Representative Pierson, who is an RN and an MNA member, sponsored our “Combat Boots” campaign legislation to address the lack of reporting identified by some of the legislators last session as a significant reason why they could not support our efforts to address violence against nurses and healthcare workers. MNA would like to thank Representative Pierson, RN for championing our legislative efforts surrounding our “Your Nurse Wears Combat Boots” campaign.

On page 4 is a copy of HB 538 – “Require reports of acts of violence against healthcare workers,” followed by the testimony MNA provided to the House Judiciary Committee, and the committee members who voted yes to table our bill (essentially killing the bill) and not allowing it out of committee and proceed to the house floor.

MNA Testimony:The Montana Nurses Association is the recognized

leader and advocate for the professional nurse in Montana. The MNA promotes professional nursing practice, standards and education; represents professional nurses; and provides nursing leadership in promoting high quality health care.

“The nursing profession will no longer tolerate violence of any kind from any source.”

Being assaulted while on duty is not a part of our jobs. This remains one of the top issues for nurses across the state of Montana. We know we can make a difference through legislation, education, and culture change.

Violence against healthcare workers rates are rising. Between 2007 and 2017, rates of violence in hospitals grew by 123 percent and our MT healthcare worker assault rates, as published by the MT DOL, rank higher

than the national averages.In the 2017 Montana legislature the House

Judiciary committee was very clear that they needed reporting data to support felony legislation. When this committee considered our bill last session to increase the penalties for those

THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION FOUNDATION Quarterly publication direct mailed to approximately 19,000 RNs and LPNs in Montana.

May 2019 • Vol. 56 • No. 2

www.mtnurses.org

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Executive Director Report

Professional Development DepartmentPage 9

current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

APRN CornerPage 15

Vicky Byrd,MSN, RN, Chief

Executive Officer

“Your Nurse Wears Combat Boots” Campaign

assaults, a representative was interviewed following that session and questioned whether there really was a problem. The representative stated that the nurses hadn’t done enough to make their case, and wondered why nurses hadn’t provided police reports for the more than 2,000 workers’ comp claims that had been paid in a recent five-year period. The representative went on to state that they noted that when the nurses told the committee about the actual 2,155 workmen’s comp claims paid to workers because of physical attacks over a five-year period (outlined in the DOL study that reviewed thousands of Montana claims), the nurses didn’t also provide the committee with actual police reports for all those claims and was quoted to say “that is a big problem.”

So, our goal was to somehow create, encourage, and support reporting as it has already been proven these assaults are severely underreported.

We continue to partner with our facilities to assist in developing more robust safety education and more aggressive safety strategies.

HB 538 is a simple mandatory reporting law, we are not charging anyone with a felony here, we are not calling it a crime of violence, we are simply stating that if the nurse or healthcare worker, while on duty, has experienced violence (which is used alone many times in code, but isn’t given its own definition) they are just reporting it. Patients are already protected if they act unknowingly or unintentionally, the nurse doesn’t report it, therefore there is no obligation on behalf of the facility, however, in the absence of transparent reporting through the facility to law enforcement, the intentional/purposeful attackers are being protected. This bill will help shed light on what’s happening and where it’s happening to more effectively address the issue.

We worked with lawmakers and the sheriff’s and peace officers, the Attorney General’s office, and reached out to the county attorneys over the last two years. We discussed the lack of reporting with law enforcement and they want healthcare workers to report these assaults. The employers will have the most accurate data on frequency and severity. This information has to be reportable and made accessible to address the violence problem effectively.

At the federal level, many nurses and healthcare organizations have been working for years to get

Executive Director Report Continued on page 4

Page 2 Montana Nurses Association Pulse May, June, July 2019

CONTACT MNAF & MNAMontana Nurses Association Foundation

and Montana Nurses Association20 Old Montana State Highway, Clancy, MT 59634• Phone (406) 442-6710 • Fax (406) 442-1841

• Email: info@mtnurses.org • Website: www.mtnurses.orgOffice Hours: 7:30 a.m.-4:00 p.m. Monday through Friday

VOICE OF NURSES IN MONTANAMNA is a non-profit, membership organization that advocates for nurse competency, scope of practice, patient safety, continuing

education, and improved healthcare delivery and access. MNA members serve on the following Councils and

other committees to achieve our mission:• Council on Practice & Government Affairs (CPGA)• Council on Economic & General Welfare (E&GW)• Council on Professional Development (CPD)• Council on Advanced Practice (CAP)

MISSION STATEMENT - MNAFPreserve the history of nursing in Montana and contribute, support and

empower the professional nurse in Montana.

MISSION STATEMENT - MNAThe Montana Nurses Association promotes professional nursing practice, standards and education; represents professional nurses; and provides

nursing leadership in promoting high quality health care.

PROFESSIONAL DEVELOPMENTMontana Nurses Association is accredited as an approver of continuing

nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Montana Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s

Commission on Accreditation.

MNAF & MNAStaff:Vicky Byrd, MSN, RN, Chief Executive OfficerPam Dickerson, PhD, RN-BC, FAAN, Director of Professional DevelopmentMary Thomas, BA, RN, RN Professional Development AssociateCaroline Baughman, BS, Professional Development AssociateRobin Haux, BS, Labor Program DirectorAmy Hauschild, BSN, RN, Labor RepresentativeSandi Luckey, Labor RepresentativeLeslie Shepherd, BSN, RN, Labor RepresentativeJill Hindoien, BS, Chief Financial OfficerJennifer Hamilton, Administrative Assistant

Board of DirectorsExecutive Committee:Board of Directors President Lorri Bennett, RNBoard of Directors Vice President Terry Dutro, MSN, APRN, AGPCNP-BCBoard of Directors Secretary Chelsee Baker, BSN, RN Board of Directors Treasurer Audrey Dee, RNBoard of Directors Member at Large Anna Ammons, BSN, RN, PCCNBoard of Directors CPGA Bobbie Cross, RNBoard of Directors PD Cheryl Richards, MS, BSN, RN-BCBoard of Directors CAP John Honsky, APRNBoard of Directors EGW Brandi Breth, BSN, RN-BC

Council on Practice & Government Affairs (CPGA)Abbie Colussi, RN Lisa Ash, RN, CNORAnna Ammons, BSN, RN, PCCN Jennifer Miller, RNLoni Conley, BSN, RN

Council on Professional Development (PD)Sandy Sacry, MSN, RN Cheryl Miller, MSN, RN-BCGwyn Palchak, BSN, RN-BC, ACM Debby Lee, BSN, RN-BC, CCRPEmily Michalski-Weber, MSN, RN-BC Abbie Colussi, RNBrenda Donaldson, BA, RN, CAPA Kim Reynen, BSN, RN

Council on Advanced Practice (CAP)Chairperson-CAP Deborah Kern, MSN, FNPChairperson Elect-CAP Keven Comer, MN, FNP-BCSecretary-CAP Nanci Taylor, APRNMember at Large-CAP Barbara Schaff, FNP-BCMember at Large-CAP Emily Michalski-Weber, MSN, RN-BC

Council on Economic & General Welfare (EGW)Delayne Stahl, RN, OCN Krystal Frydenlund, RN, CCRNLisa Ross, RN, CCRN Adrienne Harrison, RN

Questions about your nursing license?Contact Montana Board of Nursing at: www.nurse.mt.gov

Enjoy a user friendly layout and access to more information, including membership material, labor resources, Independent Study Library,

a new Career Center for Job Seekers & Employers, and more downloadable information.

Please visit MNA’s constantly updated website!

www.mtnurses.org

If you wish to no longer receive The Pulse please contact Monique:

mheddens@aldpub.com

If your address has changed please contact Montana Board of Nursing at:

www.nurse.mt.gov

PUBLISHER INFORMATION & AD RATESCirculation 19,000. Provided to every registered nurse, licensed practical nurse, nursing student and nurse-related employer in Montana. The Pulse is published quarterly each February, May,

August and November by Arthur L. Davis Publishing Agency, Inc. for Montana Nurses Association, 20 Old Montana State Highway,

Montana City, MT 59634, a constituent member of the American Nurses Association.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.

com. MNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for

errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Montana Nurses Association of products

advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. MNA and

the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of MNA or

those of the national or local associations.

WRITER’S GUIDELINES:MNA welcomes the submission of articles and editorials related

to nursing or about Montana nurses for publication in The PULSE. Please limit word size between 500–1000 words and provide resources and references. MNA has the Right to accept, edit or

reject proposed material. Please send articles to: jennifer@mtnurses.org

PULSE SUBMISSIONS

We are gathering articles that are relevant and appealing to YOU as a nurse. What is happening in your world today? Is there information we can provide that would be helpful to you? The Pulse

is YOUR publication, and we want to present you with content that pertains to your interests.

Please submit your ideas and suggestions to Jennifer.

Jennifer@mtnurses.org

What was MNA’s New Year’s Gift to its Members? MNA in collaboration with ANCC, now offers certification through ANCC’s Success Pays© Program. MNA is so excited to support you in your own professional development journey, support your employers in increasing the number of certified nurses in the workforce, and help to improve quality of care provided to the citizens of Montana.

Mary Thomas, BA, RNRN Professional

Development Associate

New MNA Member BenefitDo you have test taking anxiety? If you are

unsuccessful the first time, you can retest! You only pay the discounted fee of $260 when you PASS!

How do you sign up? Go to the MNA website www.mtnurses.org and click on the Success Pays© located in the left hand column. The MNA office will send you eligibility requirements for your Certification selection.

So how is the Success Pays© Program doing? As of March 13th, 2019 we have 31 nurses signed up! We have 13 nurses who want to be certified in Medical-Surgical Nursing (RN-BC); four in Psychiatric-Mental Health Nursing (RN-BC); two in Pediatric Nursing (RN-BC); two in Ambulatory Care Nursing (RN-BC); one each respectively in Pain Management Nursing (RN-BC), Family Nurse Practitioner (RN-BC), Adult-Gerontology (RN-BC)

Clinical Nurse Specialist (AGCNS-BC) and Ambulatory Care Nursing! What a benefit to your community you are! MNA is Proud of YOU!

