The Maryland Nurse - nursingALD.com

The Maryland Nurse 

Issue 2 Volume 3 August, September, October 2000 

Register Now for the 2000 MNA Convention 

“Healthy Nurses 2000” 

Rocky Gap Lodge and Golf Resort 

Cumberland, Maryland 

See details and registration form on pages 18 & 19 

Linda Stierle Named Executive Director 

and Chief Executive Officer of ANA 

Linda J. Stierle, MSN, RN, CNAA, a nurse leader with 

more than 30 years’ diverse management experience in 

health care operations, has been named executive director 

and chief executive officer of the 

American Nurses Association 

(ANA). Stierle was most recently 

acting executive director and chief 

operating officer for ANA. She 

joined ANA in March 2000 following 

her retirement from the 

United States Air Force where she 

held the rank of Brigadier General. 

Ms. Stierle will develop and 

implement programs designed to 

meet the vision and goals of the 

association. She will also serve as 

executive director of the American 

Commission on the Crisis in Nursing Summit 2000 

On June 6, 2000, a statewide summit was held to discuss 

the current workforce crisis in nursing in the state. 

Over 600 nurses convened for this important event which 

was an outcome of legislation passed during this year’s 

legislative session in Annapolis. That legislation introduced 

in the Senate by The Honorable Paula Hollinger, 

a registered nurse delegate, and in the House by The 

Honorable Marilyn Goldwater, also a registered nurse, 

and The Honorable Adrienne A. Mandel, called for the 

establishment of a 46 member Commission on the Crisis 

in Nursing and the convening of a Summit. 

Dr. Georges C. Benjamin, 

MD, Secretary of the Department 

of Health and Mental Hygiene, is 

named as the Chair of the 

Commission. Vice Chairs include: 

Nancy Adams, Maryland 

Organization of Nurse Executives; 

Mary Beachley, Maryland Nurses 

Association; Sharon Bernier, 

Montgomery College; Sue 

Donaldson, Johns Hopkins 

University School of Nursing; 

Charlene Hall, LPN Association; 

Kathryn Hall, Colleagues in 

Colleagues; Barbara Heller, 

Stierle 

Nurses Foundation. “It’s truly an honor and a privilege to 

serve my chosen profession and help the American Nurses 

Ramsay 

University of Maryland School of Nursing; Eleanor 

Walker, Bowie State University and Donna Dorsey, 

Maryland Board of Nursing. 

The Summit was a full day opening at 8:45 AM with 

greetings from Dr. Benjamin, Dr. David J. Ramsay, 

President of the University of Maryland, Baltimore and 

Dr. Barbara Heller, Dean of the University of Maryland 

School of Nursing. The University of Maryland generously 

provided the meeting space for the summit in the 

Association achieve its vision of one, strong united voice 

for the profession of nursing,” said Stierle. 

Stierle had been a long-time member of the Texas Nurses 

Association until February 2000 when she transferred her 

membership to the Maryland Nurses Association. She 

was instrumental in the creation of ANA’s newest constituency 

for nurses in the uniformed services, the Federal 

Nurses Association (FedNA). 

Her military awards include the Distinguished Service 

Medal, Legion of Merit with one oak leaf cluster, 

Meritorious Service Medal with three oak leaf clusters, Air 

Force Commendation Medal, Air Force Achievement 

Medal, and National Defense Service Medal with Bronze 

Star. 

Stierle earned a master’s of science in nursing from the 

University of California, San Francisco, a bachelor’s of science 

in nursing from Incarnate Word College, San Antonio, 

TX, and a diploma in nursing from Spartanburg General 

Hospital in Spartanburg, SC. 

School of Nursing’s newly constructed building and auditorium. 

Dr. Brenda Cleary, Executive 

Director for the North Carolina 

Center for Nursing was the invited 

speaker and gave an overview of 

some of the activities in the state of 

North Carolina directed to address 

the increasing shortage of nurses. 

Dr. Cleary suggested that it is 

increasingly difficult to forecast 

the need/demand for nurses 

beyond a year or two. She defined 

demand as “what the market place 

will buy;” need as “a clinical 

concept about the best practices for 

Cleary 

a population of patients” and supply as “the amount of 

labor available to work.” Dr. Cleary pointed out that while 

society is diverse, nursing is not. Only 10% of the nursing 

workforce is made up of minorities and less than 6% are 

male. She suggested that improving these percentages 

needed to be one of the focal points for addressing the 

workforce needs. “Employers,” according to Dr. Cleary, 

“are looking for faster transitions from novice to expert in 

the work setting.” “ Issues such as mandatory staffing will 

best be addressed by empowering nurses at the unit level 

and holding them accountable,” said Dr. Cleary. The 

issues are complex. Senator Paula Hollinger, in remarks 

she made to the group, said that “nurses are the worst people 

in the world when advocating for ourselves. There are 

two times more licenses nurses than doctors in Maryland 

and yet nurses are silent.” 

Beth Greenland served as a facilitator for the remainder 

of the day where the entire group of 600 participated in the 

identification of issues, the development of priorities, and 

ANA to Create Commission 

on Workplace Advocacy 

At a special session of the ANA 2000 House of 

Delegates (HOD), members voted overwhelmingly to 

support a bylaw amendment that will establish a 

Commission on Workplace Advocacy. Workplace advocacy 

is not a new focus for ANA – advocacy for nurses 

and their patients is part of the association’s 104 yearold 

history as well as its promise for the future. The 

amendment will create a commission that will advise 

and oversee the synthesis, translation and distribution 

of workplace advocacy information, programs, services, 

and products. Workplace advocacy is used successfully 

in various practice settings across the country to 

help registered nurses secure optimal working conditions 

and optimum patient care. The first meeting of the 

commission is expected to occur in late September or 

early October. (See report on HOD meeting provided 

by the Maryland Delegation beginning on page 22) 

the discussion of strategies and solutions. Individual comments 

were invited from attendees who had special perspectives 

to offer the group. 

A small group format was used to facilitate the overall 

productivity of the day. These groups were assigned specific 

topic areas relative to the nursing workforce issues. 

The topic areas included: recruitment, retention, education 

and an other issues group. 

The top five issues identified in each of these topic 

areas included the following: 

Recruitment 

• Image 

• A lack of understanding of what motivates our 

youth, other career choices 

Crisis in Nursing Summit cont. on pg. 10 

Inside this issue.... 

MNA Members in the News......................................4 

Workplace Violence: Part IV ..................................11 

A Mystery Solved....................................................12 

Public Health Nursing in MD: Our Roots ..............16 

MNA Convention ....................................................20 

ANA House of Delegates Report ............................26 

ANA Election Results 2000 ....................................30 

Medication Errors....................................................32 

Maryland Colleagues in Caring ..............................34 

Multistate Licensure Compact Bill Status ..............35 

MNA Membership Application ..............................38 

Poster Submission Form..........................................39

• PAGE P GE 2 • THE MARYL MARYLAND 

AND NURSE AUGUST UGUST, , SEPTEMBER, OCTOBER OCTOBER 

2000 

Maryland Nurses Association 

to participate in Maryland’s 

Race for the Cure 

MNA is organizing a TEAM to participate in the “8th 

Annual Komen Maryland Race for the Cure.” The event 

will take place on Sunday, October 8, 2000 on Rash 

Field at Baltimore’s Inner Harbor. We are looking for 

Nurses who are breast cancer survivors to lead our 

TEAM on this day, as well as nurses who are willing to 

take some time out of their schedules to walk with us and 

solicit support. Our team entry must be in no later than 

September 18, 2000 so please call MNA today and register 

with us to walk at 410-859-3000. 

PUBLICATION 

The Maryland Nurse Publication Schedule 

Issue Material Due to 

MNA Office 

Feb/Mar/Apr Issue January 7, 2000 

May/June/July Issue April 7, 2000 

Aug/Sept/Oct Issue July 7, 2000 

Nov/Dec/Jan Issue October 7, 2000 

Please see Editorial Guidelines for Article Submission. 

The Maryland Nurse is the official publication of the 

Maryland Nurses Association. It is published quarterly. 

Subscription price of $12.00 yearly. Postmaster: send 

change of address and correspondence and editorial and 

advertising copy to 849 International Drive, Suite 255, 

Linthicum, Maryland 21090. 

Guidelines for 

Article Development 

The editorial committee welcomes articles for publication. 

There is no payment for articles published in 

The Maryland Nurse. 

1. Articles should be word-processed using a 12-point 

font. 

2. Articles should be double-spaced. 

3. Article length should not exceed five (5) pages 8 1/2 

x 11. 

4. All references should be cited at the end of the article. 

5. It is requested that articles be enhanced with photographs, 

drawings, tables etc. as much as possible. 

6. A photograph release form must be completed for any 

photograph or image where individuals are identifiable. 

Forms are available from MNA by calling (410) 859-3000. 

7. The author of the article should submit a picture of 

himself or herself along with two to three sentences that 

gives information about the author. 

8. Articles should be submitted with two hard/paper 

copies and a 3-1/2 inch disk with name of the article and 

the program used identified. 

Submissions should be sent to: 

Editorial Committee 


849 International Drive, Suite 255 

Linthicum, Maryland 21090 

ADVERTISING 

Acceptance of advertising does not imply endorsement 

or approval by the Maryland Nurses Association of the 

products advertised, the advertisers or the claims made. 

Rejection of an advertisement does not imply that 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 advertiser 

products. Advertisements will be accepted on a firstcome, 

first-serve basis for preferred positions. MNA and 

publishers reserve the right to reject any advertising. 

FOR ADVERTISING RATES AND INFORMATION 

CONTACT THE ARTHUR L. DAVIS AGENCY, P.O. 

BOX 216, CEDAR FALLS, IOWA 50613, 319-277-2414. 

THE MARYLAND NURSES ASSOCIATION AND THE 

ARTHUR L. DAVIS AGENCY RESERVE THE RIGHT 

TO REJECT ADVERTISING. Responsibility for errors in 

advertising is limited to corrections in the next issue or 

refund of price of advertisement. 

EDITORIAL COMMITTEE 

Janet Cogliano, DNSc, RN,CS 

Karen Cowell, PhD, RN, C 

Cathy Cully Bennett, MS, RN, CNA 

Lynn Derickson, MS, RN, C 

Kathryn Hall, MS, RN, CNAA 

VISION STATEMENT 

Through our members, we touch the lives of other 

nurses and the people of Maryland everyday 

Our Vision 

To be a dynamic force in the advancement of nursing 

practice and advocate for the promotion of quality health 

care for all individuals. 

Our Values 

• Excellence in nursing practice 

• Respect for all individuals, groups and communities 

• Cultural diversity 

• Universal access to affordable, quality health care 

• Quality of life 

Our Mission 

The Maryland Nurses Association will foster the development 

and advancement of nursing practice and will 

work to achieve quality health care for all the people of 

Maryland

AUGUST UGUST, , SEPTEMBER, OCTOBER OCTOBER 

2000 THE MARYL MARYLAND 

AND NURSE • PAGE P GE 3 • 

“Rodney Dangerfield, R.N.” 

by Rob Ross Hendrickson 

Rob Hendrickson, MNA attorney, 

long-time MNA Annapolis 

lobbyist and vehement advocate of 

Nursing submitted this article 

expressing his personal views from 

that unique perspective. In so 

doing, he requested that the longstanding 

open invitation to all 

Maryland Registered Nurses to 

assist in MNA’s Annapolis activities 

be reiterated. 

Cicadian rhythms seemingly dictate 

a “Crisis in Nursing” every few 

Hendrickson 

years, each resulting from a 

“Shortage” of qualified Registered Nurses. Dislocations 

and reallocations in a fluid health care delivery system, the 

latest being managed care’s resource rationing at a time of 

unprecedented employment opportunities elsewhere for 

women, are the generally perceived causes of our current 

crisis. 

Whatever we might wish, Registered Nurses are still 

viewed institutionally as handmaidens. As the actual deliverers 

of hands-on patient care, RN’s have never taken 

advantage of their potential to force the health care system 

to recognized their worth and take them seriously. They 

have always been, and allowed themselves to be, taken for 

granted. 

What is almost never mentioned (outside of RN’s eternally 

griping among themselves) is that despite their education 

and experience, RN’s GET NO RESPECT. Society 

truly values the services of RN’s and it needs to provide the 

resources and working conditions to attract and retain qualified 

persons. Everyone gives lip-service to this acknowledged 

maxim. It’s no wonder that the public is befuddled 

that its billions of health care dollars spent aren’t adequate 

to do this. The real reason is always obscured. Nursing has 

not only failed to effectively educate Nurses but also the 

general public. 

Despite viewing themselves as professionals, Registered 

Nurses are frequently treated as day laborers. They are 

over-worked in understaffed workplaces; are required to 

make hurried split-second life or death decisions on patient 

care and be responsible for the consequences; are accountable 

for the actions or inactions of unlicensed personnel that 

come with their positions; are subject to the condescension 

of physicians and business-types whose egos or budgets 

conflict with a RN’s expertise and advocacy of quality 

patient care; are required to be available on little notice no 

matter what personal or family plans are interfered with; and 

are haunted by nursing school and employer—inculcated 

fears of being viewed as “unprofessional”, or as having 

somehow “abandoned” their patients if they aggressively 

react negatively to these conditions. As a group, Nurses suffer 

from acute “LEARNED HELPLESSNESS.” This is 

why RN’s who can leave their profession simply do and 

why the next generation of potential RN’s don’t enter in the 

first place. Registered Nurses have not insisted on their 

rightful recognition as the single most important practitioner 

in patient care. It’s the workplace perception of this low 

professional esteem, (prevalent within Nursing itself) that 

allows this to continue. Physicians have long recognized 

this and take full advantage, as do many employers and even 

some RN’s. Those considering nursing schools are obviously 

only too well-aware of this. The only people who 

don’t really see this are patients and their families for whom 

the RN (or someone they think is an RN) is their best hope 

for recovery and caring treatment. 

The current crisis in Nursing offers yet again a true opportunity 

for RN’s to awaken, assert themselves, and unteach 

this learned helplessness. For once, RN’s need to stand their 

ground; insist that their colleagues support their proper 

actions; demand that schools of nursing and employers 

focus immediately on developing leadership and community 

among all RN’s and emphasize in every course or 

workplace program the independent role and responsibility 

of the Registered Nurses; and finally emphasize to potential 

Nurses and the public that Nursing will not put up with conditions 

as they are today. Nurses must first be taught to command 

respect if they are to expect to receive it. 

In short, Nursing must be put aside its fears and internal 

bickering jealousies. RN’s singly and cohesively must take 

back their profession. Believe it or not, the public is with 

RN’s all the way and RN’s sheer numbers cannot be denied. 

No studies are needed. RN’s all know exactly what the 

problems are. The solutions are within each RN and they 

must cumulate this time to solve and not simply duck another 

crisis which then merely goes into remission maybe. 

Only from within Nursing will a real solution emerge. 

Money’s important, but no sane person has ever gone into 

Nursing for the bucks. Marketplace supply and demand 

(even blunted by Nursing’s woeful willingness to allow 

cheaper, unprepared persons to do what RN’s spend years 

being educated to do) has nonetheless worked to increase 

RN’s salaries – at least at entry level positions and the first 

few years of practice. Signing bonuses and referral fees are 

the order of the day, but they are short-term and short-sighted. 

Only those just graduating or in mid-or late career would 

choose these one-time payments as attractive momentary 

financial bumps-up in their positions as bedside caregivers. 

There is no real progressive career-long financial future for 

RN’s wishing to remain in direct patient care. Prior to the 

current crisis, many RN’s dealt with this reality by going 

into “administration”. This became tokenism and virtually 

all of them are now gone, largely replaced by non-RN 

“human resources” bean counters who tellingly oversee 

Nursing, housekeeping and maintenance. With the cost-cutting 

abolition of even these former RN administrative positions, 

RN’s must, can and do now look elsewhere-mostly 

outside of hands-on patient care or Nursing altogether. This 

has not been lost on potential nursing students who see no 

reason to expend funds and years on Nursing degrees only 

to face a later look elsewhere for a career. They are a lot 

smarter than some think and they’re sending a clear message. 

Tip O’Neil, a consummate Boston politician, was fond of 

saying “all politics is local.” All this is “politics” in its 

broadest and narrowest sense. Solutions here are also 

“local” from each individual RN, then to each’s workplace, 

then to Nurses’ professional association (The Maryland 

Nurses Association), then through the MNA Legislative 

Committee which advocates Nursing interests before the 

Maryland Legislature in Annapolis, and distantly to the 

ANA in Washington, 

Solutions take gut and commitment of time (and money). 

But guts and commitment breed guts, commitment and actual 

cures. These bring RESPECT. 

For once, Nursing must take hold of the opportunity this 

crisis affords and, kicking and screaming, demand that the 

profession of Nursing become what it should be. For themselves, 

for RN’s that might follow and for the patients whose 

advocacy is Nursing’s highest calling, nothing else is important, 

Nothing. 

Welcome New Members 

Assya Amatus-Salaam D2 

George S.J. Anderson D2 

Gail A. Bashore D5 

Naomi A. Blankenship D2 

Brenda L. Boggs D2 

Geneva S. Boyd D9 

Micke A. Brown D8 

Mary H. Codori D5 

Kimberly J. Elenberg D5 

Linda C. Goodman D8 

Oris L. Harris D2 

Dawn A. Hawkins D2 

Marie H. Hogarth D5 

Adrienne J. Hope D5 

Tammie L. James D2 

Janet Lee Jerge D4 

William R. Jones D5 

Sharon M. Kern D2 

Claudia M. Kim D3 

Kimberly J. Kodenski D2 

Peter A. LeBlanc D2 

Susan M. Marullo D5 

Kerse R. Mattox D4 

Ernestine Murray D2 

Cindy D. Myles D9 

Moira R. Namuth D2 

Bonnie Neibauer D5 

Jean A. Nicholas D5 

Reina S. Ocasio D2 

Catherine R. O’Neill D7 

Kathy Ann Palmer D8 

Valerie S. Parker D5 

Constance M. Pryor D2 

Teresa M.J. Putscher D3 

Sandra L. Sheldon D2 

Carol G. Smith D5 

Cynthia Ann Somers (White) D2 

Anita J. Tarzian D2 

Paula A. Trantas D2 

Mary D. Traver Ward D2 

Cathy D. Webb D1 

Tracey L. White D2 

Bernadette M. Wengert D2 

Mary J. Wise D8



2000 

MNA Members in the News 

On Wednesday, May 31, 2000 five members of MNA were 

invited to attend Presidential Candidate, Al Gore’s plan for 

mental healthcare for children. With his wife Tipper, at his 

side, Vice President Al Gore came to the Friendship 

Heights Community Center in Montgomery County, 

Maryland to tout his wife’s favorite cause – expanded care 

for mental illness – and to present his own view on care for 

children. MNA members who were invited to attend this 

announcement included Mary Beachley, President; 

Elizabeth Tordella, a staff nurse in psychiatry; Paul 

Kulp, a Psychiatric Advanced Clinical Specialist; Sue 

Roth, a staff nurse in psychiatry; and Diane Thompkins, 

President of MNA District 5 which covers Montgomery 

and Prince Georges Counties. 

Anita Tarzian, RN, PhD, (MNA District 2) Co-chair, 

MNA Center for Ethics and Human Rights represented the 

association through her participation in the Diane Rehms 

show a nationally syndicated radio talk show produced in 

Washington, DC and heard daily by over 750,000 listeners. 

The topic was hospice/end of life care. Kudos, Anita. 

Julie Pannell (MNA District 5) 

participated in the Beacon Heights 

Elementary School Career Day 

2000. Ms. Beth Frissell, Guidance 

Counselor and Career Day 

Coordinator called MNA to find a 

nurse speaker and Julie was an outstanding 

representative of MNA 

and of nursing. Mary Walker, 

Principal said of Julie, “Your comments 

to our students were so 

appropriate, motivating and 

reminded the students of the impor- Pannell 

tance of working hard, staying in 

school and getting along with others. We feel so lucky that 

you chose to spend the morning with us.” Thank you Julie. 

Jacquelyn Campbell, PhD, RN, 

FAAN, (MNA District 2) professor 

and associate dean at The Johns 

Hopkins University School of 

Nursing, was named to the 

Department of Defense Task Force 

on Domestic Violence. Secretary 

of Defense William S. Cohen 

announced the appointment of 

members to the task force. The 

Congressionally mandated task 

force will assess current domestic 

violence programs and policies 

within the Department of Defense 

and the military services. 

Kathleen M. White, RN, PhD, 

(MNA District 2, President) 

Associate Professor at The Johns 

Hopkins University School of 

Nursing has been appointed to a 

Maryland Health Care Commission 

steering committee charged to 

develop a system to comparatively 

evaluate the quality of care outcomes 

and performance measurements 

of hospitals and ambulatory 

surgical facilities. 

Mary L. Beachley, RN, MS, CEN 

(MNA President) represented the 

association serving as the main 

guest of the Vicki Jones Talk Show 

out of Washington, DC. Ms. 

Beachley was asked to discuss the 

impact of the nursing shortage and 

to offer a response to the article in 

JAMA that discussed the shortage. 

Calling All 

Nurse Quilters! 

by Anne Marie Barentt, RNC 

President, District 9 

Campbell 

White 

Beachley 

I have an idea (vision) that I would like to share 

with fellow nurse quilters throughout the state of 

Maryland. More than ever, I have participated in discussions 

about the decrease in number of people 

applying to nursing programs and that the general public 

doesn’t really understand what nurses do. There are 

campaigns all over, including newspaper advertisements, 

TV commercials, radio commercials, all aimed 

at telling people about what nurses do and why it is a 

rewarding career. That’s when I had an idea. 

