The North Dakota Nurses - January 2022
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<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse<br />
NORTH DAKOTA NURSES ASSOCIATION<br />
THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATION<br />
Sent to all <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> courtesy of the <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association (NDNA). Receiving this newsletter<br />
does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.”<br />
Quarterly publication distributed to approximately 20,000 RNs and LPNs in <strong>North</strong> <strong>Dakota</strong><br />
Vol. 91 • Number 1 <strong>January</strong>, February, March <strong>2022</strong><br />
INDEX<br />
Highlight a<br />
Nurse<br />
Page 3<br />
<strong>North</strong> <strong>Dakota</strong> Department of<br />
Health: Vaccine Q & A<br />
Page 4<br />
Message from the President<br />
Keep on Pushing<br />
I am sure I am not the only one feeling like I<br />
am in a hamster wheel, spinning and spinning<br />
and spinning without ending. As we enter a new<br />
year, it is imperative that we do some reflection.<br />
It is important as nurses, we pause and look<br />
back at what motivates us to get out of that<br />
spinning wheel and continue to be the best<br />
we can for our patients. Easier said than done,<br />
I know.<br />
I encourage you to ask yourself, “what<br />
motivates you?” If we can answer this question<br />
and keep it in the forefront of our care delivery,<br />
it is easier to keep pushing, especially during<br />
challenging times like the last two years. One<br />
effective way to stay motivated is to set a new<br />
goal. Say it aloud and write it down, own this<br />
goal. According to Drake (2017), “setting a goal<br />
and staying focused is one more approach to<br />
keeping yourself motivated. Establishing a goal<br />
provides you with a cause and moving toward<br />
the goal can give you positive reinforcement.<br />
When we focus on a goal, we are less likely to<br />
get side-tracked by nonessential work. And<br />
do not underestimate fear as a motivating<br />
factor. Fear of failure can often motivate us to<br />
accomplish our goals” (p.56). In stressful times,<br />
when you feel as though you are just spinning in<br />
that wheel, pause and refocus on your goal. This<br />
helps to keep pushing.<br />
As nurses, we also need to remember we<br />
always can be a leader and motivate those<br />
around us. You can<br />
motivate your work team,<br />
your church group, your<br />
family, your patients, and<br />
anybody else you meet.<br />
<strong>The</strong> easiest way to do this,<br />
is make it personal. It is<br />
important when motivating Tessa Johnson<br />
people that you know<br />
the individual and what truly motivates them.<br />
Sometimes you must get downright creative<br />
and even competitive. In addition, take time<br />
to educate yourself on motivational theories<br />
to assist in tailoring your style to your team.<br />
Motivation can be either intrinsic or extrinsic, but<br />
the key to both is a sense of achievement tied<br />
to goals and expectations. With a little push,<br />
you will be surprised how motivated you and<br />
your team members become (Drake, 2017).<br />
Remember, negativity is contagious.<br />
Unhappiness is contagious. Fear is contagious.<br />
But so is happiness. So is optimism. So is love.<br />
Surround yourself with people who bring out the<br />
best in you. Strive to be a reflection of what you<br />
want to receive. Be well, we need all of you!<br />
Drake, K. (2017). Nursing Management. <strong>The</strong><br />
Motivation to Stay Motivated, 48(12), 26.<br />
https://doi.org/https://journals.lww.com/<br />
nursingmanagement/fulltext/2017/12000/the_<br />
motivation_to_stay_motivated.12.aspx<br />
Medical Marijuana, Legislative<br />
Updates and Education<br />
Page 8<br />
current resident or<br />
Presort Standard<br />
US Postage<br />
PAID<br />
Permit #14<br />
Princeton, MN<br />
55371<br />
Executive Director’s Message<br />
Sherri Miller, BS, BSN, RN<br />
New Year<br />
We are officially in <strong>2022</strong>, and reflective<br />
about 2021. Let’s take a look at what we<br />
have done as an association in 2021 with<br />
resiliency, and as President Johnson writes<br />
in her column above - “let’s keep on<br />
pushing.”<br />
NDNA always looks to our mission to<br />
stay on track. Our mission is to advance<br />
the nursing profession by promoting<br />
professional development of nurses,<br />
fostering high standards of nursing<br />
practice, promoting the safety and wellbeing<br />
of nurses in the workplace, and<br />
by advocating on health care issues<br />
affecting nurses and the public.<br />
Advocacy<br />
• 2021 was a legislative session year; NDNA<br />
collaborated and lobbied on areas such as:<br />
o Essential Caregiver<br />
o Vitamin D coverage<br />
o School Nursing<br />
o Support for the ND Center for Nursing<br />
new workforce recruitment and<br />
retention program<br />
o Insurance coverage of telehealth<br />
o Workplace violence – assault on a<br />
health care provider<br />
o Opposition to drug importation bills<br />
o Support of school psychologists being<br />
allowed to bill for Medicaid services<br />
• New Director of Advocacy, Penny Briese,<br />
was appoint to serve!<br />
Executive Director’s Message continued on page 4
Page 2 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
How to submit an article for<br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse!<br />
<strong>Nurses</strong> are strongly encouraged to contribute to the profession<br />
by publishing evidence-based articles; however, anyone is<br />
welcome to submit content to the <strong>North</strong> <strong>Dakota</strong> Nurse.<br />
We review and may publish anything we think is<br />
interesting, relevant, scientifically sound,<br />
and of course, well-written. <strong>The</strong> editors<br />
look at all promising submissions.<br />
Deadline for submission for the next issue is 3/7/<strong>2022</strong>.<br />
Send your submissions to director@ndna.org<br />
Welcome New Members<br />
Jennifer Pederson<br />
West Fargo<br />
Debbie White<br />
Mandan<br />
Elizabeth Satrom<br />
Edgeley<br />
Heather Burnley<br />
Lincoln<br />
Kelsey Fitterer<br />
West Fargo<br />
Jesse McDonald<br />
West Fargo<br />
Elizabeth Coulson<br />
Dickinson<br />
Carl Millien<br />
Fargo<br />
Help shape the future of the nursing<br />
profession by joining NDNA.<br />
Here's a quick look at some of your individual<br />
benefits as a member of NDNA/ANA:<br />
• Subscriptions to <strong>The</strong> American Nurse and<br />
American Nurse Today<br />
• Subscription to the <strong>North</strong> <strong>Dakota</strong> Nurse,<br />
delivered personally to you four times a<br />
year.<br />
• Subscription to NDNA’s Monthly eNews and<br />
Updates<br />
• Weekly NDNA Legislative Updates --<br />
informing you of current legislative issues<br />
that affect you! (During ND legislative<br />
session)<br />
• Information and registration information<br />
for NDNA sponsored educational<br />
Melissa Marx<br />
Thompson<br />
Alyssa Lind<br />
Horace<br />
Mallory Waters<br />
Bismarck<br />
Anna Nagel<br />
Bismarck<br />
Amber Hinderscheid<br />
Grand Forks<br />
Member Benefits<br />
Lori Martinson<br />
Rolette<br />
Melisa Banish<br />
Fargo<br />
Martin Mwondha<br />
Minot<br />
Randy Hunt<br />
West Fargo<br />
Autumn Nelson<br />
West Fargo<br />
opportunities, including workshops,<br />
conferences and seminars providing<br />
contact hours delivered personally to you.<br />
• Reduced registration fees for the NDNA<br />
Annual Meeting and Fall Conference.<br />
• Leadership opportunities in a wide variety<br />
of areas and with a wide variety of time<br />
commitments to fit your schedule.<br />
• Access to exclusive ANA website and<br />
“members only” information.<br />
• Discounts on professional liability insurance<br />
offered by NSO<br />
• A voice in support of the nursing profession!<br />
*Please note that some of the benefits are<br />
only for joint NDNA/ANA members only and may<br />
not apply to Affiliate Members.<br />
ANA Member Discounts and Benefits<br />
SIGN ON BONUS<br />
AVAILABLE for<br />
RN and LPN<br />
positions -<br />
Up to $7,500<br />
Mountrail County Health Center is currently seeking<br />
RNs for the hospital. If you enjoy working in a fastpaced<br />
environment and want to provide top care to<br />
patients, please consider applying with MCHC. Our<br />
newly expanded ER is a great learning experience<br />
for new nurses coming out of college, as well as<br />
experienced nurses.<br />
Mountrail Bethel Home is currently seeking RNs &<br />
LPNs for the nursing home.<br />
MCHC offers competitive wages, top benefits and<br />
retirement.<br />
Interested, please apply online at<br />
www.stanleyhealth.org or email<br />
adebilt@stanleyhealth.org.<br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse<br />
Official Publication of:<br />
<strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association<br />
General Contact Information:<br />
701-335-6376 (NDRN)<br />
director@ndna.org<br />
Board of Directors and Staff<br />
President<br />
Tessa Johnson, MSN, BSN, RN, CDP<br />
President-Elect<br />
Mylynn Tufte, MBA, MSIM, RN<br />
Vice President of Finance<br />
Richelle Johnson, MSN, RN<br />
Director of Membership<br />
Kami Schauer, MSN, RN<br />
Director of Education and Practice<br />
Courtney Naastad, PMHNP-BC, MSN, BSN, RN<br />
Director of Advocacy<br />
Penny Briese, MS, RN<br />
Director at Large<br />
VACANT<br />
Affiliate Member Representative (LPN)<br />
Catherine Sime, LPN<br />
Executive Director<br />
Sherri Miller, BS, BSN, RN<br />
Please go to our website to learn more about the<br />
board and their roles: www.ndna.org<br />
Published quarterly: <strong>January</strong>, April, July, and October<br />
for the <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association, a constituent<br />
member of the American <strong>Nurses</strong> Association, 1515 Burnt<br />
Boat Dr. Suite C #325, Bismarck, ND 58503. Copy due<br />
four weeks prior to month of publication. For advertising<br />
rates and information, please contact Arthur L. Davis<br />
Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa<br />
50613, (800) 626-4081, sales@aldpub.com. NDNA and the<br />
Arthur L. Davis Publishing Agency, Inc. reserve the right<br />
to reject any advertisement. Responsibility for errors in<br />
advertising is limited to corrections in the next issue or<br />
refund of price of advertisement.<br />
Acceptance of advertising does not imply endorsement<br />
or approval by the <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association<br />
of products advertised, the advertisers, or the claims<br />
made. Rejection of an advertisement does not imply a<br />
product offered for advertising is without merit, or that<br />
the manufacturer lacks integrity, or that this association<br />
disapproves of the product or its use. NDNA and the Arthur<br />
L. Davis Publishing Agency, Inc. shall not be held liable for<br />
any consequences resulting from purchase or use of an<br />
advertiser’s product. Articles appearing in this publication<br />
express the opinions of the authors; they do not necessarily<br />
reflect views of the staff, board, or membership of NDNA or<br />
those of the national or local associations.<br />
Want to Make Your Nursing Voice<br />
Heard…Get Published in the<br />
<strong>North</strong> <strong>Dakota</strong> Nurse!<br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse quarterly publication accepts<br />
content on a variety of topics related to nursing. <strong>Nurses</strong><br />
are strongly encouraged to contribute to the profession<br />
by publishing evidence-based articles, but we welcome<br />
anyone to submit for publication. If you have an idea,<br />
but don’t know how or where to start, contact one of<br />
the NDNA Board Members.<br />
Please note:<br />
*Send articles to director@ndna.org<br />
*Articles should be in Microsoft Word and be double<br />
spaced.<br />
*All articles should have a title.<br />
*Articles sent should have the words “<strong>North</strong> <strong>Dakota</strong><br />
Nurse Article” in the email subject line, along with the<br />
specific title.<br />
*Deadline for submission of material for upcoming<br />
<strong>North</strong> <strong>Dakota</strong> Nurse is 3/7/<strong>2022</strong>!<br />
<strong>The</strong> Vision and Mission of the<br />
<strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association<br />
Vision: <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association, a<br />
professional organization for <strong>Nurses</strong>, is the voice of<br />
Nursing in <strong>North</strong> <strong>Dakota</strong>.<br />
Mission: <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association (NDNA)<br />
is the only professional organization representing all nurses<br />
in <strong>North</strong> <strong>Dakota</strong>. <strong>The</strong> mission of NDNA is to advance the<br />
nursing profession by promoting professional development<br />
of nurses, fostering high standards of nursing practice,<br />
promoting the safety and well-being of nurses in the<br />
workplace, and by advocating on health care issues<br />
affecting nurses and the public.
