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Volume 28 • Number 1February, March, April 2019

UTAH NURSEMany Roles. One Profession.

www.utnurse.org

Cost Analysis and Nurse Leadership

Page 6

Mind/Body/Spirit

Page 8

Co

nte

nt

Inside

The Official Publication of the Utah Nurses Association

Quarterly publication direct mailed to approximately 34,000 RNs and LPNs in Utah.

PRESIDENT’S MESSAGE

1 President’s Message2 From the Editor2 Become a Nurse Peer Reviewer3 Our Commitment to Lifelong

Learning is Focused on You!4 Join UNA and ANA4 A Voice for Nursing5 From the Membership Committee5 Nurses on Boards Coalition6 Cost Analysis and Nurse Leadership7 Practice Matters7 Falls Prevention Update

7 Proposition 3 Medicaid Expasion Has Passed! Now What?

7 GRC Report8 Mind/Body/Spirit9 Human Trafficking11 Utah Nurses Foundation12 Musings of Caring13 Leading the Way14 Seeking Nurses for Community

Volunteer Opportunities14 So What IS Climate Change?

Please join us Friday, February 22nd for Nurses’ Day at the Legislature in Salt Lake City. We will begin in the Governor’s Hall in the Capitol at 8AM, with a complimentary continental breakfast catered by Brown Brothers; including pastries, fresh fruit, muffins, orange, cranberry and apple juices, coffee, tea and bottled water. Program will commence at 9:00 am. It will be a great opportunity to learn about this year’s bills. We welcome all nurses and nursing students to attend. Your Government Relations Committee members have been following legislation proposed during the interim session since last spring.

Nurses’ Day at the Legislature

Sharon K. Dingman, DNP, MS, RN

Welcome to the New Year, 2019! As President of UNA, I extend a warm greeting to all Utah nurses and to those in your lives who support you. The Gallup 2018 annual consecutive survey, nurses rated (84%) highest for honesty and ethical standards for the 17th consecutive year. As a profession, all nurses share the privilege of earning this top spot. Nurses outpaced 22 occupations. Doctors (67%), pharmacists (66%), high school teachers (60%) and police officers (54%) rounded off the top five with all having “high” or “very high” standards (Gallup Satisfaction Survey, 2018). Congratulations!

The UNA Board wants to extend our appreciation to Aimee McLean, BSN, RN who has served faithfully for the last several years as President of UNA. Her goal has always been “get out, get educated, and get involved! Nurses are trusted, your voice is important to be heard and be present in all venues where you make a difference in patient care and outcomes.” Thank you, Aimee, for your dedication, leadership and contributions to Utah nurses, your nursing colleagues, and to ANA/UNA in the past few years. We are pleased to have you as the ANA Membership Assembly Delegate for UNA. Thank You!!

As to my introduction, I have been a nurse for 35 years. I began my nursing education at Weber State University (BSN), traveled to Brigham Young University weekly (MS), and moved to Texas for a nursing leadership position and attended Texas Christian University (DNP). My work experience moved from direct patient care at the bedside, to middle management, to consulting, and to the executive level of hospital and corporate administration, and then back to Utah in education as a faculty member in three Utah Education Systems. I have remained active in volunteer/professional service organizations. I am the author of The Caring Model® L.L.C Patient Satisfaction Program and have presented nationally and internationally. My husband and I completed a one-year church service mission working with young adult service missionaries at the Dessert Industries in Harrisville, Utah in August 2018. I am married, we have seven children, 24 grandchildren, seven great grandchildren (all under the age of three), and enjoy travel, genealogy, and spending time with family and friends.

I am excited to share an update on UNA activities for 2019. As a new Board, we meet at the end of January 2019 to welcome the new members, participate in a Board orientation, and review the goals and strategic

direction of UNA for 2019-2021. You can find a summary of our plans over the next several months on the UNA Website and ANA/UNA Member Updates beginning in February 2019 and throughout the coming year. A few highlights include: UNA Website Updates; continued collaboration with health care organization partners; support nurse initiatives such as, Opportunity to Serve, Nurses on Boards, and an annual UNA Conference expansion. We are increasing the geographical coverage of the Membership Committee, and invite new volunteers to participate with us on UNA Committees. We invite all nurses to join with us for Nurses’ Day at the Legislature on Friday, from 8am to 12noon on February 22, 2019. Get Involved in ANA/UNA “to make a difference, improve health care, and assure very best patient outcomes.” Happy New Year!

Selected Reference: Gallup Satisfaction Survey (2018). Nurses Again Outpace

Other Professionals for Honesty, Ethics. December 20, 2018; Megan Brenan. Retrieved from https://s e a r c h . a o l .c o m /a o l /s e a r c h?s _ i t=we b m a i l -searchbox&q=ht tps%3A%2F%2Fnews.ga l lup.com%2Fpoll%2F245597%2Fnurses-again-outpace-professions-honest-ethics

Attention UNA MembersYou can now find us on Facebook. Just search Utah

Nurses Association and look for the page with the UNA logo. We will be posting updates for upcoming events

and information on conventions in our blog.

The Utah Nurses Association Mission Statement:

The mission of the UNA is to advocate, educate, and be a voice for all nurses in Utah both individually and as a whole by promoting and facilitating the roles

and functions of nurses in all areas of employment and in all aspects of professional practice.

Utah Nurse • Page 2 February, March, April 2019

2018 BOARD OF DIRECTORSPresident Sharon K. Dingman, DNP, MS, RNFirst Vice President Stacey Shelley, RN, MSN, MBA-HCM, NE-BCSecond Vice President Claire LeAnn Schupbach, BSN, RN, CPC, CHPSecretary Heather Lowe, BSN, BS, RN Treasurer Linda Hofmann, PhD, RN, NEA-BC, NE-BCDirector At Large Angela Kaplar York, RN, BSN, C-AL Blaine Winters, DNP, ACNP-BC Jason M. Martinez, BSN, RN

STAFF MEMBERSExecutive Director Liz Close, PhD, RNEditor Claire LeAnn Schupbach, BSN, RN, CPC, CHP

COMMITTEECHAIRS & LIAISONSBy-Laws Open - If interested please email resume to UNA Finance Linda Hoffman, PhD, RN, NEA-BC, NE-BCGovernment Relations CJ Ewell, MS, APRN-BC Diane Forster Burke, MS, RN Kathleen Kaufman, MS, RN,Membership Sharon K. Dingman, DNP, RN Nominating Janelle Macintosh, PhD, RNEducation Committee Blaine Winters, DNP, ACNP-BC

UTAH NURSES FOUNDATIONPresident Marianne Craven, PhD, RN

ANA MEMBERSHIPASSEMBLY REPRESENTATIVESAimee McLean, MSN, RNSharon K. Dingman, DNP, MS, RN

PRODUCTIONPublisher Arthur L. Davis Publishing Agency, Inc.

Editor and Publisher are not responsible nor liable for editorial or news content.

Utah Nurse is published four times a year, February, May, August, November, for the Utah Nurses Association, a constituent member of the American Nurses Association. Utah Nurse provides a forum for members to express their opinions. Views expressed are the responsibility of the authors and are not necessarily those of the members of the UNA.

Articles and letters for publication are welcomed by the editorial committee. UNA Editorial Committee reserves the right to accept of reject articles, advertisements, editorials, and letters for the Utah Nurse. The editorial committee reserves the right to edit articles, editorials, and letters.

Address editorial comments and inquiries to the following address: Utah Nurses Association, Attn: Editorial Committee 4505 S. Wasatch Blvd., Suite 330B Salt Lake City, UT 84124 una@xmission.com, 801-272-4510

No parts of this publication may be reproduced without permission.