Five nurses are registering to test! Two nurses have the date of their testing! Congratulations to the first nurse to pass their test and is Board Certified in Medical-Surgical Nursing! Her credentials, in case you haven’t noticed, now will be RN-BC. Please display this proudly on your name tag! You earned it!

Did I mention that MNA is the first constituent/state nurses association to collaborate with the ANCC Success Pays® program!! Please take advantage of this wonderful benefit for MNA members!

May, June, July 2019 Montana Nurses Association Pulse Page 3

Labor Reports and News

Each year, your MNA Labor Department works with our member bargaining teams to negotiate new contracts. One of the most effective ways to improve our contracts through bargaining, is the ability for your bargaining teams to send a strong, unified message to the employer. The more engaged your members are, the STRONGER your local will be, and this strength… will impact positive change!

Increasing membership and union education through early engagement is the easiest way to begin building strength. Catching nurses early to

*New & Improved-New Nurse Orientation Program*

educate them on understanding what it means to be a union nurse at YOUR facility and what their rights are, is key to improving engagement. Education equals engagement, and this requires a plan for communication.

The Labor Department has created a NEW, New Hire Orientation program that can provide you with better tools to educate your new members. This includes new packets with more relevant information, training on tough questions you may be asked, scripts to use during orientation presentations, and a follow-up plan. Myles Aion, our newest Labor Department member, has worked to create a wonderful educational opportunity to help all our locals improve engagement and we would LOVE to bring this to you!

Call the MNA office for more information! In the meantime, check our new video to hear why some of our nurse leaders and members value their Union! Visit this link: https://www.youtube.com/watch?v=5D6JZY-tFWk

Robin Haux, BSLabor Program

Director

Is this your bargaining year?Before the end of the year,

I will have bargained with seven different Locals in 2019. SEVEN! While every experience bargaining is unique, there are things that ring true each time I go to the table. Negotiation years are a time of solidarity and change; with each aspect driving the other.

Change for the positive is what bargaining is all about. Our goal is always to make improvements to your contracts through negotiations with your employers. When you, as nurses, sit across the table from your employer and negotiate, your opinions drive the changes. This process exemplifies why each RN’s voice matters. This is where your voices are heard… if you participate.

Most union employees understand the importance of the bargaining process, which fosters engagement and solidarity among its members. Truthfully, no one understands the importance of bargaining like the bargaining team members. As a member of the bargaining team, you represent the collective voices of your fellow nurses, your union. Part of your role as bargaining team or support team member is to foster engagement of your fellow nurses to ensure they are represented during bargaining.

Tools for engagement vary from meetings and sticker/button days to community events and major support campaigns. When using these tools, your goal is always to have a strong united front on any issue or change being brought forward. One of the most effective tools to gather information on the opinion of your union members is through a survey. The nurses who participate in meetings and surveys will help drive changes to the contract. Sadly, if you don’t participate and share your views, it is impossible for your bargaining team to advocate for you. This is where engagement of each nurse is important.

Unions who have little engagement during bargaining, have little impact on the changes in their contract. It ends up being the handful of nurses who sit at the table that drive the few changes that are brought forward. It is up to each of YOU to create success during bargaining. Without the support of your nurses, your bargaining team will struggle to make any significant change. Your strength is exercised when you all stand together. The more engaged your union members are the more you are able to make crucial changes to your contract. Solidarity has power, but you all must participate to harness it.

“Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world.”

– Joel A. BarkerSo I implore you… participate in creating a vision for

your union, then take action to create change.

Leslie Shepherd, BSN, RN, Labor Representative

Don’t Sweat the Small Stuff

Amy Hauschild, BSN, RN, Labor Representative

I bet we can agree that life can be stressful and sometimes not that much fun. There are so many factors which influence us as the individuals we are; they shape the way in which we react to situations and how we interact with others. The digital age has only ramped this up, barraging us with data and information from both our personal and professional lives.

In the labor business it is not unusual for the employer and their nurses to have differing interests. It doesn’t mean conflict needs to ensue or the relationship needs to deteriorate into an adversarial one. Unfortunately, sometimes that happens and it can be very difficult to get the relationship back on track.

The negotiation process isn’t always tense or conflictual, though sometimes it does end up that way. It’s not unusual for one party or the other, or perhaps both, to get into a negative place. That tiny little voice keeps reliving past conflicts and is just sure “they are out to get us.” Proposals are read and re-read trying to find the “gotcha.” So much energy and so much time goes into negativity and the team dynamic erodes into a very dysfunctional group. When this happens it is really hard to get the job done and, more importantly, the relationship suffers.

A very wise RN on one of the teams I participated in once asked both parties to go into interactions with each other with a positive presumption of intent. Thank you, Lyle, you taught me a very valuable lesson. A positive presumption of intent means the parties turn off that nasty little voice, and presume the other party is entering the interaction with good intent. This is easier said than done.

I have asked other teams to take this approach as well. Seek to understand, ask more questions, come right out and inquire about intent. There is always that single question which one must ask themselves and their teammates – what don’t we know? There are so many factors that go into our individual make-ups, so many factors involved in communication and emotion, which can all lead us down the rabbit hole and a resultant chasm of understanding occurs.

Life is short, if we can let more roll off our collective backs and can drill down to the real core of an issue and deal with it, without the cloud of negative intent and harboring old angst and anger, we will all be better for it.

I am using more and more mindfulness and relaxation with my teams these days and it is working really well. Change is not easy nor instant. Focus on the positive and remember folks – we rise up together for the greater good. We might have to cry it out, or yell it out, or hug it out, but remember, don’t sweat the small stuff and remain united.

I Didn’t Know What to Expect

Jennifer Reid, RN

I have worked at my hospital for 19 years. I have never been involved in my union before, but something in our contract has been eating away at me for years. I decided the only way to make a difference is to get involved, and “figure this union thing out.” I don’t know what my expectation was for bargaining, but I was very nervous and uneasy, especially the first day. As it went on and we proposed things, and won some of them, I started to feel better. I fought for and won that issue that was weighing on my heart. It feels so incredibly awesome to make a difference for current employees and future employees. Now I feel empowered, not scared. I learned it is IMPORTANT to work to make a difference for my co-workers and be their voice to bring light to their ideas and concerns.

MNA District Map

Page 4 Montana Nurses Association Pulse May, June, July 2019

an enforceable OSHA standard to prevent workplace violence. Next week, MNA (myself and another MNA nurse who shared her assault story) will be attending the congressional hearing on Wednesday February 27th in support of the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309), introduced this week by Congressman Joe Courtney and we will be speaking to the National Press in support of this bill. MNA was chosen because of the hard work we have done with our Combat Boots campaign and Senator Courtney will be using our MT nurse’s assault story to introduce this bill to address workplace violence at the federal level.

So at the state level… Because the nurses’ anecdotal experiences were not enough, their stories, some horrific, were not enough, the statistics were not enough, workers compensations claims were not enough, supportive evidence-based literature and research was not enough, …we have heard you loud and clear and bring forward HB 538 for a do pass.

House Judiciary Vote on HB 538: Those voting to table the bill voted against MNA and killed the bill. Those voting to NOT table the bill voted with MNA to move the bill forward.

As we continue to address Montana nurse’s professional and work environment issues, nurses across the state of Montana have continued to identify workplace violence as one of the most important issues they need addressed.

At the national level, H.R. 1309/S. 851 – The Workplace Violence Prevention for Health Care and Social Service Workers Act, will require the creation of safety plans to prevent workplace assaults in healthcare and social services settings. Healthcare and social service workers – people who care for our elderly, sick and vulnerable populations – need safety plans supported by evidence-based

Executive Director Report Continued from page 1

Alan Doane (R) HD 36 Bloomfield Chair – voted to table the bill

Kathy Kelker (D) HD 47 Billings Vice Chair – voted to table the bill

Barry Usher (R) HD 40 Billings Vice Chair – voted to table the bill

Seth Berglee (R) HD 58 Joliet Member – voted to table the bill

Barbara Bessette (D) HD 24 Great Falls Member – voted to NOT table the bill

Laurie Bishop (D) HD 60 Livingston Member – voted to table the bill

Bob Brown (R) HD 13 Thompson Falls Member – voted to table the bill

Greg DeVries (R) HD 75 Jefferson City Member – voted to table the bill

David Dunn (R) HD 9 Kalispell Member – voted to table the bill

Robert Farris-Olsen (D) HD 79 Helena Member – voted to NOT table the bill

Connie Keogh (D) HD 91 Missoula Member – voted to NOT table the bill

Casey Knudsen (R) HD 33 Malta Member – voted to table the bill

Jasmine Krotkov (D) HD 25 Niehart Member – voted to table the bill

Dennis R Lenz (R) HD 53 Billings Member – voted to table the bill

Theresa Manzella (R) HD 85 Hamilton Member – voted to NOT table the bill

Terry Moore (R) HD 54 Miles City Member – voted to table the bill

Shane A Morigeau (D) HD 95 Missoula Member – voted to NOT table the bill

Zac Perry (D) HD 3 Hungry Horse Member – voted to NOT table the bill

Derek Skees (R) HD 11 Kalispell Member – voted to table the bill

solutions. According to a 2017 survey from the U.S. Bureau of Labor Statistics, these workers experience 69 percent of reported workplace violence injuries, and they are nearly five times more likely than other workers to be assaulted on the job. This problem has gotten worse over the past decade. Between 2007 and 2017, the rate of violent injuries grew by 123 percent in hospitals, 201 percent in psychiatric and substance use treatment facilities, and 28 percent in social service settings.