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 3<br />
Highlight a Nurse<br />
NDNA interviews great ND nurses to be featured in <strong>The</strong><br />
<strong>North</strong> <strong>Dakota</strong> Nurse, our monthly NDNA eNews, and on Facebook!<br />
If you know a nurse or are a nurse that NDNA can highlight,<br />
please contact director@ndna.org.<br />
Name and credentials: Mercedez Marvig, RN<br />
• Short Bio<br />
- I am Mercedez Marvig, I have been in health<br />
care for 10 years now, I have been a nurse<br />
for four years. I work at Sanford ER in Fargo as<br />
an Emergency room nurse as well as a sexual<br />
assault nurse examiner for the Midwest. I also<br />
teach at Rasmussen! I have three nursing<br />
degrees and I am working on my fourth!<br />
• What led you to become a nurse?<br />
- I have always wanted to be a nurse. <strong>The</strong><br />
reason I wanted to become an Emergency<br />
Room nurse is because in college I ate a<br />
Mercedez Marvig<br />
tree nut and became super sick, almost<br />
intubated sick and this nurse with tattoos comes in and I was<br />
undressed, had an iv in my arm, and was given meds before I<br />
could blink. She was calm, cool, and collected even though I was<br />
super sick. She realized I was alone (family was five hours away)<br />
and brought in a chair to my room and charted while sitting<br />
next to me so I did not have to be alone. She will forever be the<br />
coolest person I have met in my life and I have always tried to be<br />
like her.<br />
• What talents, gifts, or skills do you have that assist you in your dayto-day<br />
work?<br />
- I am one of the best foley placers in the emergency room. I also<br />
have a lot of love and patience for our psych population.<br />
• What is a typical day like for you?<br />
- <strong>The</strong>re are NO typical days at the ER, some days you are taking<br />
care of bumps and scratches and others you are taking care of<br />
traumas. We treat everyone from the ages of 0 to death and we<br />
see all sorts of sicknesses.<br />
• What are some of the greatest challenges for you?<br />
- Some of the patients we treat as nurses are not kind and it is<br />
hard to listen/deal with that while maintaining a good attitude.<br />
I remind myself it is always okay to step away to regroup and<br />
they are just human, same as me and they need extra love and<br />
patience!<br />
• What are some ways that you see your specialty can make a<br />
difference in a rural state?<br />
- I am one of two RNs who have the ability to treat both pediatric<br />
and adult sexual assaults. People come from all over the Midwest<br />
to see my team.<br />
Name and credentials: Andrea Sperr, RN<br />
• Short Bio<br />
- My name is Andrea! I am the oldest of three<br />
siblings, I have only ever had dalmatian<br />
dogs my entire life. I like to fish and spend<br />
time outside as much as possible. I also really<br />
enjoy fitness and workout almost daily even<br />
before I work! I won a Daisy award, and have<br />
worked med-surg trauma as an LPN for four<br />
years, then have worked for the past two<br />
years as an RN ER nurse. I also have my SANE<br />
certification, and have my TNCC, ENPC,<br />
PALs, and ACLS.<br />
Andrea Sperr<br />
• What led you to become a nurse?<br />
- When my mom would bring me with to the ER in Alexandria,<br />
MN when she would work I would follow the nurses and doctors<br />
around and I think that is where I realized that I was going to be a<br />
nurse.<br />
• What talents, gifts, or skills do you have that assist you in your dayto-day<br />
work?<br />
- I have quick wit, and work best under pressure. I really enjoy<br />
being a preceptor for students and new nurses.<br />
• What is a typical day like for you?<br />
- At work? Absolute insanity, its great and awful all at the same<br />
time. Nursing is hard but I'm glad that I'm a nurse.<br />
• What are some of the greatest challenges for you?<br />
- Holding my tongue when I‘m mad. I grew up a farmer's<br />
daughter and was taught to call it as I see it. Not all patients are<br />
appropriate and it’s hard to remain calm when they are awful.<br />
• What are some ways that you see your specialty can make a<br />
difference in a rural state?<br />
- As an ER nurse, I am part of people's worst days and can be the<br />
calm in the storm for them. Having a farm life background really<br />
helps when we get the grouchy farmers in that absolutely have<br />
no time for the things we are making them have time for.<br />
Name and credentials: Shereen Leiseth, RN BSN<br />
CCRN CEN<br />
Nursing Specialty:<br />
Referral Case Manager/Traveling Veteran<br />
Coordinator.<br />
My previous ‘specialties’ were the Critical Care<br />
and Emergency Departments.<br />
What led you to become a nurse?<br />
I chose nursing, nursing didn’t choose me (aka I<br />
didn’t have that Florence Nightingale moment). I<br />
started as a CNA - working in a nursing home and a<br />
critical access hospital. Completed my LPN - working<br />
Shereen Leiseth<br />
med/surg and walk-in clinic. I transitioned straight<br />
into the LPN to BSN program at NDSU - worked in critical care/ED/day<br />
surgery/and a smattering of other PRN positions after completing the BSN<br />
degree. I am currently finishing a MSN degree in Nursing Education.<br />
What talents, gifts, or skills do you have that assist you in your day-to-day<br />
work?<br />
I am detail oriented and flexible. I take great pride in what I do -<br />
achieving excellence and mastery is very important to me. I also believe<br />
in customer service. My job is to support those who are on the front lines.<br />
(I save lives on the computer.)<br />
What is a typical day like for you?<br />
<strong>The</strong>re are NO typical days. My job is to support case managers at<br />
non-VA hospitals in <strong>North</strong> <strong>Dakota</strong> and the upper ⅓ of Minnesota. This<br />
means non-stop trouble-shooting. I also review clinical and discharge<br />
documentation with the goal of coordinating care with the case<br />
managers, offering VA resources as appropriate. Another key aspect of<br />
my position is coordinating care for Veterans who travel from one VA to<br />
another with the Traveling Veteran Coordinators across the USA. This is a<br />
super busy time of year for that population as the snowbirds are heading<br />
south. I also work with transplant, acute rehab and LTACH patients….the<br />
list seems endless some days. As in all aspects of nursing - it is a team<br />
sport and I have amazing co-workers.<br />
What are some of the greatest challenges for you?<br />
Understanding the acronyms that come from the VA healthcare<br />
system! I view my job as being the VA 'interpreter’ for case managers in<br />
our service area.<br />
What are some ways that you see your specialty can make a difference<br />
in rural areas?<br />
Many people don’t realize that the VA can pay for unplanned<br />
episodes of care (ED visits/admissions/direct admissions) for Veterans<br />
at private healthcare facilities. I can offer the small, rural hospital VA<br />
resources for discharge planning.<br />
I am continually advocating for, and educating hospital/case<br />
management staff, Veterans and their families about VA benefits.<br />
Additionally, the Fargo VA has done an exceptional job of working<br />
to deliver healthcare to the rural populations utilizing technology with<br />
tele health options, video visits and more. With all of the pressure on<br />
overwhelmed healthcare systems right now, my goal is to offer VA<br />
resources whenever possible and appropriate.<br />
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Apply Today at www.trhealth.com<br />
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Located in Basin, Wyoming
Page 4 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
<strong>North</strong> <strong>Dakota</strong> Department of Health: Vaccine Q & A<br />
<strong>The</strong> NDNA is now working with the <strong>North</strong> <strong>Dakota</strong> Department of<br />
Health to provide education on vaccines with the goal to assist nurses<br />
in answering questions that may arise from their patients and others. In<br />
this issue of <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse, we are highlighting some common<br />
questions and answers specific to reactions from COVID-19 vaccine.<br />
What are the FDA and CDC guidelines regarding allergic reactions and<br />
administering COVID-19 vaccine? <strong>The</strong> FDA has included a history of severe<br />
allergic reactions to a previous dose of COVID-19 vaccine or any COVID-19<br />
vaccine ingredient as a contraindication for the COVID-19 vaccine.<br />
Additionally, individuals who have had an immediate allergic reaction to<br />
COVID-19 vaccine or a COVID-19 vaccine ingredient should not receive<br />
the vaccine. Because of reports of anaphylactic reactions in individuals<br />
vaccinated outside of clinical trials, additional guidance has been created.<br />
All individuals should be monitored for 15 minutes postvaccination.<br />
<strong>The</strong> CDC has recommended persons who have had a severe<br />
allergic reaction to any vaccine or injectable therapy (intramuscular,<br />
intravenous, or subcutaneous) can receive COVID19 vaccine, but under<br />
the following conditions:<br />
• Individuals must be counseled about the unknown risks of<br />
developing a severe allergic reaction and balance these risks<br />
against the benefit of vaccination.<br />
• Individuals should be observed after vaccination to monitor for the<br />
occurrence of immediate adverse reactions for 30 minutes (versus<br />
15 minutes generally recommended following vaccination).<br />
• Individuals with other types of allergies, such as food, latex, pollen,<br />
or other substances do not have to take special precautions and<br />
can receive a COVID-19 vaccine.<br />
I’ve heard reports of inflammation of the heart (myocarditis) and of<br />
the outer lining of the heart (pericarditis) following receipt of Pfizer and<br />
Moderna COVID-19 vaccines. Are these events related? Since April 2021,<br />
increased cases of myocarditis and pericarditis have been reported in the<br />
U.S. after mRNA COVID-19 vaccination (Pfizer and Moderna), particularly<br />
in adolescents and young adults. <strong>The</strong>se reports are rare, and the CDC and<br />
its partners are actively monitoring reports of myocarditis and pericarditis<br />
after COVID-19 vaccination. <strong>The</strong>re has not been a similar reporting pattern<br />
observed after receipt of Johnson & Johnson COVID-19 vaccine. In most<br />
cases, patients who presented for medical care have responded well to<br />
medications and rest and had prompt improvement of symptoms. Reported<br />
cases have occurred predominantly in male adolescents and young adults<br />
16 years of age and older. Onset was typically within several days after<br />
mRNA COVID-19 vaccination, and cases have occurred more often after<br />
the second dose than the first dose. Research has shown that incidence<br />
of myocarditis following an mRNA COVID-19 vaccine is rare and that<br />