I am a quilter and would like to gather a group of 

nurses who love to quilt like I do and put together a 

quilt that has many blocks that describe the many 

kinds of nursing practice and what nurses do to promote 

health, wellness, education, comfort, etc. Each 

block would represent areas of nursing such as, Acute 

Care, OB, Pediatrics, Long Term Care, Hospice, Home 

Health, etc. In the center of the quilt, I envision a 

Maryland State emblem. 

I have scheduled an initial planning meeting for 

September 13th, 6-8 pm at MNA Headquarters in 

Linthicum. If you have a passion for both nursing and 

quilting, please plan to attend. If you have any questions, 

you can contact me in the evenings at (301) 475- 

8456. 

Medical Errors: 

Where’s the Blame 

by Mary Beachley, RN, MS, CEN 

MNA President 

According to recent research, medical errors kill 

more than 44,000 people in hospitals each year. Errors 

occur in every health care delivery setting and are not 

limited to hospitals. There are more than 7,000 deaths 

from medication errors which occur in and out of health 

care facilities annually that exceeds the deaths from 

workplace injuries. 

The recently released policy paper by the Institute of 

Medicine (IOM), To Err is Human: Building a Safer 

Health System” has drawn the attention of Congress 

and the media to the seriousness of medical errors. The 

debate surrounding this report with challenging arguments 

were reported in the Washington Post on July 5 th . 

This problem is not new or unknown to nurses or to risk 

managers and other health care managers. The investigations 

and corrective actions that have been taken to 

address the errors, mostly staff discipline, have not had 

much impact on reducing these errors. Nurses are frequently 

caught up in the blame game. 

Dr. Lucien Leape in his lecture, “Stopping the Blame 

Game,” to the ANA 2000 Convention presented a different 

approach to preventing errors. Dr. Leape, from 

Harvard University, conducted some of the research and 

helped write the IOM report. He concluded from his 

research and investigations of medical errors that medical 

errors are complex and not simply due an individual’s 

carelessness, incompetence, inattention, or lack of 

education but rather due to system failures. He presented 

a sound argument that health care professions, agencies, 

and facilities need to promote a blame-free environment 

in which practitioners feel free to report errors, 

including their own. In order to create such an environment, 

errors cannot be used in personal performance 

evaluations. Prevention of errors in health care is only 

possible if information about near misses and actual 

errors is willingly shared and analyzed and solutions are 

disseminated to prevent similar occurrences. 

According to Dr. Leape, all health care systems must 

adopt forcing functions that eliminate or significantly 

reduce the chance of error. Forcing functions were 

described as engineered safety mechanisms in the system 

that would prevent human error. For example, 

removing all IV potassium from unit supply and having 

Potassium mixed in IV solutions in the pharmacy would 

eliminate nurse medication errors that are caused from 

mistaken substitution of IV potassium for other drugs. 

He made a plea for giving up scared cows that take up 

time but are not effective in preventing errors such as 

double checking dosages, checking against 

MAR/orders, forbidding patients to manage their own 

medicines. 

Nurses should seriously consider the recent research 

on medical errors and use a system performance 

improvement model rather than an individual performance 

improvement model to address errors in patient 

care. It is important to analyze errors for route cause 

and make appropriate changes in the system and not 

punish the individual. Discipline/punishment should 

be limited to impaired nurses and or behavior problems. 

This “new attitude” must begin in the workplace and 

extend to regulatory bodies and licensing boards. This 

change of approach in dealing with errors has broad 

reaching effects on how nursing care units are designed, 

procedures are written, roles are assigned and competencies 

are assessed. The IOM report is a wake up call 

that our current methods of protecting patients from 

medical errors is not working, and seems to be out of 

control.




One Nurses Experience on an Educational and 

Professional Visit to Egypt 

by Marsha Zanger 

Marsha is the owner of a home infusion company in 

Cumberland, Maryland. She is a past president of MNA 

District 1 and currently is serving on the Convention 

Planning Committee for the 2000 MNA Convention. 

Marsha will be a speaker at this year’s convention on 

issues around workplace safety and needleless systems. 

Little did I know when I chose the nursing profession 

back in 1965, that I would have so many interesting opportunities 

come my way. Nursing has changed dramatically 

since choosing this career so many years ago, but we 

won’t go there! However with some of the negative 

changes, there have also been some positive and interesting 

outcomes as well. We now have opportunities for professional 

growth at our disposal that we never had before. 

I never dreamed that I would one day be a partner in a 

home infusion company, nor that I would be a member of 

a People to People delegation of intravenous nurses on a 

professional visit to Cairo and Luxor Egypt. Both have 

been rewarding experiences, however the latter was a 

dream come true. I had always aspired to one-day see the 

Great Pyramids; little did I know I would see and experience 

this country in such a unique personal and professional 

way. 

During our stay in Cairo, we visited four hospitals: 

- The Dar al Fouad, affiliated with The Cleveland 

Clinic 

- Salem International 

- Kasr el Aini Teaching Hospital 

- The Cairo Fever Hospital, which cares for the HIV 

and TB patient population 

We were generally met with a little skepticism at first, 

but after brief dialogue with our fantastic delegation 

leader, Sharon Weinstein, the flood gates opened and our 

interchanges with them became animated and informative. 

Marsha enjoying her long awaited ride on a Ship of 

the Desert. 

After meeting with them and touring their facilities, they 

were so eager for more information that one Director of 

Nursing followed us to our bus wanting us to send a nurse 

back for a week of IV therapy training and another wanting 

us to come back the following day to give a presentation to 

their staff. During our planned visit to the Higher Institute 

of Nursing, I gave a presentation to approximately 50 nursing 

students regarding safety IV catheters, needleless 

devices, and midline catheters. That was my introduction 

to lecturing via interpreter! Needless to say they were fascinated 

with all our needleless gizmos. 

In Luxor, we toured an orphanage run by a British 

woman named Pearl Smith, who while on a visit to Luxor 

learned of the plight of these children and returned to open 

the Sunshine International Project. We too could not get 

the faces of these precious children out of our minds. We 

could not help but admire the fortitude of this spirited little 

woman, doing God’s work in a very special way. 

Our final professional visit was to the Karnak Charity 

Hospital which was run by a most affable OB/GYN doctor, 

who in his very small facility consisting of a small operating 

room, exam room, two rooms for overnight stays and a small 

Marsha instructing Egyptian nursing students at 

the Higher Institute of Nursing 

pharmacy, he cares as best he can for the poor maternal population 

of Luxor. We all thought so highly of this man who 

enthusiastically showed us every inch of his facility; down to 

his small stock of IV antibiotics. As we sat having a Coca- 

Cola with him he shared his many needs with us; the most 

costly of which was an ultrasound. Sharon feverishly wrote 

down his list of needs to see what contributions of goods she 

might be able to find him. It was a humbling experience! 

In case you are thinking this sounds like all work 

and no play, I saved the best for last! I shall never forget the 

awesome feeling of standing at the foot of the great Cheops 

pyramid, the glittering wealth from Tut’s tomb, the mystery 

of the Sphinx, lunch on a Felucca sailboat as we sailed lazily 

down the Nile, the wonder of the Valley of the Kings, dinner 

in the home of a most hospitable Egyptian family, and of 

course my long anticipated ride on a Ship of the Desert - yes 

a camel ride! I returned home with a much greater appreciation 

for the things we take so much for granted, as well as, 

a heightened understanding of their culture than I ever could 

have gained as a mere tourist. I encourage all nurses to Seize 

The Day – Carpei Deum – there are so many opportunities 

out there.



2000 

“I may not remember what happened, but I 

know when It happened…. 

by Sharon Culliane 

Sharon Cullinane is the Project Director for the Maryland 

Traumatic Brain Injury Demonstration Project. She holds 

a BSN from Kutztown University, 

PA and a MHS in health education/communications 

from the 

Johns Hopkins School of Hygiene 

and Public Health. Along with a 

background in critical care and 

community health nursing, she 

has been a free-lance health 

writer for many years. She is a 

member of Sigma Theta Tau 

Nursing Honor Society and the 

American Public Health Cullinane 

Association. 

A survivor of Traumatic Brain Injury (TBI) may not 

recall the events surrounding their injury—the seconds it 

took to flip their car, to fall off their roof, or to have a bullet 

pierce their skull—but they will always be able to tell 

you the month, day, year and hour of their injury. How can 

they recall such specifics and have no memory of the 

event? They learn that date and time because that is the 

moment that their lives are forever changed. In one blink 

of an eye they have entered a world that can only be truly 

understood by those who have experienced brain injury 

first hand—either as a survivor or as a survivor’s loved 

one. The aftermath of brain injury leave individuals and 

families with challenges for a lifetime. 

What is the scope of the problem? 

A little more than 2% of the U.S. population currently live 

with the sequelae of brain injury: 

• Every 15 seconds one person in the U.S. sustains a 

Traumatic Brain Injury 

• Each year in Maryland, more than 6,000 adults sustain 

brain injuries severe enough to be hospitalized. 

• Each year 373,000 Americans are hospitalized for a 

TBI. Of that number, 99,000 individuals sustain moder 

ate-to-severe brain injury that result in lifelong dis 

abling conditions. 

• An estimated 5.3 million Americans (more than 2% of 

the population) live with impairments and disabilities 

resulting from TBI. 

• One million people are seen, treated and released from 

hospital emergency departments after sustaining a brain 

injury. 

• 56,000 people die each year as a result of TBI (22% of 

those injured). 

Can we predict who will sustain a brain injury? 

Not completely, but research shows that there are individuals 

who are most at risk for a TBI: 

• Males, ages 15 -24 are at highest risk for TBI. 

• Brain injury is the leading cause of death and disability 

for Americans under the age of 45. 

• Children under 5 years of age, and the elderly over the 

age of 75, are also at higher risk. 

• The National Pediatric Trauma Registry reports more 

than 30,000 children sustain permanent disabilities as a 

result of a TBI 

• Males are twice as likely as females to sustain a brain 

injury. 

• Shaken baby syndrome and child abuse is a rising 

cause of brain injury in this nation. 

What are the costs of traumatic brain injury? 

Although there is no way to fully quantify the costs of 

brain injury, both financially and emotionally, the following 

are estimates of the monetary costs of TBI: 

• It is estimated that more than $48 billion dollars are 

spent related to TBI each year. 

• Hospital costs for TBI are $31.7 billion each year. 

• TBI fatalities in the US cost 16.6 billion each year. 

How do traumatic brain injuries occur? 

The leading cause of TBI is motor vehicle crashes. 

Note—many brain injury survivors refuse to call these 

“accidents” as they are often preventable events caused by 

drug or alcohol use or careless driving. 

Source: 

Brain Injury Association, Inc. (Spring 1999). The Costs 

and Causes of Traumatic Brain Injury. 

http://www.biausa.org/costsand.htm 

Brain Injury Association, Inc. (April 14, 1999). Special 

Report: CDC Report Shows Prevalence of Brain Injury. 

http://www.biausa.org/costsand.htm 

Sports/Rec 

Firearms 

Falls 

CAUSES OF TBI 

Other 

Vehicular Crashes 

Falls 

Firearms 

Sports/Recreation 

Other 

Vehicular 

Crashes 

50% 

21% 

12% 

10% 

7% 

MARYLAND TRAUMATIC BRAIN INJURY 

DEMONSTRATION PROJECT: 

Purpose and Objectives 

The Maryland Traumatic Brain Injury Demonstration 

Project was designed to address some of the needs of individuals 

with brain injuries identified during The Maryland 

Traumatic Brain Injury Demonstration Project—a one-year 

needs and resource assessment (1998 – 1999). A common 

need expressed by survivors, families and providers was 

for training and education about brain injury on all levels— 

from the acute care setting, through rehab and into the 

community. Another commonly reported need was that of 

increased support and services for survivors of brain 

injuries and their families. 

The primary purpose of the current project is to improve 

the lives of survivors, their families and caregivers individuals 

living with brain injury and those of their families 

and caregivers through education, training, public awareness 

and outreach activities. In accordance with this mission, 

the following objectives were developed: 

To improve understanding throughout the State about 

brain injury, its effects prevention, and the needs of those 

affected by brain injury, by increasing outreach and informational 

services to people with brain injuries, their families 

and the general public. 

To improve linkages among State agencies that serve, or 

could serve, people with brain injuries and their families by 

providing statewide training and information exchange 

programs about TBI to state, regional and local level representatives 

of designated State agencies and private 

organizations. 

To empower people with brain injuries and their families 

to be better advocates for their needs by providing 

training regarding self-advocacy, State and private 

resources, new programs and legislation related to brain 

injury. 

To improve the State’s capacity to serve diverse and 

under-served populations of brain injury survivors and 

families, as identified by the needs and resource assessments, 

such as cultural and linguistic minorities; people 

with low literacy levels; young children and their families; 

the elderly; people living in rural areas; and those in the 

criminal justice system. 

The objectives listed above are both lofty and achievable. 

Lofty, because when accomplished, they will elevate 

the state of brain injury services and supports to a new 

level in this State; achievable because individuals, organi- 

zations and communities working together can make it 

happen. 

How can you, as a nurse, become involved? 

Participate on a Work Group: Become involved by 

joining one or more of the work groups listed below. Or 

participate on a more limited basis by volunteering for 

specific work group activities. 

• Work Group for Education, Training, 

Public Awareness and Outreach. 

• Work Group for Building Community 

Capacity and Accessing Services 

• Work Group for Sustainability and 

Funding of Brain Injury Programs 

• Work Group for Definition and Data 

Collection Needs 

Support the Brain Injury Outreach Council in your 

region: If you know survivors or family members that 

would like to become a part of a growing outreach effort, 

encourage them to join the Outreach Council in their area. 

Council members represent other survivors and family 

members through support and advocacy as well as community 

outreach. 

Assist the Brain Injury Association of Maryland 

(BIAM) Regional Representatives in your region: Each 

BIAM Region has one or two representatives who function 

as an extension of the BIAM by promoting brain 

injury prevention, research, education and advocacy. 

Some regions need additional representatives to serve in 

this capacity. 

Serve as a volunteer for BIAM or The Maryland 

TBI Demonstration Project: Assist with various activities 

in the community or provide administrative support in 

the Association and Project offices. 

Assist in promoting public awareness of brain 

injury: Volunteer to staff the new BIAM tabletop display 

at health fairs and conferences; help plan and promote 

BIAM events or write articles about brain injury for 

HeadStand (BIAM Newsletter) or other publications. 

Join or start a support group: Attend your local brain 

injury support group and become involved in supporting 

others living with brain injuries in your locality. If there is 

no support group near you, learn from BIAM how to begin 

a group. 

Become a brain injury educator: Support education 

and training activities in Maryland by speaking at workshops 

or seminars on brain injury topics. Join the list of 

“faculty” willing to share their education, experience and 

knowledge. 

For more information contact: 

The Maryland Traumatic Brain Injury Demonstration 

Project 

2200 Kernan Drive 

Baltimore, MD 21207 

Tel: (410) 448-3922 Fax: (410) 448-3850 

email: mdtbiproject@erols.com




District 1 News 

District #1 of Allegany and Garrett counties recently 

named Nancy Adams as the recipient of the annual Nurse 

Recognition Award. This award is awarded to a nurse 

who shows evidence of promoting high standards innursing 

by helping to define the role of nursing, introducing 

new nursing roles, promoting nursing in the community, 

demonstrating excellence in nursing practice, contribuing 

to nursing education, nursing research, and participating 

in other areas that are beneficial to nurses. 

Nancy’s current role is Vice President of Patient Care 

Services for the Western Maryland Health System. She is 

also currently serving as President of MONE, and is Vice 

Chair to the Statewide Commission on thecrisis of the 

nursing shortage in Maryland. Her service to her community 

includes work on the Allegany County task force for 

AIDs, The League of women voters, The Allegany County 

Substance Abuse task Force., and The Family Crisis 

Resource Center. Nancy is a Nursing Graduate of 

Allegany College. She received a BSPA in Health Care 

Administration from St. 

Joseph’s College, an MBA 

from Frostburg State 

University and a Fellowship at 

Northwestern University in 

Healthcare Management from 

the Kellogg Graduate School 

of Management. 

Nancy has made numerous 

other contributions to health 

care and has served in many 

capacities on a variety of 

issues. 

This award was given at 

District 1 annual dinner meeting 

in May. 

District 1 has also been busy 

planning the MNA 2000 

Convention scheduled to be 

held at Rocky Gap Conference 

Center, November 8-10, 2000, 

titled Healthy Nurses 2000. 

Please come to Western 

Maryland and enjoy our hospitality. 

Calvert, Charles, and St. Mary’s County 

Commisioners presenting Nurse Week Proclamation. 

district 9 president, Anne Marie Barnett far right. 


by Anne Marie Barnett, RNC 

District President 

This May, District 9 celebrated National Nurses Week 

with our Annual Dinner and Program. Our guest speakers 

this year were Kay Bensing, RN, MA, MJ, writer 

for Advance for Nurses magazine, who spoke on the 

topic “Antique Lace and a New Young Face”, addressing 

past and current challenges in nursing. Mr. Vincent 

DeMarco, Executive Director for Maryland Citizens’ 

Health Initiative, also spoke about the Maryland Health 

Care Coalition that he represents. We were fortunate to 

have County Commissioners from the tri-county area to 

deliver a Nurses Week Proclamations. A large focus of 

our annual dinner and program recognizes outstanding 

nursing practice in the tri-county area. This year’s 

awards went to the following nurses: Grace E. Brown, 

Nurse Educator Award to Mrs. Annette Ragland, RN, 

MS, Nursing Instructor at Charles County Community 

College; Joanne Zwick Bedside Nurse Award to 

Joanne Hoffmaster, RN and Gail Kessler, RN, who 

are both volunteers at Health Partners Clinic in Waldorf; 

The Nurse of the Year Award to Sara Western, RN 

Snookie Davis, Karen Shaffer, Dr. Ruth Kerschner (dinner speaker), Nancy 

Adams (award recipient), Dora Long and Nancy Shircliff at District 1 Awards 

Banquet 

Attendees of District 9 Annual Nurses Week dinner 

and program 

office nurse who works for Dr. Louis Kaufman. 

District 9 also awarded a $1,000.00 Scholarship to 

Ms. Peggy Bird who will be entering her second year of 

the RN Program at Charles County Community College. 

In addition to all of these awards, District 9 also recognizes 

an Outstanding Nursing Student from an area nursing 

program and this year’s recipient of this award was 

Ms.Theresa DiZebba, from Charles County Community 

College. This award was presented at the annual Pinning 

Ceremony. 

This past year, the tri-county area lost a well respected 

nursing leader with the death of Mrs. Mona Lea 

Potter, RN, MS. Mr. Lawrence Potter and family attended 

our annual dinner and were presented with the 

Leadership Award in honor of Mrs. Potter’s contributions 

to nursing. 

With all of this fun, there was even more! We hosted 

a fund raising event to raise monies to help support 

Colleagues in Caring, enjoyed a not-so-silent, silent auction, 

and there were many door prizes for attendees. 

District 9 will also help to sponsor a representative, 

our Delegate, Cathy Vestraci, RNC to this years national 

convention in Indianapolis. We will take a break for 

the summer and then start off this fall with our planning 

meeting and quarterly Newsletter. If any of you live in 

Charles, Calvert, or St. Mary’s Counties and have not yet 

joined MNA, but are interested, don’t hesitate to call me 

in the evening at (301) 475-8456. 


by Deborah Cox, President 

District 4 celebrated Nurses Week in May with a 

dinner program held at Shore Health Systems 

Education Center in Easton. The program, “Pain 

Management,” was presented by Chris Mullikin, RN 

C, MHS, CPP, current manager of the Pain and 

Management Palliative Care Program for Shore Health 

Systems. Chris is a certified Pain Management 

Practitioner and her information was timely in view of 

JCAHOS focus on pain management. The District 

recognized Louise Cole, RN, BSN, a retired member. 

Not only is she coping with a chronic illness, but also 

she is also waiting for a donor for her kidney transplant. 

Louise has remained a dedicated District member 

for many years. 

The District was pleased to begin sales of their 

cookbook in May. Sandy Bryan, RN C, MS, spearheaded 

this project, compiling the numerous contributions 

from District members. 

Celebrating Earth Day, on April 22, 2000, several 

members showed up to clean up our stretch of adopted 

highway leading into Oxford. Fueled by donuts, gratis 

of the State Highway Administration, Jane and Steve 

Escher, Gayle Hughes, Kay Wendowski and Debbie 

and Doyle Cox donned orange vests and hats to support 

the Maryland Highway beautification program. 

The District is currently beginning to plan the 2001 

MNA Convention to be held in Ocean City. So mark 

your calendars for October-November, 2001. 

Finally, we are requesting volunteers to serve on our 

District Board or Convention Planning Committee. 

Anyone who is interested should contact Deborah 

Cox, President. 

KUDOS to District members Kathy Foster, RN, 

MS and Sandy Wieland, RN, MS for completion of 

the Psychiatric Clinical Nurse Specialist post-graduate 

program through the University of Maryland in 

Baltimore. Sandy Bryan deserves credit for completing 

a thesis and receiving a Masters in Health Services. 