Our national affiliate, American Federation of Teachers (AFT), Nurse and Healthcare Professionals (AFTNHP), invited Montana to participate at the hearing for H.R. 1309 when it was introduced by Representative Courtney in the House of Representative in Washington DC.

AFTNHP supported MNA to attend a press conference and the hearing due to the amazing work we have done with the “Your Nurse Wears Combat Boots” campaign. Our member, Adrianne Harrison, and myself, were able to attend and actively participate in the press conference and hearing on February 27th, 2019 in Washington, DC.

As our efforts at the state level were tabled, our efforts at the national level continue as violence against healthcare workers affects us all. Please see the two below fact sheets from AFTNHP addressing workplace violence prevention. Think about taking action to let our congressmen in Washington DC know this is important legislation we need them to co-sponsor H.R. 1309/S. 851, and use the fact sheet provided!

Senator Jon Tester Senator Steve Daines Representative Greg Gianforte

Ph: 202-224-2644 Ph: 202-224-2651 Ph: 202-225-3211

E: tester.senate.gov E: daines.senate.gov E: gianforte.house.gov

May, June, July 2019 Montana Nurses Association Pulse Page 5

When you began your healthcare career, you probably did not expect assaults and threats to be part of your job description – yet incidents of violence from patients, clients or visitors have become all too common. Healthcare and social services workers experience 69 percent of reported workplace violence injuries, and they are nearly five times more likely to be assaulted at work than the rest of the labor force.1 One study of staff working in psychiatric hospitals found that 85 percent of the incidents of workplace violence were never reported.2

Prevention Is PossibleSince 1996, the Occupational Safety and Health

Administration has offered guidance to employers on how to prevent violence though comprehensive programs. Research has shown that these programs can reduce the number and severity of assaults.3 But because OSHA guidance is voluntary, many employers have either failed to adopt programs or only partially implemented them. Meanwhile, between 2007 and 2017, the rate of violent injuries grew by 123 percent in hospitals, 201 percent in psychiatric hospitals and substance use treatment facilities, and 28 percent in social services settings.4

In 2016, the AFT petitioned OSHA to set an enforceable standard to protect workers in the healthcare and social services industries, but the standard has languished during the Trump administration.

It’s Time for Congress to Require OSHA to Set a Standard

Reps. Joe Courtney (D-Conn.) and Bobby Scott (D-Va.) have introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act of 2019. This bill will direct OSHA to develop an enforceable standard within 18 months of the bill’s passage. The standard will require healthcare and social services employers to implement and maintain comprehensive workplace violence prevention programs with meaningful participation of direct care employees. The bill defines workplace violence as the threat or use of physical force against an employee, regardless of whether an injury is sustained.

Employers will be responsible for implementation of a plan based on an assessment of hazards in the workplace. Solutions must be site-specific and can include equipment and policies that help to protect workers, such as cameras, panic buttons, barriers and additional exits; posting of additional security staff; preventing staff from working in isolation; flagging patients or clients with a history of violence; and regular training.

Reporting Incidents of Workplace ViolenceEmployers must develop a process to report assaults,

near misses and threats, and they must respond by investigating incidents in a timely manner. Retaliation against an employee for reporting workplace violence will be prohibited.

OSHA will require employers to keep a log of all incidents of workplace violence. Employers must evaluate the program and send a report to OSHA on an annual basis. They must also post a summary of the log where employees can see it. Employees and their representatives can request copies of the incident log at any time.

Better Training RequiredAll staff, including contract staff, will receive annual

workplace violence prevention training – in person from

qualified instructors. Workers will have the opportunity to ask questions and request additional training. New employees will be trained prior to assignment, and workers whose job circumstances have changed have the right to additional training. Staff will receive supplemental training after significant violent incidents. Managers and supervisors will be trained to recognize hazards so they can avoid assigning employees to risky situations.

Enforcement MattersThe standard will give OSHA a tool to protect

healthcare and social service workers from violence. Employers who fail to implement the standard or who retaliate against an employee for reporting violence will be cited. Violence is not part of the job. Prevention is possible – comprehensive prevention programs will reduce the number and severity of future incidents, allowing us to care for our patients and clients.

Endnotes1 U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses (Washington, D.C.: Department of Labor, 2017).

2 Lillian Bensley, et al., “Injuries Due to Assaults on Psychiatric Hospital Employees in Washington State,” American Journal of Industrial Medicine 31, no.1 (1997):92-99.

3 Government Accountability Office, Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, GSO-16-11 (Washington, D.C., 2016).

4 BLS, Survey of Occupational Injuries and Illnesses.

WORKPLACE VIOLENCE IS NOT PART OF THE JOBASK YOUR MEMBERS OF CONGRESS TO SUPPORT

THE WORKPLACE VIOLENCE PREVENTION FOR HEALTH CARE AND SOCIAL SERVICE WORKERS ACT, H.R. 1309

MNA wishes to thank Eric Anderson, our contract lobbyist, for his hard work and dedication to the nurses and their legislative needs. He has advocated for Montana nurses and educated the state of Montana’s legislators regarding MNA’s legislative priorities. MNA would also like to thank Erin MacLean, our healthcare attorney, for her expertise and guidance as we navigated this legislative session. She assisted with bill language, process, and direction to advocate for our nurse’s priorities.

Workplace violence often results in serious, even career-ending injuries. The AFT has members who have been choked, stabbed or thrown against walls. Many have suffered fractures, brain injuries, posttraumatic stress disorder, and even death.

“I went into the patient’s room to do vitals and give meds and he grabbed me twice, but I was able to get away. I told my manager, but nothing was done. I had to return to his room to take care of his IV. He grabbed me and I couldn’t get away. He threw the IV pole at me. I managed to activate the code blue button, but he picked up the monitor and threw it at me, hitting my leg. I still think about how scared I was, and nobody cared.”

– Bev, RN, Lewistown, Mont.

“A patient’s tight fist to my jaw knocked me to the floor, shattering my leg bone at my hip. Excruciating pain, immediate surgery, months of rehab, residual pain, and shock of being violated resulted. The fear and angst are always with me. Within eight years, I had two more violent assaults requiring major surgeries, lengthy rehabs, and trauma counseling, ending my nursing career. Feeling vulnerable and distressed emotionally, I could no longer face the dangers at my workplace. It was just too much.”

– Helene Andrews, RN, Danbury, Conn

The standard will cover most healthcare settings and many social service settings, including general and specialty hospitals; psychiatric and substance use treatment centers; hospital-licensed in-patient or out-patient clinics; skilled nursing homes, hospice, and long-term care facilities; non-residential treatment or service settings; treatment settings in corrections; community care settings, including group homes and mental health clinics; home healthcare services; and emergency services. It will cover direct employees and contracted workers. Public facilities not otherwise covered by a state OSHA that accept funding for Medicare will be covered.

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Workplace Violence Prevention for Health Care and Social Service Workers Act, H.R. 1309

Healthcare and social service workers face threats and assaults at work every day: They experience 69 percent of reported workplace violence incidents and are nearly five times more likely to be assaulted at work than the rest of the labor force.1 The assaults can come from patients, clients and visitors, and often result in serious, even career-ending, injuries. Victims frequently suffer from post-traumatic stress disorder or anxiety.

Many assaults are never reported due to the misguided perception that violence is “part of the job.” One study of staff working in psychiatric hospitals found that 85 percent of workplace violence incidents were not reported.2

Among those at highest risk of assault are direct care providers in emergency rooms, intensive care units, acute and long-term psychiatric and substance use treatment centers, residential care facilities for the cognitively impaired, and home-based services.

Since 1996, the Occupational Safety and Health Administration has offered guidance and resources to healthcare and social service employers on programs to prevent violence. Research has shown that these programs can reduce the number and severity of violent incidents.3 But because the OSHA guidance is voluntary, employers have either failed to adopt comprehensive programs or only partially implemented programs. Meanwhile, between 2007 and 2017, the rates of violence grew by 123 percent in hospitals, 201 percent in psychiatric hospitals and substance use treatment facilities, and 28 percent in social service settings.4

Nurses, other health professionals, social service workers and public employees can speak to their own experiences that corroborate the statistics. Some of the serious injuries ourmembers have suffered include:

• A nurse was choked to the point of unconsciousness by a patient in September 2018 in Richland, Wash.

• One nurse was stabbed in Newark, N.J., in 2017. Another was stabbed by a psychiatric patient in Cumberland, Md., in 2013.

• Members have suffered fractures and brain injuries from being thrown against walls or floors by patients, including nurses in Danbury, Conn.; Jefferson City, Mont.; Paramus, N.J.; and Catonsville, Md.

• Judy Scanlon of Buffalo, N.Y., and Elenita Congco of Brooklyn, N.Y., were murdered by patients in 1998 and 2011, respectively.

The failures of voluntary complianceWithout an OSHA standard, employers have little

incentive to prevent workplace violence. Although OSHA

may cite employers using the Occupational Safety and Health Act’s general duty clause [Section 5(a)(1)], it has not been an effective deterrent. The general duty clause requires employers to establish a workplace free from recognized hazards causing or likely to cause death or serious harm. Citations under the general duty clause must meet a high legal standard and historically have been difficult to sustain.

Citations also remain relatively rare, even though OSHA issued a directive in 2011 to its field offices on how to conduct investigations into workplace violence and what recommendations should be made to employers. In fact, the Government Accountability Office found that, in spite of increased training and direction given to OSHA inspectors, staff from all 10 OSHA regional offices “said it was challenging to cite employers for violating the general duty clause when workplace violence is identified as a hazard and staff from four regional offices said it was challenging to develop these cases within the six-month statutory time frame required to develop a citation.”5

An OSHA standard for workplace violence prevention is imperative

Research has confirmed that comprehensive workplace violence prevention programs can reduce assaults.6 These interventions include assessment of the data, implementation of policies and equipment to prevent specific hazards, improved training, and regular reassessment.