symptoms in a majority of cases resolve following care. CDC and its partners<br />
will continue to investigate these reports of myocarditis and pericarditis<br />
following COVID-19 mRNA vaccination. <strong>The</strong> known and potential benefits<br />
of COVID-19 vaccination outweigh the known and potential risks, including<br />
the possible risk of myocarditis or pericarditis. CDC continues to recommend<br />
COVID-19 vaccination for everyone 12 years and older given the risk of<br />
COVID-19 illness and related, possibly severe complications, such as longterm<br />
health problems, hospitalization, and even death.<br />
I’ve heard reports of Guillain-Barre syndrome (GBS) following receipt of<br />
Johnson & Johnson COVID-19 vaccines. Are these events related? On July<br />
13, 2021, the FDA released a statement that suggested that there is possible<br />
increased risk of GBS following receipt of a J&J COVID-19 vaccine. <strong>The</strong> FDA<br />
has added additional information to the vaccine’s FDA fact sheet on the risk<br />
of GBS. <strong>The</strong> chance of GBS occurring is very low following J&J vaccination.<br />
As of September 22, 2021, 210 preliminary reports of GBS have been identified<br />
in VAERS out of the more than 14.8 million J&J COVID-19 vaccine doses that<br />
have been administered in the U.S. Cases occur mostly in males and have<br />
largely been reported approximately two weeks after vaccination. You<br />
should seek medical attention right away if you develop any of the following<br />
symptoms following receipt of a J&J vaccine: weakness or tingling sensations,<br />
difficulty walking, difficulty with facial movement, double vision/inability to<br />
move eyes, and/or difficulty with bladder control/bowel function. <strong>The</strong> known<br />
and potential benefits of COVID-19 vaccination outweigh the known and<br />
potential risks, including the possible risk of GBS. Safety monitoring system<br />
A patient reported a delayed-onset local reaction (erythema, induration,<br />
pruritus) following a COVID-19 vaccine dose. Is this a contraindication for<br />
future COVID-19 vaccines? No, this is not a contraindication or a precaution. It<br />
is not known whether individuals who experienced a delayed-onset reaction<br />
after the first dose will experience a similar reaction after the second dose.<br />
However, these reactions are not believed to represent an increased risk for<br />
anaphylaxis after a subsequent dose. Persons who have a delayed-onset<br />
location reaction around the injection site area after the first vaccine dose<br />
should receive the second dose as the same vaccine product as the first<br />
dose and at the recommended interval, preferably in the opposite arm.<br />
How should we address anxiety-related events following COVID-19<br />
vaccine receipt? Anxiety-related events following COVID-19 vaccination<br />
are not uncommon and can be expected. In these events, a patient may<br />
experience dizziness, lightheadedness, feeling faint, rapid breathing, and<br />
sweating symptoms following receipt of a COVID-19 vaccine.<br />
It is important to be prepared for such incidence when conducting<br />
vaccination clinics, including but not limited to:<br />
• Identify people through screening with a history of fainting during<br />
the vaccination process<br />
• Provide drinks and snacks<br />
• Have a separate, quieter area for those that are feeling lightheaded<br />
or faint to sit or lie down and be monitored following vaccination.<br />
Executive Director’s Message continued from page 1<br />
Promoting Professional Development of <strong>Nurses</strong><br />
• NDNA hosted another remote nursing conference in the spring of<br />
2021 and again in the fall of 2021 with great attendance. Our overall<br />
ongoing theme has established itself clearly – health equity. We are<br />
continuing to projects and support of health equity topics.<br />
• Elections of new board members took place in the fall of 2021.<br />
Mylynn Tufte and Richelle Johnson have taken their seats at<br />
the table of the <strong>2022</strong> NDNA Board of Directors. We again have a<br />
renewed energy. Read about all board members on our website:<br />
https://ndna.nursingnetwork.com/<br />
• NDNA continues its work with the ND Center for Nursing with<br />
committee work on the Workplace Culture Designation and the<br />
Legendary Nurse awards.<br />
• NDNA began work with DNP students – legislative work,<br />
conferences, and developing self-learning modules that we will be<br />
able to offer in <strong>2022</strong>. Watch for this!<br />
• We are a constituent state of the American <strong>Nurses</strong> Association.<br />
NDNA President and Executive Director attended remote sessions<br />
of the June ANA Hill Day (with meetings with our congressmen),<br />
Membership Assembly in June and Leadership Summit in<br />
December. It is extremely valuable to connect with nurses across<br />
the country.<br />
• NDNA attended and presented to nursing students in <strong>January</strong> at<br />
the NSAND Annual Convention – an event we love. We will be there<br />
again on <strong>January</strong> 20-22 in Jamestown.<br />
• We started our new “Highlight a Nurse” series – read about three<br />
amazing nurses in this edition of <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse. Send us<br />
your nurses to highlight.<br />
Promoting the Safety and Well-being of <strong>Nurses</strong> in the Workplace<br />
• We received a grant from the <strong>North</strong> <strong>Dakota</strong> Department of Health<br />
for vaccine education!<br />
• Practicum with DNP student – Vitamin D education and more to<br />
come!<br />
• NDNA coordinated the creation of a Public Service Announcement<br />
on Covid and <strong>Nurses</strong>. Go to our Facebook page to watch it! https://<br />
www.facebook.com/ndna.org/<br />
NDNA is committed to continuing our mission and adapting to any<br />
changes we now must make so membership in NDNA is particularly<br />
important right now. Join us! RNs and LPNs can join today by visiting our<br />
website: www.ndna.org.<br />
Let’s take a moment of pride of what we have all done in all of our<br />
nursing lives in a time of such unpredictable circumstances. Thank you,<br />
nurses.<br />
Remember to follow NDNA on social media:<br />
For further information on COVID-19 vaccines, visit the ND Department<br />
of Health website – Immunization Guidance for Health Care Providers.
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 5<br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Board of Nursing (NDBON), the <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association (NDNA) and <strong>North</strong> <strong>Dakota</strong> Center for Nursing (NDCFN)<br />
collaborated to provide this comparison of the three nursing entities. Each of these entities has a unique mission and description, which makes them<br />
very different from one another. This comparison is updated and published annually and is available on the respective websites.<br />
A COMPARISON OF THE THREE ORGANIZATIONS<br />
<strong>North</strong> <strong>Dakota</strong> Board of Nursing (NDBON)<br />
919 S 7TH Street, Suite 504<br />
Bismarck, ND 58504-5881<br />
Phone: (701) 328-9777<br />
Fax: (701) 328-9785<br />
Website: www.ndbon.org<br />
Email: contactus@ndbon.org<br />
Mission:<br />
ND Board of Nursing assures <strong>North</strong> <strong>Dakota</strong><br />
citizens quality nursing care through the<br />
regulation of standards for nursing education,<br />
licensure, and practice.<br />
Description:<br />
• Governmental regulatory body established<br />
by state law under the <strong>North</strong> <strong>Dakota</strong> Century<br />
Code 43-12.1 Nurse Practices Act to regulate<br />
the practice of nursing and protect the health<br />
and safety of the public<br />
• Regulates the practice of individuals licensed<br />
and registered by the Board<br />
• Establish standards of practice for RNs, LPNs,<br />
and APRNs<br />
• Establish standards and regulate nursing<br />
education programs<br />
• Discipline licensees and registrants in response<br />
to violations of the Nurse Practices Act<br />
Board Members:<br />
NDBON, NDNA and NDCFN: What's the Difference?<br />
<strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association (NDNA)<br />
1515 Burnt Boat Dr, Suite C #325<br />
Bismarck, ND 58503<br />
Phone: (701) 335-6376<br />
E-mail: director@ndna.org<br />
Website: www.ndna.org<br />
Mission:<br />
<strong>The</strong> Mission of NDNA is to advance the<br />
nursing profession by promoting professional<br />
development of nurses, fostering high standards<br />
of nursing practice, promoting the safety and<br />
well-being of nurses in the workplace, and by<br />
advocating on health care issues affecting<br />
nurses and the public.<br />
Description:<br />
• 501(c)(6) non-profit association<br />
• Professional association for all nurses in <strong>North</strong><br />
<strong>Dakota</strong>.<br />
• Constituent member of the American <strong>Nurses</strong><br />
Association (ANA)<br />
• Influences legislation on health care policies<br />
and health issues and the nurse’s role in the<br />
health care delivery system<br />
• Promotes the continuing professional<br />
development of all <strong>North</strong> <strong>Dakota</strong> nurses<br />
• Advances the identity and integrity of the<br />
profession to enhance healthcare for all<br />
through practice, education, research, and<br />
development of public policy<br />
• Promotes the Scope and Standards of Nursing<br />
Practice and the Code of Ethics for nurses<br />
Board of Directors:<br />
<strong>North</strong> <strong>Dakota</strong> Center for Nursing (NDCFN)<br />
Box 117<br />
<strong>North</strong>wood, ND 58267<br />
Phone: (218) 791-1461<br />
Website: www.ndcenterfornursing.org<br />
Mission:<br />
<strong>The</strong> mission of NDCFN is to through collaboration<br />
guide the ongoing development of a wellprepared<br />
and diverse nursing workforce to meet<br />
health care needs in <strong>North</strong> <strong>Dakota</strong> through<br />
research, education, recruitment and retention,<br />
advocacy, and public policy.<br />
Description:<br />
• 501c3 non-profit organization Member of the<br />
National Forum of State Nursing Workforce<br />
Centers<br />
• Works to unify voice of nursing in <strong>North</strong><br />
<strong>Dakota</strong> through connecting all nurses and<br />
nursing organizations interested in policy<br />
issues.<br />
• Develops statewide programming to fulfill<br />
mission.<br />
• Works to improve nursing workplace culture.<br />
• Provides leadership and policy opportunities.<br />
• Host annual research conference.<br />
Board of Directors:<br />
Jane Christianson, RN member, Bismarck:<br />
President<br />
Dr. Kevin Buettner, APRN member, Grand Forks:<br />
Vice President<br />
Dr. Jamie Hammer, RN member, Minot: Treasurer<br />
Michael Hammer, RN member, Velva<br />
Dr. Mary Beth Johnson, RN member, Bismarck<br />
Wendi Johnston, LPN member,<br />
Kathryn Julie Dragseth, LPN member, Watford<br />
