The North Dakota Nurses - January 2022


The North Dakota Nurse



Sent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter

does not mean that you are a member of NDNA. To join please go to and click on “Join.”

Quarterly publication distributed to approximately 20,000 RNs and LPNs in North Dakota

Vol. 91 • Number 1 January, February, March 2022


Highlight a


Page 3

North Dakota Department of

Health: Vaccine Q & A

Page 4

Message from the President

Keep on Pushing

I am sure I am not the only one feeling like I

am in a hamster wheel, spinning and spinning

and spinning without ending. As we enter a new

year, it is imperative that we do some reflection.

It is important as nurses, we pause and look

back at what motivates us to get out of that

spinning wheel and continue to be the best

we can for our patients. Easier said than done,

I know.

I encourage you to ask yourself, “what

motivates you?” If we can answer this question

and keep it in the forefront of our care delivery,

it is easier to keep pushing, especially during

challenging times like the last two years. One

effective way to stay motivated is to set a new

goal. Say it aloud and write it down, own this

goal. According to Drake (2017), “setting a goal

and staying focused is one more approach to

keeping yourself motivated. Establishing a goal

provides you with a cause and moving toward

the goal can give you positive reinforcement.

When we focus on a goal, we are less likely to

get side-tracked by nonessential work. And

do not underestimate fear as a motivating

factor. Fear of failure can often motivate us to

accomplish our goals” (p.56). In stressful times,

when you feel as though you are just spinning in

that wheel, pause and refocus on your goal. This

helps to keep pushing.

As nurses, we also need to remember we

always can be a leader and motivate those

around us. You can

motivate your work team,

your church group, your

family, your patients, and

anybody else you meet.

The easiest way to do this,

is make it personal. It is

important when motivating Tessa Johnson

people that you know

the individual and what truly motivates them.

Sometimes you must get downright creative

and even competitive. In addition, take time

to educate yourself on motivational theories

to assist in tailoring your style to your team.

Motivation can be either intrinsic or extrinsic, but

the key to both is a sense of achievement tied

to goals and expectations. With a little push,

you will be surprised how motivated you and

your team members become (Drake, 2017).

Remember, negativity is contagious.

Unhappiness is contagious. Fear is contagious.

But so is happiness. So is optimism. So is love.

Surround yourself with people who bring out the

best in you. Strive to be a reflection of what you

want to receive. Be well, we need all of you!

Drake, K. (2017). Nursing Management. The

Motivation to Stay Motivated, 48(12), 26.



Medical Marijuana, Legislative

Updates and Education

Page 8

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


Executive Director’s Message

Sherri Miller, BS, BSN, RN

New Year

We are officially in 2022, and reflective

about 2021. Let’s take a look at what we

have done as an association in 2021 with

resiliency, and as President Johnson writes

in her column above - “let’s keep on


NDNA always looks to our mission to

stay on track. Our mission is to advance

the nursing profession by promoting

professional development of nurses,

fostering high standards of nursing

practice, promoting the safety and wellbeing

of nurses in the workplace, and

by advocating on health care issues

affecting nurses and the public.


• 2021 was a legislative session year; NDNA

collaborated and lobbied on areas such as:

o Essential Caregiver

o Vitamin D coverage

o School Nursing

o Support for the ND Center for Nursing

new workforce recruitment and

retention program

o Insurance coverage of telehealth

o Workplace violence – assault on a

health care provider

o Opposition to drug importation bills

o Support of school psychologists being

allowed to bill for Medicaid services

• New Director of Advocacy, Penny Briese,

was appoint to serve!

Executive Director’s Message continued on page 4

Page 2 The North Dakota Nurse January, February, March 2022

How to submit an article for

The North Dakota Nurse!

Nurses are strongly encouraged to contribute to the profession

by publishing evidence-based articles; however, anyone is

welcome to submit content to the North Dakota Nurse.

We review and may publish anything we think is

interesting, relevant, scientifically sound,

and of course, well-written. The editors

look at all promising submissions.

Deadline for submission for the next issue is 3/7/2022.

Send your submissions to

Welcome New Members

Jennifer Pederson

West Fargo

Debbie White


Elizabeth Satrom


Heather Burnley


Kelsey Fitterer

West Fargo

Jesse McDonald

West Fargo

Elizabeth Coulson


Carl Millien


Help shape the future of the nursing

profession by joining NDNA.

Here's a quick look at some of your individual

benefits as a member of NDNA/ANA:

• Subscriptions to The American Nurse and

American Nurse Today

• Subscription to the North Dakota Nurse,

delivered personally to you four times a


• Subscription to NDNA’s Monthly eNews and


• Weekly NDNA Legislative Updates --

informing you of current legislative issues

that affect you! (During ND legislative


• Information and registration information

for NDNA sponsored educational

Melissa Marx


Alyssa Lind


Mallory Waters


Anna Nagel


Amber Hinderscheid

Grand Forks

Member Benefits

Lori Martinson


Melisa Banish


Martin Mwondha


Randy Hunt

West Fargo

Autumn Nelson

West Fargo

opportunities, including workshops,

conferences and seminars providing

contact hours delivered personally to you.

• Reduced registration fees for the NDNA

Annual Meeting and Fall Conference.

• Leadership opportunities in a wide variety

of areas and with a wide variety of time

commitments to fit your schedule.

• Access to exclusive ANA website and

“members only” information.

• Discounts on professional liability insurance

offered by NSO

• A voice in support of the nursing profession!

*Please note that some of the benefits are

only for joint NDNA/ANA members only and may

not apply to Affiliate Members.

ANA Member Discounts and Benefits



RN and LPN

positions -

Up to $7,500

Mountrail County Health Center is currently seeking

RNs for the hospital. If you enjoy working in a fastpaced

environment and want to provide top care to

patients, please consider applying with MCHC. Our

newly expanded ER is a great learning experience

for new nurses coming out of college, as well as

experienced nurses.

Mountrail Bethel Home is currently seeking RNs &

LPNs for the nursing home.

MCHC offers competitive wages, top benefits and


Interested, please apply online at or email

The North Dakota Nurse

Official Publication of:

North Dakota Nurses Association

General Contact Information:

701-335-6376 (NDRN)

Board of Directors and Staff


Tessa Johnson, MSN, BSN, RN, CDP


Mylynn Tufte, MBA, MSIM, RN

Vice President of Finance

Richelle Johnson, MSN, RN

Director of Membership

Kami Schauer, MSN, RN

Director of Education and Practice

Courtney Naastad, PMHNP-BC, MSN, BSN, RN

Director of Advocacy

Penny Briese, MS, RN

Director at Large


Affiliate Member Representative (LPN)

Catherine Sime, LPN

Executive Director

Sherri Miller, BS, BSN, RN

Please go to our website to learn more about the

board and their roles:

Published quarterly: January, April, July, and October

for the North Dakota Nurses Association, a constituent

member of the American Nurses Association, 1515 Burnt

Boat Dr. Suite C #325, Bismarck, ND 58503. Copy due

four weeks prior to month of publication. For advertising

rates and information, please contact Arthur L. Davis

Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa

50613, (800) 626-4081, NDNA 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 North Dakota 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. NDNA 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 NDNA or

those of the national or local associations.

Want to Make Your Nursing Voice

Heard…Get Published in the

North Dakota Nurse!

The North Dakota Nurse quarterly publication accepts

content on a variety of topics related to nursing. Nurses

are strongly encouraged to contribute to the profession

by publishing evidence-based articles, but we welcome

anyone to submit for publication. If you have an idea,

but don’t know how or where to start, contact one of

the NDNA Board Members.

Please note:

*Send articles to

*Articles should be in Microsoft Word and be double


*All articles should have a title.

*Articles sent should have the words “North Dakota

Nurse Article” in the email subject line, along with the

specific title.

*Deadline for submission of material for upcoming

North Dakota Nurse is 3/7/2022!

The Vision and Mission of the

North Dakota Nurses Association

Vision: North Dakota Nurses Association, a

professional organization for Nurses, is the voice of

Nursing in North Dakota.

Mission: The North Dakota Nurses Association (NDNA)

is the only professional organization representing all nurses

in North Dakota. The mission of NDNA is to advance the

nursing profession by promoting professional development

of nurses, fostering high standards of nursing practice,

promoting the safety and well-being of nurses in the

workplace, and by advocating on health care issues

affecting nurses and the public.

January, February, March 2022 The North Dakota Nurse Page 3

Highlight a Nurse

NDNA interviews great ND nurses to be featured in The

North Dakota Nurse, our monthly NDNA eNews, and on Facebook!