Subscription to Utah Nurse is included with membership to the Utah Nurses Association. Complementary copies are sent to all registered nurses in Utah. Subscriptions available to non-nurse or nurses outside Utah for $25. Circulation 33,000.

All address changes should be directed to DOPL at (801) 530-6628.

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. UNA 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 Utah 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. UNA 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 UNA or those of the national or local associations.

FROM THE EDITOR

The Utah Nurse Publication Schedule for 2019

Issue Material Due to UNA OfficeMay, June, July 2019 - March 7, 2019

Guidelines for Article DevelopmentThe UNA welcomes articles for publication. There is no payment for articles published in the Utah Nurse.1. Articles should be Microsoft Word using a

12 point font.2. Article length should not exceed five (5) pages

8 x 113. All references should be cited at the end

of the article.4. Articles (if possible) should be submitted

electronically.

Submissions should be sent to: editor@utnurse.org or

Attn: Editorial Committee | Utah Nurses Association4505 S. Wasatch Blvd., Suite 330B

Salt Lake City, UT 84124 | Phone: 801-272-4510

PUBLICATION

Published by:Arthur L. Davis

Publishing Agency, Inc.

utnurse.org

Claire L. Schupbach, BSN, RN, CPC, CHP

The gift of a new year is reflecting on the core of who you are and what you do. We have focused in this edition on the most basic core of health care, humanness and human rights. We have included the ANA’s statement on the human rights of immigrant families and the response of nurses across our country to provide aide. In that same theme, we are proud to publish the UMA’s (Utah Medical Association) article on human trafficking in Utah. This is an issue rarely talked about and it is critical, we, as advocates for our patients and our communities prepare ourselves. Please, slow down, read and take to heart this issue and information.

The UNA in partnership with other western states has revamped and improved the CE process. Please ensure you make note of the changes and improvements to the process.

Again, we find ourselves in the middle of the Utah Legislative Session. Please join us at Nurses’ Day at the State Legislature, February 22nd. The legislators

care about nursing perspectives and value our insight. They come to speak and listen, sharing their time and energy. If you have an issue you care about, please note the GRC’s information on how to be involved and comment on bills during the session. We covet your involvement.

As an organization, whose mission is to be a voice for all nurses in Utah we want you to speak to us and writing a letter to the editor is a great avenue. I realized I have not detailed the requirements for this process. The journalism standards for a letter to the editor, include the author submitting the article, along with their name and contact information to the organization. Due to the sensitivity of the issue, the organization can elect to publish the letter as anonymous. If you submit an article you wish us to publish, please follow the guidelines and we are more than happy to be a voice.

Become a Nurse Peer Reviewer

Looking for a flexible schedule volunteer opportunity to serve your nursing association and your nursing community?

Become a Nurse Peer Reviewer — Supporting Quality Continuing Education

The Western Multi-State Division (WMSD) and its four member associations — AzNA, CNA, INA, and UNA invite qualified nurses to serve as peer reviewers to evaluate continuing education programs for approval. Their expertise supports continuing education activities for the nurses in our four state division and beyond.

The WMSD Accredited Approver Unit will provide training to all qualified Nurse Peer Reviewers to educate them on the ANCC/WMSD accreditation criteria.

Are you:• A currently licensed RN with a Bachelors Degree in

Nursing or higher?• Interested in joining a unique group of nurse peers

supporting providing ANCC accredited continuing education for the nurses in your community?

• A nurse planner for education programs and events or a primary nurse planner of an Approved Provider unit who wants to stay current in your knowledge of ANCC accreditation criteria?

• Willing to serve on the volunteer review panel or as an independent reviewer?

• Qualified with a background in education, training, and or relevant knowledge and experience in educating nurses that would prepare you to participate in the peer review process?

• Proficient in Microsoft Office suite, and accessing email and email attachments?

If so, learn more about the selection and training process at utnurse.org/education under the Nurse Peer Reviewers tab.

NursingALD.com can point you right to that perfect NURSING JOB!

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February, March, April 2019 Utah Nurse • Page 3

Get credit for your education efforts!

There are as many aspects to nursing practice as there are settings and types of nursing

practice. The “needs” that are identified for professional

development and practice enhancement will be as varied.

Don’t assume you can’t offer CE – Utah Nurses Association can

help.

• Contact education@westernmsd.org with questions.

• Visit www.utnurse.org/Education to view FAQs and application information.

UNA is pleased to announce we have re-named our continuing nursing education entity to better represent services available to every Utah nurse. The old name, Western Multistate Division has been replaced with Continuing Nursing Education Group (CNEG). CNEG is a partnership between UNA, ANA-Idaho and Arizona Nurses Association. There are many excellent nursing-focused educational programs offered in our state, yet some entities have felt intimidated by the complexities of the CNE application process. The good news is that CNEG has improved and streamlined this process! If you would like to apply for Continuing Nursing Education (CNE) contact hours for a single event, program or activity please visit the new website administrated by our Arizona partner www.aznurse.org/CE. You can also access this page through the UNA website.

All CE is not EqualCNEG is an accredited approver of continuing

nursing education by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. ANCC is considered the “gold standard” for CNE and only accredits organizations that demonstrate the use of evidence-based criteria and evaluation.

We Need You….If you like what you have read so far and are looking

for a way to give back to the association/nursing profession, why not consider volunteering as a Nurse Peer Reviewer (NPR)? NPRs are trained as volunteer reviewers for CNE applications. NPRs are the lifeline of CNEG. Criteria for becoming an NPR are listed on the CNEG website www.aznurse.org/CE.

Terminology 101: Did you Know?• CEU: Is a retired term no longer in use• Contact Hours: replaced CEUs• CNE: Continuing Nursing Education signifies that

the continuing education (CE) offered is specific for Nurses. This is the preferred terminology.

Everything I Need to Know I Did Not Learn in Nursing School!

Being voted the most honest and ethical profession for the last 16 years (Gallup Poll, 2017) suggests public assumption that nurses are professionally competent. The American Nurses Association (ANA Position Statement, 2014) defines competency as an expected level of performance that integrates knowledge,

skills, abilities, and judgment. ANA also states that the registered nurse is individually responsible and accountable for maintaining professional competence. Professional competence goes hand in hand with lifelong learning principles. Here are some of the benefits of CNE:

• Validates specialty knowledge, experience and judgment for Specialty Certification

• Impacts patient care quality/outcomes• Meets states’ requirement for licensure renewal.• Promotes professional advancement

The Wisdom of FlorenceLet us never consider ourselves as finished nurses…

we must be learning all our lives-Florence Nightingale

ANA (2014). Position Statement: Professional Role Competence https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/professional-role-competence/

Gallup (2017). Nurses Keep Healthy Lead as Most Honest, Ethical Profession. https://news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx

OUR COMMITMENT TO LIFELONG LEARNING IS FOCUSED ON YOU!

Nursing Opportunities Available• Emergency Room Nurse • Medical / Telemetry Unit Nurse

• Outpatient Clinic Nurse • Diabetes/Community Health Nurse Supervisor

• Diabetes/Community Health RNSage Memorial Hospital is located in Northeastern Arizona, Ganado, Arizona

For more information contact: Ernasha McIntosh, RN, BSN, DON, 928-755-4501, ernasha.mcintosh@sagememorial.com.

Applications available at http://sagememorial.com/careers/Submit applications to the Human Resources Department,

Fax#: 928-755-4659, hr@sagememorial.com

Utah Nurse • Page 4 February, March, April 2019

UNA leaders represent your interests in a wide variety of meetings, coalitions, conferences and work groups throughout the year, anticipating and responding to the issues the membership has identified as priorities. In addition to many meetings with legislators, regulators, policy makers and leaders of other health care and nursing organizations, the following is a partial list of the many places and meetings where you were represented during the past three months....

