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Volume 36 • Issue 2 June, July, August 2009

Circulation to 72,000 Registered Nurses, Licensed Practical Nurses and Student Nurses in Alabama Alabama State Nurses Association • 360 North Hull Street • Montgomery, AL 36104

The Official Publication of the Alabama State Nurses Association

Inside Alabama Nurse

CE Corner:Legal Aspects of

Nursing

Page 5

Inside this IssueAlabama Board of Nursing . . . . . . . . . . . . . . . . . . . . .18

ASNA Board of Directors . . . . . . . . . . . . . . . . . . . . . . 2

CE Corner–Schizophrenia . . . . . . . . . . . . . . . . . . . . 6-8

Convention Registration (Pull out Section) . . . . . . . 9-12

ED’s Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Financial Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Legal Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

LPN Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Membership News . . . . . . . . . . . . . . . . . . . . . . . . . . .14

President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . 3

Research Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Save These Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Elizabeth Morris Clinical Education Sessions – FACES ‘09

Attendees at first plenary session.See page 17 for more.

We’ll See YOU There!

It’s that time again, and the ASNA Board of Directors/AlaONL/AANS invites YOU to attend the 96th Annual ASNA Convention. We continue to offer the best continuing education, networking and participation opportunities for a fair price and in a convenient format to meet your needs.

Thursday, October 1, 2009 is the Mable Lamb Continuing Education Day from 10:15 a.m.–6:00 p.m. There is something for everyone and you may register separately for this event. We are having an Awards/Celebration Dinner Friday Night. Plan to come for the education or come early for the Convention and stay to meet and greet other nurses. It will be a lot of fun and a great networking opportunity for all who attend!

Friday, October 2, 2009 is the official kick-off for the 96th Annual Convention. The exhibits will be open on Friday from 8:00 a.m. to 3:00 p.m. and you’ll want to visit them all. The Silent Auction opens at 8:00 a.m. The official Opening Ceremony of the 96th Annual Convention will begin at 1:00 p.m., and you’ll want to be there for the Open Forums! This is your opportunity to have your voice heard. We’ll be discussing ANA changes, Resolutions, and other matters of importance to ASNA.

Saturday, October 3, 2009 will begin with Breakfast roundtables at 7:30 a.m. Voting polls will be open from 8:00 a.m. until 9:15 a.m. The ASNA House of Delegates will then convene at 11:00 a.m. We offer another opportunity for contact hours when you view the Poster

Presentations available from 9:00a.m.–12:00 Noon. We hope you will join us and take advantage of

the CE offerings, to network with old friends and make new ones, and to give yourself the gift of professional involvement. Several fun activities will be interspersed through out the meeting.

Mark your calendar now! Come be a part of Alabama nurses making a difference. Find out how good it can feel to represent your district and your profession as we address the critical nursing issues facing us today. Please use the Convention 2009 special pull-out section for all your registration needs.

We look forward to seeing YOU there!

ATTENTION LPNs

2009 IS LPNs RENEWAL YEARABN DEADLINE IS

NOVEMBER 30th

The ABN will have on-line capability, including payment by credit card. You may also pay by personal check.

Attend the ASNA Convention to meet your CE needs!

MEMBERS ONLY SECTION ASNA WEB PAGE

www.alabamanurses.org

Look for important convention issuesVisit ASNA’s website for:• Bylaw changes• ASNA Ballot• Proposed Resolutions

NOW ON ASNA WEBPAGE

www.alabamanurses.org• ASNA Scholarship Information• Membership Applications

SAVE THESE DATES

ASNA/AONL/AANS CONVENTION 2009

Marriott Hotel & Spa

Florence, ALOctober 1-3, 2009

Convention Registration in Pull Out Section

2009 Convention:ASNA & AlaONL

Registration

1

• The Alabama Nurse June, July, August 2009

12” AdsOPEN

ASNA Board of Directors

President . . . . . . . . . . . . . . . . . . Debbie Faulk, PhD, RNPresident-Elect . . Joyce Varner, DNP, GNP-BC, GNCSVice President . . . . . . Vanessa Barlow, BSN, RN, MBASecretary . . Faye McHaney, DNP, BSCS, RN, ARNP-CTreasurer . . . . . . . Arlene Morris, EdD, MSN, RN, CNEDistrict 1 . . . . . . . . . . . . . . . Brian Buchmann, BSN, RNDistrict 2 . . . . . . . . . Pamela Moody, PhD, RN, FNP-BCDistrict 3 . . . . . . . Delores “Dee” Sherman, MSN, BSN, RN, HCPNDistrict 4 . . . . . . . . Henrietta “Henri” Brown, CNP, RNDistrict 5 . . . . . . . . . . . . . .Margaret Howard, ADN, RNCommission on Professional Issues . . . . Debra Litton, RN, MSN, MBS, CNA ChairVA Consultant . . . . . . . . . . . . . . Jeanell Foree, BSN, RNSpecial Interest Group:Advance Practice Council . . . . . Mary Wade, MS, MSN, CRNP

ASNA STAFF

Executive Director, Joseph F. Decker, IIDirector Leadership Services,

Charlene Roberson, MEd, RN, BCASNA Attorney, Don Eddins, JD

Administrative Coordinator, Betty ChamblissPrograms Coordinator, April Bishop

334-262-8321 Phone

VISION STATEMENTOur Vision

ASNA is the professional voice of all registered nurses in Alabama.

OUR VALUES

• Modeling professional nursing practices to other nurses

• Adhering to the Code of Ethics for Nurses• Becoming more recognizably influential as an

association• Unifying nurses• Advocating for nurses• Promoting cultural diversity• Promoting health parity• Advancing professional competence• Promoting the ethical care and the human dignity of

every person• Maintaining integrity in all nursing careers

OUR MISSION

ASNA is committed to promoting excellence in nursing.

ADVERTISING

Advertising Rates Contact—Arthur L. Davis Publishing Agency, Inc., 517 Washington St., P.O. Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. ASNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Alabama State Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. ASNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect the views of staff, board, or membership of ASNA or those of the national or local associations.

Views expressed herein are not necessarily those of the Alabama State Nurses Association.

© Copyright by the Alabama State Nurses Association.

PUBLICATION The Alabama Nurse Publication Schedule for 2009Issue Material Due to ASNA OfficeSept/Oct/Nov Aug 11Dec/Jan/Feb2010 Nov 3

Guidelines for Article DevelopmentThe ASNA welcomes articles for publication. There is no payment for articles published in The Alabama Nurse.1. Articles should be microsoft word using a 12 point

font.2. Article length should not exceed five (5) pages 8 x 113. All reference should be cited at the end of the article.4. Articles should be submitted electronically.

Submissions should be sent to:[email protected]

orEditor, The Alabama Nurse

Alabama State Nurses Association360 North Hull Street

Montgomery, AL 36104

2009 ASNA AwardsAny ASNA member, group or staff may submit

nominations. The awards are as follows:• Lillian B. Smith Award• D. O. McClusky Award• Outstanding Non-Member Award• Outstanding New Member Award• Lillian Holland Harvey Award• Louise Barksdale Outstanding Nursing Practice

Award• Legislator Award• Cindajo Overton Outstanding Nurse Educator-Academe & Service• Outstanding Nursing Administrator Award- Academe & Service• Outstanding Retired Nurse Award• Outstanding Health Care OrganizationYou may use the form below or call Betty at the ASNA

office for a brochure and nomination form. Awards are presented at the ASNA Annual Convention, but the Awards Committee needs all nominations by midnight July 22, 2009.

ASNA AWARDS NOMINATIONS FORMNOMINEE INFORMATION

Name of Nominee: _____________________________

Credentials: ___________________________________

Award Nominated For: __________________________

Home Address: ________________________________

____________________________________________

Business Address: ______________________________

____________________________________________

Home Phone: _________________________________

Business Phone: _______________________________

SUPPORTING INFORMATION Attach Narrative Statement (Required)* Attach Curriculum Vitae (Required)* Attach Letters of Support (Optional) Maximum of 3 letters) Attach Additional Pertinent Information (Optional) Maximum of 5 pages.*Must be included for the application to be considered.

SUBMITTED BY:

____________________________________________(Individual’s Name or Group Name)

Address: _____________________________________

District: ___________________ Date: _____________

NOMINATIONS ARE DUE IN ASNA OFFICE BY JULY 22, 2009.

Alabama Board of Nursing Vacancies

There will be 4 RN positions open and 1 LPN position open as of January 1, 2010. The term of Patricia LeCroy, Nursing Practice; Michael Harper, Advance Practice, Debra Davis and Susan Lovett, Nursing Education and 1 LPN position, Maggie Hopkins, LPN will expire December 31, 2009. RN applications only are available from the ASNA office. Call Betty!! Call Davied Fagan at 256-974-0123 for LPNAA position

June, July, August 2009 The Alabama Nurse •

by Debbie Faulk, PhD, RNASNA President

As I began reflecting on what I wanted to convey to Alabama nurses in this third message as YOUR president of the Alabama State Nurses Association, I thought about endings. A number of events will have ended as you read this message. The current session of the Alabama Legislature will have ended; many nursing students will have finished nursing programs across the state and will have attended graduation ceremonies. Many of these former students will be anxiously preparing for, or awaiting, NCLEX results in order to assume the roles of nurses and to take their place as the future of the nursing profession. Finally, National Nurses Week will have come and gone. As I think about this last event, National Nurses Week and this year’s slogan: Nurses: Building a Healthy America, I would like to focus on this for the first part of my message.

I was personally excited about the slogan for the first time in a number of years. Why? I believe the slogan effectively reflects what nurses have been doing for a very long time… focusing on preventive health issues. I believe preventive health efforts are key to building a healthy America. About a month ago, I was the keynote speaker at IOTA Chapter of Sigma Theta Tau Research Day for Troy University School of Nursing. The theme was focused on healthy behaviors. Using the American Nurses Association’s slogan for National Nurses Week as my central theme, I talked about how important it is for nurses to continue to focus on preventive health care, but the primary thesis of my keynote was that nurses must role model healthy behaviors and accept individual accountability for their health. This is the second reason why I believe nurses are instrumental in building a healthy America. Nurses must role model self-care. If we as nurses do not practice prevention activities, we might find ourselves living with the repercussions of the very chronic diseases that we see every day in our practice settings. Consumers of health care trust nurses and they are watching US!

Although a number of events will have ended as you read this message, a huge event will have begun. I am referring to health care reform. A few days ago the Congress began debating health care reform and what it will entail. The debates are in the early stages. I would like to appeal to you as advocates for the profession and for clients to keep informed as the dialogue takes shape. Remember in my second President’s message I said

The President’s Message

Faulk

“nursing no longer has an option related to becoming involved in the political arena. It is now a mandate.” Fortunately YOUR American Nurses Association is a key player and has been invited several times to the White House to participate in health care reform conversations. The decisions that will be made about health care will impact you as a citizen, as a consumer of health care, and as a provider of care. Please stay informed and please participate in the process by writing, calling or meeting with your legislators. Please do not let others speak for nursing.

My final point within this third message is to give you an update on ASNA’s strategic plan for 2009-2010. Our initiatives include:

• Provide leadership for health policy andlegislative activities• Joe Decker has done a phenomenal job of

lobbying for the nursing scholarship bill, nurse practitioner bill and other issues impacting Alabama nurses.

• Advocate for Alabama nurses on professionalpractice issues• ASNA’s lobbying presence in the legislature• Nurse’s Day at the Capitol–21 January, 2010.

• Provide for the continuing professionaldevelopment for Alabama nurses• FACES was held the last of April and over 600

nurses and student nurses attended excellent oral presentations and poster presentations.

• Commission on Professional Issues is developing information related to best practices for retaining the older Alabama nurse. This report will be provided to the membership and shared with all Alabama nurses in the near future.

• Improvethevisibilityandimageofnursing• The ASNA membership video is within a week

of being completed and ready for approval by the board of directors.

• Nurse’s Day at the Capitol-21 January, 2010.• Evaluateorganizationaleffectiveness, relevancy,

and efficiency• On-going process.

I will end with my promised continuing message that in order to make a difference in health care, nurses must be united. While we have many voices and diverse values, we can dialogue, agree to disagree, and yet show others that we speak with one strong voice when it comes to providing quality access to care for Alabama citizens and to promoting excellence in nursing. We at ASNA strongly believe that this advocacy can be best accomplished through membership in ASNA.

