Montana Pulse - May 2021


May 2021 • Vol. 58 • No. 2


Quarterly publication distributed to approximately 13,000 RNs and LPNs in Montana.

Executive Director Report

2021 Annual Convention

Page 5



Page 14

current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

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 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

Chief Executive


OFFENSE plan with potential bill drafts:

• Healthcare Provider definitions correction in statute

& documents

• 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

Relations Platform

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



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,

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.

Please visit

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: • Website:

Office Hours: 7:30 a.m.-4:00 p.m. Monday through Friday


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.

MNA Staff

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

Development Generalist

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


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

Chairperson Elect-CAP

Margaret Hammersla, BSN, MS, PhD,



Nanci Taylor, APRN

Member at Large-CAP


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:

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


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

health emergencies.

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

healthcare system.

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.



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

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




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

or recertify

> 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 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

Jennifer Hamilton

Administrative &

Marketing Specialist

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 with any questions. To register, visit https://

> Visit 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

Erica Carbajal

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

16, 2021.

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.

Amy Hauschild,

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

are welcomed!

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


Leslie Shepherd,

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:





Weingarten Rights

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

Labor Program


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

in wages!

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

within scales

• 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??



• Stay UP-TO-DATE on all legislative issues by visiting

• Join the MNA SWAT Team by contacting

• 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

obinet Peaks

Mediclll Center

Libby, MT

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 |


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?

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.

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

these options.


Number of




Individual Activity

• 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

Approved Provider

• 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 today!

Search job listings

in all 50 states, and filter by location and credentials.

Browse our online database of articles and content.

Find events for nursing professionals in your area.

Your always-on resource for nursing jobs, research, and events.

Approval Period


• 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

the activity

• 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

professional development

• 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 for map)

After Approval

• 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

website: https://www.mtnurses.



• Email Caroline:

• Email Kristi:

Please let us know if you have any question related to options for contact hours for nursing continuing

professional development.


$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

Professional Development


Montana Nurses Association

Approved Providers

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

Vancouver, WA

Alaska Native Tribal Health Consortium

Anchorage, AK

Alaska Nurses Association

Anchorage, AK

Alzheimer’s Resource of Alaska

Anchorage, AK

Bartlett Regional Hospital

Juneau, AK

Benefis Healthcare Systems

Great Falls, MT

Billings Clinic

Billings, MT

Boise State School of Nursing

Boise, ID

Bozeman Health

Bozeman, MT

Cardea Services

Seattle, WA

Caring for Hawai’i Neonates

Honolulu, HI

Central Montana Medical Center

Lewistown, MT

Central Peninsula General Hospital

Soldatna, AK

With Distinction

Community Medical Center

Missoula, MT

Confluence Health

East Wenatchee, WA

Evergreen Health

Kirkland, WA

Foundation Health Partners

Fairbanks, AK

Kalispell Regional Healthcare System

Kalispell, MT

With Distinction

Kootenai Health

Coeur d’Alene, ID

Midland Memorial Hospital

Midland, TX

With Distinction

Montana Geriatric Education Center of UM

Missoula, MT

With Distinction

Montana Health Network

Miles City, MT

Montana VA Health Care System

Helena, MT

With Distinction

Mountain Pacific Quality Health

Helena, MT

North Valley Hospital

Whitefish, MT

Pacific Lutheran University

Tacoma, WA

With Distinction

Planned Parenthood of the Great Northwest

and the Hawaiian Islands

Seattle, WA

Providence Alaska Learning Institute

Anchorage, AK

Providence Healthcare

Spokane, WA

South Dakota Nurses Association

Pierre, SD

South Peninsula Hospital

Homer, AK

St. Luke’s Health System

Boise, ID

St. Peter’s Health

Helena, MT

St. Vincent Healthcare

Billings, MT

UF Health Shands Hospital

Gainesville, FL

With Distinction

Wisconsin Nurses Association

Madison, WI

With Distinction

Page 12 Montana Nurses Association Pulse May, June, July 2021

APRN Corner

Keven Comer


Thank you to all that

attended the 2021 Virtual

APRN Pharmacology

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.

can point you right to that perfect


Free to Nurses

Privacy Assured

Easy to Use



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 so she can

sign you up for your AANP membership or if you have

any questions.

E-mailed Job Leads

May, June, July 2021 Montana Nurses Association Pulse Page 13

ANA Excerpts

Everyone Deserves A Job They Love!!

Let Us Help Today,

Call 406.228.9541

Prairie Travelers is recruiting Traveling

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For an application or more information, visit

Helena College University of Montana is seeking a

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Please see our vacancy announcement at _ opp.aspx.

Apply to

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:


To Apply Online, please visit:

Disabled/AA/EEO/Vet Preference Employer

Apply online at:

or contact David Perry, RN - Staff Coordinator/Director of Nursing Services

406-852-6361 or 406-228-8044 |

Page 14 Montana Nurses Association Pulse May, June, July 2021

State Wide Nursing News


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.

Carolyn Taylor

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.



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

and dread.

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)


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! 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

or cause.

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

patient outcomes!


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.”

(Harris, 2014)


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

2. Apprehensive

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

15. Crying

16. Decreases in self-assurance or self-adequacy

17. Anxiety about making mistakes

18. Narrowed focus

19. Avoidance behaviors

20. Impulsiveness

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

28. Accusatory

29. Inattention

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

organizational success)

38. Curtailment/ withholding of the “Right to Know”

39. Relinquishing role responsibilities



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

cowardly lions!

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

peaceful surroundings.

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


Helping Adults:

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.

Helping Children:

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

fully vaccinated.

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

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

join our team!

Grow your career and thrive where you live. Great

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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

Healthcare Environment

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:// and-regional/




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.


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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