Mary Emma Middleton, Vice President, District 9 

presenting the Nurse of the Year Award to Ms. Sara 

Western, RN



2000 

Crisis in Nursing Summit cont. from pg. 1 

• Cost of education vs. salary offered and related 

responsibility 

• Nature of the work with shifts, weekends 

and holidays 

• Physical labor 

Retention 

• Absence of career advancement opportunities, 

salary and benefits 

• Stress and staff burnout related to mandatory shifts 

and overtime 

• Unrealistic workloads and expectation to keep doing 

more with less 

• Lack of recognition and respect 

• Increased demands of regulatory and legislative com 

pliance that results in a paper chase 

Education 

• Cost of education is too high 

• Lack of availability of flexible programs 

• Lack of preparation at the high school level for the 

science based curriculum 

• Lack of any business education in curriculum 

• High attrition rates 

Other Issues 

• Reimbursement is dictating services, cost containment 

hits nursing budgets first 

• Nurses are not good mentors and often become our 

Own worst enemy “eating our young” 

• Need to promote a different kind of collaboration 

• Nurses have not had enough involvement in the 

political arena 

• Stress 

A sample of some of the identified solutions in each of 

the issue areas include the following: 

Recruitment 

• Nurses need to educate lawmakers 

about what nurses 

actually do 

• Nurses need to clean up 

their professional appearance, 

image 

• Nurses need to be an 

ambassador for the profession 

• Duplicate paperwork needs 

to be eliminated so attention 

can be directed to patient 

care 

• A more competitive salary 

and benefit structure needs 

to be developed 

Retention 

• Dollars need to be focused 

on retaining current, experienced 

staff 

Left to right: Delegate Addie Eckart, Sanator Paula 

Hollinger, Dean Barbara Heller, Delegate Shirley 

Nathan-Polliam, Secrtetary Georges Benjamin, Dr. Sue 

Donaldson is seated directly behind Dr. Benjamin. 

• Stronger mentoring programs need to be developed 

• Nurses must be included in the decision making and 

budget decisions 

• More autonomy 

• Re-evaluation of benefits 

Education 

• Better funding should be made available 

• Curriculum should focus on increasing critical 

thinking skills 

• Salaries should reflect educational level/experience 

• Educators need to be more up to date with practice 

The Maryland Board of Nursing has a comprehensive 

summary of the proceeding of the nursing summit. They 

have also coordinated the gathering of names of persons 

who meet the criteria for appointment to the Commission. 

The Commission is charged with making a report to the 

Governor by the end of this year. Updates may be found 

on the Board of Nursing Web Site: www.mbon.org 

Auditorium view of participants during keynote address. 

A Nurses View on 

the Summit on the 

Crisis in Nursing 

by Mary Zohlen, MSN, RN 

Long Term Care (LTC) is dealing with challenges, 

which are very different from those in Acute Care. 

Therefore, the Commission should appoint a special committee 

to study the specific effects of the nursing shortage 

on the Long Term Care Industry. If the problem is to be 

permanently solved in LTC, this special committee will 

need to make recommendations for Health Care reform to 

address issues unique to Nursing Homes. 

Nursing Homes are evolving into something very different 

from what they were a few years ago. Gone are the 

days of “warehouse” care for the end of life. Gone are the 

posey vests, foley catheters, and syringe feeding as the 

treatment of choice for confused and incontinent elderly 

people. Physical and chemical restraints have disappeared; 

replaced with innovative programs, which focus on whatever 

ability to function and enjoy life, the individual 

retains. The emphasis is on maintaining quality in the life 

still left to live. 

Today, almost half of the people admitted to LTC stay a 

short time and are discharged to a lesser level of care; to 

home or Assisted Living. Individuals (not necessarily elderly) 

are admitted to Nursing Homes for a variety of reasons. 

They come for rehabilitation therapy following a 

stroke, or a fractured hip, or a car accident. They come for 

IV antibiotic therapy, for TPN, for pain management, or for 

wound care. If they are unable to be cared for at home after 

hospitalization for any acute episode, they come for follow-up 

care. Blood transfusions, chemotherapy, and renal 

dialysis are being administered in some Centers in 

response to the increased acuity. Nursing Homes have 

begun to meet the need for an institution other than a hospital 

to treat people with Cancer, AIDS, Sickle Cell, medical 

complications of drug and alcohol abuse, and other 

“young people” diseases. 

LTC nurses are constantly striving to enhance the quality 

of life for the long-term residents. They are likewise 

striving to meet the needs of the short stay persons with 

subacute medical conditions. Nurses are doing this as they 

struggle with multiple health care industry challenges. The 

requirement to complete and electronically transmit MDS 

data at frequent intervals for all residents is time consuming. 

Managed Care has introduced younger, sicker residents. 

Increased technical skills, greater documentation 

requirements, and other “paperwork” and logistical components 

have been added to the nurse’s shift by both 

Medicare and Managed Care. 

Enhanced regulatory requirements have created an 

adversarial component to both the annual and complaint 

survey process. It is true that some Nursing Homes give 

poor care, but most give very good care. The current 

process does not differentiate between the two. The nurse 

must add this additional stress to her already difficult job. 

It is my opinion that increasing the State survey to a twice 

a year event will not enhance the quality of care, and more 

frequent survey’s most certainly will not encourage nurses 

to stay in LTC. Negative press coverage with the resultant 

negative image issues discourage nurses from staying in, 

and from entering, the Nursing Home job market. This is 

a disservice to the many wonderful, capable nurses who 

give excellent care day after day in a very challenging 

environment. 

Serious financial issues are impacting the industry. Five 

of the seven largest Nursing Home chains are in bankruptcy. 

What are the financial implication on care delivery 

issues and staffing levels? Are the politicians aware of the 

implication of this crisis?




Workplace Violence: Part IV 

Employer Responsibilities 

by Carol A. Distasio, RN, MSN, 

MPH, C, CS-P, CS-HH 

The statistics on workplace violence in general are 

grim: 10-15% of violence in the United States occurs in 

the workplace (1). Despite the fact 

that workplace violence is underreported, 

the data indicate that : 

• 25 million human beings/ 

year are victimized by fear 

and violence in the workplace 

• Violence costs an estimated 

$4.3 billion annually 

• Homicide is the second leading 

cause of death in the 

workplace 

• Homicide is the leading 

cause of death in the workplace 

for women 

Distasio 

• Assaults and threats of violence number 2 million/year 

• There are 1.5 million simple assaults/year 

• There are nearly 400,000 aggravated assaults/year. 

The Occupational Safety and Health Administration 

(OSHA) has identified health care settings at workplaces 

at increased risk for violence (2). Between 1980-1990, 

106 workplace homicides occurred among pharmacists; 

physicians; registered nurses; nurses’ aides; and health 

care workers in other occupational classifications (2). 

Between 1983 and 1989, 69 registered nurses were 

killed at work, and homicide was the leading cause of 

traumatic occupational death among employees in 

nursing homes and personal care facilities (2). 

Healthcare providers, especially those who provide 

hands-on clinical services, are at higher risk for nonfatal 

assaults in the healthcare workplace across care settings 

(2). More assaults occur in the health care and 

social service industries than any other industry. 

Healthcare providers are at 16 times greater risk for violence 

than other workers (2), and nursing staff in all 

healthcare settings, particularly those in psychiatric settings, 

sustain the highest rates of nonfatal assaults per 

employee/year than all other health care provider categories 

(2). Healthcare providers in nursing & personal 

care facilities sustain nonfatal assaults at the rate of 

38 cases/10,000 workers and those in residential care 

facilities at the rate of 47 cases/10,000 workers, compared 

to workers in private industry, who sustain only 3 

cases/10,000 workers. Clearly, the risks of workplace 

violence, which pose a serious threat to all healthcare 

providers, continue to increase in frequency and severity. 

What Are The Employer’s Responsibilities In 

Workplace Violence Prevention? 

OSHA’s General Duty Clause Section 5(a)(1) states 

that each employer shall furnish to each of his employees 

employment and a place of employment which are free 

from recognized hazards that are causing or likely to 

cause death or serious physical harm. This includes the 

prevention and control of the hazard of workplace violence. 

Enlightened healthcare employers recognize the 

need to initiate violence prevention programs that 

reduce violence, severity of employee injuries, and organizational 

risks. Employers who believe that assaults are 

“part of the job” expose their organizations to legal risks, 

e.g. tort actions, that may arise when staff are injured or 

killed at work in situations where the employer failed to 

comply with OSHA’s General Duty Clause. Stated directly: 

employers who know, or who should have known, of 

risks of workplace violence owe a duty to protect against 

that risk (3). 

What Are The Components Of An Effective 

Violence Prevention Program? 

An effective violence prevention program is multidimensional, 

purposeful, evaluated, maintained by the 

employer with employee involvement, and contains the 

following five essential components: 

• Management Commitment and Employee 

Involvement 

• Worksite Analysis 

• Hazard Prevention and Control 

• Training and Education 

• Recordkeeping and Evaluation of Program. 

Management Commitment and Employee 

Involvement 

The employer must make a commitment to prevention 

of workplace violence that includes both management and 

employee involvement; visible involvement of top management; 

clear, announced, published policy statements 

of zero tolerance for violence in the workplace; a policy 

of no reprisals against employees who report violence or 

threats; and encouragement of employees to report all 

incidents and to suggest ways to reduce risks. Employees 

must become actively involved in violence prevention, 

e.g. promptly reporting all incidents and risks; participating 

in complaint procedures about safety issues; complying 

with the employer’s workplace violence prevention program, 

safety and security measures, etc. 

Management must develop and put in place a comprehensive 

program of medical and psychological counseling 

and debriefing for employees who have experienced 

and/or witnessed assaults or other violent incidents at 

work, so that recovery can be facilitated. 

Worksite Analysis 

Worksite analysis is a step-by-step evaluation of the 

workplace by a management-employee team (i.e. a threat 

assessment team) to identify potential risks of workplace 

violence and determine appropriate preventive interventions 

and actions to reduce workplace violence. The threat 

assessment team reviews all data pertaining to violent 

incidents to — 

• Identify assault patterns (e.g. units, shifts, day of the 

week, etc. 

• Identify victim characteristics (e.g. gender, age, clas 

sification, tenure, etc.) 

• Identify assailant characteristics (e.g. gender, age, 

alcohol/drug user, diagnosis, etc.) 

• Determine events that preceded the violence (e.g. 

escalation behaviors, warning cues, etc.) 

• Identify jobs with the greatest risk of violence (e.g. 

psychiatric units, emergency rooms) 

• Determine the outcomes of each violent event (e.g. 

lost time, hospitalization, death, etc.). 

The threat assessment team also evaluates the effectiveness 

of existing security measures, including engineering 

control measures to determine if risk factors have 

been reduced or eliminated. 

Hazard Prevention and Control 

Engineering controls remove hazards from the workplace 

or create barriers between employees and hazards. 

There are many types of engineering controls that employers 

may utilize, for example: 

• Metal and motion detectors 

• Alarm systems, panic buttons, cellular phones, handheld 

alarms, etc. 

• Closed-circuit video for high risk areas 

• Enclosed nurses’ stations 

• Safe rooms for employees during emergencies 

• Establishment of separate rooms for courtreferred/criminal 

patients 

• Locked access doors after visiting hours, consistent 

with applicable fire and safety codes 

• Rooms designed to facilitate hasty staff exits 

• Bright, effective lighting of indoor/outdoor areas, and 

so forth. 

These and other types of environmental controls promote 

safety and security for all concerned — staff, 

patients, visitors. 

Administrative and Work Practice Controls 

Administrative and work practice controls are systems 

to minimize workplace violence and to respond effectively 

when incidents do occur. In addition to a well-publi- 

cized zero tolerance policy, these systems require all 

employees to report all incidents of workplace assaults or 

threats; establish liaisons with local law enforcement 

authorities in advance of any violent incident(s); and 

establish trained response teams to respond to emergencies. 

Post-Incident Response 

An effective violence prevention program includes a 

comprehensive post-incident response and evaluation 

for all staff who are direct victims of violence, and for 

indirect victims, i.e. staff who witnessed or who have been 

otherwise psychologically traumatized by the event. 

Serious incidents of violence cause shock waves throughout 

a healthcare organization, in the victim’s family and 

other relationships, among coworkers, among survivors, 

and in the larger community. Critical incident stress 

debriefing and post incident counseling can help the victims 

of serious workplace violence to recover emotional 

equilibrium and return to work more expeditiously. 

Training and Education 

All employees, both management and staff, should 

receive education and training in violence prevention; 

recognition of escalating situations; the concept of 

“Universal Precautions for Violence” (violence should be 

expected but can be avoided or mitigated through preparation); 

recognition of potential security hazards and ways 

to protect themselves; location and use of safety devices; 

the organization’s response plan for volatile or potentially 

violent situations, and so forth. 

Records of all workplace violence events should be 

maintained and analyzed for the purpose of ongoing monitoring, 

identification and elimination/reduction of workplace 

safety hazards and risks. Meeting minutes, incident 

records, OSHA’s Log of Injury and Illness (OSHA 200), 

medical reports, outcomes, etc. should all be maintained, 

regularly evaluated, and revisions to the healthcare organization’s 

overall violence prevention plan made based on 

the data. 

Summary 

This article presented a summarized overview of the 

employer’s responsibility for violence prevention in the 

healthcare workplace. For a detailed discussion of OSHA’s 

violence prevention recommendations, see OSHA’s 

Guidelines for Preventing Workplace Violence for Health 

Care and Social Service Workers (2). In the final analysis, 

workplace safety is everyone’s responsibility. 

If you experience violence and/or threats from anyone 

in the healthcare workplace, including patients, visitors, 

family members, significant others, coworkers, supervisors, 

or others, report all such events promptly, both verbally 

and in writing; and seek and expect assistance and 

support from your employer. No healthcare provider has 

to, or should, work for employers whose neglect of safety 

and security in the workplace places healthcare providers at 

risk of physical assaults, verbal abuse, threats and intimidation, 

emotional trauma, temporary/permanent disability, 

or any of the other myriad effects of workplace violence, 

including loss of life. 

References 

(1) Elliott, P. Violence in Health Care: What Nurse 

Managers Need to Know. Retrieved March 26, 2000, from 

the World Wide Web 

http://www.springnet.com/ce/m712a.htm 

(2) Guidelines for Preventing Workplace Violence for 

Health Care and Social Service Workers. Washington, 

D.C: U.S. Department of Labor, Occupational Safety and 

Health Administration (1998). 

(3) Sheppard, Linda J. (1998). Workplace Violence: 

Employers’ Duties and Preventive Measures. Retrieved 

March 26, 2000, from the World Wide Web 

http://www.rbma.org/index.tat?_pi=2AD 

69223E24723CBBA89DA91



2000 

A Mystery Solved 

(or who are those Nurses in Annapolis) 

by Peggy Soderstrom 

and Rosemary Mortimer 

Two major factors affect the Registered Nurse. The 

first is the dollar-driven Health care marketplace – the 

business of health care. The second 

is the laws and regulations 

defining Registered Nursing and 

determining what Registered 

Nurses can and can’t do, their 

responsibilities and how they are 

required to go about their practices, 

whatever their workplace, 

the degrees and certifications they 

may have earned. 

Truly affecting the business of 

health care is, sadly, pretty much 

beyond the reach of nursing alone. 

However, joining with other other 

Mortimer 

Soderstrom 

care practitioner groups the 


(MNA) has had some minimal 

impact. The reality is that most of 

these shots are called by big business 

interests and government 

bureaucrats, focused only on bottom 

lines, with unlimited financial 

and personnel resources available 

to protect and further their perceived 

best interests. 

On the other hand affecting 

State laws and regulations is the 

one area where MNA is a player. While federal programs 

are largely formulated in Washington and are dealt with 

the American Nurses Association (ANA), Maryland 

Legislative and government actions directly impact RN’s 

practicing here. Each Maryland RN’s practice is governed 

by our Legislature-enacted Nurse Practice Act and largely 

by regulations adopted by the Maryland Board of Nursing 

based on it. No Nurse draws a breath or takes a step not 

regulated by these primary sources. Any Nurse who is not 

intimately and currently familiar with what these sources 

require of her or him is risking a hand-earned professional 

career. Copies of the Nurse Practice Act and 

Regulations may be obtained from the Board of Nursing. 

MNA is the spokesman for Maryland RN’s before the 

Maryland Legislature which meets each year in Annapolis 

for 90 days beginning in early January to consider bills 

that impact Nurses and our patients. The positions we 

take on bills (last year 126 out of almost 2400 bills 

reviewed) are determined by the MNA Legislative 

Committee. 

What is the MNA Legislative Committee? 

Created by By-Law, the Legislative Committee is 

charged with formulating positions on bills and assisting 

our Annapolis lobbyist (yes, we have a lobbyist) in making 

our case to Legislators. 

Who’s does the MNA Legislative Committee do? 

At present, 25 RN’s volunteer their time to meet twice a 

month in Annapolis while the Legislature is in session to 

review and take positions on bills as they are introduced. 

Off-season we meet monthly at MNA headquarters to 

review and provide directions to our lobbyist on issues 

important to RN’s. MNA publishes the “Legislative 

Update” (each Nurses should subscribe) outlining MNA 

positions on bills. Committee members also contact 

Legislators in their voting districts in support of our lobbyist 

and MNA positions. The Legislative Committee also 

coordinates Nurse’s annual reception for Legislators in 

Annapolis. 

Who’s on the MNA Legislative Committee? 

Membership consists of members of MNA who represent 

various geographical and practice areas. Its meetings 

are open to all and the views of members and non-members 

alike are always welcome. (Unfortunately, as with the 

general RN population, the Committee is aging-out and 

many long-time, experienced hands will be lost to 

retirement). While it takes time and effort to understand 

the issues presented by bills reviewed, members who stick 

with it have found their participation rewarding in their 

jobs, the friends they make and the knowledge of the law 

they absorb. The Committee fosters development of Nurse 

leaders and members have gone on to run for and be elected 

to public office. We welcome new blood and new perspectives. 

How can you help? 

Contact the MNA office and get the schedule of 

Legislative Committee Meetings. Come and JOIN US. 

No one has ever been turned-away. Whatever your viewpoint 

and concerns the Committee welcomes your input 

and assistance. Non-MNA members are also welcome 

since once you see what the MNA Committee does, we are 

confident that you’ll join MNA. 

It is a mystery to some why this small group, year 

after year, works so hard to advance and protect the interests 

of the colleagues. We are all busy people. All have important 

pressing claims on their time and energies. Members of 

the Legislative committee are busier than most. Why do 

they devote the time and effort to Nursing Legislation? Each 

has his or her own answer to this. But aside from the knowledge, 

experience and friendship they develop, the most 

important is the satisfaction that for once RN’s played a crucial 

part in determining their practice futures as Nurses - not 

simply having allowed others to do so. 

Rosemary Mortimer and Peggy Soderstrom are the 

outgoing Co-Chairs of the MNA Legislative Committee 

Annapolis 2000: 

Nursing Disaster 

Nursing had a devastating year in Annapolis this 

past session, 

• FAILED: Psychiatric Advanced Practice 

Nurses still can’t prescribe medications 

when physician service is not available. 

• FAILED: Nurse Practitioners still will not be 

designated as primary care providers and 

received reimbursement through HMO’s. 

• FAILED: Control over nurse-patient ratios in 

nursing homes is still not established. 

• FAILED: Nurse in every school to maintain 

student well being and promote healthy 

behaviors. 

AND THE LIST GOES ON! 

Don’t let history repeat itself! Support the MNA-PAC 

so that we can support those legislators who will be a 

strong voice in Annapolis for YOU as a professional 

nurse. 

Mail Contributions to: MNA-PAC 

849 International Drive 

Suite 255 

Linthicum, MD 21090




A Wellness 

Partnership 

by Larry J. Appel, BS, EMT-B 

I am your patient. I come to you not by choice, but 

by unexpected circumstances effecting my health and 

well being. 

I am your patient. I seek rest and solitude while in 

your care so that my body and spirit may heal. 

I am your patient. Although I may not comprehend 

all of the medical knowledge you have been taught, I 

ask for your guidance, understanding and patience 

while I absorb the newness of my environment and all 

of the medical test and procedures that have been 

thrust upon me. 

I am your patient. Although you have many others 

like me to attend to, don’t forget I may be scared and 

feel alone in my New World. A simple, “hello, my 

name is… how are you feeling, can I get you anything 

to make you feel more comfortable?” would be nice. 

I am your patient. I understand you are human too 

with personal obligations and life’s little annoyances. 

When your personal problems are reflected in your 

tone of voice or body language, I also experience your 

troubles. 

I am your patient. I may not be able to communicate 

with you directly and my body may need cleansing, 

but remember, I still have my dignity. 

I am your patient. I am not an account number. I am 

a flesh and blood human being with feelings the same 

as you. I am not interference during your day or an 

intrusion into your break. I am the reason you are 

here. 

* * * * 

I am your caregiver. I am here to provide a healing 

and compassionate environment to you while you are 

in my care. 

I am your caregiver. I am here to support your physical 

and emotional needs and to respond to you if you 

are in distress. 

I am your caregiver. I understand that you are not 

here by choice and that you have a life outside this 

institution just as I. Keeping this in mind, I will be 

responsive and sensitive to the requests of your family 

and friends who come to visit you. 

I am your caregiver. I subscribe to the standards of 

Service Excellence: Safety, Courtesy, Environment 

and Efficiency. 

I am your caregiver. Together, our goal will be to 

return you to a life of comfort and well being. 

I am _________________________R.N., L.P.N., 

C.N.A., M.D., EMT, Technician, Manager 

A Wellness Partnership is reprinted with the permission 

of ADVANCE for Nurses, Baltimore/Washington 

DC Metro Area 

Professionalism - How Do 

You Measure Up? 

by Barbara Kemerer, 

RN, MSN, MBA 

Assistant Professor of Nursing 

Faculty Advisor for the RN to BSN 

Program 

Shepherd College 

Shepherdstown, WV 

MNA Treasurer for District 8 

Take a look around you. Just 

Kemerer 

about now the nursing graduates of 

the new millennium are settling in 

the workplace and are taking and passing state boards. 

These graduates don’t look any different than nursing graduates 

did five, ten, even twenty years ago. But let me 

assure you, they are very different than we were. 

Today’s graduates are energetic and enthusiastic, organized, 

armed with up to date information, open-minded, 

flexible, critical thinkers who aren’t afraid to take risks. 

They are prepared to work in hospitals, nursing homes, 

home health, and any community setting you can imagine. 

They are culturally aware, strong patient advocates, committed 

to life-long learning and give service in their communities. 

In this era of nursing shortage they are the future 

of nursing, and it’s up to us to foster their growth, encourage 

and support them, and share with them our commitment 

to the profession of nursing. 

