Montana Pulse - August 2022

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August 2022 • Vol. 59 • No. 3


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

Executive Director Report

Sneak Peek at MNA

2022 Convention

Page 6

Hiring Related to Age

Page 12

MNA members,

As CEO of MNA, I care,

I advocate, I show up, and

I fight for MT nurses, our

nursing profession, and the

patients they care for.

I am a professional MT

nurse. I have been a MT

Registered Nurse (RN) for 33

years, my entire career. The

first 26 years as an acute care

pediatric oncology staff nurse

and the last seven years as

the nurse leader (CEO) at

MNA. At year 30, I went

Vicky Byrd, MSN, RN

Chief Executive


back to school and obtained my Master of Science in

Nursing with program study in Nurse Leadership and

Management, with the goal of bringing more relevance

and credibility to this role I still dearly love.

Please hope, and pray, with all your belief (no

matter what that looks like), that our nurses’ passion,

commitment, and joy from this profession can be

salvaged through our “calling” as a nurse.

Our patients (MT citizens), nurses, and healthcare

workers have been politicized and emotionalized over a

public health issue all the while our nursing profession

is fighting to keep their profession, desire, and

compassion to serve, alive.

MNA will support evidence-based science and data

and will advocate and speak up for our professional

nurses even when:

• disinformation leads to misinformation and costs

many of our patients and nurses their lives,

• our profession is under attack from lawmakers

and the public, to include nurses and our own

members, because we practice evidence-based

science-based nursing,

• nurses are misinformed from social media,

pod casts, lawmakers, YouTube, snap chat,

magazines, or the news,

• our association witnesses such a distrust and

attempted rewrite of our public health profession

and practice, by non-medical, non-nursing, and

non-healthcare state lawmakers and leaders

to fit political agendas trying to justify their

“interpretation” of public health nursing and

medical recommendations and guidelines,

• nurses are devalued and working at such a pace

that it is leading to early retirement, moral injury,

burnout, and suicide and our nursing profession

is suffering greatly because of it,

• our governing leaders are unable to put aside

politics and lead collaboratively with nurses,

physicians, medical and public health experts to

care for our patients.

MNA will also continue to:

• be honest, open, and transparent, moreover,

embrace scientific and evidence-based data,

remaining credible and defendable,

• continue to communicate a consistent evidencebased


• partner with other healthcare stakeholders

to advocate for and care for our nurses and

patients properly,

• stand up and advocate for what is right for their

nurses working conditions and for their patients to

be fully informed, with proper scientific resources,

• witness their MNA staff fiercely advocate for their

nurse members, providing quality continuing

education and professional development and

working above and beyond to ensure the

professional nurses’ right to collectively bargain

in MT is protected.

MNA, through the voice of their professional nurse

members, is the sought-after voice for the professional

nurse in Montana!


Vicky Byrd, MSN, RN

current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

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Page 2 Montana Nurses Association Pulse August, September, October 2022



Circulation 18,000. Provided to every registered

nurse, licensed practical nurse, nursing student

and nurse-related employer in Montana. The

Pulse is published quarterly each February, May,

August and November by Arthur L. Davis Publishing

Agency, Inc. for Montana Nurses Association, 20 Old

Montana State Highway, Montana City, MT 59634,

a constituent member of the American Nurses


For advertising rates and information, please

contact Arthur L. Davis Publishing Agency, Inc.,

517 Washington Street, PO Box 216, Cedar Falls,

Iowa 50613, (800) 626-4081, sales@aldpub.com.

MNA and the Arthur L. Davis Publishing Agency,

Inc. reserve the right to reject any advertisement.

Responsibility for errors in advertising is limited to

corrections in the next issue or refund of price of


Acceptance of advertising does not imply

endorsement or approval by the Montana Nurses

Association of products advertised, the advertisers,

or the claims made. Rejection of an advertisement

does not imply a product offered for advertising

is without merit, or that the manufacturer lacks

integrity, or that this association disapproves of

the product or its use. MNA and the Arthur L. Davis

Publishing Agency, Inc. shall not be held liable for

any consequences resulting from purchase or use

of an advertiser’s product. Articles appearing in this

publication express the opinions of the authors; they

do not necessarily reflect views of the staff, board, or

membership of MNA or those of the national or local



MNA welcomes the submission of articles and

editorials related to nursing or about Montana nurses

for publication in The PULSE. Please limit word size

between 500 – 1000 words and provide resources

and references. MNA has the Right to accept, edit or

reject proposed material. Please send articles to:


If you wish to no longer receive

The Pulse please contact Monique:


If your address has changed please

contact Montana Board of Nursing

at: www.nurse.mt.gov


We are gathering articles that are relevant

and appealing to YOU as a nurse. What

is happening in your world today? Is there

information we can provide that would be

helpful to you? The Pulse is YOUR publication,

and we want to present you with content that

pertains to your interests.

Please submit your ideas and

suggestions to Jennifer.


Please visit MNA’s

constantly updated website!

Enjoy a user friendly layout and access to more

information, including membership material,

labor resources, Independent Study Library,

a new Career Center for Job Seekers &

Employers, and more downloadable information.



Montana Nurses Association

20 Old Montana State Highway, Clancy, MT 59634

Phone (406) 442-6710 | Fax (406) 442-1841

Email: info@mtnurses.org | Website: www.mtnurses.org

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


MNA is a non-profit, membership organization that advocates for nurse

competency, scope of practice, patient safety, continuing education, and

improved healthcare delivery and access. MNA members serve on the

following Councils and other committees to achieve our mission:

• Council on Practice & Government Affairs (CPGA)

• Council on Economic & General Welfare (E&GW)

• Council on Professional Development (CPD)

• Council on Advanced Practice (CAP)


The Montana Nurses Association promotes professional nursing practice,

standards and education; represents professional nurses; and provides

nursing leadership in promoting high quality health care.


Montana Nurses Association is accredited with distinction as an approver

of nursing continuing professional development by the American Nurses

Credentialing Center’s Commission on Accreditation.

Montana Nurses Association is accredited with distinction as a provider

of nursing continuing professional development by the American Nurses

Credentialing Center’s Commission on Accreditation.

MNA Staff

Vicky Byrd, MSN, RN, Chief Executive Officer

Kelly Hunt, MN, RN, CNL, Director of Professional Development

Jennifer Hamilton, Professional Development Associate

Megan Hamilton, MSN, RN CFRN, NR-P, Nurse Planner & Professional

Development Generalist

Robin Haux, BS, Labor Program Director

Amy Hauschild, BSN, RN, Labor Representative

Leslie Shepherd, BSN,RN, Labor Representative

Emily Peterson, Labor Representative

Makenna Sellers, Labor Organizer

Jill Hindoien, BS, Chief Financial Officer


Board of Directors President

Board of Directors Vice President

Board of Directors Secretary

Board of Directors Treasurer

Board of Directors Member at Large

Board of Directors CPGA

Board of Directors PD

Board of Directors CAP

Board of Directors EGW

MNA Board of Directors


Anna Svendson Ammons, BSN, RN, PCCN

Rachel Clark, BSN, RN

Melissa Anderson, BSN, RN

Audrey Dee, RN


Deborah Kalarchik, MSN, BSN, RN

Deborah Lee, BSN, RN-BC, CCRP

Deanna Babb, APRN, FNP-BC, FAANP

Brandi Breth, BSN, RN-BC

Council on Practice & Government Affairs (CPGA)

