North Valley Hospital
Pacific Lutheran University
Planned Parenthood of the Great Northwest
and the Hawaiian Islands
Providence Alaska Learning Institute
South Dakota Nurses Association
South Peninsula Hospital
St. Luke’s Health System
St. Peter’s Health
St. Vincent Healthcare
UF Health Shands Hospital
Wisconsin Nurses Association
Page 12 Montana Nurses Association Pulse May, June, July 2021
MN, APRN, FNP-BC
Thank you to all that
attended the 2021 Virtual
Conference March 5-6—it was
a HUGE success. There was
80+ APRNS that “zoomed in”
to hear incredible speakers
from all over the United
States. I have to tell you that it
pushed me out of my comfort
level, and I was pleasantly
surprised – although we didn’t
have the dual tracks like we
have had in the past “inperson,”
I found that I learned so much in offerings
that I might not of normally attended. It has taught
me that even though I thought I already knew the
content, I learned something incredible and new
in each and every lecture. It has also helped the
planning team to think “outside the box” regarding
planning next year’s conference. We have already
had several APRNs reach out with offers to teach
and share their expertise. Next year, we will
resume our dual tracks, and will have two times
the offerings. If you would like to be a presenter or
know of someone who would be a great presenter,
please reach out to me and I will get you hooked
up with the MNA team. I know that many of you
know experts that would be great for us to utilize in
the virtual world.
Happy spring and summer, keep vigilant about
Montana’s full practice authority ability—let me know if
you have any issues or questions that you would like
addressed in my column. email@example.com.
can point you right to that perfect
Free to Nurses
Easy to Use
*NEW MEMBER BENEFIT*
If you are an APRN, membership to Montana
Nurses Association (MNA) includes three professional
memberships for one low membership rate.
o MNA – Montana Nurses Association
o ANA – American Nurses Association
o AANP – American Association of Nurse Practitioners
If you are currently an MNA member who is also an
APRN, please e-mail Jill at firstname.lastname@example.org so she can
sign you up for your AANP membership or if you have
E-mailed Job Leads
May, June, July 2021 Montana Nurses Association Pulse Page 13
Everyone Deserves A Job They Love!!
Let Us Help Today,
Prairie Travelers is recruiting Traveling
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For an application or more information, visit
Helena College University of Montana is seeking a
full time tenure track Nursing Instructor position for Fall 2021.
Please see our vacancy announcement at
https://helenacollege.edu/hr/job _ opp.aspx.
Great Falls College MSU is seeking a part-time Nursing Faculty
member to join the team for our Nursing Programs (ASN and PN).
BSN required, MSN preferred, State of Montana RN licensure, and
two years of experience required.
Excellent benefits package • Summers and Holidays off
Learn more about our
Nursing Programs at:
NEED EXTRA INCOME?
To Apply Online, please visit:
Disabled/AA/EEO/Vet Preference Employer
Apply online at: www.montanahealthnetwork.com
or contact David Perry, RN - Staff Coordinator/Director of Nursing Services
406-852-6361 or 406-228-8044 | email@example.com
Page 14 Montana Nurses Association Pulse May, June, July 2021
State Wide Nursing News
ESSENCE OF FEAR: RECOGNIZING THE POWER OF FEAR WITHIN
Fear is an ongoing part
of living. Fear accompanies
every activity in life. There
is a responsibility by nurse
leaders to be aware of the
good and bad aspects of
this internal feeling. Increase
personal awareness of
fear symptoms and how to
manage fear successfully will
provide increased positive
During the last part
of June 2015, President
Obama did a radio interview.
Ed.D, MN, RN
He acknowledged that through his professional
experience as a leader, he had become “fearless.”
“It took many years to reach that point to know what
to do and how to show courage and demonstrate
fearlessness,” he said. He admitted that “screwing
up” was part of the learning process—and there
was much fear involved. To become fearless, he
said, liberated him to become a better president
(leader). On January 10, 2017, President Obama
gave his last address to the nation. He encouraged
each citizen to believe in the power within
themselves. He reminded us that democracy could
buckle when we give in to fear.
