The North Dakota Nurse
NORTH DAKOTA NURSES ASSOCIATION
THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATION
Sent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter
does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.”
Quarterly publication distributed to approximately 20,000 RNs and LPNs in North Dakota
Vol. 91 • Number 1 January, February, March 2022
INDEX
Highlight a
Nurse
Page 3
North Dakota Department of
Health: Vaccine Q & A
Page 4
Message from the President
Keep on Pushing
I am sure I am not the only one feeling like I
am in a hamster wheel, spinning and spinning
and spinning without ending. As we enter a new
year, it is imperative that we do some reflection.
It is important as nurses, we pause and look
back at what motivates us to get out of that
spinning wheel and continue to be the best
we can for our patients. Easier said than done,
I know.
I encourage you to ask yourself, “what
motivates you?” If we can answer this question
and keep it in the forefront of our care delivery,
it is easier to keep pushing, especially during
challenging times like the last two years. One
effective way to stay motivated is to set a new
goal. Say it aloud and write it down, own this
goal. According to Drake (2017), “setting a goal
and staying focused is one more approach to
keeping yourself motivated. Establishing a goal
provides you with a cause and moving toward
the goal can give you positive reinforcement.
When we focus on a goal, we are less likely to
get side-tracked by nonessential work. And
do not underestimate fear as a motivating
factor. Fear of failure can often motivate us to
accomplish our goals” (p.56). In stressful times,
when you feel as though you are just spinning in
that wheel, pause and refocus on your goal. This
helps to keep pushing.
As nurses, we also need to remember we
always can be a leader and motivate those
around us. You can
motivate your work team,
your church group, your
family, your patients, and
anybody else you meet.
The easiest way to do this,
is make it personal. It is
important when motivating Tessa Johnson
people that you know
the individual and what truly motivates them.
Sometimes you must get downright creative
and even competitive. In addition, take time
to educate yourself on motivational theories
to assist in tailoring your style to your team.
Motivation can be either intrinsic or extrinsic, but
the key to both is a sense of achievement tied
to goals and expectations. With a little push,
you will be surprised how motivated you and
your team members become (Drake, 2017).
Remember, negativity is contagious.
Unhappiness is contagious. Fear is contagious.
But so is happiness. So is optimism. So is love.
Surround yourself with people who bring out the
best in you. Strive to be a reflection of what you
want to receive. Be well, we need all of you!
Drake, K. (2017). Nursing Management. The
Motivation to Stay Motivated, 48(12), 26.
https://doi.org/https://journals.lww.com/
nursingmanagement/fulltext/2017/12000/the_
motivation_to_stay_motivated.12.aspx
Medical Marijuana, Legislative
Updates and Education
Page 8
current resident or
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371
Executive Director’s Message
Sherri Miller, BS, BSN, RN
New Year
We are officially in 2022, and reflective
about 2021. Let’s take a look at what we
have done as an association in 2021 with
resiliency, and as President Johnson writes
in her column above - “let’s keep on
pushing.”
NDNA always looks to our mission to
stay on track. Our mission is to advance
the nursing profession by promoting
professional development of nurses,
fostering high standards of nursing
practice, promoting the safety and wellbeing
of nurses in the workplace, and
by advocating on health care issues
affecting nurses and the public.
Advocacy
• 2021 was a legislative session year; NDNA
collaborated and lobbied on areas such as:
o Essential Caregiver
o Vitamin D coverage
o School Nursing
o Support for the ND Center for Nursing
new workforce recruitment and
retention program
o Insurance coverage of telehealth
o Workplace violence – assault on a
health care provider
o Opposition to drug importation bills
o Support of school psychologists being
allowed to bill for Medicaid services
• New Director of Advocacy, Penny Briese,
was appoint to serve!
Executive Director’s Message continued on page 4
Page 2 The North Dakota Nurse January, February, March 2022
How to submit an article for
The North Dakota Nurse!
Nurses are strongly encouraged to contribute to the profession
by publishing evidence-based articles; however, anyone is
welcome to submit content to the North Dakota Nurse.
We review and may publish anything we think is
interesting, relevant, scientifically sound,
and of course, well-written. The editors
look at all promising submissions.
Deadline for submission for the next issue is 3/7/2022.
Send your submissions to director@ndna.org
Welcome New Members
Jennifer Pederson
West Fargo
Debbie White
Mandan
Elizabeth Satrom
Edgeley
Heather Burnley
Lincoln
Kelsey Fitterer
West Fargo
Jesse McDonald
West Fargo
Elizabeth Coulson
Dickinson
Carl Millien
Fargo
Help shape the future of the nursing
profession by joining NDNA.
Here's a quick look at some of your individual
benefits as a member of NDNA/ANA:
• Subscriptions to The American Nurse and
American Nurse Today
• Subscription to the North Dakota Nurse,
delivered personally to you four times a
year.
• Subscription to NDNA’s Monthly eNews and
Updates
• Weekly NDNA Legislative Updates --
informing you of current legislative issues
that affect you! (During ND legislative
session)
• Information and registration information
for NDNA sponsored educational
Melissa Marx
Thompson
Alyssa Lind
Horace
Mallory Waters
Bismarck
Anna Nagel
Bismarck
Amber Hinderscheid
Grand Forks
Member Benefits
Lori Martinson
Rolette
Melisa Banish
Fargo
Martin Mwondha
Minot
Randy Hunt
West Fargo
Autumn Nelson
West Fargo
opportunities, including workshops,
conferences and seminars providing
contact hours delivered personally to you.
• Reduced registration fees for the NDNA
Annual Meeting and Fall Conference.
• Leadership opportunities in a wide variety
of areas and with a wide variety of time
commitments to fit your schedule.
• Access to exclusive ANA website and
“members only” information.
• Discounts on professional liability insurance
offered by NSO
• A voice in support of the nursing profession!
*Please note that some of the benefits are
only for joint NDNA/ANA members only and may
not apply to Affiliate Members.
ANA Member Discounts and Benefits
SIGN ON BONUS
AVAILABLE for
RN and LPN
positions -
Up to $7,500
Mountrail County Health Center is currently seeking
RNs for the hospital. If you enjoy working in a fastpaced
environment and want to provide top care to
patients, please consider applying with MCHC. Our
newly expanded ER is a great learning experience
for new nurses coming out of college, as well as
experienced nurses.
Mountrail Bethel Home is currently seeking RNs &
LPNs for the nursing home.
MCHC offers competitive wages, top benefits and
retirement.
Interested, please apply online at
www.stanleyhealth.org or email
adebilt@stanleyhealth.org.
The North Dakota Nurse
Official Publication of:
North Dakota Nurses Association
General Contact Information:
701-335-6376 (NDRN)
director@ndna.org
Board of Directors and Staff
President
Tessa Johnson, MSN, BSN, RN, CDP
President-Elect
Mylynn Tufte, MBA, MSIM, RN
Vice President of Finance
Richelle Johnson, MSN, RN
Director of Membership
Kami Schauer, MSN, RN
Director of Education and Practice
Courtney Naastad, PMHNP-BC, MSN, BSN, RN
Director of Advocacy
Penny Briese, MS, RN
Director at Large
VACANT
Affiliate Member Representative (LPN)
Catherine Sime, LPN
Executive Director
Sherri Miller, BS, BSN, RN
Please go to our website to learn more about the
board and their roles: www.ndna.org
Published quarterly: January, April, July, and October
for the North Dakota Nurses Association, a constituent
member of the American Nurses Association, 1515 Burnt
Boat Dr. Suite C #325, Bismarck, ND 58503. Copy due
four weeks prior to month of publication. For advertising
rates and information, please contact Arthur L. Davis
Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626-4081, sales@aldpub.com. NDNA and the
Arthur L. Davis Publishing Agency, Inc. reserve the right
to reject any advertisement. Responsibility for errors in
advertising is limited to corrections in the next issue or
refund of price of advertisement.
Acceptance of advertising does not imply endorsement
or approval by the North Dakota Nurses Association
of products advertised, the advertisers, or the claims
made. Rejection of an advertisement does not imply a
product offered for advertising is without merit, or that
the manufacturer lacks integrity, or that this association
disapproves of the product or its use. NDNA and the Arthur
L. Davis Publishing Agency, Inc. shall not be held liable for
any consequences resulting from purchase or use of an
advertiser’s product. Articles appearing in this publication
express the opinions of the authors; they do not necessarily
reflect views of the staff, board, or membership of NDNA or
those of the national or local associations.
Want to Make Your Nursing Voice
Heard…Get Published in the
North Dakota Nurse!
The North Dakota Nurse quarterly publication accepts
content on a variety of topics related to nursing. Nurses
are strongly encouraged to contribute to the profession
by publishing evidence-based articles, but we welcome
anyone to submit for publication. If you have an idea,
but don’t know how or where to start, contact one of
the NDNA Board Members.
Please note:
*Send articles to director@ndna.org
*Articles should be in Microsoft Word and be double
spaced.
*All articles should have a title.
*Articles sent should have the words “North Dakota
Nurse Article” in the email subject line, along with the
specific title.