Thank you for your time and attention. I want ALL nurses in Alabama to know that ASNA is working with you, for you. If you are a member of ASNA, thank you! If you are not, JOIN us in promoting excellence in nursing.

AUM Nursing Administrators at the Top of State Organizations

Auburn Montgomery School of Nursing graduates Dr. Debbie Faulk, ’94, and Carol Stewart, ’92, not only lend their expertise to their alma mater, but also to nursing colleagues statewide. They serve as presidents for two Alabama professional nursing organizations.

Faulk, coordinator of the Educational Advancement for Registered Nurses program at AUM, is president of the Alabama State Nurses Association for 2008-10.

“ASNA’s mission is to promote excellence in nursing,” said Faulk. “This year, ASNA is advocating for funds for scholarships for nurse educators. We are also striving to eliminate smoking in public places, supporting the Nurse Practitioner Alliance of Alabama in their endeavors and supporting the school nurse bill.”

In addition to legislative issues, ASNA promotes excellence in nursing through continuing education programs.

“In an attempt to increase membership, a task force is developing a membership video with production support from the AUM Information Technology department,” said Faulk. “We believe this endeavor will help us to bring a consistent message about ASNA, its mission, goals and benefits.”

Faulk also plans to utilize the technology that she employs regularly in the EARN program for ASNA, as she plans for the association’s first virtual board meeting in April.

Faulk’s personal goals as president of ASNA are to introduce more technology into the functioning of the association, increase membership and advocate for legislative issues that are of interest to members of ASNA and Alabama nurses.

Carol Stewart, director of Student Health Services at AUM, is president of the Nurse Practitioner Alliance of Alabama for 2009.

The purpose of the NPAA is to represent the regional nurse practitioner groups in practice and educational issues effecting nurse practitioners.

“Legislation (SB 483) has recently been submitted in the state Senate that would help eliminate some of the practice barriers NP and certified nurse midwife practice within the state,” said Stewart. “Our primary goal is to increase access to care, focusing on the uninsured or under-insured and rural areas of Alabama.

“There is a shortage of primary care providers in Alabama and NP’s are one source to help alleviate this problem. NP’s are underutilized because of the barriers that exist. One of the issues addressed in our bill is for NP’s and CNM’s to have direct reimbursement for the services they provide. Most states have already mandated this but not Alabama,” Stewart said.

Because of the national economic crisis, funds are short for meeting health needs in Alabama, and it’s not expected to improve for some time, Stewart said.

“I meet people everyday who have recently lost their jobs and health insurance. It’s time for us to join forces to seek new and creative ways to solve our health care problems.”

Dr. Debbie Faulk and Carol Stewart lead two statewide nursing organizations.


scholarships in the Education Trust Fund Budget for 2010, despite a bleak budget forecast and initially having only $57,000 set aside for that purpose. However, our Nursing Scholarship Bill (HB50) sponsored by Rep. (Dr.) Bentley again failed to even get scheduled for a hearing in committee in the House. We’re very disappointed in that lack of progress. The Senate version (SB51) sponsored by Sen. Benefield did clear committee but not the full Senate. We must redouble our efforts next year, and increase our profile to get this bill passed. Sen. Figures’ bill prohibiting smoking in public places (SB130) cleared committee in the Senate, but was voted down twice in the upper body. It made no progress at all in the House. We were pleased that the School Nurse Bill (HB47/SB186) by Rep. (Dr.) Bentley did pass this year. This bill establishes a maximum of 5 LPNs to 1 RN supervisor in the school system; establishes an RN consultant in each district to oversee the school nurse program and report directly to the Superintendent; and establishes a state consultant.

The introduction by Sen. Coleman this session of the NPAA Nurse Practitioners bill (SB483) to improve practice privileges marked a major milestone. This bill would eliminate the requirement for a written Collaborative Agreement between nurse practitioners and physicians; set the Board of Nursing as the sole regulatory authority for NPs; restructure the current Joint Committee (ABN and BME) by retaining physicians in an advisory capacity only; declare NPs as Primary Care Providers and include them in direct reimbursement; and extend NP prescriptive authority to Class II-V. While very little progress through the system was made amid heavy opposition by MASA, this important issue has now been put on the table for future debate and action. The core issue is access to quality health care for Alabamians, especially those in underserved or rural communities. Nurse Practitioners can definitely fill this need. And the fact is that fewer and fewer physicians opt for primary care fields, preferring to specialize. This leaves an increasingly larger hole to fill in primary care providers. Because Alabama is arguably

the most restrictive state in the union for NP practice, we absolutely must turn that around if all Alabamians are to have access to care. In addition, by taking that route the possibility of substantial cost savings to programs such as Medicaid are clearly evident. While this fight has only just begun, we believe that it is a fight we will eventually win, if for no other reason than the facts on the ground will demand it.

Our 2009 Elizabeth A. Morris Clinical Education Session–FACES on 21 April at the Eastmont Baptist Church in Montgomery was another huge success. We saw another 600 nurses/nursing students in attendance, with a terrific lineup of speakers and educational tracks. The lineup included NCLEX prep for students, three different clinical tracks, a research track, geriatrics, pediatrics, women’s health and parish nursing. A wonderful lunch was available at the church as well. The folks in attendance really enjoyed the day. If you missed it, you’ll get another chance next spring. Keep an eye out for the announcements in The Alabama Nurse and on our website at www.alabamanurses.org.

Finally, ASNA has recently completed work on an informational/recruiting DVD. Our President, Dr. Debbie Faulk of AUM took the lead in the development of this innovative idea, and many of our members played a part. We hope to field the finished edition by June at the latest. We look forward to sharing it with all nurses in the state.

Dates to Remember:ASNA State Convention Nurses at the Capitol Rally1-3 October 2009 21 January 2010Marriot Shoals Hotel MontgomeryFlorence, AL

FACES 2010 ASNA State ConventionSpring 2010 30 Sep-2 Oct 2010Montgomery Riverview Plaza Hotel Mobile, AL

by Joseph F. Decker, IIExecutive Director

As the third annual session (of four in the quadrennium) of the Alabama Legislature closes, we should review the results of actions (or lack of same) on issues we have followed this year. The Alabama Board of Nursing sunset legislation did pass without incident, extending the ABN for four more years. No adverse changes to the law were involved. We were also successful in garnering a total of $257,000 for nursing

Decker

The E.D.’s Notes

Condolences: Jean McLain in the death of her mother.

Edith Shaw, long-time ASNA member of District 5.


by Don Eddins, BS, MS, JDASNA Attorney

As attorney for the Alabama State Nurses Association, I become aware all too often of nurse licensure disciplinaries that could have been avoided had the nurse simply used good common sense.

The state’s registered and licensed practical nurses generally know the rules and regulations promulgated under the Alabama Nurse Practice Act. Sometimes they just fail to follow them.

Take the issue of documentation. Nurses know that they must record that they have performed a particular task, such as administering a physician-prescribed drug when a patient is due medication.

That type documentation is elementary, but sometimes nurses take short-cuts that can have disastrous results. They “pre-chart” that a particular medicine has been given at a particular time–several hours in advance.

What if the patient goes home that day? Or has to be rushed from the nursing home to the hospital? What if the nurse takes ill and has to go home?

by Gregory Howard, LPN

For my entire nursing career, which spans more than 25 years, I can remember the emotional roller coaster of either too many or not enough nurses. And once in a while the issue seemed not to exist. The newspapers, magazines and media have given their view on this reoccurring problem. And now I would like to share my perspective on this dilemma.

It is not always clear whether the reports are biased, or that the people reporting assume that everyone is on the same page when we use the term nurses. There are levels of nurses and it would be helpful to use their name so that everyone is clear on what’s needed. Because the literature only addresses the Registered Nurse, readers may think that is the only level of nurse we are short of. So my question would be, do we need Nurse Practitioners, Associate Degree or Licensed Practical Nurses?

What is very clear is that we have a shortage of qualified Nursing Instructors and Clinical sites to meet the needs of our current pool of students.

Historically nursing facilities have used creative solutions as a quick fix / band aide for our nursing shortage which included: encouraging current employees at medical centers etc. to enter the field of nursing, asking nurses to advance to the next level in their nursing career, recruiting Foreign Nurses, to creating an unlicensed health care worker to perform nursing tasks. Facilities have done this with their” pocket books open and the money showing”.

In my web search / goggle search, which was limited, should I assume that the only shortage of nurses is the Registered Nurse? Because this is the only level of nurse that’s referenced, does this mean there are enough of the other levels of nurses?

The positive aspect of the nursing shortage is that the job outlook is very bright. And it’s likely a job is awaiting the graduates. I feel the shortage will continue to exist and increase with the coming of age of the Baby Boomers and future generations that will saturate the health care market. Until all parties get together to address strategies and formulate partnerships to eliminate this ongoing supply and demand dilemma, we will continue to have what we have always had, a nursing shortage.

LPN Corner

Howard

The Nursing ShortageWho Are We Talking

About?

Legal Corner

Eddins

In those cases, the nurse has signed documentation indicating that a drug has been administered, but in reality it has not. Where does that leave the nurse on the next shift, who unbeknownst to her is dealing with erroneous records?

Pre-charting is something that can get a nurse into trouble with the Alabama Board of Nursing.

What if correction on the nursing notes is necessary, due to a mistake or change in circumstances? Of course, corrections are permissible, as long as they are done in the correct manner. Nurses should attempt to make any corrections on the shift for which the care was given, rather than days later.

And if a nurse draws two controlled substance tablets, but only gives one during the shift, then the notes should reflect what happened to the second pill. Of course, normally it would be wasted in the presence of a witness.

And registered nurses, advanced practice nurses in particular, should never depend upon a national credentialing agency to get paperwork to the Board of Nursing showing that necessary courses have been completed.

The agencies may do the reporting properly, but the advanced practice nurse should check to ensure that the paperwork got there anyway. I am aware of several cases

in which nurse practitioners have relied upon a national credentialing agency to get the paperwork to the Board (even paid the agency a fee) only to learn that the Board had no notice that the credentialing had been completed.

Good registered nurses know these things. They should never get lax and should always follow good common sense practices to stay out of trouble with the Board of Nursing.

Numerous nurses have told me that the people at the Board seemed to have little sympathy for their unintentional mistakes. That’s my experience with the Board staff as well, so it behooves us to be especially diligent in ensuring that the rules are followed.

The good news is that if you’re a member of the Alabama State Nurses Association, you always have a friend in your corner. You can always contact ASNA and ask the professionals for advice and help.

In fact, if you do get a disciplinary notice from the Board (and if you are a current member), the ASNA attorney will accompany you through any necessary negotiation process and hearing.

So if you’ve not joined ASNA yet, now would be a good time to do it.

CE Corner


CE Corner

Authored by: Charlene Roberson, Med, RN, BC. Director of Leadership Services, ASNA and Psych/Mental Assessment Coordinator at Baptist Medical Center, Montgomery, Alabama.

Objectives: At the conclusion of this activity the learner should be able to:

1. Contrast various system clusters for schizophrenia.2. List at least 5 types of schizophrenia.3. Describe the disease course.4. Examine nursing management interventions.

Directions: Read the article carefully. Return the evaluation form and answer sheet printed at the end of the article and complete all sections. Mail to the address provided with the appropriate fee. A Continuing Education Certificate of Completion will be sent to you upon successful completion of both the post-test and the evaluation form. You must score at least 80% to pass. Should you fail the test you will be notified and offered the opportunity to retake the test. All retakes will require an additional $5.00 fee.

Contact Hours: This 2.08 contact hours (60 minutes equal 1.0 contact hour) or 2.5 contact hours (50 minutes equal 1.0 contact hour)

Accreditation: The Alabama State Nurses Association is an accredited provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

Alabama Board of Nursing (valid through March 30, 2013). Approval of this activity expires May 11, 2010.