Lucy Ednie, BA, MBA, ASN, RN-BC Charlotte Skinner, BSN, RN-C

Loni Conley, BSN, RN

Melissa Anderson, BSN, RN

Paul Lee, CCRN

Council on Professional Development (PD)

Joe Poole, BSN, RN, CHSE

Brenda Donaldson, BA, RN, CAPA

Gwyn Palchak, BSN, RN-BC, ACM Janet Smith, MN, MSHS, RN

Rachel Huleatt-Baer, MN, RN, CNL, OCN, Sally (Lisa) Sluder, DNP, APRN,

Charlotte Skinner, BSN, RN-C AGACNP-BC

Stephanie Corder, RN, ND, CHCP

Council on Advanced Practice (CAP)


Margaret Hammersla, BSN, MS, PhD,


Chairperson Elect-CAP


Ann Galloway, PhD, FNP-C

Member at Large-CAP

Sally (Lisa) Sluder, DNP, APRN,


Member at Large-CAP

Deven Robinson, MSN, FNP, PMHNP

Council on Economic & General Welfare (E&GW)

Delayne Stahl, RN, OCN

Adrianne Harrison, RN

Stacey Sheehan, BSN, RN

Robin Foley, BSN, RN CEN

Questions about your nursing license?

Contact Montana Board of Nursing at: www.nurse.mt.gov

August, September, October 2022 Montana Nurses Association Pulse Page 3

Membership reminders….

Please check your membership status.

If you fall into any of the below categories, you could qualify for

the ‘Professional Reduced Rate’ $38.65/month. Your rate will not

automatically change. You must let us know.

• You are a new graduate. You must apply within the first six months

after receiving your initial RN licensure and this rate is good for one


• You are an RN in a full-time study program working towards a higher

degree. You will need to provide proof of enrollment and you could

receive this rate for up to three years.

• You are an RN 65+ year of age who is licensed and working. You

could receive this rate for the remainder of your employment.

• If you are a retired RN and are no longer working or hold an RN

licensure you could be eligible for the retired rate of $13.07/month.

If you are working in a collective bargaining position and move into a

non-collective bargaining position, please contact the Montana Nurses

Association to let us know. Your membership dues will continue to be

paid until you authorize them to be discontinued. Please remember, only

you can cancel your membership and membership payments.

To provide MNA with information on your status or to receive

additional information on MNA membership please e-mail Jill Hindoien at





1. Anna Moate, RN-BC-Medical Surgical Nursing

2. Amy Buxbaum, RN-BC Ambulatory Care Nursing

3. Kurt Prond, RN-BC-Medical Surgical Nursing

4. Amy Gardner, RN-BC-Cardiac/Vascular Nursing

New Member Benefit: MNA now offers certification

through ANCC’s Success Pays ® Program

> Reduced fee for MNA Members to obtain initial certification

or recertify

> No cost if you don’t pass the exam; you can also take the

exam a second time at no cost

> Pay only when you pass!

> Identify your specialty practice area

How Success Pays ® Works

> Visit nursingworld.org/our-certifications/ to:

• Make sure you’re eligible to sit for the exam

• Look at the test blueprint and test preparation materials

• Make the decision to move forward

> Visit www.mtnurses.org and click on Success Pays ® option

to the left and sign up for the program!

> MNA will contact you regarding how to get the benefit.

Page 4 Montana Nurses Association Pulse August, September, October 2022

ADO – Assignment Despite Objection forms can often be

treated like a horrible complaint form used to put blame on

someone for an unsafe situation. It seems that in history, tools

and agents for change were also viewed with the same sort of

disdain. From my perspective, the first step in fixing a problem

is identifying that there is one. Without documented evidence

of recurring short staffing, lack of training, or unsafe conditions,

how can anyone advocate for change?

Assignment Despite Objection or ADO is a form used to

document any unsafe conditions for you or your patients.

Completing an ADO Form helps to make the problem known to

management, which creates an opportunity for the problem to

be addressed. We use ADO’s to document the facts about an

issue or situation, bring it to the attention of your supervisor(s),

initiate conversations to collaborate on potential solutions.

Labor Reports and News

Understanding the “ADO”

Leslie Shepherd,

BSN, RN, Labor


Lets say, you’ve just received your assignment. You have a patient with an insulin drip.

Wait, what? An insulin drip, but you’ve never had a patient with an insulin drip. In fact,

insulin drips have NEVER been on your unit before. What do you do?

While there are several answers to this question, in this particular hypothetical you go to

your charge nurse.

You go to your charge RN with concerns. They listen, they empathize, and they realize

how inappropriate this assignment is. Now in a perfect world, this patient would not be

on your unit, but here we are. The charge RN, as amazing as they are, is not a magical

being with unlimited power. They do often, however, have a semi-direct line to the decision

makers (whether that be a house supervisor, manager, or administrator on call).

This scenario can go two (possibly more) ways. Either your amazing charge nurse finds

a solution to this oversight, or they don’t. If they do, then your advocacy for patient safety

was effective, and at times, this is what you experience. But in a less than perfect world

it is possible that there is no fix. Likely because there is no solution to be had. ‘All the

beds are full. There is no-one more experienced to take the patient. But it’s a stable insulin

drip.’ The excuses are sometimes endless, but sadly it is the reality that nurses can find

themselves in.

So what to do? Beyond educating your self as best as possible and consulting with

other RNs on your department or in your facility. You do your very best, because that’s

what nurses do. You double check everything and ask your peers to check you. You are

nervous and frustrated, possibly the whole shift. Possibly even after.

How do you prevent this from happening again? From happening to someone else?

While no one can control exactly what the future brings, bringing attention to the situation

that just occurred can help propel your facility towards a solution. Insert ADO forms!

How do we use ADO’s:

1. Actually verbally object to the assignment or situation you are being asked to work

in. Notify your direct supervisor (Charge RN, House Supervisor, Manager) that you

will take your assignment, but you are objecting to it (let them know why) and that

you will be filling out an ADO.

2. If a change in assignment or additional help to improve the situation is not provided,

get an ADO form and fill out all the pertinent information regarding your situation

and what you are objecting to. Feel free to write on the back or use multiple pages

to capture the facts of the situation.

3. Provide a copy of your ADO to your direct supervisor (Charge RN, House

Supervisor, and/or Manager), keep a copy to yourself, give a copy to one of your

union reps (Unit Rep, Officer, and/or Labor Rep).

At a lot of facilities, ADO’s should be reviewed at PCC or with your Union Reps and

management, each month. If this is the case in your facility, please plan to attend PCC

and discuss your ADO. You can meet with an officer or Labor Rep in preparation. If you

are unable to attend PCC, please make sure to discuss your ADO with a Union Officer or

have someone from your unit who can speak to the situation.

In facilities where an ADO process has yet to be established, I encourage you to reach

out to your union officers and/or Labor Representative to help get this process created. A

few things to remember:

• ADO’s are not used to blame anyone for the situation, but used as a tool to capture

what is happening and allow for discussion on ways to prevent it in the future

• ADO’s are considered discoverable documents: in a situation where there is a

negative outcome, this document (when used appropriately) can be used to show

that an RN voiced their concerns to leadership, thus demonstrating use of critical

nursing judgement and advocacy for patient safety


communicating the issues up the chain of command, though the form may be

completed after the fact.

New RN Member Orientation

Each year, your MNA Labor Department works with our

member bargaining teams to negotiate new contracts. One

of the most effective ways to improve our contracts through

bargaining is to add or improve allowing New Employee

Orientation (NEO) language to your contracts. The more

engaged your members are, the STRONGER your local will be

and this strength….will impact positive change!