*Deadline for submission of material for upcoming
North Dakota Nurse is 3/7/2022!
The Vision and Mission of the
North Dakota Nurses Association
Vision: North Dakota Nurses Association, a
professional organization for Nurses, is the voice of
Nursing in North Dakota.
Mission: The North Dakota Nurses Association (NDNA)
is the only professional organization representing all nurses
in North Dakota. The mission of NDNA is to advance the
nursing profession by promoting professional development
of nurses, fostering high standards of nursing practice,
promoting the safety and well-being of nurses in the
workplace, and by advocating on health care issues
affecting nurses and the public.
January, February, March 2022 The North Dakota Nurse Page 3
Highlight a Nurse
NDNA interviews great ND nurses to be featured in The
North Dakota Nurse, our monthly NDNA eNews, and on Facebook!
If you know a nurse or are a nurse that NDNA can highlight,
please contact director@ndna.org.
Name and credentials: Mercedez Marvig, RN
• Short Bio
- I am Mercedez Marvig, I have been in health
care for 10 years now, I have been a nurse
for four years. I work at Sanford ER in Fargo as
an Emergency room nurse as well as a sexual
assault nurse examiner for the Midwest. I also
teach at Rasmussen! I have three nursing
degrees and I am working on my fourth!
• What led you to become a nurse?
- I have always wanted to be a nurse. The
reason I wanted to become an Emergency
Room nurse is because in college I ate a
Mercedez Marvig
tree nut and became super sick, almost
intubated sick and this nurse with tattoos comes in and I was
undressed, had an iv in my arm, and was given meds before I
could blink. She was calm, cool, and collected even though I was
super sick. She realized I was alone (family was five hours away)
and brought in a chair to my room and charted while sitting
next to me so I did not have to be alone. She will forever be the
coolest person I have met in my life and I have always tried to be
like her.
• What talents, gifts, or skills do you have that assist you in your dayto-day
work?
- I am one of the best foley placers in the emergency room. I also
have a lot of love and patience for our psych population.
• What is a typical day like for you?
- There are NO typical days at the ER, some days you are taking
care of bumps and scratches and others you are taking care of
traumas. We treat everyone from the ages of 0 to death and we
see all sorts of sicknesses.
• What are some of the greatest challenges for you?
- Some of the patients we treat as nurses are not kind and it is
hard to listen/deal with that while maintaining a good attitude.
I remind myself it is always okay to step away to regroup and
they are just human, same as me and they need extra love and
patience!
• What are some ways that you see your specialty can make a
difference in a rural state?
- I am one of two RNs who have the ability to treat both pediatric
and adult sexual assaults. People come from all over the Midwest
to see my team.
Name and credentials: Andrea Sperr, RN
• Short Bio
- My name is Andrea! I am the oldest of three
siblings, I have only ever had dalmatian
dogs my entire life. I like to fish and spend
time outside as much as possible. I also really
enjoy fitness and workout almost daily even
before I work! I won a Daisy award, and have
worked med-surg trauma as an LPN for four
years, then have worked for the past two
years as an RN ER nurse. I also have my SANE
certification, and have my TNCC, ENPC,
PALs, and ACLS.
Andrea Sperr
• What led you to become a nurse?
- When my mom would bring me with to the ER in Alexandria,
MN when she would work I would follow the nurses and doctors
around and I think that is where I realized that I was going to be a
nurse.
• What talents, gifts, or skills do you have that assist you in your dayto-day
work?
- I have quick wit, and work best under pressure. I really enjoy
being a preceptor for students and new nurses.
• What is a typical day like for you?
- At work? Absolute insanity, its great and awful all at the same
time. Nursing is hard but I'm glad that I'm a nurse.
• What are some of the greatest challenges for you?
- Holding my tongue when I‘m mad. I grew up a farmer's
daughter and was taught to call it as I see it. Not all patients are
appropriate and it’s hard to remain calm when they are awful.
• What are some ways that you see your specialty can make a
difference in a rural state?
- As an ER nurse, I am part of people's worst days and can be the
calm in the storm for them. Having a farm life background really
helps when we get the grouchy farmers in that absolutely have
no time for the things we are making them have time for.
Name and credentials: Shereen Leiseth, RN BSN
CCRN CEN
Nursing Specialty:
Referral Case Manager/Traveling Veteran
Coordinator.
My previous ‘specialties’ were the Critical Care
and Emergency Departments.
What led you to become a nurse?
I chose nursing, nursing didn’t choose me (aka I
didn’t have that Florence Nightingale moment). I
started as a CNA - working in a nursing home and a
critical access hospital. Completed my LPN - working
Shereen Leiseth
med/surg and walk-in clinic. I transitioned straight
into the LPN to BSN program at NDSU - worked in critical care/ED/day
surgery/and a smattering of other PRN positions after completing the BSN
degree. I am currently finishing a MSN degree in Nursing Education.
What talents, gifts, or skills do you have that assist you in your day-to-day
work?
I am detail oriented and flexible. I take great pride in what I do -
achieving excellence and mastery is very important to me. I also believe
in customer service. My job is to support those who are on the front lines.
(I save lives on the computer.)
What is a typical day like for you?
There are NO typical days. My job is to support case managers at
non-VA hospitals in North Dakota and the upper ⅓ of Minnesota. This
means non-stop trouble-shooting. I also review clinical and discharge
documentation with the goal of coordinating care with the case
managers, offering VA resources as appropriate. Another key aspect of
my position is coordinating care for Veterans who travel from one VA to
another with the Traveling Veteran Coordinators across the USA. This is a
super busy time of year for that population as the snowbirds are heading
south. I also work with transplant, acute rehab and LTACH patients….the
list seems endless some days. As in all aspects of nursing - it is a team
sport and I have amazing co-workers.
What are some of the greatest challenges for you?
Understanding the acronyms that come from the VA healthcare
system! I view my job as being the VA 'interpreter’ for case managers in
our service area.
What are some ways that you see your specialty can make a difference
in rural areas?
Many people don’t realize that the VA can pay for unplanned
episodes of care (ED visits/admissions/direct admissions) for Veterans
at private healthcare facilities. I can offer the small, rural hospital VA
resources for discharge planning.
I am continually advocating for, and educating hospital/case
management staff, Veterans and their families about VA benefits.
Additionally, the Fargo VA has done an exceptional job of working
to deliver healthcare to the rural populations utilizing technology with
tele health options, video visits and more. With all of the pressure on
overwhelmed healthcare systems right now, my goal is to offer VA
resources whenever possible and appropriate.
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Page 4 The North Dakota Nurse January, February, March 2022
North Dakota Department of Health: Vaccine Q & A
The NDNA is now working with the North Dakota Department of
Health to provide education on vaccines with the goal to assist nurses
in answering questions that may arise from their patients and others. In
this issue of The North Dakota Nurse, we are highlighting some common
questions and answers specific to reactions from COVID-19 vaccine.
What are the FDA and CDC guidelines regarding allergic reactions and
administering COVID-19 vaccine? The FDA has included a history of severe
allergic reactions to a previous dose of COVID-19 vaccine or any COVID-19
vaccine ingredient as a contraindication for the COVID-19 vaccine.
Additionally, individuals who have had an immediate allergic reaction to
COVID-19 vaccine or a COVID-19 vaccine ingredient should not receive
the vaccine. Because of reports of anaphylactic reactions in individuals
vaccinated outside of clinical trials, additional guidance has been created.
All individuals should be monitored for 15 minutes postvaccination.
The CDC has recommended persons who have had a severe
allergic reaction to any vaccine or injectable therapy (intramuscular,
intravenous, or subcutaneous) can receive COVID19 vaccine, but under
the following conditions:
• Individuals must be counseled about the unknown risks of
developing a severe allergic reaction and balance these risks
against the benefit of vaccination.
• Individuals should be observed after vaccination to monitor for the
occurrence of immediate adverse reactions for 30 minutes (versus
15 minutes generally recommended following vaccination).
• Individuals with other types of allergies, such as food, latex, pollen,
or other substances do not have to take special precautions and
can receive a COVID-19 vaccine.
I’ve heard reports of inflammation of the heart (myocarditis) and of
the outer lining of the heart (pericarditis) following receipt of Pfizer and
Moderna COVID-19 vaccines. Are these events related? Since April 2021,
increased cases of myocarditis and pericarditis have been reported in the
U.S. after mRNA COVID-19 vaccination (Pfizer and Moderna), particularly
in adolescents and young adults. These reports are rare, and the CDC and
its partners are actively monitoring reports of myocarditis and pericarditis
after COVID-19 vaccination. There has not been a similar reporting pattern
observed after receipt of Johnson & Johnson COVID-19 vaccine. In most
cases, patients who presented for medical care have responded well to
medications and rest and had prompt improvement of symptoms. Reported
cases have occurred predominantly in male adolescents and young adults
16 years of age and older. Onset was typically within several days after
mRNA COVID-19 vaccination, and cases have occurred more often after
the second dose than the first dose. Research has shown that incidence
of myocarditis following an mRNA COVID-19 vaccine is rare and that
symptoms in a majority of cases resolve following care. CDC and its partners
will continue to investigate these reports of myocarditis and pericarditis
following COVID-19 mRNA vaccination. The known and potential benefits
of COVID-19 vaccination outweigh the known and potential risks, including
the possible risk of myocarditis or pericarditis. CDC continues to recommend
COVID-19 vaccination for everyone 12 years and older given the risk of
COVID-19 illness and related, possibly severe complications, such as longterm
health problems, hospitalization, and even death.