Schizophrenia is best described as a chronic/reoccurring psychosis coupled with long-term deterioration of functional capacity. The disease is fairly common worldwide with an incidence of about one out of every 100 people. There is no relationship among ethnic groups or geographic locations. The actual diagnosis is usually made in young adulthood. But before this diagnosis is made, those around individuals with Schizophrenia notice a withdrawal from reality, disorganized and regressive behavior, impaired communication and interpersonal relationships, and acute psychotic episodes. Often a complete personal history reveals subtle functional impairments noted at an early age. Many times these subtle impairments are overlooked or ignored. Those close to the client say things like, “She has always been a little odd” or “He never was a good student in school”. Examples of the subtle impairments include communication difficulties, social ineptitude, poor school function, blunted, and/or inappropriate (odd) behaviors. It is important to note that this cluster of symptoms is not a precursor to Schizophrenia. Not all children who exhibit these behaviors go on to be diagnosed as a Schizophrenic. For many years the literature has stated that Schizophrenics are from lower socioeconomic levels. In reality they do make up greater numbers of the homeless population and have a downward drift in qualities of life measurers. However, this is probably due to under employment and not the disease process.

Pathophysiology:There is no clear-cut definitive cause for Schizophrenia.

Most researchers believe it to be a combination of both genetic and environmental factors. Schizophrenic brains are smaller and do have a tendency toward larger sulci lateral and third ventricles. A definite correlation has not been established at this time.

Symptoms:The four (4) basic symptom clusters are positive and

negative symptoms, cognitive impairments, and affective disturbances.

1. Positive symptoms are delusions, hallucinations, and disorganized thinking. This term is synonymous with psychosis and the definition refers to the active quality of the symptoms. It is these symptoms that bring most Schizophrenics to the hospital. In addition these positive symptoms help with the initial diagnosis. There is no predictive index of functional impairment. It is important to note that these symptoms are not unique to Schizophrenia and in fact may be observed with manic episodes, depression, substance abuse/withdrawal, dementia, and some other less frequently seen diagnosis. Roughly 65% of all Schizophrenics have delusions and about 50% have hallucinations

Schizophreniaand/or disorganized thoughts. Auditory hallucinations are the most common (mostly voices but can include any type of sounds), but visual, tactile, olfactory, and gustatory hallucinations also occur. The majority of patients have a combination of all three of these symptoms, which tend to come and go over the years. The good news is that these symptoms react most favorably to medications. And some patients may even have a complete remission of symptoms with pharmacological treatment; however, most have only a reduction in intensity.

2. Negative Symptoms are either absence or diminution of normal behaviors. Examples include the following:a. Alogia—diminished production of thoughts or

speech characterized by loss of interest or ability–this should not be confused with fear of speaking as would be observed in paranoid individuals.

b. Avolition—decreased or absence of goal directed behaviors.

c. Anhedonia—lack of pleasure in actions normally pleasurable or lack of satisfaction when activities are performed well.

d. Attentional impairment—loss of interest in interacting with family, friends, etc. Relationships once important to individuals are neglected and new relationships are not established or sought after.

e. Affective flattening—Affective responses include the capacity to express yourself and perceive others feelings through facial expressions, tone of voice, gestures, posture, and other non-verbal clues. Blunting is a description relating to the loss or inability to express self. A person with a blunted appearance has a blank expression, limited facial movements, monotone voice, loss of meaningful gestures, and often, downcast eyes. Blunting and flat affect are on a continuum. A profoundly blunted person’s affect is considered to be flat.

These defects are often the most noticeable in social situations. Commonly they are the first symptoms seen in Schizophrenia; however, they are non-specific and frequently overlooked. Many times these symptoms predate the onset of psychotic symptoms by months or even years. Overall, negative symptoms do not have a positive response to medications. Psychosocial treatments are usually more effective in reducing the negative symptoms in specific setting, i.e. workplace; however, it does little to reduce the symptoms overall.

3. Cognitive Impairments are noted in all aspects of a Schizophrenic’s life. Areas impacted include language, attention, memory, and executive function (diverse range of abilities exerting higher-level control over behavior and adjusting the behavior in response to changing task requirements). Patient history often reflects cognitive impairments present from birth with only a slight decline during the lifespan. This can be evaluated by an assessment of both school scores and performance. The average Schizophrenic’s IQ is 80–85 which is greater than one standard deviation from the normal IQ of 100. There is no definitive answer regarding IQ loss over the lifetime. Some authorities state there is a slight decline around 5–7 years of age whereas other authorities believe that it remains constant during the lifetime. Cognitive impairments are much like negative symptoms regarding treatment. Medications have little effect to ameliorate and psychosocial therapy can reduce the impact but has limited effect on the impairment itself.

4. Affective disturbance is common with all Schizophrenics. Most individuals have blunted, inappropriate, and odd expressions. Mood disturbances are common and as many as 60% of all Schizophrenics experience dysphoria (excessive anguish), demoralization, and depression during acute episodes. This depression is noted about four times more frequently than the “normal” population. Most often the depression becomes evident following a psychotic exacerbation. There is a question as to whether the depression follows the psychotic episode or is it easier to recognize after the psychosis has cleared.

Diagnostic Types (DSM-4) The diagnostic type refers to the type of positive symptoms Schizophrenia continued on page 7

exhibited. The diagnostic types should not be confused with symptom domains. Schizophrenic patients tend to remain in the same diagnostic subtype for the entire disease course.

1. Paranoid—This type should not be confused with individuals who have persecutory ideations. This refers to any type of delusion or hallucination. The delusions are often fixed around a single organized theme of persecution or grandeur and often coupled with auditory hallucinations, which are related to the delusion. This type has the least functional impairment and carries the best prognosis. A Schizophrenic patient who maintains employment, close relations with family and friends, and are able to live independently probable has this type. A typical client reflects some (or all) of the following behaviors: anxious, guarded, suspicious, angry, hostile, or maybe violent. Onset is usually later in life and is associated with the least regressive behavior. It has the best prognosis. However, the suicide rate is the highest probably because they have relatively good insight and higher executive functions, which enables them to appreciate and react to their diagnosis.

2. Disorganized—These individuals have prominent disorganized thoughts and a bizarre affect. The typical profile includes some (or all) of the following behaviors: incoherent, flat affect, disorganized and primitive behavior, appear odd or silly, have unusual mannerisms, giggle or cry out, distorted facial expressions, hypochondriasis (multiple physical complaints), socially inept, delusions and hallucinations which are fragmented and poorly organized, and withdrawn. At one time these individuals were classified as hebephrenic. They carry the poorest prognosis because these symptoms are not compatible with functioning in the world. This is the most commonly hospitalized Schizophrenic and make up most of the institutionalized patients. The onset is usually early in life. On history these individuals have impaired adjustment problems, which continue to decline after the diagnosis is made. Their symptoms do not respond well to antipsychotic medications.

3. Catatonic—This type has marked disturbances with psychomotor activity and lack of interaction with the environment. It is characterized by bizarre postures, meaningless gestures or postures, psychomotor retardation or excitement (patient may fluctuate between the two), or maintaining awkward position into which the patient is placed (waxy flexibility). Catatonia tends to occur episodically and it is not limited to Schizophrenia. It may be noted with depression, mania or mood disorders.

4. Undifferentiated—The largest group of Schizophrenics are classified as undifferentiated. They do not fit neatly into any one category. They display psychotic symptoms (delusions, disorganized behavior, hallucinations, and incoherence). During the course of the illness there is a tendency for many patients to drift toward the undifferentiated type. Their prognosis is somewhere between paranoid and disorganized types.

5. Schizophreniform disorder—This diagnosis is given to individuals who have the symptoms of a schizophrenia sub type but have had them for less than six months. A diagnostic subtype is not given because many of these cases resolve on their own or develop into a more clear cut diagnosis.

6. Schizoaffective disorder—The relationship of this disorder to Schizophrenia is ambiguous in the literature. Some classify the two together and some sources classify these as separates disorders. An individual with this diagnosis has periods of psychosis without affective symptoms and periods of affective symptoms while psychotic.

7. Residual—This is a partial remission of symptoms. The person remains free of the positive symptoms but continues to have some degree of negative symptoms, i.e., blunted or inappropriate affect, slightly illogical


thinking, etc. The presence of the negative symptoms indicates that there is some degree of functional impairment.

Diagnostic EvaluationsThere are no exact diagnostic measures for Schizophrenia.

The diagnosis is established with the presence of psychosis and systematic exclusion of other abnormal values.

A mental status examination includes observation of the clients demeanor, speech patterns, appearance, thought process and thought content, cognitive status, insight, judgment, suicide, homicide, and assault risk. The client’s mood is evaluated as depressed or elevated. Slurred speech and disorientation may also indicate substance intoxication. The typical profile of a Schizophrenic patient would include many of the following: blunted affect, disorganized or concrete speech, poverty of thought or speech, loose verbal associations, haphazard grooming and hygiene, delusions and hallucinations. Evaluation of suicide and homicidal ideation is especially important as about 50% of all Schizophrenics attempt suicide. Clients may not divulge being suicidal, homicidal, or having command hallucination unless asked directly. Psychosis is confirmed by the interview; behavior (both observed and reported); and collateral information obtained from family, friends, or those in contact with the client. Information needs to be verified because clients may not be candid in reporting psychotic symptoms. The interview evaluation should include direct questions about the following:

• Hallucinations (ask if they hearing voices, hear things others may not, feel thing crawling on your skin, or smell or taste thing others do not).

• Delusions (concern that others may by spying, following, trying to poison you or hurt you, feel unsafe, unusual religious beliefs, have special powers, any beliefs that others think are strange).

• Ideas of Reference (people reading your thoughts or are you reading their thoughts, receive special messages through the light switch, TV, recorded music, etc.).

A medical evaluation should include both a physical and neurological evaluation. Essential laboratory tests will include complete blood count, blood chemistries (liver, renal, and thyroid), drug screens, blood alcohol, and a syphilis screen. Additional tests may be ordered if the history or physical finding indicate. They include, EKG, Hepatitis, EEG, brain imaging (MRI or CT), heavy metal screen, or HIV screen.

Disease Course/ Prognosis10% have one (or two) episode(s) and completely recover55% have chronic symptoms35% have intermittent episodesClients who initially present with negative symptoms

(especially emotional blunting and disorganized thoughts) tend to have an insidious and progressive functional decline. The initial phase of Schizophrenia lasts about five (5) years and most of the deterioration from premorbid levels of function occurs during this time. After this time the deterioration remains fairly stable. Individuals who have mastered age appropriate tasks prior to the first psychotic episode or who have appropriate social, academic, or occupational skills have a much better prognosis overall. Prognosis is negatively affected by a delay in treatment. If a person goes untreated during an acute phase they may never respond effectively to future treatments. The most common reasons for patient relapse are non-compliance with medications, followed by substance abuse, psychosocial stressors, and physical illness. At least 80% of individuals who are non-compliant with medication relapse within one year. This can be contrasted with the fact that at least 30% of individuals who are compliant with medication also relapse within a year and do not have any of the previously named stressors. Relapse is part of the natural progression of this disease. Clients with a family history of affective disorders have a much better prognosis than a person with a family history of Schizophrenia. Schizophrenics fail to return to baseline function following an acute episode, whereas patients with affective disorders do return to baseline measurements.

Usually the negative, cognitive, and affective symptoms continue although the psychosis has resolved. Keep in mind that medication has little impact on the reduction of these symptoms. And these same symptoms become more acute in the presence of active psychosis. Medication does reduce active psychosis; so the best treatment option to prevent acute episodes is adequate and consistent antipsychotic medication compliance.

Suicide is always a consistent concern. Somewhere between 5–10% of all Schizophrenics commit suicide (up to 50% may try to commit suicide). It tends to occur early in the course of the disease. Frequently it occurs at the beginning of treatment or after resolution of an acute episode at the transition point of acute care to residential care. Suicide risk is highest among Paranoid Schizophrenics as they have the most insight and the least cognitive impairment. In short they can

contemplate and act on these suicidal thoughts. The depressive symptoms seem to improve with antipsychotic treatment alone in contrast to other forms of depression, which do not respond to antipsychotic medications. The demoralization symptoms arising from issues like loss of family, employment, etc. respond best to psychotherapy interventions.

Schizophrenia is one of the most costly and inadequately treated mental illnesses. The health care costs are staggering. They occupy the following:

½ of all mental health beds¼ total hospital beds40% long-term beds (compared to 27% for

cardiovascular disorders)Approximately 250,000 new Schizophrenics are

diagnosed each year and return to live with their families.