Increasing membership and union education through early

engagement is the easiest way to begin building strength.

Catching nurses early to educate them on understanding what

it means to be a union nurse at YOUR facility and what their

rights are, is key to improving engagement. Education equals

engagement, and this requires a plan for communication.

The Labor Department wants to assist all our local

bargaining units in creating New Hire Orientation programs that

Robin Haux, BS

Labor Program


can provide you with better tools to educate your new members. We want to update our

new member packets with the most relevant information and to assist you with training

on tough questions you may be asked, scripts to use during orientation presentations,

and a follow-up plan. Our department would LOVE to bring this to you and assist to tailor

a program that works best for your Local unit.

Call the MNA office or your labor representative for more information!

ADO forms are available online (or on each unit in some facilities) and I encourage any

RN who experiences a myriad of unsafe working conditions to document these situations.

Weingarten Rights

If this discussion could in any way lead to my being

disciplined or terminated, or affect my personal

working conditions, I respectfully request that my

Union/Unit Representative or Nurse Advocate be

present at this meeting.

Until my representative arrives, I choose not to

participate in this discussion

When Your Employer Notifies You of a Meeting...

*Immediately ask your Supervisor/Manager/Director:

• “What is the purpose of the meeting?”

• “Is the meeting investigatory?”

• “Will I be asked questions which may possibly lead to discipline?”

• “Will I be asked questions which require me to defend my conduct?”

If the meeting is investigatory or answers may

lead to discipline:

_ #1 – Respectfully inform your employer you are invoking

your Weingarten Rights & will need to have your Union/Unit

Representative or Nurse Advocate present during questioning.

_ #2 – Quickly arrange for your Union/Unit Representative or

Nurses Advocate to attend the meeting.

August, September, October 2022 Montana Nurses Association Pulse Page 5

Labor Reports and News

Shared Space Makes a Difference for Nursing Profession

Before we know it, the MNA Convention will be

days around the corner on October 6-7 at the Delta

Marriott in Helena. While on a personal level this

will be my first fully in person convention as staff, I

have heard from many MNA members and staff alike

on the importance of reconnection and establishing

community at the MNA Convention every year. It is the

annual opportunity to come together as nurses from

all corners of the Big Sky State, from Plentywood to

Polson. The diversity of skills, age, and professional

backgrounds makes the Montana Nurses Association

Annual Convention a uniquely memorable space to

listen, learn, and grow alongside our colleagues. Now

picture a world in which all 17,000 nurses in Montana

Makenna Sellers

Labor Organizer

attended their professional association’s statewide gathering for the year; that

would be a sight for the record books. How would our association adapt? What

would we accomplish? And how would we address critical issues like staffing,

workplace violence, and mentoring the next generation of nurses in Montana?

I encourage each and every one of us who are part of Montana Nurses

Association to visualize 100% engagement with nurses across the state, and

imagine what that would look like.

While a 17,000-person MNA convention may be better suited for a stadium

than a convention center (!), it is important to remember that decisions are

made by those who show up. In the words of Margaret Mead, “Never doubt

that a small group of thoughtful committed citizens can change the world:

indeed it’s the only thing that ever has.” Community is created by those who

show up. The future of nursing practice in Montana is influenced by those who

show up. These truths apply no matter if you are a union nurse, a nurse leader,

or a nursing student. We want your voice to be part of the shared space and

community that is created at the MNA convention.

See you in October.

Congratulations MNA Local #2 RNs!

Local #2 bargaining team secured a tentative

agreement on a new two-year collective bargaining

agreement CBA in late June which was ratified by the

membership. Negotiations were long and difficult and the

Local #2 team did a great job representing their nurses.

The teams received assistance from the Federal Mediation

and Conciliation Service FMCS during their eleventh

bargaining session which assisted the parties in reaching

an agreement. To make wages more competitive, the

2022 wage scale was increased to begin in July; generally,

wage scale adjustments occur in January. The team also

secured increases to differentials; they also take effect in

July. The agreement also provides for scale enhancements

and step movements in January 2023 and January 2024.

Amy Hauschild,

BSN, RN, Labor


2021-2022 MNA Government Relations Platform –

Approved 10/8/21

Montana Nurses’ Association (MNA) is the nonprofit professional association

representing the voice of nearly 18,000 Registered Nurses (RNs) in Montana

including more than 1000 licensed as Advanced Practice Registered Nurses

(APRNs). MNA is the recognized professional organization, which lobbies for

nursing practice issues to protect the practice of professional nurses and also

protect the public in all areas of health care.

MNA is the recognized leader and advocate for the professional nurse in


MNA Mission Statement: The Montana Nurses Association promotes professional

nursing practice, standards and education; represents professional nurses; and

provides nursing leadership in promoting high quality health care.

1. Improve the quality of nursing practice by:

a. Providing educational and professional development opportunities that

contribute to improving practice competency and quality of patient care.

b. Identifying and pursuing funding opportunities to assist in providing

continuing nursing education and nursing continuing professional


c. Identifying and pursuing funding sources that support research/projects to

develop evidence based and innovative nursing practice.

d. Promoting national certification of Registered Nurses.

e. Active representation on local, state and national advisory committees/


f. Supporting the regulatory authority of and collaborating with the Montana

Board of Nursing (BON) on nursing practice and regulatory issues.

g. Encouraging transparency and promoting communication from the

Montana Board of Nursing regarding relationship with NCSBN (National

Council of State Boards of Nursing) and votes/legislation/regulatory policy

changes affecting regulation of registered nurses.

h. Providing input into the implementation and enforcement of NCSBN Nurse

Licensure Compact (NLC).

i. Opposing the NCSBN APRN Nurse Licensure Compact legislation.

2. Protect the economic and general welfare of nurses by:

a. Actively engaging in legislation and campaigns that positively contribute to

the economic and general welfare of RNs.

b. Ensuring the right of RNs to engage in collective bargaining in Montana.

c. Opposing any “Right to Work” (anti-collective bargaining, anti-labor)

legislation to uphold the “Blue Eyed Nurse” bill from 1967, authored by the

late Mary Munger, RN, and former MNA member.

d. Addressing workplace environment issues including violence against

healthcare workers, safe staffing, infectious disease, and patient safety.

e. Advocating for legislation prohibiting mandatory overtime.

3. Improve access to quality, cost effective health care by developing and/or

supporting public policies which:

a. Identify the nurse’s primary commitment is to the patient, whether an

individual, family, group, community, or population.

b. Respond to the needs of the unserved and underserved populations by

promoting access to health care and healthcare coverage.

c. Identify or develop alternative health care delivery systems that are costeffective

and provide quality health care.

d. Mandate third party reimbursements directly to RNs from public and

private payers.

e. Remove barriers (financial, governmental, regulatory, and/or institutional)

that deny access to appropriate/qualified health care providers and

approved medical standard of care treatments.

f. Advocate for legislation that is transparent and bipartisan and support

policies that can achieve evidence based real healthcare reform.

g. Promote community and world health by collaborating with other health

professionals to promote health diplomacy and reduce health disparities.

4. Protect human rights by developing and/or supporting public policies which:

a. Promote access to appropriate health services.

b. Preserve individual rights to privacy.

c. Promote, debate and have consideration of ethical dilemmas in health care

d. Protect nurses, healthcare employees, and the patient (MT community)

from public health emergencies.

5. Protect the environmental health of individuals and communities through:

a. Acknowledging, supporting and addressing environmental impacts on the

health of Montanans.

b. Actively engaging with national organizational affiliates in addressing

environmental health issues in our nation.

c. Supporting and promoting the work, data, and evidence from our public

health nurses.