I’ve heard reports of Guillain-Barre syndrome (GBS) following receipt of
Johnson & Johnson COVID-19 vaccines. Are these events related? On July
13, 2021, the FDA released a statement that suggested that there is possible
increased risk of GBS following receipt of a J&J COVID-19 vaccine. The FDA
has added additional information to the vaccine’s FDA fact sheet on the risk
of GBS. The chance of GBS occurring is very low following J&J vaccination.
As of September 22, 2021, 210 preliminary reports of GBS have been identified
in VAERS out of the more than 14.8 million J&J COVID-19 vaccine doses that
have been administered in the U.S. Cases occur mostly in males and have
largely been reported approximately two weeks after vaccination. You
should seek medical attention right away if you develop any of the following
symptoms following receipt of a J&J vaccine: weakness or tingling sensations,
difficulty walking, difficulty with facial movement, double vision/inability to
move eyes, and/or difficulty with bladder control/bowel function. The known
and potential benefits of COVID-19 vaccination outweigh the known and
potential risks, including the possible risk of GBS. Safety monitoring system
A patient reported a delayed-onset local reaction (erythema, induration,
pruritus) following a COVID-19 vaccine dose. Is this a contraindication for
future COVID-19 vaccines? No, this is not a contraindication or a precaution. It
is not known whether individuals who experienced a delayed-onset reaction
after the first dose will experience a similar reaction after the second dose.
However, these reactions are not believed to represent an increased risk for
anaphylaxis after a subsequent dose. Persons who have a delayed-onset
location reaction around the injection site area after the first vaccine dose
should receive the second dose as the same vaccine product as the first
dose and at the recommended interval, preferably in the opposite arm.
How should we address anxiety-related events following COVID-19
vaccine receipt? Anxiety-related events following COVID-19 vaccination
are not uncommon and can be expected. In these events, a patient may
experience dizziness, lightheadedness, feeling faint, rapid breathing, and
sweating symptoms following receipt of a COVID-19 vaccine.
It is important to be prepared for such incidence when conducting
vaccination clinics, including but not limited to:
• Identify people through screening with a history of fainting during
the vaccination process
• Provide drinks and snacks
• Have a separate, quieter area for those that are feeling lightheaded
or faint to sit or lie down and be monitored following vaccination.
Executive Director’s Message continued from page 1
Promoting Professional Development of Nurses
• NDNA hosted another remote nursing conference in the spring of
2021 and again in the fall of 2021 with great attendance. Our overall
ongoing theme has established itself clearly – health equity. We are
continuing to projects and support of health equity topics.
• Elections of new board members took place in the fall of 2021.
Mylynn Tufte and Richelle Johnson have taken their seats at
the table of the 2022 NDNA Board of Directors. We again have a
renewed energy. Read about all board members on our website:
https://ndna.nursingnetwork.com/
• NDNA continues its work with the ND Center for Nursing with
committee work on the Workplace Culture Designation and the
Legendary Nurse awards.
• NDNA began work with DNP students – legislative work,
conferences, and developing self-learning modules that we will be
able to offer in 2022. Watch for this!
• We are a constituent state of the American Nurses Association.
NDNA President and Executive Director attended remote sessions
of the June ANA Hill Day (with meetings with our congressmen),
Membership Assembly in June and Leadership Summit in
December. It is extremely valuable to connect with nurses across
the country.
• NDNA attended and presented to nursing students in January at
the NSAND Annual Convention – an event we love. We will be there
again on January 20-22 in Jamestown.
• We started our new “Highlight a Nurse” series – read about three
amazing nurses in this edition of The North Dakota Nurse. Send us
your nurses to highlight.
Promoting the Safety and Well-being of Nurses in the Workplace
• We received a grant from the North Dakota Department of Health
for vaccine education!
• Practicum with DNP student – Vitamin D education and more to
come!
• NDNA coordinated the creation of a Public Service Announcement
on Covid and Nurses. Go to our Facebook page to watch it! https://
www.facebook.com/ndna.org/
NDNA is committed to continuing our mission and adapting to any
changes we now must make so membership in NDNA is particularly
important right now. Join us! RNs and LPNs can join today by visiting our
website: www.ndna.org.
Let’s take a moment of pride of what we have all done in all of our
nursing lives in a time of such unpredictable circumstances. Thank you,
nurses.
Remember to follow NDNA on social media:
For further information on COVID-19 vaccines, visit the ND Department
of Health website – Immunization Guidance for Health Care Providers.
January, February, March 2022 The North Dakota Nurse Page 5
The North Dakota Board of Nursing (NDBON), the North Dakota Nurses Association (NDNA) and North Dakota Center for Nursing (NDCFN)
collaborated to provide this comparison of the three nursing entities. Each of these entities has a unique mission and description, which makes them
very different from one another. This comparison is updated and published annually and is available on the respective websites.
A COMPARISON OF THE THREE ORGANIZATIONS
North Dakota Board of Nursing (NDBON)
919 S 7TH Street, Suite 504
Bismarck, ND 58504-5881
Phone: (701) 328-9777
Fax: (701) 328-9785
Website: www.ndbon.org
Email: contactus@ndbon.org
Mission:
ND Board of Nursing assures North Dakota
citizens quality nursing care through the
regulation of standards for nursing education,
licensure, and practice.
Description:
• Governmental regulatory body established
by state law under the North Dakota Century
Code 43-12.1 Nurse Practices Act to regulate
the practice of nursing and protect the health
and safety of the public
• Regulates the practice of individuals licensed
and registered by the Board
• Establish standards of practice for RNs, LPNs,
and APRNs
• Establish standards and regulate nursing
education programs
• Discipline licensees and registrants in response
to violations of the Nurse Practices Act
Board Members:
NDBON, NDNA and NDCFN: What's the Difference?
North Dakota Nurses Association (NDNA)
1515 Burnt Boat Dr, Suite C #325
Bismarck, ND 58503
Phone: (701) 335-6376
E-mail: director@ndna.org
Website: www.ndna.org
Mission:
The Mission of NDNA is to advance the
nursing profession by promoting professional
development of nurses, fostering high standards
of nursing practice, promoting the safety and
well-being of nurses in the workplace, and by
advocating on health care issues affecting
nurses and the public.
Description:
• 501(c)(6) non-profit association
• Professional association for all nurses in North
Dakota.
• Constituent member of the American Nurses
Association (ANA)
• Influences legislation on health care policies
and health issues and the nurse’s role in the
health care delivery system
• Promotes the continuing professional
development of all North Dakota nurses
• Advances the identity and integrity of the
profession to enhance healthcare for all
through practice, education, research, and
development of public policy
• Promotes the Scope and Standards of Nursing
Practice and the Code of Ethics for nurses
Board of Directors:
North Dakota Center for Nursing (NDCFN)
Box 117
Northwood, ND 58267
Phone: (218) 791-1461
Website: www.ndcenterfornursing.org
Mission:
The mission of NDCFN is to through collaboration
guide the ongoing development of a wellprepared
and diverse nursing workforce to meet
health care needs in North Dakota through
research, education, recruitment and retention,
advocacy, and public policy.
Description:
• 501c3 non-profit organization Member of the
National Forum of State Nursing Workforce
Centers
• Works to unify voice of nursing in North
Dakota through connecting all nurses and
nursing organizations interested in policy
issues.
• Develops statewide programming to fulfill
mission.
• Works to improve nursing workplace culture.
• Provides leadership and policy opportunities.
• Host annual research conference.
Board of Directors:
Jane Christianson, RN member, Bismarck:
President
Dr. Kevin Buettner, APRN member, Grand Forks:
Vice President
Dr. Jamie Hammer, RN member, Minot: Treasurer
Michael Hammer, RN member, Velva
Dr. Mary Beth Johnson, RN member, Bismarck
Wendi Johnston, LPN member,
Kathryn Julie Dragseth, LPN member, Watford
City
Cheryl Froehlich, Public member,
Mandan Dana Pazdernik, RN member, New
Salem
NDBON Staff:
Dr. Stacey Pfenning DNP, APRN, FNP, FAANP
Executive Director spfenning@ndbon.org
Kyle Martin Associate Director for Operations
kmartin@ndbon.org
Dr. Tammy Buchholz, DNP, RN, CNE, FRE
Associate Director for Education
education@ndbon.org
Melissa Hanson, MSN, RN Associate Director of
Compliance compliance@ndbon.org
Maureen Bentz, MSN, RN, CNML Associate
Director for Practice practice@ndbon.org
Corrie Lund, MSN, RN Assistant Director for
Compliance compliance@ndbon.org
Michael Frovarp Accounting/Licensure Specialist
exam@ndbon.org
Gail Rossman, Technology Specialist II (Retiring
2022) contactus@ndbon.org
Karen Hahn Administrative Service Coordinator
contactus@ndbon.org
Arverd Lachowitzer Technology Assistant/
Licensing Specialist endorse@ndbon.org
Christa Stayton Administrative Assistant/Licensing
Specialist contactus@ndbon.org
President - Tessa Johnson, MSN, BSN, RN, CDP
tjohnson@countryhouse.net
Board of Directors listed at https://ndna.
nursingnetwork.com/page/72991-board-ofdirectors
NDNA Staff (Independent Contractor):
Sherri Miller, BS, BSN, RN Executive Director
director@ndna.org
13 organizations represented. List available on
website at: http://www.ndcenterfornursing.org/
board-of-directors/
NDCFN Staff:
Patricia Moulton Burwell, PhD Executive Director
Patricia.moulton@ndcenterfornursing.org
Page 6 The North Dakota Nurse January, February, March 2022
The North Dakota Center for Nursing
Legendary Nurse Awards Announced!
