Idaho RN - August 2022

IDAHO
Aug., Sept., Oct. 2022
Volume 45, • No. 2
Official peer reviewed publication of Idaho Alliance of Leaders in Nursing & Idaho Center for Nursing
Quarterly publication distributed to approximately 34,000 RNs and LPNs in Idaho.
These organizations are members of the Idaho Center for Nursing.
ANA-IDAHO PRESIDENTIAL REPORT
2022 ANA Membership Assembly
Dori Healey MSN, APRN-CNS
President, ANA-Idaho
president@idahonurses.org
After three years of virtual meetings, nurses from
across the nation met in Washington DC at the ANA
membership assembly! The excitement was palpable as
we had the opportunity to connect with nursing leaders
from the nation. Seeing old friends and making new
friends. Our days were action packed and so much was
accomplished.
ANA-Idaho had the opportunity to attend meetings on
Capitol Hill with representatives from each congressional
office. Dori Healey, ANA-Idaho President, Anna Rostock
ANA-Idaho President Elect, and Brie Sandow ANA
Director at Large proudly represented Idaho to speak
about topics important to all nurses.
Strong representation from Idaho at our nation’s
capital. From left to right: Dori Healey ANAI
President, Brie Sandow ANA Director-at-Large,
and Anna Rostock ANAI Board.
current resident or
Non-Profit Org.
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Permit No. 14
Nearly every healthcare encounter includes an RN; they
perform physical exams, collect health histories, interpret
information, and make critical decisions about next steps,
administer treatments and medications and coordinate
care in collaboration with a wide array of health care team
members. With Idaho being the fastest growing state
nationally, it was critical that we articulated our current
work environment data and the impact on our patients.
As Idaho nurses, we were proud to discuss that in
many ways the bills we were discussing; Idaho was ahead
of the nation! ANA is urging congress to pass Workplace
Violence Prevention for Healthcare and Social Workers Act
(S. 4182/H.R. 1195) This bill would require employers to
take action to protect workers and other personnel from
workplace violence. In Idaho, under code 18-915, it is a
felony to assault a healthcare worker. This was passed
in 2014 and Idaho is one of the few states that has this
as state legislation. As Idaho nurses, we spoke about
the impact of this code and why we support national
legislation to protect healthcare workers.
We discussed the impact of APRN’s practicing with full
practice authority and the impact on patients. In Idaho,
our APRN’s practice to the full scope of their license and
provide increased access to care to patients across the
state. During the COVID-19 pandemic wavers were put
into effect allowing APRN’s across the nation to practice
without restrictions. This allowed APRN’s to utilize their
knowledge, skills, and judgement to practice to the
full extent of their education and training. Practicing at
the top of their license, APRN’s shored up health care
capacity and provided access to timely care for patients
without sacrificing quality care of patients. By removing
unnecessary barriers to care between patients and
providers, the evidence is clear; APRN’s should have
full practice authority. Idaho is already familiar with the
outstanding services APRN’s provide and provided
ANAI President continued on page 2
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INSIDE
THIS ISSUE
FEATURE
The 2022 Idaho Nursing Workforce Report
Idaho Center for Nursing Workforce PAGES 4-5
FEATURE
Exploring Hand Hygiene Expectations for NICU Nursing Staff
Megyn Flood, MSN-ED, BSN, RNC-NIC;
Hillary E. Swann-Thomsen, PhD PAGES 5-6
IDAHO CENTER FOR NURSING PARTICIPATING
ORGANIZATION UPDATES
Board of Nursing Report PAGE 7
Executive Director Report
Randall Hudspeth PhD, MBA,
MS, APRN-CNP, FAANP PAGE 8
Madison Memorial Achieves Pathway to Excellence Designation
Renae Snyder BSN, RN PAGE 9
IDAHO NURSING AWARDS AND RECOGNITIONS
Daisy Awards PAGES 10-11
Nursing Excellence PAGE 11
Leadership and Service Recognition PAGE 11
FEATURE
No, I am not going to the Orphanage!
Hispanics and Hospice Care
Diana Gilmore, BSN, RN, DNP, FNP-student;
Melody A. Weaver, Ph.D., APRN, FNP-BC PAGE 13
FEATURE
Legal Analysis: Delegation
Kendra Griffitts BSN, RN PAGES 14-15
Parting Words: Updating the Associations’ Value
Proposition to Idaho Nurses…You!
Ben Knapp PAGE 16
Notes and News PAGE 17
In Memoriam PAGES 18-19

Page 2 • RN Idaho August, September, October 2022
ANAI President continued from page 1
Brie Sandow, Dori Healey and Anna Rostock with
Senator Jim Risch.
historical context with our legislators to support removing
burdensome barriers for all APRN’s across the nation.
The last thing we discussed on Capitol Hill was
removing barriers to and improving access to care for
Seniors (S. 3018/ H.R 3173) This bill would improve
the prior authorization process and protect patients
from unnecessary delays in care by streamlining and
standardizing prior authorization under the Medicare
Advantage program. This bill has bi-partisan support
and discussion was very positive. The overwhelming
consensus is seniors deserve care in a timely manner and
this bill would provide improve care.
We will continue to work with our congressman and
their staff to stay up to date with these important topics.
We are committed to advocate for our nurses as well as
patients throughout Idaho.
SAVE
THE DATES
American Nurses Association Idaho &
Nurse Leaders of Idaho
LEAP (Learning for Education,
Administration & Practice)
November 2-3 | Grove Hotel, Boise
Call for Abstracts due Friday, Sept 23
Nurse Recognition Dinner Event
Tuesday, November 2 | Grove Hotel Ballroom,
Boise
Idaho Association of Nurse Anesthetists
AANA Annual Congress
August 12-16 | Chicago, IL
IDANA Fall Conference
September 9-11 | The Grove Hotel – Boise
Register at: Idaho Association of Nurse
Anesthetists - Events (idahoana.org)
Later in the week, we met with leaders from across the
nation and ANA leadership to review critical issues and
create statements regarding nurse staffing, verbal abuse
and workplace violence, impact of climate change on
health, and racial reckoning.
After robust debate and conversation, it was
determined that the COVID-19 pandemic has exacerbated
long-standing nurse staffing issues, the Assembly
considered changes to existing ANA policy related to
nurse-to-patient ratios. Participants stressed the need for
enforceable staffing standards and shared their successes
and challenges in implementing various models.
Nursing School Friends meet: Pam Cipriano,
President of the International Council of Nurses
and former ANA-President with Randy Hudspeth.
Assembly representatives approved a recommendation
that ANA supports safe patient standards including
ratios that are acuity and setting specific as per
nursing assessment and enforceable, and that ANA
will engage with the constituent and state nurse
associations to develop further details regarding
standards, implementation, and enforcement. Assembly
representatives also called on ANA to collaborate with
organizational affiliates to begin to develop evidencebased
staffing standards for all nursing disciplines for
publication.
Assembly representatives called on ANA to engage key
stakeholders to identify, develop and advance strategies
resulting in a comprehensive culture of safety and zerotolerance
approach to verbal abuse and violence in all care
settings, advance workplace violence prevention priorities
in nursing practice and public policy, and advocate for
better data collection to inform policy development.
To help address the public health crisis caused by
climate change, Assembly representatives approved
the recommendation that ANA and individual member
division include climate crisis and its consequential
impact on human and population health as an essential
component of their policy platform. Voting representatives
also endorsed that ANA revise and establish as an
official position the 2008 House of Delegates Statement
on Global Climate Change and Human Health. Finally,
the representatives called on ANA to promote nursing
knowledge on the relationship between climate change
and human and population health.
Finally, the voting representatives of the Assembly
unanimously voted “yes” for the association to embark
on a racial reckoning journey and adopted ANA’s Racial
Reckoning Statement. The multi-phase journey will
begin with release of the statement and supporting
communications later this summer.
=
IDAHO
RN Idaho is published by
Idaho Center for Nursing
6126 West State St., Suite 406
Boise, ID 83703
Direct Dial: 208-367-1171
Email: rnidaho@idahonurses.org
Website: www.idahonurses.nursingnetwork.com
RN Idaho is peer reviewed and published by the
Idaho Center for Nursing. RN Idaho is distributed
to every Registered Nurse and Licensed Practical
Nurse licensed in Idaho, state legislators, employer
executives, and Idaho schools of nursing. The total
quarterly circulation is over 34,000. RN Idaho is
published quarterly every February, May, August,
and November.
Editor:
Sara F. Hawkins, PhD, RN, CPPS
Editor Emerita:
Barbara McNeil, PhD, RN-BC
Executive Director:
Randall Hudspeth, PhD, MBA, MS, APRN-CNP,
FAANP
Editorial Board:
Michelle Anderson, DNP, APRN, FNP-BC, FAANP
Sandra Evans, MAEd, RN
Pamela Gehrke, EdD, RN
Beverly Kloepfer, MSN, RN, NP-C
Karen Neill, PhD, RN, SANE-A, PF-IAFN
Gus Powell, MSN, CRNA
Katie Roberts, MSN, RN
Laura J. Tivis, PhD, CCRP
RN Idaho welcomes comments, suggestions,
and contributions. Articles, editorials and other
submissions may be sent directly to the Idaho
Center for Nursing office via mail or e-mail. Visit our
website for information on submission guidelines.
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Acceptance of advertising does not imply endorsement
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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 affiliated nursing organizations,
or those of the national or local
associations.
Nurse Practitioners of Idaho
AANP National Fall Conference
Sept 15-18 | Anaheim, CA
Register at 2022 AANP Fall Conference
Annual Fall Conference
October 6-7 | Boise Center on Grove
Register at: NPI Annual Fall Conference 2022 |
The Nurse Practitioners of Idaho | ENP Network
Idaho Board of Nursing
2022 Meeting Dates
- August 11, 2022
- November 3, 2022 ANAI President continued on page 3
JOIN ANA IDAHO TODAY
WE NEED YOU!
Membership application
http://nursingworld.org/joinana.aspx

August, September, October 2022 RN Idaho • Page 3
ANAI President continued from page 2
At the end, ANA-Idaho was part of the election process for the new ANA officers
and were honored to be there to witness the election process and hear the candidates
speak. Incredible candidates for all positions and ANA will be well be well represented
moving forward. Interesting fact, our newly elected national President Jennifer Mensik-
Kennedy was a nurse in Idaho and worked at St. Luke’s Health System!
As you can see, this was a very fulfilling week filled with a lot of meaningful work.
Dori and Anna will continue to be engaged with committees and be a voice for Idaho
as we move forward and develop solutions. As always, your voice is welcomed. We
look forward to hearing from you.
Dori Healey and Anna Rostock with Jennifer Kennedy, newly elected
ANA-President and former St. Luke’s RN
NLI PRESIDENTIAL REPORT
Welcome Dr. Kevin McEwan,
DNP, RN, NEA-B, New President
to Nurse Leaders of Idaho
Dr. Kevin McEwan,
DNP, RN, NEA-B
As the newly asserted President to Nurse Leaders of
Idaho I feel what most of us have felt as new leaders. Most
first time or frontline nurse leadership openings come
through circumstantial invitation or thrust into an open
position out of convenience. Most are not truly ready or
prepared. These opportunities however or whenever they
come in our nursing journey are great opportunities to learn
and grow.
I’ve had many opportunities in nursing leadership that
have prepared me to lead in hospitals and ambulatory care
settings. Leading in a statewide professional organization
that represents leaders from academia, regulation, all levels
of practice and policy advocates is a big role. But, one
I am honored to set into. I am fortunate to have amazing
colleagues on our Board of Directors representing all regional areas of our state
and professional practice settings. We are also supported by Dr. Randy Hudspeth
who is extraordinary in his ability to support our state organizations.
We cannot advocate for nurses, nursing and our unique position in healthcare
without the support of many. I feel that there is nothing we cannot accomplish,
improve or transform as nurses when we work in unity. I also believe that all nurses
are leaders and need our support and representation regardless of title or position.
Nurses lead. It is what we do with patient care teams, classrooms, community
settings or halls of legislation. It requires a professional position that is fact and
evident based, a pen, microphone, opportunities to act and then the courage to
represent.
I am privileged to represent each of you nurse leaders and supporters of
nursing. Through our work of listening, engaging and understanding, I hope to
establish our professional positions and work to see that those positions gain
the attention and support of individuals of influence. We have a lot to do for our
profession, patients, students and communities, so let’s get to work!