6. Protecting and promoting the future of healthcare and nursing practice


a. Actively engaging in legislation that supports professional scope of

nursing practice to the fullest extent of the nurses’ education, professional

development, and training.

b. Actively promoting programs and efforts that encourage professional

development and educational progression of professional nursing practice

at local, state, and national levels.

c. Representation on boards, committees and advisory groups which

influence the future of the nursing profession and the future of our state

and national healthcare system.

d. Engaging with healthcare partners and associations to work collaboratively

to ensure healthcare as a right for all American populations.

e. Actively support science and evidence based data to drive strong

investment in safe quality public health programs at state and national


Page 6 Montana Nurses Association Pulse August, September, October 2022

Professional Development Department

Sneak Peek at MNA 2022 Convention

The Professional Development team at MNA is

busy working with our planning committee to build

an exciting and valuable day of learning for the

attendees of our annual convention this fall. After

listening to the feedback from Montana nurses, we

are excited to be planning an in-person event this

year to be held at the Delta Marriott in Helena, MT

on October 6-7, 2022. Registration is open now at

Convention - CNE by MNA

We are working to finalize our speaker list and

are excited to offer a couple of different learning

formats from what we have seen in the past. We

are also presenting nurses and nursing students

(undergraduate or graduate level students) with

Kelly Hunt, MN, RN, CNL

Director of Professional


the opportunity to submit their work to be considered for a presentation at

convention. Nurses and nursing students do exciting and innovative work

every day to advance the profession of nursing, and all that work is made

even more powerful when it is shared with our peers.

We have a confirmed keynote speaker that we are honored to have at

MNA annual convention in Gloria Donnelly, PhD, RN, FAAN, FCPP, who will

be presenting on Healing and Humor in Nursing. Dr. Donnelly is the editor in

chief for Holistic Nursing Practice and Dean and Professor Emerita and found

Dean of the College of Nursing and Health Professions at Drexel University.

Additionally, after resoundingly positive feedback from last year’s

presentation, we are thrilled to announce that Dr. Eric Arzubi, MD will be

returning to wrap up the day of learning with what we are sure will be another

engaging and rejuvenating session. Other topics that you can expect to see

covered at convention this fall include, but are not limited to professional

boundaries, trauma informed care, gender affirming care, palliative care,

ethics in nursing and patient safety/just culture. We look forward to seeing

many of you there in person in October! As always, please feel free to reach

out with any questions regarding nursing professional development at kelly@


Montana Nurses Association

Approved Providers

MNA thanks all of the Approved Provider Units we work with for their

commitment to advancing and promoting quality nursing practice through

continuing nursing education.

Alaska Native Tribal Health Consortium

Anchorage, AK

Alaska Nurses Association

Anchorage, AK

Alzheimer’s Resource of Alaska

Anchorage, AK

Logan Health

Kalispell, MT

Midland Memorial Hospital

Midland, TX

Montana Health Network

Miles City, MT

With Distinction

Bartlett Regional Hospital

Juneau, AK

With Distinction

Montana VA Health Care System

Helena, MT

Montana’s Healthcare Mutual Aid System (MHMAS) is the Emergency System for the

Advance Registration of medical professionals and non-medical responders for the state of

Montana. MHMAS is a secure, web-based online registration system used to register, verify,

and credential volunteers before a major disaster or public health emergency occurs.

Registration is open to health and medical professionals, as well as non-medical volunteers

who would like the opportunity to volunteer to respond to “all-hazards” incidents. Your

involvement as a responder will help ensure that people affected by a disaster will receive the

public health and medical care they need. You will be able to update this information at any

time as changes occur. If approved, you will receive notification of your acceptance into the

system. You will from time to time receive notifications for upcoming educational and training


Please remember that “volunteer” truly means volunteer. You can choose, at any time,

to decline any request that you may receive for your deployment. Even though you are

volunteering your time, a majority of the deployment requests will be paid positions. The pay

for each deployment varies and will be announced at the time of the request.

Thank you for your interest in lending your skills and expertise to assist Montana during an


If you would like more information or to register, please visit our web page:


Benefis Healthcare Systems

Great Falls, MT

Billings Clinic

Billings, MT

Bozeman Health

Bozeman, MT

Cardea Services

Seattle, WA

Caring for Hawai’i Neonates

Honolulu, HI

Central Montana Medical Center

Lewistown, MT | Boise, ID

Central Peninsula General Hospital

Soldatna, AK

Community Medical Center

Missoula, MT

Confluence Health

East Wenatchee, WA

With Distinction

Mountain Pacific Quality Health

Helena, MT

Office of Professional Nursing Development-

University of Florida

Gainesville, FL

With Distinction

Pacific Lutheran University

Tacoma, WA

South Dakota Nurses Association

Pierre, SD

South Peninsula Hospital

Homer, AK

St. Luke’s Health System

Boise, ID

St. Peter’s Health

Helena, MT

St. Vincent Healthcare

Billings, MT

UF Health Shands Hospital

Gainesville, FL

With Distinction

With Distinction

Evergreen Health

Kirkland, WA

Western State Hospital

Lakewood, WA

With Distinction

Foundation Health Partners

Fairbanks, AK

Wisconsin Nurses Association

Madison, WI

With Distinction

Kootenai Health

Coeur d’Alene, ID

With Distinction

August, September, October 2022 Montana Nurses Association Pulse Page 7

ANA Excerpts

Page 8 Montana Nurses Association Pulse August, September, October 2022

Where Do I Go From Here?

Sharon Broscious, PhD, RN

Program Director South University RN-BSN

Online Program

Reprinted with permission from Virginia Nurses Today,

August 2021 issue

As the COVID-19 pandemic winds down, you may

be asking yourself questions about your professional

future. What’s my next career step? What does my

professional future hold for me? The stress of the

COVID-19 pandemic may have created these nagging

questions for you, and you might be unsure what

steps you should take to answer them. The physical,

emotional, psychological, and financial impact of the

pandemic on nurses has been well documented. A

plethora of publications in professional journals and on

websites as well as newspaper and television reports

have discussed the impact of the COVID-19 pandemic

on nurses. Terms such as burnout, compassion fatigue,

moral injury, PTSD, and healthcare worker exhaustion

are used to describe the physical and mental effects of

COVID-19 on healthcare providers (Chan, 2021; ICN,

2021). In an interview on NPR, the phrase “crushing

stress” of the COVID-19 pandemic was used (Fortier,


Not only did the nursing workload change –

increased number of patients per assignment,

increased number of shifts, increased length of

workday due to insufficient staff – but also other factors

compounded the stress on staff. Lack of equipment

such as PPE, the unknowns about the disease itself

with policies changing almost daily, and perceived

lack of support from leadership have also contributed

to the COVID effect (ICN, 2021) on nurses. Some

facilities attempted to prepare and support staff for

the pandemic surges, to varying levels of successful

impact. While providing meals to nurses who could not

take time for a meal break was helpful, as the pandemic

persisted, nurses needed more support from their

leadership teams.

The recent COVID-19 report released by the

International Council of Nurses (ICN) (2021) describes

the exacerbation of burnout and exhaustion of nurses

during 2020. National nursing associations reported

approximately 80% of their members identified as

feeling stressed. In a survey of healthcare workers

conducted by Mental Health America (Lagasse, 2020),

93% indicated feeling stressed, and 76% reported

feeling burned out with 55% questioning their career

focus. Similar results were found in a survey from Brexi

(2020) with 84% of responding healthcare workers

identifying some burnout and 18% reporting total

burnout. In addition, almost half had considered quitting

their job, retiring, or changing their career focus. The

top five stressors that respondents identified, in order,

were “fear of getting COVID-19, long hours/shifts,

general state of the world, fear of spreading COVID-19,

and family responsibilities/issues” (Berxi, 2020, para 2).