City<br />
Cheryl Froehlich, Public member,<br />
Mandan Dana Pazdernik, RN member, New<br />
Salem<br />
NDBON Staff:<br />
Dr. Stacey Pfenning DNP, APRN, FNP, FAANP<br />
Executive Director spfenning@ndbon.org<br />
Kyle Martin Associate Director for Operations<br />
kmartin@ndbon.org<br />
Dr. Tammy Buchholz, DNP, RN, CNE, FRE<br />
Associate Director for Education<br />
education@ndbon.org<br />
Melissa Hanson, MSN, RN Associate Director of<br />
Compliance compliance@ndbon.org<br />
Maureen Bentz, MSN, RN, CNML Associate<br />
Director for Practice practice@ndbon.org<br />
Corrie Lund, MSN, RN Assistant Director for<br />
Compliance compliance@ndbon.org<br />
Michael Frovarp Accounting/Licensure Specialist<br />
exam@ndbon.org<br />
Gail Rossman, Technology Specialist II (Retiring<br />
<strong>2022</strong>) contactus@ndbon.org<br />
Karen Hahn Administrative Service Coordinator<br />
contactus@ndbon.org<br />
Arverd Lachowitzer Technology Assistant/<br />
Licensing Specialist endorse@ndbon.org<br />
Christa Stayton Administrative Assistant/Licensing<br />
Specialist contactus@ndbon.org<br />
President - Tessa Johnson, MSN, BSN, RN, CDP<br />
tjohnson@countryhouse.net<br />
Board of Directors listed at https://ndna.<br />
nursingnetwork.com/page/72991-board-ofdirectors<br />
NDNA Staff (Independent Contractor):<br />
Sherri Miller, BS, BSN, RN Executive Director<br />
director@ndna.org<br />
13 organizations represented. List available on<br />
website at: http://www.ndcenterfornursing.org/<br />
board-of-directors/<br />
NDCFN Staff:<br />
Patricia Moulton Burwell, PhD Executive Director<br />
Patricia.moulton@ndcenterfornursing.org
Page 6 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Center for Nursing<br />
Legendary Nurse Awards Announced!<br />
Our NDNA President, Tessa Johnson, was selected to receive the<br />
Leadership Award this year. We are very proud. Congratulations to Tessa<br />
and all the recipients!!<br />
NDNA sponsored the Rising Star Award this year.<br />
Leadership Award- Demonstrates exceptional leadership (either in a<br />
formal or informal role) in either their place of employment or in a nonprofit<br />
or nursing organization.<br />
Sponsored by the ND Organization of Nurse Leaders (NDONL)<br />
Paige Wegner, Fargo, Essentia Health<br />
Tessa Johnson, Dickinson, Country House<br />
<strong>The</strong>resa Knox, City of Grand Forks Public Health Department<br />
Clinical Practice Excellence Award- Demonstrates exceptional clinical<br />
practice or patient care.<br />
Amanda Anderson, Grand Forks, Altru Family Birthing Center<br />
Courtney Kniert, Grand Forks, Altru Family Birthing Center<br />
Floyd Nemer, Bismarck, VA Health System<br />
Marilyn Schwartzbauer, Bismarck Sanford ICU<br />
Faculty Achievement Award- Demonstrates excellence in teaching,<br />
engaging students in the love for nursing and supports student growth.<br />
Sponsored by College and University Nursing Education Administrators<br />
(CUNEA)<br />
Nancy Turrubiates, Fargo, <strong>North</strong> <strong>Dakota</strong> State University<br />
Anna Anderson, Bismarck State College<br />
Nurse Executive Leadership Award - Provides exceptional leadership<br />
(over five years) in a top executive role for Nursing such as Nurse<br />
Executive, Vice President, Chief Nursing Officer, Dean, Director or<br />
Program Chair.<br />
Sponsored by Evelyn Quigley and Carla Hansen<br />
Sue Leupp, Mohall, Good Samaritan Society<br />
Brett Kallis, Dickinson, Southwestern District Health Unit<br />
Sara Senn, Richardton Health Center<br />
Rising Star Award - A nurse in the first two years of practice that<br />
exhibits leadership and professionalism in their field of nursing.<br />
Sponsored by the <strong>North</strong> <strong>Dakota</strong> <strong>Nurses</strong> Association<br />
Joan Garia Ortiz, Grand Forks Altru Health System<br />
Evidence Based Practice Award - Excellence in the promotion and<br />
utilization of evidence based practice principles in the pursuit of clinical<br />
excellence.<br />
Margo Daily Filipkowski, Minot Trinity Health<br />
Amy Lamb, Fargo VA Health Care System<br />
Preceptor Award - Excellence in encouraging and supporting nursing<br />
student education through clinical precepting or organizational<br />
orientation for nurses transitioning from student to professional practice.<br />
Stacie Weible, Fargo Sanford Health<br />
Champion for Nursing Award - A non-nurse or organization who has<br />
demonstrated a strong commitment in supporting the nursing profession<br />
and/or made significant contributions to the nursing profession.<br />
Sponsored by Sigma <strong>The</strong>ta Tau Xi Kappa at Large and Kappa Upsilon<br />
Chapters.<br />
Michael Essex, Fargo Sanford Health<br />
Julie Wittkopp, Fargo VA Health System<br />
Randolph Peterson, Fargo VA Health System<br />
School <strong>Nurses</strong> and Telemedicine<br />
Penny Briese, PhD, RN<br />
At the NDNA Fall 2021 conference, nurses from across the state<br />
heard from several very knowledgeable speakers on the topics of both<br />
telemedicine and the toll Covid-19 has taken on not only <strong>North</strong> <strong>Dakota</strong>n’s<br />
physical health but their mental health as well. Thomasine Heitkamp,<br />
Dr. Shawnda Schroeder, and Rachel Navarro spoke specifically about<br />
how rural communities encounter more barriers to accessing behavioral<br />
health support than their urban counterparts due to lack of resources;<br />
in Native American communities, access issues are even worse. Much of<br />
the problem appears to stem from an overall lack of mental healthcare<br />
providers in our state. <strong>The</strong> lack of pediatric mental healthcare specialists<br />
is even more concerning. <strong>North</strong> <strong>Dakota</strong> children are experiencing<br />
upheavals in their normal schedules due to the uncertainty of schools<br />
closing due to Covid outbreaks, being put into quarantine for close<br />
contact or positive tests, having to transition from classroom to online<br />
learning environments, and just the uncertainty of when vaccines will<br />
be available for younger school-aged children. “Currently, nearly 22<br />
Belcourt, ND<br />
Multiple Nursing Opportunities<br />
in OB, Clinic, Med/Surg & ER<br />
<strong>The</strong> Quentin N. Burdick Memorial Health Care Facility is an Indian<br />
Health Service unit located on the Turtle Mountain Reservation<br />
in Belcourt, ND. <strong>The</strong> Facility provides comprehensive primary<br />
care and preventive care and hosts a medical clinic, dental clinic,<br />
optometry clinic, pharmacy, radiology services, mental<br />
health services, outpatient surgical services, labor<br />
and delivery services, emergency room and inpatient/<br />
acute care unit.<br />
<strong>The</strong> site qualifies as a student loan payback site and offers benefits including annual<br />
and sick leave, health/dental/vision benefits, life insurance, and retirement.<br />
For more information, please visit www.usajobs.gov<br />
or call Lynelle Hunt, DON (701) 477-6111 ext. 8260.<br />
All RNs encouraged to apply or call for more information.<br />
percent of children ages 3 to 17 in the United States are affected by a<br />
mental, emotional, developmental, or behavioral condition. Only about<br />
20 percent of children with mental, emotional, or behavioral disorders,<br />
however, receive care from a specialized provider.”(1)<br />
This trend has been noted by school nurses across the country. School<br />
nurses are in a prime position to be the first to notice when children are<br />
experiencing mental distress or crisis. (2) <strong>The</strong> National Association of<br />
School <strong>Nurses</strong> (NASN) states that children’s health and wellness must be<br />
a priority for them to succeed in school. <strong>The</strong>y further state that disparities<br />
related to social determinants of health, which includes where students<br />
reside (rural VS urban) must be addressed. And school nurses now have a<br />
new tool with which to do just that.<br />
<strong>The</strong> Biden/Harris Administration has taken the issue of pediatric mental<br />
healthcare access to heart. Recently, it was reported in the news that<br />
“the U.S. Department of Health and Human Services (HHS) awarded<br />
$10.7 million from the American Rescue Plan (ARP) to expand pediatric<br />
mental health care access by integrating telehealth services into<br />
pediatric care. <strong>The</strong> awards were made through the Health Resources<br />
and Services Administration (HRSA).”(1) <strong>The</strong>se grants will expand access<br />
to children, regardless of where they live, through telehealth visits with<br />
pediatric mental health specialists. Health and Human Services (HHS)<br />
Secretary Xavier Becerra said, "<strong>The</strong> COVID-19 pandemic has taken a toll<br />
on all of us, especially children. This critical funding will not only improve<br />
the livelihoods of children and their families, but also secure the future<br />
of our country. We will continue to make investments that ensure our<br />
youngest Americans grow up strong and healthy." (1)<br />
<strong>The</strong> Pediatric Mental Health Care Access Program has expanded<br />
access from 21 awards in 21 states to 45 awards in 40 states, as well<br />
as DC, the Virgin Islands, and the Republic of Palau. (1) Two Native<br />
American tribal areas have also benefitted: the Chickasaw Nation and<br />
the Red Lake Band of the Chippewa Indians (1)<br />
"Primary care providers strive to address the many mental health<br />
challenges children and families are experiencing due to the pandemic,<br />
but they need more support," said HRSA Acting Administrator Diana<br />
Espinosa. "Expanding the Pediatric Mental Health Care Access program<br />
offers new opportunities for providers to offer families the mental<br />
and behavioral health services they need but that often aren't easily<br />
accessible." (1)<br />
To learn more about Promoting Positive Mental Health in Rural Schools,<br />
please go to https://mhttcnetwork.org/centers/mountain-plains-mhttc/<br />
product/promoting-positive-mental-health-rural-schools<br />
To learn more about HRSA's Pediatric Mental Health Care Access<br />
program, visit: https://mchb.hrsa.gov/training/pgm-pmhca.asp.<br />
For a list of HRSA awards, visit: https://mchb.hrsa.gov/maternal-childhealth-initiatives/mental-behavioral-health/arp-pediatric-mental-health.<br />
Sources<br />
1. Biden-Harris Administration Invests $10.7 Million in American Rescue Plan Funds<br />
to Expand Pediatric Mental Health Care Access. Retrieved from https://<br />
www.hhs.gov/about/news/2021/08/27/biden-harris-admin-invests-nearly-11-<br />
million-for-pediatric-mental-health-access.html<br />
2. <strong>The</strong> Behavioral Health and Wellness of Students. Retrieved from https://www.<br />
nasn.org/advocacy/professional-practice-documents/position-statements/<br />
ps-behavioral-health
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 7<br />
Welcome New NDNA Officers!<br />
NDNA welcomed new officers effective<br />