Our NDNA President, Tessa Johnson, was selected to receive the
Leadership Award this year. We are very proud. Congratulations to Tessa
and all the recipients!!
NDNA sponsored the Rising Star Award this year.
Leadership Award- Demonstrates exceptional leadership (either in a
formal or informal role) in either their place of employment or in a nonprofit
or nursing organization.
Sponsored by the ND Organization of Nurse Leaders (NDONL)
Paige Wegner, Fargo, Essentia Health
Tessa Johnson, Dickinson, Country House
Theresa Knox, City of Grand Forks Public Health Department
Clinical Practice Excellence Award- Demonstrates exceptional clinical
practice or patient care.
Amanda Anderson, Grand Forks, Altru Family Birthing Center
Courtney Kniert, Grand Forks, Altru Family Birthing Center
Floyd Nemer, Bismarck, VA Health System
Marilyn Schwartzbauer, Bismarck Sanford ICU
Faculty Achievement Award- Demonstrates excellence in teaching,
engaging students in the love for nursing and supports student growth.
Sponsored by College and University Nursing Education Administrators
(CUNEA)
Nancy Turrubiates, Fargo, North Dakota State University
Anna Anderson, Bismarck State College
Nurse Executive Leadership Award - Provides exceptional leadership
(over five years) in a top executive role for Nursing such as Nurse
Executive, Vice President, Chief Nursing Officer, Dean, Director or
Program Chair.
Sponsored by Evelyn Quigley and Carla Hansen
Sue Leupp, Mohall, Good Samaritan Society
Brett Kallis, Dickinson, Southwestern District Health Unit
Sara Senn, Richardton Health Center
Rising Star Award - A nurse in the first two years of practice that
exhibits leadership and professionalism in their field of nursing.
Sponsored by the North Dakota Nurses Association
Joan Garia Ortiz, Grand Forks Altru Health System
Evidence Based Practice Award - Excellence in the promotion and
utilization of evidence based practice principles in the pursuit of clinical
excellence.
Margo Daily Filipkowski, Minot Trinity Health
Amy Lamb, Fargo VA Health Care System
Preceptor Award - Excellence in encouraging and supporting nursing
student education through clinical precepting or organizational
orientation for nurses transitioning from student to professional practice.
Stacie Weible, Fargo Sanford Health
Champion for Nursing Award - A non-nurse or organization who has
demonstrated a strong commitment in supporting the nursing profession
and/or made significant contributions to the nursing profession.
Sponsored by Sigma Theta Tau Xi Kappa at Large and Kappa Upsilon
Chapters.
Michael Essex, Fargo Sanford Health
Julie Wittkopp, Fargo VA Health System
Randolph Peterson, Fargo VA Health System
School Nurses and Telemedicine
Penny Briese, PhD, RN
At the NDNA Fall 2021 conference, nurses from across the state
heard from several very knowledgeable speakers on the topics of both
telemedicine and the toll Covid-19 has taken on not only North Dakotan’s
physical health but their mental health as well. Thomasine Heitkamp,
Dr. Shawnda Schroeder, and Rachel Navarro spoke specifically about
how rural communities encounter more barriers to accessing behavioral
health support than their urban counterparts due to lack of resources;
in Native American communities, access issues are even worse. Much of
the problem appears to stem from an overall lack of mental healthcare
providers in our state. The lack of pediatric mental healthcare specialists
is even more concerning. North Dakota children are experiencing
upheavals in their normal schedules due to the uncertainty of schools
closing due to Covid outbreaks, being put into quarantine for close
contact or positive tests, having to transition from classroom to online
learning environments, and just the uncertainty of when vaccines will
be available for younger school-aged children. “Currently, nearly 22
Belcourt, ND
Multiple Nursing Opportunities
in OB, Clinic, Med/Surg & ER
The Quentin N. Burdick Memorial Health Care Facility is an Indian
Health Service unit located on the Turtle Mountain Reservation
in Belcourt, ND. The Facility provides comprehensive primary
care and preventive care and hosts a medical clinic, dental clinic,
optometry clinic, pharmacy, radiology services, mental
health services, outpatient surgical services, labor
and delivery services, emergency room and inpatient/
acute care unit.
The site qualifies as a student loan payback site and offers benefits including annual
and sick leave, health/dental/vision benefits, life insurance, and retirement.
For more information, please visit www.usajobs.gov
or call Lynelle Hunt, DON (701) 477-6111 ext. 8260.
All RNs encouraged to apply or call for more information.
percent of children ages 3 to 17 in the United States are affected by a
mental, emotional, developmental, or behavioral condition. Only about
20 percent of children with mental, emotional, or behavioral disorders,
however, receive care from a specialized provider.”(1)
This trend has been noted by school nurses across the country. School
nurses are in a prime position to be the first to notice when children are
experiencing mental distress or crisis. (2) The National Association of
School Nurses (NASN) states that children’s health and wellness must be
a priority for them to succeed in school. They further state that disparities
related to social determinants of health, which includes where students
reside (rural VS urban) must be addressed. And school nurses now have a
new tool with which to do just that.
The Biden/Harris Administration has taken the issue of pediatric mental
healthcare access to heart. Recently, it was reported in the news that
“the U.S. Department of Health and Human Services (HHS) awarded
$10.7 million from the American Rescue Plan (ARP) to expand pediatric
mental health care access by integrating telehealth services into
pediatric care. The awards were made through the Health Resources
and Services Administration (HRSA).”(1) These grants will expand access
to children, regardless of where they live, through telehealth visits with
pediatric mental health specialists. Health and Human Services (HHS)
Secretary Xavier Becerra said, "The COVID-19 pandemic has taken a toll
on all of us, especially children. This critical funding will not only improve
the livelihoods of children and their families, but also secure the future
of our country. We will continue to make investments that ensure our
youngest Americans grow up strong and healthy." (1)
The Pediatric Mental Health Care Access Program has expanded
access from 21 awards in 21 states to 45 awards in 40 states, as well
as DC, the Virgin Islands, and the Republic of Palau. (1) Two Native
American tribal areas have also benefitted: the Chickasaw Nation and
the Red Lake Band of the Chippewa Indians (1)
"Primary care providers strive to address the many mental health
challenges children and families are experiencing due to the pandemic,
but they need more support," said HRSA Acting Administrator Diana
Espinosa. "Expanding the Pediatric Mental Health Care Access program
offers new opportunities for providers to offer families the mental
and behavioral health services they need but that often aren't easily
accessible." (1)
To learn more about Promoting Positive Mental Health in Rural Schools,
please go to https://mhttcnetwork.org/centers/mountain-plains-mhttc/
product/promoting-positive-mental-health-rural-schools
To learn more about HRSA's Pediatric Mental Health Care Access
program, visit: https://mchb.hrsa.gov/training/pgm-pmhca.asp.
For a list of HRSA awards, visit: https://mchb.hrsa.gov/maternal-childhealth-initiatives/mental-behavioral-health/arp-pediatric-mental-health.
Sources
1. Biden-Harris Administration Invests $10.7 Million in American Rescue Plan Funds
to Expand Pediatric Mental Health Care Access. Retrieved from https://
www.hhs.gov/about/news/2021/08/27/biden-harris-admin-invests-nearly-11-
million-for-pediatric-mental-health-access.html
2. The Behavioral Health and Wellness of Students. Retrieved from https://www.
nasn.org/advocacy/professional-practice-documents/position-statements/
ps-behavioral-health
January, February, March 2022 The North Dakota Nurse Page 7
Welcome New NDNA Officers!
NDNA welcomed new officers effective
January 1, 2022. We are thankful to have
these talented nurses join us as LEADERS as we
advance the nursing profession in North Dakota!
Thank you all for your willingness to serve!
President-Elect
Mylynn Tufte,
MBA, MSIM, RN
Membership Assembly
Representative
Susan Indvick,
MSN, RN
The Nominating Committee will be: Cheryl
Lantz, RN, PhD, CDCP, Richelle Johnson, MSN,
RN, and Mylynn Tufte, MBA, MSIM, RN
Bottineau, ND
Full-Time RN/LPN
Also hiring CNAs and
CS/ER Technicians
NEW competitive salary &
excellent benefit package
ND licensure/certification required.