Your Dream
Find
Job Now!
Nursing
Page 4 • RN Idaho August, September, October 2022
FEATURE
The 2022 Idaho Nursing Workforce Report is Released
The biennial Idaho Nursing Workforce Report
was released June 15. It confirmed what many
in healthcare already knew, but some additional
issues were identified. This report is published every
other year in the even years following the odd year
RN and APRN license renewals. The Idaho Center
for Nursing does the research and generates the
report as a part of its nursing workforce monitoring
program.
Based on the nursing supply database for
March 15, 2022, there are 23,735 RN licensed in
Idaho. Removing APRNs and RNs with out of state
addresses, there are 18,650 RNs available to work.
Of that total, 1,250 report that they are not working
and not seeking work, resulting in 17,400 nurses
available. There are 3,836 LPNs with Idaho licenses
and 3,177 of them reside in Idaho. Of LPNs, 210 are
not employed and not seeking employment, yielding
2022 Total Idaho Licensed Nurses by Category Including
Nurses that Reside in Surrounding States and Counites
Resident Location LPN RN
APRN-
CNP
APRN-
CRNA
APRN-
CNM
APRN-
CNS
Idaho Residents 3,177 18,650 1,707 450 71 39
Military 1 18 2 0 0 0
Washington Total ** 109 1,985 255 50 0 5
Washington Border Counties
(included in Washington total)
66
Spokane - 829
Whitman - 106
Clarkston - 206
Oregon** 43 671 56 16 0 0
Oregon Malheur Co.
(included in Oregon total)
20 121
Nevada** 11 173 21 1 0 0
Utah** 0 21 127 16 0 2
Wyoming** 0 7 14 3 0 0
Montana** 1 23 22 9 0 0
All Other States 494 2,166 715 51 4 4
Foreign 0 21 0 0 0 0
Total Licensed 3,836 23,735 2,919 596 75 50
* RN license numbers do not include APRNs, even though they hold RN licenses.
a 2,967-employment potential. The following chart
details nursing numbers.
Nurse employment information from the Bureau
of Labor Statistics shows that 93% of all nurses
are currently working either full or part-time, which
is comparable to 63% on average for all other
professions having qualified and licensed members
of their professions. This means that the potential
employee recruitment pool is smaller than other
professions and poses greater recruitment and
staffing issues.
Geographic distribution continues to be an
important issue in Idaho. In 2018 it was identified
that 6,495 RNs lived in rural areas of Idaho. In 2020
that number had further reduced and in 2022 only
4,558 RNs live in rural Idaho. This is a loss of 1,921
RNs from rural communities. The greatest number
of RNs report employment in Boise, Meridian or
** Border states with Idaho. Washington has the most residents working in Idaho, commonly in Lewiston,
Moscow and Coeur d’Alene.
Nampa representing 48.4% of all RNs. Although,
compared to 2020, Boise has 110 fewer RNs
working.
How many RNs does Idaho need? There is a
national statistic to determine need. In the United
States it is 10.6 RNs per 1,000 population. Idaho
has a growing population (Dec 2021 reported as
18,620,123) that is the result of adults moving into
Idaho from other states, compared to some other
states, like Utah, that has a population increase
due to birth rate. This older population in-migration
adds an increased demand on the healthcare
system, and a further demand has been added
because many of these new citizens bring one or
more elderly parents to Idaho within 18 months of
their own re-location. Using census numbers alone,
Idaho has a deficit of 1,119 RNs.
In addition to the need calculation based
on census, the need number from expected
retirements must also be calculated. For RNs there
are 3,464 age 56-65 years and 1,731 are 65 years
or older and they can be expected to retire at the
regular retirement age of 66, thus beginning within
a year. This represents 28% of the RN workforce.
For LPNs, there are 679 who are 56-65 years
and 306 greater than age 65 years, representing
31% of the LPN workforce. This will further
add to the significant shortage of LPNs that is
exacerbated because this group has not historically
been a mobile workforce that relocates for a job.
Today, most LPNs have the same address and zip
code that they have had in previous years of the
report.
2022 RN ratio per 1,000 Population
Idaho actual
Idaho Target
based on
census
Deficit number
RNs
2022 Idaho
projected
population
(reported
Dec 21)
1,860,123
2022
Number
RNs
RNs Per
1000
population
18,650 9.97
19,769
1,119
10.6
national
standard
Nursing education outputs of new graduate
nurses in Idaho has remained stagnant for more
than 20 years at 775-825 annual graduates. The
state needs more than 1,000 annual graduates to
meet current needs. There are two basic problems
that prevent an increase in student numbers,
and they have been presented to the Idaho State
Board of Education and to Idaho Legislators
multiple times without any action. First, to increase
the number of students we need to increase
the number of nursing faculty. This can only be
accomplished by paying nurse faculty salaries
that compete with the private sector, and as long
as the private sector-namely hospitals-pays more,
and usually significantly more, then they will get the
nurses. This concept seems to evade those who

August, September, October 2022 RN Idaho • Page 5
have control over funding. To assist with increasing
the number of students, hospitals and schools
have implemented some mitigation strategies.
Hospitals, for their part, have attempted to enter
into relationships with schools whereby qualified
hospital nursing staff can be relieved of clinical
duties to teach students in the facility. Schools
have implemented some admission preferences to
Idaho residents who will add to the Idaho nursing
workforce versus admitting out of state students.
Second, the number of clinical sites in Idaho is
limited and needs to be increased. It is difficult in
a small rural state to have clinical sites that can
accommodate only one or two students because
that requires a faculty compared to one faculty
covering 10 students in a hospital.
Because of faculty and clinical site limitations,
bringing additional education programs into Idaho
to educate nurses is oftentimes considered to
be a quick fix, but it is problematic. History, over
the past 20 years, demonstrates that when new
programs open in Idaho, they compete for current
clinical faculty and often times hire nurses away
from state schools or hospitals. They also compete
for the existing clinical sites. The end result has
been more schools, more competition for faculty,
more competition for clinical sites and no more
graduates than we have ever had.
Another component of the workforce report is
the information that nurses reported voluntarily.
The ICN used a SurveyMonkey tool to query
nurses. The access was marketed using the weekly
Nursing Flash for eight weeks. For RNs, out of
18,650 potential responses we received 7,128,
representing a 38% response rate. Results were
similar to previous surveys with two predominant
exceptions. Only 41% of RNs reported that they
currently worked in a hospital. This is consistent
with national trends which show a decrease of RN
hospital employment from the 64% in 2010. There
was an unexpected response to the question, “If
you are unemployed or seeking to change your
nursing job, what employment sector would you
choose?” Only 14% of nurses said they would
consider a hospital as among their top three
choices. This is a significant red flag for Idaho
hospitals.
Other issues were also identified. Affordable
housing in Ada and Canyon counties is a barrier
for nurses to relocate because the salaries are not
supportive of higher rents or purchase prices, and
this is coupled with the limitations on schools and
daycare for their children.
In summary, the take-away findings from the
2022 Idaho Nursing Workforce Report are that
we have a significant current nursing shortage of
both RNs and LPNs and there is no evidence that
this will change in the near future. Barriers that
would facilitate an increase in students and thus
more new graduates continue unresolved. The
most often identified barriers are non-competitive
nursing faculty salaries and limited clinical sites.
Two main issues are driving the demand for
nurses. They are Idaho’s fast-growing census
of older adults who experience more healthcare
needs than younger people, and an aging
incumbent nurse workforce that represents 30%
of Idaho nurses and who are within a few years of
retirement.
Idaho cannot rely on an in-migration of
nurses from other states to meet the staffing
requirements. We may recruit some, but we will
not recruit anywhere near our statewide need of
more than 1,100 vacancies today. Our surrounding
states all have significant nurse shortages also,
and most pay more money than Idaho and do not
have as tight of a housing market. Idaho policy
makers must work with nurse leaders and other
stakeholders to address how Idaho can fix this
problem with a grow our own nurse strategy that is
adequately funded.
The Idaho Center for Nursing will continue to
share this data and to engage policy makers as a
means to affect change. The full report is available
on the ICN website at: Idaho biennial Nursing
Workforce Report-June 2022 | Idaho Center for
Nursing | Nursing Network
FEATURE
Exploring Hand Hygiene Expectations
for NICU Nursing Staff
Megyn Flood, MSN-ED, BSN, RNC-NIC1, Hillary
E. Swann-Thomsen, PhD2
¹St. Luke’s Health System Neonatal Intensive
Care Unit, Nampa, ID 83687
2
St. Luke’s Health System Applied Research
Division, Boise, ID 83712
Nurses in the NICU provide life-saving care to
one of the youngest and most vulnerable of patient
populations. These infants are often at increased risk
of infections, particularly antibiotic-resistant infections,
because of their underdeveloped immune systems,
closeness to other ill infants, necessity of invasive
procedures such as intravenous catheter placement,
and increased contact with NICU staff who may
inadvertently carry pathogens between patients
(Sekar, 2010; Collins, Weitkamp, & Wynn, 2008; Lam,
2004;). Infections in the NICU can result in poor clinical
and non-clinical outcomes for both the infants and
their families (Różańska, 2015; Cotten, 2016; Tzialla
et al., 2012; Roque, Lasiuk, Radünz, & Hegadoren,
2017; Beck, 2003; Lakshmanan et al., 2017). The wellbeing
of these vulnerable infants relies on lowering
the occurrence rate and spread of infection in the
NICU. A key to infection prevention is proper hand
hygiene practices, but compliance among healthcare
providers is problematically low. In addition, there
is inconsistency and variability in hospital policies
regarding hand hygiene expectations for staff and
visitors, including patient families. We found through
an informal examination of several children’s hospital
websites within the United States that policy and
guidelines for hand hygiene ranged from a 30-second
wash to a two-minute surgical scrub, and in fact, one
hospital did not indicate any set time for hand washing.
Boise
Dean Bigelow
Robert Botkin
Andrea Campbell
Gloria Chavier
Debbie Demint
Ashley Duvall
Rosemary Gold
Brett Gustafson
Mary Kaye Jenks
Sara Palma
Ruth See
Buhl
Ashley Taylor
Caldwell
Laura Killion
Jenny Selby
Coeur D’Alene
Rachel Pottenger
Driggs
Susan Clarke
Eagle
John Carr
Filer
Stephaney Osburne
Firth
Maeleigh Dye
Garden City
Reilly Christenson
Grangeville
Margretta Fortin
Hailey
Shelly Abell
Idaho Falls
Elizabeth Breidenbaugh
Marianne Nelson
Benjamin Pixton
Alice Teasdale
Juliaetta
Suzie Wright
Kendrick
Lindsay Schmidt
Kimberly
Nadine Eaton
Jeanine Stefani
Kuna
Elizabeth Furlong
Amanda Franks
Phil Okuyama
There is limited research to offer an evidencebased
approach to hand hygiene policy for NICU staff
and visitors. This lack of clarity allows for variation in
the understanding of expectations and practices
within the NICU which can result in inconsistent
hand hygiene methods for staff and can also lead to
nursing staff providing ambiguous and capricious
recommendations to NICU families. All of this can
increase the risk of negative outcomes for these
susceptible infants. The purpose of this study was to
evaluate the knowledge and understanding among
NICU nurses to identify inconsistencies in hand
hygiene expectations within the NICU setting.
Methods and Results
RNs providing care to NICU patients in a multisite
health system in Idaho were recruited to complete
an anonymous survey about their knowledge and
understanding of NICU hand hygiene policy. All
respondents provided an acknowledgement of
consent prior to completing the survey. A total of 63
NICU RNs responded to the survey, however, 21
respondents either did not complete the survey or
were ineligible and were excluded from analyses. The
findings for the remaining respondents (N=42) are
described here. Respondents were asked questions
about their employment length, location, and their
understanding of expectations for hand hygiene for
both nursing staff and parents. All study procedures
were reviewed and approved by the organization’s
Institutional Review Board.
Lewiston
Margaret Klemp
McCall
Tim Dorsey
Meridian
Dawn Swick
Moscow
Stephanie Voss
Nampa
Abigail Frakes
Alivia Miller
Christina Remaly
Naples
Marie Atkins
Pingree
Teiah Truman
Exploring Hand Hygiene continued on page 6
ANA Idaho Welcomes New & Returning Members
Apr-Jun, 2022
Pocatello
Megan Burnham
Kathy Musetti
Post Falls
Carrie McLaughlin
Preston
Terin Sessions
Rathdrum
Amber Whitehead
Rexburg
Melisa Robinson
Sagle
Yvonne Moran
Salmon
Sarah White
Star
Jana Murphy