<strong>January</strong> 1, <strong>2022</strong>. We are thankful to have<br />
these talented nurses join us as LEADERS as we<br />
advance the nursing profession in <strong>North</strong> <strong>Dakota</strong>!<br />
Thank you all for your willingness to serve!<br />
President-Elect<br />
Mylynn Tufte,<br />
MBA, MSIM, RN<br />
Membership Assembly<br />
Representative<br />
Susan Indvick,<br />
MSN, RN<br />
<strong>The</strong> Nominating Committee will be: Cheryl<br />
Lantz, RN, PhD, CDCP, Richelle Johnson, MSN,<br />
RN, and Mylynn Tufte, MBA, MSIM, RN<br />
Bottineau, ND<br />
Full-Time RN/LPN<br />
Also hiring CNAs and<br />
CS/ER Technicians<br />
NEW competitive salary &<br />
excellent benefit package<br />
ND licensure/certification required.<br />
SIGN-ON<br />
BONUS<br />
For more information or an application, please contact<br />
Human Resources at 228-9314 or visit our website at<br />
www.standrewshealth.com<br />
Vice President of Finance<br />
Richelle Johnson,<br />
MSN, RN<br />
Cheryl Lantz,<br />
RN, PhD, CDCP<br />
Unity Medical Center, located in Grafton is<br />
recruiting for Med Surg/ER <strong>Nurses</strong> to work<br />
in our new addition that consists of 11 new<br />
patient rooms and a new ED department.<br />
Director of Membership<br />
Kami Schauer,<br />
MSN, RN<br />
Richelle Johnson<br />
Mylynn Tufte<br />
12 hour shifts rotating days and nights<br />
every 3rd weekend and rotating Holidays.<br />
Please contact Jenny, CNO at 701-352-1620<br />
or apply online at<br />
www.unitymedcenter.com<br />
EOE
Page 8 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
Medical Marijuana, Legislative Updates and Education<br />
Gail Pederson, SPRN, HN-BC<br />
Be Well Healing Arts, PLLC<br />
I would like to update the nursing community<br />
on the status of Cannabis (Medical Marijuana) in<br />
<strong>North</strong> <strong>Dakota</strong> and the changes recently passed by<br />
the 2021 legislature. I will also add my activity as a<br />
Cannabis Nurse Consultant and Educator.<br />
If you are not familiar with the <strong>North</strong> <strong>Dakota</strong><br />
Medical Marijuana law, it is ND Century Code<br />
Chapter 19-24.1 and is found at: https://www.legis.<br />
nd.gov/cencode/t19c24-1.html.<br />
To be an advocate for your patients, I would<br />
recommend reading it.<br />
Gail Pederson<br />
Here are a few statistics that I have pulled from the yearly report of the<br />
Medical Marijuana Program (MMP). It can be found at https://www.health.<br />
nd.gov/sites/www/files/documents/Files/MM/Annual_Report_2021.pdf.<br />
As of the July 2021, end of the FY report, there are 5,754 card holders,<br />
139 caregivers cards and over 400 employees in the industry.<br />
297 providers have certified patients for cards. <strong>The</strong> make up of those<br />
certifying are:<br />
• 60% Physicians<br />
• 32% Advanced Practice Registered <strong>Nurses</strong><br />
• 8% Physician Assistants<br />
Since our vote to allow Medical Cannabis in the state in 2016, our law<br />
has evolved over 3 legislative sessions. Wording has been changed to<br />
help the certification process be more palatable to providers. Conditions<br />
have been added. Allowable amounts were increased (still not enough<br />
for some conditions), changes were made to allow Veterans easier<br />
access. Several conditions were added in 2019. I was active during our<br />
2021 legislative session, speaking whenever possible for changes in<br />
our program. A few made it through legislation, but a lot more that we<br />
advocates had hoped for, did not.<br />
<strong>The</strong> 2021 legislative session was more patient focused, I felt. More<br />
about patient protections, not as much implementation issues. <strong>The</strong>re<br />
were important changes to our caregiving program that came up and<br />
were easily passed. On a national level, Cannabis Nurse colleagues<br />
noted these changes as important.<br />
Our law allowed one caregiver the legal right to purchase and<br />
dispense/dose a cannabis card holder. One person only! This did not<br />
allow another parent, grand parent or other significant person such<br />
as a daycare provider to medicate that person in need of assistance<br />
with Cannabis dosing. This became personal when a cannabis activist<br />
mom nominated me for the 2019 ND Legendary Nurse Award for<br />
Advocacy. She was the only caregiver for her autistic son. His bus was<br />
10 minutes late. Because she needed to medicate him she missed<br />
presenting me the award. I stated jokingly to the lawmakers that they<br />
had never made out a 24/7/365 day a year scheduling like us nurses<br />
have. Three caregivers were requested by the sponsor, which I asked<br />
the HHS committee to raise to 5. This law also changed the make up of<br />
the Medical Marijuana Advisory Board, adding a patient representative<br />
and a legislator from each chamber. <strong>The</strong> state chose to removal the $50<br />
registration fee for caregivers. <strong>The</strong>y still have to go through a background<br />
check at their expense. In another bill, if a person is applying to be a<br />
caregiver for a terminal patient. <strong>The</strong> background check is waived for 6<br />
months, with the ability to renew for another six months.<br />
Those of us working to improve our program had proposed these items<br />
which did not make it into law. We will try again.<br />
• <strong>The</strong> ability of patients to grow their own Cannabis. This was in the<br />
original measure we voted on. I remember talk on the floor of<br />
people growing 20 pounds with one plant and mold covering the<br />
inside of homes, endangering our families. <strong>The</strong> average amount<br />
that I have been told by my many Cannabis Nurse grower friends<br />
across the country is 4-6 ounces per plant. This extreme amount<br />
brought up is not realistic and continues the fear mongering around<br />
this plant.
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 9<br />
• A food grade edible product. Again,<br />
this was taken out of the original bill. All<br />
cannabis is ingestible in its different forms.<br />
To have a lozenge, gummy, chocolate that<br />
is a set milligram-usually 10 mg just makes<br />
sense to a person who wants an accurate<br />
dose.<br />
• Reciprocity of patient cards between<br />
states. This is a nationally discussed issue<br />
and I supported it. Our legislators were<br />
worried about misuse of residents “from<br />
Minnesota” that may come to a dispensary<br />
in Fargo, get flower that is not available<br />
in MN, smoke it and drive impaired back<br />
to MN. <strong>The</strong>re were concerns that a state’s<br />
accepted conditions are different than<br />
ours. <strong>The</strong>re are few conditions that <strong>North</strong><br />
<strong>Dakota</strong> does not have compared to other<br />
states. <strong>The</strong> fear and mistrust is great.<br />
• <strong>The</strong> ability of a caregiver of a minor to<br />
utilize plant matter “Flower” to use other<br />
than as a combustible, such as making an<br />
oil. This is to utilize a specialized treatment<br />
based on the whole plant cannabinoids,<br />
flavonoids and terpenes. It is trial and error<br />
for our kids with cancer, Epilepsy or on the<br />
Autism Spectrum disorder. Parents need to<br />
be able to find which strain (Chemovar)<br />
works best. As it stands now, the pediatric<br />
product, a solution, though cheap for<br />
minors, may not be the one that is best for<br />
them. An excellent video on pediatrics was<br />
made for us by one of the top cannabis<br />
MDs in the country, Dr Bonni Goldstein.<br />
Unfortunately, we could not get this bill to<br />
the floor.<br />
• Our monthly patient limits are inadequate<br />
for cancer, pain management and<br />
other conditions. Another issue is there<br />
is no leeway for milligram differences in<br />
the products within the program. Each<br />
bottle of tincture or other concentrate<br />
is a different mg, depending on the<br />
percentage of THC in the cannabis<br />
product. A patient I know could not get a<br />
concentrate of the strain that works well<br />
for him, because it was 1.5mg over his<br />
limit on a product that averages 800mg<br />
plus. Concentration limit increases had<br />
been put in place, but disappeared from<br />
legislation. <strong>The</strong> fear of “diversion” of the<br />
product by the legislators is a factor in<br />
this. I do support adult use legalization for<br />
the ethical and social issues it involves and<br />
because of continued limitations to our<br />
medical program.<br />
I have been active in a Long Term Care<br />
working group of the American Cannabis<br />
<strong>Nurses</strong> Association. We have been looking<br />
at policy for those in LTC or communal living<br />
(like my disabled adult son) to use cannabis.<br />
This is what prompted me to ask for adequate<br />
caregivers. Within this group, data has been<br />
complied of a study using CBD in a small,<br />
private memory care setting. <strong>The</strong> results<br />
are promising with better sleep patterns,<br />
less anxiety, and overall better mood and<br />
interactions. Learning the steps to publish a<br />
peer reviewed article has been eye opening.<br />
I’ve told the others involved that I’m learning so<br />
much and just along for the ride.<br />
As I look back at my past articles, I noted<br />
that I had said that I will be launching my<br />
continuing education program “Cannabis 101:<br />
What Medical Professionals Need to Know”<br />
in 2019. <strong>The</strong>n Covid hit. I will now attempt to<br />
offer it again. This is a comprehensive program<br />
focusing on the National Counsel for State<br />
Boards of Nursing Guidelines on Patients<br />
Who Use Marijuana (1.5 CEUs for <strong>Nurses</strong> and<br />
Licensed Social Workers at the present time).<br />
<strong>The</strong> topics included are the history, state law,<br />
the Endocannabinoid system, routes of use,<br />
medication intereactions and side effects.<br />
Legal, institutional and ethics are discussed.<br />
It is open to all medical professionals. <strong>The</strong><br />
goal of setting up presentations across the<br />
state depend again on Covid, for myself and<br />
those I care for. I will be offering it in our larger<br />
communities and targeting specific facilities.<br />
If you have any questions or would like to<br />
schedule a presentation for your facility, please<br />
contact me. I think it is an important subject.<br />
Gail Pederson, SPRN, HN-BC is a Board<br />
Certified/Special Practice RN in Holistic Nursing<br />
and the owner of Be Well Healing Arts, PLLC.<br />
She is a Cannabis trained nurse providing<br />
Consultation and Education on Cannabis as<br />
medicine. Gail is a member of the American<br />
Cannabis <strong>Nurses</strong> Association and the Cannabis<br />
<strong>Nurses</strong> Network. She may be contacted at<br />
bewellhealingarts@gmail.com, “Like” Be Well<br />
Healing Arts, pllc on Facebook or call 701-490-<br />
2132 for further information.