The GAO made three recommendations to OSHA in 2016:

• OSHA should provide further information to the inspectors on developing citations.

• The agency should follow up on warning letters to employers when serious hazards exist that do not meet criteria for a general duty clause citation.

• OSHA should assess the results of its efforts to determine whether the development of a standard may be needed.

In fact, on Jan. 10, 2017, then-Assistant Secretary of Labor for OSHA David Michaels said that OSHA would put workplace violence in healthcare and social assistance on the regulatory agenda. The standard needed would require covered employers to develop, implement and regularly reassess a written workplace violence prevention program with meaningful involvement from direct care staff. But since then, the agency has made little progress.

State efforts are not enoughNine states have passed laws requiring healthcare

employers to develop comprehensive workplace violence prevention programs. The laws range from strong standards enforced by state OSHA plans in New York and California to laws in Maryland and Maine that lack an enforcement mechanism.

The New York standard, which covers public employees and is enforced by the state’s Public Employee Safety and Health Bureau, has been rigorously enforced since its implementation in 2006. In California, Cal/OSHA promulgated a standard that went into effect in 2017.

Enforcement remains a challenge in Connecticut, Illinois, New Jersey, Oregon and Washington, where laws were passed to protect healthcare employees through prevention programs. In New Jersey and Connecticut, the state OSHA agencies only cover public employees.7 As a result, enforcement of violence prevention laws was assigned to state departments of health, agencies that are not equipped to conduct workplace occupational safety inspections.

It is time for OSHA to protect the workers who care for the sick, the elderly and the mentally ill. It’s time for a national, comprehensive standard to prevent violence in healthcare and social services workplaces, through the Workplace Violence Prevention for Health Care and Social Service Workers Act, H.R. 7141.

Endnotes1 U.S. Bureau of Labor Statistics, Survey of Occupational Injuries

and Illnesses (Washington, D.C.: Department of Labor, 2017).2 Lillian Bensley et al., “Injuries Due to Assaults on Psychiatric

Hospital Employees in Washington State,” American Journal of Industrial Medicine 31, no. 1 (1997): 92-99.

3 Government Accountability Office, Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, GSO-16-11; (Washington, D.C., 2016).

4 BLS, Survey of Occupational Injuries.5 Workplace Safety and Health: Additional Efforts Needed to

Help Protect Health Care Workers from Workplace Violence (Washington, D.C.: Government Accountability Office, 2016), 27-28.

6 Workplace Safety and Health: Additional Efforts, 35-38; Judith Arnetz et al., “Application and Implementation of the Hazard Risk Matrix to Identify Hospital Workplaces at Risk for Violence,” American Journal of Industrial Medicine 57, no. 11 (2014): 1276-1284; Judith Arnetz et al., “Understanding Patient-to-Worker Violence in Hospitals: A Qualitative Analysis of Documented Incident Reports,” Journal of Advanced Nursing 71, no. 2 (2014): 338-348; Judith Arnetz et al., “Using Database Reports to Reduce Workplace Violence: Perceptions of Hospital Stakeholders,” Work 51, no. 1 (2015): 51-59; and Judith Arnetz et al., “Development and Application of a Population-Based System for Workplace Violence Surveillance in Hospitals,” American Journal of Industrial Medicine 54, no. 12 (2011): 925-934.

7 Only 22 states have state OSHA agencies that cover both private and public sector workers. Connecticut, Illinois, Maine, New Jersey, New York and the Virgin Islands have state OSHAs that cover only public sector workers; private sector workers in those jurisdictions are covered by federal OSHA. Private sector workers in the remaining states are covered by federal OSHA and state and local public employees have no coverage.

WORKPLACE VIOLENCE IN HEALTH CARE AND SOCIAL SERVICES

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May, June, July 2019 Montana Nurses Association Pulse Page 7

MEMBERSHIPMATTERS!

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BENEFITS INCLUDE:• EMPOWERING RNs TO USE THEIR VOICES

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Applications also available onour website.

mtnurses.org

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To update your contact information, please email or call

Montana Nurses Association: jill@mtnurses.org or 406-442-6710

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Page 8 Montana Nurses Association Pulse May, June, July 2019

Professional Development Department

Licensure Implications for Your Continuing EducationNurses in Montana are currently required to earn a

minimum of 24 contact hours in each two-year licensure renewal period. Why does this matter, and what happens if you don’t meet this requirement?

The Montana Board of Nursing has created administrative rules to enforce laws related to the safe practice of nursing. These administrative rules speak to an RN’s responsibility to apply the nursing process and to function as a member of the nursing profession, among others. One of these expectations is to “accept responsibility for individual nursing actions and competence” (administrative rule 24.159.1205 (1)(b)). How are you going to stay current in your knowledge and skills unless you engage in relevant continuing education and professional development activities? If you are not safely and appropriately using the nursing process and meeting the board’s identified obligations for a registered nurse, you are putting your license at risk.

How do you select your continuing education activities? Purposefully conducting a periodic self-assessment helps you determine what you need to know or learn to do in order to stay competent and up-to-date. Choosing continuing education should be more purposeful than “collecting certificates” to get to 24 contact hours. Focusing on your own needs for professional growth supports the fact that you have accepted responsibility, as expected by Board rule, and demonstrates your commitment to keeping your patients safe.

Your practice may not be at the bedside or in other settings with direct patient care responsibilities, but you are still required to meet the continuing education requirement so that your own practice is safe and appropriate. Those who work in education, research, administration, or other non-clinical settings do not have direct patient contact but certainly impact others who do. If your leadership skills are not appropriate, or if the education you provide is not accurate, the risk to patient and population health is significant. Given that the ultimate responsibility of the Board of Nursing is to protect the public, every nurse is held to the standards of safe practice as a member of the nursing profession.

If you are a new graduate, or have just relocated to Montana and obtained a license at some point in the two-year renewal cycle, you are accountable to obtain contact hours equivalent to the number of months you were licensed during that renewal period. In other words, if your license expires in December of 2020 and you received your license in May of 2019, you would need to have 20 contact hours (eight months for 2019 and 12 months for 2020).

If you are currently enrolled as a student to advance your nursing education, you can use college credit in lieu of contact hours – the credit certainly reflects your engagement in life-long learning! The Board of Nursing has determined that one semester hour is equivalent to 15 contact hours, and if your school is on a quarter system, one quarter is equivalent to 12.5 contact hours.

When you renew your license, you do not provide evidence of completion of your CE requirement to the board. Rather, you indicate in the on-line renewal application that you have obtained the required education. Random audits are then conducted to verify that the licensee has completed the required continuing education work. If you are audited, you need to provide the board with copies of certificates showing that you have earned your 24 hours of continuing education during the licensure period in question. Therefore, it is important to keep your certificates, not only for the current licensure period but also for the previous one. For example, a nurse who is audited in 2019 will need to provide proof of licensure in the previous licensure period (2016-2018), not the current one (2019-2020).

The Board of Nursing’s administrative rules state that a nurse can have licensure suspended if the audit shows that those 24 contact hours were not obtained during the previous licensure period. There are serious implications to this action. Suspension is one of the disciplinary actions the board can take when a licensee doesn’t follow the law or the administrative rules of the state related to the practice of nursing. Once disciplinary action is taken by a licensure board, that action becomes public knowledge and is permanently noted as part of the nurse’s licensure history. Even if or when the requirement is met and the suspension is lifted, the fact that the nurse has been disciplined by the regulatory board remains part of the public record. Employers and others who work with registered nurses frequently use www.nursys.com to verify licensure and confirm that there are no disciplinary actions that have been taken on that license. Evidence of disciplinary action may result in loss of opportunities for employment or other nursing roles. As an example, one of the requirements for being a nurse planner for a continuing education activity is that the person must have an “unencumbered” license – meaning that there has been no disciplinary action taken on the license.

One additional note: Because of the change in licensure year assignment for Montana licensees, some nurses did not need to renew licenses in 2018. If you are in the “odd” renewal group, you will renew your license between 11/1/19 and 12/31/19. For this one time only, you may use continuing education credit accrued from 1/1/17 through 12/31/19 to meet your CE requirement. Future licensure renewals will be on the two-year odd or even cycle for all Montana licensed nurses.

Additional information regarding Montana continuing education requirements can be located at http://www.mtrules.org/gateway/Subchapterhome.asp?scn=24.159.21 for rules and http://boards.bsd.dli.mt.gov/Portals/133/Documents/nur/Reminder_on_Continuing_Education_Oct_2016.pdf for frequently asked questions.

Pam A. Dickerson, PhD, RN-BC, FAAN

Director of Professional Development

www.cnebymna.com

Be sure to check out our CNEbyMNA Website for Continuing Education opportunities. Sign up for upcoming events and online learning courses. It is

constantly updated with new Webinars and Courses for your continued learning!

*Montana Nurses Association is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing

Center’s Commission on Accreditation*

Transitions to PracticeJanuary 27-28, 2019HELENA, MT

Legislative DayJanuary 31, 2019HELENA, MT

APRN Pharmacology ConferenceMarch 1-2, 2019HELENA, MT

see more

see more

see more

see more

$15.00 $15.00

$15.00 $15.00

more information

Performing a Quick and Helpful Physical Assessment

What is Your Learning Environment?

Transitions of Care:Interfacility Transfers

Quick Review of 12-lead ECG

May, June, July 2019 Montana Nurses Association Pulse Page 9

Professional Development Department

January 27th, 28th 2019 Transitioning from Graduate Nurse to Professional Nurse Leadership Reception and Workshop

MNA has held the Transitioning from Graduate Nurse to Professional Nurse Workshop since 2013! In 2013 MNA held its first Transition to Practice Workshop with six Senior Student Nurses in attendance. The 2019 Annual Transition from New Graduate to Professional Nurse Leadership Reception and Workshop has exploded, with a record 176 senior student nurses in attendance with representation from Miles City Community College, MSU-Northern, MSU-Bozeman, MSU-Great Falls, MSU-Billings, Carroll College, Helena College, Montana Tech and Aaniiih Nakoda College.