SIGN-ON
BONUS
For more information or an application, please contact
Human Resources at 228-9314 or visit our website at
www.standrewshealth.com
Vice President of Finance
Richelle Johnson,
MSN, RN
Cheryl Lantz,
RN, PhD, CDCP
Unity Medical Center, located in Grafton is
recruiting for Med Surg/ER Nurses to work
in our new addition that consists of 11 new
patient rooms and a new ED department.
Director of Membership
Kami Schauer,
MSN, RN
Richelle Johnson
Mylynn Tufte
12 hour shifts rotating days and nights
every 3rd weekend and rotating Holidays.
Please contact Jenny, CNO at 701-352-1620
or apply online at
www.unitymedcenter.com
EOE
Page 8 The North Dakota Nurse January, February, March 2022
Medical Marijuana, Legislative Updates and Education
Gail Pederson, SPRN, HN-BC
Be Well Healing Arts, PLLC
I would like to update the nursing community
on the status of Cannabis (Medical Marijuana) in
North Dakota and the changes recently passed by
the 2021 legislature. I will also add my activity as a
Cannabis Nurse Consultant and Educator.
If you are not familiar with the North Dakota
Medical Marijuana law, it is ND Century Code
Chapter 19-24.1 and is found at: https://www.legis.
nd.gov/cencode/t19c24-1.html.
To be an advocate for your patients, I would
recommend reading it.
Gail Pederson
Here are a few statistics that I have pulled from the yearly report of the
Medical Marijuana Program (MMP). It can be found at https://www.health.
nd.gov/sites/www/files/documents/Files/MM/Annual_Report_2021.pdf.
As of the July 2021, end of the FY report, there are 5,754 card holders,
139 caregivers cards and over 400 employees in the industry.
297 providers have certified patients for cards. The make up of those
certifying are:
• 60% Physicians
• 32% Advanced Practice Registered Nurses
• 8% Physician Assistants
Since our vote to allow Medical Cannabis in the state in 2016, our law
has evolved over 3 legislative sessions. Wording has been changed to
help the certification process be more palatable to providers. Conditions
have been added. Allowable amounts were increased (still not enough
for some conditions), changes were made to allow Veterans easier
access. Several conditions were added in 2019. I was active during our
2021 legislative session, speaking whenever possible for changes in
our program. A few made it through legislation, but a lot more that we
advocates had hoped for, did not.
The 2021 legislative session was more patient focused, I felt. More
about patient protections, not as much implementation issues. There
were important changes to our caregiving program that came up and
were easily passed. On a national level, Cannabis Nurse colleagues
noted these changes as important.
Our law allowed one caregiver the legal right to purchase and
dispense/dose a cannabis card holder. One person only! This did not
allow another parent, grand parent or other significant person such
as a daycare provider to medicate that person in need of assistance
with Cannabis dosing. This became personal when a cannabis activist
mom nominated me for the 2019 ND Legendary Nurse Award for
Advocacy. She was the only caregiver for her autistic son. His bus was
10 minutes late. Because she needed to medicate him she missed
presenting me the award. I stated jokingly to the lawmakers that they
had never made out a 24/7/365 day a year scheduling like us nurses
have. Three caregivers were requested by the sponsor, which I asked
the HHS committee to raise to 5. This law also changed the make up of
the Medical Marijuana Advisory Board, adding a patient representative
and a legislator from each chamber. The state chose to removal the $50
registration fee for caregivers. They still have to go through a background
check at their expense. In another bill, if a person is applying to be a
caregiver for a terminal patient. The background check is waived for 6
months, with the ability to renew for another six months.
Those of us working to improve our program had proposed these items
which did not make it into law. We will try again.
• The ability of patients to grow their own Cannabis. This was in the
original measure we voted on. I remember talk on the floor of
people growing 20 pounds with one plant and mold covering the
inside of homes, endangering our families. The average amount
that I have been told by my many Cannabis Nurse grower friends
across the country is 4-6 ounces per plant. This extreme amount
brought up is not realistic and continues the fear mongering around
this plant.
January, February, March 2022 The North Dakota Nurse Page 9
• A food grade edible product. Again,
this was taken out of the original bill. All
cannabis is ingestible in its different forms.
To have a lozenge, gummy, chocolate that
is a set milligram-usually 10 mg just makes
sense to a person who wants an accurate
dose.
• Reciprocity of patient cards between
states. This is a nationally discussed issue
and I supported it. Our legislators were
worried about misuse of residents “from
Minnesota” that may come to a dispensary
in Fargo, get flower that is not available
in MN, smoke it and drive impaired back
to MN. There were concerns that a state’s
accepted conditions are different than
ours. There are few conditions that North
Dakota does not have compared to other
states. The fear and mistrust is great.
• The ability of a caregiver of a minor to
utilize plant matter “Flower” to use other
than as a combustible, such as making an
oil. This is to utilize a specialized treatment
based on the whole plant cannabinoids,
flavonoids and terpenes. It is trial and error
for our kids with cancer, Epilepsy or on the
Autism Spectrum disorder. Parents need to
be able to find which strain (Chemovar)
works best. As it stands now, the pediatric
product, a solution, though cheap for
minors, may not be the one that is best for
them. An excellent video on pediatrics was
made for us by one of the top cannabis
MDs in the country, Dr Bonni Goldstein.
Unfortunately, we could not get this bill to
the floor.
• Our monthly patient limits are inadequate
for cancer, pain management and
other conditions. Another issue is there
is no leeway for milligram differences in
the products within the program. Each
bottle of tincture or other concentrate
is a different mg, depending on the
percentage of THC in the cannabis
product. A patient I know could not get a
concentrate of the strain that works well
for him, because it was 1.5mg over his
limit on a product that averages 800mg
plus. Concentration limit increases had
been put in place, but disappeared from
legislation. The fear of “diversion” of the
product by the legislators is a factor in
this. I do support adult use legalization for
the ethical and social issues it involves and
because of continued limitations to our
medical program.
I have been active in a Long Term Care
working group of the American Cannabis
Nurses Association. We have been looking
at policy for those in LTC or communal living
(like my disabled adult son) to use cannabis.
This is what prompted me to ask for adequate
caregivers. Within this group, data has been
complied of a study using CBD in a small,
private memory care setting. The results
are promising with better sleep patterns,
less anxiety, and overall better mood and
interactions. Learning the steps to publish a
peer reviewed article has been eye opening.
I’ve told the others involved that I’m learning so
much and just along for the ride.
As I look back at my past articles, I noted
that I had said that I will be launching my
continuing education program “Cannabis 101:
What Medical Professionals Need to Know”
in 2019. Then Covid hit. I will now attempt to
offer it again. This is a comprehensive program
focusing on the National Counsel for State
Boards of Nursing Guidelines on Patients
Who Use Marijuana (1.5 CEUs for Nurses and
Licensed Social Workers at the present time).
The topics included are the history, state law,
the Endocannabinoid system, routes of use,
medication intereactions and side effects.
Legal, institutional and ethics are discussed.
It is open to all medical professionals. The
goal of setting up presentations across the
state depend again on Covid, for myself and
those I care for. I will be offering it in our larger
communities and targeting specific facilities.
If you have any questions or would like to
schedule a presentation for your facility, please
contact me. I think it is an important subject.
Gail Pederson, SPRN, HN-BC is a Board
Certified/Special Practice RN in Holistic Nursing
and the owner of Be Well Healing Arts, PLLC.
She is a Cannabis trained nurse providing
Consultation and Education on Cannabis as
medicine. Gail is a member of the American
Cannabis Nurses Association and the Cannabis
Nurses Network. She may be contacted at
bewellhealingarts@gmail.com, “Like” Be Well
Healing Arts, pllc on Facebook or call 701-490-
2132 for further information.
Page 10 The North Dakota Nurse January, February, March 2022
COVID-19 Booster Doses – Which Vaccine Should I Get?
As of October 21, 2021, the CDC has expanded eligibility for
COVID-19 booster shots in the United States. There are now booster
recommendations for all three available COVID-19 vaccines in the United
States.
For individuals who received a Pfizer-BioNTech or Moderna COVID-19
vaccine, the following groups are eligible for a booster shot at six
months or more after their initial series: 65 years and older; age 18+ who
live in long-term care settings; age 18+ who have underlying medical
conditions; and age 18+ who work or live in high-risk settings.
For individuals who received the Johnson & Johnson COVID-19 vaccine,
booster shots are recommended for those who are 18 and older and
who were vaccinated two or more months ago.
Are there any safety concerns with mixing brands for COVID-19 boosters?
There have been no safety concerns identified with mixing and
matching products. Any side effects reported during booster studies
appear to be limited to the same side effects seen after receipt of a
homologous (same brand) series. The most common side effects include
fatigue, headache, chills, and muscle aches.
How do COVID-19 boosters compare?
Data suggests that mixing COVID-19 vaccine brands boosts the
immune response to the virus that causes COVID-19. Below is a summary
of this study.