• UNA Board Meeting• UNA Executive Committee Meeting• Health and Human Services Committee of Utah State Legislature Interim

Meetings• Utah Nursing Consortium• Utah State Board of Nursing• Utah Recovery Assistance Program Meetings• Academic Leadership Council of UONL• UNA 28th Annual Conference & Advocacy Day• WEX Meeting• Utah Health Policy Roundtable• Sigma Theta Tau Nu Nu Chapter Board Meeting• Utah Board of Student Nursing Association Meeting• Sigma Theta Tau Gamma Rho Chapter Induction Ceremony• National Quarterly President’s Call (ANA)• UACH (Utah Action Coalition for Health) Health Insights• Falls Prevention Committee • Natural Resources, Agriculture and Environment Interim Meeting • UHPP Annual Conference

A Voicefor Nursing

Full-time, 9-month position with the possibility of either a tenure-track or non-tenure track position to start August 16, 2019.

Master or Doctorate of Nursing required with Utah licensure.

Apply online at www.suu.edu. Please contact Human Resources at jobs@suu.edu or 435-586-7754 if you have questions.

ASSISTANT PROFESSOR OF NURSING

February, March, April 2019 Utah Nurse • Page 5

FROM THE MEMBERSHIP COMMITTEE

Sharon K. Dingman, DNP, MS, RN

Welcome to our new members and renewing members. We are inviting you to encourage your colleagues to join UNA this year. The 2019 goals for the Membership Committee include:

1. Clarify and promote the value of UNA membership

2. Maintain communication with members regarding

benefits

3. Membership growth

4. Promote auto pay of monthly vs. annual dues

onetime payment

5. Maintenance of membership services

6. Support the value of conference participation

Here is what we do: The UNA Membership Committee assists the Board and Executive Director (in alignment with ANA) in creating value for membership, nurse engagement, nurse excellence support, nurse health and wellbeing, and healthy work environments. The Membership Committee is responsible to recruit, retain, and increase Utah nurse awareness about the benefits of ANA/UNA membership and their active participation with the organization.

Along with increasing membership, we would like to “grow” our Membership Committee.

For questions about joining the UNA Membership Committee, please contact:

• Dr. Sharon Dingman, UNA Membership

Committee Chair at membership@utnurse.org

• Dr. Liz Close, UNA Executive Director at

execdirector@utnurse.org

• Contact the UNA Office at (801) 272-4510.

Membership Benefit Information Online – Take a few minutes to visit the sites below!

Being a member of ANA/UNA makes a powerful statement about you and your commitment to nursing. Membership provides a way for nurses across the United States and Utah to speak on behalf of nurses and patients for safe and consistent quality care. Continuing Education and member programs provide access to learning opportunities keep nurses up-to-date nursing knowledge and career advancement. Membership provides information about personal health and healthy work environments that are safe, empowering, and satisfying.

As a member, there is access to up-to-date journals and publications: The American Nurse Journal; The Online Journal of Issues in Nursing (OJIN) by using a member log-in; E-News Letters: ANA SmartBrief, ANA Nurse CareerBrief, Nursing Insider, and Member News.

Network and connect through social media with your state and national associations by visiting the UNA

Website http://www.utnurse.org. For additional local information contact UNA at una@xmission.com or send correspondence to Utah Nurse Association, 4505 S. Wasatch Blvd. Suite 330B, Salt Lake City, UT 84124 to the attention of UNA Membership Committee Chair/Executive Director.

Please take a few minutes to review the current benefits of ANA/UNA Membership Information online.

UNA/ANA-Membership gives you direct access to nursing knowledge, career development, and professional connections, enabling you to provide top-quality patient care and be the best nurse you can be. UNA Website: https://una.site-ym.com/page/HowToJoinUNAANA

Benefits for ANA/UNA Membership includes access to professional tools to use in your professional life, including access to research tools, nursing resources, etc. Join or access through your MyANA account at https://www.nursingworld.org

Visit Utah Nurses Association at: https://una.site-ym.com or https://www.nursingworld.org/membership/find-my-state/

IMPORANT CONTACTS AT-A-GLANCE for Membership

ANA Membership Services: 1-800-923-7709, FAX: 1-301-628-5355, Mail: American Nurses Association, 8515 Georgia Avenue, Suite 400, Silver Spring. MD 20910

• Update your Profile: NursingWorld.org /MyANA

ANA E-mail Addresses:

• Membership: memberinfo@ana.org

• American Nurses Foundation ANF: anf@ana.org

• ANA-PAC: ana-pac@ana.org

• NursesBooks.org: anp@ana.org

• Ethics Issues: ethics@ana.org

• Lobbying – Federal and State: gova@ana.org

• Meetings and Conferences: meetings@ana.org

• Nursing World: https://www.nursingworld.org/

Professional Development and Networking Resources Online:

• ANA Careers Center: https://www.nursingworld.

org/education-events/career-center/

• ANA Leadership Institute: https://www.

nursingworld.org/continuing-education/online-

courses/nurse-leadership-bundle---self-paced-

online-course-a59ddd1a/

• ANCC Certifications:

https://www.nursingworld.org/anc

• Online Continuing Education: http://ana.

nursingworld.org/ce/cewelcom.cfm

• Navigate Nursing: https://offers.

wherenurseslearn.org/anamembers/

American Nurses Credentialing Center: 1-800-284-CERT (2378)

In 2010, the Institute of Medicine released a landmark report, The Future of Nursing: Leading Change, Advancing Health, which recommended increasing the number of nurse leaders in pivotal decision-making roles on boards and commissions that work to improve the health of everyone in America. The Nurses on Boards Coalition (NOBC) was created in response to this, as a way to help recruit and engage nurses to step into leadership roles.

The NOBC represents nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions. The coalition’s goal is to help ensure that at least 10,000 nurses are on boards by 2020, as well as raise awareness that all boards would benefit from the unique perspective of nurses to achieve the goals of improved health in the United States.

We encourage each and every one of you, over three million strong, to visit www.nursesonboardscoalition.org, sign up to be counted if you are on a board and read more about the efforts being made to help build the future of our profession.

We are seeking six (6) registered nurse members from different geographical areas in

the state to join the UNA Membership Committee from inpatient/outpatient clinical care, education,

and management. Come join us!

Please visit website for more information

myUNP.org

BENEFITS OF BEING A MEMBER

MEMBERSHIPFull Membership: $90

Student Membership: $45

BENEFITS

Network opportunities

with other NPs

Forum for addressing NP related issues

Participation on UNP committees

and projects

DISCOUNTS PROGRAMM

yUNP

with American Association of Nurse Practitioners (AANP)

MEMBERSHIP DUESREDUCED

Annual Pharmacology Conference* Park City Marriot, April 26-27, 2019

*Membership Discounts

Day at the CapitolUNP Advocacy

February 8, 2019

RN-BSN Online Program• DSUs Nursing

Department offers a RN-BSN program that is

completely online.• Students are admitted

every fall, spring, and summer semester.

• DSU has one of the lowest tuitions in Utah for

an RN-BSN program.

To register, call 435.879.4813For more information:

health.dixie.edu/nursing/rn-to-bsn-program/

• Program completion in as little as 2

semesters with full-time enrollment;

part-time enrollment is always available.

• Enrollment is open up to 4 weeks prior to the beginning of each

semester

Utah Nurse • Page 6 February, March, April 2019

Leading the Way

Debra HamptonPhD, MSN, RN, FACHE, NEA-BC, CENP

Implementing projects and purchases requires an

understanding of costs and benefitsYOUR ORGANIZATION has a computed tomography (CT) scanner that’s six years old. Because of technology upgrades and advances in care, the organization is considering whether it’s time to replace the equipment. The cost of a new CT scanner ranges from $1 million to more than $2.5 million, depending on the scanner type. These questions need to be answered:

• Is it necessary to replace this machine at this time?