Now—what does that mean for you? Yes, you will
have a fear of making new and challenging leadership
decisions that produce positive outcomes. Yes, you
will “screw up” once in a while. But, you will learn
from your mistakes! There will be times of success
when you make appropriate decisions from the fear
information I have imparted to you in this document.
You will learn to make proper decisions and see
your positive outcomes result in your trek toward
fearlessness. It will liberate you (as it did for President
Obama) to become a better leader.
DEFINITION OF FEAR, PHOBIA,
AND GUILTY FEAR
Fear is a universal state of emotion. It results in
tension and pessimism that is promoted by concern
over physical or psychological harm. Therefore, a
consciously recognized threat or danger to personal
existence or equilibrium exists. Fear is specific with
a definite source or cause bordering on rationality
Do you need to be lifted up from the
effects of the pandemic?
We are here to listen.
Everyone is facing challenges impacted by the
effects of COVID-19. Especially Nurses who are
dedicated to taking care of others and often put
their own needs last.
Take the time to care for yourself. If you
are experiencing emotions such as anxiety,
depression, stress, sadness, or fear,
you are not alone.
Trained crisis counselors are available to help
10 am to 10pm everyday.
To receive free and confidential counseling
services call: 1-877-503-0833
Phobia is very similar to fear as it is an irrational
fear or aversion to something. However, a phobia
goes beyond usual proportions. These aspects
of fear are usually able to be controlled through
reasoned action. A person will go to great lengths to
avoid situations causing a personal phobia. Phobias
are specific by name and can even be overlapping.
The “fear trigger” in the head/brain says that
something is wrong. What is known as the “fight
or flight” response causes changes within the
nervous system. Biological responses such as
hormones are released, muscles become tense,
breathing increases, pulse increases, headaches
occur, vomiting can occur, and behavioral changes
occur. The result is a burst of energy. The most
significant damage occurs when this biological
response remains day after day. Such heightened
fear decreases the quality of life and reduces the
chance of a healthy life. Conversely, the outcome
can be helpful in times of extreme emergencies as it
heightens life-saving awareness.
The definition of fear is also related to an
emotion called “guilty fear.” This type of fear
comes to a person during the process of doing
something, resulting in disapproved, illegal, or
immoral behavior. This type of fear seeks to avoid
punishment, yet there is a fear of getting what is
deserved. According to NANDA I, Inc (2015-2017),
the definition of fear identifies fear as a response to
a consciously recognized threat.
Eckhart Toole (2006), a well-known international
educator, explains that fear is an underlying emotion
that governs all the activities of the ego (self)—
including the fear of being “nobody,” nonexistence,
and death. He explains that we design our activities
to eliminate fear. He claims that there is always a
sense of insecurity (fear) around the ego (self) even if
they appear confident.
Psychophysiological (psychosomatic) disorders
can manifest themselves as an emotion of fear
accompanied by physiological changes. Such a
combination of fear and physiological distress can
cause serious physical illness, such as a migraine,
peptic ulcer, rheumatoid arthritis, ulcerative
colitis, dermatitis, irritable bowel syndrome, high
blood pressure, frequent urination, impotence,
obesity, and anorexia nervosa. Because a
psychophysiological disorder is severe and can be
physically life-threatening, address a medical crisis
intervention technique as the first primary concern.
Dan Harris (2014), a well-known anchor
newsperson and author of 10% Happier, provided
statements of his personal experience with fear and
related emotion and tension. It presents an initial
response to fear. He experienced these recognized
emotions while on the set of Good Morning
“It started fine. ‘Good morning, Charlie and
Diane. Thank you,’ I said in my best morning-anchor
voice. Out of nowhere, I felt like I was being stabbed
in the brain with a raw animal fear. A paralytic wave
of panic rolled up through my shoulders, over the
top of my head, then melted down the front of my
face. The universe was collapsing in on me. My
heart started to gallop. My mouth dried up. My
palms oozed sweat. As I began the third story about
cholesterol drugs, I was starting to lose my ability to
speak, gasping as I waged an internal battle against
the wave of howling terror, all of it compounded
by the knowledge that the whole debacle was
being beamed out live. I tried to fight it with mixed
results. The official transcript of the broadcast
reflects my descent into incoherence: ‘Researchers
report people who take cholesterol-lowering
drugs called statins for at least five years may also
lower their risk for cancer, but it’s too early to-----
-prescribe statins slowly for cancer production.’
