The Official Voice of VA NorCal Health Care System

www.northerncalifornia.va.gov

Summer 2019

In This Edition…

» VA NorCal Launches New Health Care Options Under MISSION Act

» Spotlight on the VA Post-Baccalaureate Nurse Residency Program

Meet Jacob Nur: Chief Nurse by Day and

World-Class Runner by Night page 4

www.northerncalifornia.va.gov

2 The Northern – The Official Voice of VA Northern California Health Care System

CONTENTS

3 VA NorCal Launches New Health Care Options Under MISSION Act

4 Meet Jacob Nur: Chief Nurse by Day and World-Class Runner by Night

5 NorCal Veterans Bring Their Best at Golden Age Games 6 East Bay Institute for Research & Education 7 Spotlight on the VA Post-Baccalaureate

Nurse Residency Program

8 Addiction and Nutrition Patient Experience

Office

About the Publication William Martin Chief Public Affairs Officer Jon-Nolan Paresa Publisher/Photographer Darren Ebbing Webmaster/Graphic Design Produced by Forte Information Resources LLC

The Northern | SUMMER 2019The Northern is an authorized publication of the Department of Veterans Affairs. All photographs are the property of VA, unless otherwise indicated.

VA NorCal Health Care Facilities to Go Smoke-FreeAs a health care system devoted to the well-being of Veterans, VA NorCal is always exploring ways to improve the settings in which our patients receive their care. As part of that effort, each of our facilities will become smoke-free by October 1, 2019.Although VA NorCal has permitted patients to smoke in designated areas in the past, study after study proves that smoking—and exposure to secondhand smoke—creates significant medical risks. These risks are in direct opposition to the VA NorCal mission: providing high-quality, compassionate care to Veterans. As of October, VA NorCal will prohibit smoking by patients, visitors, volunteers, contractors, and vendors at its health care facilities. VA NorCal’s smoke-free policy applies to cigarettes, cigars, pipes, as well as electronic smoking devices, such as e-cigarettes, e-cigars, and vape pens. VA NorCal is not alone in this move to smoke-free campuses. Not only are VA health care facilities across the nation adopting the same smoke-free policy, but more than 4,000 health care facilities and four national health care systems in the U.S. have already implemented smoke-free grounds. The well-being of our Veterans demands that we do the same.In closing, let me encourage those Veterans ready to quit smoking to visit VA’s extensive list of no-cost and proven resources at www.mentalhealth.va.gov/ quit-tobacco/. — David Stockwell

Letter from the Director

SUMMER 2019 – www.northerncalifornia.va.gov 3

VA NorCal Launches New Health Care Options Under MISSION Act

“We’re committed to providing not only high-quality, compassionate health care to Northern California Veterans, but also providing that care at the right time and place,” said VA NorCal Director David Stockwell.

The VA MISSION Act (officially titled, “VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018”):

• Strengthens VA’s ability to recruit and retain clinicians

• Statutorily authorizes “Anywhere to Anywhere” telehealth provision across state lines

• Empowers Veterans with increased access to community care

• Establishes a new, urgent care benefit that eligible Veterans can access in the community

Veterans can now work with their VA NorCal health care provider or other staff to determine if they are eligible to receive care in the health care community outside of VA NorCal. (It is important to note that eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA NorCal provide their care.)

Veterans are eligible to choose to receive care in the community if they meet any of the following six eligibility criteria:

1. A Veteran needs a service not available at any VA medical facility.

2. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire, and the U.S. territories of Guam,

American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands.

3. A Veteran qualifies under the “grandfather” provision related to distance eligibility for the Veterans Choice Program.

4. V A cannot furnish care in a manner that complies within certain designated access standards. The specific access standards are described below.

• Average drive time to a specific VA medical facility:a. 30-minute average drive time for primary care, mental

health care, and noninstitutional extended care servicesb. 60-minute average drive time for specialty care

• Appointment wait time at a specific VA medical facility:a. 20 days for primary care, mental health care, and

noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider

b. 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider

5. The Veteran and the referring clinician agree that it is in the best medical interest of the Veteran to receive community care based on defined factors.

6. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality.

For more information on the MISSION Act and its impact on VA health care across Northern California, visit www.missionact.va.gov.

If you have been paying attention to news in the Veteran community lately, you have probably noticed a lot of talk about something called the MISSION Act. Locally, the MISSION Act will empower the more than 100,000 Northern California Veterans that VA NorCal serves each year to have more options for their health care decisions.

4 The Northern – The Official Voice of VA Northern California Health Care System

Jacob Nur is a master’s-prepared registered nurse and has worked for the VA for over 27 years, most of those years spent right here at VA Northern California Health Care

System. Jacob has worked in various specialties including spinal cord injury, medical surgical units, hematology/oncology, and the intensive care unit. He currently serves as chief nurse of acute care at the Sacramento VA Medical Center.Since taking it up as a hobby just 10 years ago, Jacob has totally refined the craft of running. In that short amount of time and at the tender age of 63, he has become a world-class age group champion! He competes at a variety of distances ranging from cross country, 5K, 10K, and half marathons, while excelling in full marathons. Since December he has run three full marathons: the California International Marathon, the Boston Marathon, and most recently, the Rock ‘n’ Roll San Diego Marathon. It was after running the San Diego Marathon that he made his mark by becoming one of the top-ranked runners in the

world for his age group (60–64). That means he runs faster than nearly all of those similarly aged runners worldwide. Prior to this most recent accomplishment, Jacob was recognized by the Sacramento Running Association the last three years in a row with an annual achievement award: in men’s cross country, marathon, and road racing; he has been inducted into their Hall of Fame as well. He has also won the Buzz Oates Race Series for the last three years.

Due to his exemplary accomplishments, he will be invited to compete at the London Marathon in

Meet Jacob Nur: Chief Nurse by Day and World-Class Runner by Night

NorCal Veterans Bring Their Best at Golden Age GamesBy Coralee “Corkie” CelliniVA NorCal Occupational Therapist and Coach

April 2020 in a race against other qualifiers

in his age group from around the world. We

hope to see him emerge victorious as one

of the overall top-ranked world champions!

Locally, he has won many awards as the top

age-graded runner in the Sacramento area.

What an amazing accomplishment considering

that he works full-time and has a family to

whom he is deeply devoted.

Congratulations, Jacob, and best of luck in

London! Keep running!

The National Veterans Golden Age Games (NVGAG) is the premier senior adaptive rehabilitation program in the United States, and the only national multievent sports and recreational seniors’ competition program designed to improve the quality of life for older Veterans.

This is the tenth year that VA NorCal patients from across Northern California participated in the VA National Games. The Veterans who competed in Anchorage, Alaska, identified how their involvement and training support their recovery and contributes to a healthy lifestyle.

“The 2019 National Veterans Golden Age Games was for me the culmination of a personal treatment plan to fend off a severe case of depression and anxiety,” said Joe Passarelli.

VA NorCal encourages senior Veterans to be proactive in embracing a healthier lifestyle, thus achieving the NVGAG “Fitness for Life” motto. The Games are open to Veterans aged 55 or older who receive health care from the Department of Veterans Affairs.

Veterans representing VA NorCal in this year’s games include:• Charles Morphy, silver medal in boccia doubles and horseshoes

• Richard “Woody” Wright, silver medal in boccia doubles

• Joe Passarelli, bronze medal in 100-meter sprint and several ribbons

• Nelson Martinez, bronze medal in basketball free throws

• Armand Alfred, competed in golf, boccia, air rifle, and air pistol

• Jimmie Wynn, competed in air rifle, air pistol, and boccia

The team would like to thank VA NorCal Voluntary Services for its support in providing donated funds to assist Veterans with travel and lodging expenses for this year’s event in Anchorage.

SUMMER 2019 – www.northerncalifornia.va.gov 5

There are two ways that VA NorCal can receive and administer medical research funding: (1) Through Veterans Health Administration, funded

by Congress. These funds are administered entirely through the VA NorCal Research Service Office.