It is up to the health care provider and the patient to determine which
COVID-19 vaccine brand is the best option for a booster dose. The CDC
allows for a “mix and match” approach to booster doses. Deciding
which booster is right for you can be challenging. It is important that
patients weigh the risks of severe illness from COVID-19 with the benefits
and risks of vaccination. Below is some information to consider when
deciding which booster to receive.
What are the benefits of a COVID-19 booster dose and the risks of
COVID-19 illness?
The benefits of a COVID-19 booster dose may include a reduced
risk of SARS-CoV-2 infection (the virus that causes COVID-19) and a
reduced risk for severe COVID-19. Receiving a booster dose may prevent
illness (including post-COVID/long-term symptoms) and may reduce
transmission of the virus to other people. Individuals should consider the
following risk factors for SARS-CoV-2 infection and the potential impact of
SARS-CoV-2 infection:
• Risk of exposure to SARS-CoV-2. Factors that would be expected to
affect the risk of exposure to SARS-CoV-2 include work or residence
in certain settings; level of community transmission; rates of
COVID-19 vaccination in their community; the likelihood of frequent
interactions with possibly unvaccinated people from outside
an individual’s household; and adherence to recommended
prevention measures.
• Risk for developing SARS-CoV-2 infection. A person’s risk for
developing SARS-CoV-2 infection may vary based on time from
completing a primary COVID-19 vaccine series and time from prior
SARS-CoV-2 infection due to waning immunity. Serologic testing
or cellular immune testing is not recommended as part of the
individual risk-benefit assessment.
• Risk for severe infection related to underlying conditions. A person’s
risk of developing severe COVID-19 may vary by the type, number,
and level of control of specific medical conditions as well as other
yet to be defined variables. Pregnant people may receive a
COVID-19 vaccine booster. Separately, also see Considerations
for COVID-19 vaccination in moderately and severely
immunocompromised people.
• Potential impact of SARS-CoV-2 infection. SARS-CoV-2 infections that
are not severe may still lead to illness (e.g., post-COVID-19/longterm
symptoms). A person’s individual circumstances should also be
considered; these may include living with/caring for a person who is
medically frail or immunocompromised or a child who is not eligible
for COVID-19 vaccine or the inability to work or meet other personal
obligations when infected, even if not severely ill with COVID-19.
To access electronic copies of
The North Dakota Nurse, please visit
http://www.nursingALD.com/publications
*In this study a full dose of Moderna COVID-19 vaccine was used
as the booster dose. A half-dose of Moderna COVID-19 vaccine is
authorized in the United States for the booster dose.
Are there any safety concerns for choosing a booster dose of the mRNA
(Pfizer or Moderna) vaccine?
The serious safety concern seen most commonly with the mRNA
vaccines (Pfizer and Moderna) is myocarditis (inflammation of the
muscle around the heart). Based on current data from the primary
vaccine series, the highest risk of myocarditis occurring following receipt
of an mRNA vaccine is seen in males aged 12-30 years old. The rate of
myocarditis occurring following receipt of an mRNA vaccine in males
ages 18-24 years old is 39 cases per one million doses administered.
Myocarditis is also associated with COVID-19 illness. Additionally, data
suggests that myocarditis occurs at a higher rate following a COVID-19
illness compared to receipt of a COVID-19 vaccine. There have been
no reported deaths associated with myocarditis following a COVID-19
vaccine. Most cases of myocarditis are mild and patients typically
recover fully within six months.
A male who is a young adult should consider their own individual risks
and benefits when deciding which booster to choose. If an individual
is concerned about their risk of acquiring serious COVID-19 illness more
than the risk of myocarditis post-vaccination, then they may want to
consider receiving an mRNA booster dose. If that individual is more
concerned about their risk of myocarditis, then they may want to choose
a booster dose of Johnson and Johnson COVID-19 vaccine.
Are there any safety concerns for choosing a booster dose of the
Johnson and Johnson vaccine?
There have been 47 cases of rare blood clots, thrombosis with
thrombocytopenia syndrome (TTS), reported to the Vaccine Adverse
Events Reporting System (VAERS) following 15.3 million doses of Jonhson
and Johnson COVID-19 vaccine administered in the United States.
This event happens most frequently in women 18-49 years old, with the
highest reporting rate in 30-39 year old females at 10 cases per one
million doses administered. Women of childbearing age should consider
receiving a booster dose of mRNA (Pfizer or Moderna) vaccine given
their increased risk of TTS.
Guillain-barré syndrome (GBS), a rare autoimmune disorder, may be
associated with the Johnson and Johnson COVID-19 vaccine. Through
July 24th, 130 cases of GBS following vaccination have occurred, most
frequently in males 50 years of age and older. The highest reporting rate
of 16 cases per one million doses administered is in males ages 50-64.
Older males may want to consider mRNA vaccination for their booster
dose.
I need more guidance on choosing which COVID-19 booster dose to
receive. Who should I talk to?
For specific medical questions, the North Dakota Department of
Health recommends an individual talk to their trusted medical provider.
This provider will be able to offer insight into a persons individual medical
decisions.
January, February, March 2022 The North Dakota Nurse Page 11
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Page 12 The North Dakota Nurse January, February, March 2022
Factors Influencing Medication Errors
Anna Holen, Abby Seifert, & Christine Vetsch
BSN Students, University of Jamestown
Editor: Penny Briese, PhD(c), RN
University of Jamestown
Clinical Question: What are some factors that
influence nurses’ medication errors?
Medication safety is a priority for nurses,
considering medication administration
accounts for 40% of the nurse’s occupational
duties and nurses “are responsible for 26-
38% of medication errors” (Dougal, 2020,
p. 7). There are factors that influence and
increase/decrease the chances of making
medication errors. Being aware of these
factors can promote medication safety and
decrease the number of errors that are too
prominently occurring in the nursing field. Six
different articles related to medication errors
in the nursing profession were included in this
miniature literature review.
In 2018, Treiber and Jones performed a
quantitative study in an effort to understand
individual and system level factors that
contribute to medication errors from the
perspective of BSN nursing graduates. The
researchers investigated perceptions of
adequacy of preparatory nursing education,
contributory variables, emotional responses,
and treatment by employers following the error
(Treiber & Jones, 2018). The study consisted
of 168 participants who completed an
online survey. The survey was sent out to BSN
graduates from Kennesaw State University in
Georgia who graduated between the years
of 2009-2013. Most of the participants were
white (71%), female (89%), and nearly all were
currently practicing nursing (Treiber & Jones,
2018). More than half of the respondents
indicated they had made a medication error
since becoming a registered nurse; a majority
stated that when they made an error their
facility was supportive. Reasons that a nurse
did not report a medication error included
fear of repercussion, perception the error was
not serious, and the process to report the error
being too time consuming (Treiber & Jones,
2018).
Bekes, Sackash, Voss, and Gill (2021)
focused their study on medication errors
seen specifically in pediatric patients in the
perioperative period. The researchers sought
to answer two main questions: 1) what are
the main types of medication errors in the
pediatric population in the perioperative
period, and 2) what mitigation strategies had
the best outcome that can be incorporated
into practice? This was a narrative literature
review of 17 articles. The inclusion criteria for
this review included a patient population
from one to 18 years of age, articles printed in
the English language, full-text publications,
and focused on perioperative periods of care
(Bekes et al., 2021). The researchers scored
each article using the critical appraisal skills
program qualitative checklist because it
breaks down the methodological approach
to determine the quality of each article.
They found that the most frequent errors
mentioned in the multiple research studies
were incorrect doses (77%) including dilution
errors, calculation errors, and incorrect intervals.
Other examples of common medication errors
included incorrect medication, grabbing the
incorrect syringe, inappropriate medication
labeling, and giving a known allergen (Bekes
RECENTLY
INCREASED
WAGES
Full or Part Time RN or LPN
For More Information Contact
Kasey Brandenburger, RN DON
kasey.brandenburger@stgerards.org
701-242-7891
St. Gerard’s Community of Care
Hankinson, ND
Stgerards.org
et al., 2021). The researchers concluded by
discussing interventions that reduce medication
errors which entailed standardized labeling,
prefilled syringes, two-person checks, drug
library/ electronic-based references, quality
improvement safety analytics, pharmacy
support, computer check systems, staff
education, standardized workspace, zerotolerance
philosophy, and checklists (Bekes et
al., 2021).
Ragau, Hitchcock, Craft, and Christensen
(2018) wanted to look specifically at the
individual human factors that can cause
medication errors. They used the HALT model
(hungry, angry, late, lonely, and tired) to try
and reduce the incidence of medication
errors by 25% by allowing nurses to “be more
aware of how their emotional behavior may
have a deleterious effect” on medication
administration (Ragau et al., 2018, p. 1333).
The HALT model was implemented in a 32-bed
acute medical unit. ‘HALT’ posters were placed
throughout the unit to remind the team to
“effectively ‘HALT’ and take time to reflect on
what was occurring for them on an emotional
level and then take the appropriate action”
(Ragau et al., 2018, p. 1333). The model was
also used during shift hand-off to highlight any
emotions that needed to be addressed before
the shift change. After the implementation of
the HALT model, there was a decrease in total
medication errors by 31.7% over a two-month
period, a 25.3% decrease in errors relating
to human error, and a 22.9% decrease in
communication and documentation-related
errors (Ragau et al., 2018, p. 1334). Although this
study had a positive response, “caution should
be used when addressing other contributing
factors associated with medication errors as
using HALT alone will not address these” (Ragau
et al., 2018, p. 1334).