Page 6 • RN Idaho August, September, October 2022
Exploring Hand Hygiene continued from page 5
Most RNs (n=31) were employed at one of the three NICU campuses within the
health system. Half of the respondents had worked in the NICU for five years of
more (n=21), 40% for two to four years (n=17), and 10% for a year or less (n=4).
Among the RNs, we found four themes describing their understanding of hand
hygiene policy for both NICU nursing staff: when hand hygiene occurred, the limb
coverage included, how hand hygiene should occur, and duration of hand hygiene.
Most RNs reported that hand hygiene should occur when entering the NICU
(n=40), entering and exiting patient areas (n=31), and after patient care (n=32). Only
five RNs listed that hand hygiene should occur as part of the CDC’s five moments
of hand hygiene—nor did the majority of respondents list these as separate points
of hand hygiene. Half of respondents shared that hand hygiene should occur
any time hands were soiled (n=21) and before patient care (n=23). Responses
also included between patient care (n=14), after touching personal belongings
(n=11), and after doffing gloves (n=17). Most respondents listed hands as the limb
coverage for hand hygiene practices (n=24) with 29% of respondents should
include up the elbows (n=12). Importantly, 17% of respondents did not include
what limb coverage should be included in hand hygiene practices for nursing staff.
We also found that the majority RN respondents (n=31) did not include a specific
cleanser in their response (i.e., hand sanitizer or soap). However, 34 respondents
did include that RNs should scrub their hands (or other indicated limb coverage),
suggesting that the implied cleanser would be soap versus hand sanitizer. Out of
the 42 respondents, most stated that hand hygiene should last for two minutes
(n=31) however the remaining respondents (n=11) did not include a duration in their
response.
The same themes were identified for RN understanding of hand hygiene
expectations for parents and families of NICU patients—when hand hygiene
occurred, limb coverage included, how hand hygiene occurred, and duration
of hand hygiene. Similar to RN hand hygiene policy, many participants indicated
that parents should practice hand hygiene when entering the NICU (n=32).
Respondents also included hand hygiene before (n=25) and after (n=31) patient
care, which included activities such as diaper changes, feeding or touching their
infant. Interestingly, respondents included that parents/families should clean their
cell phones regularly (n=10). Again, the majority of respondents did not include
what limb coverage should be included as part of hand hygiene (n=20) with only
16 respondents stating that hands should be included in hand hygiene practices
and seven stating up to elbows for limb coverage. Similarly, we also found that
To access electronic copies
of RN Idaho, please visit
http://www.NursingALD.com/
publications
respondents did not specify what type of cleanser should be used by parents and
families with only 11 respondents including the type of cleanser (soap and water,
n=2; sanitizer, n=9). The majority of respondents included that the duration should
be for two minutes (n=24), however, 16 respondents did not include a duration.
Discussion
This study provides insight into the current understanding of hand hygiene
expectations within the NICU setting while lacking a clearly written policy. Overall,
the themes and patterns identified in RN knowledge and expectations were
consistently identified by NICU RNs for NICU staff as well as patient visitors
with some notable differences. Increased clarity in expectations may increase
compliance, which contributes to overall better infection prevention. Additionally,
further clarity for both staff and visitors regarding the routine cleaning of personal
belongings, (particularly cell phones) to prevent these items from becoming
vectors for infections would be advantageous. Despite recommendations on hand
hygiene guidelines from both the CDC and the WHO, there remain substantial
variations in NICU hand hygiene policies across the United States. When caring
for at-risk populations, it is important to use clear, consistent, and evidencebased
approaches to guide our bedside procedures. For NICU infants, this means
ensuring that we dutifully comply with consistent hand hygiene practices. These
expectations should be clearly outlined in health system policy rather than relying
on our tribal knowledge. These results represent an opportunity for us to develop
consistent messaging for NICU RNs and families. It is the recommendation of
the authors that there be a universally adopted and explicitly stated expectation
regarding hand hygiene in the NICU setting applicable to NICU staff as well as
visitors throughout each health care system in which a NICU operates.
Acknowledgements
The authors wish to acknowledge the support of the Institute of Translational
Health Sciences (Grant Support UL1 TR002319, KL2 TR002317, and TL1
TR002318 from NCATS/NIH). The authors would also like to thank Kelly Graff
for her contributions to study design and data analysis and Laura Tivis for her
contributions to study design and review of previous manuscript drafts.
Declaration of Conflicting Interests: The authors have no financial
disclosures or competing interests to declare.
References
Collins, A., Weitkamp, J. H., & Wynn, J. L. (2018). Why are preterm newborns at increased
risk of infection?. Archives of Disease in Childhood-Fetal and Neonatal Edition, 103(4),
F391-F394. https://doi.org/10.1136/archdischild-2017-313595
Cotten, C. M. (2016). Adverse consequences of neonatal antibiotic exposure. Current
Opinion in Pediatrics, 28(2), 141. https://doi.org/10.1097/MOP.0000000000000338
Lakshmanan, A., Agni, M., Lieu, T., Fleegler, E., Kipke, M., Friedlich, P. S., ... & Belfort, M.
B. (2017). The impact of preterm birth< 37 weeks on parents and families: a crosssectional
study in the 2 years after discharge from the neonatal intensive care unit.
Health and Quality of Life Outcomes, 15(1), 1-13. https://doi.org/10.1186/s12955-017-
0602-3
Lam, B. C., Lee, J., & Lau, Y. L. (2004). Hand hygiene practices in a neonatal intensive care
unit: a multimodal intervention and impact on nosocomial infection. Pediatrics, 114(5),
e565-e571. https://doi.org/10.1542/peds.2004-1107
Roque, A. T. F., Lasiuk, G. C., Radünz, V., & Hegadoren, K. (2017). Scoping review of the
mental health of parents of infants in the NICU. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 46(4), 576-587. https://doi.org/10.1016/j.jogn.2017.02.005
Różańska, A., Wójkowska-Mach, J., Adamski, P., Borszewska-Kornacka, M., Gulczyńska,
E., Nowiczewski, M., ... & Bulanda, M. (2015). Infections and risk-adjusted length of
stay and hospital mortality in Polish Neonatology Intensive Care Units. International
Journal of Infectious Diseases, 35, 87-92. https://doi.org/10.1016/j.ijid.2015.04.017
Sekar, K. C. (2010). Iatrogenic complications in the neonatal intensive care unit. Journal of
Perinatology, 30(1), S51-S56. https://doi.org/10.1038/jp.2010.102
Tzialla, C., Borghesi, A., Perotti, G. F., Garofoli, F., Manzoni, P., & Stronati, M. (2012). Use and
misuse of antibiotics in the neonatal intensive care unit. The Journal of Maternal-Fetal
& Neonatal Medicine, 25(sup4), 27-29. https://doi.org/10.3109/14767058.2012.714987
Corresponding Author Contact Information:
Hillary E. Swann-Thomsen, PhD
Applied Research Division, St. Luke’s Health System
701 E. Morrison Knudsen Drive, Boise, ID 83712, US
swannthoh@slhs.org
Idaho Sound Beginnings
Early Hearing Detection &
Intervention (EHDI)
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but hearing problems can be detected
in the first months of life.
The reason to screen is to intervene!
For more information, please call
Idaho Sound Beginnings at (208) 334-0829 or
at www.IdahoSoundBeginnings.dhw.idaho.gov

August, September, October 2022 RN Idaho • Page 7
BOARD OF NURSING REPORT
Zero Based Regulation and the Impact on the Board of Nursing
Zero Based Regulation (ZBR) was the first executive order of 2020 signed by
Governor Little on January 16th. The order details a process by which every state
agency will undertake a systematic review of its rules chapters. While aligned
to the Licensure Freedom Act and Red Tape Reduction Act, ZBR differs in that
it begins from a “zero base” point. In other words, it is a complete repeal and
replace of the current rules chapter. The process requires the use and publication
of a prospective analysis that evaluates the legal authority of each rule, the
legislative intent of it, and compares Idaho’s approach to that of neighboring states,
Alaska and South Dakota among other elements. The goal of the ZBR process
is to ensure the rules in place have both the legal authority and provide the “right
touch” of regulation to protect the public.
The Idaho Board of Nursing is currently undertaking the ZBR process. Of the
major health professions, the current rule chapter of the Board of Nursing contains
forty-one pages. Medicine, by comparison, has only eleven pages and pharmacy
has twenty-three pages. Due to the length of the rule chapter a systematic
approach is being utilized to divide the rule chapter into four portions. One of the
four portions is brought before the board at the beginning of each meeting. The
strategy for rules review for nursing is to scrutinize a portion of the rules chapter
for discussion at each meeting. The board will then discuss each topic, review
evidence, and analyze prospective analysis information. The board will provide
staff with direction and in turn staff will wordsmith in between each meeting. This
process will extend through the summer and into the fall in preparation for the 2023
legislative session.
The Board first reviewed continuing education then nursing education. The
continuing education discussion centered around whether it should by continued
for RN’s and LPN’s. For nursing education, the implementation of national
accreditation requirement for nursing education programs was contemplated.
Next the board reviewed the definitions sections, licensure requirements and
finally discipline. Each definition was reviewed from the perspectives of its use
in rule, duplication in statute, and if the word is universally understood. Licensure
requirements were reviewed for alignment with the Nurse Practice Act as well as
the Occupational Licensure Reform Act. Of particular interest is the use of nurse
apprentices, student nurses, and unlicensed assistive personnel in this section.
Discipline rules were analyzed for duplication within statute and whether the rule
was aligned with the Administrative Procedure Act. The remaining sections will be
reviewed by the board at upcoming meetings.
The ZBR process requires boards and agencies to actively collaborate with
stakeholders. Currently, the board is seeking input through formal hearings as
well as open public board meetings. Interested groups of stakeholders may also
request informal hearing opportunities with board staff to discuss the rule changes
the board is considering. The public hearing dates are July 11, July 20 and Aug 10,
2022. The upcoming board meetings are scheduled for Aug 11 and November 3,
2022. If unable to attend a hearing or board meeting written comments are being
accepted at this time. If interested in reviewing proposed rule changes, a copy can
be found on the DOPL website and will be posted along with the agenda for each
of the publicly noticed meetings. We hope all will carefully consider the changes
and provide their thoughts and perspectives to the board over the coming weeks.
On a separate note, the Board of Nursing has moved.
The new location is on the
State of Idaho - Chinden Campus. The address is
11341 W. Chinden, Boise, ID 83713.