Treatment PhasesThe three (3) phases of treatment are referred to as the

acute, stabilization, and maintenance phase.

1. Acute—Think safety/safety/safety. Safety is always the first consideration for any psychiatric patient. Very often the clients are aggressive, agitated, suicidal or homicidal. Law enforcement personnel may be required to prevent the patient from harming self, others or property. In addition law enforcement may be needed for transportation to a medical facility. Family members should be taught to also use law enforcement as needed. Involuntary hospitalization is necessary at times if a patient represents a danger to themselves or their behavior is so profoundly disturbed that they are unable to provide for food or shelter for self. Psychosis alone is not enough to warrant an involuntary hospitalization. There are no legal mechanisms anywhere to force a psychotic individual into care if they are not engaged in harmful behavior. Very often families need help in understanding this concept. All areas of the United States have some mechanism to enforce an involuntary hospitalization and each municipality has a different mechanism to activate the process.

Agitated and aggressive individuals need sedation and may require restraint and/or seclusion. The least restrictive restraint and seclusion method is necessary and the client should be free of this as soon as the behavior is calmer. Restraint and seclusion may be applied only to prevent danger to the client, staff, and/or property.

Injectable medications are necessary when the client is unable to cooperate and include Aripiprazole (Abilify), Haloperidol (Haldol), Olanzapine (Zyprexa), Risperidone (Risperdal), and Ziprasidone (Geodon). {See figure 1—Medication Chart}. As soon as the person is able to cooperate a transition should be made to oral medications. If they are willing to take oral medication but have marginal cooperation a disintegrating tablet should be used. Only Olanzapine and Risperidone have disintegrating tablets. Although the tablets dissolve in the mouth they are not absorbed transmucosally, instead they are absorbed in the GI tract at the same rate as standard pills. Oral and injectable medications are very similar in rate of response and efficacy. An agitated individual may also benefit from the administration of a benzodiazepine such as Lorazepam (Ativan). It is compatible with antipsychotic drugs and may be administered via various routes.

Cooperative psychotic individuals may or may not be hospitalized. Usually hospitalization is especially advantageous if a medication adjustment is planned. This decision is made between the client, family/care givers, and psychiatrist or nurse practitioner. The client and family need clear explanations in order to make the best decision regarding care.

2. Stabilization Phase—This is the phase where individuals are stabilized on their routine antipsychotic medications. Any side effects the person experiences may be addressed by education, dose adjustment, reassurance, and/or medication changes. It is imperative for the client and their caregivers understand the role of medication and potential side effects. Many side effects will disappear in a couple of weeks. During this phase therapeutic relationships need to be established as well as a formal plan of care needs to ease the return to the community.

3. Maintenance Phase—Most antipsychotic medication reduce the active symptoms to a tolerable level in about 70% of all clients. Clients and their caregivers should be aware that this is a lifetime process for most patients. If compliance is an issue then long-term depot medication should be considered. {Figure 1—Medication chart}. After the psychosis subsides the client should focus on other issues such as maintenance of health and continuing treatment. Compliance with medication is unlikely when individuals have housing problems, limited income, limited social support, and difficulty accessing care as well as obtaining medications. These individuals tend to cycle back quickly into the acute phase. In an ideal setting all clients have access to a case manager who intercedes and coordinates needed

services. During this time family/caregiver support is needed to deal with the stress of the disease process. These issues may be compliance problems, social stigma, communication, understanding the disease process, etc. Hopefully the client can engage in social skills training. These are sometimes called day treatment programs. The idea is to help the person deal with deficits in communication and social skills/interactions. Some vocational rehabilitation is effective. Clients are rarely able to engage in long-term employment—especially if the job site is stressful or competitive. They do best in a sheltered workshop or a protected environment. They need a job that can be accomplished with episodic employment. Health maintenance is important as many of the medication’s side effects cause weight gain and increased lipid levels. Education should be provided to help clients monitor their medication side effects. Support need to be given to help them maintain optimum health.

Some communities have ACT’s Teams (Assertive Community Treatment), which keep vurnable patients who are at risk for long-term institutionalization in the community. The services are available 24/7. Each team has nurses, physicians, counselors, and social workers. ACT Teams provide case management, assessments, psychiatric services, employment and housing options, family support, education, substance abuse services, and other services critical to a person with a chronic mental illness remaining in the community.

Treatment ComplicationsThe average person with Schizophrenia has about a 20%

reduction in life expectancy as compared to the general population. Causes include suicide, homelessness, poor self-care (either lack of resources or motivation), substance abuse, medical conditions usually related to medication side effects. Statistics show that as many as 80% of Schizophrenics abuse alcohol or other drugs and about 75% abuse nicotine and they have the highest relapse rate. Common chronic medical conditions include Chronic Obstructive Lung Disease, Hepatitis C, Hypothyroidism, Diabetes with complications, fluid and electrolyte disorders, Hyperlipidemia (the Metabolic syndrome), and cardiac risk (prolongation of the qTc ratio [measure of time between onset of ventricular depolarization and completion of ventricular repolarization–prolongation can provoke life threatening arrhythmias]). The development of Diabetes, Metabolic Syndrome, and prolongation of the qTc ratio is usually directly related to antipsychotic medications. Typical and atypical antipsychotic medications are mandated by the Food and Drug Administration to carry a Black Box warning label about weight gain, metabolic syndrome, and prolongation of the qTc ratio.

Figure 1

Nursing InterventionsDuring an acute episode the patient needs hospitalization.

The usual behaviors noted are danger to self or others, exhibiting profound disorganized and inappropriate behavior, or are unable to meet own needs for food, shelter, or clothing. The hospitalization will provide medication stabilization and a structured environment, which provides relief from the psychosocial stressors. Education, guidance, and appropriate aftercare should be provided before discharge.

Nursing Management Psychosocial Therapy—A hallmark of Schizophrenia is

the inability to form and/or maintain meaningful interpersonal relationships. Therefore the main focus of interventions is to help the client develop and maintain meaningful socializations within their ability. The following can foster this:

Schizophrenia continued on page 8

Schizophrenia continued from page 6

DrugsapprovedbytheFDAtoTreatSchizophrenia:

Conventional antipsychotic drugs

Chlorpromazine (Thorazine)*Haloperidol (Haldol)Loxaoine (Loxitane)Molindone (Moban)

Perphenazine (Trilafon)Thiothixene (Navane)

Trifluperazine (Stelazine)

Atypical Antipsychotic

*Aripiprazole (Abilify)Clozapine (Clozaril)

*Olanzapine (Zyprexia)Paliperidone (Invega)Quetiapine (Seroquel)

*Risperidone (Risperal)*Ziprasidone (Geodon)

*Depot (Injection) Medications


1. Therapeutic Nurse-Client relationship—The goal of this intervention is for the client to attain a sense of self worth and acceptance. Once trust has been established the client can learn and practice new skills, be given non judgmental feedback about their progress, and thus they can continue to gain and accept support and encouragement. The nurses’ focus will be limited to having the client develop interpersonal communications and socialization skills, independence issues, and survival skills for post hospitalization.

2. Behavior Modification—Usually behavior modification techniques are much more effective for clients with Schizophrenia than insight-orientated groups. The goal is to reinforce appropriate behaviors and conversely negatively reinforce inappropriate behaviors. Initially the client must have a thorough assessment to determine abilities, strengths, and deficits. Then specific behaviors are targeted. Positive techniques include praise, privileges, or tokens, which may be exchanged for food or cigarettes. Negative behaviors are ignored or not rewarded. This is only effective with the client’s understanding and cooperation.

3. Group Therapy—Selective types of groups are effective but must be tailored to the client’s needs and abilities. Groups that depend on insight development, problem-solving, or personality reconstruction are ineffective for individuals with Schizophrenia. They need/benefit from groups which provide education, motivation and support. Low functioning individuals need a low stress group–one that provides positive reinforcement for any achievement. Types of issues discussed might include activities of daily living, hygiene, relaxation techniques, identification and support of strengths, socialization skills, etc. Also all clients need to be involved in a discussion about their personal vulnerability in social situations. This discussion should involve avoidance of personal injury and ways not to be taken advantage of by society. Mentally ill individuals have a higher incident of victimization than the non-mentally ill population.

4. Family Therapy—Family support goes a long way to prevent relapse of a person with Schizophrenia. The main focus of family therapy is to provide education

Schizophrenia continued from page 7 about the disease process and provide a vehicle for dialogues about their problems dealing with the family member with Schizophrenia. The client and family/significant others need to understand that this is a lifetime disease. These symptoms wax and wane over time but rarely, if ever, completely disappear. Usually, early, consistent institution of treatment improves the symptom management. Clients who go on and off their medications have a poorer prognosis overall.

Discharge Criteria The following general concepts indicate a person is ready

for discharge. • State a decrease or absence of hallucinations (NOTE:

individuals with Chronic Schizophrenia may never be totally free of hallucinations but develop mechanisms to cope and they need closer supervision)

• Verbalize the relationship between increased stress and anxiety and developing hallucinations

• List several appropriate ways to reduce stress/anxiety• Have a support network of family or friends or

caretakers• Know how to contact physician, clinics, etc.• Exhibit an understanding of the importance of

medication compliance as well a general knowledge about the medications

• Be able to state personal responsibility in own wellness—aftercare, preventative health concepts, taking medications, keeping appointments, etc.

This disease can be frustrating for both the client and the family/significant others. One of the best support mechanisms to help them understand how the disease process often waxes and wanes. Medications compliance often goes a long way to prevent exacerbations and importantly the fact that support is available when the health care system is accessed.

Answer the following:1. Schizophrenia affects about 1 out of 100 people worldwide. A. True B. False

2. Examples of positive symptoms include alogia and avolition. A. True B. False

3. About 75% of all Schizophrenics have hallucinations and disorganized thoughts.

A. True B. False

4. Positive symptoms react favorably to medications. A. True B. False

5. Blunting relates to the loss or inability to express self. A. True B. False

6. The average IQ for a Schizophrenic is 95–105. A. True B. False

7. Paranoid Schizophrenics always have persecutory ideations. A. True B. False

8. Paranoid Schizophrenics usually have a later onset in life. A. True B. False

9. Suicide rates are higher with Disorganized Schizophrenics. A. True B. False

10. A person diagnosed with Schizophreniform disorder has been diagnosed with Schizophrenia for less than 6 months.

A. True B. False

11. 50% of all Schizophrenics attempt suicide. A. True B. False

12. Mental deterioration from the premorbid state continues to decline through out a Schizophrenic lifespan.

A. True B. False

13. Schizophrenics occupy about one half of all mental health beds.

A. True B. False

14. The presence of psychosis is a criterion for involuntary hospitalization.

A. True B. False

15. Many of the unpleasant medication side effects disappear within two (2) weeks of starting treatment.

A. True B. False

16. Antipsychotic medications reduce active symptoms to a tolerable level in about 70% of all clients.

A. True B. False

17. Disintegrating tablets (Olanzapine and Risperidone) are absorbed transmucosally.

A. True B. False

18. Examples of Conventional antipsychotic drugs include Haloperidol (Haldol), Thiooridazine (Mellaril), and Ziprasidone (Geodon).

A. True B. False

19. Over ¾ of Schizophrenics abuse alcohol or other drugs. A. True B. False

20. Diabetes and the Metabolic Syndrome are frequent treatment complications related to antipsychotic medications.

A. True B. False

21. One primary nursing focus is to help the patient develop meaningful socializations within their ability.

A. True B. False

22. If a Schizophrenic remains on medication they are usually able to maintain long-term employment.

A. True B. False

23. Groups that are focused on insight development are effective groups for individuals with Schizophrenia.

A. True B. False

24. Clients who take medication sporadically have a poor prognosis overall

A. True B. False

25. Discharge criteria includes willingness to sign a “No Harm Contract”

A. True B. False

Schizophrenia Post-Test Questions

Schizophrenia2.08 (ANCC) or 2.5 (ABN) contact hours Activity #: 4-0.894

Name: __________________________________________________ Fee and Payment Method

Address: ________________________________________________ ____ ASNA Member ($18)

________________________________________________________ ____ Non Member ($25) City State Zip ____ Check—Make Payable to ASNAPhone: __________________________________________________ Visa M/C Discover AmExABN License Number _____________________________________ CC Security Code:Email Address: __________________________________________

____________________________ / _________ ________________ ____________________________ Credit Card Number Exp. CC Security Code Signature

Place correct answers in box below appropriate number

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

ACTIVITY EVALUATION

GOAL: Review current status of schizophrenia.