Berdot et al. (2021) conducted a study
on nurses wearing a special vest indicating
a time of requested un-interruption. They
analyzed whether the introduction of the vest
reduced medication errors during medication
administration. This was a multicenter,
randomized controlled trial performed in 29
adult units in four hospitals. Over the course of
the study, 178 nurses in 14 units wore a ‘do not
interrupt’ vest during 383 observed medication
rounds to examine the main outcome of
administration error rate. The error rate was
defined as “number of Opportunities for Error,
OE, calculated as one or more errors divided by
the Total Opportunities for Error, TOE, multiplied
by 100” (Berdot et al., 2021, p. 1). Berdot et al.
(2021) found that the administration error rates
in the experimental group was 7.09% and 6.23%
in the control group (p. 1). The interruption
rates were also similar, with the experimental
group being 15.04% and the control group
being 20.75% (Berdot et al., 2021, p. 6). These
results indicate that the “vest had no impact on
medication administration error or interruption
rates” (Berdot et al., 2021, p. 6).
Dougal (2020) conducted a quantitative nonexperimental
study to determine the perception
of medication administration and medication
errors from registered nurses, related to
the risks, benefits, frequency, and cautions
associated with it. The researcher had three
research questions; 1) do nurses perceive risk in
medication administration in everyday practice,
2) how is an RN’s self-reporting behavior related
to medication administration errors and risks,
and 3) do nurses perceive benefit and risk to
medication safety during the administration
process? (Dougal, 2020) This study surveyed
1,445 RN’s using an online seven-point Likert
scale questionnaire. Most RNs reported that
they were “not at all likely” to report medication
errors and believed they do not make errors in
medication administration or are “unlikely” to
do so within the next 12 months (Dougal, 2020,
p. 9). They believe their peers were “very likely”
to make errors in medication administration
within the next 12 months (Dougal, 2020, p. 9).
Most RNs in this study reported not following
proper medication administration processes
due to self-reported distractions, interruptions,
and multi-tasking.
Ekkens and Gordon (2021) conducted a
quantitative quasi-experimental study to
determine if adding mindfulness thinking to
current protocol will eliminate or minimize
medication errors. This study consisted of 111
nurses from rural hospitals located in northern
California. The treatment group in this study
received an intervention of mindfulness
training while the control group did not receive
training. “The instrument used for the study
was based on the medication error index from
the NCC MERP” (Ekkens et al., 2021, p. 119). This
instrument is designed to categorize medication
errors into nine levels of severity, each level
corresponding to mild, moderate, significant,
or severe severity. The researchers found that in
the treatment group, errors were reduced from
15 to four, whereas the control group showed a
reduction in errors from seven to six. The result
from this study concludes that “nurses are not
consistently mindful enough when administering
medications; this contributes to errors” (Ekkens
and Gordon, 2021, p. 120). Mindful thinking and
effective training may help to reduce errors and
help nurses focus on the task at hand.
Conclusion
There are many factors that can contribute
to medication errors, but in return there are
many interventions to help decrease the risk of
errors and ensure patient safety. Medication
errors have been studied extensively due
to the danger that errors present to patient
safety. The six articles summarized in this
literature review support a numerous array
of interventions that both feed into and can
prevent medication errors. At an educational
level, professors and mentors need to stress the
importance of medication errors and prepare
students for clinical experiences. New nursing
graduates mentioned they should have had
more hands-on experience with medication
administration, especially IV, and time
management skills to encourage effective care
management (Treiber & Jones, 2018). It is highly
recommended that even experienced nurses
should always go through the medication
rights such as correct dose, time, patient, route,
refuse, and medication. Nurses should not be
afraid to question doses that seem odd and
they should not solely rely on technology to
recognize mistakes. Facilities should support
nurses in the field because, although reporting
the error can be intimidating, reporting can
help nurse administrators recognize systematic
problems. Not all interventions are helpful and
nurses often blame themselves for medication
errors and feel guilty regardless of whether or
not the error harmed the patient. Hospitals must
find what works best for their individual nurses
because the reasons for medication errors are
quite individualized. Medication errors and
safety continue to be a growing concern in the
healthcare profession.
References
Bekes, J.L., Sackash, C.R., Voss, A.L., & Gill C.J. (2021).
Pediatric medication errors and reduction
strategies in the perioperative period. AANA
Journal 89(4), 319-324.
Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge,
M., Corny…Sabatier, B. (2021). Effectiveness
of a ‘do not interrupt’ vest intervention to
reduce medication errors during medication
administration: a multicenter cluster randomized
controlled trial. BMC Nurs, 20(153), 1-11. doi:
10.1186/s12912-021-00671-7
Dougal, R.L. (2020). RN perceptions of medication
administration and medication errors: Results
from a quantitative nursing research study. RN
Idaho, 43(1), 7-9.
Ekkens, C. L. and Gordon, P. A. (2021). The mindful
path to nursing accuracy: A quasi-experimental
study on minimizing medication administration
errors. Holistic Nursing Practice, 35(3), 115-122.
doi: 10.1097/HNP.0000000000000440.
Ragau, S., Hitchcock, R., Craft, J., & Christensen.
(2018). Using the HALT model in an
exploratory quality improvement initiative
to reduce medication errors. British Journal
of Nursing, 27(22). 1330-1336. doi: 10.12968/
bjon.2018.27.22.1330
Treiber, L.A. & Jones, J.H. (2018). After the medication
error: Recent nursing graduates’ reflections on
adequacy of education. Journal of Nursing
Education, 57(5), 275-280. doi:10.3928/01484834-
20180420-04
January, February, March 2022 The North Dakota Nurse Page 13
Reducing Central Line-Associated Bloodstream Infections
Ali Glynn, Amber Domres, & Hayley Johnson
BSN students, University of Jamestown
Editor: Penny Briese, PhD(c), RN
University of Jamestown
Clinical Question: What are the current best practices for preventing
central line-associated bloodstream infections (CLABSI)?
Bloodstream infections of central venous access lines are occurring at
unacceptable levels in practice (Conwell, Ghidini, Perazella, Aniskiewicz,
DeVaux, & Giullian, 2019). There are ways in which healthcare
professionals can increase the safety of patients and improve care to
reduce mortality risk. This miniature literature review will describe the
evidence and best practices recommendations of six research studies
focusing on central line-associated bloodstream infections (CLABSI).
In one quantitative study, medical professionals at Yale New
Haven Hospital in Connecticut evaluated their hemodialysis unit for
the occurrence of CLABSI (Conwell et al., 2019). Observations within
their dialysis unit showed that a central line infection occurred at a
rate of 0.39%, however, of those with an acquired infection “mortality
following a CLABSI ranged from 12-25%” (Conwell et al., 2019, p. 587). The
implementation plan of their study included “a list of findings evident
upon admission that could trigger further evaluation for infection early
in the course of hospitalization” (Conwell et al., p. 588). Dressing changes
were required to be documented, registered nurses were retrained on
caring for central lines and were tested with new competencies to prove
understanding. Research showed “the number of CLABSI events was
notably lower following implementation of the program as over 2,280
treatments were performed on 382 patients in 2017 and no CLABSIs
occurred” (Conwell et al., p. 588-589). The researchers concluded by
reiterating the importance of prevention of central line infections in order
to prevent lengthy hospital stays, high costs, and reduce mortality.
One intervention commonly used in practice to decrease the risk of
CLABSI is using chlorhexidine gluconate (CHG) bathing for infection
prevention. Reynolds, Woltz., Keating, Neff, Elliott, Hatch, Yang, &
Granger (2021) performed an academic and community-based study
with 1,640 participants from hospital units who had at least 1 CLABSI
event in the last year. All patients with a central line were given a CHG
antimicrobial bath throughout the course of their treatments. Results
showed that the units reported a decrease in patient stay of 1.67 days
along with a 27.4% reduction in rates of CLABSI (Reynolds et al., 2021).
Part of the intervention also included educational outreach to all
members of the health care team regarding the purpose of the CHG
bath, which generated this very positive outcome.
In another study, five hospitals were evaluated between the years
of 2013 and 2015 for CLABSI and their association with lines being
“manipulated by healthcare workers and patients” (Sheth, Trifan, Feterik,
& Jovin, 2017, 2017, p. 217). The incidence of CLABSIs has been reduced
thruogh the implementation of CDC CLABSI prevention bundles;
however, manual manipulation of lines are also suspected to be a cause
of infection. During this study, 30 CLABSI events were reported and 16 of
these events had noted “line manipulation 48-72 hours prior to infection”
(Sheth et al., 2017, p. 217). Manipulation of the line includes flushing the
line, administering fluids and medications. Overall, this study concluded
that CLABSI prevention bundles helped reduce the number of CLABSIs,
but more interventions are needed to reduce infections related to
central line manipulation.