Page 8 • RN Idaho August, September, October 2022
EXECUTIVE DIRECTOR REPORT
Idaho Center for Nursing Celebrates Five Years…Will We Sustain It?
Randall Hudspeth PhD, MBA, MS, APRN-CNP, FAANP
Executive Director, Idaho Center for Nursing
randhuds@msn.com
In August the Idaho Center for Nursing (ICN) will mark
five years since it evolved from the former Idaho Alliance
of Leaders in Nursing. The focus of ICN’s work is to
elevate the status of nursing in Idaho through increased
public awareness and interactions, to leverage nurses and
nursing causes to better the healthcare of all Idahoans,
to provide a framework to sustain the many and varied
nursing organizations in Idaho, and to impact public policy
for the betterment of healthcare in general and for nurses.
The background of the ICN is based on the
consolidation in 2003 of the former Idaho Organization
of Nurse Executives (IONE) and the Idaho Commission Randall Hudspeth
on Nursing and Nursing Education that was formed by
Governor Robert Smylie in the 1960’s to address how a more connected nursing
education system in Idaho could help solve the nursing shortage of the time. These
two small groups felt that by affiliating they could better impact nursing in Idaho.
The initial work of the IALN was the management of grants using money allocated
by the Dept of Health and Welfare from excess Medicaid upper payment limit
funds. Those monies were distributed to nursing projects that impacted quality of
care mostly in critical access hospitals across Idaho. That money ceased in 2009.
At about the same time, the laws governing what tax-exempt organizations
could do changed. It became necessary for membership organizations that
utilized lobbying activities for their causes to form a different tax-exempt status.
Thus the 501c3 IALN became different than the newly formed Nurse Leaders of
Idaho that was a 501c6 organization. IALN had limited funding and no members.
Under then executive director Margaret Henbest, a Robert Wood Johnson
Foundation grant was secured that focused on implementing the Institute
of Medicine Future of Nursing recommendations (IOM, 2010). That brought
a large amount of money to IALN that was used over five years to implement
many programs in Idaho that we benefit from to this day. By the time that the
RWJF grant funds terminated not all of the goals had been achieved, although
of the 29 states that received the grants, Idaho was the leader in successful
implementation. To maintain the momentum, the Idaho Board of Nursing agreed
to be a five-year sponsor for 2017 through 2022.
What were the successful outcomes from this investment? A national
goal was to achieve an 80% BSN nursing workforce by 2025. In 2013 Idaho
was at 57%. Today we are at 78.9% BSN because the associations worked
together to support and sustain effective articulation agreements, supported
RN to BSN through degree completion and concurrent enrollment programs.
Idaho is the national leader. RN IDAHO is a nationally recognized peer revied
publication that goes to every Idaho nurse without a charge. The same is true
with the weekly Nursing Flash update. The Idaho Nurses Fund has sponsored
scholarships for nursing students and graduate project funding. Practice
barriers for APRNs have been removed and a big success was global signature
legislation that NPI facilitated.
Looking to the future and evaluating the issues that Idaho based membership
nursing organizations were having at the time in terms of member sustainability,
costs of running an organization and that many organizations had the same
members and many of the same goals, the IALN re-focused its work to nursing
organization sustainability and how to impact public policy through nursing that
would better the healthcare of Idahoans. Wanting to re-focus on nursing beyond
only those nurses who were in leadership roles, the decision to rename the
organization was taken and the Idaho Center for Nursing evolved.
In 2018, the American Nurses Association of Idaho decided to bring the physical
operations of the former Idaho Nurses Association (INA) back to the state. Solely
because of the cost to maintain a nursing membership organization, the INA had
opted to use an organizational management company, first in Georgia and later the
Arizona Nurses Association. But membership had increased, and they were able to
fund an Idaho return. But they needed a home. This prompted the ICN to develop
an entire program on member organization management as one of its business
operational activities.
Today many Idaho nursing professional organizations are affiliated with the ICN.
As an affiliated organization they can choose what services that are offered by ICN
they want to utilize with the understanding that each organization pays the cost of
the service on a proportional basis, without any cost escalation for any profits by
the ICN. ICN offers (1) a physical office, (2) secretarial support, (3) telephone and
message services, (3) mail management, (4) financial management in terms of bill
pay, bookkeeping, audit, tax filing, CPA services, (5) liability insurances for directors
and officers, (6) event management and event insurance, (6) website management,
(7) communication opportunities through RN IDAHO and the weekly Nursing Flash,
(8) Executive Director support, (9) advocacy and lobby services, (10) paid programs
such as SurveyMonkey and Zoom, (11) a learning management system for ondemand
continuing education (CE) from the organizations, as well as (12) providing
any program supports that an organization might need and the ICN has a potential
to assist with.
Each of the nursing organizations that have affiliated with ICN and that have
used the services that are offered have benefitted. Organizational operational costs
have been reduced as much as two-thirds in most cases. This has positioned the
organizations to be sustainable and solvent. However, this benefit has not been
easily recognized or appreciated by the general nursing population. Organizations
run on membership dues, and membership is a problem in Idaho just as it is in
every state. Out of 18,650 licensed RNs who are Idaho residents, only around
2,500 are engaged with a professional association as a dues paying member.
All organizations probably need to focus on a better answer to the question
asked by most nurses, “What do I get out of membership?” Here is what I know
specifically. In 2021 more than 1,000 nurses used the CE offering to meet their
license renewal requirements. All Nurse Practitioners benefitted from the efforts of
Nurse Practitioners of Idaho at the legislature to get a Medicaid Reimbursement
Rate increase for NPs, even though all 1,707 Idaho NPs will benefit, only 228
actually are members of the association that supported and funded getting this
bill passed. Each year the associations work to protect the current law that makes
workplace violence against nurses a felony in Idaho. The is continually challenged
by disability rights groups. We lobby for better funding to nursing education
programs because we know that funding faculty is a primary need to increase
enrollments and to address the nursing shortage. The associations are the “go-to”
nurse groups for public policy makers, the governor’s office, legislators, and other
associations the feel nursing input is important to be heard. These efforts continue
to evidence that the vast majority of nurses reap benefits that result from the efforts
and dues paid by the minority.
Without a doubt the nursing professional groups in Idaho have greatly
benefitted from the Idaho Center for Nursing. But its sustainability, like
the sustainability of all membership organizations, depends on the nurses
themselves and their willingness to join and pay dues in their own organizations.
I encourage each of you to seriously evaluate your professional engagement and
to strongly consider joining the Idaho professional association that best reflects
your career, and for staff nurses that is membership in the American Nurses
Association of Idaho.

August, September, October 2022 RN Idaho • Page 9
Madison Memorial’s Journey to Pathway Designation
Renae Snyder BSN, RN
Three years ago, March 2019, my husband and I
moved to eastern Idaho, where I began my new job
as Director of Perioperative Services for Madison
Memorial Hospital and Surgery Center, in Rexburg,
ID. Little did I know at the time that within seven
months I’d be serving as the chair of the hospital’s
newly-created Pathway to Excellence (PTE)
Committee.
When the invitation came out asking for volunteers
to participate in the Pathway to Excellence
committee, there was some hesitation. So, I did
some research on PTE to get a better understanding Renae Snyder
as to what it stood for and what kind of commitment
would be involved. I learned that the PTE designation is nurse-focused and
evidence-based for a positive practice environment. I happily replied to the
request as a volunteer for the committee.
In September 2019 the PTE committee met for our initial meeting; our
commitment to our PTE journey had begun. The magnitude of this project
became clear, as did the need for increased committee structure. The PTE
committee needed to identify a chair, co-chair, and lead for each standard
along with direct-care nurse volunteers to participate with each standard.
With the structure in place, our first order of business was to perform a gap
analysis to help identify our strengths and weaknesses.
With our gap analysis completed, we reviewed our assessments and
initially focused on our areas of improvement. We met monthly after that,
brainstorming and charting our progress, building on our positives, mapping
out the necessary changes, and planning our strategy. Not only did our
performance have to match the PTE requirements; we also had to supply
verifiable evidence that we were, in fact, actually meeting them. Little did
we know, 4 months into our journey towards PTE, we would be met with
the challenges of Covid-19. However, we chose to move forward, working
towards providing staff a place of safety, wellness, leadership, quality,
shared decision-making and professional development as a testament to
the pathway framework. Looking back, it was the right decision.
Our theme, based in part on our physical proximity to Grand Teton
National Park, was mountaineering. The goal of achieving PTE designation
was likened to arriving at the summit of the highest peak. With the deadline
for submission quickly approaching, our PTE team approved the final
documents; we had reached the summit. We gathered the committee in
celebration as we formally submitted our documents on November 1st, 2021.
I felt a sense of relief. All the hard work that our committee members did in
gathering information, reading and re-reading standards, and scrutinizing the
materials for weaknesses, inaccuracies or mistakes, was over.
After our submission was reviewed by three PTE appraisers, we were
asked to provide additional information on seven of the 58 elements of
performance (EOP’s). We met again with the team leads and nurses to
address the needed updates, and resubmitted the documents within one
week. Once our documents with the updates were approved, our nursing
staff participated in an anonymous survey, validating our submission
documents. Greater than 50% of the respondent had positive responses to
each survey statements and greater than 75% had favorable responses to
21 of the 28 statements.
On April 18th, 2022 we once again gathered in celebration as we were
informed that the survey results exceeded the Pathway requirement and we
became the first organization in Idaho to achieve the Pathway to Excellence
designation.
Corresponding Author:
Renae Snyder, BSN, RN
Director of Perioperative Services
Madison Memorial Hospital
450 E. Main St.
Rexburg, ID 83440

Page 10 • RN Idaho August, September, October 2022
IDAHO NURSING
AWARDS AND
RECOGNITIONS
RN Idaho recognizes nurses who make significant contributions to the advancement of nursing from the
bedside to the boardroom. We are extremely proud of Idaho Nurses and congratulate you for the positive
effect you have on patient and professional outcomes!
DAISY AWARD RECIPIENTS
Amy Buckley
West Valley Medical Center
Caldwell
A special #DaisyAward this #NursesWeek. A patient,
Katie, nominated her nurse, Amy, to receive the award
after a difficult delivery. “You often hear how nurses are
superheroes but she’s much more than that to me. She
was my advocate, my comforter, my supporter.”
Katie says Amy was there for her and her husband
during a very difficult delivery and even came to check
on them the next day on her day off. “She was so
patient and loving.”
“She is someone who has impacted my life for the
better in many ways...we were truly blessed with the
best and it’s something we will never forget.”
Sara Moody
West Valley Medical Center
Caldwell
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Congrats to Sara, another #DaisyAward recipient.
Sara is a nurse with our Case Management team.
She recently made sure a patient and their family felt
supported during a very difficult time.
“Sara’s actions were above and beyond and really
brought some light to a sad and unexpected situation.”
Thank you, Sara for all you did for this family and for all
that you do day in and day out for every family that you
come in contact with.
Denise Mariner
Eastern Idaho Regional Medical Center
Idaho Falls
She is the heart and soul
of this department. There
are so many different
situations where she has
made an impact on
patients being treated for
cancer. She goes way
out of her way to help our
patients during one of the
hardest times of their
lives. She takes time to
talk with people and gets
to work with her. I have
yet to meet a patient who does not love her. She
has a magnetic personality. She is always so
happy and cheerful. She is one of the hardest
working people I have ever come across in the 17
years I have been a nurse. I have heard multiple
patients say how much they love her and are so
grateful for her help. Being treated for cancer is
one of the scariest times in a person’s life. She
supports people in their lowest of times and is their
cheerleader when they need it. She is the epitome
of an extraordinary nurse. She deserves the Daisy
Award for her kindness, strength and compassion.
She is one of a kind and I am so lucky to be able to
with her. - Courtney Kelsch, RN
She is the most caring nurse for me since my
cancer began in 2011. She listens to any problems
and is such a happy and friendly person. - Patient
nomination
This one time I went to see the doctor and his
nurse came to talk to me. I was feeling really
down and depressed and sick. She took the
time to encourage me, uplift me and pray with
me. She showed me extra care, compassion and
understanding. Thank you. - Patient nomination
She is always smiling and very comforting
to see. She always makes sure my client
understands why she is there and what is going
on all the time. All in all, she is a real true gem. -
Caregiver nomination
Vanessa Telford
Eastern Idaho Regional Medical Center
Idaho Falls
I was moved from the ED
to the PCU because after
being treated for COVID
with regimen, my heart
went into Afib and my
heart rate went to 175.
They could not get it
down so I was admitted
to the PCU where I was
assigned to her.
Right from the start
I knew I was in good
hands. She got me
settled in and explained to me about the care I was to
be given in detail, how exactly they planned to address
my heart issues and continue COVID treatment.
All evening and night long I never felt alone. She
was right here when I needed her with her soft and
gentle mannerism.
During the night she came in and needed to put in
a second IV. I told her that I am an extremely hard
stick and I was scared. I remember how slowly,
carefully and gently she stroked both my arms. To my
amazement and joy she inserted the IV on the first try.
Unheard of.
When done and she was about to leave, I told her
I was beginning to lose hope. She came to the other
side of my bed to encourage me not to do that. She
assured me that I was going to be alright. Her calming
voice and her warmth of personality touched my heart
and gave me the reassurance I needed. I needed her.
She needs to be acknowledged.
Thank you and God Bless you.
Leigh Short
Eastern Idaho Regional Medical Center
Idaho Falls
When I had my labor
scare, Leigh was my
nurse and gave amazing
care when I told her that
at 17 years old, I wanted a
natural birth. She was one
of the first to support it
and make me feel my
decision wasn’t wrong
and even told me she
would give me birthing
classes.
I almost switched
hospitals until that day, when she proved that I would
get amazing support and care where I was. When it
came time to have my baby, I went through with the
natural birth and was very happy with the decision.
She wasn’t just a nurse, but an inspirational support.
Audrey Krahn
St. Joseph’s Regional Medical Center
Lewiston