So whether you graduated last year or thirty years ago, 

take a moment to reflect on your activities and accomplishments 

and see how well you meet the characteristics of a 

“professional nurse”. Miller, Abbot, and Bell (1993) have 

identified several behaviors that nurses must attain in order 

to be considered professional. 

HIGHER EDUCATION - Are you a diploma or AD 

graduate? Consider going back to school part-time. There 

are many programs locally, regionally, and nationally that 

are flexible and designed for the working RN. Maybe distance 

learning through the Internet would be a good choice 

for you. Some programs can be completed faster than others, 

but that doesn’t necessarily make them better, so shop 

around. Compare the total costs for the program not just 

cost per credit. Ask to talk to some graduates of the program 

so you can get the “real scoop”. 

AUTONOMY - Nunnery (1997) believes autonomy 

involves critical thinking, communication, collaboration, 

and leadership. Nurses have lots of autonomy. If you don’t 

agree with that, consider taking a course on power. Nursing 

autonomy is granted by the state board of nursing through 

its nurse practice act. If you don’t have a current copy, call 

for one. Nursing students learn about power in their leadership 

courses. Knowledge gives you power. Don’t be afraid 

to share your knowledge with others. Be proactive and 

seek out ways to broaden your power base and influence 

those around you. Use your power to effect positive 

change. 

CODE of ETHICS - The ANA Code for Nurses (1985) 

guides us in our practice and we are required to adhere to 

its guidelines. Do you own a copy of it? Can you recite 

any of the criteria? There are 11 standards and these should 

be reviewed periodically. The Code for Nurses can be 

ordered from the ANA website www.nursingworld.org. 

CONTINUING EDUCATION/COMPETENCY - Have 

you taken time lately to identify your learning needs? 

Don’t wait for your employer to sign you up for a class. 

Assess where you are in your life-long learning. You 

might want to consider certification in a specialty or take 

that college computer class you’ve been looking at. 

Increasing your knowledge is a must for ensuring competency 

and can also be acquired through journal reading or 

surfing the net using one of the health search engines such 

as achoo.com or healthatoz.com. 

COMMUNICATION/PUBLICATION - One of the 

standards of the Code for Nurses is that we must participate 

in activities that contribute to the ongoing development 

of the profession’s body of knowledge. Have you 

written any articles lately? You don’t have to publish your 

dissertation to contribute. Consider writing for The 

Maryland Nurse, or one of the local journals or newsletters. 

Consider joining a chat room (on the Internet) for 

nurses in your specialty area or one you’re interested in. 

The Nursing Spectrum has weekly chat rooms @ nursingspectrum.com. 

PROFESSIONAL ORGANIZATIONS - It’s not enough 

to pay your dues and belong to a professional organization. 

It’s a beginning, but make a commitment to become actively 

involved. The American Nurses Association is a great 

place to start. Not only do they represent nursing in the 

political arena, they are the front runners for many projects 

that shed a positive light on nursing to the general public. 

You can get actively involved at your district and state 

level where networking is both fun and rewarding. 

COMMUNITY SERVICE - Nurses have always given 

to their communities. When I’m introduced at parties my 

friends very proudly announce, “she’s a nurse”. Have you 

volunteered lately? Consider helping out with the scouts, 

4H, your church, or the local homeless shelter or food 

bank. Take time to promote nursing as a career choice in 

your local high schools. If you have the time and interest, 

organizations are always looking for members of the community 

to sit on their boards, or help with fundraising or 

program planning. 

RESEARCH INVOLVEMENT - Have you read any 

research-based studies recently? Your clinical practice 

may be outdated. Share what you find with your colleagues. 

Get involved in your institution’s quality 

improvement program, conduct a survey or study to look at 

patient outcomes, or offer to collect data for a study in 

progress. You might start with something as simple as a 

client satisfaction survey. 

There you have it, eight simple criteria for our 

profession that can be met in a variety of ways, all of which 

are challenging and exciting. The new nursing graduates 

of 2000 are ready for these challenges. They will be looking 

to the rest of us for guidance and encouragement. How 

will you measure up? 

REFERENCES 

American Nurses Association. (1985). Code for nurses 

with interpretive statements. 

(Publication No. G-56). Kansas City, MO: Author. 

Miller, B. K., Adams, D., Beck, L., (1993). A behavioral 

inventory for professionalism in nursing. Journal of 

Professional Nursing, 9, 290-295. 

Nunnery, R. K. (1997). Advancing your career: 

Concepts of professional nursing. 

Philadelphia: F.A. Davis Company.



2000 

RSV: Not Just A Pediatric Problem 

by Carol J. Gallo, RN, MS 

Carol J. Gallo, RN, MS holds a part-time faculty position 

at Towson University Department of Nursing. In addition, 

she also works per diem on the pediatric floor at 

Franklin Square Hospital Center. Since 1979 Ms. Gallo 

has worked in several areas of pediatrics including PICU, 

NICU, and acute care, in addition to teaching in both the 

classroom and clinical. She is a member of Sigma Theta 

Tau and serves as Treasurer of the Iota Epsilon chapter. 

What is RSV? 

Respiratory Syncytial Virus (RSV) is generally 

thought of as a respiratory virus of children; however, 

adults can be affected and pass the virus onto susceptible 

infants and children. In this article, the clinical course, 

treatment, transmission, and prevention of RSV among 

children is emphasized, but the nursing implications for 

adult practice will be discussed. 

RSV is a major cause of bronchiolitis and pneumonia 

in infants under one of year age and a leading cause of 

lower respiratory infection in young children. However, 

most children and adults infected with RSV have only 

upper respiratory tract involvement. Adults and older 

children who become infected with RSV usually have 

symptoms similar to having a mild to moderate cold. 

Younger children (preschool age) with RSV may exhibit 

what appears to be a mild to severe cold. 

Children between the ages of six weeks and two years 

old are most susceptible to RSV. Infants less than six 

weeks old seem to have protection from RSV due to 

active maternal antibodies. There tends to be a strong 

correlation between age and the severity of symptoms. 

The younger the child the more severe the disease tends 

to be and mortality is highest between two to six months 

old (McMillan, DeAngelis, Feigin, & Warshaw, 1999). It 

is primarily infants younger than one year of age who 

require hospitalization. RSV accounts for the most hospitalizations 

and fatal outcomes for acute respiratory 

problems in children younger than two years old. Among 

children who are hospitalized for RSV, 2%-5% develop 

respiratory failure (McMillan et al., 1999). Infants who 

are born prematurely or have low birth weight are at 

greatest risk for acquiring RSV and may require intensive 

care. One study (Brooks, McBride, McConnochie et al, 

1999) examined the presenting signs and symptoms of 

542 previously healthy full-term infants who where 

infected with RSV and admitted to the hospital. The 

researchers compared the initial signs and symptoms of 

infants who were able to remain on a general pediatric 

floor and those who needed to be transferred to the PICU 

and found no significant differences. In other words, predicting 

which infants will require intensive care was not 

possible based on presenting factors. 

Clinical course 

RSV occurs in annual epidemics worldwide. In the 

United States these epidemics usually begin in early fall, 

peak in winter, and continue until late spring. Children 

and adults of any age can become infected with RSV. 

Initially a child with RSV presents with rhinorrhea consisting 

of thick yellow green secretions, increased pulse 

and respiratory rate, retractions and nasal flaring. In some 

cases symptoms may include pharyngitis, irritability, poor 

feeding, lethargy and a low grade fever. A cough often 

develops in older children after one to two days of the illness. 

The young child has an immature respiratory system 

in both anatomical size and physiology, so the mechanism 

to create an effective cough is weak at best and often nonexistent 

in infants with RSV (Bowden, Dickey, & 

Greenberg, 1998). In young children, and in children who 

are developmentally delayed, the upper airway cannot be 

cleared by a forced cough or nose blowing, increasing the 

risk of partial or complete airway obstruction from the 

thick secretions. Rhinorrhea continues throughout the 

course of the disease. Auscultation often reveals diffuse 

rhonchi and in some cases, wheezing. 

Children and adults with only upper respiratory tract 

involvement usually have mild symptoms and the disease 

resolves in approximately seven days. Symptoms may 

linger for several weeks for infants, young children, and 

those who have lower respiratory tract involvement. 

Infants and children are susceptible to re-infection, especially 

during epidemic periods. 

Most commonly, positive diagnosis is determined via 

laboratory assay of the RSV antigen in nasal secretions. 

This type of testing is widely preferred since the results 

are accurate and available in a few hours. The health 

care professional obtains nasal secretions by suctioning 

the nares and should send the specimen to the laboratory 

immediately. The suctioning causes temporary discomfort, 

but usually has a result of helping to clear the nose of 

thick secretions, possibly creating less labored breathing. 

Other types of testing available are less desirable because 

these tests take several days to obtain results, are more 

invasive, and are not known to be more accurate than the 

preferred method. 

Treatment 

Most children only require treatment for symptom 

relief and airway clearance. Frequent suctioning is necessary 

to maintain a patent airway. Supplemental oxygen 

may be necessary to correct hypoxemia and to maintain 

an oxygen saturation level greater than 93%. Frequent 

pulse oximetry assessments are necessary. If cyanosis, 

dyspnea, and a respiratory rate over 60 breaths per 

minute, are assessed then blood gas values should be 

obtained. IV fluids are started to prevent or correct dehydration, 

however strict I&O is needed to prevent overhydration 

and edema. Adequate hydration also helps to 

loosen secretions. 

Currently Ribavirin (Virazole) is the only approved 

medication specific for treating RSV. The American 

Academy of Pediatrics has provided recommendations 

determining which patients should receive Ribavirin therapy 

due to the high cost and problems with the administration 

of the drug (see www.aap.org). Ribavirin therapy 

is administered via aerosol or nasotrachial tube for a continuous 

duration of 12-20 hours per 24 hours over an 

average of three days of treatment. The length of treatment 

is individualized and terminated when clinical 

improvement has occurred. Ribavirin works by interfering 

with messenger RNA, thus inhibiting viral protein 

synthesis (Filippell & Rearick, 1993). Ribavirin forms 

large crystallized particles when aerosolized and is difficult 

to contain around the infected patient. The 

aerosolized drug is irritating to the mucous membranes of 

those who are not infected. The particulate also can cause 

obstruction and internal damage to ventilators, especially 

if proper filters are not installed in the ventilator. 

Transmission 

The transmission of RSV typically occurs through 

direct or close contact with contaminated nasal secretions. 

The most common mode of transmission involves 

hand contact on the secretions and transferring the contaminant 

to the mucosa. RSV from acutely infected 

infants can survive on non-porous surfaces, such as crib 

rails and stethoscopes, for more than six hours and on 

porous surfaces, such as clothing and skin for 30-60 minutes 

(McMillan et al., 1999). Hospital staff can contribute 

to the spread of RSV through carelessness in hand 

washing and poor isolation techniques. During community 

epidemics children in intensive care nurseries and 

children’s rehabilitation hospitals are at greatest risk for 

RSV infection and death. 

RSV cont. on pg. 15




RSV cont. from pg. 14 

Prevention 

The primary means of prevention involves measures 

to control the transmission of RSV. Meticulous hand 

washing of those caring for infants and young children is 

paramount. In adults, many viruses including RSV cause 

cold-like symptoms. Nevertheless, limiting exposure of 

infants and children to individuals (regardless of age) 

who have cold-like symptoms is highly recommended. 

Hospitalized children infected with RSV are placed on 

isolation using gown, gloves, and mask when within 

three feet of the infected child for the duration of the illness. 

Children who have tested to be RSV positive 

should only share a room with other RSV infected children 

or a child highly suspected of harboring RSV. 

Children who are highly suspected of being RSV positive 

are placed in isolation while waiting for test results to 

decrease the transmission of RSV. Strict isolation is necessary 

for anyone receiving Ribavirin therapy. 

Currently there are two drugs available for RSV prophylaxis 

(see www.aap.org). The first drug is RSV intra- 

venous immune globulin (RSV-IGIV) which is administered 

to non-infected, infants or young children at high 

risk by monthly infusions throughout the RSV season 

with the first dose prior to the beginning of the season 

(Oertel, 1996). Monthly doses are needed to maintain 

protection. The child must be closely monitored during 

and post infusion due to the potential side effects of this 

blood product. RSV-IGIV was approved by the FDA in 

1996 for children less than 24 months old and who were 

born prematurely or who have a history of bronchopulmonary 

dysplasia. While the infant is receiving RSV- 

IGIV, measles and varicella vaccinations must be postponed 

(McMillan et al., 1999). In 1998, Palivizumab 

(Synagis) was approved by the FDA for RSV prophylaxis 

using similar criteria for use as RSV-IGIV. 

Palivizumab is an RSV monoclonal antibody that is 

administered IM and given monthly during the RSV season. 

There is no need to postpone immunizations with 

Palivizumab which has fewer known side effects than 

RSV-IGIV (McMillan et al., 1999). 

The Bottom Line 

RSV pertains to all nurses and plays a significant role 

in areas other than pediatrics. Nurses working with 

adults should be aware of RSV, so they might include this 

information with discharge teaching especially if the 

adult has a respiratory infection or any adult who has contact 

with newborns and young children. 

References 

Bowden, V. R., Dickey, S. B., & Greenberg, C. S. 

(1998). Children and their families: The continuum of 

care. Philadelphia: W. B. Saunders. 

Brooks, A., McBride, J. T., McConnochie, K. M. et al 

(1999). Predicting deterioration in previously healthy 

infants hospitalized with respiratory syncytial virus infection. 

Pediatrics, 104 (3), 463-467. 

Filippell, M. B., & Rearick, T. (1993). Respiratory 

syncytial virus. Nursing Clinics of North America, 28 

(3), 651-670. 

McMillan, J. A., DeAngelis, C. D., Feigin, R. D., & 

Warshaw, J. B. (Eds.). (1999). Oski’s Pediatrics: 

Principles and Practice (3rd ed.). Baltimore: Lippincott 

Williams & Wilkins. 

Oertel, M. D. (1996). RespiGam: An RSV immune 

globulin. Pediatric Nursing, 22 (6), 525-528.



2000 

Public Health Nursing in Maryland: Our Roots 

by Marlene H. Cianci, PhD, RN 

The author is a community 

health nurse, recently retired from 

the faculty of the College of 

Nursing and Health Science, 

George Mason University 

Maryland’s history of commitment 

to public health can be traced 

to the early colonists, who in 1704 

enacted their first public law “for the 

protection of children from the ravages 

of wolves” (1). The Baltimore 

City Health Department was estab- Cianci 

lished in 1793, in an attempt to ward 

off a yellow fever epidemic raging in Philadelphia. 

Communicable diseases continued to plague the state, 

because of its central location for industrialization, commerce, 

and immigration.(2). By the end of the 19th century, 

tuberculosis was the leading cause of death, with a mortality 

rate in Maryland of 212.8:100,000 (3). 

Interior of the Healthmobile (well child services), c. 1940 

(Montgomery County Archives, Rockville, MD, U.S. Public 

Health Service Folder 3, 1939-1940). 

The Baltimore Instructive Visiting Nurse Association 

(IVNA), established in 1896 to provide bedside nursing 

care and health instruction to families in their homes, hired 

the first tuberculosis nurse in 1903 with funds raised by 

Mrs. William Osler (4). Tuberculosis work quickly reached 

such magnitude that it was transferred to the Baltimore 

City Health Department (BCHD) in 1910, and a Division 

of Tuberculosis was established, under the direction of a 

nursing supervisor (5). 

The Baltimore City Health Department inaugurated its 

nursing service in 1905, with the appointment of one nurse 

Lay midwives receiving instruction form a public health 

nurse, c. 1930s. (Montgomery County Archives, Rockville, 

MD. U.S. Public Health Service, Folder 2, 1939-1940). 

to the city’s public schools. Four additional nurses were 

hired the following year to expand the program to public 

and parochial schools (6). In 1915, a communicable disease 

program of preventive services, consisting of isolation, 

quarantine, and hygiene instruction in the homes of 

families with communicable diseases was established with 

three nurses. By 1919, with maternal, infant, and child 

services a major focus, the health department established a 

Bureau of Child Hygiene with 12 specialized nurses to 

visit all newborn infants. A specialized maternal hygiene 

service was added in 1921 (7). The BCHD took its first 

step toward generalized nursing services, in 1920, in 

response to fiscal realities and the obvious needs of the city 

in relation to available resources. Specialized communicable 

disease, school health, and tuberculosis nursing services 

were combined into a generalized program, including 

specialty clinics. Nursing activities expanded to include 

Public Health Lay Council station wagon with driver 

Elizabeth Tipton (in dark flower print dress) and patients, c. 

1942 (Montgomery Conty Archives, Rockville, MD) 

Tuberculosis screening clinic, Miss Lucy Conklin, X-ray 

technician, c. 1940 (Montgomery County Archives, Rockville, 

MD, Records of Health Department TB Clinics & Christmas 

Seals Volunteers 1939-1950). 

dental clinics, Schick clinics, venereal disease clinics, ophthalmia 

treatment, typhoid culturing, psychiatry, and playground 

programs. Public health nurses enjoyed considerable 

autonomy while being responsible for quarantine for 

communicable diseases, placarding homes, excluding from 

school all children with the disease or who never had it, 

and instructing the family in care (8). The Bureau of 

Nursing assigned each of its public health nurses to spend 

six months at Sydenham Hospital for Communicable 

Diseases to learn care of patients and control of communicable 

diseases (9). 

The Eastern Health District, established in 1932 in a 

partnership between the City Health Department and Johns 

Hopkins School of Hygiene and Public Health served as a 

population laboratory for research, administration, and 

teaching. Public health nurses were the primary surveyors, 

collecting data on every household every three years, for 

the development of a comprehensive public health program. 

In addition, nurses “provided health education, interpreted 

physicians’ findings, gave instructions on isolation 

technique to families of tuberculosis patients, prepared 

admission forms to sanitoria, assessed home conditions 

before discharge of premature infants from the hospital, 

and, in emergency cases, gave bedside care.” Public health 

nurses were full partners in the Eastern Health District: 

nursing supervisors as well as physicians taught public 

health administration courses at the School of Hygiene 

(10), and an on-site training center was established in 1933 

to provide public health clinical training for and by nurses 

(7). Throughout the city, PHNs on home visits collected 

paint chips for analysis by the health department laboratories. 

These studies led to national policies for the removal 

of lead from paint (9). 

Roots cont. on pg. 17




Roots cont. from pg. 16 

Rural public health nursing began in 1903, with a 

visiting nurse provided by the IVNA to Baltimore County, 

and in 1910, with three IVNA nurses to Annapolis and 

points along the way of the Baltimore and Annapolis 

Railroad. The Anne Arundel County Chapter of the Red 

Cross Town and Country Service assumed home nursing 

services until 1949 (11). Gradually, IVNA services were 

turned over to the county health departments as they were 

established. (12) Washington County hired its first TB 

nurse at the behest of a group of public minded women in 

Hagerstown. A second nurse was hired for the county and 

both nurses provided general nursing services. So successful 

were they that Johns Hopkins School of Hygiene and 

Public Health and the U.S. Public Health Service targeted 

the county for epidemiological studies, leading to the 

Hagerstown Health Studies. Again PHNs were the primary 

data collectors (13). 

The State Health Department initiated its public health 

nursing program in 1920, when a nursing supervisor was 

hired to develop public health nursing in the 23 counties. 

The Bureau of Child Hygiene was established in 1922 and 

four nurses were hired to cover the state. Field nurses were 

the first public health workers in many counties, preceding 

health officers by many years. By 1926, there was at least 

one PHN in each county. By 1934, Maryland had fulltime, 

county-wide services with a health officer, sanitarian, 

and a PHN in each county (14). 

The trajectory of rural public health nursing gained 

momentum as a result of State Department of Health and 

community efforts to meet local needs and expectations. 

Health care, when and where available, had been provided 

by country doctors, lay midwives, and a few public health 

and visiting nurses. Alliances among physicians, nurses, 

official and voluntary agencies, the Rockefeller 

Foundation, and the Johns Hopkins School of Hygiene and 

Public Health brought public health programs to fruition. 

The rural nurse encountered many of the same health 

problems as did her urban sisters, with the added challenge 

Hand Washing on a prenatal home visit, c. 1935 

(Montgomery County Archives, Rockville, MD, U.S. Public 

Typhoid Immunizations, Crew of Stockley Road Camp, 

Calvert County, MD, 1915 (Maryland State Department of 

Health and Mental Hygiene). 

of fewer, or non-existent resources. Poverty, malnutrition, 

communicable diseases, prematurity, and venereal diseases 

were rampant, demanding public health measures (14). 

Rural nurses, in addition, were responsible for the instruction 

and supervision of as many as eight lay midwives 

(15). 

Rural public health nurses mobilized community partnerships 

to help identify and solve health problems and 

build on existing programs to foster health promotion and 

disease prevention. 

Public health nurses found the school population to be 

the “best captive group for health promotion and prevention” 

(16). The nurses coordinated with Boards of 

Education and civic organizations to maximize School 

Health Day in May for immunizations, health screening 

and education for students and families, and school roundup 

for fall (14). Similar activities were conducted during 

National Negro Health Week in April in Baltimore and all 

counties with large black populations, in response to the 

alarming morbidity and mortality rates among blacks and 

the appalling disparity of rates between blacks and whites. 

Special programs were planned for each day, promoting 

child, family, and environmental health, including medical 

examinations, dental clinics, immunization clinics, and 

community clean-up campaigns. So much interest was 

generated over the years that the week’s activities were 

reflected in public health programs throughout the year 

(17). 

The state Healthmobile was the most effective vehicle 

for delivering public health services to remote areas during 

the summer months. The unit was staffed by a physician, 

dentist, and chauffeur. County public health nurses and 

health officers organized, publicized, and assisted with 

mobile services. Films on dental care, immunizations, 

nutrition, and personal hygiene were shown in the school 

or church upon arrival. Families returned with their children 

the next day for physical and dental examinations, 

immunizations, vision and hearing screenings, and gross 

examinations for rickets (14). 