It was at this point, shortly after my reference to
‘cancer production,’ with my face drained of blood
and contorted with tics, that I knew I had to come
up with something drastic to get myself out of the
situation.” (Harris, 2014)
IMPORTANCE OF FEAR
The existence of patient fear could mask
significant health problems. Therefore, this can
result in misdiagnosis, inaccurate nursing care
planning, mistreatment of presenting health
problems, and inappropriate nurse leader
decisions. During the fear episode, the patient has
a diminished ability to personally focus on his/her
participation in personal health care information
and achieving their health outcomes. It is also easy
for health care providers to miss the recognition of
a psychosomatic disorder when an acute medical
problem is present.
When an astute nurse leader is introduced to a
patient, an immediate intuitive feeling can be elicited
from a nurse’s experience to determine a fear that
interferes with general health. Enhancement of this
inherent feeling occurs with the nursing experience.
The immediate attention to a possible fear should
occur after meeting emergency medical needs.
FEAR OR ANXIETY?
FEAR IS NOT ANXIETY, and ANXIETY IS NOT
FEAR! Anxiety is not specific (as in fear). Therefore,
anxiety is the opposite of fear. Anxiety is irrational
with an unknown source or cause. Anxiety usually
cannot be controlled through a reasoned or known
source or origin; therefore, it requires a specific
action that curtails such feelings of anxiety. The
patient presents as helpless to determine a source
It becomes essential in a therapeutic nursing
observation to determine if what is exhibited by the
patient and observed by the nurse leader is fear or
anxiety. The accurate recognition of this underlying
intrusive emotion (fear or anxiety) will determine the
difference in precise nursing assessment, planning,
intervention, therapeutic nursing success, and
THE ENEMY – FEAR
Being confronted with poor or declining health
can be terrifying! The presence of fear can bring
forth experiences and happenings of the past and
overtly project them into the present. The stoic
personality profile of a patient may hinder the
recognition of his/her fears. To NOT be afraid (or
May, June, July 2021 Montana Nurses Association Pulse Page 15
State Wide Nursing News
at least not show the signs) can be socially known
to present character strength. The need to seek
approval is known psychologically to repress the
apparent recognition of hidden fear and can (as an
outcome) manifest itself in many forms of illness.
Dan Harris (2014) tells of personal changes in
his head and nervous system as a result of fear—
(his enemy within). His origin of fear as described in
selected excerpts from his book preface:
“The voice in my head can be a total pill. I’d
venture to guess yours can, too. Most of us
are so entranced by the nonstop conversation
we’re having with ourselves that we aren’t even
aware we have a voice in our head. — I’m
not talking about ‘hearing voices,’ I’m talking
about the internal narrator, the most intimate
part of our lives. Our inner chatter isn’t all bad,
of course. —But, when we don’t pay close
attention—which very few of us are taught
how to do—it can be a malevolent puppeteer.”
SIGNS AND SYMPTOMS OF FEAR
Recognition of fear is one of the first happenings
recognized in others and him/herself by an
excellent nurse leader.
Even though there is an attempt to state the
common fears of humankind, it is acceptable that
numerous unknown fears have their root in the
many life experiences that are specifically related
to each individual’s mindset. Fears are in all sorts
of behavior, verbal statements, physical response,
and psychological concerns.
Some nurse employee characteristics showing
possible fear while on the job are – (not in order of
1. Easily alarmed
3. Statements of being scared
4. Reports feelings of dread
5. Shows or reports excitement
6. Shows over excitement
7. Presents or messages increased tension
8. Appears or reports jitteriness
9. Reports or feels panic
10. Reports or feels terror
11. Expectation of crime
12. Late or frequent absences
13. Sleeping or sleepiness
14. Concerned about success
16. Decreases in self-assurance or self-adequacy
17. Anxiety about making mistakes
18. Narrowed focus
19. Avoidance behaviors
21. Increased alertness
22. Narrowed focus
23. Adverse physical symptoms—Nausea, Vomiting,
Diarrhea, Dyspnea, Fatigue, Dry mouth, Muscle
tightness, Pallor, Pupil dilation, tremor
24. Language barrier with misinterpretation
25. Asking many unfounded questions
26. Rapid respirations
27. Increased activity
30. Frequent absences
31. Frequent unfounded complaints of pain
32. Need for frequently repeated directions
33. Facial Tics
34. Attempt to control others (see example below)
35. Inappropriate nepotism (see example below)
36. Ineffective encouragement of Due Process
37. No checks and balances (counter determinations
of behavior that supports and promotes
38. Curtailment/ withholding of the “Right to Know”
39. Relinquishing role responsibilities
LEADERSHIP BEHAVIOR TO HELP
Verbally stating a recognized fear is acceptable.