Additional stressors identified by Shun (2021) include

physical, emotional and moral distress related to ethical

issues faced by nurses such as dealing with patient

deaths, scarce resources, and forced changes in


The 2021 Frontline Nurse Mental Health and Well

Being Survey (Trusted Health, 2021) revealed for nurses

under age 40, 22% indicated they were less committed

to nursing. Ninety-five percent of the nurses responding

indicated their physical and mental health were not a

priority in their workplace or the support received from

leadership was inadequate. Finally, 66% of respondents

indicated they were experiencing depression and a

decline in their physical health. A poll by the Washington

Post-Kaiser Family Foundation (2021) indicated 62%

of healthcare workers felt mentally stressed from the

pandemic with their greatest fears of them getting

infected, infecting their families, or other patients.

Another challenge identified was working while wearing

PPE (Kirzinger et al., 2021).

Prior to the pandemic, Shah, et al. (2021) reported

burnout was the third leading cause of nurses leaving

their jobs. However, the pandemic intensified levels of

stress and burnout. From the perspective of Maslow’s

hierarchy, Virkstis (2021) described the need for

leadership to focus on basic needs of staff, not high

level self-actualization. The basic needs were identified

as: a safe working environment, clear mission, time to

reflect on what was happening, and time to connect

with peers.

Considering the factors identified here, it is no

surprise that you may be asking what is the next

step for you in handling stress, burnout, and career


Step 1 – Do I stay where I am?

You may be asking the following: Do I leave my job

as other nurses have? Do I want to, or can I continue

working where I am? Do I just need some time off?

The first step to take is self-reflection or selfevaluation.

If you are unsure about a change, pause

and take some time to think about it. Consider staying

where you are to determine how your workday has

changed after COVID-19 and whether factors such as

workload, staffing, and equipment, for example, have

improved. Remember wherever you go, everyone will

be rebuilding after the pandemic and trying to return to

a previous level of normalcy, or an improved level based

on lessons learned from the pandemic.

Before making a decision, reflect on your job prior to

the pandemic. Was this job a good fit for you? Were you

happy with your job? Answers to these questions can

guide you to remain in your current job to see if those

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MMT strives to be on the leading edge of transport medicine, fostering a workplace

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To apply for consideration go to our website

Montana Medical Transport | Transportation Service |

Helena, MT or call 406-457-8205.

August, September, October 2022 Montana Nurses Association Pulse Page 9

same positive feelings come back after the pandemic. The area you work in may

not be exactly the same as it was, but it could be even better. Other reasons leading

you to consider a change may include the work environment, the leadership of your

current unit, or lack of potential for growth in your current position. This introspective

evaluation provides time to think about other opportunities or make plans for change

if that is your final decision.

Step 2 – Do I change my career path?

There are numerous websites that provide steps to take when changing your

specialty or your role, but the first step should be:

1. Identify your passion. What makes you happy? Self-reflection and serious

thought can help provide this answer.

Additional steps to consider include:

2. Complete a SWOT analysis. Guidelines for completing a SWOT analysis can

be found on the internet.

• Identify your strengths: skills, experiences, education, support from peers/


• Identify weaknesses: communication skills, leadership skills, skills needed

for a new path.

• Identify opportunities: What specialty areas might be of interest? Do

you want to be in a hospital or in the community? Do you want to move

to administration or education and have less direct patient contact? What

works for your family? The Johnson & Johnson Campaign for Nursing’s

Future, provides information about 96 nursing specialties; this might be a

good place to start looking for new opportunities as it may present some

potential employment ideas you had not previously considered. A list of

more than 100 nursing organizations is available at https://nurse.org/orgs.

shtml In addition, the Illinois Nursing Workforce Center web page includes

a list of professional nursing organizations (http://nursing.illinois.gov/


• Identify threats. What barriers exist that might keep you from making this

change – family responsibilities, work hours desired, access to a new role

in your geographic area, skills or specific educational background needed.

A threat such as educational level may turn into an opportunity to return to


3. What are your goals in five or ten years?

4. When you have decided on a new role – develop an action plan or timeline

to establish your transition to the new role. What steps do you need to take

to make this change?

5. Refresh your resume. While you may consider that a move from pediatrics

to geriatrics would not provide you with appropriate skills, there are many

skills you have that are transferable – your assessment skills for example,

understanding lab results, providing care to someone who may be unable

to describe how they feel, or organization skills.

6. Network. Talk to someone who currently works in the specialty you are

considering. If the specialty has a professional organization, peruse

their website, attend a local meeting, or read their journals and social

media networks to help you connect with nurses in the specialty you are


7. Draw on your support system and mentors to overcome any barriers/

challenges that may be keeping you from making a change.

8. Resources on the VNA/ANA websites provide information about available

jobs, resume writing, and interviewing. Scheduling a live meeting with a

career coach is also available.

9. After you have made a specialty change, give yourself a chance to get

acclimated to the new path you have chosen.

10. Consider staying on good terms with your current employer. A reference will

be needed when applying for a new position. Staying on good terms may

also be beneficial if the new specialty or organization change does not work



Berxi. (December 8, 2020). State of healthcare workers in 2020. Business Wire. https://www.


Chan, G.K., Bitton, J.R., Allgeyer, R.L., Elliott, D., Hudson, L.R., Moulton Burwell, P. (May 31, 2021)

The impact of COVID-19 on the nursing workforce: A national overview OJIN: The Online

Journal of Issues in Nursing 26 (2), Manuscript 2. DOI:10.3912/OJIN.Vol26No02Man02

Fortier, J. (December 16, 2020). ICU Workers are quitting due to crushing stress from COVID-19

surge. (Radio broadcast) Morning Edition – NPR.

International Council of Nurses. (January 13, 2021). The COVID-19 Effect: World’s nurses facing

mass trauma, an immediate danger to the profession and future of our health systems.



Jobs, S. (June 12, 2005), Stanford Commencement Address. https://news.stanford.


Kirzinger, A, Kearney, A, Hamel, L., & Brodie M. (April 6, 2021). KFF/The Washington Post Frontline

Health Care Workers Survey. https://www.kff.org/report-section/kff-the-washington-





Lagasse, J. ed (December 8, 2020) Healthcare workers experiencing burnout, stress due to

COVID-19 pandemic. Healthcare Finance News https://www.healthcarefinancenews.com/


Shun, S.C. (2021). COVID-19 Pandemic: The challenge to the professional identity or nurses

and nursing education. The Journal of Nursing Research 29(2), e138. doi: 10.1097/


Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N., Moore, M., & Ali, M. (2021). Prevalence of

and factors associated with nurse burnout in the US. JAMA Network Open 4(2), e2036469


Trusted Health. (2021). 2021 Frontline Nurse Mental Health & Well- Being Survey https://www.


Virkstis, K. (March 11, 2021). Nurse burnout didn’t start with Covid-19. (And it won’t end with

Covid-19, either.). Advisory Board https://www.advisory.com/daily-briefing/2021/03/11/nurseburnout


If you are an APRN, membership to Montana Nurses Association (MNA) includes

three professional memberships for one low membership rate.

o MNA – Montana Nurses Association

o ANA – American Nurses Association

o AANP – American Association of Nurse Practitioners

If you are currently an MNA member who is also an APRN, please e-mail Jill at

jill@mtnurses.org so she can sign you up for your AANP membership or if you have

any questions.