If you know a nurse or are a nurse that NDNA can highlight,

please contact

Name and credentials: Mercedez Marvig, RN

• Short Bio

- I am Mercedez Marvig, I have been in health

care for 10 years now, I have been a nurse

for four years. I work at Sanford ER in Fargo as

an Emergency room nurse as well as a sexual

assault nurse examiner for the Midwest. I also

teach at Rasmussen! I have three nursing

degrees and I am working on my fourth!

• What led you to become a nurse?

- I have always wanted to be a nurse. The

reason I wanted to become an Emergency

Room nurse is because in college I ate a

Mercedez Marvig

tree nut and became super sick, almost

intubated sick and this nurse with tattoos comes in and I was

undressed, had an iv in my arm, and was given meds before I

could blink. She was calm, cool, and collected even though I was

super sick. She realized I was alone (family was five hours away)

and brought in a chair to my room and charted while sitting

next to me so I did not have to be alone. She will forever be the

coolest person I have met in my life and I have always tried to be

like her.

• What talents, gifts, or skills do you have that assist you in your dayto-day


- I am one of the best foley placers in the emergency room. I also

have a lot of love and patience for our psych population.

• What is a typical day like for you?

- There are NO typical days at the ER, some days you are taking

care of bumps and scratches and others you are taking care of

traumas. We treat everyone from the ages of 0 to death and we

see all sorts of sicknesses.

• What are some of the greatest challenges for you?

- Some of the patients we treat as nurses are not kind and it is

hard to listen/deal with that while maintaining a good attitude.

I remind myself it is always okay to step away to regroup and

they are just human, same as me and they need extra love and


• What are some ways that you see your specialty can make a

difference in a rural state?

- I am one of two RNs who have the ability to treat both pediatric

and adult sexual assaults. People come from all over the Midwest

to see my team.

Name and credentials: Andrea Sperr, RN

• Short Bio

- My name is Andrea! I am the oldest of three

siblings, I have only ever had dalmatian

dogs my entire life. I like to fish and spend

time outside as much as possible. I also really

enjoy fitness and workout almost daily even

before I work! I won a Daisy award, and have

worked med-surg trauma as an LPN for four

years, then have worked for the past two

years as an RN ER nurse. I also have my SANE

certification, and have my TNCC, ENPC,

PALs, and ACLS.

Andrea Sperr

• What led you to become a nurse?

- When my mom would bring me with to the ER in Alexandria,

MN when she would work I would follow the nurses and doctors

around and I think that is where I realized that I was going to be a


• What talents, gifts, or skills do you have that assist you in your dayto-day


- I have quick wit, and work best under pressure. I really enjoy

being a preceptor for students and new nurses.

• What is a typical day like for you?

- At work? Absolute insanity, its great and awful all at the same

time. Nursing is hard but I'm glad that I'm a nurse.

• What are some of the greatest challenges for you?

- Holding my tongue when I‘m mad. I grew up a farmer's

daughter and was taught to call it as I see it. Not all patients are

appropriate and it’s hard to remain calm when they are awful.

• What are some ways that you see your specialty can make a

difference in a rural state?

- As an ER nurse, I am part of people's worst days and can be the

calm in the storm for them. Having a farm life background really

helps when we get the grouchy farmers in that absolutely have

no time for the things we are making them have time for.

Name and credentials: Shereen Leiseth, RN BSN


Nursing Specialty:

Referral Case Manager/Traveling Veteran


My previous ‘specialties’ were the Critical Care

and Emergency Departments.

What led you to become a nurse?

I chose nursing, nursing didn’t choose me (aka I

didn’t have that Florence Nightingale moment). I

started as a CNA - working in a nursing home and a

critical access hospital. Completed my LPN - working

Shereen Leiseth

med/surg and walk-in clinic. I transitioned straight

into the LPN to BSN program at NDSU - worked in critical care/ED/day

surgery/and a smattering of other PRN positions after completing the BSN

degree. I am currently finishing a MSN degree in Nursing Education.

What talents, gifts, or skills do you have that assist you in your day-to-day


I am detail oriented and flexible. I take great pride in what I do -

achieving excellence and mastery is very important to me. I also believe

in customer service. My job is to support those who are on the front lines.

(I save lives on the computer.)

What is a typical day like for you?

There are NO typical days. My job is to support case managers at

non-VA hospitals in North Dakota and the upper ⅓ of Minnesota. This

means non-stop trouble-shooting. I also review clinical and discharge

documentation with the goal of coordinating care with the case

managers, offering VA resources as appropriate. Another key aspect of

my position is coordinating care for Veterans who travel from one VA to

another with the Traveling Veteran Coordinators across the USA. This is a

super busy time of year for that population as the snowbirds are heading

south. I also work with transplant, acute rehab and LTACH patients….the

list seems endless some days. As in all aspects of nursing - it is a team

sport and I have amazing co-workers.

What are some of the greatest challenges for you?

Understanding the acronyms that come from the VA healthcare

system! I view my job as being the VA 'interpreter’ for case managers in

our service area.

What are some ways that you see your specialty can make a difference

in rural areas?

Many people don’t realize that the VA can pay for unplanned

episodes of care (ED visits/admissions/direct admissions) for Veterans

at private healthcare facilities. I can offer the small, rural hospital VA

resources for discharge planning.

I am continually advocating for, and educating hospital/case

management staff, Veterans and their families about VA benefits.

Additionally, the Fargo VA has done an exceptional job of working

to deliver healthcare to the rural populations utilizing technology with

tele health options, video visits and more. With all of the pressure on

overwhelmed healthcare systems right now, my goal is to offer VA

resources whenever possible and appropriate.

Now Hiring Experienced and

New Graduate Registered Nurse




$10,000 Sign On Bonus Available

Apply Today at

Best People, Best Care… Anywhere!

Located in Basin, Wyoming

Page 4 The North Dakota Nurse January, February, March 2022

North Dakota Department of Health: Vaccine Q & A

The NDNA is now working with the North Dakota Department of

Health to provide education on vaccines with the goal to assist nurses

in answering questions that may arise from their patients and others. In

this issue of The North Dakota Nurse, we are highlighting some common

questions and answers specific to reactions from COVID-19 vaccine.

What are the FDA and CDC guidelines regarding allergic reactions and

administering COVID-19 vaccine? The FDA has included a history of severe

allergic reactions to a previous dose of COVID-19 vaccine or any COVID-19

vaccine ingredient as a contraindication for the COVID-19 vaccine.

Additionally, individuals who have had an immediate allergic reaction to

COVID-19 vaccine or a COVID-19 vaccine ingredient should not receive

the vaccine. Because of reports of anaphylactic reactions in individuals

vaccinated outside of clinical trials, additional guidance has been created.

All individuals should be monitored for 15 minutes postvaccination.

The CDC has recommended persons who have had a severe

allergic reaction to any vaccine or injectable therapy (intramuscular,

intravenous, or subcutaneous) can receive COVID19 vaccine, but under

the following conditions:

• Individuals must be counseled about the unknown risks of

developing a severe allergic reaction and balance these risks

against the benefit of vaccination.

• Individuals should be observed after vaccination to monitor for the

occurrence of immediate adverse reactions for 30 minutes (versus

15 minutes generally recommended following vaccination).

• Individuals with other types of allergies, such as food, latex, pollen,

or other substances do not have to take special precautions and

can receive a COVID-19 vaccine.

I’ve heard reports of inflammation of the heart (myocarditis) and of

the outer lining of the heart (pericarditis) following receipt of Pfizer and

Moderna COVID-19 vaccines. Are these events related? Since April 2021,

increased cases of myocarditis and pericarditis have been reported in the

U.S. after mRNA COVID-19 vaccination (Pfizer and Moderna), particularly

in adolescents and young adults. These reports are rare, and the CDC and

its partners are actively monitoring reports of myocarditis and pericarditis

after COVID-19 vaccination. There has not been a similar reporting pattern

observed after receipt of Johnson & Johnson COVID-19 vaccine. In most

cases, patients who presented for medical care have responded well to

medications and rest and had prompt improvement of symptoms. Reported

cases have occurred predominantly in male adolescents and young adults

16 years of age and older. Onset was typically within several days after

mRNA COVID-19 vaccination, and cases have occurred more often after

the second dose than the first dose. Research has shown that incidence

of myocarditis following an mRNA COVID-19 vaccine is rare and that

symptoms in a majority of cases resolve following care. CDC and its partners

will continue to investigate these reports of myocarditis and pericarditis

following COVID-19 mRNA vaccination. The known and potential benefits

of COVID-19 vaccination outweigh the known and potential risks, including

the possible risk of myocarditis or pericarditis. CDC continues to recommend

COVID-19 vaccination for everyone 12 years and older given the risk of

COVID-19 illness and related, possibly severe complications, such as longterm

health problems, hospitalization, and even death.