August, September, October 2022 RN Idaho • Page 11
Audrey is always willing to
help wherever and
whenever she’s needed
and does so with a smile
on her face. While covering
a shift for an ill coworker,
Audrey was in the right
place at the right time for a
patient who needed her,
and this patient wanted to
recognize her for the role
she had in his care at St.
Joe’s.
The patient wrote that he was scared and anxious,
but with Audrey’s specific step-by-step explanations,
encouragement and comfort, he was able to be more
at ease, trusting that she would ensure he received
great care. And, he is truly grateful, sharing that he will
not soon forget her name nor her competence and the
way he felt genuinely cared for. He added, “I did quite
a bit of praying that God would watch over me during
this. He sent Audrey.”
Audrey is a shining example of the difference nurses
make in the lives of patients. Thanks, Audrey, for
taking such great care of our patients, and doing so
with compassion and kindness.
Kassie Wilson
St. Luke’s Hospital
Nampa
Kassie cared for me
when I delivered triplets in
October and two were in
the Nampa NICU. Two
weeks postpartum, I
developed pre-eclampsia
and was admitted myself
on magnesium. My
husband was at home
taking care of our two
toddlers and the other
newborn triplet, so I was
alone in the hospital.
Kassie was caring for my babies in the NICU and went
above and beyond to take me back and forth to the
NICU and include me in cares. She advocated for me
to be able to come visit, even while on mag, and took
responsibility for watching over me while in the NICU.
She always let me know what was going on with the
babies and even would call me at home to update me
on little things about the babies after I went home. She
coordinated cares for me to participate in and just took
outstanding care of our two NICU babies.
Viktoriya Vorozhko
St. Luke’s Hospital
Nampa
I arrived in the maternity
ward the late morning of
Tuesday 5 April 2022. I
had given birth via
c-section in the main O.R.
due to placenta previa and
placenta previa conditions.
I also underwent a
hysterectomy as a result.
From the moment we
arrived in the maternity
ward, Viktoriya came right
in and introduced herself.
She has a very welcoming and genuine personality.
Because of the extent of my surgery, I was laid up and
felt useless, which I’m not used to. Viktoriya assisted in
everything I or my baby needed and if I wanted to do it
on my own, she was right there to help. She also truly
loves her job, and it shows. The care she showed
my baby was amazing. She also took the time to give
me a refresher on infant CPR. I am a radar technician in
the U.S. Air Force, so we get certified in CPR every
couple of years. However, we don’t cover children and
infant in detail for obvious reasons. She took the time to
give me a refresher on how to help my baby if she
needs it. I can’t say enough good things about how she
treated us during our stay.
Tauna Egan
Madison Memorial Hospital
Rexburg
Today I watched Tauna
comfort and quietly hug
the wife of a patient who
had passed away in the
ER. She didn’t say a
word. Her embrace said it
all! As someone who
struggles with hugs/
human contact, I could
feel the love and strength
that she was giving this
heartbroken wife. Tauna is
an amazing nurse! She is
tough as nails with the heart of an angel! When I grow
up, I want to be just like Nurse Tauna!!! In an
environment where kindness is oftentimes viewed as a
weakness, I am honored to have witnessed such love
and kindness being shown. This is what TRUE nursing
entails! I am grateful to have worked with Tauna!
NURSING EXCELLENCE
Eastern Idaho Regional Medical Center
Idaho Falls
Sharee Poole, HCA Healthcare Excellence in Nursing,
Compassionate Care Award. Given to a nurse who
demonstrates exceptional nursing knowledge and expert
skills and consistently applies both with compassion and
integrity so that the quality of the care experience and the
care outcomes are improved for patients.
“Sharee is an exceptional
nurse and beautiful human
being. She is ALWAYS
willing to lend a hand to
anyone in need of help.
Her patients adore her and
find her care to be
compassionate,
professional and proficient.
She displays integrity and
is always advocating for
her patients…. She has
changed patient’s lives,
coworker’s lives, and my life. She is an exceptional
example of excellence.”
“Sharee is a beacon of knowledge, calmness
in the storm, and caring nature. Staff refer to her
as Mama Bear, including staff in other units. The
patients always give her the highest praise and
she goes out of her way to provide them with
exceptional care.”
“Sharee Poole deserves to be recognized for
excellence in nursing because she is the heart of EIRMC.”
“She is an exceptional nurse, charge nurse, mentor
and peer. We are so grateful she works with us.”
Kristi Caldera, HCA Healthcare Excellence in Nursing,
Professional Mentoring Award. Given to a nurse who
advances nursing practice in any clinical setting or
nursing specialty by guiding or supporting career
development for individuals or groups of nurses, or by
advancing evidence-based nursing knowledge.
“Kristi unifies our two
departments, promoting
education and collaboration.
Our nurses are included in
critical care education
classes, sitting beside ICU
nurses. Before Kristi took
over the fourth floor as
director, the morale was low
and staffing was sparse.
The work her team put in
grew our floor where
people want to work here,
new grads ask to start on our floor. We carried some of
the heaviest load during Covid, yet remain one of the best
staffed floors in the hospital.”
“Her years of critical care experience have made her
an asset in so many ways. She quite literally helps every
manager of every department. We all look up to her!
She understands all the ins and outs of every program,
meeting, and dynamic that we face as leaders here at
EIRMC. She is the mentor of mentors and she does it all
with complete humility. She is not afraid to jump in and
help on any unit at a moment’s notice.”
“EIRMC has had a turnover in nursing administration,
and Kristi stepped up to be an informal leader in this
space. She essentially kept the wheels on the bus for all
the managers and directors. Kristi was the unsung hero
in the background keeping the positive “we can do this”
energy going when we were all feeling defeated. Kristi
showed what real leaders do when the cards are down…
work harder, be more positive, be more supportive and
lead from the front.”
LEADERSHIP AND
SERVICE RECOGNITION
Former St. Luke’s Nurse
is elected President of
the American Nurses
Association. On Saturday,
June 11, The American
Nurses Association (ANA)
Membership Assembly
elected Jennifer Mensik
Kennedy, PhD, MBA, RN,
NEA-BC, FAAN, currently of
the Oregon Nurses
Association, as the
association’s next president
to represent the interests of the nation’s more than 4.3
million registered nurses. Mensik has more than 25 years
of nursing experience in a variety of settings ranging from
rural critical access hospitals and home health to hospital
administration, and academia.
She has served as President of the Arizona Nurses
Association and 2nd Vice President and Treasurer of
ANA. During the mid-2010’s she was a nurse at St.
Luke’s, Boise. The term of service for her and all other
newly elected leaders will begin January 1, 2023.
Dori Healey, MSN, MBA,
APRN-CNS, the current
president of ANA-Idaho,
successfully won the May
Idaho Primary election as a
Republican candidate for
Idaho State Legislature
House Seat 15B. The only
other healthcare
professional that will be on
the November ballot is a
chiropractor. If she is
elected, she will be the only
nurse in the Idaho Legislature. The only physician in the
Legislature retired and did not seek re-election, and the
only current nurse, Senator Mary Souza of Coeur d’Alene
was not successful in her primary run for Secretary of
State, and will not be returning to the Senate.