Step 3 – Do I leave nursing and change my profession?

Your reflection may lead you to leaving the nursing profession. Many of the steps

in this process are the same or similar to the steps above in changing your career


1. Begin again with self-reflection/evaluation. What makes you feel fulfilled?

What would you like to do? What are your interests?

2. Identify areas of interest. There are a number of free aptitude tests available

on the internet that can guide you in identifying a new career or attend

a career fair. New careers could be with pharmaceutical companies,

insurance companies, the government, or in education for example.

3. Complete a SWOT analysis

4. What are your goals?

5. Identify the skills/education needed for the new career

6. Develop action plan

7. Network

8. Career counseling – obtain a career coach, see the VNA/ANA websites

9. Connect with your support system

10. Keep your license current, you may decide at some point in time you want

to return to nursing.

The COVID-19 pandemic has likely changed you personally and professionally,

has certainly changed healthcare, and has without a doubt changed the world.

What you do to fulfill your life is a priority, so take time to carefully consider what

you want to do and where you want to be.

As Steve Jobs (2005) said, “Your work is going to fill a large part of your life,

and the only way to be truly satisfied is to do what you believe is great work. And

the only way to do great work is to love what you do. If you haven’t found it yet,

keep looking. Don’t settle. As with all matters of the heart, you’ll know when you

find it.”

Page 10 Montana Nurses Association Pulse August, September, October 2022

Getting Clear on Bullying Versus Incivility

Renee Thompson, DNP, RN, CSP

Reprinted with permission from the Florida Nurse, February 2022 Issue

Numerous studies show the prevalence and

devastating impact disruptive behaviors have on nurse

retention and satisfaction, patient safety and the financial

health of an organization. Today, more than ever, the

unpredictable, life-and-death nature of the pandemic

has created an environment that is ripe for an increase in

workplace bullying and incivility. Research at the Healthy

Workforce Institute shows an uptick in bad behavior and

nurses are experiencing greater workplace incivility now

more than ever before. Additional studies show:

• 45.7% of nurses said they witnessed more incivility

than before the pandemic (El Ghaziri et al., 2021). Dr. Renee Thompson

• 14.3% of surgery patients had higher complications

with surgeons who had one to three reports of unprofessional behaviors

compared to those surgeons who had no reports of disruptive behaviors

(Cooper et al., 2019).

• 94% of individuals have worked with a toxic person in the last five years; 51%

of the targets stated they are likely to quit as a result (Kusy, 2017).

Developing successful, targeted interventions to reduce bullying and incivility

among nurses will require that leaders develop awareness and understanding

of nurses’ unique experiences with disruptive behavior. One of the biggest areas

of confusion that makes it difficult to address and eliminate bad behavior is a

misunderstanding about the differences between bullying and incivility.

An important first step to educating yourself and your employees is to get

clear on those differences. This will help you raise awareness, set expectations,

and develop appropriate strategies to eliminate each type of disruptive behavior.

Bullying should be a NEVER event, but not everything is bullying and when we

call everything bullying, we lessen our chances of identifying and addressing true

bullying behavior.


For a behavior to be considered bullying, it must include three things:

A Target-This target can be a single person or group of people. Group targets

can include the opposite shift, new nurses, or nurses who have a particular ethnic


Harmful-The behavior must be harmful in some way. This harm can be to the

target or harmful to a patient.

Repeated-The most important element of bullying. The behavior can’t be

just a one-time event, it must be repeated over time.


Incivility is different from bullying but tends to be much more pervasive. While the

behaviors can be similar, they tend to be lower level. Incivility shows up as your typical

rude, unprofessional, inconsiderate behaviors: eye-rolling, condescension, favoritism,

alienation, gossiping, mocking, cursing. Make no mistake about it, incivility is a healthy

and professional workplace killer, and needs to be addressed.

The Bottom Line

Bullying and incivility can destroy work environments and impact patients in a negative

way. The key is to get very clear on the behavior – is it bullying (target, harmful, repeated)

or incivility (low level, rude, and unprofessional). We are hemorrhaging nurses due to bad

behavior and it’s time we get educated on how to recognize and address bullying and

incivility so that we can cultivate a more respectful and professional work culture.


Cooper, W., Spain, D., Guillamondegui, O., et al. (2019, June). Association of Coworker Reports

About Unprofessional Behavior by Surgeons with Surgical Complications in Their Patients.

JAMA Surgery, 154(9), 828–834. doi:10.1001/jamasurg.2019.1738

El Ghaziri, M., Johnson, S., Purpora, C., Simons, S. and Taylor, R. (2021, July). Registered Nurses’

Experiences with Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-

State Survey. Workplace Health & Safety. doi:10.1177/21650799211024867

Kusy, M. (2017). Why I don’t work here anymore: A leader’s guide to offset the financial and

emotional cost of toxic employees. Boca Raton, FL: CRC Press


As an international speaker and consultant, Dr. Renee Thompson tackles the

challenges facing healthcare leaders today. With 30 years as a nurse, Renee is an expert

on creating healthy workforces by eradicating bullying & incivility. She is in demand as a

keynote speaker and has authored several books on bullying.

To access electronic copies of The Pulse, please visit


August, September, October 2022 Montana Nurses Association Pulse Page 11

Consider a Tax-Deductible

Donation to:

Montana Nurses


Foundation – (MNAF)

➢ Donations to the MNAF foundation

are 100% tax deductible.

➢ MNAF mission statement: “The

Montana Nurses Association

Foundation (MNAF) is the charitable

and philanthropic branch of the

Montana Nurses Association (MNA),

with a mission to preserve the

history of nursing in Montana and

contribute, support and empower the

professional nurse in Montana.”

➢ The purposes for which the

Corporation is organized are as


“(a) charitable; (b) educational; (c) to

accept healthcare/nursing research

and educational grants; (d) to provide

continuing educational grants to

licensed registered nurses; and (e)

to award scholarships to qualifying


Discover CoreCivic and

Make a Difference to

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We are currently hiring LPNs,

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Easy apply at


For info contact:

Leslie Godleski, HR Manager

(406) 434-7424

CoreCivic is a Drug Free Workplace and Equal Opportunity Employer

A secure future starts here.

Page 12 Montana Nurses Association Pulse August, September, October 2022

State Wide Nursing News

Hiring Related to Age

Applying for a job can be

an epiphany! The hidden

message might be, “we want

a younger (hmmm) person in

the leadership/administrative


Age and experience

are important factors that

determine leadership style,

and age is one of the most

important factors! It is

commonly believed that

experiential aging is an

important contributor when

determining behavior displayed

Carolyn Taylor

Ed.D, MN, RN

by a leader. Numerous complex and contradictory findings

on the relationship between leadership ability and age


In 1997, the research found that younger leaders

were perceived to be more effective than older leaders.

However, about 2003, increased leader age and follower


Full- Time positions, Competitive Salary,

Retirement, Great Benefits

To discuss our current opportunities

call (406)843-4201 or

email hr@madisoncountymt.gov.

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satisfaction were positively related to more senior leaders,

and negative satisfaction was associated with younger


Intelligent administrators/leaders understand that

a significant research finding is intended to augment

our understanding of a researched topic. There is an

awareness that there are exceptions to every research

finding. However, significant research findings should

cause a pause in our thinking to the point of (at least)

increased awareness of the past, present, and intended

future job hiring behaviors as leaders.