Sunday night, Nurse Leaders from across the state shared their stories on being a new nurse and how they’ve grown as a professional and where they are now in their careers. We were honored to have the following Montana Nurse Leaders participate: Sarah Shannon PhD, RN, FAAN, the Dean and Professor of Bozeman College of Nursing, Missy Poortenga MHA, BSN, RN, Executive Director of the Board of Nursing, Kari Parmer MS, RN, Senior Nursing Director of Inpatient Health at St Peter’s Health, Kelly Amtmann, MSN, RN, EdD(c), Dean of the College of Health Sciences at MSU Northern, and Sandy Sacry, MSN, RN, Nursing Director of Helena College, University of Montana.

The Transitioning from Graduate Nurse to Professional Nurse Workshop was the following day. Mandy Pokorny, MHS, BSN, RN, and Megan Hamilton, MN, CFRN, EMTP, and MNA’s Professional Development Director, Pam Dickerson, PhD, RN-BC, FAAN, continue to be a stellar team in facilitating this fabulous experience for graduating nursing students.

A shocking reality statement during Mandy Pokorny’s session was the following: “Statistically, about one third of the 176 students in this room of new nurses will leave their job within the first 12 months of hire!” The challenge to everyone in that room was: Who here plans to be a part of this statistic?”

First year Registered Nurse Delaney Cummings, described her first year of practice and how enlightening it is to be realistic with oneself and embrace your newness! Sharing with a Patient that you are a new graduate RN begins a trusting relationship, as patients appreciate your honesty. All the students enjoyed networking with each other and were relieved that all shared the same fears such as making that first medication error, or how to react when their first patient dies.

Studies have shown that after six months of employment as a nurse, it is normal for a nurse to have feelings of uncertainty, doubt, confusion and even depression. Traditional orientation is usually only six months in length… right when the nurse is experiencing an inner crisis! The students

Mary Thomas, BA, RNRN Professional

Development Associate

Six Montana RN’s graduated with advanced nursing degrees, Master of Science in Nursing at University of Mary in Bismarck, ND April 27th, 2019!! Congratulations to Vicky Byrd, MNA CEO, Samantha Miller, Michelle Smith, Keri Cross, Michele Cummings and Shannon Crable!!

University of Mary Master of Science in Nursing Class of 2019!!

Montana Nurses Association Approved Providers

Acute Care EducationVancouver, WA

Montana Geriatric Education Center of UMMissoula, MT With Distinction

Alaska Division of Public HealthAnchorage, AK

Montana Health NetworkMiles City, MT

Alaska Native Tribal Health Consortium Anchorage, AK

Montana VA Health Care SystemHelena, MT With Distinction

Alaska Nurses AssociationAnchorage, AK

Mountain Pacific Quality HealthHelena, MT

Alaska Regional HospitalAnchorage, AK

North Valley Hospital Whitefish, MT With Distinction

Alzheimer’s Resource of AlaskaAnchorage, AK

Pacific Lutheran UniversityTacoma, WA

Bartlett Regional HospitalJuneau, AK With Distinction

Partnership Health CenterMissoula, MT

Benefis Healthcare SystemsGreat Falls, MT With Distinction

Planned Parenthood of the Great Northwest and the Hawaiian IslandsSeattle, WA

Billings ClinicBillings, MT

Providence Alaska Learning Institute Anchorage, AK

Bozeman Deaconess HospitalBozeman, MT

Providence HealthcareSpokane, WA

Cardea ServicesSeattle, WA

Providence St. Patrick HospitalMissoula, MT With Distinction

Caring for Hawai’i NeonatesHonolulu, HI

South Dakota Nurses Association Pierre, SD

Central Peninsula General Hospital Soldatna, AK With Distinction

South Peninsula Hospital Homer, AK

Cheyenne Regional Medical CenterCheyenne, WY

St. Alphonsus Health SystemBoise, ID

Community Medical Center Missoula, MT

St. James Healthcare Butte, MT

Evergreen HealthKirkland, WA

St. Luke’s Health System Boise, ID

Fairbanks Memorial Hospital Fairbanks, AK

St. Peter’s Health Helena, MT

Kadlec Regional Medical CenterRichland, WA

St. Vincent Healthcare Billings, MT

Kalispell Regional Healthcare System Kalispell, MT

UF Health Shands Hospital Gainesville, FL

Kootenai HealthCoeur d’Alene, ID

Wisconsin Nurses Association Madison, WI With Distinction

Mat-Su Regional Medical Center Palmer, AK

Wrangell Medical Center Wrangell, AK With Distinction

MNA thanks all of the Approved Provider Units we work with for their commitment to advancing and promoting quality nursing practice through continuing nursing education.

were given tools to breakthrough rather than breakdown at this crisis time. Residency programs were discussed and what to look for when interviewing for your first place of employment.

Megan Hamilton facilitated a session on self-care strategies to promote and maintain well-being during the transition period as well as throughout your career. During the breakout sessions, student nurses used their artistic skills targeting awareness of physical and psychological effects of stress and how to manage it both at work and home. (See above)

As a Professional Registered Nurse, Pam Dickerson spoke on creating and sustaining a healthy work environment with suggestions and discussion on creating a portfolio. As a professional, all nurses should maintain and update their portfolio. Each and every Nurse must individually decide whether they want nursing to be an occupation or a profession.

How do you become a Nursing Professional? “Once you get your job, start with email, then staff meetings, unit-specific projects, then unit council, so on and so forth, Join your Professional Nursing Association (MNA); like MNA and ANA on Facebook! Be certified; be educated!!!

Page 10 Montana Nurses Association Pulse May, June, July 2019

The Montana Nurses Association is doing so many wonderful things for the Nursing profession in Montana. We are the Professional Nursing Association and we advocate for all RN’s and APRN’s in the state. To join and be a part of your professional association visit our website at www.mtnurses.org

Facts about MNA membership:• If you are a new college graduate,

an RN in full-time study towards an advanced degree, 65+ years of age who is licensed or retired you can receive a reduced membership rate. If you are a current member and qualify for this reduced rate, please call MNA at 1-406-442-6710.

• You do not have to work at a facility with a collective bargaining agreement to be a member of MNA. Any RN/APRN in the state can join membership.

• With your membership to MNA you also receive a membership to ANA.

• Just because you receive a copy of The Pulse, does not mean that you are necessarily a member of MNA. All RN’s in the state of Montana receive The Pulse.

• MNA has 2500+ members.• Your membership to MNA matters, as

MNA advocates for all RN’s in the state of Montana.

• You can join MNA online by going to www.mtnurses.org and clicking on ‘Join’.

Jill Hindoien, BSChief Financial Officer

Excerpts from ANA

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May, June, July 2019 Montana Nurses Association Pulse Page 11

Statewide Nursing News

COULD IF WORK FOR CRAZY NURSING SCHEDULES?That’s not a typographical error. IF stands for

intermittent fasting and it has really caught on lately as an approach to control weight and improve overall health. Now, of course, I want you to use your GOD GIVEN common sense toward ANY approach concerning the diet you consume. Review the material. Discuss it with your doctor. Delve into the details for yourself with a dietician you like and trust. If you have blood sugar issues or take medications, all bets are off. Don’t attempt fasting until you feel like you have a good idea of how you will approach it and how it will affect you in your day to day life. Likewise, if you suffer from an eating disorder, please hear me – intermittent fasting may not be for you at this time in your life. Consider the options and weigh it out for YOU. Nuff said.

So, I have been doing intermittent fasting since realizing that SOMETHING had to change, given that I was a TREAT-GOBBLING MACHINE over the holidays. No joke. Out of. Con.Trol. I started doing some research on safe ways to lower my weight. Heck. What am I saying? I am SUPER cheap. Who am I kidding? I started looking for ways to lose weight for FREE! No gimmicks or stuff to buy. I am WAY too cheap for that! For real.

Fasting seemed like a good place to start. What could be more cost effective than not buying ANYthing? But I had no plan, no clue where to start. Alas! To the internet! I’ll walk you through my discoveries:

WHAT IS Intermittent Fasting?

• In short, IF is the period between eating and not eating. There are a few varied ways to approach these cycles but in essence, we as nurses are ALREADY doing it – whether we are aware of it or not. The only change we need to make is to fast on purpose, with self-improvement and our own health in mind.

HOW does it work?

• Basically, you choose a period of time in which you will not consume any calories. That could be eight hours a day or 12 hours a day or 16 hours a day or some folks do 20 hours a day routinely! Because I work nights, my shifts and IF work like this for me:

• Wake up around 4 or 5 pm. Make lunch. Head to work. Don’t eat.

• Push through until 2 am when I will eat the food I made

• Don’t eat after 7 or 8 am. Go to bed. Sleep until 4 or 5. Start all over.

• That way I am only eating from 2 am to about 8 am – I am fasting for about 18 hours! Now, I still drink coffee with a little creamer and I do enjoy bone broth during this time but for the most part, I try really hard to just drink water and refrain from eating solid food at all.

• I am sleeping for six to eight hours of my fasting and honestly, it is a relief to not have to try to SLAM something down my throat on the way out the door or sneak away during the crazy first few hours of my shift.

Joey Traywick, CMSRN,

BS Kinesiology

USUALLY, I can steal away to eat later in the shift, like around 2 am to eat the lunch I prepared. The trick is NOT eating when I leave work AND picking satiating foods that will “carry” me all the way from 8 am to 4 pm.

• If you are a “day” person, the same basic rules apply. Sleep from 9 pm to 5 am or whatever schedule you are on and then try to stretch the period in which you just drink water or simply refrain from eating. Maybe that is 12 hours, from 9 pm to 9 am? Just find what works for you and YOUR routine.