Lay health associations formed at the local level and 

responded to the priorities of the community. In some 

instances, private benefactors responded to obvious community 

needs, built health centers, furnished equipment 

and supplies, assisted with clinic services, and provided 

transportation for mothers and children. PHNs assessed 

the health needs of the community, compiling morbidity, 

mortality, and demographic statistics, identifying needs, 

resources, and expectations, and coordinating the volunteers. 

(In Anne Arundel County, five health centers are still 

owned and maintained by their respective lay health associations.) 

In more remote counties where the only organized 

groups were churches and schools, PHNs relied on 

PTAs, clergy, and parishioners for support (14). 

Support for public health nursing came from official, 

voluntary, and private foundations and individuals, which 

sometimes determined the availability. PHNs in county 

health departments supported by the Rockefeller 

Foundation, the USPHS, and Johns Hopkins School of 

Hygiene and Public Health practiced in demonstration 

programs involved in research and service, based on the 

most current knowledge and principles. The greatest impetus 

for public health nursing came from the New Deal 

Programs. Social Security funds enabled the state and 

counties to hire prepared supervisors, consultants, instructors, 

and additional staff nurses. Educational funds enabled 

nurses at all levels to continue their education at advanced 

levels (18). Maryland public health nurses strove to 

achieve and maintain practice within the definition and 

guidelines of the National Organization for Public Health 

Nursing and the Federal Emergency Relief Administration 

(19). APHA Appraisal Forms were used in some counties 

to evaluate services and plan improved programs (20). 

Maryland public health nurses during the Great 

Depression provided a model and firm foundation for 

much of contemporary public health nursing today. Then 

as now public health nurses based their practice on 1) community 

strengths, needs, and expectations; 2) current sci- 

Sara Fetter, PHN, Nurse Midwife, Demonstrating transportation 

of a premature infant in a special carrier from 

home to hospital, 1947. (Maryland State Department of 

Health and Mental Hygiene) 

Health Service folder 2, 1939-1940). Roots cont. on pg. 18



2000 

Roots cont. from pg. 17 

entific knowledge; 3) available resources; 4) accepted criteria 

and standards of nursing practice; 5) agency purpose, 

philosophy, and objectives, and 6) the participation, cooperation, 

and understanding of the population” (21). The 

endeavors of our forebears, in the face of economic adversity 

, should give inspiration, guidance, and hope to 

today’s public health nurses, striving to improve current 

practice and to prepare for the future. 

References 

1. Annual Report of the State Health Department of 

Maryland, 1932. Hall of Records, Annapolis, MD. MdHR 

1110, location 2-7-6-5. 

2. Howard, W. T. (1924). Public health administration 

and the natural history of disease in Baltimore, Maryland 

1797-1920. Washington, DC: Carnegie Institution of 

Washington. 

3. Riley, R. H. (n.d.). Maryland’s program for the control 

of tuberculosis. Baltimore: Maryland Tuberculosis 

Association. 

4. Brainard, M. (1922). The evolution of public health 

nursing. Philadelphia: W. B. Saunders. 

5. Newman, J. B. (1924, April). Bureau of Nursing. 

Annual Report of the Health Department, 1925. 

Department of Public Safety Annual Report, Sub- 

Department of Health, to the Mayor and City Council of 

Baltimore for the Fiscal Year Ended December 31, 1925. 

6. Division of Public Health Nursing, Maryland State 

Department of Health. (n.d.). Public health nursing in 

Maryland, 1887–. Unpublished Manuscript. 

7. Sundberg, A. M. (1955).Fifty years of public health 

nursing, city health department: 1905-1955. Baltimore 

Health News. 32, 168-171. 

8. Important and interesting work is performed by City 

Health Department Bureau of Nursing (1927, November 

21). Baltimore Municipal Journal, 15 (22), 1, 3-4 

9. Sundberg, A. M. Personal communication, 

September 23, 1996. 

Lead paint hazards, c. 1930. There were as many as 17 layers 

of lead paint in some homes. (Baltimore City Health 

Department). 

10. Fee, E.(1987). Disease and discovery: A history of 

the Johns Hopkins School of Hygiene and Public Health, 

1916-1939. Baltimore: Johns Hopkins University Press. 

11. Wohlgemuth, M. (n.d.). Papers of Margaret 

Wohglemuth. Anne Arundel County Health Department 

files. 

12. Visiting Nurse Association of Baltimore.(1994). 

Historical Highlights 1895-1994. Unpublished Document. 

Files of the author. 

13. Comstock, G. W. (1983, April). Hagerstown Health 

and Morbidity Studies. Papers of G. W. Comstock, 

Washington County Health Department. 

14. Annual Reports of the State Health Department of 

Maryland, 1931-1940. Hall of Records, Annapolis, MD. 

MdHR 1110, Location 2-7-6-5. 

15. Smith, K. S., personnel communication, April 2, 

1996. 

16. Scholl, A. C. (1980). Review and recommendations 

for community nursing systems. Draft prepared for the 

Baltimore City Health Department Study Group. The 

Johns Hopkins School of Hygiene and Public Health. Files 

of the author. 

17. Riley, R. H. (1934, January/March). Negro Health 

Week awards and cleanliness and neatness improvement 

contests. National Negro Health News, 2(1), 3. 

18. U.S. Public Health Service. (1937).The public 

health program under Title VI of the Social Security Act. 

Washington, DC: U. S. Government Printing Office. 

19. Federal Emergency Relief Administration. (1993). 

Rules and regulations No. 7 governing medical care provided 

in the home to recipients of unemployment relief. 

Washington, DC: U. S. Government Printing Office. 

20. Annual Report of Montgomery County Health 

Department, 1935-1947. Montgomery County Archives, 

Rockville, MD RG 7, Box, Folder 2. 

21. American Public Health Association, Public Health 

Nursing Section. (1996). The definition and role of public 

health nursing. Washington, DC: Author. 

Baltimore City public health nurse and car, 1908. 

(Baltimore City Health Department) 

Central trailer - Dr. Briger’s Trailer, Colesville Methodist 

Church, September 5, 1940 (Montgomery County Archives, 

Rockville, MD, Records of Health Department) 

A Day in the Life of a Rural 

Public Health Nurse, 1943 

It was autumn, in a rural isolated county on the Eastern 

Shore of Maryland. The public health nurse was assisting 

a lay midwife with the delivery of a premature baby. The 

dilapidated house, lacking electricity and indoor plumbing, 

contained few material possessions. The nearest hospital, 

in the next county, was not equipped to care for premature 

infants. The nurse knew she must transport this 

baby to Johns Hopkins Hospital if he were to survive. She 

retrieved a pet carrier from her car, pumped water, heated 

it on the wood stove and filled empty pint whiskey bottles 

(which she had gathered from dumps during her travels 

throughout the county) with the hot water. She lined the 

carrier with blankets and the improvised hot water bottles, 

placed the newborn in the carrier, and began her journey. 

She drove a distance of some thirty miles to Kent Island, 

where she boarded the ferry for the four mile trip across 

the Chesapeake Bay to the Western Shore, and then continued 

her trip to Johns Hopkins Hospital, where the baby 

at least had some chance of survival. This was just a part 

of a day in the life of a Maryland public health nurse, 

whose important work may have saved a life, helped lower 

the extremely high infant mortality rate, and provided care 

and support to a needy family (K. S. Smith, personal communication, 

April 2. 1996). 

A Day in the Life of a Balitmore 

City School Nurse, 1927 

Screening of school children for diseased tonsils and 

adenoids was routine. The Robert Garrett Hospital, at 27 

North Carey Street, reserved a clinic, operating room, and 

ward where T&As were performed by a specialist on 

Mondays and Thursdays, for a maximum fee of $5.00, or for 

free for families unable to pay. School nurses coordinated 

the care, obtaining parental written permission for surgery, 

and transporting the children to the hospital by late morning, 

for surgery to be performed in the afternoon. During the preoperative 

time, a nurse especially suited for the work entertained 

or kept the children amused with stories, puzzles, 

toys, and magazines. Health department nurses in the generalized 

nursing program were specially trained in surgical 

nursing, to administer anesthesia, and to assist in the operating 

room. The children received over night post-operative 

nursing care by their respective school nurses and were 

returned to their homes the following day, “in a closed automobile 

kept for this purpose and driven by a nurse who 

[was] an experienced driver.” The school nurse gave the 

“mother or guardian of each child the most careful instructions 

in taking proper care of the case.” 

(Important and interesting work is performed by City 

Health Department Bureau of Nursing (1927, November 

21) Baltimore Municipal Journal, 15(22), 1, 3-4.)




Long Term Care 

Coalition 

by Anne Marie Barnett, RNC 

The Long Term Care Coalition is a group of professionals 

who represent an interest and expertise in caring for the 

resident in a long term care (LTC) facility. This group was 

formed in an effort to identify essential core functions for: 

the licensed nurse in charge of a unit; the Director of 

Nursing; the Nursing Home Administrator; and, the 

Medical Director. These essential core functions are 

derived from the overall roles and responsibilities of contemporary 

long term care facilities and respective professional 

standards of practice for these professional 

groups/disciplines. A variety of roles and professionals as 

well as organizations are represented on the Coalition. 

These include but are not limited to: registered nurses representing 

staff development, quality assurance, temporary 

nursing staffing agency, nurse psychotherapist, Directors 

of Nursing, Home Health, nurse recruiters and “charge” 

nurses. In addition, associations and educational institutions 

are represented such as the Maryland Association of 

Long Term Care Medical Directors, National Association 

of Directors of Nursing Administration Long Term Care - 

Maryland Chapter, Maryland Nurses Association, LPN and 

RN associate degree nursing education programs and a 

Baccalaureate Nursing education program. 

The Coalition meets monthly and continues to work on 

identifying essential core functions as outlined above. If 

you have any questions regarding the Coalition, please 

contact me at (301) 475-8456.



2000 

Official Registration Form 

Official Registration Form – Healthy Nurses 2000 

November 8-10, 2000 * Rocky Gap Lodge * Cumberland Maryland 

PLEASE PRINT 

Last Name _________________________First Name ____________________Credentials _________________ 

Home Address _______________________________________________________________________________ 

City ____________________________________State ___________________________Zip _________________ 

Daytime Phone _______________________________________________________________________________ 

Email Address________________________________________________________________________________ 

MNA District___________________________________________________Membership # _________________ 

Member rates apply to MNA members in good standing, members of MNA Affiliates, and other ANA state 

nurses association members with membership number or card. 

2000 Convention Rates 

Member Rate Full Time Others 

Undergraduate Student 

Full Convention (Includes all programs and meals as indicated Wed – Fri) 

____ $190.00 _____ $100.00 ____ $250.00 

Early Bird Discount ____ $165.00 _____ $75.00 ____ $225.00 

(Prior to Oct. 5th) 

Daily Rate 

Wednesday, Nov. 8th _____ $40.00 _____ $30.00 _____ $50.00 

Thursday, Nov. 9th _____ $110.00 _____ $50.00 _____ $190.00 

Friday, Nov. 10th _____ $50.00 _____ $30.00 _____ $60.00 

Business Meeting ONLY Open to MNA Members – no charge _______ 

* Members 65 years and older, please call for rate information 

* Student Groups of 15 or more accompanied by an instructor, please call for rate information 

Cancellations will be accepted until October 13, 2000. A $25.00 administrative fee will be charged for cancellations. 

Please Identify Session Selections on Convention Program form and return with registration form and check 


849 International Drive 


Phone 410-859-3000 

FAX 410-859-3001 

Convention Hotel 

Information 

The 2000 MNA Convention will be held at Rocky Gap 

Lodge and Golf Resort in Cumberland Maryland. 

Reservations can be made by calling 800-724-0828, 

please indicate you are with the Maryland Nurses 

Association. Rates are $98.00 single or double. 

Guestrooms offer cable television, mini bars, telephones 

with data ports. There is an indoor/outdoor pool, fitness 

center, tennis courts, gift shop, whirlpool, and golf. The 

hotel sits on a beautiful lake and there are boat rentals also 

available. 

Directions: 

From Baltimore: Take I-70 West to I-68 West 

(Handcock, MD) proceed approximately 40 miles to exit 

50, Rocky Gap State Park , Take right off the exit, Hotel is 

visible from the road. 

From Washington: Take I-270 North to I-70 West. Take 

I-70 West approximately 60 miles to I-68 West. Proceed 

approximately 40 miles to exit 50, Rocky Gap State Park, 

Take right off the exit, Hotel is visible from the Road. 

The Department of Natural Resources has a few cabins 

that are near the hotel if you want to be more rustic. You 

can call 301-784-8403 for information. There is also 

camping trailer hook ups available as well. 

ATTENTION 

People who are registering for the 

conference will need to fill out both 

the “Official Registration form” (below) and 

the “Convention Program Form” (next page). 

Bring Your Spouse 

or Family 

Western Maryland is beautiful in early November and 

there are lots of things to keep your spouse and families busy 

while you are in learning sessions. 

In addition to the many activities right at Rocky Gap, 

including boating, fishing, hiking golf and tennis. 

Cumberland is only a short 5 to 10 minute drive away. 

Shopping – Cumberland’s first shop was opened in 1749 

by Christopher Grist who erected a stockade and trading 

post. Since its inception, this historic city has offered travelers 

a chance to find anything from antiques to today’s hottest 

fashions 

Historic Cumberland Mall – a wide array of boutique, 

antique and specialty shops located in the heart of town. 

Antique Mall – numerous vendors with a variety of collectibles 

and furniture 

Country Club Mall – indoor shopping mall offering a 

wide selection of over 75 stores 

Farmers Market – “Fruit Bowl” where you can find fresh 

fruits and vegetables all year round, along with the most delicious 

baked goods and candies anywhere. 

Western Maryland Scenic Railroad – operates on weekends 

during November, but you may want to stay and extra 

day and take advantage of this wonder historic steam train 

excursion through the mountains. 

Falling Waters – One of the famous Frank Lloyd Wright 

homes is just about 1 hour away from Rocky Gap. It is 

worth seeing and if you are interested and let us know in 

advance we can arrange for your tickets. This may be fun to 

do early on Wednesday or Friday afternoon. Give us a call. 

The District One members will have more on site information 

when you arrive, however if you have some specific 

questions about planning to for your family, give us a call.




Take A Hike 

The District One Convention Planning Committee 

invites you to join trail guide, Dora Long, RN, on 

November 9th at the 

MNA Convention for 

a leisurely walk 

(hike) around the 

lake shore trail at 

beautiful Rocky Gap 

Lodge. As you hike 

along the trail the 

pristine lake is 

always in view. You 

may see a loon or a 

migrating hooded 

merganser, not to 

mention a deer and a 

squirrel or two. 

Plan on wearing 

your jeans and bring 

a lightweight jacket, 

gloves, hat and good 

sneakers or hiking 

boots. The trail is 

challenging. You 

should be in good 

physical condition. 

Dora Long, “Take A Hike” Guide 

for November’s Convention and 

member of the District One 

Convention Planning Committee 

Hiking is one passion that Dora uses to keep in good shape. 

Western Maryland has been Dora’s home for all of her 

life and she is anxious to share a little bit of he backyard 

with all convention participants. There will be a sign up 

sheet at the registration table when you arrive at Rocky 

Gap. 

P.S. Bring a camera 

Bring your Nursing 

Cap and wear your 

pin to dinner 

Thursday night 

HEALTHY NURSES 2000 

97th Annual Conference of The Maryland Nurses Association 

Rocky Gap Lodge and Golf Resort 

Cumberland, Maryland 

November 8 – 10, 2000 

Wednesday, November 8, 2000 

Dinner on Your Own 

6:00 PM Registration Opens 

6:30 – 7:30 PM Welcome/Exhibits Open 

7:30 – 8:30 PM Indicate First and Second Choice, limited class size, assignments done on a first receipt basis 

_____ Massage Therapy, Biofeedback & Aroma Therapy Leah Yoder, RN, MST 

_____ Reflexology Ken & Debbie Unger 

_____ Osteoporosis 

(includes a complimentary bone density study) 

Debbie Meyers, RN, MSN, CCRN 

_____ Acupuncture Dr. David Bohn, BS, OC 

8:30 – 9:00 PM Dessert 

9:00 – 10:00 PM Indicate First and Second Choice, limited class size, assignments done on a first receipt basis 

_____ Massage Therapy, Biofeedback & Aroma Therapy 

_____ Reflexology 

Leah Yoder, RN, MST 

Thursday, November 9, 2000 

8:00 AM Registration Opens 

_____ Osteoporosis 

(includes a complimentary bone density study) 

Debbie Meyers, RN, MSN, CCRN 

_____ Acupuncture Dr. David Bohn, BS, OC 

8:15 AM Continental Breakfast 

9:00 – 9:05 AM Welcome & Introductions Karen Shaffer, D-1 President 

9:05 – 9:50 AM Keynote “Survival For Nurses” Melody Chenevert, MS, RN 

10:00 – 11:00 AM 

How to survive the challenges of today’s fast paced, ever changing health care environments. 

What to do when you feel the pressure cooker is about to explode. 

Concurrent Sessions ( Indicate First and Second Choice, See separate description) 

____ Herbal Medicines and their potential interactions with over-the-counter and 

prescription drugs: Willow Moore, D.C., N.D. 

____ “Safe Needles Save Lives”: Marsha Zanger, RN 

Workplace safety is a growing concern for all nurses. Learn about the ANA initiative and 

hear one nurse’s personal experience with the fiscal and personal cost of needlestick 

____ Aging and The Law: Counsel for Nurses: Joan L. O’Sullivan, JD, University of Maryland 

School of Law. Learn more about the issues of informed consent, surrogate decision 

making, end of life including assisted suicide and palliative care. 

11:00 – 11:15 AM Break 

11:15 – 12:15 PM Concurrent Sessions (Indicate First and Second Choice, See separate description) 

____ Healthy Communities 2010 Dr. Fred Tola 

Hear a discussion about what makes a healthy community. 

____ Parish Nursing Linda Santymire RN 

____ 

Something old is new again. Impact of providing health care information in a 

spiritual community. 

Transplant: Alexandra Brock, RN, BS, BSN, Maryland Transplant Resource Center 

12:15 – 1:30 PM Boxed Lunch/Exhibits 

Introduction of Elected Officials 

Students will have a separate NCLEX review session with lunch - Debbie Dillon, RN, MS 

1:45 – 2:45 PM ____ Internet Access to Medical Information: Michelle Bealieu, RN 

____ The Genetics of Breast Cancer: Maimon Cohen, PhD and Karen Eanet, RN, MS 

What you should know about genetic research and counseling related to breast cancer 

____ Practice & Education “Workplace Violence” a growing issue for nursing 

Kathleen White, RN, PhD 

Participants will be invited at the end of the session to participate in the development of 

a white paper for MNA on workplace violence. 

2:45 – 3:30 PM 2000 Poster Session (Contact Hours available for posters) 

Exhibits/Door Prizes/Refreshments 

5:30 – 6:30 PM Evening Keynote: Linda Stierle, ANA Executive Director 

6:30 PM Dinner (Chose one: Anyone who does not identify a choice will receive Salmon) 

____ Hickory Smoked Prime Ribeye of Beef 

____ Pan Seared Beijing Salmon Filet 

7:30 PM Program (Please wear your nursing pin and if you have it bring your school cap) 

Announcement of 2001 Convention, District 4 

Friday, November 10, 2000 

8:15 AM Full Seated Breakfast 

8:45 – 9:30 AM Breakfast Speaker: Dr. Georges Benjamin, Secretary of the Department of Health and Mental 

Hygiene 

9:30 – 10:00 AM Awards Presentation 

10:15 AM – 12:15 PM Annual Business Meeting 

Special Requirements: Anyone requiring special accommodations, requirements or meals must contact MNA no 

later than September 15, 2000, to ensure that we will be able to meet your needs. 

Accreditation: Contact Hours will be offered for all educational sessions and the poster session.



2000 

Anatomy of a Consortium 

Debbie Kisner RN, MS, CNOR 

Debbie is a Clinical Nurse 

Specialist and Educational 

Coordinator for the Surgical 

Services Line at Franklin 

Square Hospital Center. She 

has 22 years experience in 

perioperative services. She is 

a founding member and past 

chair of the Chesapeake 

Critical Care Consortium. She 

currently chairs the Kisher 

Chesapeake Bay Perioperative 

Consortium of which she is also a founding member. 

It has been my experience that my time has become 

more and more of a commodity in the workplace. 

Education departments are constantly inundated with 

requests for educational programs to bridge the gap from 

new grad to practicing RN. This is certainly no surprise 

knowing that it is near impossible for the nursing school 

curriculum to prepare new grads for each and every type 

of nursing in which they may choose to work. 

Additionally, there are many more opportunities available 

in today’s workplace other than bedside in-hospital nursing, 

and clinical rotation time can’t explore them all. 

The face of healthcare has also changed dramatically 

over the last decade. These changes have made it necessary 

for many practicing nurses to develop new skills and 

competencies. Consequently, educators are getting an 

equally staggering number of requests for educational programs 

to transition experienced nurses from one clinical 

specialty to another. To add to this growing demand, statistics 

show that we are in the throes of yet another nursing 

shortage. It is estimated that there is one nurse entering 

the workforce to replace every four that retire. 

Although not exclusive to any one area, the higher 

demands for skilled nurses have emerged in highly specialized 

areas such as critical care, and perioperative 

services. 

100 

Institutions have developed their own training 80 

programs for nurses in order to staff their special- 60 

40 

ty areas. While this process has been education- 20 

ally effective it has most certainly not been cost 

0 

effective. Frequently these programs are run for 

a handful of participants. Typical length for the 

didactic portion may be anywhere from several 

days to several weeks depending on the area. 