Significant research finding merely means there is

a preponderance of evidence to indicate the research

finding’s correctness. Combining these external research

findings with an organization’s nondiscriminatory policies

and procedures, applicant information, and an unbiased

job description provides a broad-spectrum professional

perspective for employment consideration.

Published Significant Research Findings Related to the

Leadership Qualities of Older People.

Older people more often than younger people –

1. Experience positive feelings and avoid negative


2. Have learned to comprehend better and resolve

negative events.

3. Predict emotions elicited by future events more


4. Have a high control over their feelings.

5. Exhibit more positive and stable emotions.

6. Show positive feelings and emotions.

7. Exhibit less anger.

8. Have low arousal of negative feelings causing more


9. Have low arousal of negative feelings related to


10. Have less anger, a low incident of sadness, and a

high state of enthusiasm.

11. Prioritize positive information over negative


12. Pay greater attention to positive social cues, which

positively affect emotions.

13. Have more experience and, therefore, less

dependent on outside information.

14. Analyze a situation to comprehend and resolve

challenging events.

15. Use Transformational Leadership (considered

“superior leadership” characterized by the

“four I’s” — idealized influence, Inspirational

motivation, Individual consideration, and Intellectual


16. Have the traits of empathy, collaboration, and

emotional intelligence.

17. Exhibit more positive leadership behaviors.

Experientially-aged professional leaders require

university/college academic leadership preparation and

administrative/leadership ability. The experienced and

academically prepared leader supports and promotes

highly successful and effective employees. This

preparation of experience and education is a predominant

happening of successful leadership.

Society expects (in many cases) that successful

leadership is associated with masculinity, and females

are often associated with caregiving, social work, and

educational roles. Regardless, research findings confirm

that age is a far more significant consideration in both

genders in determining leadership abilities.

The skills of accomplishing a successful administrative/

leadership role include “having been there” as an

employee. Age, with all its implications, has its unspoken

positive place. The administrator/leader who can harness

a lifetime of experience on behalf of a leadership role

provides an advantage. Life experience prepares a person

for leadership. Life teaches lessons that cannot be learned

sitting at a desk, and life also teaches from the “school

of hard knocks.” Life lessons are often painful, but the

lessons are not forgotten, and the leadership role success

is the product of true grit--Passion and Perseverance.

Sign On and Retention Bonus

Relocation Assistance

Now Hiring! RN’s, LPN’s, CNA’s &

Medical Assistants - Full Time

Contact Us Today!

Call us at 406-683-3021 or

email careers@barretthospital.org.



Need Help Managing Your Student Loan Debt?

Join MNA and our national union, the American Federation of

Teachers, Nurses, and Health Professionals (AFT-NHP) for our

student debt clinics this summer, exclusively for MNA members!

WHEN: August 25, 9 - 10:30 pm MT | WHERE: Zoom

TO Register: https://aft.zoom.us/meeting/register/


Over 45 million people in the United States are struggling to

make their monthly student loan payments, and millions more see

economic and personal opportunities pass as they prioritize paying

down their debt. Does this sound like you or someone you know?

Many of these people may qualify for free federal programs that can help reduce their monthly payments and

eventually lead to student loan forgiveness, but these lifeline programs are significantly under-enrolled. Thanks to

new rules just put in place by the Department of Education, many folks who thought loan forgiveness was out

of reach are now finding that it is finally within grasp. To help our members get access to these programs and

understand these new rules, MNA and AFT-NHP are proud to host Student Debt Clinics this summer which will

provide information and resources that will help you enroll in Income-Driven Repayment plans and Public Service

Loan Forgiveness, both of which are available to health care professionals working public and non-profit settings!

Managing your student loan debt is the first step in taking on the inequities which plague our system of higher

education, and we look forward to seeing you at the Student Debt Clinic and working together to find a collective

solution to the problems of student debt and college affordability!


Apply online at: www.montanahealthnetwork.com

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

406-852-6361 or 406-228-8044 | contact@montanahealthnetwork.com

August, September, October 2022 Montana Nurses Association Pulse Page 13

State Wide

Nursing News


Trauma System Section

has published/updated

several reports:

• EMS data on Opioid Overdose 2021 describes

volume/demographic data on opioid related

overdoses recorded by Montana EMS providers

during 2021.

• EMS QI report Q3-Q4 2021 is a serialized report

that describes Montana and US performance

on selected EMS quality improvement measures

for the second half of 2021. Each EMS agency

that submits data to the Montana EMS Registry is

provided a corresponding agency-level report.

• Naloxone administration by EMS 2021 describes

EMS events with Naloxone administration from 2021.

• Trauma annual report 2022 is a serialized report

describing severe injury in Montana as recorded in

the State Trauma Registry. The information includes

demographic, geographic, cause, severity and

target injury information.

For information on any of these reports, please contact

Hannah Yang (Hannah.yang@mt.gov 406-444-3746)

Added Support for

Quit Line Participants

with Behavioral Health


On average, people with a serious mental illness

die fifteen years earlier than the general population

largely due to conditions caused or worsened by

smoking, according to the Centers for Disease Control

and Prevention. On July 1, the Montana Tobacco

Quit Line launched a new program to better support

participants with behavioral health conditions on

their journey toward successfully quitting all forms of

commercial tobacco. Participants in the behavioral

health program will benefit from:

• Seven scheduled telephone coaching sessions

that focus on developing and practicing coping

skills to manage stress while quitting;

• Specially trained tobacco treatment coaches

who understand behavioral health conditions;

• Eight-weeks of FREE Nicotine Replacement

Therapies (NRT) with combinations of patch,

gum, or lozenge; or

• Three-months of FREE prescription cessation

medications like Bupropion.

For more information, visit QuitNowMontana.com or

call 1-800-QUIT-NOW.

The Montana

Cancer Coalition

*The Montana Cancer Coalition developed online

maps to help cancer patients, health care providers,

and caregivers locate the closest cancer access

services that are key to improving quality of life for all

Montanans on the cancer journey.


At McKenzie-Willamette Medical Center,

we take caring for people very personally.

Join our MWMC family today in the

beautiful Pacific NW!

We have RN positions available in our

Operating Room and Cath Lab.

The Cath, Hybrid, EP, and Operating Rooms are more than just

procedural areas at MWMC. While collaboratively working

to promote operational efficiency, fiscal responsibility, and

purposeful change, we strive to empower each individual with the

tools necessary to foster learning and growth while enhancing

patient, staff, and physician satisfaction.

Sign-on bonuses up to $20,000 available!

Explore our Nursing Opportunities:



The Missoula College – UM ASN

program in beautiful Missoula, MT

is looking for a full-time adjunct instructor to

teach Adult Nursing I, Adult Nursing II, and

Managing Client Care.

Qualified applicants must possess a BSN

or higher. Teaching experience desired

but not mandatory.

We offer a competitive salary and excellent

benefits package.

For more information, please contact

Linda Barnes, Nursing Program Director at

(406) 243-7875 or linda.barnes@umontana.edu

Page 14 Montana Nurses Association Pulse August, September, October 2022

Sleep and Your Health

Cynthia Meyer, MSN, RN, CHSE

Debra Rose Wilson, PhD, MSN, RN, IBCLC,


Reprinted with permission from Tennessee Nurse

May 2022 issue

To sleep, perchance to dream. – Shakespeare

One in three adults do not get the uninterrupted sleep that is recommended,

and inadequate sleep has a direct effect on the functioning of the immune system.