I’ve heard reports of Guillain-Barre syndrome (GBS) following receipt of

Johnson & Johnson COVID-19 vaccines. Are these events related? On July

13, 2021, the FDA released a statement that suggested that there is possible

increased risk of GBS following receipt of a J&J COVID-19 vaccine. The FDA

has added additional information to the vaccine’s FDA fact sheet on the risk

of GBS. The chance of GBS occurring is very low following J&J vaccination.

As of September 22, 2021, 210 preliminary reports of GBS have been identified

in VAERS out of the more than 14.8 million J&J COVID-19 vaccine doses that

have been administered in the U.S. Cases occur mostly in males and have

largely been reported approximately two weeks after vaccination. You

should seek medical attention right away if you develop any of the following

symptoms following receipt of a J&J vaccine: weakness or tingling sensations,

difficulty walking, difficulty with facial movement, double vision/inability to

move eyes, and/or difficulty with bladder control/bowel function. The known

and potential benefits of COVID-19 vaccination outweigh the known and

potential risks, including the possible risk of GBS. Safety monitoring system

A patient reported a delayed-onset local reaction (erythema, induration,

pruritus) following a COVID-19 vaccine dose. Is this a contraindication for

future COVID-19 vaccines? No, this is not a contraindication or a precaution. It

is not known whether individuals who experienced a delayed-onset reaction

after the first dose will experience a similar reaction after the second dose.

However, these reactions are not believed to represent an increased risk for

anaphylaxis after a subsequent dose. Persons who have a delayed-onset

location reaction around the injection site area after the first vaccine dose

should receive the second dose as the same vaccine product as the first

dose and at the recommended interval, preferably in the opposite arm.

How should we address anxiety-related events following COVID-19

vaccine receipt? Anxiety-related events following COVID-19 vaccination

are not uncommon and can be expected. In these events, a patient may

experience dizziness, lightheadedness, feeling faint, rapid breathing, and

sweating symptoms following receipt of a COVID-19 vaccine.

It is important to be prepared for such incidence when conducting

vaccination clinics, including but not limited to:

• Identify people through screening with a history of fainting during

the vaccination process

• Provide drinks and snacks

• Have a separate, quieter area for those that are feeling lightheaded

or faint to sit or lie down and be monitored following vaccination.

Executive Director’s Message continued from page 1

Promoting Professional Development of Nurses

• NDNA hosted another remote nursing conference in the spring of

2021 and again in the fall of 2021 with great attendance. Our overall

ongoing theme has established itself clearly – health equity. We are

continuing to projects and support of health equity topics.

• Elections of new board members took place in the fall of 2021.

Mylynn Tufte and Richelle Johnson have taken their seats at

the table of the 2022 NDNA Board of Directors. We again have a

renewed energy. Read about all board members on our website:

• NDNA continues its work with the ND Center for Nursing with

committee work on the Workplace Culture Designation and the

Legendary Nurse awards.

• NDNA began work with DNP students – legislative work,

conferences, and developing self-learning modules that we will be

able to offer in 2022. Watch for this!

• We are a constituent state of the American Nurses Association.

NDNA President and Executive Director attended remote sessions

of the June ANA Hill Day (with meetings with our congressmen),

Membership Assembly in June and Leadership Summit in

December. It is extremely valuable to connect with nurses across

the country.

• NDNA attended and presented to nursing students in January at

the NSAND Annual Convention – an event we love. We will be there

again on January 20-22 in Jamestown.

• We started our new “Highlight a Nurse” series – read about three

amazing nurses in this edition of The North Dakota Nurse. Send us

your nurses to highlight.

Promoting the Safety and Well-being of Nurses in the Workplace

• We received a grant from the North Dakota Department of Health

for vaccine education!

• Practicum with DNP student – Vitamin D education and more to


• NDNA coordinated the creation of a Public Service Announcement

on Covid and Nurses. Go to our Facebook page to watch it! https://

NDNA is committed to continuing our mission and adapting to any

changes we now must make so membership in NDNA is particularly

important right now. Join us! RNs and LPNs can join today by visiting our


Let’s take a moment of pride of what we have all done in all of our

nursing lives in a time of such unpredictable circumstances. Thank you,


Remember to follow NDNA on social media:

For further information on COVID-19 vaccines, visit the ND Department

of Health website – Immunization Guidance for Health Care Providers.

January, February, March 2022 The North Dakota Nurse Page 5

The North Dakota Board of Nursing (NDBON), the North Dakota Nurses Association (NDNA) and North Dakota Center for Nursing (NDCFN)

collaborated to provide this comparison of the three nursing entities. Each of these entities has a unique mission and description, which makes them

very different from one another. This comparison is updated and published annually and is available on the respective websites.


North Dakota Board of Nursing (NDBON)

919 S 7TH Street, Suite 504

Bismarck, ND 58504-5881

Phone: (701) 328-9777

Fax: (701) 328-9785




ND Board of Nursing assures North Dakota

citizens quality nursing care through the

regulation of standards for nursing education,

licensure, and practice.


• Governmental regulatory body established

by state law under the North Dakota Century

Code 43-12.1 Nurse Practices Act to regulate

the practice of nursing and protect the health

and safety of the public

• Regulates the practice of individuals licensed

and registered by the Board

• Establish standards of practice for RNs, LPNs,

and APRNs

• Establish standards and regulate nursing

education programs

• Discipline licensees and registrants in response

to violations of the Nurse Practices Act

Board Members:

NDBON, NDNA and NDCFN: What's the Difference?

North Dakota Nurses Association (NDNA)

1515 Burnt Boat Dr, Suite C #325

Bismarck, ND 58503

Phone: (701) 335-6376




The Mission of NDNA is to advance the

nursing profession by promoting professional

development of nurses, fostering high standards

of nursing practice, promoting the safety and

well-being of nurses in the workplace, and by

advocating on health care issues affecting

nurses and the public.


• 501(c)(6) non-profit association

• Professional association for all nurses in North


• Constituent member of the American Nurses

Association (ANA)

• Influences legislation on health care policies

and health issues and the nurse’s role in the

health care delivery system

• Promotes the continuing professional

development of all North Dakota nurses

• Advances the identity and integrity of the

profession to enhance healthcare for all

through practice, education, research, and

development of public policy

• Promotes the Scope and Standards of Nursing

Practice and the Code of Ethics for nurses

Board of Directors:

North Dakota Center for Nursing (NDCFN)

Box 117

Northwood, ND 58267

Phone: (218) 791-1461



The mission of NDCFN is to through collaboration

guide the ongoing development of a wellprepared

and diverse nursing workforce to meet

health care needs in North Dakota through

research, education, recruitment and retention,

advocacy, and public policy.


• 501c3 non-profit organization Member of the

National Forum of State Nursing Workforce


• Works to unify voice of nursing in North

Dakota through connecting all nurses and

nursing organizations interested in policy


• Develops statewide programming to fulfill


• Works to improve nursing workplace culture.

• Provides leadership and policy opportunities.

• Host annual research conference.

Board of Directors:

Jane Christianson, RN member, Bismarck:


Dr. Kevin Buettner, APRN member, Grand Forks:

Vice President

Dr. Jamie Hammer, RN member, Minot: Treasurer

Michael Hammer, RN member, Velva

Dr. Mary Beth Johnson, RN member, Bismarck

Wendi Johnston, LPN member,

Kathryn Julie Dragseth, LPN member, Watford


Cheryl Froehlich, Public member,

Mandan Dana Pazdernik, RN member, New


NDBON Staff:

Dr. Stacey Pfenning DNP, APRN, FNP, FAANP

Executive Director

Kyle Martin Associate Director for Operations

Dr. Tammy Buchholz, DNP, RN, CNE, FRE

Associate Director for Education

Melissa Hanson, MSN, RN Associate Director of


Maureen Bentz, MSN, RN, CNML Associate

Director for Practice

Corrie Lund, MSN, RN Assistant Director for


Michael Frovarp Accounting/Licensure Specialist

Gail Rossman, Technology Specialist II (Retiring


Karen Hahn Administrative Service Coordinator

Arverd Lachowitzer Technology Assistant/

Licensing Specialist

Christa Stayton Administrative Assistant/Licensing


President - Tessa Johnson, MSN, BSN, RN, CDP

Board of Directors listed at https://ndna.