Page 10 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
COVID-19 Booster Doses – Which Vaccine Should I Get?<br />
As of October 21, 2021, the CDC has expanded eligibility for<br />
COVID-19 booster shots in the United States. <strong>The</strong>re are now booster<br />
recommendations for all three available COVID-19 vaccines in the United<br />
States.<br />
For individuals who received a Pfizer-BioNTech or Moderna COVID-19<br />
vaccine, the following groups are eligible for a booster shot at six<br />
months or more after their initial series: 65 years and older; age 18+ who<br />
live in long-term care settings; age 18+ who have underlying medical<br />
conditions; and age 18+ who work or live in high-risk settings.<br />
For individuals who received the Johnson & Johnson COVID-19 vaccine,<br />
booster shots are recommended for those who are 18 and older and<br />
who were vaccinated two or more months ago.<br />
Are there any safety concerns with mixing brands for COVID-19 boosters?<br />
<strong>The</strong>re have been no safety concerns identified with mixing and<br />
matching products. Any side effects reported during booster studies<br />
appear to be limited to the same side effects seen after receipt of a<br />
homologous (same brand) series. <strong>The</strong> most common side effects include<br />
fatigue, headache, chills, and muscle aches.<br />
How do COVID-19 boosters compare?<br />
Data suggests that mixing COVID-19 vaccine brands boosts the<br />
immune response to the virus that causes COVID-19. Below is a summary<br />
of this study.<br />
It is up to the health care provider and the patient to determine which<br />
COVID-19 vaccine brand is the best option for a booster dose. <strong>The</strong> CDC<br />
allows for a “mix and match” approach to booster doses. Deciding<br />
which booster is right for you can be challenging. It is important that<br />
patients weigh the risks of severe illness from COVID-19 with the benefits<br />
and risks of vaccination. Below is some information to consider when<br />
deciding which booster to receive.<br />
What are the benefits of a COVID-19 booster dose and the risks of<br />
COVID-19 illness?<br />
<strong>The</strong> benefits of a COVID-19 booster dose may include a reduced<br />
risk of SARS-CoV-2 infection (the virus that causes COVID-19) and a<br />
reduced risk for severe COVID-19. Receiving a booster dose may prevent<br />
illness (including post-COVID/long-term symptoms) and may reduce<br />
transmission of the virus to other people. Individuals should consider the<br />
following risk factors for SARS-CoV-2 infection and the potential impact of<br />
SARS-CoV-2 infection:<br />
• Risk of exposure to SARS-CoV-2. Factors that would be expected to<br />
affect the risk of exposure to SARS-CoV-2 include work or residence<br />
in certain settings; level of community transmission; rates of<br />
COVID-19 vaccination in their community; the likelihood of frequent<br />
interactions with possibly unvaccinated people from outside<br />
an individual’s household; and adherence to recommended<br />
prevention measures.<br />
• Risk for developing SARS-CoV-2 infection. A person’s risk for<br />
developing SARS-CoV-2 infection may vary based on time from<br />
completing a primary COVID-19 vaccine series and time from prior<br />
SARS-CoV-2 infection due to waning immunity. Serologic testing<br />
or cellular immune testing is not recommended as part of the<br />
individual risk-benefit assessment.<br />
• Risk for severe infection related to underlying conditions. A person’s<br />
risk of developing severe COVID-19 may vary by the type, number,<br />
and level of control of specific medical conditions as well as other<br />
yet to be defined variables. Pregnant people may receive a<br />
COVID-19 vaccine booster. Separately, also see Considerations<br />
for COVID-19 vaccination in moderately and severely<br />
immunocompromised people.<br />
• Potential impact of SARS-CoV-2 infection. SARS-CoV-2 infections that<br />
are not severe may still lead to illness (e.g., post-COVID-19/longterm<br />
symptoms). A person’s individual circumstances should also be<br />
considered; these may include living with/caring for a person who is<br />
medically frail or immunocompromised or a child who is not eligible<br />
for COVID-19 vaccine or the inability to work or meet other personal<br />
obligations when infected, even if not severely ill with COVID-19.<br />
To access electronic copies of<br />
<strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse, please visit<br />
http://www.nursingALD.com/publications<br />
*In this study a full dose of Moderna COVID-19 vaccine was used<br />
as the booster dose. A half-dose of Moderna COVID-19 vaccine is<br />
authorized in the United States for the booster dose.<br />
Are there any safety concerns for choosing a booster dose of the mRNA<br />
(Pfizer or Moderna) vaccine?<br />
<strong>The</strong> serious safety concern seen most commonly with the mRNA<br />
vaccines (Pfizer and Moderna) is myocarditis (inflammation of the<br />
muscle around the heart). Based on current data from the primary<br />
vaccine series, the highest risk of myocarditis occurring following receipt<br />
of an mRNA vaccine is seen in males aged 12-30 years old. <strong>The</strong> rate of<br />
myocarditis occurring following receipt of an mRNA vaccine in males<br />
ages 18-24 years old is 39 cases per one million doses administered.<br />
Myocarditis is also associated with COVID-19 illness. Additionally, data<br />
suggests that myocarditis occurs at a higher rate following a COVID-19<br />
illness compared to receipt of a COVID-19 vaccine. <strong>The</strong>re have been<br />
no reported deaths associated with myocarditis following a COVID-19<br />
vaccine. Most cases of myocarditis are mild and patients typically<br />
recover fully within six months.<br />
A male who is a young adult should consider their own individual risks<br />
and benefits when deciding which booster to choose. If an individual<br />
is concerned about their risk of acquiring serious COVID-19 illness more<br />
than the risk of myocarditis post-vaccination, then they may want to<br />
consider receiving an mRNA booster dose. If that individual is more<br />
concerned about their risk of myocarditis, then they may want to choose<br />
a booster dose of Johnson and Johnson COVID-19 vaccine.<br />
Are there any safety concerns for choosing a booster dose of the<br />
Johnson and Johnson vaccine?<br />
<strong>The</strong>re have been 47 cases of rare blood clots, thrombosis with<br />
thrombocytopenia syndrome (TTS), reported to the Vaccine Adverse<br />
Events Reporting System (VAERS) following 15.3 million doses of Jonhson<br />
and Johnson COVID-19 vaccine administered in the United States.<br />
This event happens most frequently in women 18-49 years old, with the<br />
highest reporting rate in 30-39 year old females at 10 cases per one<br />
million doses administered. Women of childbearing age should consider<br />
receiving a booster dose of mRNA (Pfizer or Moderna) vaccine given<br />
their increased risk of TTS.<br />
Guillain-barré syndrome (GBS), a rare autoimmune disorder, may be<br />
associated with the Johnson and Johnson COVID-19 vaccine. Through<br />
July 24th, 130 cases of GBS following vaccination have occurred, most<br />
frequently in males 50 years of age and older. <strong>The</strong> highest reporting rate<br />
of 16 cases per one million doses administered is in males ages 50-64.<br />
Older males may want to consider mRNA vaccination for their booster<br />
dose.<br />
I need more guidance on choosing which COVID-19 booster dose to<br />
receive. Who should I talk to?<br />
For specific medical questions, the <strong>North</strong> <strong>Dakota</strong> Department of<br />
Health recommends an individual talk to their trusted medical provider.<br />
This provider will be able to offer insight into a persons individual medical<br />
decisions.
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 11<br />
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Page 12 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
Factors Influencing Medication Errors<br />
Anna Holen, Abby Seifert, & Christine Vetsch<br />
BSN Students, University of Jamestown<br />
Editor: Penny Briese, PhD(c), RN<br />
University of Jamestown<br />
Clinical Question: What are some factors that<br />
influence nurses’ medication errors?<br />
Medication safety is a priority for nurses,<br />
considering medication administration<br />
accounts for 40% of the nurse’s occupational<br />
duties and nurses “are responsible for 26-<br />
38% of medication errors” (Dougal, 2020,<br />
p. 7). <strong>The</strong>re are factors that influence and<br />
increase/decrease the chances of making<br />
medication errors. Being aware of these<br />
factors can promote medication safety and<br />
decrease the number of errors that are too<br />
prominently occurring in the nursing field. Six<br />
different articles related to medication errors<br />
in the nursing profession were included in this<br />
miniature literature review.<br />
In 2018, Treiber and Jones performed a<br />
quantitative study in an effort to understand<br />
individual and system level factors that<br />
contribute to medication errors from the<br />
perspective of BSN nursing graduates. <strong>The</strong><br />
researchers investigated perceptions of<br />
adequacy of preparatory nursing education,<br />
contributory variables, emotional responses,<br />
and treatment by employers following the error<br />
(Treiber & Jones, 2018). <strong>The</strong> study consisted<br />
of 168 participants who completed an<br />
online survey. <strong>The</strong> survey was sent out to BSN<br />
graduates from Kennesaw State University in<br />
Georgia who graduated between the years<br />
of 2009-2013. Most of the participants were<br />
white (71%), female (89%), and nearly all were<br />
currently practicing nursing (Treiber & Jones,<br />
2018). More than half of the respondents<br />
indicated they had made a medication error<br />
since becoming a registered nurse; a majority<br />
stated that when they made an error their<br />
facility was supportive. Reasons that a nurse<br />
did not report a medication error included<br />
fear of repercussion, perception the error was<br />
not serious, and the process to report the error<br />
being too time consuming (Treiber & Jones,<br />
2018).<br />
Bekes, Sackash, Voss, and Gill (2021)<br />
focused their study on medication errors<br />
seen specifically in pediatric patients in the<br />
perioperative period. <strong>The</strong> researchers sought<br />
to answer two main questions: 1) what are<br />
the main types of medication errors in the<br />
pediatric population in the perioperative<br />
period, and 2) what mitigation strategies had<br />
the best outcome that can be incorporated<br />
into practice? This was a narrative literature<br />
review of 17 articles. <strong>The</strong> inclusion criteria for<br />
this review included a patient population<br />
from one to 18 years of age, articles printed in<br />
the English language, full-text publications,<br />
and focused on perioperative periods of care<br />
(Bekes et al., 2021). <strong>The</strong> researchers scored<br />
each article using the critical appraisal skills<br />
program qualitative checklist because it<br />
breaks down the methodological approach<br />
to determine the quality of each article.<br />
<strong>The</strong>y found that the most frequent errors<br />
mentioned in the multiple research studies<br />
were incorrect doses (77%) including dilution<br />
errors, calculation errors, and incorrect intervals.<br />
Other examples of common medication errors<br />
included incorrect medication, grabbing the<br />
incorrect syringe, inappropriate medication<br />
labeling, and giving a known allergen (Bekes<br />
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et al., 2021). <strong>The</strong> researchers concluded by<br />
discussing interventions that reduce medication<br />
errors which entailed standardized labeling,<br />
prefilled syringes, two-person checks, drug<br />
library/ electronic-based references, quality<br />
improvement safety analytics, pharmacy<br />
support, computer check systems, staff<br />
education, standardized workspace, zerotolerance<br />