• What CT scanner should your organization purchase to get the best return on investment (ROI)?

To make this important decision, your organization needs to perform a cost analysis. The purpose of a cost analysis is to determine the total cost of an item, program, or project—in this case, a new CT scanner.

We use three primary types of cost analysis in healthcare: cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis. As nursing leaders, we can do cost analyses:

• to justify the purchase of new equipment• to outline the costs compared to the benefits of

beginning a new program• to support the need for adding staffing

positions or increasing staffing in the unit or department

• to justify why we need to implement specific safety or quality initiatives.

Let’s learn about each type of analysis, decide which option (or options) will help you make the best CT scanner purchase, and how nurse leaders can use cost analyses to justify the purchase of equipment or the implementation of new programs or services.

Cost-benefit analysisA cost-benefit analysis allows us to compare

the costs of a purchase or a new program to the

COST ANALYSIS AND NURSE LEADERSHIP

benefits obtained. The first step is determining the objectives—tangible and measurable—you hope to achieve. For example, a cost-benefit analysis will help you determine the impact of increasing staffing on nursing-sensitive outcomes and staff satisfaction.

After determining the objectives, determine the cost of the equipment, service, or program and all other associated costs (including the purchase cost and all costs associated with executing the venture, such as any related equipment, supplies, staffing/labor, development, and implementation). Then quantify the benefits (including assigning a dollar value to each) and determine the ratio between the costs versus the benefits. Do the benefits exceed the costs and if so, by how much? When doing a cost-benefit analysis, every benefit should have a dollar value assigned to it. For example, if a new piece of equipment will reduce repair costs, how much have repairs cost in the past year? If increasing staffing will reduce falls, patient infections, or other patient complications, what is the average cost of a fall or a catheter-associated infection and how many falls or infections will be prevented.

Cost-effectiveness analysisIn cost-effectiveness analysis, we consider the

value of our purchase and determine if the value and usage is going to be worth what we paid. Usually when doing a cost-effectiveness analysis, we look at two alternatives and try to determine which is the most cost-effective. As a nursing leader, you might do a cost-effectiveness analysis to determine the value of one type of skin pressure-relieving support surface over another. You could do this by trialing both products and comparing the outcomes, taking into account patient comfort, ease of caring for patients on each type of surface, nursing care, patient skin condition, and cost.

Once you’ve quantified value in terms of benefits, you can compare the benefits of both products in relation to the cost. The question to ask in cost-effectiveness analysis is: Which alternative returns the most value in relation to the overall cost? Nursing literature includes several examples of cost-effectiveness analysis. For instance, to answer the question about the cost-effectiveness of higher hour per patient day staffing targets, Twigg et al published a systematic review of the impact of increased staffing on patient outcomes.

We could do the same type of analysis related to the CT scanner purchase. After we narrow our choice to two or three different manufacturers and determine the objectives we want to meet—such as image area scanned, image resolution, and radiation dosage—we can obtain the cost of CT scanners with varied features and then quantify the value of additional features.

Cost-utility analysisA cost-utility analysis can be used to determine the

value of a product or medication on the maintenance and improvement of the length and quality of a patient’s life or the allocation of health resources. It compares the cost of different treatment options with their outcomes in terms of health utility. (See Quality-adjusted life year.)

Penner reminds us that cost and benefits aren’t the only things that should be considered when making decisions about initiatives we want to implement. She notes that “neither the least costly nor the most costly intervention is certain to result in the best clinical outcomes.” (See Comparative effectiveness research.)

ROIA final term frequently used in healthcare is ROI,

which means how much profit or loss is made from money invested in equipment (such as a CT scanner), programs, or projects. An ROI example is returning to school to obtain an advanced degree. The investment of your money and time can result in a promotion or new job opportunity that results in higher income and future career advancement.

Justifying the investmentBefore making financial commitments in most

healthcare settings, some type of cost analysis or ROI analysis is done to justify the investment. As leaders in today’s value-based healthcare world, we must quantify the benefit of equipment we recommend, projects that need to be completed, or programs that we would like to implement. We should always consider the cost and benefit of requests. How will patient outcomes be affected? Will staff satisfaction be improved? Leaders at all levels must be competent at creating and presenting a business case that includes the appropriate type of cost analysis.

Debra Hampton is an assistant professor and academic program coordinator of the Executive Leadership DNP and MSN to DNP programs at the University of Kentucky College of Nursing in Lexington.

Selected referencesFornell, D. What to consider when buying a new CT scanner.

October 14, 2016. dicardiology.com/article/what-consider-when-buying-new-ct-scanner

Leonard K. How to distinguish between cost benefit analysis and cost effective analysis. Chron. June 26, 2018. smallbusiness.chron.com/distinguish-between-cost-benefit-analysis-cost-effective-analysis-61326.html

McCabe C. What is cost-utility analysis? What Is…? Series. February2009. www.bandolier.org.uk/painres/download/whatis/What_is_cost-util.pdf

National Information Center on Health Services Research and Health Care Technology. Health economics information resources: A self-study course. July 12, 2016. nlm.nih.gov/nichsr/edu/healthecon/ 04_he_03.html

Penner SJ. Economics and Financial Management for Nurses and Nurse Leaders. 3rd ed. New York: Springer Publishing Company; 2017.

Twigg DE, Myers H, Duffield C, Giles M, Evans G. Is there an economic case for investing in nursing care—what does the literature tell us? J Adv Nurs. 2015:71(5);975-90.

Reprinted from American Nurse Today

February, March, April 2019 Utah Nurse • Page 7

Kathleen Kaufman, MS, RN, GRC Co-ChairDiane Forster-Burke, MS, RN, GRG Co-Chair

Participation in the Government Relations Committee is open to any interested member. We conduct our work via email; we post bills on a Dropbox, discuss the bills, and then assess for a consensus on the bill enabling the UNA to publish a position. CJ Ewell is the 3rd co-chair and contributes insight on bills from a nursing and a nurse practitioner standpoint. Her comments are eloquent and highly valued. Join the GRC and provide us with your insights on bills.

Due to the recent election, (as of late December) specifics on only a few bills are, yet, on the legislative website. https://le.utah.gov/ From this site, you can look under “bills requested for 2019” and view legislators’ plan to propose for the Session. Topics we generally follow closely are health care, health care providers, and health care facilities. We also “look further afield” and watch bills under education, insurance, etc. We do know that Nurse Practitioners will be opening the Nurse Practice Act to address independence in practice with the goal of aligning with other state NPs and, therefore, be in a Multistate Compact for nurse practitioners. They are looking at MD involvement in prescribing, as well as, the hours required, from education to full practice. We have noted a “mental health in schools” bill and the sponsor has been contacted. Another legislator has a bill about mental health teams for schools. A new legislator has worked with Dr Cosgrove on a funding model for more school nurse positions. Another legislator is pursuing the idea of using an apprenticeship model for some professions regulated by DOPL. We generally support clean air bills and will be looking at bills related to domestic violence and access to firearms for those with violent tendencies. We anticipate a bill or two about the cost of pharmaceuticals.

For those of you who have served on the GRC, we thank you, and want to know if you are still interested in participating. For the people who want to start on the GRC, welcome and let us know how to contact you.

Nurses Day at the Legislature is Feb 22 and we will be in the Capitol Rotunda again in the morning with break out rooms to follow. We are currently developing the agenda, if you have suggestions, please contact the UNA GRC committee.

You can contact us by emailing the UNA Executive Director, Liz Close at execdirector@utnurse.org with “GRC Committee” in the subject line of the email.