NDNA Staff (Independent Contractor):

Sherri Miller, BS, BSN, RN Executive Director

13 organizations represented. List available on

website at:


NDCFN Staff:

Patricia Moulton Burwell, PhD Executive Director

Page 6 The North Dakota Nurse January, February, March 2022

The North Dakota Center for Nursing

Legendary Nurse Awards Announced!

Our NDNA President, Tessa Johnson, was selected to receive the

Leadership Award this year. We are very proud. Congratulations to Tessa

and all the recipients!!

NDNA sponsored the Rising Star Award this year.

Leadership Award- Demonstrates exceptional leadership (either in a

formal or informal role) in either their place of employment or in a nonprofit

or nursing organization.

Sponsored by the ND Organization of Nurse Leaders (NDONL)

Paige Wegner, Fargo, Essentia Health

Tessa Johnson, Dickinson, Country House

Theresa Knox, City of Grand Forks Public Health Department

Clinical Practice Excellence Award- Demonstrates exceptional clinical

practice or patient care.

Amanda Anderson, Grand Forks, Altru Family Birthing Center

Courtney Kniert, Grand Forks, Altru Family Birthing Center

Floyd Nemer, Bismarck, VA Health System

Marilyn Schwartzbauer, Bismarck Sanford ICU

Faculty Achievement Award- Demonstrates excellence in teaching,

engaging students in the love for nursing and supports student growth.

Sponsored by College and University Nursing Education Administrators


Nancy Turrubiates, Fargo, North Dakota State University

Anna Anderson, Bismarck State College

Nurse Executive Leadership Award - Provides exceptional leadership

(over five years) in a top executive role for Nursing such as Nurse

Executive, Vice President, Chief Nursing Officer, Dean, Director or

Program Chair.

Sponsored by Evelyn Quigley and Carla Hansen

Sue Leupp, Mohall, Good Samaritan Society

Brett Kallis, Dickinson, Southwestern District Health Unit

Sara Senn, Richardton Health Center

Rising Star Award - A nurse in the first two years of practice that

exhibits leadership and professionalism in their field of nursing.

Sponsored by the North Dakota Nurses Association

Joan Garia Ortiz, Grand Forks Altru Health System

Evidence Based Practice Award - Excellence in the promotion and

utilization of evidence based practice principles in the pursuit of clinical


Margo Daily Filipkowski, Minot Trinity Health

Amy Lamb, Fargo VA Health Care System

Preceptor Award - Excellence in encouraging and supporting nursing

student education through clinical precepting or organizational

orientation for nurses transitioning from student to professional practice.

Stacie Weible, Fargo Sanford Health

Champion for Nursing Award - A non-nurse or organization who has

demonstrated a strong commitment in supporting the nursing profession

and/or made significant contributions to the nursing profession.

Sponsored by Sigma Theta Tau Xi Kappa at Large and Kappa Upsilon


Michael Essex, Fargo Sanford Health

Julie Wittkopp, Fargo VA Health System

Randolph Peterson, Fargo VA Health System

School Nurses and Telemedicine

Penny Briese, PhD, RN

At the NDNA Fall 2021 conference, nurses from across the state

heard from several very knowledgeable speakers on the topics of both

telemedicine and the toll Covid-19 has taken on not only North Dakotan’s

physical health but their mental health as well. Thomasine Heitkamp,

Dr. Shawnda Schroeder, and Rachel Navarro spoke specifically about

how rural communities encounter more barriers to accessing behavioral

health support than their urban counterparts due to lack of resources;

in Native American communities, access issues are even worse. Much of

the problem appears to stem from an overall lack of mental healthcare

providers in our state. The lack of pediatric mental healthcare specialists

is even more concerning. North Dakota children are experiencing

upheavals in their normal schedules due to the uncertainty of schools

closing due to Covid outbreaks, being put into quarantine for close

contact or positive tests, having to transition from classroom to online

learning environments, and just the uncertainty of when vaccines will

be available for younger school-aged children. “Currently, nearly 22

Belcourt, ND

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Health Service unit located on the Turtle Mountain Reservation

in Belcourt, ND. The Facility provides comprehensive primary

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All RNs encouraged to apply or call for more information.

percent of children ages 3 to 17 in the United States are affected by a

mental, emotional, developmental, or behavioral condition. Only about

20 percent of children with mental, emotional, or behavioral disorders,

however, receive care from a specialized provider.”(1)

This trend has been noted by school nurses across the country. School

nurses are in a prime position to be the first to notice when children are

experiencing mental distress or crisis. (2) The National Association of

School Nurses (NASN) states that children’s health and wellness must be

a priority for them to succeed in school. They further state that disparities

related to social determinants of health, which includes where students

reside (rural VS urban) must be addressed. And school nurses now have a

new tool with which to do just that.

The Biden/Harris Administration has taken the issue of pediatric mental

healthcare access to heart. Recently, it was reported in the news that

“the U.S. Department of Health and Human Services (HHS) awarded

$10.7 million from the American Rescue Plan (ARP) to expand pediatric

mental health care access by integrating telehealth services into

pediatric care. The awards were made through the Health Resources

and Services Administration (HRSA).”(1) These grants will expand access

to children, regardless of where they live, through telehealth visits with

pediatric mental health specialists. Health and Human Services (HHS)

Secretary Xavier Becerra said, "The COVID-19 pandemic has taken a toll

on all of us, especially children. This critical funding will not only improve

the livelihoods of children and their families, but also secure the future

of our country. We will continue to make investments that ensure our

youngest Americans grow up strong and healthy." (1)

The Pediatric Mental Health Care Access Program has expanded

access from 21 awards in 21 states to 45 awards in 40 states, as well

as DC, the Virgin Islands, and the Republic of Palau. (1) Two Native

American tribal areas have also benefitted: the Chickasaw Nation and

the Red Lake Band of the Chippewa Indians (1)

"Primary care providers strive to address the many mental health

challenges children and families are experiencing due to the pandemic,

but they need more support," said HRSA Acting Administrator Diana

Espinosa. "Expanding the Pediatric Mental Health Care Access program

offers new opportunities for providers to offer families the mental

and behavioral health services they need but that often aren't easily

accessible." (1)

To learn more about Promoting Positive Mental Health in Rural Schools,

please go to


To learn more about HRSA's Pediatric Mental Health Care Access

program, visit:

For a list of HRSA awards, visit:


1. Biden-Harris Administration Invests $10.7 Million in American Rescue Plan Funds

to Expand Pediatric Mental Health Care Access. Retrieved from https://


2. The Behavioral Health and Wellness of Students. Retrieved from https://www.


January, February, March 2022 The North Dakota Nurse Page 7

Welcome New NDNA Officers!

NDNA welcomed new officers effective

January 1, 2022. We are thankful to have

these talented nurses join us as LEADERS as we

advance the nursing profession in North Dakota!

Thank you all for your willingness to serve!


Mylynn Tufte,


Membership Assembly


Susan Indvick,


The Nominating Committee will be: Cheryl

Lantz, RN, PhD, CDCP, Richelle Johnson, MSN,

RN, and Mylynn Tufte, MBA, MSIM, RN

Bottineau, ND

Full-Time RN/LPN

Also hiring CNAs and

CS/ER Technicians

NEW competitive salary &

excellent benefit package

ND licensure/certification required.



For more information or an application, please contact

Human Resources at 228-9314 or visit our website at

Vice President of Finance

Richelle Johnson,


Cheryl Lantz,


Unity Medical Center, located in Grafton is

recruiting for Med Surg/ER Nurses to work

in our new addition that consists of 11 new

patient rooms and a new ED department.

Director of Membership

Kami Schauer,


Richelle Johnson

Mylynn Tufte

12 hour shifts rotating days and nights

every 3rd weekend and rotating Holidays.

Please contact Jenny, CNO at 701-352-1620

or apply online at


Page 8 The North Dakota Nurse January, February, March 2022

Medical Marijuana, Legislative Updates and Education

Gail Pederson, SPRN, HN-BC

Be Well Healing Arts, PLLC

I would like to update the nursing community

on the status of Cannabis (Medical Marijuana) in

North Dakota and the changes recently passed by

the 2021 legislature. I will also add my activity as a

Cannabis Nurse Consultant and Educator.