Nurses and other health care workers are part of the 18 to 20% of Americans who

work alternating shift schedules. Sleep is essential, not only as restorative but

because of its role in the regulation of immune response. There has been some

interesting research in the last 20 years that explored the connections between

sleep, inflammation, and immune function. With this information at hand, a nurse

can improve self-care and appreciate the importance of teaching sleep hygiene as

part of holistic patient health care system.

The sleep-wake cycle balances biological health, mental well-being, and

helps the immune system adapt as needed. The sleep-wake is based on the

24-hour circadian clock that regulates complex bodily functions, including the

cardiovascular system, inflammation, and immune response. Cytokines are

messenger proteins that can be pro-inflammatory or anti-inflammatory, triggering

a response to infection or injury. People with chronic inflammatory disease, sleep

problems, and depression have higher levels of circulating pro-inflammatory


While the body is awake, the immune system is protecting the body against

foreign pathogens. Anti-inflammatory cytokines (IL-4, IL-10, IL-13, and TGF-β) are

active. Natural killer (NK) cells act by stopping the growth of mutating cells such

as cancer, and increase production during the wakeful state. These immune

cells are very responsive to stress and lower or discontinue production when

the sympathetic nervous system spills the stress hormones. The longer you are

stressed during wakeful periods, the less opportunity NK cells have to increase

in numbers and the greater the chance that rogue cells will continue to mutate.

The body can’t do maintenance work on immune function when the resources are

being transferred to first aid and alarm response systems when stressed. For those

who experience a great deal of stress, sleep is even more important. Once asleep,

the body is put back into balance as CD4+ T cells and Th1 and Th2 respond,

and production is higher. Natural killer cells, melatonin, and stress hormones can

replenish themselves.

Sleep Deprivation

Both short-term and long-term sleep deprivation disrupts the 24-hour circadian

clock and immunological functions. Sleep deprivation increases inflammation,

so those with a pre-existing inflammatory disease (such as RA, depression, or

bowel disease) need consistent sleep even more than others. With increased

inflammation and decreased melatonin risk for CVD, breast cancer, and other

inflammatory diseases rise. Thermoregulation, insulin levels, vaccine response, and

cognitive flexibility are impaired with inadequate sleep. Those with sleep apnea are

at higher risk for diabetes, hypertension, coronary issues related to the increased

inflammation. For those who are significantly stressed, quality sleep is difficult to

achieve. The sleep-wake cycle is disrupted when pro-inflammatory cytokines and

stress hormones (e.g., cortisol, epinephrine, and norepinephrine) are released.

Shift work

Current estimates are that about 20% or one-fifth of the workforce currently

participate in shift work. Of those working in the healthcare sector, 52% report

short sleep duration. Studies also showed that those working the night shift

reported poorer quality sleep and sleep deprivation. The general recommendation

is for individuals to get between seven to nine hours of sleep, but shift workers get

less than six hours daily or one to four hours less per week. Those working the

night shift may not be able to make up for lost sleep which is needed for relaxation

and physical restoration.

Shift work is essential for healthcare. Nurses must work hours that may not

be conducive to sleep to provide round-the-clock care for patients. These hours

may cause a disruption in sleep. Circadian rhythms are what regulate the sleepwake

cycle, and these cycles rely on light to direct the cycle. Daylight causes us

to become more alert and awake, while darkness leads to melatonin production,

which prepares the body for sleep. Shift work disrupts the natural sleep-wake

cycle, and research has shown that over time the physical and mental health of

those who participate in shift work may be impacted by the disruption in sleep.

Shift work has been shown to have a negative impact on the psychological

and social health of the individuals working those hours. Shift work sleep disorder

(SWSD) occurs when work schedules disrupt the natural circadian rhythms, and

the disruptions cause excessive sleepiness, fatigue, or insomnia. Eventually, these

symptoms may result in distress or impairment in mental, physical, and social

functioning. Furthermore, sleep deprivation can lead to increased stress which

in turn can lead to decreased job satisfaction for nurses. Studies showed that

health professionals who worked night shifts had higher levels of psychological

and mental health problems than their day shift counterparts. This included higher

levels of depression, irritability, stress, OCD, and mood disorders. Shift workers

also exhibited negative feelings, isolation, and difficulty in relationships.

Sleep allows the body to heal itself, and it helps boost immune function. Nurses who

do shift work are not exempt from the negative effects of inadequate sleep. Obesity is

more common in shift workers, and there is an increased risk of metabolic syndrome

and diabetes. Shift work compromises immune function and places individuals at

an increased risk for breast and colorectal cancer. When compared to day shift

workers, those doing shift work have an increased risk of cardiovascular disease.

Continued alterations in the circadian rhythms have also been linked to gastrointestinal

issues such as gastritis, indigestion, appetite disorders, irregular bowel movements,

constipation, heartburn, and pain. Since nursing is predominantly a female profession,

it is worth noting the correlation between shift work and reproductive issues such as

decreased fertility, altered menstrual cycles, and other reproductive issues.


Shift work can have negative effects on health; however, these crazy hours are

necessary for the nursing profession. There are things workers can do to improve

sleep and maintain adequate rest. The following tips are included for surviving shift


• Maintain a consistent sleep schedule

o Keep the same sleep-wake cycle on days off

o Sleep directly after a shift or adopt a split-nap schedule

o Take a short nap prior to shift on workdays but avoid naps longer than 30


• Maintain an ideal sleep environment

o Cool environment between 68-72 degrees Fahrenheit

o Limit noise using white noise or earplugs

o Limit light using an eye mask or blackout curtains

o Stay away from electronic devices such as a computer screen or cell

phone in the two hours prior to sleep.

• Promote sleep

o Take a hot shower, go for a walk, or use meditation for relaxation

o Limit strenuous exercise

o Limit caffeine, alcohol, nicotine three to four hours before bed

o Maintain a healthy diet and avoid fatty, spicy foods before bed

o If you tend to be cold, wear socks to bed

• Things to do at work

o Eat healthy

o Use caffeine in moderation and avoid 4 to 6 hours before sleep

o Take short, frequent breaks

o Keep the work environment well lit

o Schedule wisely with no more than three consecutive 12-hour shifts and

have 11 hours off to ensure adequate rest time

o Nap before driving home if needed

o Get out into the sunshine on your breaks when possible

o Give yourself stress management breaks where you rest, meditate, or

practice breath work.


Shift work is part of our profession, but changes in sleep rhythms have a

negative impact. Lack of sleep in nurses not only increases the chance of error

but leads to health issues. This is a global issue for nurses. Assess your own

sleep. The National Sleep Foundation (NSF; sleepfoundation.org) has a Sleepiness

Test that examines sleep patterns over the past 2 weeks. There is the Epworth

Sleepiness Scale that assesses daytime sleepiness and STOP BANG screening

questions for sleep apnea. If you aren’t sure about your sleeping habits, try a sleep

diary. The NSF can guide you through keeping a week of journaling with quality

of sleep, caffeine intake, bedroom environment, and sleep hygiene. What are you

going to do to improve your quality of sleep?

References Available Upon Request

Cynthia Meyer, MSN, RN, CHSE – Cindy is an Assistant Professor and the

Simulation Lab Coordinator at Austin Peay State University, currently working on

her PhD at East Tennessee State University.

Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT – Dr. Wilson is

a Health Psychologist and a Professor of Nursing at Austin Peay State University

and was the 2017-18 American Holistic Nurse of the year. She has been educating

nurses in Tennessee for over 20 years, and has a private hypnosis practice in the

Nashville area, and teaches hypnosis to nurses and psychologists.

August, September, October 2022 Montana Nurses Association Pulse Page 15



Montana Nurses Association would like to

invite you to join us today!









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