Circle your response using this scale: 3 – Yes 2 – Somewhat 1 – No

Rate the relationship of the objectives to the goal of the activity 3 2 1

Rate your achievement of the objectives for the activity 3 2 1

Objectives:

1. Contrast various system clusters for schizophrenia 3 2 1

2. List at least 5 types of schizophrenia 3 2 1

3. Describe the disease course 3 2 1

4. Examine nursing management interventions 3 2 1

How effective was this activity as a teaching/learning resource? 3 2 1

Was activity free of commercial bias? 3 2 1

On a scale of 1 – 5 knowledge of topic before home-study 5 4 3 2 1

On a scale of 1 – 5 knowledge of topic after home-study 5 4 3 2 1

How much time did it take you to complete the program? ________ hours ________ minutes.

ADDITIONAL COMMENTS:


2009 Convention

Nominations and Election of Officers Alabama State Nurses Association’s (ASNA) nomination and election of Officers shall be conducted in accordance

with Robert’s Rules of Order, 10th Edition during the official meeting of the ASNA House of Delegates (HOD).

1. NOMINATIONSA. Nominations Committee

a. Nominations from the Nominations Committee shall be accomplished according to ASNA Bylaws.B. Nominations from the floor of the HOD shall be accomplished according to Robert’s Rules of Order, 10th

Edition.

2. ELECTION OF OFFICERSA. Elections will be by secret ballot.B. Only credentialed delegates will be allowed to vote. C. Voting times and polling location will be announced at the House of Delegates.D. Election monitor(s) will verify eligibility of delegates (current membership card, delegate ribbon, and photo

I.D.) at the entrance to the polling area. E. No campaigning will be permitted in the polling area.F. Each delegate will place his or her completed ballot into the designated container. G. Once the delegate has finished voting he or she must exit the polling area.H. Polling area will be open and closed promptly at specified time.I. Ballots will be controlled and counted by a minimum of three (3) tellers.J. One Teller will give each delegate one (1) ballot as the delegate enters the polling area.K. One Teller will monitor the ballot box to assure that each delegate places a single ballot into the container.L. One Teller will monitor the polling area to be sure delegates exit after voting.M. Once the polling area is closed the Tellers will count the ballots.N. The Head Teller will complete the Teller’s Report.O. The Head Teller will present the official election results to the President in accordance with Robert’s Rules of

Order, 10th Edition.P. The President will report the result to the HOD in accordance with Robert’s Rules of Order, 10th Edition.

Preliminary Ballot for ASNA ConventionCandidates for 2009-2011

The following slate will be voted on at the ASNA Convention by the elected ASNA Delegates.

Vice President Jackie Williams, MSN, RNC Sonya Capps, BSN, RN, CNN, CLNC

Write-in candidate: _______________________________

Secretary: Mardell Davis, PhD, RN


Commission on Professional Issues (Vote for 4) Richard Brown, MSN, CRNP, JD Stuart Pope, RN Jean Ivey, DSN, RN, CRNP Cam Hamilton, MSN, RN Michelle Schutt, ED.d.,RN, CNE


Nominating Committee (Vote for 3) Glenda Smith, RNC, MSN, NNP Cindy McCoy, PhD, CCRN, BC


Instructions for Mail-in Ballot

for ASNA Members Only1. Fill out Official Ballot2. Outside envelope must have your name and address on it.3. For privacy-if-desired you may place ballot in

second blank envelope. Send official ballot cut from Alabama Nurse/or a facsimile.

4. Mail to ASNA at 360 North Hull Street Montgomery, AL 361045. Ballot must be postmarked no later than September

15, 2009. Ballots will not be counted postmarked after September 15, 2009.

OFFICIAL ASNA BALLOT

Alabama State Nurses Association

OFFICIAL BALLOT–2009FOR ASNA MEMBERS ONLY

ANA Delegates for year 2009-2011Vote for 8

____ Vanessa Barlow, MBA, BSN, RN____ Mardell Davis, PhD, RN____ Paula Gasser, MPH, RN____ Lygia Holcomb, DSN, CRNP____ Jean Ivey, DSN, RN,CRNP____ Lori Lioce, MSN, CRNP____ Ruby Morrison, DSN, RN____ Jacqueline Moss, DSN, RN____ Arlene Morris, ED.d., MSN, RN____ Janice Vincent, DSN, RN____ Helen A. Wilson, MSN, RN

Alternate to Alternate:____ Charlene Roberson, MEd, RN, BC

*ANA Delegates will be elected by ballot mailed in the Jun/July/Aug issue of the Alabama Nurse. All other positions will be elected by the ASNA House of Delegates at ASNA Convention October 1-3, 2009 in Florence, AL.


2009 Convention

1-3 October 2009Marriott Shoals Hotel & Spa(on the Robert Trent Jones Golf Trail)

Florence, Alabama

Convention details may be located at www.alabamanurses.org

Thursday, Mabel Lamb Pre Convention1 October 2009 Sessions

10:15 AM “Climb for the Cause (featuring the women of Mt. Kilimanjaro)”, Dr. Penny Wright

11:30 AM–1:00 PM AlaONL Annual Meeting AlaONL Key Note Address Speaker TBA (sponsored by Hill-Rom) Lunch (provided)

Concurrent Sessions Workshop I Clinical Nursing1:30–6:00 PM Workshop II AlaONL Track– Nursing Sensitive Indicators: Quality and Cost Implications Workshop III Mental Health Workshop IV Leadership Competency Series

6:00 PM President’s Reception (provided)

6:30 PM Supper (provided)To Follow ASNA Game Night or ASNA Board

of Directors Meeting

(NOTE: AANS schedule TBA)

Friday, 2 October 20097:15 AM Breakfast

8:00 AM–3:00 PM Exhibits

8:00 AM Silent Auction opens

Education Sessions8:00 AM–12Noon “Nurses Around the World” Dr. Sue Morgan “Nursing Education–a Global Focus” TBA “Environmental Safety–What’s in

Our Water” Nelson Brook

12 Noon Lunch (provided in exhibit area)

1:00 PM– 5:30 PM House of Delegates Key Note Address Dr. Lynda Harrison

6:00 PM Awards Celebration and banquet

(NOTE: AANS schedule TBA)

3 October 20097:30 AM Breakfast Roundtable Sessions “Best Practices in Nursing”

8:00 AM–8:45 AM Polls open

9:00 AM–12 Noon Posters

9:15 AM Human Trafficking Helen Wilson

10:15 AM Political Forum State Legislators invited

11:00 AM House of Delegates

12:30 PM Lunch (provided)

1:00 PM Alabama Board of Nursing Update N. Genell Lee, JD, MSN

Alabama State Nurses AssociationAlabama Organization of Nurse Leaders

Alabama Association of Nursing Students

Annual Convention


2009 Convention

ASNA & AlaONL Registration

Name & Credentials ____________________________________________________________________________

Address: _____________________________________________________________________________________ City State Zip

Day Phone (______) _______________________________ Fax (_______) ______________________________

E-mail ___________________________________ Credit Card #:___________________ Exp. Date: __________

Registration: Fees include educational sessions and food events for the days registered including single day registration. Individuals registering the day of the Convention will be issued food tickets ONLY if available. Additional guest tickets may be purchased for food functions only. Registration for the Full Convention does not include the Mable Lamb Educational Day on Thursday, October 1, 2009. All Pre Convention and all Convention attendees are invited to the Dinner October 1, 2009 at 6:00 PM.

Payment: Amount of registration is determined by postmark if mailed or date received in case of phone, fax, or online. Payment or Purchase Orders must accompany registration in order to be processed. All registrations received after September 15, 2009 will be processed on site.

Before August 3, 2009 will be considered early registration.After September 1, 2009 will be considered regular registration.

Confirmations: Only e-mail confirmations will be sent (approximately two weeks after receipt of registration form). No confirmation will be sent after September 11, 2009.

Cancellations: A written request must be received prior to August 31, 2009. A refund minus a $20 processing fee will be given. No refund will be given after August 31, 2009. We reserve the right to cancel the activity if necessary. In that case a full refund will be given.

Continuing Education: The Alabama State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

Alabama Board of Nursing (Valid through March 30, 2013). 1.0 contact hours are awarded for each session attended, including Posters. A maximum of 7.0 contact hours may be earned. An additional 6.0 contact hours may be earned by attending the Pre Convention sessions.

Returned Check Fee: $30 returned check fee for any returned checks.

How to Register for ConventionRegister online at www.alabamanurses.org. or send registration

form and payment to (check made payable to ASNA) ASNA, 360 North Hull Street, Montgomery, AL 36104-3644 or if paying by credit card Fax to 334-262-8321 (do not mail if faxing or registering on line).

For hotel reservations, contact the Marriott Shoals Hotel & Spa in Florence, AL at 1-866-746-2507. Room rates are $129.00 for a Single/Double. Please inform the hotel that you are part of ASNA when making reservations by August 31, 2009 TO BE INCLUDED IN THE ROOM BLOCK. Reservations made after that date will be based on a space and rate availability.

800 Cox Creek Parkway South–Florence, Alabama 356301-866-746-2507

Fees:Mabel Lamb Continuing Education Day Workshops, Thursday, October 1, 2009 (includes Lunch, Supper and President’s Reception)

Circle one of the following choices:

Track I Clinical

Track ll AONL (Quality & Cost Implications) ASNA member $119 Non-member $139

Track III Mental Health

Track IV Leadership NOTE: Add $10 to above fees if received after August 31, 2009

2.) Convention, Friday and Saturday, October 2-3, 2009 (includes tickets to all meal functions listed in this application)–Select one of the following choices:

ASNA Delegates Only (must register for entire convention)*Received on or before August 3, 2009–$239 Received after September 1, 2009–$255

Non Delegates–Full convention *Received on or before August 3, 2009 ASNA Member–$255 Non Member–$280

Received after September 1, 2009 ASNA Member–$270 Non Member–$295

Daily Registration *Received on or before August 3, 2009 ASNA Member–$165/day Non Member–$180/day

Received after September 1, 2009 ASNAMember–$170/day Non Member–$195/day

Additional Meal/Function Tickets• Thursday, October 1, 2009 – Luncheon . . . . . . . . . . . . .$30• Thursday, October 1, 2009 – Supper . . . . . . . . . . . . . . . .$30• Friday, October 2, 2009 – Breakfast/Breaks . . . . . . . . .$35• Friday, October 2, 2009 – Lunch . . . . . . . . . . . . . . . . . .$25• Friday, October 2, 2009 – Awards Banquet . . . . . . . . . .$50 Select One: ( ) Pistachio Salmon or ( ) Beef Tenderloin • Saturday, October 3, 2009 – Roundtable Breakfast . . . .$25• Sunday, October 3, 2009 – Luncheon . . . . . . . . . . . . . . .$25

Total Enclosed: $ ________________

*ASNA Special Dues members (65+/Retired or Completely Disabled) receive an additional 10% discount on registration.Registrations postmarked or received after Sept. 15, 2009 will be considered “at-door”.

INDICATE BANQUET CHOICEFriday, October 2, 2009

Beef Tenderloin Pistachio Salmon

Alabama Organization of

Nurse Leaders and ASNA Partner at the

ConventionDr. Linda Roussel, AlaONL President

[email protected]

The Alabama Organization of Nurse Leaders (AlaONL) will again partner with ASNA at the ASNA Convention offering a luncheon meeting with a featured speaker from Hill-Rom on October 1, 2009. The luncheon meeting will include continuing education. AlaONL appreciates the opportunity to work with ASNA to share healthcare policy updates and future trends. AlaONL will also offer a Leadership Track at the Convention focusing on Nursing Sensitive Indicators: Quality and Cost Implications. Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care and include pressure ulcers, falls, and intravenous infiltrations. CEs will also be awarded for this track. AlaONL is partnering with Alabama Quality Assurance Foundation (AQAF) to provide an all day workshop, Annual AlaONL Leadership Conference. The National Patient Safety Goals: Clinical and Academic Partnership will be offered on Friday, August 21, 2009 in Montgomery. Please contact Dr. Linda Roussel ([email protected]) for details.