Even as a nurse leader, it is essential to be honest
with yourself. Life and responsibilities can be
Man’s search for happiness and perfection does
not include making a fool out of him/herself. The
fear about something is always there, however.
The focus on the critical things that matter (rather
than overtly focusing on the feeling of fear) is to
present genuine professional prowess. As a leader,
preparation by knowing the required information
and imparting information in a caring, controlled
manner will decrease everyone’s fear. Emitting an
essence of calmness and legitimate knowledge in
how you want others to exhibit in return regarding
their responsibilities will encourage employees
to mirror the positive image that, hopefully, they
observe in you as their leader.
FOR GOODNESS SAKE (literally)—be the nurse
leader that makes the decisive difference. Go the
extra mile on behalf of others, support others for
the right cause, and be the person who dares to
be the dissenter to promote something better when
others shrink into the woodwork—perhaps, due to
Be known to be fearless and tenacious to move
the unpopular worthy choice forward. Dare to say
“NO”—AND MAYBE “HELL NO”—when in your
heart you feel you are right in your conviction. Also,
dare to say “YES” when the cause and outcome
are virtuous. You (and sometimes only you) will
stand for a worthy cause while being circled by
The Pratipaksha-Bhavana Method encourages
a fearful person to close their eyes and meditate
on courage, the advantages of courage, and the
disadvantage of fear. It also fosters a selection of
your quiet place of natural beauty and serenity,
where you (nurse leader) can purge your wavering
thoughts of fear by concentrating on beauty and
Essence of Fear continued on page 16
Page 16 Montana Nurses Association Pulse May, June, July 2021
State Wide Nursing News
Essence of Fear continued from page 15
The Effective Nurse Administrator and Nurse Leader Encourage Employees
to be Fearless by –
1. Having confidence in their thinking.
2. Supporting others by validating their efforts of creative thinking.
3. Using productive critical thinking.
Verbally stating the recognized fear without judging whether the
observation is acceptable or not acceptable is essential. Excellence as a
nurse leader means that the leader is nonjudgmental regarding possible
evidence of fear. A nurse leader merely states the behavior recognized as
fear (without judging the action) to a fearful employee or patient to bring into
awareness the action and consideration of why he/she is exhibiting fearful
Positively Responding to Post-Traumatic Stress Disorder –
Many nurse leaders are hiring and assisting individuals that have Post-
Traumatic Stress Disorder (PTSD). It can relate to many situations—war,
divorce, death of loved ones, or any tragic life happening. Many (probably
most) people have happenings in their lives that result in personal PTSD. It can
result in fear of remembering adverse details and experiencing a trigger of a
happening or situation, fear of repeating the happening, fear of being identified
as being “weak” because the fear is too challenging to overcome. There is
psychological pain that will accompany PTSD. The fear is haunting to the point
that the lack of ability to function adequately may be all-encompassing at times.
Too often, the inconsolable fears are so disabling that they result in suicidal
ideation, and unfortunately, too many suicides.
Therefore, as a nurse leader, never underestimate the impact of hidden
fears that are an outcome of overt or covert PTSD. Inattention to the existence
of the problem could lead to the employee’s destruction. Ever feel like you
have to be like a psychologist to be an excellent, sensitive leader? You are
correct. Empathy, caring, firmness, and supportive performance expectations
sometimes help affected employees keep moving forward with a painful life.
Be gentle – make positive happenings occur for these employees. If you, as
a nurse leader, have never experienced PTSD in any situation, count yourself
Nurse Administrator’s (DON) Help for Nurse Leaders and Adult Patients –
Listen carefully to what is being said by a nurse leader or an adult patient.