WHY would anyone DO that!?Well, that’s a great question. Honestly, I jumped in because my snacking on

junk was beyond anything CLOSE to healthy. So, I needed a “RESET” if you will. However, there is a growing body of evidence that suggests that taking periods away from eating may help restore insulin sensitivity which could lower insulin resistance. Also, research suggests that allowing our metabolism to slow or take a break from digestion may also allow for cellular repair to take place. But don’t just take my word for it – look it up. See what you think. Here’s a really annoying link to the Harvard Health blog that you can try to type in but, honestly, you’re smart. Do your homework. Make up your OWN mind.

ht tps://www.health.harvard.edu/blog/ intermit tent-fasting-surpr is ing-update-2018062914156

Or check out the book “FAST 5:2” by Michael Mosley or “The Complete Guide to Fasting” by Dr. Jason Fung.

The point is, we as nurses go EXTENDED periods without eating ALL THE TIME. The PROBLEM is, we grab nachos or tater tots in between because we are not INTENTIONAL about our periods of not consuming calories. If we could take a “draw back” of our crazy shift work life and turn it into a “perk” of our daily schedule - imagine the health benefits we would reap!

Now, if I can JUST find some research about how NOT going to the bathroom for 12 hours is actually good for you...

Page 12 Montana Nurses Association Pulse May, June, July 2019

Belonging to your professional organization is a professional and personal obligation. The Montana Nurses Association (MNA) is the recognized leader and advocate for all professional nurses in Montana, whether they are members or not. MNA, as a member driven organization, has a statewide and national voice and is tackling legislative, educational, and professional issues that affect registered nurses.

Many registered nurses and other associations across the state assume MNA is only a union. Actually, our MNA professional organization is a blended organization comprised of both union and non-union nurses, including Advanced Practice Registered Nurses (APRNs). Not every Montana professional nurse is an association member, but the association advocates for all nurses across the state whether they are a member or not. Our goal is to encourage all RNs and APRNs to join MNA and collectively contribute to the business, advocacy, legislative needs, and voice of Montana nurses. MNA membership is a joint membership and includes an American Nurses Association (ANA) membership as well, therefore a joint MNA/ANA member.

Your membership in MNA/ANA makes a powerful statement about you as a professional. It shows employers, colleagues, and patients your commitment to nurses and the nursing profession. Membership identifies you as a nurse who is serious about the profession as well as purposeful about staying informed, educated, and involved.

When you become an MNA/ANA member, you join with nurses across your state and the country, speaking with one strong voice on behalf of your profession and your patients. You are committed to providing superior care to your patients. It is your passion, and you invest extensive energy in your work and profession.

Listed below are some MNA highlights.

1. MNA endorses NSO for our liability and malpractice needs.

Nurses Service Organization (NSO) Professional Liability Insurance for Nursing Professionals

All it takes is one lawsuit… Your employer-provided coverage may be focused on your employer and protecting the interests of the business and its shareholders—not your best interests. You need coverage that places your needs first. Professional liability insurance through NSO allows you to have peace of mind whether you’re on the job, off the job, or between jobs. Whether you’re an employee or self-employed, coverage through NSO is here to help you purchase professional liability insurance at an affordable cost

Why choose NSO?• Experience: 20 years protecting Nurse

Professionals (even at the Board of Nursing)• Expertise: Developed and refined by defending

nursing professionals for two decades • Commitment: We're dedicated to the

education of nursing professionals in the field of risk management

Call NSO today at 1-800-247-1500

2. Legislatively for RN’s and APRN’s we are being heard. Policy & Advocacy

• From state legislatures to the White House, nurses have a unique opportunity to lend their expertise in influencing policy at all levels of government. The ANA ensures that all 3.1 million nurses are represented across the board and that nurses’ interests are not ignored by bureaucrats who lack true knowledge of the issues nurses face. Being the #1 most trusted profession in the country allows nurses to truly take charge and make a difference in the policy arena. MNA represents and advocates for all 20,000+ nurses in the state legislature and in Washington, DC on critical nursing and healthcare issues. MNA will continue to move forward with “Your Nurse Wears Combat Boots” Campaign-improving workplace safety for healthcare workers, as directed by our MNA members. Every year at our MNA annual convention, our members approve their legislative agenda. MNA members have lobbied the state legislature and congress, with significant successes in advancing nursing and health care.

3. Continuing Education at MNA, your portal for quality professional development.

• MNA is accredited with distinction as an approver and provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Often contact hours are at a reduced cost and there are free CE opportunities to advance your own professional development. Reduced fees are offered to members who serve as nurse planners for activities submitted to MNA for approval, so you have an opportunity to develop and implement your own continuing education activities, which MNA can approve using international quality standards specified by ANCC’s Accreditation Program. Contact

hours you earn through MNA are accepted almost everywhere in the world. Check out our professional development website specific for continuing education at www.cnebymna.com.

4. Opportunities to attend National Conventions.• Whether you run at the state level for a delegate

position or submit your name to be drawn for members to attend a national nursing conference, MNA has designated funds to support our membership and allow nurses from across the state to participate in an all-expense paid opportunity to attend a national convention. The networking they experience and education they gain is priceless and fulfills the membership’s request to put more resources into our individual members. Last month, nine members from across the state attended the ANA Quality Conference in Orlando.

5. Increased MNA events.• MNA has many annual educational conferences

in addition to webinars, workshops, and other events developed based on learner need:

1. Transition From New Graduate to Professional Nurse: for senior nursing students and New Graduates

2. APRN Pharmacology Conference3. Labor Retreat for leaders and members of

collective bargaining units4. Continuing Education Update for Providers of

CNE5. Annual Convention for all members, includes

the House of Delegates6. Veterans Care Conference, an interprofessional

conference jointly provided with our Fort Harrison VA facility

7. Legislative day (every other year)

A frequent piece of misinformation is “I receive the Pulse, so I am already a member” but keep in mind, just because you receive a copy of our official publication the Pulse, it does not mean you are a MNA member. We distribute the Pulse to every registered nurse in Montana whether the RN is a member or not because communication about our profession is imperative and we see this as great value to all nurses from MNA.

Join your professional association today and tap into the many resources it has to offer. Go to www.mtnurses.org or call 406-442-6710 or email Jennifer@mtnurses.org for more information.

The More You Know

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patient, the family, care partner, and health care team are central to the creation of environments where personal growth and healing can occur.

Living in this Alaskan community offers great advantages, including year round outdoor activities, affordable housing and great schools.

To learn more about the requirements of the position(s) and to apply, please visit our website at www.cpgh.org/careers

Critical Position Bonus

$10,000 may apply to some

positions.

Rewards package includes: Relocation assistanceFull benefits package

All positions require:AK licensure at time of hireSpecific clinical experience

CPH, a Planetree designated organization in Soldotna, Alaska, is seeking RN’s for the following positions:

• RN Behavioral Health • RN Emergency • RN ICU • RN OB • RN Med/Surg • RN PACU

1-907-714-4785

May, June, July 2019 Montana Nurses Association Pulse Page 13

VERBAL COMMUNICATION: A “NO REFUND” HAPPENING(Part II of a two-part series)

Carolyn TaylorEd.D, MN, RN

NEVER UNDERESTIMATE THE POWER OF A CONVERSATION! YOU ARE THE MESSAGE – SO ACT, LOOK, AND BE WHAT YOU INTEND TO COMMUNICATE!

ACTIVE LISTENING AND DETERMINING CONGRUENCE

One of the most important skills you can learn is the skill of listening. This places your body into an attention mode. Body language, in general, changes with a slight leaning forward, eyes on the person object, and non-verbal responses confirming that what is being said is heard. Posturing and nodding of your head as a listener confirms a listening stance. These behaviors are considered congruent with the process of active listening.

Listening also means that the person who is doing the listening watches for the congruency of the person talking to note the differences (if any) between what is verbally said and what the body movement and posturing says. For a person to be heard correctly and wanting to be heard, the person doing the talking must be congruent in the message. That is, verbal and nonverbal are considered in agreement according to the culture of the individual.

Example If a person is laughing while they are reprimanding

someone verbally and perhaps raising a fist to hit that person at the same time, there is incongruence in the combined message and behavior. Such lack of congruence between verbal communication (laughing) and an accompanying behavior (hitting) brings to the attention of the listener that two confusing forces are being witnessed – happiness and anger. Such incongruence that sends overt mixed messages often presents a probable mental disturbance or instability.

Mixed messages cause confusion on the part of the listener; therefore, if possible, the behavior and the verbal message must be examined carefully by the listener in order to understand the intended communication/message (if there is an intended message).

MULTICULTURAL COMMUNICATION As a nurse, you will experience culturally diverse

people. This is called a “global-centric experience.” Therefore, it is important to have a multicultural perspective on leadership and cultural literacy. There are differences between the western cultures and the eastern cultures.

The western cultures involve debate and discussion with low non-verbal content. Just think of the many times you have been called to a meeting for the purpose of discussing a topic of concern. It was the verbal exchange and the debate around the topic that was the driving force of the meeting. There finally was a tendency to get to the point of the discussion and make a decision.

The eastern cultures are more likely to use direct communication rather than discussion or debate. Their desire is to maintain and preserve the relationship. To help preserve the relationship, it is often difficult for them to say, “No.” There is a tendency to talk around the point of discussion and not say what they mean. Yet, there is a tendency to finally get to the point of the discussion. Often, this gives the westerner a feeling of bluntness, rudeness, and procrastination. Information during a conversation is important between individuals – not necessarily groups.

There are some general multicultural recommendations set forth by the America Medical Association (AMA) to encourage and enhance

multicultural communication. These are paraphrased as being:

1. Recognize that miscommunication is likely to happen when working with significant cultural differences.

2. Realize that miscommunication could lead to unwanted conflict.

3. Learn to adapt to different communication styles requiring adaptation.

4. Never shout. 5. Define meanings of words and phrases. 6. Learn to simplify the message to meet the

cultural need. 7. Avoid non-standard abbreviations (such as

“UR” for “you are”). 8. Show patience with different logic. 9. Ask a person to repeat what he/she said

or to say it in different words if you do not understand.