2009 Convention Pleminary Sponsors

& ExhibitorsSPONSORS:

GOLDArthur L. Davis Publishing Agency, Inc.

2009 CONVENTION EXHIBITORSAlabama Auxiliary of the Gideons InternationalAlabama Organ CenterBeijo Handbags & AccessoriesCengage Learning/Delmar PressDCH Health SystemEmory University School of NursingFirst Fidelity GroupHurst Review ServicesJackson HospitalMiddle Tennessee School of AnesthesiaRinehart & AssociatesSylvia Rayfield & Associates/Ican PublishingTroy University School of NursingUniversity of Alabama-Capstone College of Nursing


2009 Convention

Being a Delegate to a state convention can be an exciting experience but one that also has some inherent responsibility. As you may know, the House of Delegates (HOD) is the governing and official voting body of the Alabama State Nurses Association (ASNA). The House meets annually. Members of the HOD have a crucial role in providing direction and support of the work of the Alabama State Nurses Association. Delegates are elected to the HOD to work for the betterment of ASNA and the nursing profession. Each delegate is expected to study the issues thoroughly, attend each session of the HOD (including the Open Forums), and engage in active listening and debate. Also, delegates are encouraged to use the extensive resources and collective knowledge available at each meeting to provide direction and support for the work of the organization. Such a commitment benefits the individual delegate, the association, and the nursing profession.

If a delegate in unable to attend the 2009 ASNA House of Delegates, his/her district nurses association (DNA) should be notified at once. When alternate delegates are substituted

So You Are An ASNA Delegatefor delegates, it is the responsibility of the District President to notify ASNA of the change immediately.

Important information for ASNA Delegate RegistrationDelegates are encouraged to register for convention in

advance to expedite the on-site credentialing process. See the registration form in the pull out section of this issue for registration fees. Full registration includes, Friday Evening Awards/Celebration Dinner, Saturday and Sunday breakfast and lunch. Additional tickets can be purchased for these events. Utilize the special pullout section of The Alabama Nurse to register for convention. Please note the cut off date for the hotel discount is August 31, 2009. ASNA has blocked a certain amount of rooms for this convention. Please consider

that off-site hotel registration of delegates causes a financial hardship to the organization if the room block is not met.

To ensure eligibility for the credentialing process, delegates are required to present their current ANA membership card and one picture ID at the Delegate Registration desk. If you do not have a current membership card please contact April Bishop, Programs Coordinator for assistance. Each delegate will be issued a name badge, a delegate ribbon, and informational materials upon proof of identification. The name badge and delegate ribbon must be worn in order to be admitted to the floor of the House of Delegates.

Please call the ASNA office at 1-800-270-2762 or 334-262-8321 if you have questions or concerns.


Lorraine Bonaldi-Moore, RN, MBA, MSN

“Most people know they can’t get into the hospital without a doctor. What they don’t know is that they won’t get out of one~ at least not alive~ without a nurse,” Joan Lynaugh, Nursing Historian

How do we define “profession” and “professionalism”? What do these terms mean to Registered Nurses? What do these terms mean to the general public? What should the entry level to practice education be for RNs? How do we characterize attributes of the professional RN? What does the future hold for the nursing professional?

The meaning of professionalism has been the subject of much debate for decades, perhaps centuries. The Carnegie Foundation produced one of the first papers on this subject in 1910. The Flexner Report focused on the profession of medicine and tendered the incentive for future writings, discussion and efforts to define this concept. The Flexner Report suggested activities must be intellectual in their pursuit as opposed to physical; they must be based on knowledge. Additionally, it was recommended that there must be ‘teachable’ techniques and that practitioners must be motivated by altruism. Author Abraham Flexner is quoted “If the sick are to reap the full benefit of recent progress in medicine, a more uniformly arduous and expensive medical education is demanded” (1910).

Another report produced by Bixler and Bixler (1959) stated the characteristics of a profession must have a specialized body of knowledge and use that body of knowledge to expand and improve the techniques, education, and service through scientific research methods, it must entrust the education of its practitioner at institutes of higher education, and help formulate professional policies and control of the professional activities.

As a profession, we must agree that nursing is a profession, act professionally, and propel our profession forward. We clearly have some work to do in this regard. There are many important issues ‘we’ must address, and decisions to be made on these matters so as to strengthen and advance the nursing profession. As counter-intuitive as it may feel or counter to conventional wisdom, we should use and exploit the current critical shortage of nurses to advance our position, our evidenced-based practices, re-examine and resolve the entry-level to professional practice issue and be assertive in controlling the practice of nursing as physicians did in the early 20th century. We can not merely permit our professional significance to be defined by arbitrary regulation, a union contract, or a hospital policy or procedure,” nor can we sit idly by while policy makers dictate our patient care load, the hours we work, or the education of our future nursing professionals.

It is up to YOU, it is up to me, it is up to ‘we’ as part of the nursing profession to reshape our image into a strong, competent, capable, and powerful profession that is intellectually demanding, exciting, rewarding and challenging. This is not up to hospital CEO’s, Senators and Congressmen, it is up to us!

Buresh and Gordon (2006) so aptly describe the work which is necessary to our success and voicing our silence as we work to improving the image of nursing and sharing with the world our professionalism and importance: “This will be hard work indeed. It means fighting against deeply rooted stereotypes…visibility is not an option, it’s an obligation…if we fail to make our work visible, we are betraying our mission, our patients present and future, and society itself” (p. 275). Are you ‘just a nurse’, no YOU are something MORE, do not diminish what you do, who you are and what this profession means to the world.

(See Appendix A)

Ask Not What Nursing Can Do for YOU; ask what YOU can do for the Profession of NursingNurses have a lot of power

ReferencesArtz, M. (2006). Ask not what nursing can do for you…Nurses

have a lot of power. American Journal of Nursing 106 (9), 91-92. Beck, A. H. (2004). The Flexner report and the standardization

of American medical education. JAMA 291, 2139-2140. Retrieved September 26, 2006 from http://jama.ama-assn.org

Bixler, G.K. & Bixler, R.W. (1959). The professional status of nursing, Am J Nurs 59(8):1 142-147, 1959. Brown EL: Nursing for the future, New York, 1948, Russell Sage.

Buresh, S. & Gordon, S. (2000). From silence to voice. (2nd ed.). Ottawa, Canada: Canadian Nurses Association Press.

Flexner, A. (1910). Medical education in the United States and Canada. New York, NY: Carnegie Foundation for the Advancement of Teaching.

Hallmarks of the professional nursing practice environment (2002). American Association of Colleges of Nursing. Retrieved September 2, 2006, from http://www.aacn.nche.edu/Publications/positions/hallmarks.htm

Professionalism in NursingAppendix A

Just a Nurseby Suzanne Gordon

I’m just a nurse.I just make the difference between life and death.

I’m just a nurse.I just have the educated eyes that prevent medical errors, injuries and other catastrophes.

I’m just a nurse.I just make the difference between pain and comfort.

I’m just a nurse.I’m just a nurse researcher who helps nurses and doctors give better, safer, and more effective care.

I’m just a nurse.I’m just a professor of nursing who educates future generations of nurses.

I’m just a nurse.I just work in a major teaching hospital managing and monitoring patients who are involved in cutting-edge

experimental research.I’m just a nurse.

I just educate patients and families about how to maintain their health.I’m just a nurse.

I’m just a geriatric nurse practitioner who makes a difference between an elderly person staying in his own home or going to a nursing home.

I’m just a nurse.I just make the difference between dying in agony and dying in comfort and with dignity.

I’m just a nurse.I’m just the real bottom-line in health care.Wouldn’t you like to be just a nurse, too?

Reprinted with permission from Lorraine Bonaldi-Moore, RN, MBA, MSN, an Assistant Professor at Orvis School of Nursing, University of Nevada. Original article in RNFormation.


Membership News

Alabama League for Nursing

Press ReleaseMs. Lori Lioce, a graduate

of the University of Alabama in Huntsville College of Nursing and President-elect, Nurse Practitioner Alliance of Alabama, was one of nine nurses statewide awarded the Alabama League for Nursing Lamplighter Award. A banquet in honor of the nominees was held at the Marriott Grand Hotel, Point Clear, Alabama on April 2, 2009.

The ALN Lamplighter Award is part of a prestigious recognition program designed to pay tribute to individuals who have made a substantial contribution to the nursing profession and/or society. Ms. Lioce is an active member of the Alabama State Nurses Association, and serves on the ASNA Legislative Committee and Advanced Practice Council. She also served as the Committee Chair for Advanced Practice Nursing in Retail Clinics, a subcommittee of the American Nurses Association (ANA) Congress on Nursing Practice. She is currently the co-chair of the ANA Congress on Nursing Practice and Economics Health Reform Care Coordination Subcommittee. Ms. Lioce is both a practitioner in advance practice nursing and an educator.

Lioce

Here I am receiving the Applied Gerontology Award in St. Pete at the Southern Gerontological

Society annual meeting last month. I am so proud to receive this honor!

-Dr. Joyce Varner, ASNA President Elect

Applied Gerontology Award

New/RenewMembers

District 1:Frances Gillespie, RNSheila Shook, RNDonna Everett, RN, BS, CICSharon Flanagan, LPNCheryl Bailey, BSN, RN, MBAMark Hodges, RN, NP-CLaTunya Ashford, BSN, RNRebecca Viall, RNRebecca Wierenga, RN, ADN

District 2:Brenda Clearman, RNRhonda Snow, RNBetty Odom, RNSandra Warren, MSN, RN

District 3:Terry Hill, RN, CM, ANDMary Franklin, RNJudith (Kay) Morris, MSN, RNRonda Bush, RNElizabeth Gulledge, MSN, RNTeresa Holt, RNAvis McKay, RNMichelle Stubbs, RNLinda Taylor, RNMarlynn West, RNJohn McCarter, RNJamie Sessions, RNRhonda Thomas, BSN, RN

District 4:Mary H. King, RN

District 5:Alice Antone, RNMildred Negron, RNAngela Nix, RNGwendolyn White, RN

Members, if your credentials are incorrect please accept our apologies and contact April Bishop at [email protected] with corrections.


Financial Corner

by Mark Miehle

Let’s say you leave your job for whatever reason. You get another job, you are ready to retire or you unfortunately are let go. What should you do about your retirement account?

This is a big question for a lot of people. When you leave your job you have to choose between one of three alternatives. Let’s examine what those alternatives are.

The first alternative I name after an old Beatles song: “Let It Be”. That is to do nothing and leave your retirement account right where it is. Now since you are no longer working at your former employer, you are no longer able to make any more contributions. If you are no longer making any more contributions your former employer will no longer contribute to your retirement. The account value of your retirement account is only going up or down based on market conditions.

The second option is to roll your current retirement account into a new retirement account.

If you are going to work at another job, you may roll your previous retirement account into your new employers 401(k) or 403 (b) retirement plan. Not knowing how long you are going to stay at that the new position your money is probably better off than leaving where it was.

What most financial advisors will recommend is that you roll your retirement account into a traditional Individual Retirement Account (IRA). By rolling your retirement account into your own IRA, typically you have

a little more control of your retirement account and more choices of what you can invest in.

For example with IRA’s you are not limited to investing in just cash, bonds, or mutual funds (stocks). Depending on how you set up your IRA you can invest in other products that are guaranteed not to go down in value, but also offer upside potential if the market goes up or if the market doesn’t go up still offer a fixed rate of return.

You can set up an IRA with most brokers, bankers or financial advisors. Be sure to ask them a number of questions such as: What they will do?, Will there be any fees? and others. For a list of questions contact me directly and I will send you free a list of ”10 Tough Questions To Ask a Financial Advisor ”.

Perhaps the most important thing in rolling over is to make sure that you never actually take receipt of the money in the retirement account. You want to make sure that the money rolls directly from one retirement account to another retirement account. This is why it is important to have an experienced advisor help you do it correctly.

Now your last option is the definitely the worst of the three alternatives. The third alternative is to cash out of your retirement account. No matter if you are cashing out an IRA, 401 (k), or 403(b) there are strict guidelines and laws as to when and how you can access your money. With any of this money you can not access it until you reach the age of 59 ½. If you take your money out early not only do you have to pay income tax on that money, but you also have to pay a penalty to IRS in the amount of 10%.