(2) Through a nonprofit corporation established to serve VA NorCal. Funding sources include non-VA federal funding entities (for example: National Institutes of Health; Department of Defense) as well as private pharmaceutical companies, foundations, and philanthropic entities.

East Bay Institute for Research & Education (EBIRE) is one of about 80 nonprofit corporations affiliated with a VA medical center, established as a 501(c) (3) organization for purposes of supporting medical research. EBIRE collaborates with VA NorCal leadership, research scientists, and staff to maximize research-related opportunities. The Board of Directors provides executive-level oversight in accordance with VHA Handbook 1200.17 and EBIRE’s by-laws. Staff manage EBIRE’s infrastructure, including: board of directors; reporting and audit requirements to both the IRS and VA’s Nonprofit Program Office; application and administration of grant funding that aligns with the needs

of VA NorCal Veterans; employing personnel to support the actual research effort; and recordkeeping.Current specialties targeted for VA NorCal Veterans include:

6 The Northern – The Official Voice of VA Northern California Health Care System

East Bay Institute for Research &

EducationBy John C. Johnson, PsyD, MSW

Chief Executive Officer VAMC WOC Affiliate

Name Title VA FunctionDavid Stockwell Statutory VA Director DirectorWilliam Cahill Statutory VA Director Chief of StaffRaja Jagadeesan Statutory VA Director ACOS - EducationDawn Schwenke Statutory VA Director ACOS - ResearchVacant Secretary/Treasurer Chief Financial OfficerHarry Moos Statutory Non-VA Director Veteran & VAMC ConsumerVacant Statutory Non-VA Director Community MemberRegina Godbout Voluntary Director Deputy Chief of StaffParamita Ghosh Voluntary Director Professor & Researcher Siba Raychaudhuri Voluntary Director Professor & Clinician-ScientistJohn Johnson Chief Executive Officer WOC AffiliateNote: WOC is Without Compensation.

VA Northern California Health Care System (VA NorCal) consistently strives to provide outstanding medical care to Northern California’s Veterans, including access to cutting-edge research opportunities.

• Abdominal Aortic Aneurysms

• Cancer Therapies• Cardiovascular Disease• Clostridium Difficile Colitis

“C. Diff”• Cognitive Studies• Colonoscopy Advancements• Diabetes• Emergency Medicine• Inflammatory Bowel Disease

• Pulmonary & Sleep Disorders

• Post-Traumatic Stress Disorder

• Psoriasis & Rheumatoid Arthritis

• Speech Disorders• Stroke• Traumatic Brain Injuries• Women’s Health• Wound Healing

SUMMER 2019 – www.northerncalifornia.va.gov 7

Spotlight on the VA Post-Baccalaureate Nurse Residency ProgramBy Neftali Cabezudo, PhD, MSN, RN-BC, CNLVA Program Co-Director & Faculty, VANAP USFNursing Education & Professional Development

One of the initiatives that has transformed how we prepare our future VA nurses has been the implementation of the Post-Baccalaureate Nurse Residency (PBNR) program.Now in its fourth year, the PBNR experience is a 12-month transition for newly graduated nurses to prepare them for the clinical and professional expectations of the registered nurse role through immersion in the entire VA Northern California Health Care System (VA NorCal). Residents not only receive classroom instruction on VA nursing practice and Veteran-centric health issues but also spend clinical time exploring all of the services that we provide for Veterans. This spectrum includes units such as Home Health, Emergency Department, Quality Improvement, Infection Control, Primary Care, and many other areas in which nursing plays a major role in the Veteran’s health care. The goal of the program is to develop nursing leaders who are well versed with the services we have available for our Veterans and better serve them by ensuring that they receive the services they require as their needs arise.

To date, the PBNR program has graduated 18 nurse residents, 16 of which were hired into the VA, one of whom is working with Veterans at UC Davis Medical Center, and one of whom was commissioned into the United States Air Force. Currently, we have six nurse residents who are actively involved in three-week hospital rotations through all of our inpatient departments and will start their two-month intensives on July 28, 2019. This “home unit” experience will be their final clinical rotation before they transition

into independent practice. They will graduate the program on October 9, 2019.