If you are not familiar with the North Dakota

Medical Marijuana law, it is ND Century Code

Chapter 19-24.1 and is found at: https://www.legis.

To be an advocate for your patients, I would

recommend reading it.

Gail Pederson

Here are a few statistics that I have pulled from the yearly report of the

Medical Marijuana Program (MMP). It can be found at

As of the July 2021, end of the FY report, there are 5,754 card holders,

139 caregivers cards and over 400 employees in the industry.

297 providers have certified patients for cards. The make up of those

certifying are:

• 60% Physicians

• 32% Advanced Practice Registered Nurses

• 8% Physician Assistants

Since our vote to allow Medical Cannabis in the state in 2016, our law

has evolved over 3 legislative sessions. Wording has been changed to

help the certification process be more palatable to providers. Conditions

have been added. Allowable amounts were increased (still not enough

for some conditions), changes were made to allow Veterans easier

access. Several conditions were added in 2019. I was active during our

2021 legislative session, speaking whenever possible for changes in

our program. A few made it through legislation, but a lot more that we

advocates had hoped for, did not.

The 2021 legislative session was more patient focused, I felt. More

about patient protections, not as much implementation issues. There

were important changes to our caregiving program that came up and

were easily passed. On a national level, Cannabis Nurse colleagues

noted these changes as important.

Our law allowed one caregiver the legal right to purchase and

dispense/dose a cannabis card holder. One person only! This did not

allow another parent, grand parent or other significant person such

as a daycare provider to medicate that person in need of assistance

with Cannabis dosing. This became personal when a cannabis activist

mom nominated me for the 2019 ND Legendary Nurse Award for

Advocacy. She was the only caregiver for her autistic son. His bus was

10 minutes late. Because she needed to medicate him she missed

presenting me the award. I stated jokingly to the lawmakers that they

had never made out a 24/7/365 day a year scheduling like us nurses

have. Three caregivers were requested by the sponsor, which I asked

the HHS committee to raise to 5. This law also changed the make up of

the Medical Marijuana Advisory Board, adding a patient representative

and a legislator from each chamber. The state chose to removal the $50

registration fee for caregivers. They still have to go through a background

check at their expense. In another bill, if a person is applying to be a

caregiver for a terminal patient. The background check is waived for 6

months, with the ability to renew for another six months.

Those of us working to improve our program had proposed these items

which did not make it into law. We will try again.

The ability of patients to grow their own Cannabis. This was in the

original measure we voted on. I remember talk on the floor of

people growing 20 pounds with one plant and mold covering the

inside of homes, endangering our families. The average amount

that I have been told by my many Cannabis Nurse grower friends

across the country is 4-6 ounces per plant. This extreme amount

brought up is not realistic and continues the fear mongering around

this plant.

January, February, March 2022 The North Dakota Nurse Page 9

• A food grade edible product. Again,

this was taken out of the original bill. All

cannabis is ingestible in its different forms.

To have a lozenge, gummy, chocolate that

is a set milligram-usually 10 mg just makes

sense to a person who wants an accurate


• Reciprocity of patient cards between

states. This is a nationally discussed issue

and I supported it. Our legislators were

worried about misuse of residents “from

Minnesota” that may come to a dispensary

in Fargo, get flower that is not available

in MN, smoke it and drive impaired back

to MN. There were concerns that a state’s

accepted conditions are different than

ours. There are few conditions that North

Dakota does not have compared to other

states. The fear and mistrust is great.

The ability of a caregiver of a minor to

utilize plant matter “Flower” to use other

than as a combustible, such as making an

oil. This is to utilize a specialized treatment

based on the whole plant cannabinoids,

flavonoids and terpenes. It is trial and error

for our kids with cancer, Epilepsy or on the

Autism Spectrum disorder. Parents need to

be able to find which strain (Chemovar)

works best. As it stands now, the pediatric

product, a solution, though cheap for

minors, may not be the one that is best for

them. An excellent video on pediatrics was

made for us by one of the top cannabis

MDs in the country, Dr Bonni Goldstein.

Unfortunately, we could not get this bill to

the floor.

• Our monthly patient limits are inadequate

for cancer, pain management and

other conditions. Another issue is there

is no leeway for milligram differences in

the products within the program. Each

bottle of tincture or other concentrate

is a different mg, depending on the

percentage of THC in the cannabis

product. A patient I know could not get a

concentrate of the strain that works well

for him, because it was 1.5mg over his

limit on a product that averages 800mg

plus. Concentration limit increases had

been put in place, but disappeared from

legislation. The fear of “diversion” of the

product by the legislators is a factor in

this. I do support adult use legalization for

the ethical and social issues it involves and

because of continued limitations to our

medical program.

I have been active in a Long Term Care

working group of the American Cannabis

Nurses Association. We have been looking

at policy for those in LTC or communal living

(like my disabled adult son) to use cannabis.

This is what prompted me to ask for adequate

caregivers. Within this group, data has been

complied of a study using CBD in a small,

private memory care setting. The results

are promising with better sleep patterns,

less anxiety, and overall better mood and

interactions. Learning the steps to publish a

peer reviewed article has been eye opening.

I’ve told the others involved that I’m learning so

much and just along for the ride.

As I look back at my past articles, I noted

that I had said that I will be launching my

continuing education program “Cannabis 101:

What Medical Professionals Need to Know”

in 2019. Then Covid hit. I will now attempt to

offer it again. This is a comprehensive program

focusing on the National Counsel for State

Boards of Nursing Guidelines on Patients

Who Use Marijuana (1.5 CEUs for Nurses and

Licensed Social Workers at the present time).

The topics included are the history, state law,

the Endocannabinoid system, routes of use,

medication intereactions and side effects.

Legal, institutional and ethics are discussed.

It is open to all medical professionals. The

goal of setting up presentations across the

state depend again on Covid, for myself and

those I care for. I will be offering it in our larger

communities and targeting specific facilities.

If you have any questions or would like to

schedule a presentation for your facility, please

contact me. I think it is an important subject.

Gail Pederson, SPRN, HN-BC is a Board

Certified/Special Practice RN in Holistic Nursing

and the owner of Be Well Healing Arts, PLLC.

She is a Cannabis trained nurse providing

Consultation and Education on Cannabis as

medicine. Gail is a member of the American

Cannabis Nurses Association and the Cannabis

Nurses Network. She may be contacted at, “Like” Be Well

Healing Arts, pllc on Facebook or call 701-490-

2132 for further information.

Page 10 The North Dakota Nurse January, February, March 2022

COVID-19 Booster Doses – Which Vaccine Should I Get?

As of October 21, 2021, the CDC has expanded eligibility for

COVID-19 booster shots in the United States. There are now booster

recommendations for all three available COVID-19 vaccines in the United


For individuals who received a Pfizer-BioNTech or Moderna COVID-19

vaccine, the following groups are eligible for a booster shot at six

months or more after their initial series: 65 years and older; age 18+ who

live in long-term care settings; age 18+ who have underlying medical

conditions; and age 18+ who work or live in high-risk settings.

For individuals who received the Johnson & Johnson COVID-19 vaccine,

booster shots are recommended for those who are 18 and older and

who were vaccinated two or more months ago.

Are there any safety concerns with mixing brands for COVID-19 boosters?

There have been no safety concerns identified with mixing and

matching products. Any side effects reported during booster studies

appear to be limited to the same side effects seen after receipt of a

homologous (same brand) series. The most common side effects include

fatigue, headache, chills, and muscle aches.

How do COVID-19 boosters compare?

Data suggests that mixing COVID-19 vaccine brands boosts the

immune response to the virus that causes COVID-19. Below is a summary

of this study.

It is up to the health care provider and the patient to determine which

COVID-19 vaccine brand is the best option for a booster dose. The CDC

allows for a “mix and match” approach to booster doses. Deciding

which booster is right for you can be challenging. It is important that

patients weigh the risks of severe illness from COVID-19 with the benefits

and risks of vaccination. Below is some information to consider when

deciding which booster to receive.

What are the benefits of a COVID-19 booster dose and the risks of

COVID-19 illness?

The benefits of a COVID-19 booster dose may include a reduced

risk of SARS-CoV-2 infection (the virus that causes COVID-19) and a

reduced risk for severe COVID-19. Receiving a booster dose may prevent

illness (including post-COVID/long-term symptoms) and may reduce

transmission of the virus to other people. Individuals should consider the

following risk factors for SARS-CoV-2 infection and the potential impact of

SARS-CoV-2 infection:

• Risk of exposure to SARS-CoV-2. Factors that would be expected to

affect the risk of exposure to SARS-CoV-2 include work or residence

in certain settings; level of community transmission; rates of

COVID-19 vaccination in their community; the likelihood of frequent

interactions with possibly unvaccinated people from outside

an individual’s household; and adherence to recommended

prevention measures.