Active listening will allow the nurse leader to clarify the meaning in more detail.
Clarification increases mutual understanding of the fear. This understanding,
then, becomes the basis of an effective leadership intervention. Be sure to
show appreciation to an employee that is attempting to understand personal
fearful behaviors. Introspection can be threatening to the ego. Support the
nurse leader or adult patient to make a positive change in their behavior/life.
You, as the nurse administrator, are the one that can make a positive difference
in another human being’s life.
Interventions for Reducing Fear in general – (Many requiring professional
1. Remain nearby to calm and support.
2. Perform safety measures.
3. Assess the source of fear.
4. Have the employee visually draw or write down the source of fear.
5. Discuss the real or imagined threat.
6. Consider relaxation and meditation techniques.
7. Explore underlying feelings.
8. Discuss what worked or did not work last time when fearful.
9. Provide tactile support—suggest professional massage, desensitization/
exposure training, Therapeutic Touch (TT), Cognitive Behavioral Therapy
(CBT), Animal Assistive Therapy.
10. Set positive incremental expectation events for success.
11. Provide frequent and routine happenings to provide a general sense of
12. Provide breaks, quiet time.
13. Teach how to support and respond effectively to specific fears.
14. Encourage time for exercise and nutritional dietary opportunities.
15. Assure and reassure through earnest comments of safety.
16. Encourage mindfulness and mediation. (Think of positive thoughts instead
of negative thoughts.)
17. Encourage deep breathing and visually see fearful thoughts burst like a
18. Encourage the thinking of thoughts that are safe and warm.
19. Encourage Transcendental Meditation.
20. Encourage Biofeedback Training.
21. Encourage Psychotherapy.
22. Encourage group or individual therapy.
23. Encourage relaxation techniques.
24. Encourage Yoga classes.
25. Encourage possible acupuncture.
26. Encourage the practice of personal religious beliefs.
27. Teach staff members to understand and intervene with cultural values and
28. Consider the possibility of adverse reactions to medications.
29. Consider decreases mental capacity resulting in recognized poor
30. Know relevant theory.
31. Trust your personal ability to lead others.
1. Have the child draw his/her fear.
2. Determine what worked last time when fearful.
3. Consider the early onset of depression.
4. Provide comfort and relaxation techniques.
Helping the Elderly:
1. Establish trust.
2. Monitor mental deterioration.
3. Provide consistency and predictability.
4. Consider adverse medication reactions.
5. Assess environmental safety concerns.
6. Encourage exercise routines.
Helping Multicultural People:
1. Help to identify cultural fears and anxiety.
2. Assess fearful cultural statements.
3. Listen to concerns related to race differences.
4. Teach staff to understand cultural values.
AUTHOR: Carolyn R. Taylor, Ed.D. M.N. R.N.
May, June, July 2021 Montana Nurses Association Pulse Page 17
State Wide Nursing News
Montanans encouraged to get the COVID-19 vaccine
The COVID-19 vaccine is now available to all
Montanans age 16 and older.
As of March 29, over 450,000 total doses have
been administered and over 180,000 Montanans are
Local information regarding vaccine availability and
scheduling is available here.
To find out if there is available vaccine in your area
through a retail pharmacy, visit vaccinefinder.org
To track Montana’s efforts to distribute the
COVID-19 vaccine click here.
DPHHS has also developed free COVID-19 vaccine
promotional materials here.
For more information go to covidvaccine.mt.gov
join our team!
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Falls, Montana is an exceptionally safe, affordable
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To view complete position
descriptions for these and other
nursing positions, and to apply, visit
Great Falls Clinic Hospital
3010 15th Ave. S, Great Falls, MT 59405
To access electronic copies of The Pulse, please visit
Page 18 Montana Nurses Association Pulse May, June, July 2021
State Wide Nursing News
MT Missing and Murdered Indian Women
Various national and regional studies have found
that violence against women is more widespread
and severe among self-identified American Indian/
Alaskan Native (AI/AN) women than among other
North American people (Crossland et al., 2013;
CDC, 2017). For example, authors of the National
Violence Against Women Survey found that selfidentified
AI/ AN women were significantly more
likely than women from all other backgrounds
to encounter violence at some point in their
lifetime (Tjaden & Thoennes, 2006). Furthermore,
according to estimates from the National Crime
Victimization Survey, self-identified AI/AN women
experienced the highest rate of IPV (18.2%), when
compared to White women (6.3%), African American
women (8.2%), and Asian American women
(1.5%) (Catalano, 2007). However, the results from
these studies cannot produce reliable estimates
of violence against AI/AN women on or off the
reservation (Crossland et al., 2013).