Your educator would be tied up with this program 

for the entire time and not be able to complete or 

even work on any other projects until the students move on 

to the clinical portion, which is traditionally completed 

with a preceptor. This is usually not the best use of time 

for an educator. Some institutions do not have educators 

who can pull together such a specialty education package. 

They must either pull expert staff away from patient care 

to fill this void or send employees to an outside program 

for big bucks, if such a program does even exist. The good 

news is the Maryland General Assembly has introduced 

emergency bills to create a Statewide Commission on the 

Crisis in Nursing to address the critical nursing shortage. 

The bad news is, this will not help us today. So, how do 

you do more with less? 

One way our institution has been able to work smarter 

rather than harder is through the use of specialty consortiums. 

Forming consortiums to assist with our already 

overloaded plates has proved to be an innovative and cost 

effective way to provide the needed education. By definition, 

a consortium is a coalition for a venture requiring vast 

resources. In practice, consortiums are multi-institution 

groups who band together with the common goal of providing 

specific education to a large number of individuals. 

6 

4 

2 

0 

Through consortiums you can provide quality education 

for a fraction of the time it would take to implement the 

entire program alone. 

I have had the unique opportunity to be in from ground 

level formation of two consortiums in this area, the 

Chesapeake Critical Care Consortium, and the Chesapeake 

Bay Perioperative Consortium. Both were formed in 

1994 

1996 

Figure 1 

Number of Classes per Year 

Critical Care Consortium 

Yr-1994 Yr -1995 Yr-1996 Yr -1997 Yr-1998 Yr -1999 Yr -2000 

Figure 2 

Average Attendance per Class 

Critical Care Consortium 

1998 

2000 

Class 1 

Class 2 

Class 3 

Class 4 

Class 5 

Class 6 

response to the growing demand for educational programs 

for their respective specialty areas. 

Church Hospital, Franklin Square Hospital Center, 

Harbor Hospital Center, Maryland General Hospital, 

Mercy Medical Center, Sinai Hospital, and Union 

Memorial Hospital with AACN as the sponsoring body 

formed the Chesapeake Critical Care Consortium in 1994. 

After our debut class in October 1994, we began offering 

a ten-day critical care course three times per year. Member 

institutions were allowed to send an unlimited number of 

participants. Diligent review of the course and evaluations 

allowed us to revise the content and decrease the course to 

nine days. With rising attendance and membership, we 

decided to increase the number of times the course was 

offered. As attendance and membership continued to rise, 

we continued to increase the number of class offerings (See 

Figure 1). When we reached six times per year, we could not 

go any higher. At this point we decided to limit the number 

of participants per member institution. We also noticed that 

we had higher attendance on the EKG days, so we started 

offering those days separately as a basic EKG course in addition 

to offering them as part of the nine day course. All of 

these efforts allowed us to continue to present a quality program 

yet keep the class size manageable (See Figure 2). In 

Consortium cont. on pg. 23




Consortium cont. from pg. 22 

addition to the basic and EKG courses, we have also been 

able to offer advanced cardiac and respiratory programs. Our 

current membership has grown to 19 institutions and we have 

provided critical care education for more than 1100 nurses. 

The Chesapeake Bay Perioperative Consortium was 

formed in 1999 in response to a severe shortage of perioperative 

nurses. The program has been presented three 

times with class size in the 30-40 range. Our current 

membership boasts 18 member institutions. We began 

with a nine-day course in September 1999. Once again, 

conscientious review of the course and evaluations 

allowed us to decrease the didactic course to six days. 

Although we are in the infant stages of development, we 

have already provided perioperative education for over 

100 nurses. We plan to offer the course three times per 

year. 

Consortiums provide an excellent opportunity to share 

knowledge and expertise. You have the ability to provide 

content experts each and every class. Students get the 

most up to date knowledge designed to mirror national 

standards rather than institutional idiosyncrasies. You 

need to teach only a few hours rather than a few days or 

weeks. This frees up your time to do other projects. Never 

underestimate the ability to network. You have a direct 

contact with the outside world that allows you easy access 

to policies, community standards, employee and student 

job references, and educational programs. This is also a 

good place to survey for best practices. A final benefit I 

personally have reaped from consortium participation is 

friendship. I have had the privilege of working with some 

extremely talented and knowledgeable colleagues. We 

have a great team spirit in both consortiums, which has 

made our work successful and quite enjoyable. 

Although consortium participation has worked well for 

our institution, it may not be right for your institution. One 

downside is that you are committed to providing the same 

support (teaching hours) for each offering whether you 

send ten participants or zero. You will need to travel to 

various institutions for meetings and course presentations. 

You may not be able to present your favorite topic. There 

is a lot of negotiation involved in content assignment. 

Some individuals may be more limited in their expertise 

and will have a smaller range of topics they can present. 

You need to be flexible and open minded. Just make sure 

that you understand what you are committing to before you 

sign on the dotted line to avoid confusion and hard feelings 

in the future. 

If you are interested in forming your own consortium, 

here are a few basics to get you started. First, talk with 

your colleagues to see if there is a need for the type of program 

you are looking for. Consortiums work best for 

longer programs that run over multiple days rather than 

several-hour workshops. Are there established programs 

out there? Is there a National curriculum? Who would be 

interested in participating? After you have established the 

need, get the group together and set down some formal 

ideas. Make sure you agree on your mission and vision 

before you jump into the course outline. Also be sure to 

include responsibilities for each member institution, such 

as meeting attendance, lecture hours, backup hours, 

development of handouts and test questions, reproduction 

of materials, hosting the course, chairing the group, and 

contract approval to name a few. Also consider how 

often you will offer the program, if there will be a fee and 

if so what the fee will be, if refreshments will be provided 

and by whom, if contact hours will be offered, and if 

you need to limit the number of participants. Keep in 

mind that all duties and responsibilities should be shared 

equally. You will also need to spell out the consequences 

of not fulfilling your obligations. Also, decide if and 

when you will take on new member institutions and how 

you will deal with outside participants (non-member 

institutions). All of these points need to be in writing. 

Signing of the contract will denote agreement. 

As you develop your course outline include the topics 

and their presentation times. Remember to include ample 

time each day for breaks and lunch. Consider the spacing 

between class days. You don’t want to overload the 

participants, yet you don’t want to space the classes so far 

apart that there is poor retention of material. If some of 

the material requires hands-on skills, you may want to 

space the didactic portions every other day so that the 

participants can practice the skill they learned about the 

next day while it is fresh in their minds. Unfortunately, 

you are most probably at the mercy of the conference 

room schedule, meaning you take what’s available. 

Don’t forget to include extra days and an emergency plan 

if your course is being offered during the snowy season. 

Decide how you will measure outcomes. At a very 

minimum you will need to develop a program evaluation. 

If you will test participants, you will need to decide what 

will be tested, how the test will be constructed, when the 

exams should be inserted into the overall course outline, 

and what constitutes a passing score. Program evaluations 

and tests should be reviewed after each course 

offering so that revisions are made on an ongoing basis. 

A final word of advice is, keep things simple. Use 

the best practices from each institution rather than 

recreating the entire program. Look at established consortiums 

and learn from their mistakes. Your consortium 

doesn’t have to be a clone of them. This is your 

program, so make it work for the members of your 

group.




This publication is provided to you by the Maryland Nurses Association. 

Without MNA, this is what you would be reading to keep you informed about nursing 

Is this enough to keep you on top of nursing’s issues? 

MNA 

Working to assure quality healthcare for all people by protecting and enhancing 

professional nursing in all environments. 

Are you a member? 

Join us today... You can use the membership application found in this issue.



2000 

Maryland Delegation Travels to Indianapolis 

For ANA House of Delegates Meeting 

The ANA 2000 House of Delegates meeting took place in 

Indianapolis, Indiana, June 23 – 28, 2000, and Maryland was 

well represented and well prepared. Maryland had eight delegates 

attend this key ANA meeting. They included Sandy 

Bryan (District 4), Fran Damratowski (District 3), Paul 

Kulp (District 5), Roberta Niklewski (District 8), Nayna 

Philipsen (District 2), Carlene Spangler (District 7), 

Catherine Vestraci (District 9) and MNA President Mary 

Beachley. 

This was a key meeting not only for ANA but also for 

Maryland and other constituent members of ANA who do not 

actively engage in collective bargaining. Aspecial bylaws proposal 

was on the floor of the House that would establish a formal 

Workplace Advocacy structure within ANA. The adoption 

of these bylaws would elevate the importance of supporting 

nurses through means other than collective bargaining for 

those state associations who are not bargaining agents. In 

addition to this important issue, the House dealt with a number 

of other key concerns affecting the association and nursing. 

This was also an election year and the House voted on a number 

of ANA offices including the election of a new President. 

ANA House of 

Delegates Report 

One of the highlights of this 

years Convention was an address 

given by Tipper Gore, wife of 

Vice President and Presidential 

candidate Al Gore. Mrs. Gore 

serves as President Clinton’s 

mental health policy adviser. 

She gave a speech that focused 

on mental health concerns, 

telling the nurses in attendance 

that acceptance was still the most 

difficult thing to accomplish with 

mental illness. She called for 

more information and education. 

Mrs. Gore mixed her serious 

message with some good humor, 

but declined to address her husband’s 

thoughts about a possible 

running mate. I wonder if it 

could be a nurse? 

Pictures in this “ANA House of Delegates Report” were provided by Delegate 

Fran Damratowski. 

by Mary Beachley 

MNA has been very influential in moving the agenda 

of the non-collective bargaining states within the ANA 

organization. Kathy Hall, executive director of MNA, has 

served as Chair of the Workplace Advocacy Coalition that 

represents more than 40 member states. These states use 

workplace advocacy strategies as a means to address 

workplace issues for nurses. The Workplace Advocacy 

Coalition was successful in passing an ANA bylaws 

change to create the Commission on Workplace 

Advocacy during the ANA 2000 Convention in 

Indianapolis. 

The work of the ANA 2000 Convention delegates was 

very relevant to all practicing nurses. The House of 

Delegates heard hearings on topics of staffing levels, use 

of mandatory overtime, restraint of trade against advanced 

practice nurses, patient safety, reduction of the use of 

patient restraints, pain assessment, violent behavior of 

youth in schools and registered nurses as first assistants. I 

will summarize the outcome of the discussions on three 

major issues that were addressed, (1) mandatory overtime, 

(2) IOM report, and (3) threat to advanced practice nurses. 

More detail on these hearings is presented in other 

articles in this newsletter. 

Mandatory overtime: 

A reference hearing was held on the use of mandatory 

overtime as a staffing solution. Many nurses across the 

country are voicing concern about inadequate staffing and 

are struggling with unsafe overtime work hours to meet 

patient care needs. It was pointed out that recent research 

on fatigue supported the nurses concern that overtime can 

contribute to medical errors. There are currently laws that 

regulate the number of hours that pilots and truck drivers 

can work. These laws are based on the relationship 

between hours worked and fatigue. The goal is to reduce 

fatigue that contributes to human error. Nurses are not 

flying planes or driving trucks but they are providing 

patient care that includes giving medications and using 

equipment that could be a threat to life or produce an 

undesired outcome for the patient if an error is made. As 

a result of this hearing, the House voted to oppose manda- 

Pre-House of Delegates meeting of the Maryland Delegation. Pictured left to right 

are: Paul Kulp, Carlene Spangler, Roberta Niklewski, Sandy Bryan, Mary 

Beachley, Cathy Vestraci and Kathy Hall 

MNA Involved in Creation of New ANA Structure 

tory overtime and directed the Board and ANA staff to 

work with appropriate organizations, agencies, and legislators 

to promote safe staffing levels while finding alternative 

solutions to staffing that does not include mandatory 

overtime. 

IOM Report: 

Patient safety as a vital component of quality care was 

discussed in relation to the 1999 Institute of Medicine 

(IOM) report, “To Err is Human.” This topic was part of 

a reference hearing where recommendations were made 

for ANA to support the specific IOM recommendations 

and promote nursing research on patient safety. Also, a 

plenary session, “Stopping the Blame Game”, was devoted 

to the topic of errors. The emphasis of this session was 

on promoting blame-free work environments, which use 

quality improvement methods to improve the systems in 

order to eliminate errors. Many nurses from across the 

country working in various practice settings identified 

patient safety as a major concern. 

Threat to Advanced Practice Nurses: 

The American Medical Association’s (AMA) Citizen’s 

Petition received an emergency hearing in the convention 

reference hearings. The AMA has sent this petition only 

to physicians (not to the public). The AMA intends to file 

these signed petitions with the Health Care Finance 

Administration (HCFA) to demand implementation of a 

system to ensure that Medicare reimbursement to Nurse 

Practitioners (NPs) and Clinical Nurse Specialists (CNSs) 

is made only if the services are furnished in collaboration 

with a physician. The petition essentially pressures 

HCFA to adopt a much more stringent and restrictive 

approach to “collaboration” than is reflected in the current 

regulations. The AMA is defining collaboration as supervision. 

This petition is seen by ANA as part of a larger 

campaign by the AMA, which is to promote an agenda 

that is not based on concerns for patient safety or enforcement 

of existing laws; rather its goal is to restrict the 

scope of practice of advanced practice nurses as well as 

other providers who are not physicians. Nurses view this 

action by the AMA as an attempt to restrain trade. 

Therefore, the ANA delegates voted to accept the recommendation 

to have ANA staff and the Board develop an 

immediate rebuttal to the AMA petition and present it to 

HCFA. 

The Maryland delegation worked diligently through 

the sessions of the House of Delegates to promote the passage 

of the Bylaws change to create a Workplace 

Advocacy Commission within the ANA organizational 

structure and to amend certain recommendations that 

were put before the house. The delegates, who have 

attended previous conventions, commented that this 

House of Delegates was the most effective for collaborative 

action and compromise to define and set priorities 

that would benefit all nurses. 

If you would like more detail on the reference hearing 

outcomes or the convention activities, please contact your 

district delegate or the MNA office. 

As you can see from the ANA Convention summary, 

this is a critical time for our nursing profession. We all 

need to be alert to the ongoing threats to our practice and 

act proactively as well as reactively to these threats. 

Information is power but only if it is current and, in this 

fast paced information age, information must be timely. 

Each of us can contribute to the future of our profession 

by being informed and acting through our professional 

nursing association. MNA needs your continued support 

through your membership as well as your support for your 

elected MNA leaders in the districts and the state.




ANA House of Delegates Report 

Paul Kulp addressing ANA House of Delegates 

International Nursing: 

Developing NNA to NNA Partnerships 

by Carlene Spangler 

This proposal , submitted by the South Dakota Nurses 

Association, challenges ANA to promote and strengthen 

nursing globally through greater involvement with other 

national nurses organizations. The report builds on the 

19991 house action that directed ANA to facilitate the 

establishment of relationships between other countries’ 

nurses association and state nurses associations. This proposal 

meets all ANA core issues. 

In recent years, concerns over domestic issues within 

the ANA have overshadowed a parallel focus on international 

issues. International involvement is important and 

necessary for the association in fulfilling its mission both 

domestically and abroad in the future. This proposal may 

allow opportunities to seek solutions to some of the recurrent 

American nursing issues and could provide the structure 

and consultation for countries that wish to form professional 

nursing associations. The proposal includes recommendations 

to: “Explore the feasibility of an exchange 

program or partnership with one or more NNAs,” and to 

“Engage in collaborative exchanges with nurses of the 

international community with focus on achievement, partnerships, 

flexibility, inclusiveness, and vision.” 

This proposal met with some concern in the House of 

Delegates due to finances. A delegate suggested that the 

goals of the proposal needed to be more focused with welldefined 

outcomes and future expenses articulated in light 

of ANA’s current budget deficit. Members of the finance 

committee clarified the fiscal implications, stating that 

only $29,800 of new costs would be incurred. The 

Director of the International Nursing Center stressed the 

need to address nursing issues at local, state, national, and 

international levels. She contended that ANA should pay 

attention to nursing and health concerns around the world. 

The Maryland delegation was in agreement with this position. 

This proposal was approved with a final vote of: 414 

voting yes; 143 voting no, and 3 abstentions. 

Cathy Vestraci, Carlene Spangler, and Nanya 

Philipsen at Maryland Caucus meeting 

Caucus meeting in Indianapolis: Mary Beachley, Roberta Niklewski, Paul Kulp 

and Sandy Bryan 

Suspension of MIP 

by Carlene Spangler 

The Membership Incentive Program (MIP) was created 

at a time when Constituent Member Associations (CMA) 

were expending significant financial resources in the area 

of membership recruitment. The MIP created a financial 

partnership with ANA which allowed CMAs to keep a portion 

of their membership dues each year. Over the last few 

years, ANA has begun to experience financial difficulties. 

ANA has not had a dues increase since 1989 and inflation 

has increased by 32%. During these years, ANA has also 

committed considerable financial resources to membership 

recruitment and retention. The ANA Board of 

Directors had planned on bringing a proposal to the 2000 

House of Delegates for a dues increase. In April of 2000, 

however, ANA’s constituent members raised strong opposition 

to an increase in dues. Other steps became necessary 

to ensure ANA’s financial viability. This proposal, 

submitted by the President and the ANA Board of 

Directors, would reduce financial obligations. The recommendation 

is to: “Suspend the Membership In Incentive 

Program to become effective with the 2000 dues year and 

to continue until such time as it is brought back to the 

House of Delegates for reinstatement.” 

Some delegates objected to this proposal citing ways in 

which the extra money had been helpful to CMA’s and 

expressing concern that lack of money night harm the 

smaller CMA’s. Most delegates, including the Maryland 

Delegation, supported this proposal, feeling it represented 

sound financial management by ANA. It was decided to 

add an additional recommendation to the proposal to 

“Develop alternatives for recruitment and association 

image enhancement.” 

The proposal was approved with a final vote of: 474 

voting yes, 66 voting no, and 7 abstentions.



2000 


Nanya Philipsen, Paul Kulp and Cathy Vestraci on House floor. Maryland Delegation in Indianapolis, It wasn’t all work. 

Building Safer Health Care Systems for Informed Patients 

by Bobbi Niklewski 

This is my third year as MNA District #8 delegate to the 

ANA Convention, and I can honestly say that this was the 

best House of Delegates I was ever a part of. The spirit of 

cooperation and compromise to make sure that the best 

interests of nurses and nursing were always the highest priority 

was the best I have ever witnessed. I was honored to 

be a part of this ANA Convention. 

Summary of Purpose: One of ANA’s core issues for 

year 2000 is “Patient Safety/Advocacy” with the potential 

to effect positive changes for patients by demonstrating the 

linkage between nurse staffing and the prevention of 

patient adverse events and errors. While errors may be 

more easily detected in hospitals, they occur in every 

health care setting, and using even the lower estimate, 

more people die of medical mistakes each year than from 

highway accidents, breast cancer, or AIDS (Centers for 

Disease Control, 1999). 

This recommendation, “Building Safer Health Care 

Systems for Informed Patients,” was submitted by the 

ANA Board of Directors, and focused on the issue of errors 

as cited in the Institute of Medicine (IOM) report “To Err 

is Human: Building a Safer Health System” (Kohn, 

Corrigan, Donaldson, 1999). This major policy paper 

addressed the contributing factors, such as complex systems 

and technology, inappropriate staffing, and unskilled 

workers, and has focused the attention of Congress, policy 

agencies, and the health care industry on the seriousness of 

these issues. 

ANA has long recognized this problem and has worked 

to address issues related to nursing care that enhance 

patient safety and outcomes for many years. All speakers 

in Reference Hearing C on June 25th supported the report 

with only a few changes that urged ANA to take the lead 

regarding the importance of patient safety and not just support 

the IOM report. 

The final Recommendation that was supported by 

the Maryland Delegation and approved by the HOD on 

June 28, 2000, at an estimated cost of $281,000 moved that 

the ANA: 

• Promote awareness among the public and 

policymakers about the effects of health care system 

downsizing, restructuring, and reorganization 

that undermines quality and safety of patient care. 

• Support the IOM recommendations. 

• Promote passage of whistle blower legislation that 

protects the essential role of nurses in efforts to correct 

system errors. 

• Continue the implementation of strategies identified 

in the 1998 HOD action report “Shared 

Accountability in Today’s Work Environment.” 

• Promote nursing research on patient safety. 

• Educate nurses on the science of system safety and 

system safety issues. 

• Work with the Agency for Healthcare Quality and 

Research and other organizations to make quality of 

care and patient safety a priority. 

• Promote development and implementation of policies 

that support: 

- Development and utilization of safe standardized 

procedures for the use of medical devices. 

- Adequate and appropriate nurse staffing levels; 

- Improved information-sharing among practitioners 

treating the same patient; 

- Continuing education, enhancement of knowledge 

and technical skills of practitioners; 

- Demonstrated improvement of quality of care and 

reduction of errors through collection of data 

using nursing quality indicators.





Safer Staffing Levels/APRN Access to 

Medicare Reimbursement 

by Catherine Vestraci 

Hearing A consisted of two pre-scheduled action 

reports dealing with safer staffing issues and the addition 

of an emergency action report to oppose the 

American Medical Association’s (AMA) attempt to discredit 

APRN access to Medicare reimbursement. These 

were very intense issues that the House of Delegates 

(HOD) was quite prepared to address. Many delegates 

spoke to endorse action and fine tune each recommendation. 

The first action report about “Identifying Adequate 

and Appropriate Registered Nurse Staffing Levels 

Where Health Care Services are Delivered” was submitted 

by the Congress on Nursing Practice and 

Economics (CNPE). Much discussion ensued and 

numerous states proposed changes at both the hearing 

forum and HOD meetings that provided language to 

include staffing decisions based on nursing assessments 

and direct-care RNs participation. Massachusetts was 

instrumental in motions to hone the wording of the recommendation, 

which passed with a strong 97.7%. 