• Risk for developing SARS-CoV-2 infection. A person’s risk for

developing SARS-CoV-2 infection may vary based on time from

completing a primary COVID-19 vaccine series and time from prior

SARS-CoV-2 infection due to waning immunity. Serologic testing

or cellular immune testing is not recommended as part of the

individual risk-benefit assessment.

• Risk for severe infection related to underlying conditions. A person’s

risk of developing severe COVID-19 may vary by the type, number,

and level of control of specific medical conditions as well as other

yet to be defined variables. Pregnant people may receive a

COVID-19 vaccine booster. Separately, also see Considerations

for COVID-19 vaccination in moderately and severely

immunocompromised people.

• Potential impact of SARS-CoV-2 infection. SARS-CoV-2 infections that

are not severe may still lead to illness (e.g., post-COVID-19/longterm

symptoms). A person’s individual circumstances should also be

considered; these may include living with/caring for a person who is

medically frail or immunocompromised or a child who is not eligible

for COVID-19 vaccine or the inability to work or meet other personal

obligations when infected, even if not severely ill with COVID-19.

To access electronic copies of

The North Dakota Nurse, please visit

*In this study a full dose of Moderna COVID-19 vaccine was used

as the booster dose. A half-dose of Moderna COVID-19 vaccine is

authorized in the United States for the booster dose.

Are there any safety concerns for choosing a booster dose of the mRNA

(Pfizer or Moderna) vaccine?

The serious safety concern seen most commonly with the mRNA

vaccines (Pfizer and Moderna) is myocarditis (inflammation of the

muscle around the heart). Based on current data from the primary

vaccine series, the highest risk of myocarditis occurring following receipt

of an mRNA vaccine is seen in males aged 12-30 years old. The rate of

myocarditis occurring following receipt of an mRNA vaccine in males

ages 18-24 years old is 39 cases per one million doses administered.

Myocarditis is also associated with COVID-19 illness. Additionally, data

suggests that myocarditis occurs at a higher rate following a COVID-19

illness compared to receipt of a COVID-19 vaccine. There have been

no reported deaths associated with myocarditis following a COVID-19

vaccine. Most cases of myocarditis are mild and patients typically

recover fully within six months.

A male who is a young adult should consider their own individual risks

and benefits when deciding which booster to choose. If an individual

is concerned about their risk of acquiring serious COVID-19 illness more

than the risk of myocarditis post-vaccination, then they may want to

consider receiving an mRNA booster dose. If that individual is more

concerned about their risk of myocarditis, then they may want to choose

a booster dose of Johnson and Johnson COVID-19 vaccine.

Are there any safety concerns for choosing a booster dose of the

Johnson and Johnson vaccine?

There have been 47 cases of rare blood clots, thrombosis with

thrombocytopenia syndrome (TTS), reported to the Vaccine Adverse

Events Reporting System (VAERS) following 15.3 million doses of Jonhson

and Johnson COVID-19 vaccine administered in the United States.

This event happens most frequently in women 18-49 years old, with the

highest reporting rate in 30-39 year old females at 10 cases per one

million doses administered. Women of childbearing age should consider

receiving a booster dose of mRNA (Pfizer or Moderna) vaccine given

their increased risk of TTS.

Guillain-barré syndrome (GBS), a rare autoimmune disorder, may be

associated with the Johnson and Johnson COVID-19 vaccine. Through

July 24th, 130 cases of GBS following vaccination have occurred, most

frequently in males 50 years of age and older. The highest reporting rate

of 16 cases per one million doses administered is in males ages 50-64.

Older males may want to consider mRNA vaccination for their booster


I need more guidance on choosing which COVID-19 booster dose to

receive. Who should I talk to?

For specific medical questions, the North Dakota Department of

Health recommends an individual talk to their trusted medical provider.

This provider will be able to offer insight into a persons individual medical


January, February, March 2022 The North Dakota Nurse Page 11

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Page 12 The North Dakota Nurse January, February, March 2022

Factors Influencing Medication Errors

Anna Holen, Abby Seifert, & Christine Vetsch

BSN Students, University of Jamestown

Editor: Penny Briese, PhD(c), RN

University of Jamestown

Clinical Question: What are some factors that

influence nurses’ medication errors?

Medication safety is a priority for nurses,

considering medication administration

accounts for 40% of the nurse’s occupational

duties and nurses “are responsible for 26-

38% of medication errors” (Dougal, 2020,

p. 7). There are factors that influence and

increase/decrease the chances of making

medication errors. Being aware of these

factors can promote medication safety and

decrease the number of errors that are too

prominently occurring in the nursing field. Six

different articles related to medication errors

in the nursing profession were included in this

miniature literature review.

In 2018, Treiber and Jones performed a

quantitative study in an effort to understand

individual and system level factors that

contribute to medication errors from the

perspective of BSN nursing graduates. The

researchers investigated perceptions of

adequacy of preparatory nursing education,

contributory variables, emotional responses,

and treatment by employers following the error

(Treiber & Jones, 2018). The study consisted

of 168 participants who completed an

online survey. The survey was sent out to BSN

graduates from Kennesaw State University in

Georgia who graduated between the years

of 2009-2013. Most of the participants were

white (71%), female (89%), and nearly all were

currently practicing nursing (Treiber & Jones,

2018). More than half of the respondents

indicated they had made a medication error

since becoming a registered nurse; a majority

stated that when they made an error their

facility was supportive. Reasons that a nurse

did not report a medication error included

fear of repercussion, perception the error was

not serious, and the process to report the error

being too time consuming (Treiber & Jones,


Bekes, Sackash, Voss, and Gill (2021)

focused their study on medication errors

seen specifically in pediatric patients in the

perioperative period. The researchers sought

to answer two main questions: 1) what are

the main types of medication errors in the

pediatric population in the perioperative

period, and 2) what mitigation strategies had

the best outcome that can be incorporated

into practice? This was a narrative literature

review of 17 articles. The inclusion criteria for

this review included a patient population

from one to 18 years of age, articles printed in

the English language, full-text publications,

and focused on perioperative periods of care

(Bekes et al., 2021). The researchers scored

each article using the critical appraisal skills

program qualitative checklist because it

breaks down the methodological approach

to determine the quality of each article.

They found that the most frequent errors

mentioned in the multiple research studies

were incorrect doses (77%) including dilution

errors, calculation errors, and incorrect intervals.

Other examples of common medication errors

included incorrect medication, grabbing the

incorrect syringe, inappropriate medication

labeling, and giving a known allergen (Bekes




Full or Part Time RN or LPN

For More Information Contact

Kasey Brandenburger, RN DON


St. Gerard’s Community of Care

Hankinson, ND

et al., 2021). The researchers concluded by

discussing interventions that reduce medication

errors which entailed standardized labeling,

prefilled syringes, two-person checks, drug

library/ electronic-based references, quality

improvement safety analytics, pharmacy

support, computer check systems, staff

education, standardized workspace, zerotolerance

philosophy, and checklists (Bekes et

al., 2021).

Ragau, Hitchcock, Craft, and Christensen

(2018) wanted to look specifically at the

individual human factors that can cause

medication errors. They used the HALT model

(hungry, angry, late, lonely, and tired) to try

and reduce the incidence of medication

errors by 25% by allowing nurses to “be more

aware of how their emotional behavior may

have a deleterious effect” on medication

administration (Ragau et al., 2018, p. 1333).

The HALT model was implemented in a 32-bed

acute medical unit. ‘HALT’ posters were placed

throughout the unit to remind the team to

“effectively ‘HALT’ and take time to reflect on

what was occurring for them on an emotional

level and then take the appropriate action”

(Ragau et al., 2018, p. 1333). The model was

also used during shift hand-off to highlight any

emotions that needed to be addressed before

the shift change. After the implementation of

the HALT model, there was a decrease in total

medication errors by 31.7% over a two-month

period, a 25.3% decrease in errors relating

to human error, and a 22.9% decrease in

communication and documentation-related

errors (Ragau et al., 2018, p. 1334). Although this

study had a positive response, “caution should

be used when addressing other contributing

factors associated with medication errors as

using HALT alone will not address these” (Ragau

et al., 2018, p. 1334).