philosophy, and checklists (Bekes et<br />
al., 2021).<br />
Ragau, Hitchcock, Craft, and Christensen<br />
(2018) wanted to look specifically at the<br />
individual human factors that can cause<br />
medication errors. <strong>The</strong>y used the HALT model<br />
(hungry, angry, late, lonely, and tired) to try<br />
and reduce the incidence of medication<br />
errors by 25% by allowing nurses to “be more<br />
aware of how their emotional behavior may<br />
have a deleterious effect” on medication<br />
administration (Ragau et al., 2018, p. 1333).<br />
<strong>The</strong> HALT model was implemented in a 32-bed<br />
acute medical unit. ‘HALT’ posters were placed<br />
throughout the unit to remind the team to<br />
“effectively ‘HALT’ and take time to reflect on<br />
what was occurring for them on an emotional<br />
level and then take the appropriate action”<br />
(Ragau et al., 2018, p. 1333). <strong>The</strong> model was<br />
also used during shift hand-off to highlight any<br />
emotions that needed to be addressed before<br />
the shift change. After the implementation of<br />
the HALT model, there was a decrease in total<br />
medication errors by 31.7% over a two-month<br />
period, a 25.3% decrease in errors relating<br />
to human error, and a 22.9% decrease in<br />
communication and documentation-related<br />
errors (Ragau et al., 2018, p. 1334). Although this<br />
study had a positive response, “caution should<br />
be used when addressing other contributing<br />
factors associated with medication errors as<br />
using HALT alone will not address these” (Ragau<br />
et al., 2018, p. 1334).<br />
Berdot et al. (2021) conducted a study<br />
on nurses wearing a special vest indicating<br />
a time of requested un-interruption. <strong>The</strong>y<br />
analyzed whether the introduction of the vest<br />
reduced medication errors during medication<br />
administration. This was a multicenter,<br />
randomized controlled trial performed in 29<br />
adult units in four hospitals. Over the course of<br />
the study, 178 nurses in 14 units wore a ‘do not<br />
interrupt’ vest during 383 observed medication<br />
rounds to examine the main outcome of<br />
administration error rate. <strong>The</strong> error rate was<br />
defined as “number of Opportunities for Error,<br />
OE, calculated as one or more errors divided by<br />
the Total Opportunities for Error, TOE, multiplied<br />
by 100” (Berdot et al., 2021, p. 1). Berdot et al.<br />
(2021) found that the administration error rates<br />
in the experimental group was 7.09% and 6.23%<br />
in the control group (p. 1). <strong>The</strong> interruption<br />
rates were also similar, with the experimental<br />
group being 15.04% and the control group<br />
being 20.75% (Berdot et al., 2021, p. 6). <strong>The</strong>se<br />
results indicate that the “vest had no impact on<br />
medication administration error or interruption<br />
rates” (Berdot et al., 2021, p. 6).<br />
Dougal (2020) conducted a quantitative nonexperimental<br />
study to determine the perception<br />
of medication administration and medication<br />
errors from registered nurses, related to<br />
the risks, benefits, frequency, and cautions<br />
associated with it. <strong>The</strong> researcher had three<br />
research questions; 1) do nurses perceive risk in<br />
medication administration in everyday practice,<br />
2) how is an RN’s self-reporting behavior related<br />
to medication administration errors and risks,<br />
and 3) do nurses perceive benefit and risk to<br />
medication safety during the administration<br />
process? (Dougal, 2020) This study surveyed<br />
1,445 RN’s using an online seven-point Likert<br />
scale questionnaire. Most RNs reported that<br />
they were “not at all likely” to report medication<br />
errors and believed they do not make errors in<br />
medication administration or are “unlikely” to<br />
do so within the next 12 months (Dougal, 2020,<br />
p. 9). <strong>The</strong>y believe their peers were “very likely”<br />
to make errors in medication administration<br />
within the next 12 months (Dougal, 2020, p. 9).<br />
Most RNs in this study reported not following<br />
proper medication administration processes<br />
due to self-reported distractions, interruptions,<br />
and multi-tasking.<br />
Ekkens and Gordon (2021) conducted a<br />
quantitative quasi-experimental study to<br />
determine if adding mindfulness thinking to<br />
current protocol will eliminate or minimize<br />
medication errors. This study consisted of 111<br />
nurses from rural hospitals located in northern<br />
California. <strong>The</strong> treatment group in this study<br />
received an intervention of mindfulness<br />
training while the control group did not receive<br />
training. “<strong>The</strong> instrument used for the study<br />
was based on the medication error index from<br />
the NCC MERP” (Ekkens et al., 2021, p. 119). This<br />
instrument is designed to categorize medication<br />
errors into nine levels of severity, each level<br />
corresponding to mild, moderate, significant,<br />
or severe severity. <strong>The</strong> researchers found that in<br />
the treatment group, errors were reduced from<br />
15 to four, whereas the control group showed a<br />
reduction in errors from seven to six. <strong>The</strong> result<br />
from this study concludes that “nurses are not<br />
consistently mindful enough when administering<br />
medications; this contributes to errors” (Ekkens<br />
and Gordon, 2021, p. 120). Mindful thinking and<br />
effective training may help to reduce errors and<br />
help nurses focus on the task at hand.<br />
Conclusion<br />
<strong>The</strong>re are many factors that can contribute<br />
to medication errors, but in return there are<br />
many interventions to help decrease the risk of<br />
errors and ensure patient safety. Medication<br />
errors have been studied extensively due<br />
to the danger that errors present to patient<br />
safety. <strong>The</strong> six articles summarized in this<br />
literature review support a numerous array<br />
of interventions that both feed into and can<br />
prevent medication errors. At an educational<br />
level, professors and mentors need to stress the<br />
importance of medication errors and prepare<br />
students for clinical experiences. New nursing<br />
graduates mentioned they should have had<br />
more hands-on experience with medication<br />
administration, especially IV, and time<br />
management skills to encourage effective care<br />
management (Treiber & Jones, 2018). It is highly<br />
recommended that even experienced nurses<br />
should always go through the medication<br />
rights such as correct dose, time, patient, route,<br />
refuse, and medication. <strong>Nurses</strong> should not be<br />
afraid to question doses that seem odd and<br />
they should not solely rely on technology to<br />
recognize mistakes. Facilities should support<br />
nurses in the field because, although reporting<br />
the error can be intimidating, reporting can<br />
help nurse administrators recognize systematic<br />
problems. Not all interventions are helpful and<br />
nurses often blame themselves for medication<br />
errors and feel guilty regardless of whether or<br />
not the error harmed the patient. Hospitals must<br />
find what works best for their individual nurses<br />
because the reasons for medication errors are<br />
quite individualized. Medication errors and<br />
safety continue to be a growing concern in the<br />
healthcare profession.<br />
References<br />
Bekes, J.L., Sackash, C.R., Voss, A.L., & Gill C.J. (2021).<br />
Pediatric medication errors and reduction<br />
strategies in the perioperative period. AANA<br />
Journal 89(4), 319-324.<br />
Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge,<br />
M., Corny…Sabatier, B. (2021). Effectiveness<br />
of a ‘do not interrupt’ vest intervention to<br />
reduce medication errors during medication<br />
administration: a multicenter cluster randomized<br />
controlled trial. BMC Nurs, 20(153), 1-11. doi:<br />
10.1186/s12912-021-00671-7<br />
Dougal, R.L. (2020). RN perceptions of medication<br />
administration and medication errors: Results<br />
from a quantitative nursing research study. RN<br />
Idaho, 43(1), 7-9.<br />
Ekkens, C. L. and Gordon, P. A. (2021). <strong>The</strong> mindful<br />
path to nursing accuracy: A quasi-experimental<br />
study on minimizing medication administration<br />
errors. Holistic Nursing Practice, 35(3), 115-122.<br />
doi: 10.1097/HNP.0000000000000440.<br />
Ragau, S., Hitchcock, R., Craft, J., & Christensen.<br />
(2018). Using the HALT model in an<br />
exploratory quality improvement initiative<br />
to reduce medication errors. British Journal<br />
of Nursing, 27(22). 1330-1336. doi: 10.12968/<br />
bjon.2018.27.22.1330<br />
Treiber, L.A. & Jones, J.H. (2018). After the medication<br />
error: Recent nursing graduates’ reflections on<br />
adequacy of education. Journal of Nursing<br />
Education, 57(5), 275-280. doi:10.3928/01484834-<br />
20180420-04
<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 13<br />
Reducing Central Line-Associated Bloodstream Infections<br />
Ali Glynn, Amber Domres, & Hayley Johnson<br />
BSN students, University of Jamestown<br />
Editor: Penny Briese, PhD(c), RN<br />
University of Jamestown<br />
Clinical Question: What are the current best practices for preventing<br />
central line-associated bloodstream infections (CLABSI)?<br />
Bloodstream infections of central venous access lines are occurring at<br />
unacceptable levels in practice (Conwell, Ghidini, Perazella, Aniskiewicz,<br />
DeVaux, & Giullian, 2019). <strong>The</strong>re are ways in which healthcare<br />
professionals can increase the safety of patients and improve care to<br />
reduce mortality risk. This miniature literature review will describe the<br />
evidence and best practices recommendations of six research studies<br />
focusing on central line-associated bloodstream infections (CLABSI).<br />
In one quantitative study, medical professionals at Yale New<br />
Haven Hospital in Connecticut evaluated their hemodialysis unit for<br />
the occurrence of CLABSI (Conwell et al., 2019). Observations within<br />
their dialysis unit showed that a central line infection occurred at a<br />
rate of 0.39%, however, of those with an acquired infection “mortality<br />
following a CLABSI ranged from 12-25%” (Conwell et al., 2019, p. 587). <strong>The</strong><br />
implementation plan of their study included “a list of findings evident<br />
upon admission that could trigger further evaluation for infection early<br />
in the course of hospitalization” (Conwell et al., p. 588). Dressing changes<br />
were required to be documented, registered nurses were retrained on<br />
caring for central lines and were tested with new competencies to prove<br />
understanding. Research showed “the number of CLABSI events was<br />
notably lower following implementation of the program as over 2,280<br />
treatments were performed on 382 patients in 2017 and no CLABSIs<br />
occurred” (Conwell et al., p. 588-589). <strong>The</strong> researchers concluded by<br />
reiterating the importance of prevention of central line infections in order<br />
to prevent lengthy hospital stays, high costs, and reduce mortality.<br />
One intervention commonly used in practice to decrease the risk of<br />
CLABSI is using chlorhexidine gluconate (CHG) bathing for infection<br />
prevention. Reynolds, Woltz., Keating, Neff, Elliott, Hatch, Yang, &<br />
Granger (2021) performed an academic and community-based study<br />
with 1,640 participants from hospital units who had at least 1 CLABSI<br />
event in the last year. All patients with a central line were given a CHG<br />
antimicrobial bath throughout the course of their treatments. Results<br />
showed that the units reported a decrease in patient stay of 1.67 days<br />
along with a 27.4% reduction in rates of CLABSI (Reynolds et al., 2021).<br />
Part of the intervention also included educational outreach to all<br />
members of the health care team regarding the purpose of the CHG<br />
bath, which generated this very positive outcome.<br />
In another study, five hospitals were evaluated between the years<br />
of 2013 and 2015 for CLABSI and their association with lines being<br />