Long-term care issues have been everywhere in the news lately–from stories of people needing these services to how the government is responding. But there is also a lot of conflicting, and even mistaken, information. Misconceptions may have prevented you from including long-term care planning into your retirement portfolio. But long-term care planning can be a critical component to any comprehensive retirement plan. So now is the time to dispel these myths.

Myth #1: I’ll never need long-term careMost people can’t imagine themselves needing long-

term care services. But, the U.S. Department of Health and Human Services indicates that people age 65 face at least a 40% lifetime risk of entering a nursing home sometime during their lifetime1. Living a long life may increase your risk of needing long-term care. Isn’t it better to insure against what that risk may do to your family and your financial plans?

Myth #2: Long-term care is only for the elderlyActually, a surprising amount of long-term care services

are provided to younger people. The U.S. Government Accountability Office estimates that 40% of 13 million people receiving long-term care services are between the ages 18 and 642. The unexpected need for long-term care could arise at any age for any number of reasons, including illness, or an accident.

Myth #3: I’ll pay for my own long-term careIn 2008, nursing home costs averaged over $76,400

a year nationally, but in some regions these costs are sometimes twice that amount3. How long can you pay for these expenses without jeopardizing your financial plan or exhausting your savings? It may make good sense to transfer this financial risk just like you do with your homeowner’s insurance or auto insurance. Even if you can afford to pay for long-term care services out of pocket, why would you want to when you can transfer the cost to an insurer for premiums that may total a fraction of the cost of care?

Myth #4: Medicare will cover my long-term care expenses

Medicare does pay for nursing home care, but only for a maximum of 100 days and if the 3-day qualifying hospital stay requirement has been met. In addition, Medicare will only pay as long as you are showing progress towards recovery. Once your condition becomes stable, even if you are not fully well or back to a completely healthy state of being, Medicare rules indicate that benefits will stop. Also, Medicare does not pay for individuals to attend an adult

Leaving Your Job? What About Your Retirement Account?

The Myths About Long-Term Careday care or for the room & board expenses at an assisted living facility.

Myth #5: Medicaid will cover my long-term care expenses

Medicaid was developed partially to cover long-term care costs for Americans of any age who need help paying for those services. Medicaid is currently the largest payer of long-term care costs in the United States, primarily for care in nursing homes. However, Medicaid focuses on helping people with limited or minimal income and assets, and in order to qualify for benefits, you have to demonstrate a financial need for help. Qualifying means spending nearly all of your own money on your own care before the government will step in to help.

Myth #6: My family will take care of meThe financial, physical and emotional stress that

full-time care-giving may place on families can be overwhelming. Many families have struggled to provide care for parents or siblings only to eventually realize that the care required is more than they can provide. The truth is, sometimes the best way for a family to take care of a loved one needing long-term care is to make sure that they have access to professional care. With the advances in home care services, many people needing long-term care are actually able to stay at home, with or near families, and still get the professional care they need.

Myth #7: Long-term care insurance covers only nursing homes

Everyone wants to stay at home. Long-term care insurance can offer valuable benefits that may keep you at

home for as long as possible. Long-term care insurance can also help cover the cost of care in other locations, such as adult day care centers, assisted living facilities and hospice care.

With long life comes long-term planning. Make a plan for you and your family today. For more information on long-term care insurance, please contact Scott Key, Agent, New York Life Insurance Company at 334-274-4789, E-mail: [email protected].

The purpose of this piece is solicitation of insurance. An insurance producer (agent) may contact you. New York Life Insurance Company long-term care insurance is issued on policy form series ILTC-5000 and INH-5000 with a state identifier and edition date. Example: Examples: for Idaho ILTC-5000 (ID) (1001) and INH-5000 (ID) (1001) and for North Carolina ILTC-5000 (NC) (1001) (Rev. 0606) and INH-5000 (NC) (1001) (Rev. 0606) and for Pennsylvania ILTC-5000 (PA) (1001), FLTC-5000 MLP (PA) (0503), for Tennessee ILTC-5000 (TN) (1001) and INH-5000 (TN) (1001) and for Texas ILTC-5000 (TX) (0305) and INH-5000 (TX) (0305). New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010.

1 Health Insurance Association of America. A Guide to Long-Term Care Insurance. 2007. Page 3.

2 Health Insurance Association of America. A Guide to Long-Term Care Insurance. 2007. Page 3.

3 New York Life Insurance Company. Survey of Nursing Home Costs. 2008.

Editorial Note: The financial articles presented in this column are for informational/educational purposes only. No endorsement by ASNA is given or implied.

For example, let’s say you have $10,000 you are cashing out of your retirement account. Assuming you are under the age of 59 ½, the first thing you get hit with is a 10% penalty or $1,000. Then you have to pay taxes on the $10,000 which will be about $2,800 (assuming a 28% state and federal marginal tax rate). So when you thought you were going to get $10,000 you end up with $6,200. Now you can wait until you are 59 ½ and avoid paying the penalty, but you will never avoid paying the taxes.

Now sometimes there are circumstances or situations where cashing out of a retirement account is necessary to address some financial crisis and despite the penalty, can not be avoided. But most advisors will tell you that you should try all legal means to try not to cash your retirement account in.

If you leave a job for whatever reason, don’t forget that you have three alternative as what you can do with your retirement account. Just like none of you would forget about a patient under our care, don’t forget to care about your retirement account and decide which alternative is best for you.

Mark MiehlePrincipalFirst Fidelity Group LLCDirect Line (205) 266-2136Email: [email protected]

Editorial Note: The financial articles presented in this column are for informational/educational purposes only. No endorsement by ASNA is given or implied

Join the Alabama State Nurses

Association Today!

Download an Application from our website at

www.alabamanurses.org


Research Corner

Some pregnancy-related complications are minimized for women who have had weight-loss surgery

Women who undergo weight-loss surgery, known as bariatric surgery and later become pregnant after losing weight may be at a lower risk for pregnancy-related diabetes and high blood pressure−complications that can seriously affect the mother or her baby−than pregnant women who are obese. The findings are part of an evidence review that was led by Melinda A. Maggard, M.D., M.S.H.S., of the University of California at Los Angeles, and the RAND Corporation in Santa Monica, California, and performed by the Agency for Healthcare Research and Quality’s (AHRQ) Southern California Evidence-based Practice Center at RAND (contract no.290-02-0003). The review was based on findings from 75 studies, including 3 that compared pregnancies of nonobese women with those of obese women as well as with pregnancies of women who lost weight surgically.

In one study of laparoscopic gastric banding, a type of bariatric surgery, the authors found that none of the women who underwent surgery developed gestational diabetes or high blood pressure during their pregnancies. By comparison, 22 percent of obese pregnant women developed diabetes and 3 percent developed high blood pressure in the same study. Thirteen other studies supported these findings. Neonatal outcomes, like preterm delivery, low birth weight, and high

birth weight, were also likely to be better pregnancies of women following bariatric surgery than in pregnancies of obese women.The evidence report also found that:

• Nutritional problems during pregnancy following two types of bariatric surgeries, gastric bypass and laparoscopic gastric band procedures, appear to be uncommon and may result from not following instructions for taking supplements. Nutritional problems appear to be more frequent and severe in mothers who undergo another bariatric surgical procedure, biliopancreatic diversion surgery.

• There is not enough evidence to determine if having bariatric surgery affects the likelihood of needing a cesarean section to give birth.

• There is some evidence to guide a woman’s decision as to how long she should wait after having bariatric surgery to become pregnant. The typical recommended time period is 1 year, which usually coincides with the period of most rapid weight loss.

• The effects of bariatric surgery on a woman’s fertility have not been well studied. Studies including a small number of patients report possible improvement in the ability to conceive and deliver a child following bariatric surgery. These results, along with reports

Women’s Healthof normalization of sex hormones and menstrual irregularities, as well as improvement in polycystic ovary syndrome-a health problem that can affect a woman’s ability to have children-following surgery suggest that fertility many improve.

Some pregnancy-related complications are minimized for women who have had weight-loss surgery. Adverse events following bariatric surgery are probably uncommon; their true incidence is not known and case reports tend to be the main source to date capturing such events. Bowl obstruction, which is most commonly due to internal hernia, is the most frequently reported surgical complication in pregnant women following bariatric surgery procedures. Deaths of mothers and fetuses have been reported in some of these cases. Of note, bowel obstruction also occurs in bariatric surgery patients who do not become pregnant.

Details are in “Pregnancy and fertility following bariatric surgery: A systematic review,” by Dr. Maggard, Irina Yermilov, M.D., M.P.H., Zhaoping Li, M.D.,Ph.D, and others, in the November 19, 2008 JAMA, 300(19), pp. 2286-2296. The evidence report, Bariatric Surgery in Women of Reproductive Age: Special Concerns for Pregnancy, AHRQ publication no. 08-E013, is available online at www.ahrq.gov/clinic/tp/barireptp.htm. Printed copies of the report are also available from AHRQ.

Reprinted from January, 2009 Research Activities

Jennifer Bell, Ph.D.; Jim Collins, Ph.D., MSME; Traci L. Galinsky, Ph.D.;

Thomas R. Waters, Ph.D., CPE

Healthcare workers often experience musculoskeletal disorders (MSDs) at a rate exceeding that of workers in construction, mining, and manufacturing.1 These injuries are due in large part to repeated manual patient handling activities, often involving heavy manual lifting associated with transferring, and repositioning patients and working in extremely awkward postures. The problem of lifting patients is compounded by the increasing weight of patients to be lifted due to the obesity epidemic in the United States and the rapidly increasing number of older people who require assistance with the activities of daily living.2,3

Direct and indirect costs associated with back injuries in the healthcare industry are estimated to be $20 billion annually.4 Additionally, nursing aides and orderlies suffer the highest prevalence (18.8%) and report the most annual cases (269,000) of work-related back pain among female workers in the United States.5 In 2000, 10,983 registered nurses (RNs) suffered lost-time work injuries due to lifting patients. Twelve percent of nurses report that they left the nursing profession because of back pain.6

As our nursing workforce ages (average age 46.8 years) and we face a critical nursing shortage in this country (an expected 20% shortage by 2015 and 30% by 2020), preserving the health of our nursing staff and reducing back injuries in healthcare personnel is critical. The National Institute for Occupational Safety and Health (NIOSH) has a comprehensive research program aimed at preventing work-related MSDs with major efforts to reduce lifting injuries in healthcare settings. NIOSH’s research with diverse partners has already made great strides in developing and implementing practical intervention strategies, with further progress expected.

The first research effort was a comprehensive lab and field study to identify safer ways to lift and move nursing home residents by removing the excessive forces and extreme postures that can occur when manually lifting residents. Historically, the caregiver has used his or her own strength to provide manual assistance to the resident. NIOSH conducted a large field study to determine if an intervention consisting of mechanical equipment to lift physically dependent residents, training on the proper use of the lifts, a safe lifting policy, and a preexisting medical management program would reduce the rate and the associated costs of the resident handling injuries for the nursing personnel in a real world setting.7

During the 6-year period, from January 1995 through December 2000, 1,728 nursing personnel were followed before and after implementation of the intervention. After the intervention, there was a significant reduction in injuries involving resident handling, workers’ compensation costs, and lost work day injuries. When injury rates associated with patient handling were examined, workers’ compensation claims rates per 100 nursing staff were reduced by 61%; Occupational Safety and Health Administration (OSHA) recordable injury rates decreased by 46%; and first reports of employee injury rates were reduced by 35%. The initial

Preventing Back Injuriesinvestment of $158,556 for lifting equipment and worker training was recovered in less than 3 years on the basis of post-intervention savings of $55,000 annually in workers’ compensation costs and potentially more quickly if indirect costs (lost wages, cost of hiring and retraining workers, etc.) are considered. This is significant given that cost is an often cited barrier to purchasing lifting equipment. Another advantage of lifting equipment is the reduction in the rate of assaults on caregivers during resident transfers—down 72%, 50%, and 30% on the basis of workers’ compensation, OSHA recordable incidents, and the first reports of injury data, respectively.