Berdot et al. (2021) conducted a study

on nurses wearing a special vest indicating

a time of requested un-interruption. They

analyzed whether the introduction of the vest

reduced medication errors during medication

administration. This was a multicenter,

randomized controlled trial performed in 29

adult units in four hospitals. Over the course of

the study, 178 nurses in 14 units wore a ‘do not

interrupt’ vest during 383 observed medication

rounds to examine the main outcome of

administration error rate. The error rate was

defined as “number of Opportunities for Error,

OE, calculated as one or more errors divided by

the Total Opportunities for Error, TOE, multiplied

by 100” (Berdot et al., 2021, p. 1). Berdot et al.

(2021) found that the administration error rates

in the experimental group was 7.09% and 6.23%

in the control group (p. 1). The interruption

rates were also similar, with the experimental

group being 15.04% and the control group

being 20.75% (Berdot et al., 2021, p. 6). These

results indicate that the “vest had no impact on

medication administration error or interruption

rates” (Berdot et al., 2021, p. 6).

Dougal (2020) conducted a quantitative nonexperimental

study to determine the perception

of medication administration and medication

errors from registered nurses, related to

the risks, benefits, frequency, and cautions

associated with it. The researcher had three

research questions; 1) do nurses perceive risk in

medication administration in everyday practice,

2) how is an RN’s self-reporting behavior related

to medication administration errors and risks,

and 3) do nurses perceive benefit and risk to

medication safety during the administration

process? (Dougal, 2020) This study surveyed

1,445 RN’s using an online seven-point Likert

scale questionnaire. Most RNs reported that

they were “not at all likely” to report medication

errors and believed they do not make errors in

medication administration or are “unlikely” to

do so within the next 12 months (Dougal, 2020,

p. 9). They believe their peers were “very likely”

to make errors in medication administration

within the next 12 months (Dougal, 2020, p. 9).

Most RNs in this study reported not following

proper medication administration processes

due to self-reported distractions, interruptions,

and multi-tasking.

Ekkens and Gordon (2021) conducted a

quantitative quasi-experimental study to

determine if adding mindfulness thinking to

current protocol will eliminate or minimize

medication errors. This study consisted of 111

nurses from rural hospitals located in northern

California. The treatment group in this study

received an intervention of mindfulness

training while the control group did not receive

training. “The instrument used for the study

was based on the medication error index from

the NCC MERP” (Ekkens et al., 2021, p. 119). This

instrument is designed to categorize medication

errors into nine levels of severity, each level

corresponding to mild, moderate, significant,

or severe severity. The researchers found that in

the treatment group, errors were reduced from

15 to four, whereas the control group showed a

reduction in errors from seven to six. The result

from this study concludes that “nurses are not

consistently mindful enough when administering

medications; this contributes to errors” (Ekkens

and Gordon, 2021, p. 120). Mindful thinking and

effective training may help to reduce errors and

help nurses focus on the task at hand.


There are many factors that can contribute

to medication errors, but in return there are

many interventions to help decrease the risk of

errors and ensure patient safety. Medication

errors have been studied extensively due

to the danger that errors present to patient

safety. The six articles summarized in this

literature review support a numerous array

of interventions that both feed into and can

prevent medication errors. At an educational

level, professors and mentors need to stress the

importance of medication errors and prepare

students for clinical experiences. New nursing

graduates mentioned they should have had

more hands-on experience with medication

administration, especially IV, and time

management skills to encourage effective care

management (Treiber & Jones, 2018). It is highly

recommended that even experienced nurses

should always go through the medication

rights such as correct dose, time, patient, route,

refuse, and medication. Nurses should not be

afraid to question doses that seem odd and

they should not solely rely on technology to

recognize mistakes. Facilities should support

nurses in the field because, although reporting

the error can be intimidating, reporting can

help nurse administrators recognize systematic

problems. Not all interventions are helpful and

nurses often blame themselves for medication

errors and feel guilty regardless of whether or

not the error harmed the patient. Hospitals must

find what works best for their individual nurses

because the reasons for medication errors are

quite individualized. Medication errors and

safety continue to be a growing concern in the

healthcare profession.


Bekes, J.L., Sackash, C.R., Voss, A.L., & Gill C.J. (2021).

Pediatric medication errors and reduction

strategies in the perioperative period. AANA

Journal 89(4), 319-324.

Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge,

M., Corny…Sabatier, B. (2021). Effectiveness

of a ‘do not interrupt’ vest intervention to

reduce medication errors during medication

administration: a multicenter cluster randomized

controlled trial. BMC Nurs, 20(153), 1-11. doi:


Dougal, R.L. (2020). RN perceptions of medication

administration and medication errors: Results

from a quantitative nursing research study. RN

Idaho, 43(1), 7-9.

Ekkens, C. L. and Gordon, P. A. (2021). The mindful

path to nursing accuracy: A quasi-experimental

study on minimizing medication administration

errors. Holistic Nursing Practice, 35(3), 115-122.

doi: 10.1097/HNP.0000000000000440.

Ragau, S., Hitchcock, R., Craft, J., & Christensen.

(2018). Using the HALT model in an

exploratory quality improvement initiative

to reduce medication errors. British Journal

of Nursing, 27(22). 1330-1336. doi: 10.12968/


Treiber, L.A. & Jones, J.H. (2018). After the medication

error: Recent nursing graduates’ reflections on

adequacy of education. Journal of Nursing

Education, 57(5), 275-280. doi:10.3928/01484834-


January, February, March 2022 The North Dakota Nurse Page 13

Reducing Central Line-Associated Bloodstream Infections

Ali Glynn, Amber Domres, & Hayley Johnson

BSN students, University of Jamestown

Editor: Penny Briese, PhD(c), RN

University of Jamestown

Clinical Question: What are the current best practices for preventing

central line-associated bloodstream infections (CLABSI)?

Bloodstream infections of central venous access lines are occurring at

unacceptable levels in practice (Conwell, Ghidini, Perazella, Aniskiewicz,

DeVaux, & Giullian, 2019). There are ways in which healthcare

professionals can increase the safety of patients and improve care to

reduce mortality risk. This miniature literature review will describe the

evidence and best practices recommendations of six research studies

focusing on central line-associated bloodstream infections (CLABSI).

In one quantitative study, medical professionals at Yale New

Haven Hospital in Connecticut evaluated their hemodialysis unit for

the occurrence of CLABSI (Conwell et al., 2019). Observations within

their dialysis unit showed that a central line infection occurred at a

rate of 0.39%, however, of those with an acquired infection “mortality

following a CLABSI ranged from 12-25%” (Conwell et al., 2019, p. 587). The

implementation plan of their study included “a list of findings evident

upon admission that could trigger further evaluation for infection early

in the course of hospitalization” (Conwell et al., p. 588). Dressing changes

were required to be documented, registered nurses were retrained on

caring for central lines and were tested with new competencies to prove

understanding. Research showed “the number of CLABSI events was

notably lower following implementation of the program as over 2,280

treatments were performed on 382 patients in 2017 and no CLABSIs

occurred” (Conwell et al., p. 588-589). The researchers concluded by

reiterating the importance of prevention of central line infections in order

to prevent lengthy hospital stays, high costs, and reduce mortality.

One intervention commonly used in practice to decrease the risk of

CLABSI is using chlorhexidine gluconate (CHG) bathing for infection

prevention. Reynolds, Woltz., Keating, Neff, Elliott, Hatch, Yang, &

Granger (2021) performed an academic and community-based study

with 1,640 participants from hospital units who had at least 1 CLABSI

event in the last year. All patients with a central line were given a CHG

antimicrobial bath throughout the course of their treatments. Results

showed that the units reported a decrease in patient stay of 1.67 days

along with a 27.4% reduction in rates of CLABSI (Reynolds et al., 2021).

Part of the intervention also included educational outreach to all

members of the health care team regarding the purpose of the CHG

bath, which generated this very positive outcome.

In another study, five hospitals were evaluated between the years

of 2013 and 2015 for CLABSI and their association with lines being

“manipulated by healthcare workers and patients” (Sheth, Trifan, Feterik,

& Jovin, 2017, 2017, p. 217). The incidence of CLABSIs has been reduced

thruogh the implementation of CDC CLABSI prevention bundles;

however, manual manipulation of lines are also suspected to be a cause

of infection. During this study, 30 CLABSI events were reported and 16 of

these events had noted “line manipulation 48-72 hours prior to infection”

(Sheth et al., 2017, p. 217). Manipulation of the line includes flushing the

line, administering fluids and medications. Overall, this study concluded

that CLABSI prevention bundles helped reduce the number of CLABSIs,

but more interventions are needed to reduce infections related to

central line manipulation.