“manipulated by healthcare workers and patients” (Sheth, Trifan, Feterik,<br />
& Jovin, 2017, 2017, p. 217). <strong>The</strong> incidence of CLABSIs has been reduced<br />
thruogh the implementation of CDC CLABSI prevention bundles;<br />
however, manual manipulation of lines are also suspected to be a cause<br />
of infection. During this study, 30 CLABSI events were reported and 16 of<br />
these events had noted “line manipulation 48-72 hours prior to infection”<br />
(Sheth et al., 2017, p. 217). Manipulation of the line includes flushing the<br />
line, administering fluids and medications. Overall, this study concluded<br />
that CLABSI prevention bundles helped reduce the number of CLABSIs,<br />
but more interventions are needed to reduce infections related to<br />
central line manipulation.<br />
Suttle Buffington, Madden, & Dawson (2019) studied 85 participants in a<br />
29-bed hematology oncology specialty unit at the University of Alabama<br />
at Birmingham Hospital. <strong>The</strong> study included “patient engagement and<br />
empowerment” to reduce infections of central lines (Suttle et al., 2019,<br />
p. 10). <strong>The</strong> independent variable of this study was the implementation<br />
of the EPIC bundle, which included an “educational video, poster,<br />
patient silicone bracelet and a nursing staff sticker” (Suttle et al., 2019, p.<br />
12). <strong>The</strong> dependent variable was the prevalence of CLABSIs. Two factors<br />
were found to interfere with patient education: 1) health care workers<br />
feeling unsure of just how much responsibility to place on patients, and 2)<br />
patients not wanting to bother healthcare workers and ask them to wash<br />
their hands. <strong>The</strong> intervention of the EPIC bundle reduced the number of<br />
infections by “46% within eight weeks” (Suttle et al., 2019. p. 11). <strong>The</strong> results<br />
of this study showed that, overall, following implementation of the EPIC<br />
bundle, patients felt more empowered and in control of their care leading<br />
to a reduction of CLABSIs.<br />
Another study done by Wilder, Wall, Haggard, & Epperson (2016)<br />
assessed the effectiveness of integrating central-line principles and a<br />
team-based approach into CLABSI reduction in neonatal intensive care<br />
units. This study aimed to reduce CLABSI rates by the implementation of<br />
a line-rounding tool (Wilder et al., 2016). <strong>The</strong> line-rounding included small<br />
dedicated CLABSI prevention teams who took over doing peripherally<br />
inserted central catheter (PICC) dressing changes with a specified<br />
technique, while including training opportunities for other neonatal nurse<br />
practitioners. <strong>The</strong> study showed an improvement in CLABSI rates by 93%<br />
(Wilder et al., 2016). <strong>The</strong> reduction in CLABSI rates was accompanied by<br />
reduced patient harm, reduced length of stay and costs. <strong>The</strong> research<br />
concluded that implementing line-rounding teams, raising awareness of<br />
a “safety-first culture”, along with a multidisciplinary team approach to<br />
central line maintenance can make a significant impact on CLABSI rates.<br />
And finally, in discussing multidisciplinary team approaches in CLABSI<br />
reduction, the final study reviewed showed significant findings with the<br />
integration of collaborating care teams in achieving reduced CLABSI<br />
rates (p < 0.05). Evidence-based practices were discussed in the article<br />
but so were new technologies like “disinfecting caps and needleless<br />
securement devices” (Layne & Anderson, 2019, p. 285). In this study, a<br />
hospital multidisciplinary team wanted to address central line practices<br />
that were occurring. <strong>The</strong>ir findings of their assessment were based on<br />
two components of prevention: dressing maintenance and caregivers’<br />
critical skills (Layne et al., 2019, p. 285). <strong>The</strong> collaborative team also<br />
identified that two critical skills in particular needed improvement;<br />
dressing changes and blood draws. <strong>The</strong> team used these findings<br />
to initiate central line maintenance skills re-education for practicing<br />
nurses and found rapid improvements in securement and dressing<br />
maintenance and there was a 57% reduction in CLABSI occurrences in<br />
the fiscal year 2016 to 2017 (Layne et al., 2019).<br />
Conclusion<br />
<strong>The</strong> incidence of CABSI remains high in healthcare today. It is<br />
imperative that healthcare providers continue to search the literature<br />
for best practices. <strong>The</strong> findings of this miniature literature review<br />
indicate that the use of admission checklists, antiseptic bathing, patient<br />
empowerment, patient care bundles, and multidisciplinary team<br />
approaches and reeducation are all integral practices associated with<br />
the reduction of CLABSI in the hospital settings.<br />
References<br />
Conwell, R., Ghidini, J., Perazella, M., Aniskiewicz, M., DeVaux, L., & Giullian,<br />
J. (2019). A hospital-based program to reduce central line-associated<br />
bloodstream infections among hospitalized patients receiving hemodialysis<br />
using a central venous catheter for vascular access. Nephrology Nursing<br />
Journal, 46(6), p. 587-592.<br />
Layne, D. M., & Anderson, T. (2019). A collaborative approach to reducing<br />
Central line-associated bloodstream infections. Journal of Nursing Care<br />
Quality, 34(4), 285–286. https://doi.org/10.1097/ncq.0000000000000419<br />
Reynolds, S.S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q.,<br />
& Granger, B. (2021). Results of the CHlorhexidine Gluconate Bathing<br />
implementation intervention to improve evidence-based nursing<br />
practices for prevention of central line associated bloodstream infections<br />
study (CHanGing BathS): a stepped wedge cluster randomized trial.<br />
Implementation Science, 45(16), p. 1-16. Doi: 10.1186/s13012-021-01112-4<br />
Sheth, H., Trifan, A., Feterik, K., & Jovin, F. (2017). Expanding central line care<br />
bundle to address line manipulations. Canadian Journal of Infection<br />
Control, 32(4), 217–221.<br />
Suttle, R. D., Buffington, H. M., Madden, W. T., & Dawson, M. A. (2019). Central Line<br />
Care: Empowering patients to prevent infection and injury via EPIC². Clinical<br />
Journal of Oncology Nursing, 23(1), E10–E16. https://doi.org/10.1188/19.CJON.<br />
E10-E16<br />
Wilder, K. A., Wall, B., Haggard, D., & Epperson, T. (2016). A systemic central line<br />
quality improvement initiative integrating line-rounding principles and a<br />
team approach. Advances in Neonatal Care, 16(3), 170-177. https://doi.<br />
org/10.1097/anc.0000000000000311<br />
<strong>The</strong> ongoing COVID pandemic has made it difficult for people to<br />
maintain their mental health and well-being. Developed in 2019, the<br />
<strong>North</strong> <strong>Dakota</strong> Community Clinical Collaborative (NDC3) is helping<br />
communities across <strong>North</strong> <strong>Dakota</strong> create a culture of health, where<br />
prevention and wellness are the norm. NDC3 houses programs that<br />
provide education, fitness instruction, and self-care strategies for<br />
participants; they do not replace clinical care provided by doctors,<br />
nurses, and other medical professionals. NDC3 also provides the ability<br />
for caregivers and health care providers to refer loved ones or patients to<br />
appropriate programs.<br />
Through partnerships across the state, NDC3 connects evidence-based health<br />
management activities that promote health and prevent disease to adults with<br />
or caring for people with chronic health conditions. <strong>The</strong>se programs have been<br />
developed using rigorous research and demonstrate reliable and consistently<br />
positive changes in health-related outcomes among participants. Lisa Thorp,<br />
BSN, CDCES wrote:<br />
“I was recently visiting with colleagues about the availability of certain services across<br />
the state. Often, it appears that there are more services available on the eastern side<br />
of the state. NDC3 helps level the playing field by organizing the information of virtual<br />
classes that are available. As a Certified Diabetes Care and Education Specialist, I love<br />
the fact that people with diabetes can search NDC3 and find classes to help them better<br />
manage their diabetes. A search can be done to find a Diabetes Prevention class, or<br />
a Better Choices Better Health-Diabetes Class, and attend them virtually! In addition<br />
to diabetes classes, there are also other classes for chronic conditions and pain, and<br />
strengthening, which can help reduce falls in the home. I encourage other nurses, diabetes<br />
educators, primary care providers to use the referral option. Provide the patient contact<br />
information and they will get called to help them find a class. Check out Connecting you to<br />
community health programs - NDC3! Feel free to contact me for questions at lisa.thorp@<br />
greatplainsqin.org”
Page 14 <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse <strong>January</strong>, February, March <strong>2022</strong><br />
ANA Call for<br />
Proposals<br />
On behalf of ANA's Professional Policy<br />
Committee, I encourage you to engage in the<br />
identification of strategic policy topics and the<br />
submission of proposals for discussion by ANA's<br />
governing body, the Membership Assembly,<br />
at the <strong>2022</strong> annual meeting in June. Your<br />
involvement in ANA's policy work is critical!<br />
Of particular interest to ANA for this Call for<br />
Proposals are proposals specific to addressing<br />
issues related to nurse staffing, with particular<br />
focus on the acute care setting, and strategies<br />
to reduce workplace violence against nurses<br />
and other health care employees. All proposals<br />
submitted should be solution oriented.<br />
Section 1 of the <strong>2022</strong> Membership Assembly<br />
Policy Development Guide includes questions<br />
for you to consider prior to submitting a<br />
proposal. In Appendix A of the Guide, you'll find<br />
the ANA Enterprise 2020-2023 Strategic Goals.<br />
<strong>The</strong> Guide also contains detailed information<br />
on the submission and review of proposals,<br />
including emergent proposals; Dialogue<br />
Forums; and examples of approaches used by<br />
state nurses' associations that have successfully<br />
engaged members in ANA's policy work.<br />
TO SUBMIT PROPOSALS FOR CONSIDERATION<br />
– Click here to access the online proposal form.<br />
Completed proposals MUST BE submitted (by<br />
using the online proposal forms) by 5:00pm ET<br />
on Monday, February 7, <strong>2022</strong>. Refer to Appendix<br />
D in the Guide for key dates and direct<br />
questions to Cheryl Peterson, Vice President,<br />
Nursing Programs, via email (practice@...).<br />
Sincerely,<br />
Cheryl Peterson, MSN, RN<br />
Vice President, Nursing Programs<br />
American <strong>Nurses</strong> Association<br />
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<strong>January</strong>, February, March <strong>2022</strong> <strong>The</strong> <strong>North</strong> <strong>Dakota</strong> Nurse Page 15<br />
ANA Nominations<br />
and Elections<br />
ANA's Gail Peterson<br />
(Nominations and Elections Committee Chair)<br />
<strong>The</strong> ANA Nominations<br />
and Elections Committee<br />
is identifying candidates<br />
that meet the minimum<br />
competency requirements<br />
for open positions. If you or<br />
someone you know would<br />
be a great candidate,<br />
please apply or encourage<br />
them to apply. Click here or<br />
go to the NDNA website –<br />
News & Annoucements tab.<br />
Gail Peterson<br />
Now Hiring RNs and LPNs<br />
Sign on Bonus up to $10,000<br />
Family orientated environment<br />
Flexible scheduling available<br />
Located in Valley City, the most beautiful town in <strong>North</strong> <strong>Dakota</strong>.<br />
For more information, call 701-845-8222 or<br />
visit our website at www.smphealth.org/straphael/.<br />
Visit our new Facebook page www.facebook.com/SMPHealthStRaphael<br />
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To Apply: EMHC Employment www.mhanation.com/emhcemployment<br />
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