Although AI/AN women are less likely to be killed
as the result of another felony (e.g., robbery), when
compared to White (5%) and African American (4%)
females, AI/AN are more likely (7%) to be murdered
as the result of rape or sexual assault (Bachman et
al., 2008). In the U.S., AI/AN women are murdered
at a rate ten times the national average (Pember,
2016). Non-partner sexual violence is experienced
by at least 7% of women in their lifetime (Abrahams,
Devries, Watts, Pallitto, Petzold, Shamu, et al.,
It is essential to include human trafficking in
the analysis of violence against women. The
International Labor Organization (2012) reported
human trafficking, or “Modern Day Slavery,” occurs
when people are commodities and then victimized
by force, fraud, or coercion for the purpose of
physical or sexual exploitation. The International
Labor Organization reported 20.9 million global
trafficking victims, making human trafficking
the third largest worldwide criminal enterprise
(International Labor Organization, 2012).
Human trafficking in Indian Country is a
significant problem, with AI/AN women and girls
suffering disproportionately when compared to
the general population. The federal agencies who
investigated or prosecuted human trafficking
in Indian Country are the Federal Bureau of
Investigation, Bureau of Indian Affairs, Immigration
and Customs Enforcement, and the United
States Attorney’s Office. These federal agencies
reported 14 federal investigations and two federal
prosecutions of human trafficking offenses in Indian
Country from fiscal years 2013 through 2016. From
fiscal years 2013 through 2015, there were over
6,100 federal human trafficking investigations and
approximately 1,000 federal human trafficking
prosecutions, overall. In certain circumstances,
state or tribal law enforcement may have jurisdiction
to investigate crimes in Indian country; therefore,
these figures likely do not represent the total
number of human trafficking-related cases in Indian
Country. Also, considering that human trafficking is
known to be an underreported crime, it is unlikely
that these figures, or any other investigative or
prosecutorial data, represent the full extent to which
human trafficking occurs (Goodwin, 2017).
American Indian and Alaska Native women
experience risk factors that can lead to victimization
more often than other groups. The number of
murdered and missing AI/AN women has reached
into the hundreds, but scant records have made
tracking those cases difficult. According to the
Federal Bureau of Investigation, AI/AN people
disappear at twice the rate of Whites (Lutey, 2019).
One explanation is that AI/AN women and girls are
targeted by traffickers “for their exotic beauty” (St.
Claire, 2017). Another explanation is that Indian
Country is where predators can more easily get
away with their crimes. An overview of the legal and
law-enforcement environment is critical to further
understanding the disparity.
The current crisis of Missing Murdered Indian
Women (MMIW) and girls is tied to the structural
conditions and lived material realities that upend the
lives of AI/AN peoples, rendering them disposable,
unworthy, precarious, and even exposed to violent
victimization and homicide (Monchalin, Marques,
Reasons, & Arora, 2019). A critical aspect of the
environment for AI/AN women and the focus of
this paper is the healthcare environment and the
290,000 nurse practitioners who operate within it
(More Than 290,000 Nurse Practitioners, 2020).
The health implications associated with human
trafficking are varied, as victims commonly exhibit
signs of physical, psychological, and sexual trauma.
In one study Donahue and colleagues (2019)
surveyed hundreds of trafficking victims and found
that 88% reported that they received medical
care during their captivity, and of those, 63% had
been seen and treated in hospital emergency
departments. In 2016, 5,712 AI/AN women and
girls were reported missing in the United States
(Lucchesi & Echo-Hawk, 2017). Healthcare
practitioners serve an essential role in the
identification and assistance of victims many times;
Nurse Practitioners are the first person a victim
may encounter. Nurse Practitioners are in a unique
position to interact with a person missing and seen
in the clinical setting (Hachey & Phillippi, 2017).