GRC REPORT

Diane Forster-Burke, MS, RN

Senator Iwamoto sponsored a resolution in 2017 creating a multi-disciplinary task-force to prevent falls in the community. This has become the Utah Fall Prevention Alliance https://utahfallsprevention.org/. As we have attended these meetings, we have learned of the resources available through the Area Agencies on Aging (AAA), as well as health insurance company case managers. These dedicated professionals need to be notified of members who have fallen to direct resources and help. We’ve also learned of the Home Health Association’s work in providing physical therapists in the home setting to help with strength and balance. Often when there is a fall in the home setting, EMS is called, but depending on their assessment, the patient may not be transferred. If not admitted to a hospital, then HIPAA doesn’t permit the sharing of the fall information to the patient’s provider or health insurer or AAA. If not notified, then help cannot be offered. Data analysis cannot be done with insufficient data collection.

The CDC and NIH have information on fall prevention. There is also the TUG (Timed Get Up and Go) test https://www.youtube.com/watch?v=BA7Y_oLElGY nurses can be aware of and perform with at-risk clients. CDC has https://www.youtube.com/watch?v=grrYoBucNPE as well as https://www.cdc.gov/homeandrecreationalsafety/falls/community_preventfalls.html. As nurses in the home or clinic setting, we can focus our awareness on risk factors for falls and education to prevent falls. The National Institutes on Aging has many articles including https://www.nia.nih.gov/health/prevent-falls-and-fractures. The American Nurse Today just published an article on falls in the acute care setting https://www.americannursetoday.com/preventing-falls-hospitalized-patients/?utm_source=Pardot&utm_medium=Email&utm_campaign=ANT_NL_20181204.

The https://utahfallsprevention.org site has a range of links to many fall prevention programs or activities, most of which are local. This site also has a falls prevention brochure with a short fall risk assessment questionnaire that can be easily used by family, caregivers and the older adult. We encourage you to be more alert to fall risks for your patients and help educate them to prevent a future fall.

FALLS PREVENTION UPDATE

PROPOSITION 3MEDICAID EXPANSION

HAS PASSED!

NOW WHAT?Kathleen Kaufman, MS, RN

Diane Forster-Burke, MS, RN

Thanks to everyone who voted in favor of and spoke to others about supporting Proposition 3, the Medicaid Expansion ballot initiative. This initiative did pass and Medicaid expansion has now become law in Utah. The next step is to prepare people to apply for Medicaid. According to the Utah Department of Health, the application for acceptance to Medicaid will begin April 1st as of this writing. As nurses, we need to know how to direct people to apply who have not used the state system.

A direct way to apply for Medicaid assistance is by calling Utah Health Policy Project (UHPP) at 801-433-2299. It is likely an insurance navigator will answer at that number. Another option is to call 211 and dial 4 for health insurance information. Eventually the call will be directed to a person or “agent” who can answer questions.

After applying, it will likely take a of couple weeks to be notified of acceptance; which is common with the Medicaid system. (Of course, many people may be submitting applications at the same time which may delay response time.)

After being accepted to Medicaid, the newly insured will next need to learn where to seek health care. Their past practice of utilizing ERs for care can now be directed to establishing a relationship with a primary care provider. When they are accepted to one of the four plans available to recipients of Medicaid, a list of providers currently accepting their Medicaid plan will be provided. Specific questions regarding healthcare coverage are best addressed by calling UHPP.

As a nurse, you can help in this process when educating your patients for discharge or ongoing care. They need to know practical things such as making appointments in a timely way (not the day before the person hopes to be seen), being sure to take their Medicaid card and ID with them to appointments, as well as calling the provider’s office if they will be missing an appointment. You may think of other key information to share, if you do, please write a letter to our editor at the Utah Nurse to share your ideas and experience with the rest of us throughout the state.

ANA and nurses call for migrant family reunifications

IMMIGRATION across our southern border took the spotight earlier this year. People chose sides based on personal views about how a child or family entered our country. But one thing was clear for the American Nurses Association (ANA) and nurses across the nation: The time it took from feeling outraged to wanting to take action was barely perceptible. Migrant children were being forcibly separated from their parents, housed in detention centers that included a vacant big box store and a warehouse, and reportedly not allowed the basic comfort of human touch, even from siblings. Any child enduring these conditions and separation from the only person they know and love for even a short period of time was unthinkable.

Nurses quickly contacted both ANA and me person- ally to ask what could be done to end this inhumane and emotionally damaging practice. Nurses also wanted to determine how they could directly provide health- care, support, and comfort to these frightened children, including those already traumatized by domestic and gang violence in their home countries. We know from our nursing experience and from research that children and adults may suffer physical and emotional symp- toms—anxiety, depression, and posttraumatic stress dis- order—from forced separation and detention, character- ized as “toxic stress.”

Further, unsafe and austere conditions were start- ing to be reported and, in some cases, captured in media images: children sleeping on concrete floors

surrounded by chain-link fencing; frigid indoor tem- peratures; inadequate food, water, and sanitation; and a lack or the forced use of medications. All these fac- tors can contribute to both short- and long-term poor health outcomes, especially without critical healthcare interventions.

ANA was among the early nursing, healthcare, and human rights organizations publicly calling for all migrant families to be reunited immediately. We also wanted to determine how we could mobilize members and all nurses who wanted to help. ANA’s Membership Assembly, which includes representatives from our con- stituent and state nurses associations, affiliated specialty nurses organizations, and our Individual Member Divi- sion, also issued calls to action at our June meeting.

I personally contacted Administration officials to try to persuade them to allow nurses and humanitarian groups to provide immediate and ongoing physical, emotional, and spiritual care. We continue to work in- dependently and with the greater nursing community, other key stakeholders, and lawmakers from both sides of the aisle seeking the reunification of families, as well as an investigation into and greater transparency around conditions at the detention centers.

As I write this, the situation remains fluid. Over 2,000 children have been reunited with their families or released. But the fate of hundreds of children still remains in the balance, and the Trump administration proposed a rule that could detain migrant children long- er. ANA also learned that some nurses from the United States Public Health Service reportedly have been sent to help, but

Practice Matters

HUMAN RIGHTSwe have no details about their deployment. Deportations, including for asylum-seekers, still loom, and the passage of comprehensive federal immigration legislation remains up in the air.

Some people may question why ANA and nurses nationwide are advocating so strongly on this and other human rights and social justice issues. The answer is easy: As nurses, we have a longstanding tradition of advocating for and providing expert, compassionate care to vulnerable populations, and we are bound by our Code of Ethics to always preserve the human rights of vulnerable groups, such as children, women, and refugees.

Yes, laws need to be enforced, but at the same time we will not stop speaking out and working for the common good, including humane treatment for all who seek refuge in the United States. Quality healthcare, social justice, and human rights are inextricably linked. As nurses, we will continue to advocate. And we stand ready to provide critical healthcare to all wherever it is needed.

FROM YOUR ANA PRESIDENT

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN President, American Nurses Association

Reprinted from American Nurse Today

Utah Nurse • Page 8 February, March, April 2019

Mind/Body/SpiritWellness 101

SPIRITUAL WELLNESS: A JOURNEY TOWARD WHOLENESS

David Hrabe, PhD, RN, NC-BC; Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP,

FNAP, FAAN; Susan Neale, MFA

Through spirituality, we connect with the world around us.

Editor’s note: This is the last installment in a 10-article series on wellness. You can read all of articles in the se- ries at americannursetoday.com/category/wellness101/. Thank you to the authors at The Ohio State University College of Nursing for their support of nurse wellness.

HAVE you ever felt like a “human doing” instead of a “human being?” As we fling ourselves from one activity to another, we sometimes find that getting beyond our list of “to do’s” and staying in touch with those aspects of our lives that mean the most to us is difficult. Remember that well-rounded self-care also involves spiritual wellness.