August, September, October 2022 RN Idaho • Page 13
FEATURE
No, I am not going to the Orphanage! Hispanics and Hospice Care
Diana Gilmore, BSN, RN, DNP, FNP-Student
Melody A. Weaver, Ph.D., APRN, FNP-BC
Providing hospice care
at the end of life (EOL)
to Hispanics has many
challenging barriers due to
underlying cultural traditions.
However, the cultural
characteristics of Hispanics,
such as minimizing suffering
and being family-oriented, are
consistent with hospice (Rising
et al., 2019). An example of a
cultural trait directly affecting Diana Gilmore
EOL care is found within the
translation of hospice terminology into Spanish. For
example, the word hospice, which is frequently translated
into Spanish as “hospicio,” is understood to mean an
orphanage or a place for poor people (National Hospice
and Palliative Care Organization [NHPCO], 2016), p. 20).
Therefore, awareness of appropriate EOL language,
culture, and family responsibilities are essential when
working with the Hispanic community.
Cultural competence involves awareness of
conscious and unconscious personal biases,
improving attitudes towards other cultures, gaining
knowledge, and developing skills to provide culturally
congruent health care (North Carolina State University
[NCSU], 2021). While familiarizing with Hispanics and
hospice workers of Eastern and Southern Idaho, it
was apparent that an educational tool was needed
to supply hospice providers with the knowledge and
skills to deliver hospice care to Hispanics, ultimately
improving self-reported cultural confidence. A video
and an associated web page were made available
to the local community as resources to help expand
attitudes regarding Hispanic culture and address
the importance of using terminology that makes
sense to Hispanic hospice users and potential
users. Additionally, the resources presented spiritual
nuances, the role of the family unit, and gender roles in
the care of Hispanic patients at the end of life. Finally,
it was hoped that the video and web page would help
hospice providers offer Hispanics access to hospice
resources, ultimately achieving hospice equity and
equality.
Methods
Since the project was part of a quasi-experimental
doctoral program involving human subjects, ethical
approval from the Institutional Review Board at Idaho
State University (study number IRB-FY2021-247:
Hispanic Cultural Sensitivity for Hospice Clinicians:
An Education Module) was obtained in June 2021.
After approval, different hospice agencies (private
hospice providers) located in Eastern and Southern
Idaho were approached to access their clinical staff.
Data collection occurred from June to September 202.
After affirming informed consent, the hospice workers
completed four steps.
First, the participants answered demographic
questions establishing ages, educational experiences,
cultural background, and more. Second, a pre-test
was conducted to understand the hospice workers’
previous awareness and understanding of the
Hispanic culture. Third, after the pre-test, participants
watched an educational video developed specifically
for this project. The fourth and final component was
a post-test and access to the webpage. The pre-and
post-test, taken from the Clinical Cultural Competence
Questionnaire (Like & Fulcomer, 2001), asked about
self-reported cultural competence and awareness.
The video and webpage developed for the project
used evidence-based literature, providing definitions of
culturally appropriate Hispanic terminology, common
rituals of death and dying, and Hispanic culture
material.
Results
The participating agencies’ regions provided care
for 19% of the population of Idaho, 12% of whom are
Hispanic. Originally 57 people participated in the study.
Forty-one people completed all four steps. 85% of the
responses came from urban Idaho agencies that also
serve rural and remote areas of the region. The sample
comprised 71% female participants with an average age
of 45. Participants represented all hospice roles, with the
majority being registered nurses (29%), followed by social
workers (17%), with 66% of the sample having a bachelor’s
or graduate degree. The average hospice experience of
the participants was five years, and 44% of participants
spoke more than one language.
After the participants watched the video and took
the post-test, there was an improvement of 16% in the
knowledge of Hispanic culture, beliefs, and rituals. The
participants’ self-reported skills at gathering information
and providing culturally appropriate care increased
by 18%, and their self-reported comfort at navigating
language barriers and interpreting Hispanic expression of
loss increased by 8%. The participants’ attitudes about
receiving training in Hispanic culture increased by 7%.
These results point to the effectiveness of the resources
given to enrich the cultural competence and awareness of
the hospice workers who could provide care to Hispanic
patients and to the need to increase this type of training for
all environments that have the potential to interact with the
Hispanic population in the process of death and dying.
Implications for Practice
This research found the terminology and cultural
dynamics that make Hispanics unique when approaching
death. As identified earlier, familiar hospice terminology
within the English language has a very different meaning
in Spanish. It becomes imperative to recognize and
avoid these terms such as hospice and hospicio aiding
Hispanics in the transition to hospice care. Furthermore,
Costa-Muniz et al. (2020) agree that becoming familiar with
the compassion, familism, secrecy, spirituality, fatalism,
and resistance to talking about death found within this
community will build a partnership between patients,
families, and hospice providers, developing trust and
improving patient health outcomes. In addition, providing
a service that makes sense to the patient, their family,
and caregivers is essential. Adding a Spanish-speaking
hospice worker can be an intervention to improve hospice
service even if that worker is wholly fluent (NHPCO, 2009,
p. 6).
Conclusion
In summary, access to and use of the educational
video and webpage increased hospice providers’ cultural
competence and awareness. These two resources have
the potential to meet the Hispanic population’s culturally
competent hospice care needs and close the end-oflife
disparity this population experiences. To facilitate
decreasing the gap between this community and hospice,
Ask about our sign-on bonus!
the authors would like to provide the
video and webpage as resources to
all interested; find them at: https://sites.
google.com/view/hispanic-culturalsensitivity/home
References
Costas-Muniz, R., Garduno-Ortega, O., Torres-Blasco, N.,
Castro-Figueroa, E., & Gany, F. (2020). “Maintaining
hope:” challenges in counseling Latino patients with
advanced cancer. Journal of Psychosocial Oncology
Research and Practice, 2(3), e028. https://journals.lww.
com/jporp/Fulltext/2020/10000/_Maintaining_hope___
challenges_in_counseling.8.aspx
Fischer, S. M., Kline, D. M., Min, S. J., Okuyama-Sasaki, S. &
Fink, R. M. (2018). Effect of Apoyo con Cariño (Support
with Caring): trial of a patient navigator intervention to
improve palliative care outcomes for Latino adults with
advanced cancer: A randomized clinical trial. Journal
of the American Medical Association Oncology, 4(12),
1736-1741. https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC6440710/Henderson, S., Horne, M.,
Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural
competence in healthcare in the community: A concept
analysis. Health and Social Care in the Community, 26(4),
590-603. https://doi.org/10.1111/hsc.12556
Like, E. C., & Fulcomer, M. (2001). Clinical Cultural Competency
Questionnaire (CCCQ). Center for Healthy Families and
Cultural Diversity, Department of Family Medicine and
Community Health, Rutgers Roberts Wood Johnson
Medical School. Aetna Foundation Funded Cultural
Competence/Quality Improvement Study. http://rwjms.
rutgers.edu/departments_institutes/family_medicine/
chfcd/grants_projects/documents/Pretraining.pdf
National Hospice and Palliative Care Organization. (2009).
Hospice and palliative care. Retrieved from https://www.
nhpco.org/education/tools-and-resources/diversity/
latino_outreach_guide/
North Carolina State University. (2021). Cultural competence
toolkit. https://diversity.ncsu.edu/cultural-competencetoolkit/
Rising, M. L., Hassouneh, D. S., Lutz, K. F., Berry, P., & Lee, C.
S. (2019). Hispanic hospice utilization: Integrative review
and meta-analysis. Journal of Health Care for the Poor
and Underserved, 30, 468-494. https://doi.org/10.1353/
hpu.2019.0042
Vespa, J., Medina, L., & Armstrong, D. M. (2018). Demographic
turning points for the United States: Population
projections for 2020 to 2060. U.S. Department of
Commerce. Retrieved from https://www.census.gov/
content/dam/Census/library/publications/2020/demo/
p25-1144.pdf
Corresponding Author:
Diana Gilmore, Idaho State University, Pocatello, ID
dianagilmore@isu.edu

Page 14 • RN Idaho August, September, October 2022
FEATURE
Legal Analysis: Delegation
Kendra Griffitts BSN, RN
Gonzaga University
One health care delivery issue relevant to advance practice nursing roles is
delegation. The principles of delegation are the same between registered nurses
and advanced practice providers, which is concerning from a legal perspective.
The blanket definition of delegation, directing another person to perform nursing
tasks and activities, ignores the unique responsibilities of each member in the
medical team (National Council of State Boards of Nursing & American Nurses
Association, n.d.). Although clear distinction of delegation among members of the
medical team is necessary, that is not the focus of this paper. The purpose of this
paper is to recognize and define the five rights of delegation that are lacking in the
Idaho Administrative Code IDAPA 23.01.01.
Delegation
Delegation has been identified as one of the most necessary and complex
nursing skills, both in a clinical and leadership setting (Hancock, 2017). In a clinical
setting, delegation requires authority and accountability. In a leadership setting,
delegation allows for collaborative care and shared decision-making. Additional
studies have revealed that delegation, when done appropriately, is psychologically
empowering to employees (Zhang et al., 2017). To contrast, ineffective delegation
has been proven to result in poor patient outcomes, negatively impacting: (1) quality
measures, (2) patient satisfaction, and (3) institutional reimbursement (Bittner &
Gravlin, 2009).
In Idaho state, delegation is defined as a licensed nurse assigning tasks to be
performed by others (Idaho State Board of Nursing, 2019). The National Council
of State Boards of Nursing and American Nurses Association (2019) further
elaborates on delegation, requiring the employer to create policies and procedures
to outline what tasks can be delegated, and what tasks cannot be delegated.
The Idaho Administrative Code (2019), IDAPA 23.01.01 states the following
legislation regarding delegation.
Deciding to Delegate. When delegating nursing care, the licensed nurse
retains accountability for the delegated acts and consequences of delegation.
Before delegating any task, the nurse shall:
a. Determine the acts to be delegated are not expressly prohibited by the Nurse
Practice Act or Board rules and that the activities are consistent with job
descriptions or policies of the practice setting.
b. Assess the client’s status and health care needs prior to delegation, taking
into consideration the complexity of assessments, monitoring required, and
the degree of physiological or psychological instability.
c. Exercise professional judgement to determine the safety of the delegated
activities, to whom the acts may be delegated, and the potential for harm.
d. Consider the nature of the act, the complexity of the care needed, the degree
of critical thinking required and the predictability of the outcome of the act to
be performed.
e. Consider the impact of the timeliness of care, continuity of care, and the level
of interaction required with the patient and family.
f. Consider the type of technology employed in providing care and the knowledge
and skills required to effectively use technology, including relevant infection control
and safety issues.
g. Determine that the person to whom the act is being delegated has documented
education or training to perform the activity and is currently competent to perform
the act.
h. Provide the appropriate instruction to perform the act.
Monitoring the Delegation.
a. Evaluate the patient’s response and the outcome of the delegated act and take
such further action as necessary.
b. Determine the degree of supervision required and evaluate whether the activity
is completed in a manner that meets acceptable outcomes. The degree of
supervision shall be based upon the health status and stability of the patient, the
complexity of the care and the knowledge and competence of the individual to
whom the activity is delegated.
The statutory language is clear but could be more explicit in the five rights of
delegation, which are: (1) right task, (2) right circumstance, (3) right person, (4) right
supervision, and (5) right direction and communication (Barrow & Sharma, 2021).
The variance of delegation policies among health care organizations creates gaps in
state laws. Because of the ethical and legal constraints that can arise from delegation,
the American Nurses Association (ANA) created the five rights of delegation as a
framework to help nurses safely delegate. The inadequate definition of the five rights of
delegation in IDAPA 23.01.01 allows health care organizations to implement the five
rights of delegation at their own discretion, instead of meeting a state standard. The
gap between organizational policy and state law has the potential to put patients and
providers at risk, both ethically and legally. For example, the misunderstanding of the five
rights of delegation may result in failure to supervise and inappropriate delegation. In a
court of law such errors are judged against state standards of professional practice, with
organizational policies holding insignificant value. If organizations want to protect their
providers and patients, their policies must match state standards.
Formal Analysis of the Law
Delegation is complex. It begins with healthcare administration who are responsible
for: (1) identifying nursing tasks that can be delegated, to whom, and under what
circumstances, (2) developing delegation procedures and policies, (3) regularly evaluating
delegation processes, and (4) promoting a positive culture and workplace environment
(National Council of State Boards of Nursing & American Nurses Association, 2019).
The responsibility of delegation then falls upon the nurse, who is responsible for: (1)
determining patient needs, (2) when to delegate, (3) ensuring the availability to delegate,
(4) evaluating outcomes, and (5) maintaining accountability for the delegated responsibility.
Lastly, the delegatee must: (1) accept delegated activities based on their level of
competency, (2) maintain competence for the delegated responsibility, and (3) maintain
accountability for delegated activity. Because the process of delegation is multifaceted,
the American Nurses Association created the five rights of delegation to use as a mental
checklist for nurses to identify critical elements in the delegation process that may
otherwise be overlooked (National Council of State Boards of Nursing, 1997).
Strengths and Weakness of Existing Language
Strengths in the current language of Idaho’s state law of delegation is that it promotes
nurse independence by allowing the nurse to critically evaluate what tasks to delegate
and to whom to delegate to within the policies and procedures of the organization. IDAPA
23.01.01 identifies the need to consider the complexity of the patient, family involvement,
continuity of care, educational level and required training of the delegatee, and the
outcome of the delegated tasks. All of which are crucial elements in delegation.
Weakness of the existing language is the lack of identifying and explicitly defining each
of the five rules of delegation. Some, including right person and right task, are loosely
included in Idaho law, but a clear definition of each is not.
Proposed Language
Proposed language to include in IDAPA 23.01.01 on the inclusion and expansion of the
five rights of delegation is as follows:
When delegating the nurse should consider the five rights of delegation.
a. Right task. Including, what tasks are legally appropriate to delegate per Idaho
state law? Can I delegate these tasks based upon my organizations policies and
procedures?
b. Right circumstance. Is the appropriate equipment and resources available to
perform this task? Is the environment favorable for delegation of this task?
c. Right person. Does the potential delegatee have the necessary education, training,
and experience to complete delegated tasks safely? Is the potential delegatee
competent to complete the delegated tasks without direct supervision? What
problems has the potential delegatee encountered in the past while performing this
task (Barrow & Sharma, 2021)?
d. Right supervision. Is the appropriate supervision of the delegated task feasible?
After tasks completion, the delegatee must report to the nurse and provide
feedback. Additionally, the nurse must evaluate the outcome of the task with the
patient.