One of our residents, Zachery Bohn, has found his PBNR experience thus far to be extremely valuable in shaping his nursing career: “The PBNR is unique compared to other residencies or first-time jobs because I have had the opportunity to rotate throughout the VA health care system, learning from all the experts in outpatient and inpatient departments. In my rotations, I have become oriented to the entire hospital, built rapport with nurses and nurse leaders in all departments, and acquired knowledge from doctors and other multidisciplinary teams.”

Zachery, much like his colleagues, embraces this program experience not only as a development of professional nursing skills but also as an opportunity to learn about the scope and essence of Veteran-centric care: “I feel that the PBNR has set me up for success in my nursing career. I have a much deeper understanding of the VA health care system and all its resources. Knowing all the resources available helps me give the best care I can to our Veterans. I also have a deeper appreciation for all of the work that happens away from the bedside by nurses in health care. The PBNR has helped me see and understand the big picture of health care, and has provided me with the tools to become a great nurse and health care leader.”

FEEL FREE TO TAKE THIS MAGAZINE HOME!

8 The Northern – The Official Voice of VA Northern California Health Care System

Addiction and Nutrition

Good nutrition is crucial for everyone, from infancy throughout one’s life span. However, our nutritional status may occasionally become compromised; at times like this, increased focus on proper nutrition is key. For people who are recovering from addictive substances, drugs—whether prescription or illicit—can affect behaviors surrounding food and fluid, taste preference, and body weight.

Malnutrition is common as well, because appetite can be suppressed or increased, leading to cravings of less healthful foods. Micronutrients including iron, folate, and B vitamins (B6 and B12) are important to mental health. When these nutrients are deficient, symptoms mimicking mental health problems may occur, such as depression, fatigue, poor attention, and altered sleep patterns. Ensuring proper nutrition by eating three well-spaced balanced meals, with

no more than four to five waking hours between meals, is recommended. To maintain a healthy weight, consume meals composed of complex carbohydrates, protein, and fiber with low-moderate fat intake.

If appetite is diminished, smaller, more frequent meals should be considered. Limiting added sugar intake can help with mood fluctuations and avoid excessive weight gain. Curbing caffeinated beverages can also aid in mood stability. Diarrhea and constipation can occur during recovery, making adequate hydration—specifically, water during and between meals—an important focus. The VA has many resources to aid in the recovery process. Your primary care physician can send a referral to a Registered Dietitian to assist Veterans in achieving optimal nutrition.

Patient Experience Office

The Patient Experience Office oversees the Patient Advocacy Program for VA NorCal. At times, communication between Veterans and their health care team can be complex and may lead to

misunderstandings. As well, there may be concerns that seem difficult to resolve. Whenever a Veteran has a health care concern or disagreement with the health care provider or team, he or she has the right to ask questions. The Patient Advocate serves as the liaison between the Veteran and their health care team.

VA NorCal employs Patient Advocates to help Veterans resolve any such issues. Patient Advocates provide services that support the ability of VA to improve the health and well-being of Veterans. Our Advocates work closely with the health care teams to find a resolution by active listening, asking questions, ensuring clear communication, and assisting in finding solutions. Patient Advocates document and monitor concerns raised by Veterans so that if the same issues are brought forth by several people, those concerns can be communicated to senior leaders at the facility. Finally, Veterans may wish to compliment an employee or discuss something that is going well with their health care.

Patient Advocates are not clinical providers and are not qualified to interpret clinical data or recommend treatments. Most of the VA NorCal sites have an Advocate in place to assist Veterans on a drop-in basis. Advocates also offer telephone service and respond to secure messaging through MyHealtheVet and Inquiry Routing & Information System (IRIS) inquiries. Our team stands ready to assist with any concerns that you may have regarding your care at VA Northern California Health Care System. Thank you for choosing the VA for your care!

By Lynne Skaggs, MAAssistant Chief, Patient Experience Office

By Dana Beattie, MS, RD, CNSCInpatient Dietitian