Recommendation 2, which was also introduced by 

the CNPE, probably elicited the most emotional discussion 

as it dealt with mandatory overtime as a staffing 

solution. The HOD unanimously decided that consideration 

of any model process for assignment of overtime 

was promotional, in nature, to the practice, and unacceptable 

as it would, in itself, endorse its continued use. 

Patient abandonment was the other concern in regards 

to a nurse’s decision to reject additional hours of work. 

Patient/ Workplace 

Safety 

by Paul Kulp 

The 2000 ANA HOD passed two Action Reports or 

motions relevant to patient and/or workplace safety. 

The first was “Reduction of Patient Restraint and 

Seclusion in Health Care Settings.” The House directed 

ANA to establish a policy paper on patient restraint and 

seclusion to provide direction for nursing practice in 

varied settings. Delegates made amendments to the 

original action report to ensure that such a policy would 

include principles of evidenced-based practice, assessment 

by an appropriately licensed practitioner (including 

a RN), and the protection of human rights. The 

House also added that ANA should establish a position 

statement to provide direction for nursing practice in the 

use of chemical restraint. 

MNA President Mary Beachley making statement to the full ANA House 

Guides for nursing code, regulatory and case law, 

advisory opinions and position statements were cited as 

guides for defining patient abandonment for validation 

of nurses’ decision to reject mandatory overtime. 

Building on research to examine the relationship 

between hours worked and the ability to provide safe 

care was included, as well as providing a tool which 

defines a nurse’s rights and responsibilities when faced 

with overtime. The HOD clearly sought to strengthen 

the action report in an attempt to advocate for safe 

patient care by advocating safe nursing practice. 

Recommendation 2 passed with a 97.8%. 

The last action report of Hearing A was an emergency, 

on-site, addition by ANA president, Mary Foley, to 

oppose the “AMA Citizens’ Petition to HCFA”. This 

petition is an AMA attempt to undermine APRNs ability 

to independently bill Medicare. Ohio and Maine APRN 

delegates repeatedly spoke to the severity of consequences 

from AMA’s recent effort. The HOD stood in 

full support of opposing such a petition of manipulation 

as it passed with a 92.8% vote. 

The HOD was impressively unified as it collectively 

did much work to have ANA stand firm in all three current, 

critical issues faced by nursing. 

During pre-convention discussions and on-site caucuses, 

Maryland delegates endorsed each recommendation 

of Hearing A. With our own participating legal 

counsel, N. Philipsen, we were able to be informed 

endorses when we voted on accepting guides for patient 

abandonment in relation to opposing mandatory overtime. 

The delegates of Maryland were in full support of 

proposed ANA directives to facilitate firm positions and 

promote the Workplace Advocacy issues. 

Violent Behavior of 

Youth in School 

Settings 

by Paul Kulp 

In a second Action Report, entitled “Nursing’s 

Response to Violent Behavior of Youth in School 

Settings,” The House directed ANA to address youth 

violence In the public schools by advancing nursing 

education in the identification of Youth violence and 

its root causes, by promoting multiple strategies including 

conflict resolution to address the issue, and by promoting 

adequate numbers of nurses in all school and 

educational systems. A MNA delegate attempted to add 

language supporting alternatives to incarceration as a 

response to youth violence and the provision of adequate 

comprehensive mental health services to this 

population, but the amending motion was defeated. 

RN First Assistant 

Nayna Philipsen 

The purpose of this action report was to emphasize 

the need for ANA to support federal activities supporting 

the role of the registered nurse surgical first assistant. 

Lack of Medicare reimbursement for RNFAs is a 

“significant barrier to their full scope of practice.” 

HCFA requires master’s preparation for direct reimbursement. 

HR 3911 was introduced to provide coverage 

under Medicare for RNFAs. 

The original recommendation was for the ANA to 

“advocate” for federal legislative and regulatory 

actions that “support” the role and scope of practice of 

the RN as surgical first assistant. That was changed 

after hearing to “seek passage of federal and state legislation 

and regulatory actions that will “protect” the 

role and scope of practice of the RN as surgical first 

assistant. 

Also as part of the original recommendation was for 

ANA to implement strategies to address threats to practice 

for the RNFA. That changed after hearing to “support 

the utilization of only appropriately credentialed 

RNFAs, qualified nurse practitioners, nurse midwives, 

clinical nurse specialists, physicians, and physician 

assistants as first assistants.” The House of Delegates 

accepted that wording, but deleting all wording after 

RNFAs. 

The original recommendation was to amend ANA 

position statement on RNFA “qualifications” to include 

requirement for certification as registered nurse first 

assistant. That was changed after hearing to “Support 

collaboration with appropriate nursing organizations to 

develop and implement basic perioperative nursing 

curricula in schools of nursing and a masters degree 

program in RNFAs.” The proposal to support a master’s 

degree program was very contentiously debated 

by the House of Delegates. Supporting states argued 

that a master’s degree “might raise the bar” which they 

clearly did not want to do. They argued that RNFA is 

an expanded role, not an advanced practice. Other delegates 

argued that enhancing competence is our professional 

duty, and were concerned that “dumbing down” 

the substance of the RNFA’s preparation weakens ANA 

efforts to successfully promote legislation protecting 

exclusive practice, reimbursement, and safety. The 

final recommendation omitted the master’s degree program. 

The final recommendations passed. The Maryland 

delegation supported these recommendations. The 

Maryland Delegates also support demonstrated competence 

commensurate with responsibility. That includes 

encouraging the development of educational programs 

that maximize both professional competence, and citizen 

confidence and safety.



2000 

ANA Election Results 2000 

American Nurses Association delegates elected Mary 

E. Foley, MS, RN to serve a two-year term as president 

of the nation’s leading professional organization representing 

the major health policy, practice, and workplace 

issues of registered nurses in the United States. Foley 

assumed the role of president in January 2000 when 

Beverly L. Malone, vacated the position to accept the 

position of Deputy Assistant Secretary of the Department 

of Health and Human Services. The full election results 

are as follows: 

President Mary E. Foley, MS, RN 

First Vice President Patricia W. Underwood, RN, 

PhD 

Second Vice President A. Louise Hart, RN, MSN, 

DNS 

Secretary Patricia S. Yoder-Wise, RN, C, 

EdD, CNAA, FAAN 

Treasurer Rebecca M. Patton, RN, MSN, 

CNOR 

Board of Directors Mary Lynn Behrens, BSN, 

MSN, FNPC, RN 

Christina L. Sieloff, RN, PhD, 

CAN 

Betty Smith Campbell, RN, 

ARNP, PhD 

Staff Nurse Board Positions Jan Bussert, RN 

Other elections include: 

Katheren Koehn, RN 

Chair of Constituent Assembly Mary Lou Burnnell, 

MSN, RN 

Chair of the UAN Cheryl Johnson, BSN, 

RN 

Congress on Nursing Practice and Economics: 

Joan M. Caley, RN, MS, CNAA, CS 

Naomi E. Ervin, PhD, RN, CS, FAAN 

Saul Josman, RN, BSN 

David R. Marshall, RN, BSN, JD 

Marva Wade, RN 

Nominating Committee: 

Patricia Ann DeShazer, RN, BSN 

Jujuan B. English, MSN, RN 

Miriam Gonzalez, RN, BS 

Sarah A. Liptak, RN, MSN 

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depending on experience 

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benefits package 

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Contact Cathy Somerville, 

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410-778-6800 or call toll free 

888-784-0137, ext. 2109




Letter to the Editor 

Dear Editor, 

I am starting to know how it must of felt in the west when 

the gold rush was over. Little by little your friends and 

neighbors packed it up and moved to some other town 

where new opportunities existed. Little by little there was 

no one left. Finally there were just ghost towns standing. 

Hospitals are feeling the shuffle of their workforce moving 

about like nomads grabbing up sign on bonuses. If your 

hospital does not pay your sign on bonuses you may be left 

in the ghost town. 

Are sign on bonuses the answer to the nursing shortage? 

From my lookout point I see people scrambling to go to 

work where the higher bonuses are, even if it means an extra 

hours drive to work. They do that for a year then move onto 

another hospital still willing to pay even yet another sign on 

bonus. Sign on bonuses irritate established nurses who 

remain loyal to their hospital. They create a disharmony 

between the efforts of retention and recruitment. 

I was very fortunate to start my nursing career on a nursing 

unit where I had a nursing leader who was very solid in 

her supervision but she was also skillful to gradually groom 

individuals to become autonomous. Nursing is not a job 

you can do alone. The greatest benefit in staying in one 

place for a long time is that you do become part of a team 

that represents a reliable place where the public can come 

for care. Patients with chronic conditions grow to depend 

on continuity. 

It takes time for groups to unite and grow into thereaputic 

teams. Changing members of a work group because of 

turnover causes the groups to reform over and over. Just 

when you get into a predictable pattern someone leaves. 

Some of this turnover is expected but when it is excessive 

chaos can prevail. 

What would happen if hospitals just stopped giving sign 

on bonuses? Maybe some of the nomadic movement would 

end? Maybe some stability would emerge? What would 

happen if orientations were longer? The money used for 

sign on bonuses could be used instead on skillful staff 

development creating nurses that were more prepared to 

become autonomous to deal with the difficult job that nursing 

is. 

In my opinion the sink or swim mentality does not produce 

a good swimmer. Most people I know who were 

thrown in the water are just afraid of water. I feel the same 

thing applies to being thrown in with your idealistic nursing 

student mentality where theory and reality meet. Most people 

who are not adequately prepared for their new role are 

afraid of the reality. When they get in over their head or 

become frightened about making a serious mistake they 

leave the profession. 

So many times we speak about values. Taking care of 

patients is about producing a work force that understands 

the value of loyalty, responsibility, accountability, camaraderie, 

professionalism and caring about others as well as 

yourself. We have to care about our nurses, our physicians 

and all of the people who work to make health care a positive 

experience. Nurses love their work when they are confident 

they are doing a good job and they are getting the 

support to make a difference. If you love your job you are 

more apt to stay. 

Sadly too, the nursing schools are having a difficult time 

recruiting students. This problem will take state and government 

interventions such as free tuition and room and 

board. The media could also help in the fight to foster a realistic 

image of nurses. I hope that our profession can work 

together to end the nurse shortage soon. 

Sincerely, 

Dora M. Long, RN



2000 

Medication Errors 

by Georgia A. Martin, 

J.D., Ph.D., MSN, BSN, RN, CS-P 

With greater than 8,000 drugs to 

choose from, the most educated 

professional health care providers 

make medication errors, and somewhat 

less experienced providers 

compound the problem. 1 The 

Institute of Medicine’s report, To 

Err Is Human, indicated that 

approximately 3.75 billion drugs 

are administered annually to inpatients. 

In one large teaching hospital, 

the medication error rate was 

estimated to be 3.13%. However, 

acknowledged medication errors 

killed 7,391 people in 1993. 2 

Martin 

Ten common causes of medication errors are listed in 

Table 1. Other causes include infusion pump/parenteral 

administration errors, inadequate monitoring, faulty drug 

stocking or delivery methods, preparation errors, lack of 

standardization, and confusion about a patient’s identity. 

Table 1 

Ten Common Causes Of Medication Errors 3 

1. Sleep deprivation. 

2. Mental lapses and fatigue. 

3. Inadequate knowledge of drugs. 

4. Inadequate knowledge of a patient’s 

existing medical conditions. 

5. Use of multiple drugs 

6. Allergies. 

7. Deviations from medication rules and procedures. 

8. Faulty drug identification. 

9. Transcription and handwriting errors. 

10.Dosage errors. 

Legal Issues Regarding Medication Errors 

Of all malpractice claims filed, approximately 30% 

involve drug-related injuries. An average payment of 

$99,721 was made for 2,195 out of the 6,646 claims reported 

to the Physician Insurers Association of America during 

the period 1985 through 1992. 4 Anyone who manufactures, 

sales, distributes, prescribes, dispenses, or administers 

drugs, as well as, the health care facility that employees 

them or places the medication in their formulary can be sued 

for patient injuries. 5 

Theory of Liability 

If a health care provider sued for a medication error is 

found liable, it is generally under the theory of negligence. 

Negligence is a type of tort that arises from an injury caused 

by conduct that deviates from a “standard of care.” Medical 

malpractice is a type of negligence that denotes an injury to 

a patient caused by a health care provider’s conduct that 

deviates from professional standards of practice expected 

within the profession. In a malpractice claim based upon 

medication error, a jury assesses a healthcare provider’s 

conduct to determine whether it adhered to the professional 

standards of practice required by both his profession and the 

law. In determining the strength and weaknesses of the 

case, the plaintiffs and defendants hire expert witnesses 

with similar experiences and training in order to analyze the 

medical records and determine whether the health care 

provider’s actions were within acceptable standards of practice. 

Malpractice Defenses 

Defenses are legal justifications to escape liability from 

lawsuits. The traditional defenses to negligent medication 

injuries are discussed in Table 2. 

The Federal Tort Claims Act, which specifically protects 

federally employed health care providers from liability. 

Another defense deserving mention is the “learned 

intermediary” doctrine. Under this doctrine, drug manufacturers 

fulfill their duty to warn consumers about the hazards 

associated with their products by warning physicians of 

known risks, side effects, and contraindications. With limited 

exceptions, the prescriber determines which warnings 

to advise the patient of during the informed consent process. 

This doctrine implies that the manufacturer has accurately 

and completely informed the physician of all the risks 

associated with a particular drug. Some courts have refused 

to enforce the doctrine when the manufacturers’ warnings to 

physicians were inadequate or defective. A warning may be 

defective if it did not disclose safety and efficacy data to the 

FDA that should have been included in the product labeling. 

The adequacy of the warning depends on what risks are 

included on the label, whether the warnings were conveyed 

to the physician in an appropriate manner under the circumstances, 

and whether the risks were downplayed during 

aggressive marketing campaigns. 7 

Table 3 

Traditional Informed Consent Components 

1. The medical problem necessitating a proposed 

medication, treatment, or procedure. 

2. The therapy’s purpose, description, what is 

involved and probable outcome. 

3. Likely benefits. 

4. Probable complications, temporary pain, or dis 

comfort. 

5. Probable permanent results, disfigurement, dis 

ability, scarring, and required care and related 

medical costs. 

6. Known, anticipated, or foreseeable material 

risks including possible death. 

7. Alternative procedures and treatments and their 

known side effects, risks, and benefits includ 

ing no treatment at all. 

8. The consequences and rights of the patient to 

refuse or withdraw consent for any reason. 

Informed Consent 

Prior to prescribing or administering new medications, as 

with all procedures or treatments, a health care provider 

must obtain the patient’s informed consent. Informed consent 

in this context involves the disclosure of the material 

risks, benefits, and alternatives to a medication. The adequacy 

of this disclosure often forms the basis of informed 

consent litigation. Traditional informed consent components 

that need to be discussed with a patient are outlined in 

Table 3. Risks that usually need not be disclosed are those 

that are commonly known or remote unless the risk is 

deemed significant to the patient. 

The majority of states use the “reasonable practitioner” 

standard to determine the degree of disclosure required. 

This standard requires a practitioner to disclose the information 

that most practitioners in similar circumstances 

would disclose. Most of the remaining states use the “reasonable 

patient” standard which requires the practitioner to 

disclose the information that a reasonable patient in similar 

circumstances would want to know. A few states use the 

“subjective patient” standard which requires the practitioner 

to disclose that information which a particular patient 

would want to know. The courts do not generally accept 

this particular standard, however, because it is too susceptible 

to manipulation. 8 

The information in Table 4 can be used as a step-by-step 

guide for obtaining informed consent. 

Table 4 

Checklist for Obtaining Informed Consent 

✓ Use words, phrases, and language the patient 

understands. 

✓ Complete document of all discussions must 

be recorded in the medical record because 

these records may be used as evidence at trial. 

Documentation should include: 

• How much time was spent in the discus 

sion. 

• What was discussed. 

• Whether written information was provided. 

✓ Provide opportunities for the patient to ask ques 

tions. 

✓ Evaluate the patient’s level of understanding 

by asking questions and using a check sheet to 

be maintained as a permanent part of the medical 

record. 

Medical Errors cont. on pg. 33




Medical Errors cont. from pg. 32 

Case Reviews 

In Harris County Hosp. Dist. v. Estrada, 9 a medical resident 

prescribed Bactrim for a 73-year-old patient. The 

patient immediately had a reaction and died sixteen days 

later. The patient’s family sued the physician, the hospital, 

and the nursing, clerical and pharmacy staff. Prior to trial, 

the physician settled the claim against him for $230,000. At 

trial, it was learned that the defendants had relied on a computer 

generated Medication Administration Record (MAR) 

which listed “no allergies” for the patient. The plaintiffs 

were able to show that the defendants had failed to thoroughly 

review the patient’s medical records for allergies or 

check the MARs for any inconsistencies. The court concluded 

that the defendant health care providers had failed 

their responsibilities to verify the appropriateness of the 

patient’s prescriptions and to bring potential problems to the 

attention of the prescriber. The plaintiffs were awarded 

$350,000 in damages. 

In Pellerin v. Humedicenters, Inc., 10 a patient was admitted 

to a hospital’s emergency department complaining of 

chest pain. Following an evaluation by a staff physician, an 

intramuscular injection of Demerol and Vistaril was administered 

in the patient’s left hip. Subsequently, the patient 

sued when the site became irritated, painful, and red. At 

trial 10 years later, the defendant health care provider could 

not remember giving the injection. The patient’s medical 

records indicated that the provider had signed the medication 

administration sheet, but failed to document the time, 

location, or the injection technique. This lack of documentation 

allowed the jury to conclude that the injection had 

been administered improperly. The patient was awarded 

$90,000 in damages. 

These cases illustrate that standards of practice for medication 

administration require health care providers to thoroughly 

assess the appropriateness of the proposed medication 

and to thoroughly document administration. In the first 

case, the failure of the defendant health care providers to 

assess for allergies caused the wrongful death of the patient 

and to a subsequent award to the surviving family members. 

In the second case, the failure of the provider to document 

the time, location, and injection technique led to a large 

award for the patient’s injuries. 

Risk Management: Prevention of Medication Errors 

Computer-based patient safety systems are currently 

being used by several hospitals to reduce medication errors. 

However, researchers warn that computers are not errorfree, 

but create their own unique mistakes. Some hospitals 

have reduced their error rates by eliminating drugs with 

similar names, by standardizing drug orders, and revamping 

the process for ordering, dispensing, administering, and 

monitoring ¡drugs. Programming errors associated with 

computerized patient controlled analgesia (PCAs) machines 

have been reduced by making user instructions short, clear, 

and easy to understand. Additional ways in which PCA 

related errors could be reduced would include decreasing 

the rates of machines that are infusing narcotics, and by frequently 

monitoring vital signs, oxygen saturation, capillary 

refill, and patient responsiveness. 11 

Some studies have shown that assigning pharmacists to 

patient care teams in medical intensive care units reduced 

medication prescription errors by 66% to 77%. 12 In addition, 

the direct involvement of pharmacists can help prevent 

medication errors by assuring that adequate stock levels 

of drugs are maintained on patient care units, and that 

health care providers are ordering patient medications during 

regular pharmacy hours. 

Certain individual medications, as well as certain classifications 

of medications, have been identified as having a 

higher potential for adverse drug reactions (ADRs). The 

classifications in which most errors occur are antimicrobials 

(40%), cardiac, steroids, non-steroidal anti-inflammatory, 

and surgical medications. Common medications having 

a higher potential for ADRs include insulin, heparin, 

opiates, patient-controlled analgesia, and potassium chloride. 

It has been estimated that medication errors in hospitals 

can be reduced by 33 percent with respect to these medications 

alone. 13 

Teaching patients about their medications also helps to 

prevent medication errors. Table 5 lists helpful hints to 

Table 5 

Patient Teaching 

• Help patients familiarize themselves with the col 

ors and shapes of all their medications so they 

can better identify unfamiliar medications. 

• The patient should be encouraged to question 

healthcare providers when in doubt. 

• Urge patients to purchase a drug reference book 

for home use. 

• Provide them with Internet addresses of sites 

related to medications. 

• Instruct patients to keep current written records 

listing their prescription and nonprescription 

medications, as well as, any adverse reactions to 

individual medications and dyes used during 

diagnostic testing. 

• Instruct patients to use one pharmacy, to ask for 

written information about each of their prescrip 

tions, to review the information with their phar 

macist, and to insure that the pharmacist has a 

computerized list of all the patient’s current med 

ications including over-the-counter drugs, as well 

as his or her allergies and medical conditions. 

assist in teaching patients about their medications. 

Summary 

Improving health care while preventing medication 

errors, attendant expenses and subsequent liability, requires 

an extensive knowledge of medications and due diligence 

in prescribing, dispensing, and administering medications. 

Legally, health care providers are responsible for understanding 

the medications they prescribe, dispense, and 

administer. They must know the dosage ranges, possible 

adverse effects, toxicity levels, indications, and contraindications. 

Moreover, the provider is responsible for clarifying 

incomplete or ambiguous orders, for following routine 

safeguard procedures, and for notifying the primary health 

care provider of potential problems. Good communication 

among all health team members, in addition to complete 

documentation, patient assessment, and patient education 

are essential. 14 

Currently, there is no nationwide mandatory requirement 

to report medication errors. However, they may be voluntarily 

reported to the Institute for Safe Medical Practices- 

United States Pharmacopeial Convention Medication Error 

Reporting Program at (800) 233-7767, and to the FDA 

MedWatch program at (800) FDA-1088. 15 

References 

Lesar, T. et al. Medication Prescribing Errors in a 

Teaching Hospital, JAMA 1990: 263:2329-34 

Kohn LT, et. al. To err is human. Building a safer 

health system. Institute of Medicine; 1999; 27-34. 

Leape LL, et. al. System analysis of adverse drug 

events. JAMA 1995;274:35-43. 

Physician Insurers Association of America. 

Medication error study. Washington, DC: Physician 

Insurers Association of America; June 1993. 