10. Get help to clarify the information when there is no one to interpret or you do not understand.

11. Note the distance a hand is extended when shaking hands to determine a person’s comfort zone.

12. Give a person the benefit of the doubt when you do not understand. Consider alternatives to what you thought you heard.

13. Use several media types to impart information when doing presentations. Be sure that each type of media has the same message.

14. Offer to read documents they have written to ascertain understanding.

15. Have employees with English as a second language work directly with employees who speak English as a first language.

16. Have an employee who attends a meeting reiterate what he/she understands as the outcome of the meeting. Clarification could then occur if there is a misunderstanding of the outcome of the meeting.

It is important to realize that multicultural staffing or accepting multicultural persons in the facility/organization is challenging, yet a rewarding experience. The sharing of cultural insight can be stimulating and provide a unique learning experience for the entire facility.

CLARIFICATION Sometimes when a person tells you something,

the message is not clear. The most common response that helps to clarify the meaning is “I don’t understand.” Those words said immediately post

the message tells the person that there is something wrong with his/her communication. It is better to identify that you do not understand (if that is true) than it is to continue with the conversation on a note of misunderstanding. It is important to explain WHY you do not understand. This clarification of why you do not understand helps the person focus on the exact information that will increase your understanding. Say what you mean exactly and mean what you say!!

Example

A police officer stopped a man carrying a penguin in the back of his truck. “Take the penguin to the zoo,” was the direction given by the police officer. “OK,” said the truck driver – and off he went. The next week – there the truck was again with the penguin in the back of the truck. “I thought I told you to take that penguin to the zoo,” the police officer said. “I did” said the truck driver – “and now I am taking him to the rodeo.”

LIMIT-SETTING There are times when a person needs to

understand the parameters of behavior that are acceptable. By verbalizing what is acceptable with a limit, the person can continue behaving appropriately

according to the limit. This often works well with children. There is a need for a child to feel secure and this control placed on their behavior provides them with a sense of security.

When working with adults that request something of you that is something you do not want to do or cannot do, the usual answer is “No.” However, if you will compromise (when appropriate) just a little and do a little something toward meeting their request, you project a feeling of cooperativeness with realistic expectations.

When you request a behavior, the key to success is that you say what you want to happen by limit-setting. You need to include in the limit-setting comments about what you DO NOT want to happen.

This should be congruent with what you know about the person’s past behavior and testing behaviors.

POSITIVE STATEMENTS Everyone likes to be around a positive-type person.

A person who is a positive thinker and behaves in positive ways just seems to get through life’s trauma just a little easier. It is also catching. Being positive rubs off on other people – and THEY become more positive. After all, where does negativity get anybody in this difficult world?

The key to communication that makes people feel better is to recognize the good in them. We all have negative aspects, but how nice it is to hear the good about each of us!

Such statements that encourage movement of behavior in a positive direction might be: “I knew you could do it!” or “I know you can do it!” or “That is the best I have ever seen!” or “Keep up the good work!” There a million other statements that encourage positive behavior. The goal is to make positive changes in their lives because of it!

NONJUDGMENTAL Everyone seems to have a barometer for expected

behavior – verbal or nonverbal. We often act as if we know what is good, right, not so good, or terrible about situations other than our own. Remember that old adage about not judging another person until you walk in their shoes? There is a reason for every behavior. We, as individuals, try to understand, but cannot fully comprehend the actions or reasons for the behavior of another person.

Keep in mind that each person has had a path to walk (so to speak) in their lives, with obstacles leaving their impression on their mind and behavior. It is very difficult to understand different behaviors and their complexity as an outcome of life experiences. However, a person does what has worked in the past!

Wisely select your words – always use words of comfort or understanding. Words of anger or discouragement close communication lines, and then the helpful communication ends.

FALSE REASSURANCE Too often the comment is, “Everything will be fine!”

How do you, as a nurse, know that everything will be fine? Whose needs are being met when such things are said or inferred? Obviously, the nurse who makes that comment is the one reassuring him/herself. No – things are not always going to be fine!

Always take the time to listen to another person’s concerns. Your reassurance is not about what is going to happen to them, but that you, as a caring nurse, will be there for THEM regardless of what happens.

REDIRECTION There are times when a person will want to talk

about something that you do not want to talk about for some reason. You can listen to them, but you do not need to respond. The skill of redirection is to change the direction of the conversation to be something else. Often, you can take the topic that you do not want to talk about and turn a question back to the person by changing the topic completely. Remember – if you are skilled at this, you will not have to answer anyone’s question(s) presented to you unless you want to answer the question(s). (Haven’t we heard politicians do this?)

Page 14 Montana Nurses Association Pulse May, June, July 2019Use redirection in conjunction with the other skills

described in this document. Skillful nurses put the emphasis on a person under their direction and learn to make the conversation about what is important to the other person.

HALO EFFECT – DEVIL/HORN EFFECT This Halo Effect is a cognitive bias where

perception of a person’s total traits can be influenced by a perception of one or more stated positive trait(s). Individual reviewers would not see another person with mixed traits (good and bad). But, because of a group sharing of a previously established positive mindset, the person would be seen as totally wonderful. These positive traits of perception can be determined by verbal or nonverbal communication as set forth by another person.

In reverse, the Horns/Devil Effect is a cognitive bias where perception of a person’s total traits can be influenced by a perception of one or more stated negative trait(s). Individual reviewers would not see another person with mixed traits (good and bad). But, because of a group sharing of a previously established negative mindset, the person would be seen as totally bad. These negative traits of perception can be determined and shared with others by verbal or nonverbal communication.

This happening is often seen in a job interview – or any other situation, for that matter. Also, when a person is considered for a job, it is not uncommon for the first impression (good or bad) to determine whether the person is hired. The contrast is: Where the Halo Effect is an outcome of just a mention of a shared previously established positive impression of a person, the Horns/Devil Effect is an outcome of just a mention of a shared previously established negative impression of a person. The mere influence of a group from even one person’s comment (positive or negative) can influence and determine a final decision and/or change outcomes.

CONFRONTATION Confrontation is an approach to communication

that is often the most difficult for some people. It requires that you, as a nurse, have a good self-image and be fearless regarding the response of the other person. If the approach is accomplished with sensitivity and a desire to understand the circumstance you confront, it can result in a positive

outcome. The key to success has to do with your ability to use all of the other stated techniques as you converse with another person toward a better understanding about what is going on and end with a resolution to an identified problem. It is alright to make a personal stand on a topic. It is better to share (than not share) your stand on a topic and try to understand the other person’s stand on the topic.

If the person you confront becomes defensive, you just listen. If they have comments to make, you reflect and paraphrase. If you do not understand, clarify what you do not understand. Compromise is a common positive outcome. Sometimes, you just cannot win the total war – take a deep breath and compromise.

Remember, you do not confront another person to become argumentative, but to better understand and solve what you consider to be a possible problem. You WIN when the other person changes his/her mind or behavior to your liking because they, personally, made the decision to change – not that YOU insisted on the change.

THE POWER OF “YES” When you first respond to a statement by someone

else, try starting your response with “yes.” This gets the other person’s attention and they feel that you are listening to what they have said or want to say. There are a thousand ways to continue the conversation once the word “yes” has been said.

Examples 1. “Yes, I hear what you are saying; however, ----

--------------------” 2. “Yes, tell me more about -------------------------

----------------------”

RESPONDING TO THE MESSAGE “Earth to Mars… Hello… Are you there?” Doesn’t a

person feel like that when a message is ignored? Sometimes you are lucky to get a grunt from a

verbal comment. Regarding e-mails: Sometimes sending a message of friendship is overlooked by others. The feeling is projected: “Well, what do you expect of me in return?” Yes – we all do expect something!! To tell a person in a few words that you heard what he/she said is known as “a courtesy response.”

At least look at the person who is trying to verbally communicate with you. Try – huh huh, OK, Ya, (at

least) to a verbal statement. Even a more intelligent remark for either a verbal comment or e-mail would be very nice! Let’s face it – the more you actually and intellectually hear what is said and the implications of what is inferred the more likely you are to respond in an intelligent manner. Now, if you decide not to respond, isn’t that a message, too? If you have a question about the meaning of what you heard, read, or thought you saw, you better get some clarification. To hear a verbal message, try looking at the person as they speak and you will more likely hear the intended message.

The idea is that when someone directs communication your way (verbal, written, nonverbal, or even a product as a gift) there is a responsibility to respond – in some way. Ignoring in any situation is unacceptable. The outcome of ignoring is that the communication between individuals will eventually cease. As a nurse desiring to retain a powerful stance, this cannot happen. Listen to all aspects of communication, hear the message (actual or inferred), and respond professionally. Remember, whatever you share as an extension of yourself always carries a message.

RECIPROCITY AND FAIR EXCHANGE Conversation is sometimes one-sided. Listening

to the same tale or hearing continually what Suzie and Sally continually are doing becomes “old hat.” Sometimes it would be nice to hear – “Hey, tell me about yourself” or “Tell me about what you did over the weekend.” Why don’t we listen or ask about other people and their life happenings? Do our cohorts need to hear just what we do or about us? Try listening and finding out about them instead of just telling them about you and yours.

Have you ever sent messages and in return received no response? Or, you have done special favors without a response. Intelligent people are expected to have a cadre of words from which they can select an intelligent response.

Being extremely minimal with your words during any type of conversation shows a lack of interest and (who knows) it could be seen as minimal intelligence. Who wants that reputation as a nurse?!

REMEMBER – YOU ARE NOT JUST RESPONSIBLE FOR WHAT YOU VERBALLY SAY, BUT WHAT OTHERS HEAR YOU SAY AND SEE IN YOUR BEHAVIOR.