August, September, October 2022 RN Idaho • Page 15
e. Right direction and communication. The delegator must communicate tasks
expectations clearly and directly, including a deadline for task completion.
Stakeholders
Stakeholders involved in delegation include: (1) patients, (2) nurses, (3) nurse
educators, (4) administrators, (5) researchers, (6) physicians, (7) governments,
including legislative bodies and regulators, (8) professional associations, and
(9) accrediting agencies (Ballard, 2003). Delegation has become a necessity in
healthcare due to fiscal constraints, staff shortages, and an increase in patient
complexity. Studies have shown, that when done correctly, delegation improves
patient outcomes while bridging the gaps in healthcare mentioned above (Barrow &
Sharma, 2021). All stakeholders would benefit from correctly performed delegation.
Barriers to Change
Barriers to change include: (1) poor partnerships, among staff members
and organizational leadership, (2) unhealthy attitudes, and (3) a lack of a sense
of a team (Cipriano, 2010). To summarize, a barrier to change is the lack of
empowerment from organizations. Empowerment and delegation have been
considered one in the same. Both allow leaders to be more productive and
effective while encouraging them to engage with and further develop their
teams. Studies echo this claim by identifying empowerment as a predictor of
organizational commitment to staff, associating it with: (1) decreased burnout, (2)
staff working to the fullest extent of their education and training, and (3) improved
patient outcomes (Hancock, 2017). Gottlieb et al. (2021) found leadership integral
in promoting environments where nurses felt empowered to be autonomous
and exercise their own agency, resulting in improved safety and quality of care
to patients and their families. Additionally, organizational empowerment is highly
correlated with psychological empowerment, a preventative factor in employee
burnout (Amor et al., 2021).
Action Plan for Change
Before proposing the addition of the five rights of delegation to IDAPA 23.01.01,
a review of delegation in healthcare organizations should be conducted statewide.
A survey would be distributed throughout hospitals in Idaho state examining: (1)
current attitudes towards delegation, (2) current barriers in delegation, and (3) the
efficiency of delegation among organizations. If improvement is required and the
proposed language is considered beneficial to improve delegation in healthcare,
it will be added to IDAPA 23.01.01. Following its addition to IDAPA 23.01.01.,
healthcare organizations will be required to implement these changes within their
Joining Your Professional Organization
“The rising tide raises all ships…” Engaging with your professional organization
has many benefits for both you and the profession as a whole. No one is expected to join
every organization but choose the one that best meets your professional needs and join
it. Membership is important and it sustains the organizations which in turn benefits every
professional nurse and helps promote and benefit the profession as a whole.
Joining is easy! It can be accomplished on the organization website. Visit the website
HOME PAGE of the association you want to support and follow the instructions how to join. All of
the nursing organizations listed below participate in the Idaho Center for Nursing.
organization. Doing so will require organizations to educate all staff members on
the changes to this law, with an added emphasis among providers, nurses, and
unlicensed health care providers (UAPs). Delegation should then be reexamined six
months after implementing these changes.
Conclusion
The purpose of this paper was to recognize the lack of identifying and defining
the five rights of delegation in the Idaho Administrative Code IDAPA 23.01.01. The
best practice answer in response to this gap is to: (1) review and assess the current
understanding and success of delegation statewide, (2) evaluate the necessity of
the proposed language to be added to state law, (3) if deemed necessary, add the
proposed language to state law and require organizations to edit current policies
and procedures on delegation to meet these standards, (4) educate staff members
on the five rights of delegation as described in IDAPA 23.01.01., and (5) reevaluate
the effectiveness of delegation six months after enhancements to delegation
have been put into practice. Strategies to enact this new legislation include
organizational surveys, assessments on current benefits and barriers of delegation,
and annual educational courses on delegation for members of the healthcare team.
Declaration of Conflicting Interests
Author has no conflict of interest to disclose.
References
Amor, A. M., Xanthopoulou, D., Calvo, N., & Vasquez J. P. A. (2021). Structural
empowerment, psychological empowerment, and work engagement: A crosscountry
study. European Management Journal, (39)6, 779-789. https://doi.
org/10.1016/j.emj.2021.01.005
Ballard, K. (2003). Patient safety: A shared responsibility. Online Journal of Issues in
Nursing, 8(3). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/
ANAPeriodicals/OJIN/TableofContents/Volume82003/No3Sept2003/
PatientSafety.html#:~:text=These%20stakeholders%20include%3A%20society%20
in,professional%20associations%3B%20and%20accrediting%20agencies.
Barrow, J. M. Sharma, S. (2021). Five rights of nursing delegation. StatPearls. https://www.
ncbi.nlm.nih.gov/books/NBK519519
Bittner, N.P. & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing
practice. The Journal of Nursing Administration, 39(3), 142-146. doi: 10.1097/
NNA.0b013e31819894b7
Cipriano, P. (2010). Overview and summary: delegation dilemmas: standards for skills and
practice. The Online Journal of Issues in Nursing, 15(2). https://doi.org.10/3912/OJIN.
Vol15No02ManOS
Gottlieb, L. N., Gottlieb, B., & Bitzas, V. (2021). Creating empowering conditions for nurses
with workplace autonomy and agency: How healthcare leaders could be guided by
strengths-based nursing and healthcare leadership (SBNH-L). Journal of Healthcare
Leadership, 13, 169-181. https://doi.org/10.2147/JHL.S221141`
Hancock, K. (2017). Empowerment and delegation: Two vital skills every nurse leader
needs. Cleveland Clinic. https://consultqd.clevelandclinic.org/empowermentdelegation-two-vital-skills-every-nurse-leader-needs/
Idaho Board of Nursing. (2019). Rules of Idaho board of nursing. https://adminrules.idaho.
gov/rules/2019%20Archive%20C2/23/230101.pdf
National Council of State Boards of Nursing. (1997). The Five Rights of Delegation. https://
www.cde.state.co.us/sites/default/files/documents/healthandwellness/download/
school%20nurse/five%20rights%20of%20delegation.pdf
National Council of State Boards of Nursing & American Nurses Association. (n.d.) Joint
statement on delegation. https://www.ncsbn.org/Delegation_joint_statement_
NCSBN-ANA.pdf
National Council of State Boards of Nursing & American Nurses Association. (2019).
National guidelines for nursing delegation. https://www.ncsbn.org/NGND-
PosPaper_06.pdf
Zhang, X., Qian, J., Wang, B., Jin, Z., Wang, J., & Wang, Y. (2017). Leaders’ behaviors
matter: The role of delegation in promoting employees’ feedback-seeking behavior.
Frontiers in Psychology, 8, 920. https://doi.org/10.3389/fpsyg.2017.00920
RNs:
idahonurses.nursingnetwork.com/
Nurse Practitioners:
npidaho.enpnetwork.com/
CRNAs:
idahoana.org/
Nurse Leaders of Idaho:
nurseleadersidaho.nursingnetwork.com/

Page 16 • RN Idaho August, September, October 2022
PARTING WORDS
Updating the Associations’ Value Proposition to Idaho Nurses…You!
Ben Knapp
Idaho Center for Nursing
The nursing associations are focusing on
refreshing and repositioning the value propositions,
which are those items that are most impactful to
members. For Idaho nurses we have established an
updated proposition as well as new key messaging
with supporting details that you will see over the
coming weeks and months on the association
websites, social media, the weekly Nursing Flash,
and RN Idaho.
The value proposition defines a forward-looking
position to build over time. The key messaging
and supporting details provide avenues to look
back and reflect on the organizational legacy, yet
it also positions the organizations to look ahead at
creating opportunities to increase their membership
and engagement. Together, these will serve as the
foundation for the Associations’ public communication.
ANA-Idaho is the partner to staff nurses in
professional elevation and evolution. It believes
all nurses are critical partners in the value and
importance of nursing for all Idaho communities.
With an unwavering focus, the association has the
privilege of providing a suite of centralized resources
to help all Idaho nurses elevate their professional
experience, advance the profession, and define and
drive the evolution of nursing practice in Idaho.
Associations are helpful and have expert
association leadership teams ready to assist you at
a moment’s notice. They focus on complementing,
not competing, with the collaborative community to
achieve positive and progressive change. They offer
knowledgeable nursing experts to field questions and
solve problems quickly. They also provide continuing
education, peer reviewed articles, white papers, and
professional conferences to enrich a nurse’s practice.
The associations are trusted, local professionals
fueled by passion and expertise to advance nursing
throughout Idaho. Their legacy is focused on
charting the elevation and evolution of the nursing
in Idaho. With advocacy, nurse associations can
improve more lives, businesses, practices, and
communities through issue identification and
representation. As a community, they reinforce
nursing power through networking opportunities,
membership, and engagement.
The associations are connected through
relationships with healthcare industry partners to
advance nursing throughout Idaho. They specialize
in, and are dedicated to, nursing for all career
stages: student, entry into practice, mid-stage
to late-stage careers, and retirement. They have
centralized resources, news, and information when,
where, and how you need it. They are committed to
doing association work to provide resources to help
you do yours as efficiently as possible.
Positioning and messaging are about what
associations would like to be known for in the minds
of their key stakeholders. It articulates what work
will be achieved and fulfilled, speaks from a unified
viewpoint, and aligns words with actions taking
place across Idaho’s many nursing organizations.
This work is not a tagline or a creative theme; it is
not a magical solution to solve all nursing problems,
nor is it a strategy to do so, though it has influenced
the development of an updated marketing plan.
Most importantly, it has been curated with nurses as
the center of focus.
This type of value proposition and framework
reinforces the importance of expanding the
association’s social media presence to meet you
where you already are. We need your help and
your expertise to make and keep the social media
experience relevant and contemporary.
So, here is a proposition for you.
Help nurses from across Idaho to elevate the
legacy of the change makers who came before
us and focus our energies on the community of
innovators we are today and will remain long into
the future. If you have not already, follow the nursing
associations on Facebook and Instagram. Add your
voice to the conversation through likes, comments,
and shares. Respond to, interact with, and engage
your peers on a neutral platform that will empower
and unify all nurses.
Ultimately, YOU are the key to success, the
strength and power of the profession, and the
future, as we elevate and evolve the associations
by contributing value to the communities we serve.
Join the association that represents your clinical
interest and help to change the conversation,
challenge the status quo, and embrace who we are
as professional innovators to obtain more seats at
the table and define the profession’s impact.

August, September, October 2022 RN Idaho • Page 17
NOTES & NEWS
Dr. Randy Hudspeth, Executive Director for the Idaho Center for Nursing
graciously lent Saint Joseph Regional Medical Center (SJRMC) nurses and
nursing students from Lewis and Clark State College his guidance and
wisdom during this year’s Nurses’ Week celebration. SJRMC’s nurses are
unquestionably hard-working, compassionate, and devoted to our community
and deserving of praise and recognition during this special week. Randy’s
discussion provided an opportunity to reflect on a deeper appreciation for the
history of the profession and the advancements that have been made.
LPN license renewal is in progress and needs to be completed by August
31. A component of license renewal is the documentation of continued
competency. One method of that is obtaining 15 hours of continuing
education, which is available at: icn - CE Catalog (ce21.com). This program will
meet 100% of LPN CE needs.
Nurse Practitioners in Idaho are celebrating 50 years of legal
recognition in 2022. In 1972 Idaho became the first state in the U.S. to
recognize NP in statute and to begin issuing licenses to practice.
Idaho Nursing Flash is sent by email every Tuesday to Idaho nurses. It
contains links to the most read nursing articles nationally as well as Idaho,
and includes regional and state information that is pertinent to Idaho nurses.
The email comes from the ANA-Idaho in the same manner that RN IDAHO is
emailed. Nurses are asked to review their junk or spam mail folders if they
are not receiving this weekly update. Set the link to your recognized and safe
emails to receive the regular weekly mailing without it going to trash or junk
folders.
Nursing Association Staffing Change was announced. Karin Iuliano
retired after 15 years with the IALN, NLI, ANA-I and NPI as the Director of
Operations. Job realignments were made and Ben Knapp was hired to fill the
newly created position of Manager of Operations & Programs.
LEAP Conference Call for Abstracts: The 2022 annual LEAP
Conference (Learning in Education, Administration and Practice) will be held at
the Gove Hotel, Boise, Tuesday and Wednesday, November 2-3. The Abstract
from is available on both the Nurse Leaders of Idaho and ANA-Idaho websites,
and are due by Friday, September 23. Completion instructions are on the
forms available at: LEAP 2022 “Creating a Collaborative Culture” CALL FOR
ABSTRACTS | ANA-Idaho | Nursing Network
The team at Saint Joseph Regional Medical Center with Dr. Randy Hudspeth
for Nurses’ Week 2022.