Smith M. Nurses and litigation: 1990-1997. Journal 

of Nursing Law. 5:2: 7. 

Benjamin DM. Defenses in professional negligence. 

Available at: http:// 

www.channel1.com/users/medlaw/legal/prof.htm. 

Accessed October 28, 1999. 

Benjamin DM. The learned intermediary doctrine. 

Available at: http:// www.channel1.com/users/medlaw/prm/learned.htm. 

Accessed October 28, 1999. 

Mawn SV. Informed consent. Legal Medicine 

Open File. 1994; 1994-2, 1-6. 

Harris County Hosp. Dist. v. Estrada, 872 S.W. 2d 

759. 

Pellerin v. Humedicenters, Inc., 696 So. 2d 590. 

Bates DW. More than 80 percent of medication 

errors eliminated by computerized physician order 

entry systems. Available at: http:// 

www.mederrors.org/html/announce.html. Accessed 

September 2, 1999. 

Leape LL, et. al. Pharmacist participation on physician 

rounds and adverse drug events in the intensive 

care unit. JAMA. July 21, 1999. Vol. 282, No. 2, 267- 

270. 

See supra note 4. 

See supra note 5. 

See supra note 2, 74-86.



2000 

Background information: 

In June 1996, Maryland was one of 20 project sites 

from across the nation to receive funding from the 

Robert Wood Johnson Foundation to address current 

and future nursing work force needs. Additional funding 

was awarded to Maryland in July 1999 to support 

the continuation of statewide project activities. Over 

the past four years, the Maryland Colleagues in 

Caring Collaborative has grown by leaps and bounds 

and is currently comprised of over 275 members who 

represent nursing employers, schools of nursing, insurers, 

and a variety of local and state agencies. It exists 

as a formal mechanism for determining work place 

needs and availability of an appropriate supply of 

qualified nurses for all regions of the state and all practice 

settings across the continuum of care and intends 

to continue its efforts to collect, interpret, and disseminate 

data about the work force supply and demand. 

Colleagues in Caring work group activity focuses on 

the following major themes: 

• Improving public image and knowledge of 

nurses’ role in health and health care 

• Improving accessibility of nursing education 

• Fostering appropriate utilization of nurses in 

practice 

• Building and strengthening partnerships between 

educational settings and practice settings 

For more information about the Colleagues in 

Caring project, contact Kathryn Hall, Project Director 

or Susan Veise-Berry, Project Assistant at 410-859- 

3000. 

Maryland Colleagues in Caring 

Regional Collaboratives for Nursing Work Force Development 

TODAY’S NURSE Campaign Update 

The TODAY’S NURSE campaign, which was officially 

launched in March 2000, is being made possible through 

the contributions of many! This is an opportunity to 

acknowledge and thank all those who have sponsored the 

campaign to date. They are as follows: 

CORPORATE LEVEL SPONSORS 

** DIAMOND SPONSORS** 

$10,000 Contribution Level 

The Johns Hopkins Health System 

Mercy Medical Center 

University of Maryland Medical System/University of 

Maryland School of Nursing 

GOLD SPONSORS 


Anne Arundel Medical Center 

Helix Health-Med Star Health 

The Maryland Hospital Association, Inc. 

SILVER SPONSORS 

$2,500-$3,000 Level 

Greater Baltimore Medical Center 

Montgomery General Hospital, Inc. 

St. Joseph Medical Center 

BRONZE SPONSOR 

$2000 Contribution Level 

LifeBridge Health 

PEWTER SPONSORS 


Association of Operating Room Nurses 

Atlantic General Hospital & Health System 

FutureCare Health and Management Corporation 

Maryland General Hospital 

Progressive Nursing Staffers 

Stella Maris, Inc. 

St. Agnes Health Care 

OTHER SPONSORS 

Anne Arundel Medical Center Unit A-4 

Anne Arundel Medical Center Unit A-5 

Chesapeake Society of Gastroenterology 

Nurses and Associates 

District 4 - Maryland Nurses Association 

Genesis Health Ventures 

Maryland Council of Directors of Associate Degree and 

Baccalaureate Nursing Programs 

Maryland Organization of Nurse Executives 

Maryland State Council Emergency Nurse Association 

INDIVIDUAL SUPPORTERS 

LOUISA PARSONS SPONSORS 

$250 and above 

Madeline Turkeltaub 

LILLIAN WALD SPONSORS 

$100 and above 

Wanda Brethauer Priscilla Mills 

Carloyn Buppert Marion Mulholland 

Catherine Crowley Karen Peddicord 

Fran Damratowski Virginia Pichler 

Noel Eller Joan Spear 

Linda Epstein Dianne Taylor 

Kathryn Hall Patricia Travis 

Mary Etta Mills Margo Zink 

OTHER SPONSORS 

Christina Barrick Sheryl Jacobs 

Joanna Basuray Joan Jordan 

Beth Anne Batturs Felicia Kendall 

Mary Beachley Vicky Kent 

Jan Black Mary Kraaij 

Marilyn Brown Lynn Kuebler 

Michelle Brusio Debra Lanham 

Janet Cogliano Mary Lashley 

Debbie Collins Lena Lee 

Linda Cook Lisa Malick 

Deborah Dang Kim McCarron 

Christine D’Angelo Evelyn Parsons 

Marcia Dawson Kathleen Parsons 

Lynn Derickson Cheryl Rappoport 

Ruth Ann Derr Rebecca Rice 

Carol Dignon Daria Rovinski 

Susan Fosbrook Linda Sayre 

Deborah Greener Betty Schweitzer 

Marilyn Halstead JoAnn Shelley 

Norma Hamilton Elaine Sparks 

Sandra Heeley Nancy Smith 

Elaine Jae Holman Susan Thompson 

Maureen Holtzman Connie Watson 

Susan Immelt Susan Veise-Berry 

The TODAY’S NURSE campaign contributions total 

$67,525 to date. This supported the production of the first 

TV segment that has been airing intermittently since 

March 2000. In addition to the TV segment, the 

TODAY’S NURSE Web Site has also been active. It can 

be accessed through the WBAL Web Site @ 

www.wbaltv.com. The names of the TODAY’S NURSE 

Corporate Sponsors are identified and those at the higher 

support levels also have a direct link to their web sites. 

This has been beneficial to nurses who are seeking information 

about employment opportunities. 

The TODAY’S NURSE campaign has grown form a 

partnership with WBAl-TV and aims to enhance public 

perception about nursing as a profession and encourage 

the brightest and best students to pursue a career in nursing. 

Future TV segments will continue to highlight the 

importance of Nursing in the delivery of quality health 

care. 

Additional financial contributions are needed in order to 

sustain the TODAY’S NURSE campaign for the proposed 

12-month period. for more information about this 

statewide effort, please contact the Colleagues in Caring 

office at 410-859-3000. 

THE NEXT COLLEAGUES IN CARING CONSOR- 

TIUM MEETING WILL BE HELD ON MONDAY, SEP- 

TEMBER 18, 2000 FROM 9:30 A.M. - 11:30 A.M. AT 

THE HOWARD COUNTY GENERAL HOSPITAL 

WELLNESS CENTER IN COLUMBIA, MD. PLEASE 

CONTACT THE COLLEAGUE IN CARING OFFICE IF 

YOU WOULD LIKE TO BE ADDED TO THE MAIL- 

ING LIST.




Multistate Licensure 

Compact Bill Status 

State Bill # Status Date of Effective 

Last Action Date 

Arkansas S 28 Signed by Governor 2/24/1999 7/1/2000 

Deleware H 439 To House Policy Analysis & Government 1/18/2000 N/A 

Accoutability Committee 

Idaho H 405 To Health & Welfare Committee 1/17/2000 N/A 

Iowa HF 2105 Signed by Governor 3/16/2000 7/1/2000 

Maine LD 2558 Legislature and Governor Have Empowered 4/12/2000 No later than 

the Board of Nursing to Enter a Written 9/1/2000 

Licensure Compact Through Rule-Making: 

Board Action Pending 

Maryland S 590 Signed by Governor 4/27/1999 7/1/1999 

Mississippi H 535 Signed by Governor 4/22/2000 7/1/2001 

Nebraska L 523 Signed by Governor 2/15/2000 1/1/2001 

North 

Carolina S 194 Signed by Governor 7/2/1999 7/1/2000 

South 

Dakota H 1045 Signed by Governor 2/16/2000 1/1/2001 

Texas H 1342 Signed by Governor 6/19/1999 1/1/2000 

Utah S 146 Signed by Governor 3/14/1998 1/1/2000 

Wisconsin A 305 Signed by Governor 12/17/1999 1/1/2000



2000 

A Day in the Life 

by Anne O’Reilly, RN 

Anne O’Reilly, RN has worked as a clinical coordinator 

for the Transplant Resource Center of Maryland since 

September of 1999. She has fifteen years of critical care 

experience, and began her nursing education at St. 

James’ University Hospital School of Nursing, Leeds, 

England. 

“Could you write an article from the point-of-view of the 

nurses involved in the donation process for The Maryland 

Nurse?” “Sure, no problem,” I said. That should be easy, 

but then I started to think about all the people involved. 

The clinical coordinators, RN’s like myself, the ICU nurses, 

the secretaries on the units, the echo techs, the cath. lab 

staff, the OR staff, the clergy, the Medical Examiners, the 

specialists back at the Transplant Resource Center (TRC), 

the donor family, the surgeons - the list goes on. There are 

many, many people involved in this process. Including 

them all in this article would create a book, but to not 

acknowledge them would be to do them a disservice. For 

donation to succeed it takes an incredible amount of team 

work. So with that acknowledgment, this is a day in the life 

of a clinical coordinator for the Transplant Resource 

Center of Maryland, Inc., the non profit organ procurement 

organization for the State of Maryland. 

It is a little after 09:00, and I am walking into the multi 

trauma ICU at University of Maryland Medical System’s R 

Adams Cowley Shock Trauma Center. Ben 1 is a 17-yearold 

white male who has been ejected from a car involved 

in an MVC (Motor Vehicle Collision), “shock trauma 

speak” for an MVA (they do not believe in calling them 

accidents). He was not wearing a seatbelt, and sustained a 

devastating head injury. He has returned from cerebral 

blood flow studies which demonstrated no blood flow to 

the brain. The results of this study and his clinical exam 

have given him the diagnosis of brain death 2 . 

Consent for donation has already been given to the coor- 

dinator, Dennis, who has been working with the staff and 

family through the night. He is still on site, and that is who 

I am looking for as I enter the unit. I find Dennis with the 

phone in one hand and a pen in the other. A large percentage 

of our time is spent on the phone. In fact, approximately 

200 phone calls will be made to facilitate this donation. 

Dennis quickly brings me up to date on the case. 

Death was declared at 06:45 and, shortly after, the attending 

physician informed the family. At 08:30 Dennis and 

his orientee, Donna sat down with Ben’s family to discuss 

the option of donation. Ben’s parents, like an increasing 

number of people, had already talked about donation, and 

Ben had made his wishes known by designating “donor” 

on his driver’s license. Informed consent was obtained for 

organs and tissues, for both transplant and research. 

The next step in the process is to obtain blood for serologies 

and to continue the evaluation phase started by 

Donna. She had arrived just before 01:00 following a call 

from the ICU to the Maryland Donor Hotline. They called 

because Ben’s GCS (Glasgow Coma Scale) was less than 

five, he was on a ventilator, and he had experienced a neurological 

event, the three key factors needed to trigger a 

call to the Hotline. Donna had gone through Ben’s chart, 

not just to evaluate the potential for donation but also, to 

check on his lab work and clinical course to evaluate 

which organs and tissues he could potentially donate. In 

view of Ben’s age and lack of past medical history we 

were expecting to place the heart, lungs, liver, kidneys, 

pancreas, skin, corneas and bone, for transplantation. 

With that in mind I took over the case, allowing Dennis 

and Donna to go home and get some well deserved rest. A 

stat Bronchoscopy and an Echocardiogram were ordered 

to evaluate the heart and lungs. While waiting for them to 

be performed, I made contact with Ben’s nurse, Mark - a 

veteran of many donor cases who was taking everything in 

his stride. This is not always the case. Frequently this is 

the nurse’s first involvement in donor management. So we 

have an information sheet that walks the nurse through 

which labs and tests to order - when and why. Mark had 

already drawn the blood for the serologies, Hepatitis B and 

C, RPR 3 , CMV 4 , HTLV 5 , and HIV 6 . The blood is sent out 

and we are able to get the results back in about six hours. 

Although a positive serology may affect the case, only HIV 

and HTLV terminate it. 

My job now is to do a complete physical assessment of 

the patient. Part of the purpose of this is purely clinical, (ie. 

heart sounds, breath sounds, pulses, surgical scars etc.), and 

part is examining for clues to high risk behaviors such as 

track marks and tattoos. My physical findings should 

match with the detailed medical social history taken from 

Ben’s parents - it does. 

It is now 12:30 and the Echocardiogram, Bronch, EKG, 

and Chest x-ray have all been performed at the bedside and 

reports have been written. During this time the Medical 

Examiner has been contacted and has placed no restrictions 

on the donation, nor does he require the body for autopsy. 

The information gathered so far is faxed into our In House, 

where Emily, the In House specialist, will now field a multitude 

of phone calls from recipient coordinators and surgeons. 

They will be asking for more information, clarifying 

details and processing primary and backup offers. 

Meanwhile, we wait. Not the passive, feet up kind of 

wait, but the keep-the-donor-stable kind of wait. The goal 

is to correct the electrolyte imbalance and free water 

deficit, correct or maintain the acid base balance, and prevent 

or treat: 

• hypothermia, 

• diabetes insipidus, 

• disseminated intravascular coagulation (DIC) 

• adult respiratory distress syndrome (ARDS), 

• neurogenic pulmonary edema 

and, at the same time, maintain perfusion to the organs and 

hemodynamic stability. 

Each donor presents his or her own unique set of problems 

and challenges. Some require additional time to opti- 

Day in the Life cont. on pg. 37




Day in the Life cont. from pg. 36 

mize individual organs, thereby improving their chance of 

being accepted for transplant. Others may already be in 

their optimal state and would do best by proceeding quickly 

to the OR. A third and the most common group are those 

with individual organs at different states of readiness. 

Couple these challenges with those of mobilizing recipients 

and surgeons, and OR availability and it is easy to see 

why donation is such a rare and special event. There were 

77 organ donors in Maryland in 1999. 

Meanwhile, Mark has worked hard. Ben was relatively 

stable, in fact his dopamine had been decreased from 6.5 

mcg/kg/min to 3 mcg/kg/min. His systolic blood pressure 

was comfortably above 100 mmHg, urine output was 

200cc/hr and with the help of a warming blanket his temperature 

was 98.2F. He had required several liters of 0.45% 

saline, and potassium, phosphorus and magnesium 

replacements earlier in the day, but now his IV was only at 

100cc/hr. Although this was not Mark’s only patient, frequently 

they are a “one-to-one.” 

At 16:20 the serology results were back. Ben was CMV 

positive, a common result that does not prevent transplantation. 

It does, however, need to be communicated to the 

recipient’s surgeon, so that the recipient receives appropriate 

follow-up care. We were ready for the OR. I was hoping 

to go at 18:00. I had already spoken to the OR charge 

nurse to give her a heads up. 

My pager went off, it was Emily. She and I had spoken 

on the phone throughout the day updating each other, but 

this particular call I had been expecting and dreading, a 

delay going to the OR. The reason - the potential lung 

recipient needed time to get to her hospital so, “could we 

change the OR to 23:30?” It was now 17:30 and I had to 

say yes. Ben was stable and I had no reason not to wait. 

Had he been unstable, we would not have waited. To do so 

would have put the other organs at risk. 

John was now Ben’s nurse, since Mark had left at change 

of shift. John helped with the transfer of Ben to the OR. 

The move to the OR gave me the surge of adrenaline I 

needed; this was the home stretch. The time in the OR 

varies depending on the number and type of organs being 

recovered. Ben was to donate seven organs. There could be 

as many as ten surgeons involved working in four different 

teams, as well as the scrub nurse, circulator and TRC staff. 

So the bigger the OR room, the better. Ben’s organs were 

to be procured by just five surgeons working in two teams, 

thoracic and abdominal. I had also just found out that the 

lung recipient was actually going to be the heart recipient 

too, which decreased the number of potential surgeons 

greatly. 

My main job in the OR is to keep the lines of communication 

open between the recovery surgeons and the potential 

recipient’s surgeons. Although the kidneys could wait 

greater than 24 hours until they were transplanted, the 

heart/lung recipient was already being prepped across 

town. 

The procedure went well, the heart had been stopped at 

03:20, and the anesthesiologist had been thanked and had 

left. A short while later the heart and lungs were out en 

bloc, details of their anatomy recorded, and the thoracic 

surgeons were on their way. Liver was next, followed by 

pancreas then kidneys. Again, my job was to document the 

anatomies as reported by the surgeon. The incision was 

closed and post mortem care was carried out. Copies of the 

chart, that had been created over the last 30 hours, were 

sent with each organ. It was time to leave. 

I walked out into the warm night air at 05:00, I was still 

on call for three more hours but something told me that my 

pager would not go off . . . donors don’t happen every day. 

1. The name has been changed. 

2. Brain death is defined as the irreversible loss of 

clinical function of the brain, including the brain stem. 

3. Rapid Plasma Reagin the test for Syphilis. 

4. Cytomegalovirus. 

5. Human T-Lymphotropic Virus. 

6. Human Immunodeficiency Virus 

Correction 

In the February, March, April 2000 issue of The 

Maryland Nurse there was a wonderful article titled 

“The Gift of Life: Nursing Provides a Vital Link in the 

Organ and Tissue Donation Process.” The author of 

this important article was misstated and should have 

read Karen Kennedy, RN, CPTC, Director, Clinical 

and Hospital Services for the Transplant Resource 

Center of Maryland, Inc. Our apologies to Ms. 

Kennedy for this error. The Transplant Resource 

Center of Maryland, Inc. and their staff will be regular 

contributors to The Maryland Nurse.




Maryland Nurses Association’s 6th Annual Poster Session 

Deadline for Proposal - September 25th 

Presentations will be November 9, 2000 

2:45-3:45 PM 

All Nurses, Nursing Students and Other Health 

Care Professionals: Share your creative nursing care 

approaches, research finds, clinical innovations or student 

projects with your colleagues. All convention participants 

are invited to submit a poster proposal on any aspect of 

their practice, research, or student activities. 

What is a poster? 

• The poster should be a summarization of a creative 

activity 

• It should fit on a poster board measuring approximately 

30” wide by 36” long 

• A poster should reflect an innovative aspect of nursing 

practice, education, or research 

• It may be supplemented by handouts 

• It should fit easily on an easel 

• The poster’s presenter must be available for the 

open poster session to address questions 

How to submit a poster proposal: 

• Complete the submission form at right (➔) 

• Mail or Fax your proposal, no later than September 

25, 2000, to: 

Convention Posters 


849 International Drive, Suite 255 


Fax #410-859-3001 

You will be notified by October 13, 2000 regarding the 

acceptance of your poster. You do not have to be an MNA 

member to submit a poster, however all poster presenters 

must be registered Convention participants. 

Poster Policy: 

Posters must avoid commercialism. Posters that constitute 

promotion and advertising will not be accepted. 

Statements made in posters are the sole responsibility of 

the author or presenter. Statements should not be viewed 

as, or considered representative of, any formal stance or 

position taken on any subject, issue or product by MNA. 

Selection Criteria 

Each poster submission will be reviewed for the following 

elements: 

• Quality 

• Broad appeal to the nursing community 

• Creativity 

• Timeliness 

• Uniqueness 

Poster Submission Form for MNA Convention 

Poster Title and Description ___________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

Developers Name and Credentials ______________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

Objective Statement__________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

Mailing Address _____________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________Zip _____________________________ 

Phone _______________________________________FAX __________________________________________




Multistate Licensure 

Compact Bill Status 

State Bill # Status Date of Effective 

Last Action Date 

Arkansas S 28 Signed by Governor 2/24/1999 7/1/2000 

Deleware H 439 To House Policy Analysis & Government 1/18/2000 N/A 

Accoutability Committee 

Idaho H 405 To Health & Welfare Committee 1/17/2000 N/A 

Iowa HF 2105 Signed by Governor 3/16/2000 7/1/2000 

Maine LD 2558 Legislature and Governor Have Empowered 4/12/2000 No later than 

the Board of Nursing to Enter a Written 9/1/2000 

Licensure Compact Through Rule-Making: 

Board Action Pending 

Maryland S 590 Signed by Governor 4/27/1999 7/1/1999 

Mississippi H 535 Signed by Governor 4/22/2000 7/1/2001 

Nebraska L 523 Signed by Governor 2/15/2000 1/1/2001 

North 

Carolina S 194 Signed by Governor 7/2/1999 7/1/2000 

South 

Dakota H 1045 Signed by Governor 2/16/2000 1/1/2001 

Texas H 1342 Signed by Governor 6/19/1999 1/1/2000 

Utah S 146 Signed by Governor 3/14/1998 1/1/2000 

Wisconsin A 305 Signed by Governor 12/17/1999 1/1/2000 

Glen Meadows Retirement Community 

is Looking For: 

RNs or LPNs 

Skilled Nursing Unit 

7 - 3 every other weekend and 1 weekday 

RNs 

Skilled Nursing Unit 

11- 7 PRN with a strong need for every other 

Tuesday 

LPN 

Assisted Living Unit 

11 - 7 every other weekend and 2 weekdays for a 

total of 6 shifts every two weeks. 

Very nice rural setting Continuing Care Retirement 

Community in Baltimore County near Loch Raven 

Reservoir. Ten minutes from Cromwell Bridge Road 

and the Beltway. Great Benefits and Wages. To 

explore this fantastic opportunity fax your resume 

to 410-592-6175. Attention Tom McMahan.

The Maryland Nurse - nursingALD.com

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