Healthcare providers get moments of privileged
access to victims who often are out of reach to law
enforcement (Donahue et al., 2019). There are nearly
6,000 hospitals in the country, but only an estimated
1.0% have policies for treating patients who are
being trafficked. At present, only two states, Florida,
and Michigan, require health care workers to
complete some form of human trafficking training as
part of their licensure (Donahue et al., 2019).
American Indian women are murdered at a rate
ten times higher than the national average, and an
estimated one third of American Indian women will
be raped at some point in their lifetime (Cohen,
2018). American Indian women have long been
considered invisible and disposable in society, and
those vulnerabilities attract predators making AI/AN
women at disproportionate risk for rape or murder
(Deer, 2005). Homicide is the third leading cause
of death among AI/AN women between 10 and 24
years of age and the fifth leading cause of death
for AI/AN women between 25 and 34 years of age
(Heitkamp, 2017). There is also reason to believe
that AI/AN women who are missing may be victims
of human trafficking. Evidence suggests that chronic
poverty, rape, homelessness, childhood abuse,
and racism all play a part in human trafficking (New
Report on Prostitution, n.d.).
Violence against AI/AN women is a critical public
health and safety issue. The Violence Against
Women Act recognized AI/AN women’s unique
vulnerabilities to violence (Violence Against Women
Act of 1994 as cited by Crossland et al., 2013).
Abrahams, N., Devries, K., Watts, C., Pallitto, C., Petzold,
M., Shamu, S., Garcia-Moreno, C., 2014). Worldwide
prevalence of non-partner sexual violence: A
systemic review. Lancet, 383(9929), 1648-1654. doi:
Centers for Disease Control and Prevention, (2015).
Intimate partner violence surveillance uniform
definitions and recommended data elements. Online:
Cohen, S. (2018). Not Invisible: Why are Native American
women vanishing? Havre Daily News. https://
Crossland, C., Palmer, J., & Brooks, A. (2013). NIJ’s
Program of Research on Violence Against American
Indian and Alaska Native Women. Violence
Against Women, 19(6), 771-790. https://doi.
Deer, S. (2005). Sovereignty of the soul: Exploring the
intersection of rape law reform and Federal Indian
Law. Suffolk University Law Review, 38, 455-466.
Donahue, S., Schwien, M., & LaVallee, (2019). Educating
emergency department staff on the identification
and treatment of human trafficking victims. Journal
of Emergency Nursing, 45(1), 16-23, doi: 10.1016/j.
Goodwin, G. L., (2017). Human Trafficking Investigations
in Indian Country or Involving Native Americans and
Actions Needed to Better Report on Victims Served.
United States Government Accountability Office,
Hachey, L. M., & Phillippi, J. C. (2017). Identification and
management of human trafficking victims in the
emergency department. Advanced Emergency
Nursing Journal, 39(1), 31-51.
Heitkamp, H., (2018). S.1942-Savanna’s Act 115 the
Congress (2017-2018). Congress Gov. Retrieved
International Labour Office Special Action Programme
to Combat Forced Labour, (2012). ILO global
estimate of forced labour results and methodology.
International Labour Organization. Retrieved from
Lucchesi, A., & Echo-Hawk, A. (2017). Missing and
murdered Indigenous women and girls: A snapshot
of data from 71 urban cities in the United States.
Seattle: Urban Indian Health Institute. Online: http://
Lutey, T. (2019, January 8). Tester demands answers for
FBI, BIA response to Montana girl’s disappearance.
Billings Gazette. Retrieved from https://
Monchalin, L., Marques, O., Reasons, C., & Arora, S.
(2019). Homicide and Indigenous peoples in North
America: A structural analysis. Aggression and
Violent Behavior, 46, 212-218. doi.org/10.1016/j.
St. Claire, A., (2017, June 2). Sex trafficking a ‘significant
problem’ in Indian Country U.S.
Senators told human trafficking in Indian Country
occurring at higher rates. Navaho Hope, Retrieved
May, June, July 2021 Montana Nurses Association Pulse Page 19
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