Page 18 • RN Idaho August, September, October 2022
RN Idaho is pleased to honor Registered Nurses and Licensed Practical Nurses, who served the profession and are now deceased. The names are also
submitted annually for inclusion in the Idaho section of the nursing memorial of the American Nurses Association. A nursing school graduation photograph is
included when available. Inclusion dates are 12 March through 10 June, 2022.
Anderson, Shirley Butcher,
1951-2022, Meridian. Shirley
graduated nursing school as
an LPN and later devoted her
life to raising her children.
Ashby, Billie Jo, 1953-2022,
Burley. Billie attended schools
in Burley, graduating from Burley
High School in 1971. She then
served 10 years in the U.S. Air
Force before she attended ISU,
where she graduated from the
Nursing Program in 1985.
Ballou, Mary C., 1921-2022,
Buhl. Mary graduated high
school and went on to become a
RN in 1942. During the war she
served as a nurse and would
also go on to nurse in Twin Falls
County Hospital as well as UMC
in Las Vegas, Nevada.
Barrus, Yvonne, 1925-2022,
Malad. Yvonne enjoyed a
career in nursing. She attended
nursing school in Ogden, Utah,
and practiced nursing in
Malad, ID, Dallas, TX, San
Diego, CA, and Idaho Falls, ID.
Barton, Doris Arlene, 1930-
2022, Ontario. Doris went to
nursing school at St Luke’s in
Boise, Idaho. She was on a
three-year program where she
received credit for a fourth year
by working at the hospital
when she was not attending
classes. She graduated in 1952 as an RN from
that program. Soon after Doris went to work for
Holy Rosary Hospital, working two graveyard
shifts a week so she could help care for her
children. She worked for many years as an OB-
GYN nurse. She loved her job and it suited her
hard-working nature.
Bloxham, Peggy, 1929-2022,
Twin Falls. Peggy trained and
graduated as a Licensed
Practical Nurse at Sacred
Heart Hospital in Idaho Falls.
Upon graduation she moved to
the Magic Valley working at
Magic Valley Regional Medical
Center until retirement.
Brown-Barnes, Donya Mae,
1939-2022, Jerome. Donya
attended nursing school in
Boise, Idaho; inspired by her
fervent love for people.
Carey, LuDean Hulse, 1933-2022,
LuDean took nursing training at
Bingham Memorial Hospital,
receiving her certification LPN in
1959, and Psych Tech certification
at San Jose, California. She worked
in the nursing field for more than 30
years.
Carpenter, Iris Baugh, 1932-2022,
Meridian. After high school, Iris
attended nursing school. Iris worked
as a nurse for over 27 years for
many doctors in New Plymouth and
Boise and made many friends
among her coworkers.
Dallas, Mary Frances, 1927-2022,
Boise. Mary went to Oregon State
College for two years, after which
she attended Oregon Medical
School for three years, graduating in
1951 with her BSN. Mary went back
to school at the University of Idaho,
graduating in 1983 with a master of
Education. Mary was a nurse at St. Benedict’s
Hospital in Jerome, Idaho from 1971 to 1975. She
taught in the Licensed Practical Nursing program at
Boise State from 1975 until her retirement. Mary was
recognized for her dedication, service, and significant
impact on BSU and the students she taught by being
recognized as an emeritus professor.
Eden, Alicia Constance, 1934-
2022, Gooding. Alicia went to St.
Alphonsus School of Nursing in
Boise, Idaho and graduated as a
registered nurse in 1955. Most of
her career was in the Magic Valley
area. She did home dialysis for
many years and was one of the first
RNs to open the new, and only, dialysis center at St.
Benedicts Hospital in Jerome in 1985.
Frances Baker, Joan, 1932-2022,
Filer. Joan went to the Rhode Island
Hospital School of Nursing, where
she earned her associate degree
and became a registered nurse in
1953. While living in Nampa, Joan
worked at several extended care
facilities. She loved her patients and
loved working with the elderly. She brought joy to so
many of her residents every day.
Gorgonzola, Audrey Beth Lehman,
1935-2022, Meridian. Audrey
received her R.N. diploma at Bethel
Deaconess Hospital School of
Nursing in Newton, KS. She went
on to earn a Bachelor of Science
degree in Nursing Education from
Florida State University, and a
Master of Science degree from University of Delaware.
Audrey started her nursing career in American Falls,
ID. She went on to work at Veterans Administration
Hospitals in New York City; Albuquerque, NM;
Wilmington, DE; Minneapolis, MN; Omaha, NE and
retired from her nursing career while working on Long
Island, NY.
Hall-Matlock, Linda Louise, 1958-2022,
Caldwell. In 1986, Linda pursued one of her
many passions in life, and became a Licensed
Practical Nurse.
Hardiman, Donna Morene,
1935-2022, Meridian. Donna
grew up in Meridian. She then
graduated from the Saint
Alphonsus Hospital School of
Nursing in August 1956. Donna
would begin her nursing
career, starting as an
emergency room nurse, but later specializing in
maternity/OB nursing.
Howe, Susan Carol, 1945-
2022, Bonners Ferry. After
graduating from Bonners Ferry
High School in 1963, Susan
took nurses training for a year
while living at the Nurse’s
Cottage for the Community
Hospital. She enjoyed taking
care of others working as an LPN for doctors,
hospitals, and convalescent homes.
Jorgensen, Ellen, 1932-2022,
Idaho Falls. From an early age
Ellen wanted to be a nurse.
Although it took many years,
she realized her dream later in
life. She first volunteered with
the Rigby Quick Response
Team. In 1980, she started
working at Riverview Hospital as a technician. In
1983, she started studying at Vo Tech and got
her LPN a year later. She worked part-time at
Riverview Hospital and also part-time at a
doctors’ practice. The doctors encouraged her to
go back to school and become a registered
nurse. She went to school in the morning and
worked in the evening. She graduated from Rick’s
College in 1992.
Keyt, Esther Pauline, 1929-
2022, Meridian. Of Esther’s
many accomplishments,
passing the State board to
become a Licensed Practical
Nurse was one of which she
was most proud.
King, Sally Irene Saling, 1936-
2022, Ammon. Sally went to
BYU to study Nursing. She
moved several times between
Utah and Idaho while working
as a nurse. When they moved
the second time to Teton
Valley, Idaho, she became an
Idaho Public Health Nurse, with her office in
Driggs, Idaho.
Langer, Debra, 1955-2022,
Nampa. After graduation from
high school in Council she
attended Boise State University
School of Nursing. Some of her
greatest memories were the
years spent as a nurse at Holy
Rosary Hospital in Ontario and

August, September, October 2022 RN Idaho • Page 19
at Weiser Memorial Hospital. She absolutely
loved taking care of patients and being at
bedside. She shared her compassion and sense
of humor with patients and treated them all with
empathy. She developed long-life friends with
nurses and taught many. She is the mother of
ANA-Idaho current president, Dori Healey.
Leydet, Jean, 1922-2022,
Mountain Home. Jean
attended nursing school at St.
Anthony’s in Pocatello. Jean
met her husband while in
nursing school and they were
married in 1942 and moved to
Mountain Home.
Long, Heather Dale, 1941-
2022, Idaho Falls. Heather
graduated from Idaho Falls
High School in the class of
1959 and then attended
Licensed Practical Nursing
School at Sacred Heart
Hospital in Idaho Falls and
graduated Valedictorian of her class in 1961.
Nishizaki Abo, Shizue, 1923-
2022, Burley. Shizue
graduated from Glenns Ferry
High School in 1941, and
enrolled in the nursing program
at Saint Alphonsus Hospital in
Boise graduating in 1944. She
did post graduate work in
Obstetrics at Mayarot Hospital in Jersey City, NJ.
She was a supervisor of Obstetrics in Los
Angeles after graduation and spent later years
working at Cassia Memorial Hospital, retiring in
1982, for a total of 40 years in the nursing career.
Pomeroy, Carol Jean, 1929-
2022, Bonners Ferry. Carol
graduated with an RN from
Sacred Heart School of Nursing
in 1949, where she was vice
president of her class. She went
to work as a registered nurse at
the Veterans Hospital in Boise.
Powell, Barbara Jean, 1935-2022,
Chubbuck. Barbara received her
Nursing degree from St. Luke’s
Hospital School of Practical Nursing
in February 1960. She began her
career at Bannock Memorial
Hospital in April 1965 working in
pediatrics, nursery, and NICU.
Barbara retired after 30 plus years form BMH.
Smith, Kellie Jo, 1960-2022, Twin Falls. After
attaining her nursing degree in 1982, Kellie worked
at the Twin Falls, Idaho Clinic for a few years before
taking her skills on the road. She traveled the far
reaches of the country from Maine to Alaska, providing
exceptional care and friendship along the way.
Smith, Nina, 1934-2022, Ammon.
Nina completed nurses training at
Ashton Memorial Hospital and
became a Licensed Practical Nurse
in 1953.
Sollender, Barbara, 1935-2022,
Rexburg. Barbara was a volunteer
EMT and a home health nurse for
the Department of Health and
Welfare.
Stone, Ann, 1939-2020,
Emmett. She entered the Los
Angeles County Hospital School of
Nursing in 1959 and graduated
three years later. A friend from
nursing school recalled, “A loss for
everyone that knew and loved her.
My memories of her in Nursing
School are of her ability to make everyone laugh and
feel good and important.” After graduation she
immediately began her RN career as charge nurse to
LA County Hospitals. Later, she worked as
receptionist, nurse and bookkeeper in a Ketchum
Medical Clinic. She also worked with the American
Red Cross Bloodmobile for seven years and was cochairwoman
for two years. As an RN she did
Community Home Health Care and was certified
as a Red Cross Nurse in 1992. She moved to
Emmett to work in the newly formed
government Community Health Clinic for a short
time. Ann and her husband were both accepted
to go on a mission to Mozambique, where a
Nursing School was part of the mission function.
Ann was censured for her classes being too
noisy and having too much fun; Nursing School
was supposed to be serious.
VanOrden, Michelle, 1972-
2022, Blackfoot. Michelle
attended ISU where she
graduated top of her class with
a Bachelors degree as a
registered nurse. She worked
as a nurse for 12 years and in
2016, she began working with
the new moms and babies at Portneuf Medical
Center. She loved this job where she worked until
her medical condition prohibited her from
working.
Wanner, Joyce, 1934-2022,
Preston. Joyce graduated from
Weber State University and
completed her degree in
nursing while raising her
children. She was an excellent
nurse and retired after 35 years
of working in pediatrics.
Wilson, Joyce Blair, 1948-
2022, Sandpoint. Joyce
earned a Bachelor of Nursing
in 1974. She began her
professional career as an
intensive care nurse at St.
Joseph’s hospital in Omaha,
before returning to Creighton
University to earn her master’s degree and
Nurse Practitioner License in 2003 (at the age
of 55). In 2007 she began practicing as a nurse
practitioner in Sandpoint, specializing in
diabetes care. She reconnected with old
friends and met new ones, providing an
incredible and much-needed service to the
community.
SEASON TWO: PERINATAL SUBSTANCE USE DISORDER
SOMETHING
FOR THE PAIN
PROJECT ECHO - IDAHO
PODCAST
New episodes now available for free CE/CME/CEUs!
Featuring lectures presented by Idaho’s leading maternal fetal medicine
and addiction treatment experts on treating pregnant patients with cooccurring
substance use disorders.
uidaho.edu/echo-podcast
This project was supported by Grant No.15PBJA-21-GG-04557-COAP awarded by the Bureau of Justice Assistance. The Bureau
of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of
Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims
of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent
the official position or policies of the U.S. Department of Justice.