Legislative and Government Relations

SB 94 “Signature Authority for Advanced Practice Registered Nurses.” Signed into law March 12, 2019 with Governor Bullock and our sponsor Senator Gauthier.

SB 94 is simply a signature authority of certified registered nurse practitioners. Therefore, when a provision of law or administrative rule requires a signature, certification, stamp, verification, affidavit, or endorsement by a physician, the requirement may be fulfilled by an advanced practice registered nurse practicing within the scope of the advance practice registered nurse's certification; provided, however, that nothing in this section shall be construed to expand the scope of practice of nurse practitioners.

Advance practice registered nurses (APRNs) in Montana have full practice and prescriptive authority to the full extent of their education. APRNs include Nurse practitioners, Certified Nurse Midwives, Clinical Nurse Specialists and Certified Registered Nurse Anesthetists.

As many APRNs provide primary and specialty care in Montana, they are still unable to sign required

documents for patients, insurance companies, and referrals that are within their scope of practice due to the form, document or verification still requiring a physician’s signature. Because of this, many patients are being forced to see a physician unfamiliar with their health care history adding stress and anxiety to the patient and increasing healthcare costs. This bill will pave the way for patients to continue to receive care from their chosen primary care provider and decrease costs to consumers.

As part of their daily practice, APRNs provide comprehensive health care to patients within the scope of their licensure, education, and certification. Outdated signature laws may direct that some of the ‘paperwork’ associated with this care include a physician’s signature in order to be recognized, even though the physician did not provide the care to the patient.

Examples of signature authority activities include but not limited to:

• Providing certification for disabled patients to obtain parking permits/placards from the DMV

• Signing sports physicals for student athletes• Signing physicals for school bus drivers to

transport our students• Signing important forms related to end-of-life

care• Signing forms excusing a potential jury member

due to illness

• Signing workers’ compensation forms for employees injured on the job

• Providing proof that a patient has a health need that requires their utilities to remain on despite inability to pay their bill for the month

• Signing Immunization exemption forms• Patient referrals• DPHHS medical/healthcare forms

This bill does not expand the scope of practice for APRNs; it simply authorizes them to “treat the paperwork” for the care they have already provided to the patient.

In conclusion, this legislation clarifies that whenever any law or regulation requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, these statements shall be applied and deemed appropriate to be signed by an advanced practice registered nurse within their scope of practice. It in no way expands the scope of practice and this bill will ease the burden of costly duplicative services and not delay care for patients.

The Montana Nurses Association, on behalf of the professional nurses they represent, would like to thank Senator Gauthier for being a champion for professional nurse issues and sponsoring this legislation to improve access to healthcare for the patients in Montana our APRNs provide care for.

Vicky Byrd,MSN, RN

May, June, July 2019 Montana Nurses Association Pulse Page 15

APRN CornerAnother successful APRN

pharmacology conference – Years ago when we started the APRN conference I remember the first year we only had about 40 attendees and this year over 120 signed up – Thank you all for attending and spreading the word to fellow APRNS.

I have to say it is always so energizing to attend, see and connect with colleagues and meet new NPs from around the state. This year, the conference was moved to the Delta Hotel (the old Colonial Inn), as we have outgrown the Great Northern. Be sure to mark your calendar for next year’s conference February 28th & 29th, 2020. If you would like to be a presenter, or know someone who would be a great speaker, please reach out to Mary Thomas at mary@mtnurses.org, or myself keven.comer@gmail.com.

Fabulous news: On March 12, Governor Bullock signed into law Senate Bill 94 – Global Signature Authority. MNA has worked since the 2017 legislative session with Senator Gauthier (R) on the language and sponsorship. We can’t thank him enough for his participation and partnership. In addition, MNA was able to collaborate with AANP to identify areas of existing law requiring MD signature, provide model

bill language, talking points and rebuttal arguments. It was truly a collaborative effort. The Montana Hospital Association and the MT Board of Nursing were supportive as well. MNA will be spending some time identifying the avenues needed to put the law into practice. This law allows APRNs to sign forms within our scope that for one reason or another, the APRN was left off of the official ability to sign. Some of these include state hunting permits, police physical exams and school paperwork. For more information see the Legislative and Government Relations section.

Remember, you have the ability to support MNA and its efforts to be your advocate at the legislature and pulse of nursing by becoming a CAP-C Member.

Keven ComerMN, APRN, FNP-BC

This will help maintain full practice authority and ongoing diligence by MNA staff preserving APRN licensure. Your CAP-C membership is only $99 a year.

This is a small sum to pay to ensure the ongoing presence and oversight from the Montana Nurses Association, ensuring ongoing full practice for all Montana APRNs.

CAP-C Membership is a collaborative member of the Council on Advanced Practice and dues will be utilized for legislative issues, CAP council designation and MNA operations. CAP-C members will receive a $50 discount on registration for MNA’s annual APRN conference and for MNA’s Annual Convention.

To become a CAP-C MNA member please contact the MNA office at 406-442-6710 or email Jennifer@mtnurses.org

Montana Nurses Association Foundation (MNAF) 501c3The Montana Nurses Association Foundation

(MNAF) was launched at our annual convention October 2017 hosting a silent auction with great success. Many nurses donated to our foundation and the foundation has recently invested those donations to begin meeting our mission and purposes. MNAF is excited to spread the word across the state of Montana that donations (100% tax deductible) can now be accepted and used to support our mission below. MNAF will leverage the strength of our organization and our MNA members to drive excellence in practice and education, and ensure that the history, voice and vision of professional nurses in Montana thrives. MNAF helps our communities through charitable grants and helps nurses improve the lives of patients and their families locally and throughout the state.

MissionThe Montana Nurses Association Foundation

(MNAF) is the charitable and philanthropic branch of the Montana Nurses Association (MNA), with a mission to preserve the history of nursing in Montana and contribute, support and empower the professional nurse in Montana.

Purposes: from our articles of incorporation• Charitable• Educational• Grants to licensed registered nurses• Awards scholarships• Provide continuing education grants

• Historical record preservation• Stimulate and promote the professional

development of nurses

Areas of Interest • Elevating the image of nursing • Improving health • Strengthening leadership • Generating new knowledge and policy • Fostering philanthropy

To give to the Montana Nurses Association Foundation contact Jill Hindoien at 406-442-6710 or email Jill@mtnurses.org. You can also donate in honor of, or in memory of someone. If you wish to do this, please be sure to include the name and address of the family members you want notified of your donation. The family will receive an acknowledgement letter from MNA with the donation information.

Example letter:

MONTANA NURSES ASSOCIATION FOUNDATION20 Old Montana State Highway ~ Clancy, MT 59634

Phone (406)442-6710 ~ Fax (406)442-1841FEIN: 81-3002564

July 10, 2018Dear Mr and Mrs xxx,The Montana Nurses Association Foundation

(MNAF) was established in 2016 and is the charitable and philanthropic branch of the Montana Nurses Association (MNA), with a mission to preserve the history of nursing in Montana and contribute, support, and empower the professional nurse in Montana.

The Montana Nurses Association Foundation has received a generous monetary donation from Mr and Mrs xxx in memory of your loved one, xxxx. Through this generous donation, MNAF is able to provide continuing educational grants to Montana registered nurses, award scholarships to Montana nurses pursuing advanced degrees in nursing, and preserve Montana nursing history.

Sincerely,

Vicky Byrd RN, BA, OCNPresident/Executive Director406-442-6710Vicky@mtnurses.org

Announcing Career OpportunitiesYou’ve Been Waiting For!

Crossroads Correctional FacilityShelby, Montana

Now Hiring:LPNs & RNs

New Licensed Graduates Welcome!Competitive Salary and Pay Based on Experience.

To learn more, please contact:Cyndy McClimate - Medical Recruiter

615.263.3148

Apply online at jobs.corecivic.com

CoreCivic is a Drug Free Workplace & EOE - M/F/Vets/Disabled.

Become a member today!Visit mtnurses.org to join.

Are you looking for a fulfilling nursing career that allows for work-life balance, offers a strong benefits package, and competitive wages?

The State of Montana is currently seeking nurses at all levels (RNs, LPNs and APRNs) to join our collaborative treatment and medical teams at our various treatment, residential, and nursing facilities to support individuals in therapeutic environments.

The State of Montana offers a comprehensive benefits package which includes health, dental, life insurance, retirement package(s), and paid time off (15 paid vacation days, 12 paid sick days, and 10 paid holidays).

Various shifts are available. These positions will receive on-the-job training to advance skills and abilities.

We are hiring nurses at the following facilities:Montana Chemical Dependency Center (MCDC) - Butte MTMCDC provides intensive inpatient treatment that cares for the disease of addiction, including withdrawal. For more information: Email KLincoln@mt.gov or call 406-496-5413.

The Montana State Hospital (MSH) - Warm Springs MTProvides inpatient psychiatric treatment for adults with serious mental illness. For more information: Email Holly.Callarman@mt.gov or call 406-225-4402.

The Intensive Behavior Center (IBC) - Boulder MTAn intensive, short-term treatment facility for individuals who have intellectual disabilities. For more information: Email JBuck3@mt.gov or call 406-225-4426.

Montana Mental Health Nursing Center (MMHNCC) - Lewistown MTLicensed residential facility for the long-term care and treatment of persons who have mental disorders. For more information: Email DGies@mt.gov or call 406-535-6935.

Montana Veteran’s Home (MVH) - Columbia Falls MTA Medicare/Medicaid and Veteran’s Administration certified facility with 105 intermediate/skilled-care beds and 12 domicillary beds. For more information: Email MWilliams3@mt.gov or call 406-892-3256, Ext 248.

To Apply: Go to https://StateCareers.mt.gov

MT DPHHS is Hiring Nurses!

For further Information, contact MT DPHHS Human Resources at 406-444-3136 or email hhshumanresources@mt.gov.