Suttle Buffington, Madden, & Dawson (2019) studied 85 participants in a
29-bed hematology oncology specialty unit at the University of Alabama
at Birmingham Hospital. The study included “patient engagement and
empowerment” to reduce infections of central lines (Suttle et al., 2019,
p. 10). The independent variable of this study was the implementation
of the EPIC bundle, which included an “educational video, poster,
patient silicone bracelet and a nursing staff sticker” (Suttle et al., 2019, p.
12). The dependent variable was the prevalence of CLABSIs. Two factors
were found to interfere with patient education: 1) health care workers
feeling unsure of just how much responsibility to place on patients, and 2)
patients not wanting to bother healthcare workers and ask them to wash
their hands. The intervention of the EPIC bundle reduced the number of
infections by “46% within eight weeks” (Suttle et al., 2019. p. 11). The results
of this study showed that, overall, following implementation of the EPIC
bundle, patients felt more empowered and in control of their care leading
to a reduction of CLABSIs.
Another study done by Wilder, Wall, Haggard, & Epperson (2016)
assessed the effectiveness of integrating central-line principles and a
team-based approach into CLABSI reduction in neonatal intensive care
units. This study aimed to reduce CLABSI rates by the implementation of
a line-rounding tool (Wilder et al., 2016). The line-rounding included small
dedicated CLABSI prevention teams who took over doing peripherally
inserted central catheter (PICC) dressing changes with a specified
technique, while including training opportunities for other neonatal nurse
practitioners. The study showed an improvement in CLABSI rates by 93%
(Wilder et al., 2016). The reduction in CLABSI rates was accompanied by
reduced patient harm, reduced length of stay and costs. The research
concluded that implementing line-rounding teams, raising awareness of
a “safety-first culture”, along with a multidisciplinary team approach to
central line maintenance can make a significant impact on CLABSI rates.
And finally, in discussing multidisciplinary team approaches in CLABSI
reduction, the final study reviewed showed significant findings with the
integration of collaborating care teams in achieving reduced CLABSI
rates (p < 0.05). Evidence-based practices were discussed in the article
but so were new technologies like “disinfecting caps and needleless
securement devices” (Layne & Anderson, 2019, p. 285). In this study, a
hospital multidisciplinary team wanted to address central line practices
that were occurring. Their findings of their assessment were based on
two components of prevention: dressing maintenance and caregivers’
critical skills (Layne et al., 2019, p. 285). The collaborative team also
identified that two critical skills in particular needed improvement;
dressing changes and blood draws. The team used these findings
to initiate central line maintenance skills re-education for practicing
nurses and found rapid improvements in securement and dressing
maintenance and there was a 57% reduction in CLABSI occurrences in
the fiscal year 2016 to 2017 (Layne et al., 2019).
Conclusion
The incidence of CABSI remains high in healthcare today. It is
imperative that healthcare providers continue to search the literature
for best practices. The findings of this miniature literature review
indicate that the use of admission checklists, antiseptic bathing, patient
empowerment, patient care bundles, and multidisciplinary team
approaches and reeducation are all integral practices associated with
the reduction of CLABSI in the hospital settings.
References
Conwell, R., Ghidini, J., Perazella, M., Aniskiewicz, M., DeVaux, L., & Giullian,
J. (2019). A hospital-based program to reduce central line-associated
bloodstream infections among hospitalized patients receiving hemodialysis
using a central venous catheter for vascular access. Nephrology Nursing
Journal, 46(6), p. 587-592.
Layne, D. M., & Anderson, T. (2019). A collaborative approach to reducing
Central line-associated bloodstream infections. Journal of Nursing Care
Quality, 34(4), 285–286. https://doi.org/10.1097/ncq.0000000000000419
Reynolds, S.S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q.,
& Granger, B. (2021). Results of the CHlorhexidine Gluconate Bathing
implementation intervention to improve evidence-based nursing
practices for prevention of central line associated bloodstream infections
study (CHanGing BathS): a stepped wedge cluster randomized trial.
Implementation Science, 45(16), p. 1-16. Doi: 10.1186/s13012-021-01112-4
Sheth, H., Trifan, A., Feterik, K., & Jovin, F. (2017). Expanding central line care
bundle to address line manipulations. Canadian Journal of Infection
Control, 32(4), 217–221.
Suttle, R. D., Buffington, H. M., Madden, W. T., & Dawson, M. A. (2019). Central Line
Care: Empowering patients to prevent infection and injury via EPIC². Clinical
Journal of Oncology Nursing, 23(1), E10–E16. https://doi.org/10.1188/19.CJON.
E10-E16
Wilder, K. A., Wall, B., Haggard, D., & Epperson, T. (2016). A systemic central line
quality improvement initiative integrating line-rounding principles and a
team approach. Advances in Neonatal Care, 16(3), 170-177. https://doi.
org/10.1097/anc.0000000000000311
The ongoing COVID pandemic has made it difficult for people to
maintain their mental health and well-being. Developed in 2019, the
North Dakota Community Clinical Collaborative (NDC3) is helping
communities across North Dakota create a culture of health, where
prevention and wellness are the norm. NDC3 houses programs that
provide education, fitness instruction, and self-care strategies for
participants; they do not replace clinical care provided by doctors,
nurses, and other medical professionals. NDC3 also provides the ability
for caregivers and health care providers to refer loved ones or patients to
appropriate programs.
Through partnerships across the state, NDC3 connects evidence-based health
management activities that promote health and prevent disease to adults with
or caring for people with chronic health conditions. These programs have been
developed using rigorous research and demonstrate reliable and consistently
positive changes in health-related outcomes among participants. Lisa Thorp,
BSN, CDCES wrote:
“I was recently visiting with colleagues about the availability of certain services across
the state. Often, it appears that there are more services available on the eastern side
of the state. NDC3 helps level the playing field by organizing the information of virtual
classes that are available. As a Certified Diabetes Care and Education Specialist, I love
the fact that people with diabetes can search NDC3 and find classes to help them better
manage their diabetes. A search can be done to find a Diabetes Prevention class, or
a Better Choices Better Health-Diabetes Class, and attend them virtually! In addition
to diabetes classes, there are also other classes for chronic conditions and pain, and
strengthening, which can help reduce falls in the home. I encourage other nurses, diabetes
educators, primary care providers to use the referral option. Provide the patient contact
information and they will get called to help them find a class. Check out Connecting you to
community health programs - NDC3! Feel free to contact me for questions at lisa.thorp@
greatplainsqin.org”
Page 14 The North Dakota Nurse January, February, March 2022
ANA Call for
Proposals
On behalf of ANA's Professional Policy
Committee, I encourage you to engage in the
identification of strategic policy topics and the
submission of proposals for discussion by ANA's
governing body, the Membership Assembly,
at the 2022 annual meeting in June. Your
involvement in ANA's policy work is critical!
Of particular interest to ANA for this Call for
Proposals are proposals specific to addressing
issues related to nurse staffing, with particular
focus on the acute care setting, and strategies
to reduce workplace violence against nurses
and other health care employees. All proposals
submitted should be solution oriented.
Section 1 of the 2022 Membership Assembly
Policy Development Guide includes questions
for you to consider prior to submitting a
proposal. In Appendix A of the Guide, you'll find
the ANA Enterprise 2020-2023 Strategic Goals.
The Guide also contains detailed information
on the submission and review of proposals,
including emergent proposals; Dialogue
Forums; and examples of approaches used by
state nurses' associations that have successfully
engaged members in ANA's policy work.
TO SUBMIT PROPOSALS FOR CONSIDERATION
– Click here to access the online proposal form.
Completed proposals MUST BE submitted (by
using the online proposal forms) by 5:00pm ET
on Monday, February 7, 2022. Refer to Appendix
D in the Guide for key dates and direct
questions to Cheryl Peterson, Vice President,
Nursing Programs, via email (practice@...).
Sincerely,
Cheryl Peterson, MSN, RN
Vice President, Nursing Programs
American Nurses Association
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January, February, March 2022 The North Dakota Nurse Page 15
ANA Nominations
and Elections
ANA's Gail Peterson
(Nominations and Elections Committee Chair)
The ANA Nominations
and Elections Committee
is identifying candidates
that meet the minimum
competency requirements
for open positions. If you or
someone you know would
be a great candidate,
please apply or encourage
them to apply. Click here or
go to the NDNA website –
News & Annoucements tab.
Gail Peterson
Now Hiring RNs and LPNs
Sign on Bonus up to $10,000
Family orientated environment
Flexible scheduling available
Located in Valley City, the most beautiful town in North Dakota.
For more information, call 701-845-8222 or
visit our website at www.smphealth.org/straphael/.
Visit our new Facebook page www.facebook.com/SMPHealthStRaphael
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To Apply: EMHC Employment www.mhanation.com/emhcemployment
or visit us at www.elbowoodshealth.com
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Designed for Registered Nurses
As a nurse, your time is precious.
Waldorf University’s RN to BSN completion
program empowers you to earn your degree on your
schedule while keeping your current job a priority.
Textbooks are provided at no cost and Waldorf
allows up to 90 credits to be transferred
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