What is spirituality?Barbara Dossey, a pioneer in the holistic nursing

movement, writes that our spirituality involves a sense of connection outside ourselves and includes

our values, meaning, and purpose. Your spiritual well-being isn’t what you own, your job, or even your physical health. It’s about what inspires you, what gives you hope, and what you feel strongly about. Your spirit is the seat of your deepest values and character. Whether or not you practice a religion, you can recognize that a part of you exists beyond the analytical thinking of your intellect; it’s the part of you that feels, makes value judgments, and ponders your connection to others, to your moral values, and

to the world. For this reason, spirituality frequently is discussed in terms of a search. Spiritual wellness is a continuing journey of seeking out answers and connections and seeing things in new ways. It also means finding your purpose in life and staying aligned with it.

Although religion and spirituality can be connected, they’re different. A faith community or organized religion can give you an outlet for your spirituality, but religion isn’t spirituality’s only expression. Hope, love, joy, meaning, purpose, connection, appreciation of beauty, and caring and compassion for others are associated with spiritual well-being.

Spirituality as part of nurses’ DNAAs nurses we’re fortunate that the very basis of our

practice is grounded in spiritual ideals. From the be- ginning of our education, we learn about the impor- tance of spirituality in relation to a person’s overall health. Even our ethics emphasize the value of a spiritual connection. Provision 1 of the Code of Ethics for Nurses with Interpretive Statements states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” But many nurses are surprised to find that Provision 5 extends this compassion and respect to nurses themselves: “The nurse owes the same duties to the self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.” We have a responsibility to both our patients and to ourselves to honor our spiritual heritage.

Think about your job and what you do every day. When do you feel most energized? Great satisfaction can come from learning a new skill and mastering it, and of course it’s vital that you complete your many tasks efficiently and competently, but there’s more. When asked about the times they felt most energized, many nurses cite moments when they really connected with another person—family, friends, colleagues, patients. This is the “more”—when we go beyond just our needs and wants to connect beyond ourselves. Humans are wired to be in relationship with others. Spirituality is fundamental to nursing practice.

Disconnected much?Although most nurses would likely agree that

spirituality is an important component in the care they provide and in their personal lives, too often the pressures of modern life interfere with what’s most important to us. Crushing workloads, family responsibilities, financial pressures, and fast-paced living create the perfect storm that makes acting on our values difficult. Many nurses suffer chronic

Spiritual Wellness continued on page 10

Reprinted from American Nurse Today

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February, March, April 2019 Utah Nurse • Page 9

for assaultive injuries, has been threatened with risk of death, or if the patient gives the health care provider permission to contact authorities. Consider contacting the National Human Trafficking Hotline number (888.3737.888) to provide guidance and Utah-specific resources.

With a basic knowledge of this local human trafficking crisis, and an awareness of its indicators in our patient population, we can help not only identify these victims, but also connect them with the resources they may need to escape this victimization and become survivors.

References1. International Labor Organization. Global estimate of forced labour: Executive summary.

2012;Available at: http://www.ilo.org/wcmsp5/groups/public/---ed_norm/---declaration/documents/publication/wcms_181953.pdf

2. Victims of Trafficking and Violence Protection Act. Accessed at http://www.state.gov/j/tip/laws/61124.htm

3. Zimmerman C, Borland R. Caring for trafficked persons: Guidance for health providers. International Organization for Migration, 2009; accessed at http://www.iom.int

4. Greenbaum J, Crawford-Jakubiak JE, Committee on Child Abuse and Neglect. Child sex trafficking and commercial sexual exploitation: Health care needs of victims. Pediatrics, 2015;135(3):566-574.

Additional Resources• United Nations Office on Drugs and Crime. Global report on trafficking in persons.

Accessed at http://www.unodc.org/documents/data-and-analysis/glotip/Trafficking_in_Persons_2012_web.pdf

• National Human Trafficking Resource Center: www.polarisproject.org• Office of Refugee Resettlement, Anti-Trafficking in Persons (U.S. Dept of Health and

Human Services): www.acf.hhs.gov/programs/orr/programs/anti-trafficking • American Medical

Association. H-65.966: Physicians Response to Victims of Human Trafficking. 2015;Accessed at https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2Fresources%2Fhtml%2FPolicyFinder%2Fpolicyfiles%2FHnE%2FH-65.966.HTM

• American Academy of Pediatrics. 34.35SB Human trafficking education as a component of medical education and pediatric training 2014; Accessed at http://nysaap.org/resolutions-for-the-2013-alf/

Corey J. Rood, MD, FAAPChild Abuse PediatricianSafe & Healthy Families,

Primary Children’s HospitalAssistant Professor of Pediatrics,

University of UtahUtah Trafficking in Persons (UTIP) Task Force Executive Committee,

Medical Subcommittee Co-Chair

Child Abuse Champion – Utah AAP

Human trafficking is a major global public health problem affecting adults and children from at least 152 different countries worldwide.1 Human trafficking is defined as the use of force, fraud, or coercion to obtain some type of labor or commercial sex act. The International Labor Organization recently estimated that 4.5 million people are victims of forced sexual exploitation and 14.2 million are victims of forced labor annually in the international private economy.1 In one global study, up to 49% of the victims were women and 33% were children.2 When crimes of a sexual nature are committed against children (<18 years) for financial or other economic reasons, the crime is defined as commercial sexual exploitation of children (CSEC) and may be either domestic or transnational. It is difficult to get solid data about the extent of this abuse; however, the National Human Trafficking Hotline keeps statistics on calls they receive. Since 2007, the Hotline received 820 calls and 199 cases of human trafficking in Utah. In addition, in Utah in 2018 to date, 26% of human trafficking victims were children.

Current research indicates that victims of trafficking often experience severe emotional and physical effects of their victimization, including physical injuries, infections, HIV/AIDS, malnutrition, unwanted pregnancy, drug and alcohol abuse, PTSD and major depression with suicidality.3 Research from the United States indicates that up to 88% of the domestic victims of sex trafficking seek medical attention at least once during their period of exploitation.3 Because of this, it is imperative that all medical providers and staff are aware of potential indicators of trafficking, and resources to access when concerns arise. Educated health care professionals are in a unique position to identify those in need, report their concerns to appropriate government agencies, and offer or refer to appropriate services.

Medical staff should be aware of the potential indicators that a patient, or patient’s family, may be victims of human trafficking. Indicators of control may include: patient accompanied by someone who claims to be a parent, relative, significant other, or “friend,” but on further investigation is not. This person will often control responses to health questions, will correct the patient, and will not allow the patient to be alone. This person doesn’t necessarily need to be male, as many traffickers will use the most trusted victim under their control to accompany other victims in public. A victim may not know their current address, may not know which city they are in, may provide false identification, or may lie about their age. A victim may be dressed in clothing inappropriate for the weather, may not be in control of their personal identification, or may be labeled a “runaway” or “prostitute.” Be aware that transnationally-trafficked victims may not speak English, and this language barrier can unfortunately disguise victimization.

When concerns or suspicions are raised by medical staff that a patient, or family, could be a victim of human trafficking (sex or labor), certain steps can be taken to address these concerns. The first is to have a protocol in place for a medical provider and social worker to speak with the individual(s) alone, using an interpreter if needed. This conversation is to screen for safety, domestic violence, and potential trafficking. Limits of confidentiality should be reviewed with the patient, including a discussion of the provider’s role as a mandated reporter. Recent literature has identified a few highly sensitive screening questions for sex trafficking.4

1. Did someone ever ask you to have sex in exchange for something you wanted or needed (money, food, shelter, clothing, drugs, alcohol, etc)?