More information on this study can be found in the NIOSH publication Safe Lifting and Movement of Nursing Home Residents. Based on the successes achieved in the long-term care industry, NIOSH is undertaking a six-year longitudinal research study to evaluate the effectiveness of a “best practices” safe patient handling program at two large acute-care hospitals in the United States.

Another major study demonstrating success in reducing back injuries to health care workers was funded by NIOSH through a cooperative agreement. The study examined the long-term effectiveness of a safe lifting program with the primary objective to reduce injuries to healthcare workers resulting from manual lifting and transferring of patients..8 The safe lifting programs, which used employee management advisory teams (participatory-team approach), were implemented in seven nursing homes and one hospital. The eight facilities varied in the available number of beds and number of nursing personnel. In this study, manual lifting and transferring of patients was replaced with modern, battery operated, portable hoists, and other patient-transfer assistive devices. Ergonomics committees with nearly equal representation from management and employees selected the equipment and implemented the safe lifting programs.

Injury statistics were collected post-intervention for 51 months and were compared with 37 months of pre-intervention data. The results were compelling. The number of injuries from patient transfers decreased by 62% (range = 3979%), lost work days by 86% (range = 5099%), restricted workdays by 64% (96% decrease to 17% increase), and workers’ compensation costs by 84% (range = 5399%). Overall, the eight facilities experienced decreases of 32% in all injuries, 62% in all lost work days, 6% in all restricted work days, and 55% in total workers’ compensation costs. The program produced many intangible benefits including improvements in patient comfort and safety during transfers and patient care. The nursing personnel perceived that their backs were less sore and that they were less tired at the end of their shifts. More pregnant and older workers were able to perform their regular duties and stay on the job for a longer period.

Despite the obvious advantages to using lifting equipment, schools of nursing continue to teach, and nurses’ licensure exams9 continue to include, outdated and unsafe manual patient handling techniques. This is due in large part to outdated books and curricula which promote unsafe patient handling practices. To address this, a team of experts from NIOSH, the American Nurses Association, and the Veterans

Health Administration developed and evaluated an evidence-based training program on safe patient handling for educators at schools of nursing. The study found that when using the curriculum, nurse educator and student knowledge improved significantly as did the intention to use mechanical lifting devices in the near future.10,11 The curriculum module, which won the 2008 National Occupational Research Agenda (NORA) Partnership Award, is ready for broad-scale dissemination across nursing schools to reduce the risk of MSDs among nurses.

Looking ahead: Beginning in 2009, NIOSH will conduct a project aimed at improving safety while lifting and moving bariatric patients. In healthcare settings, the term “bariatric” is used to refer to patients whose weights exceed the safety capacity of standard patient lifting equipment (300 lbs), or who otherwise have limitations in health, mobility, or environmental access due to their weight/size.12 Compared to the non-obese population, obese individuals require more frequent and extensive healthcare due to obesity-related health problems, and healthcare personnel are encountering hospitalized and critical-care bariatric patients on an increasingly frequent basis.13,14,15 In the extreme, such patients can weigh over 1,200 pounds. The upcoming NIOSH project will evaluate bariatric patient handling practices at multiple hospitals, including intervention programs and health/safety outcomes, in order to identify and promote evidence-based best practices.

We all have a vested interest in taking care of those who help take care of us and our families when we need medical attention. It is likely that the implementation of the research presented here will significantly reduce injuries and illnesses for healthcare workers and increase the quality of patient care. In turn, reducing MSDs among nurses may help address the critical issues of nurse recruitment and retention.

As we contemplate further research, we would like to hear about your experiences with lifting equipment and practices in medical settings. Additionally, your thoughts about retooling student nursing curriculum as well as your opinions on state laws regulating safe patient handling and movement would be appreciated.

Dr. Bell is a research epidemiologist in the Analysis and Field Evaluations Branch in the NIOSH Division of Safety Research.

Dr. Collins is (Captain, U.S. Public Health Service) is the Associate Director for Science for the NIOSH Division of Safety Research.

Dr. Galinsky (Captain, U.S. Public Health Service) is a research psychologist in the NIOSH Division of Applied Research and Technology.

Dr. Waters is a research safety engineer in the Division of Applied Research and Technology.

“Reprinted from the NIOSH Science Blog. To comment on this piece visit the blog at www.cdc.gov/niosh/blog/ns092208_lifting.html”


Elizabeth A. Morris Clinical Education Sessions

Our annual Elizabeth A. Morris Clinical Education Sessions–FACES 2009 was held on Tuesday, 21 April at the Eastmont Baptist Church in Montgomery. We had another tremendously successful event, with over 600 attendees, an outstanding lineup of excellent speakers and presenters, and a list of terrific exhibitors. This was our fourth year at Eastmont, and the church staff was, as always, very supportive and welcoming. Those of you that enjoyed lunch at the church can also testify that the prepared meal was delicious; never mind the great desserts! This year we had an extensive series of tracks from which to choose: AANS; three different clinical tracks; Education and Research; Geriatries; Pediatrics; Women’s Health and Parrish Nursing. In addition, the poster presentations were excellent, with 1st place winners Diane Bilotta, MSN, RN, CPAN, Deborah Wagner, RN, CNOR, Shellie Miles, RN, Guy Harrell, RN & Patrick Lux, RN, CCRN (Building a Safe Patient Handling Program…) and Dr. Tina Holloway. (Does Patient Perception of Quality Impact Health Outcomes). Honorable Mention (the Geriatric Units for Maintaining Functional Levels), Elizabeth Drinkard, Christian Killingsworth,LisaKopecandJohnPinkston.Please see a list of our sponsors and exhibitors elsewhere in this issue.

A Special Thank You to Our Exhibitors and Sponsors at Elizabeth A. Morris Clinical

Education Sessions (FACES)

Sponsors:

Arthur L. Davis Publishing Agency, Inc.

Exhibitors:

Alabama Auxiliary of the Gideons InternationalAlabama Organ Center

ALL KidsDCH Health SystemFirst Fidelity Group

Jackson HospitalJSU College of Nursing & Health ScienceMiddle Tennessee School of Anesthesia

Plexus BiomedicalRinehart & Associates

Troy UniversityUniversity of Alabama, Capstone College of Nursing

FACES


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Alabama Board of Nursing

Katie Drake-Speer, MSN, RNNurse Consultant, Continuing Education

Alabama Board of Nursing

Alabama licensed nurses are required to have 24 contact hours (not CEUs) of continuing education to renew their nursing licenses. Rules and regulations regarding continuing education are published in the Alabama Administrative Code. The Alabama Board of Nursing (ABN) revised the continuing education rules, effective March 30, 2009, to clarify course content, method of obtaining the contact hours, and to address contact hours allowed by standardized national programs.

Continuing Education ContentContinuing education is planned, organized learning

experiences designed to augment the knowledge, skill, and attitudes for the enhancement of the practice of nursing to the end of improving health care to the public. To answer frequent questions about courses not directly related to nursing practice, the ABN included specific examples in the revised rules of types of courses/classes that are not acceptable to use as contact hours. The unacceptable types of courses include:

• Self improvement classes (weight loss, self-awareness, self-therapy, changes in attitude, and yoga).

• Classes designed for lay people.• Classes taken for personal economic gain (investment,

retirement, financial planning).• Orientation programs (specific activities designed

to familiarize employees with the policies and procedures of an institution or specific job duties, or general orientation in–service).

Continuing Education Contact HoursTo allow the licensed nurse flexibility in selecting which

method to obtain continuing education contact hours, there is no longer a distinction between attended or independent study continuing education contact hours. In the old rules, licensed nurses were limited to 12 continuing education

Changing the Look of CE for Nurses in Alabamacontact hours for independent study.

Continuing education earned from a Board–approved or Board–recognized provider in any of these activities is acceptable and the licensed nurse can earn all required continuing education contact hours from these activities (ABN Administrative Code, Rule 610-X-10-.05): workshop, seminar, classroom, web cast, internet courses, intranet courses, home study courses, continuing education contained in journals and pod cast.

If approved by a Board-approved provider, a licensed nurse can earn continuing education for the development and oral presentation of a paper before a professional or lay group (on a subject that explores new or current areas of nursing theory, or practice); authoring or contributing to an article, book, or publication; or designing or conducting a research study. Licensed nurses can earn one time credit for a single presentation or project. Board–approved providers may award credit for presentations or research activities that are not part of regular job requirements e.g., if a job requirement includes instructing in ACLS courses, continuing education credit should not be allowed. If however, a licensed nurse presents a segment or entire ACLS course as a professional endeavor outside the job, the Board–approved provider may choose to award contact hours in accordance with the degree of participation. The Board–approved provider must electronically transfer the award of contact hours to the ABN. The licensed nurse cannot enter the class information to his or her online individual continuing education record.

Standardized National ProgramsThe ABN recognizes continuing education offered

by national approving bodies and by providers who offer standardized national programs. The ABN accepts standardized national programs for continuing education in accordance with ABN Administrative Code, Rule 610-X-10. The national provider determines the number of hours and the ABN staff contacted these providers to obtain the number of contact hours identified for each program.

The licensed nurse must maintain evidence of the number

of hours awarded by maintaining the certificate or card awarded upon completion of the course/class.

The hours listed in the rule and seen below are the maximum number of contact hours the Board shall recognize, unless an Alabama Board of Nursing -approved provider awards more in accordance with Rule 610-X-10-.04 of the ABN Administrative Code. The ABN accepts the following standardized courses:

• Basic Life Support Healthcare Provider Initial Course: 4.5 contact hours.

• Basic Life Support Healthcare Provider Renewal Course: 3 contact hours.

• Advanced Cardiac Life Support Initial Course: 13.5 contact hours.

• Advanced Cardiac Life Support Renewal Course: 9 contact hours.

• Pediatric Advanced Life Support Initial Course: 14 contact hours.

• Pediatric Advanced Life Support Renewal Course: 8.5 contact hours with optional lessons; 6.5 contact hours without the optional lessons.

• Trauma Nursing Core Course (TNCC): 14.42 contact hours.

• Emergency Nursing Pediatric Course (ENPC): 15.33 contact hours.

• Course in Advanced Trauma Nursing (CATN): 13 hours

• Cardiopulmonary Resuscitation/Automatic External Defibrillator (CPR / AED) for Professional Rescuer: 8 contact hours for initial course or four (4) contact hours for review / update course

• Instructor Course for CPR / AED for Professional Rescuer: 16 contact hours

• International Trauma Life Support (a) International Trauma Life Support–Advanced

Provider: 16 contact hours(b) International Trauma Life Support–Instructor: 8

contact hours(c) International Trauma Life Support–Pediatric–

Provider: 8 contact hours• Neonatal advanced life support or neonatal

resuscitation program: The Board may recognize the total contact hours awarded by a Board-approved or Board-recognized provider.

Submission of HoursThe ABN receives frequent inquires from licensed nurses

regarding how and when to add class information to their online individual continuing education record.

Since January 2006, all ABN-approved providers are required to electronically transfer class information to the ABN. Class information submitted by the Board–approved provider will populate the licensed nurse’s individual online continuing education record. The licensed nurse cannot edit the entries made by the Board–approved provider. However, licensed nurses can add class information from recognized providers to their record. Licensed nurses can access their online individual record at the ABN web site, www.abn.alabama.gov.

The Continuing Education Earning PeriodThe Continuing Education Earning Period is the two-

year period of time during which contact hours are earned for license renewal. The license renewal year for licensed practical nurses occurs every odd year. The license renewal year for registered nurses occurs every even year. Effective January 1, 2008, the earning period for licensed practical nurses is the same as the license period. The earning period is from January thru December. Although the earning period is January 1, 2008 through December 31, 2009, for the 2009 LPN renewal nurses may use continuing education earned between October 1, 2007-December 31, 2009 to meet the continuing education renewal requirement.

Effective January 1, 2009, the earning period for registered nurses is the same as the license period. RNs renewing in 2010 must earn their continuing education contact hours from January 1, 2009 through December 31, 2010.

The changes in the new CE rules should assist all licensed Alabama nurses in meeting the continuing education requirements for license renewal. If you have questions please contact the continuing education area, 1-800-656-5318, [email protected] or [email protected]

For a detailed review of the rules, you can access them at www.abn.alabama.gov by clicking on Administrative Code and then selecting Chapter 610-X-10 Continuing Education for Licensure.

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