Suttle Buffington, Madden, & Dawson (2019) studied 85 participants in a

29-bed hematology oncology specialty unit at the University of Alabama

at Birmingham Hospital. The study included “patient engagement and

empowerment” to reduce infections of central lines (Suttle et al., 2019,

p. 10). The independent variable of this study was the implementation

of the EPIC bundle, which included an “educational video, poster,

patient silicone bracelet and a nursing staff sticker” (Suttle et al., 2019, p.

12). The dependent variable was the prevalence of CLABSIs. Two factors

were found to interfere with patient education: 1) health care workers

feeling unsure of just how much responsibility to place on patients, and 2)

patients not wanting to bother healthcare workers and ask them to wash

their hands. The intervention of the EPIC bundle reduced the number of

infections by “46% within eight weeks” (Suttle et al., 2019. p. 11). The results

of this study showed that, overall, following implementation of the EPIC

bundle, patients felt more empowered and in control of their care leading

to a reduction of CLABSIs.

Another study done by Wilder, Wall, Haggard, & Epperson (2016)

assessed the effectiveness of integrating central-line principles and a

team-based approach into CLABSI reduction in neonatal intensive care

units. This study aimed to reduce CLABSI rates by the implementation of

a line-rounding tool (Wilder et al., 2016). The line-rounding included small

dedicated CLABSI prevention teams who took over doing peripherally

inserted central catheter (PICC) dressing changes with a specified

technique, while including training opportunities for other neonatal nurse

practitioners. The study showed an improvement in CLABSI rates by 93%

(Wilder et al., 2016). The reduction in CLABSI rates was accompanied by

reduced patient harm, reduced length of stay and costs. The research

concluded that implementing line-rounding teams, raising awareness of

a “safety-first culture”, along with a multidisciplinary team approach to

central line maintenance can make a significant impact on CLABSI rates.

And finally, in discussing multidisciplinary team approaches in CLABSI

reduction, the final study reviewed showed significant findings with the

integration of collaborating care teams in achieving reduced CLABSI

rates (p < 0.05). Evidence-based practices were discussed in the article

but so were new technologies like “disinfecting caps and needleless

securement devices” (Layne & Anderson, 2019, p. 285). In this study, a

hospital multidisciplinary team wanted to address central line practices

that were occurring. Their findings of their assessment were based on

two components of prevention: dressing maintenance and caregivers’

critical skills (Layne et al., 2019, p. 285). The collaborative team also

identified that two critical skills in particular needed improvement;

dressing changes and blood draws. The team used these findings

to initiate central line maintenance skills re-education for practicing

nurses and found rapid improvements in securement and dressing

maintenance and there was a 57% reduction in CLABSI occurrences in

the fiscal year 2016 to 2017 (Layne et al., 2019).


The incidence of CABSI remains high in healthcare today. It is

imperative that healthcare providers continue to search the literature

for best practices. The findings of this miniature literature review

indicate that the use of admission checklists, antiseptic bathing, patient

empowerment, patient care bundles, and multidisciplinary team

approaches and reeducation are all integral practices associated with

the reduction of CLABSI in the hospital settings.


Conwell, R., Ghidini, J., Perazella, M., Aniskiewicz, M., DeVaux, L., & Giullian,

J. (2019). A hospital-based program to reduce central line-associated

bloodstream infections among hospitalized patients receiving hemodialysis

using a central venous catheter for vascular access. Nephrology Nursing

Journal, 46(6), p. 587-592.

Layne, D. M., & Anderson, T. (2019). A collaborative approach to reducing

Central line-associated bloodstream infections. Journal of Nursing Care

Quality, 34(4), 285–286.

Reynolds, S.S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q.,

& Granger, B. (2021). Results of the CHlorhexidine Gluconate Bathing

implementation intervention to improve evidence-based nursing

practices for prevention of central line associated bloodstream infections

study (CHanGing BathS): a stepped wedge cluster randomized trial.

Implementation Science, 45(16), p. 1-16. Doi: 10.1186/s13012-021-01112-4

Sheth, H., Trifan, A., Feterik, K., & Jovin, F. (2017). Expanding central line care

bundle to address line manipulations. Canadian Journal of Infection

Control, 32(4), 217–221.

Suttle, R. D., Buffington, H. M., Madden, W. T., & Dawson, M. A. (2019). Central Line

Care: Empowering patients to prevent infection and injury via EPIC². Clinical

Journal of Oncology Nursing, 23(1), E10–E16.


Wilder, K. A., Wall, B., Haggard, D., & Epperson, T. (2016). A systemic central line

quality improvement initiative integrating line-rounding principles and a

team approach. Advances in Neonatal Care, 16(3), 170-177. https://doi.


The ongoing COVID pandemic has made it difficult for people to

maintain their mental health and well-being. Developed in 2019, the

North Dakota Community Clinical Collaborative (NDC3) is helping

communities across North Dakota create a culture of health, where

prevention and wellness are the norm. NDC3 houses programs that

provide education, fitness instruction, and self-care strategies for

participants; they do not replace clinical care provided by doctors,

nurses, and other medical professionals. NDC3 also provides the ability

for caregivers and health care providers to refer loved ones or patients to

appropriate programs.

Through partnerships across the state, NDC3 connects evidence-based health

management activities that promote health and prevent disease to adults with

or caring for people with chronic health conditions. These programs have been

developed using rigorous research and demonstrate reliable and consistently

positive changes in health-related outcomes among participants. Lisa Thorp,

BSN, CDCES wrote:

“I was recently visiting with colleagues about the availability of certain services across

the state. Often, it appears that there are more services available on the eastern side

of the state. NDC3 helps level the playing field by organizing the information of virtual

classes that are available. As a Certified Diabetes Care and Education Specialist, I love

the fact that people with diabetes can search NDC3 and find classes to help them better

manage their diabetes. A search can be done to find a Diabetes Prevention class, or

a Better Choices Better Health-Diabetes Class, and attend them virtually! In addition

to diabetes classes, there are also other classes for chronic conditions and pain, and

strengthening, which can help reduce falls in the home. I encourage other nurses, diabetes

educators, primary care providers to use the referral option. Provide the patient contact

information and they will get called to help them find a class. Check out Connecting you to

community health programs - NDC3! Feel free to contact me for questions at lisa.thorp@”

Page 14 The North Dakota Nurse January, February, March 2022

ANA Call for


On behalf of ANA's Professional Policy

Committee, I encourage you to engage in the

identification of strategic policy topics and the

submission of proposals for discussion by ANA's

governing body, the Membership Assembly,

at the 2022 annual meeting in June. Your

involvement in ANA's policy work is critical!

Of particular interest to ANA for this Call for

Proposals are proposals specific to addressing

issues related to nurse staffing, with particular

focus on the acute care setting, and strategies

to reduce workplace violence against nurses

and other health care employees. All proposals

submitted should be solution oriented.

Section 1 of the 2022 Membership Assembly

Policy Development Guide includes questions

for you to consider prior to submitting a

proposal. In Appendix A of the Guide, you'll find

the ANA Enterprise 2020-2023 Strategic Goals.

The Guide also contains detailed information

on the submission and review of proposals,

including emergent proposals; Dialogue

Forums; and examples of approaches used by

state nurses' associations that have successfully

engaged members in ANA's policy work.


– Click here to access the online proposal form.

Completed proposals MUST BE submitted (by

using the online proposal forms) by 5:00pm ET

on Monday, February 7, 2022. Refer to Appendix

D in the Guide for key dates and direct

questions to Cheryl Peterson, Vice President,

Nursing Programs, via email (practice@...).


Cheryl Peterson, MSN, RN

Vice President, Nursing Programs

American Nurses Association

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January, February, March 2022 The North Dakota Nurse Page 15

ANA Nominations

and Elections

ANA's Gail Peterson

(Nominations and Elections Committee Chair)

The ANA Nominations

and Elections Committee

is identifying candidates

that meet the minimum

competency requirements

for open positions. If you or

someone you know would

be a great candidate,

please apply or encourage

them to apply. Click here or

go to the NDNA website –

News & Annoucements tab.

Gail Peterson

Now Hiring RNs and LPNs

Sign on Bonus up to $10,000

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Located in Valley City, the most beautiful town in North Dakota.

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