2. Did someone ever ask you to have sex with another person?3. Did someone ever take a nude or sexual picture or video of you or post such a

picture or video of you on social media or the Internet?

Additional questions, although less sensitive and requiring thorough follow-up questions for clarification may include:

1. Where do you work and live?2. Were you ever not paid the money you were promised for the work you did,

and/or did someone else ever receive the money you were promised for the work you did?

3. Were you ever threatened, intimidated, or assaulted at the place you work?4. Did you ever have a family member or loved one threatened or assaulted when

you didn’t do a specific work for your employer or to convince you to do a specific work?

Remember, important dynamics to consider for assessment include:• Keep in mind the victim may not self-identify as a human trafficking victim• Victims have been conditioned not to trust others• Victims have been conditioned not to tell the truth• Speak to the patient alone without accompanying adults (adults may portray

themselves as relatives)• Prioritize the patient’s medical needs and safety as the primary reason for the

assessment

If the patient is a minor or a vulnerable adult and there is a significant concern for trafficking based on these questions, or other indicators, even if the screening questions are denied, a report should be made to Law Enforcement and Child Protective Services (CPS) for minors and Adult Protective Services (APS) for Vulnerable Adults. Include in the report as much demographic detail and contact information as possible. A social worker can help make these reports. In most cases with trafficking victims, compliance with medical follow-up is difficult to achieve once the patient leaves the current medical encounter. For this reason, involvement of CPS or APS is imperative. Other resources for assistance include the on-call child abuse pediatrician through Safe and Healthy Families at Primary Children’s Hospital and the local Children’s Justice Center (CJC). If the patient is a competent adult, the health care provider only has to make a report to Law Enforcement if the patient is being treated

Resources:National Human Trafficking Hotline

1-888-373-7888Department of Child and Family

Services (DCFS)1-855-323-3237

Adult Protective Services (APS) 1-801-538-3567

Safe and Healthy Family on-callpediatrician

1-801-662-1000

HUMAN TRAFFICKING: AN OFTEN-OVERLOOKED LOCAL HEALTHCARE CRISIS

FREE Continuing Education & Scholarships

The Utah Department of Health holds a FREE monthly Diabetes Webinar Series that provides Continuing Education Credits at no charge for Registered Nurses and Registered Dietitians. The webinar series covers a wide variety of topics related to diabetes on the third Wednesday of every month from 12:00PM-1:00PM MST.

The Utah Department of Health also awards SCHOLARSHIPS to providers interested in becoming a Diabetes Self-Management Education (DSME) program in Utah. The scholarships cover initial accreditation costs with AADE or ADA.

Please visit the Living Well website for patient and provider resources and to locate a program, or email Brittany Ly (bly@utah.gov) to join the listserve and get more information on webinars and scholarships.

livingwell.utah.gov/

Utah Nurse • Page 10 February, March, April 2019

illnesses, including depression, at a rate greater than the general population and other health professionals. In a study, Letvak and colleagues demonstrated that nurses are twice as depressed as the patients they serve. A study by Melnyk and colleagues of more than 2,000 nurses across the country found more than half of the nurses reported poor mental or physical health and depression. Additionally, nurses with “...worse health were associated with 26% to 71% higher likelihood of having medical errors.”

Living life on purposeIn his groundbreaking work with professional ath-

letes, performance psychologist Jim Loehr, EdD, ar- gues that being out of touch with our life’s purpose creates an extraordinary energy drain. People may run in marathons, eat the healthiest foods, and be at the top of their game professionally, but these really good things can become an end to themselves when they’re disconnected from life’s purpose. Without that connection, anything can become meaningless.

Spiritual Wellness continued from page 8 Joy in the journeyAll of us experience tragedy, sadness, and

grief; they’re part of the human condition. If you’re wondering if finding joy and peace is possible under what appear to be impossible conditions, remember this: History is replete with ordinary humans rising to challenges of the day in extraordinary ways. They were able to unlock that part of themselves that gave them the strength and courage to carry on.

Nurses are extraordinary—don’t lose sight of the amazing work you do to improve the lives and comfort of the people you touch. It’s never too late to make a positive change in your life.

The authors work at The Ohio State University in Columbus. David Hrabe is associate professor of clinical nursing and executive director of academic innovations and partnerships for The Ohio State University College of Nursing. Bernadette Mazurek Melnyk is the vice president for health promotion, university chief wellness officer, dean and professor in the College of Nursing, professor of pediatrics and psychiatry in the College of Medicine, and executive director of the Helene Fuld Health Trust National Institute for Evidencebased Practice in Nursing and

Healthcare. Susan Neale is senior writer/editor of marketing and communications in the College of Nursing.

Selected referencesAmerican Nurses Association. Code for Nurses with

Interpretive Statements. 2nd ed. Silver Spring, MD: Nursebooks.org; 2015.

Dossey BM. Integrative health and wellness assessment. In: Dossey BM, Luck S, Schaub BS, eds. Nurse Coaching: Integrative Approaches for Health and Well-being. North Miami, FL: International Nurse Coach Association; 2015; 109-21.

Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clin Nurse Spec. 2012;23(3):177-82.

Loehr J. The Power of Story: Rewrite Your Destiny in Business and in Life. New York: Free Press; 2007.

Melnyk BM, Orsolini L, Tan A, et al. A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. J Occup Environ Med. 2018;60(2):126-31.

Moskowitz JT, Carrico AW, Duncan LG, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409-23.

University of Utah Health is Growing!

Apply online at http://employment.utah.edu

RN positions available in:

Acute Care/Med-Surg Critical Care/ICU Surgical/Procedural Outpatient Clinics

Behavioral Health/Psych Oncology Ambulatory Care Complex (coming 2019)

Inpatient Rehab Hospital(coming Winter 2019)

Continue the journeyHere are some ideas to consider as you continue your nursing journey. You’ll notice that many are connected to recommendations we’ve made for other dimensions of wellness. This isn’t a mistake. We’re whole human beings, and these practices support multiple dimensions.

Reconnect/reimagine your life’s purpose and passion: Set aside some time for a “retreat with yourself” to carefully consider your purpose and whether/how you’re living it out. Where do you need to make adjustments? What do you need to stop doing? What do you need to start doing? What would you do in the next 5 to 10 years if you knew that you couldn’t fail? Periodically “taking stock” is critical to staying on track.

Ramp up your positive outlook: In their work with people newly diagnosed with HIV, Moskowitz and colleagues developed an intervention to improve patients’ emotional outlook even in the midst of a very challenging circumstance. The intervention involves cultivating positive emotions through these daily practices:

• Recognize a positive event each day.

• Savor that event and log it in a journal or tell someone about it.

• Start a daily gratitude journal.• List a personal strength and note

how you used it.• Set an attainable goal and note

your progress.• Report a relatively minor stress and

list ways to reappraise the event positively.

• Recognize and practice small acts of kindness daily.

• Practice mindfulness, focusing on the here and now rather than the past or future.

• Results were promising and showed that, over time, the positive effects increased. Cultivating an attitude of gratitude” is cited by many spiritual leaders from multiple faith traditions as essential to their daily practice.

Consider some kind of meditative practice: Traditional forms of meditation can include prayer, chanting, or sitting in stillness with a quiet mind. Some people prefer physical action that incorporates meditation, such as yoga, tai chi, gardening, or simply walking. Experiment to find what works for you.

February, March, April 2019 Utah Nurse • Page 11

FOU NDAT ION

This form is to be used to request research funding assistance from Utah Nurses Foundation (UNF). Completed forms should be submitted electronically to UNF in care of the Utah Nurses Association at UNA@xmission.com. Requests will be evaluated based on need, support for nursing and the nursing profession, and available UNF funds.

Those receiving funds may be asked by UNF to provide personal pictures and narratives to be published in The Utah Nurse indicating that UNF funds were provided for this project.

Title of project: __________________________________________________________________

Applicant’s Name and credentials: _________________________________________________

Professional Association/Affiliations (if any): __________________________________________

Are you currently a nursing student? Yes No

If a student, what nursing school? _________________________________________________

Pursuing what degree? ___________________________________________________________

Have you received funding for this project from any other source? Explain:

1) Describe the proposed work, paying particular attention to the evaluation criteria listed in the proposal writing guidelines (one page maximum). Project Overview:

Research Process and Desired Outcomes:

Benefits to Patient Care and Education, Nursing Education, and /or Nursing Profession:

2) Describe the proposed budget for this project and how you would use the funds provided (1 page maximum):

3) Provide contact information for you as well as someone who can attest to this projecta) Personal contact information:

b) Contact Information for individual at the School or Facility where research will be conducted:

Each proposal will be evaluated according to the following criteria. Please address these criteria in your description of both the proposed work and the budget.

1) The proposed activity benefits patient care, advances nursing education or research.2) The proposed activity demonstrates merit with regarding to enhancing the discipline of

nursing.3) The proposed activity clearly describes the desired results or outcomes.4) The proposal delineates the efficient use of resources, utilizing a complete and

understandable budget narrative.5) The proposed work offers students and nurses involved a quality, meaningful research

opportunity that will merit submission for publications in a professional journal.

Utah Nurse Foundation use only

Committee discussion of proposal:

Committee decision: Award _______________ Do not award _______________

Amount Awarded $ __________________

Is applicant eligible to apply for funds again? Yes _____________ No _____________

Nursing Research Grant Proposal

To download application, visit www.utnurse.org.

The guidelines listed below shall assist in ensuring the best possible coordination in receiving and processing nursing student requests for scholarships. Scholarships will be awarded for tuition and books only.

SCHOLARSHIP INFORMATION:• Scholarships must be postmarked by June 1st or October 1st of

each calendar year to be considered. • Applicants will receive notice of the Board’s recommendations by

July 15th and October 15th of each calendar year.• Recipients are only eligible to receive scholarships twice. • Applicants must abide by the criteria listed below.

GENERAL SCHOLARSHIP CRITERIA:The applicant must:• Have a cumulative grade point average, which is equivalent to a 3.0

or higher on a 4.0 scale.• Be a United States citizen and a resident of Utah.• Have completed a minimum of one semester of core nursing courses

prior to application.• If a student in undergraduate nursing programs, be involved in the

school’s chapter of the National Student Nurses Association.• If a registered nurse completing a Baccalaureate Degree or an

Advanced Nursing Degree, be a member of Utah Nurses Association (state only) or a member of Utah Nurses Association/American Nurses Association.

• Submit a personal narrative describing his/her anticipated role in nursing in the state of Utah that will be evaluated by the Scholarship Committee.

• Submit three original letters of recommendation. Letters submitted from faculty advisor and employer must be originals addressed to the Utah Nurses Foundation Scholarship Committee.

• Be enrolled in six credit hours or more per semester to be considered. Preference will be given to applicants engaged in full-time study.

• Demonstrate a financial need. All of the applicant’s resources for financial aid (scholarships, loans, wages, gifts, etc.) must be clearly and correctly listed (and include dollar amounts and duration of each source of aid) on the application.

• The Scholarship Committee shall consider the following priorities in making scholarship recommendations to the Board of Trustees: ¡ RNs pursuing BSN¡ Graduate and postgraduate nursing study¡ Formal nursing programs - advanced practice nurses ¡ Students enrolled in undergraduate nursing programs

• The Applicant is required to submit the following with the completed application form:

• Copy of current official transcript of grades (no grade reports).• Three letters of recommendation:¡ One must be from a faculty advisor, and¡ One must be from an employer (If the applicant has been

unemployed for greater than 1 year, one must be from someone who can address the applicant’s work ethic, either through volunteer service or some other form).

¡ At least one should reflect applicant’s commitment to nursing.¡ All must be in original form,¡ All must be signed and addressed to the UNF scholarship

committee.• Narrative statement describing applicant’s anticipated role in nursing

in Utah, upon completion of the nursing program.• Letter from the school verifying the applicant’s acceptance in the

nursing program.• Copy of ID from National Student Nurses Association or Utah Nurses

Association with membership number.

AGREEMENTIn the event of a scholarship award:• The nursing student agrees to work for a Utah Health Care Facility or

Utah Educational Institution as a full-time employee for a period of one year, or part- time for a period of two years.

• Student recipient agrees to join the Utah Nurses Association within 6 months of graduation at the advertised reduced rate.

• If asked by UNF, provide personal pictures and narratives to be published in The Utah Nurse indicating that UNF scholarship funds were received.

• If for any reason the educational program and/or work in Utah is not completed, the scholarship monies will be reimbursed to the Utah Nurses Foundation by the nursing student.

Nursing Grant-in-Aid Scholarship Guidelines

Utah Nurse • Page 12 February, March, April 2019

Sharon K. Dingman, DNP, MS, RN

This is the 3rd edition of “Musing of Caring” and we invite you to share your stories with other nurses and colleagues. Nurses and care givers continue to enhance patient’s moments of care by interactions in moments of connection - one human being with another at a time.

Musings Defined – What is a Musing?

Musing are forms of self-reflection and personal introspection by being contemplative, thoughtful, logical and philosophical expressed in caring moments of care delivery. These moments of self-reflection are opportunities to recall and share our connection with patients and families with one another. The nursing literature provides many examples of the impact of nurse caring interactions on patient-care outcomes, satisfaction with care, and nurse wellbeing.

Connection DefinedConnection between nurses and patients are defined as having “authentic empathy,

respectful caring, collaborative awareness, calming presence, engaged spirit, informed presence and quality outcomes” (Dingman, 2012). Moments of shared connection promote patient/family satisfaction with care and service delivered. In addition to being informed of the progress of their own care or that of a loved one, patients and their families value meaningful affective interactions with their care providers at all levels of interaction within the organization.

Caring Defined

Nurses and caregivers define caring by their actions and expressions, especially during their one-on-one interactions at the bedside. Caring is defined as an intentional presence, affective behaviors, respect for human dignity, genuine service, a partnership, and as a matter of integrity that is given and received between individuals (Dingman, 2018).

Musings DefinedMusings are moments of caring presence by the nurse and other care givers with

the patient, family, and/or significant others by being present in delivering quality care (Dingman, 2018). Caring experiences are often shared with other nurses in a spirit of celebration of our practice that we share together in moments of connection and respect for our care of patients.

Caring Experience #1: Musing of Caring and Presence – Dingman Family

Nurses and caregivers provide the framework to be visible around the work of patient care. So important is the question, “Is there one more thing I can do for you before I leave the room? shared with the patient and/or family before leaving for other assignments.

The following story is a reflective moment of a grandmother (a nurse), daughter-in-law, and son and a five-week-old grandchild’s admission to the hospital with RSV at the height of the flu season with labored breathing, retracting, fever, low saturation. “I watched the various nurses and care givers interact with her parents and the grandparents.” We saw and felt firsthand how important is was to feel cared about as people…not just another RSV admission…and the nursery was full. The nurses were in the process of transporting on life flight two infants to a higher level of care. The trust and respect of our son and daughter-in-law had for their child’s nurses and care givers was great to see as they thanked them for their efforts. The nurses and caregivers explained what was happening, encouraged them to fully participate in the care, and encouraged both parents to ask questions—and no question was not of value…and the nurses and care givers never made a promise they did not keep. The parents never felt they were intruding if they had to find someone for help. We all could feel the spirit of caring and the parents knew their daughter was in good hands.

As a grandmother/nurse, this experience was a celebration for the roles of healers (nurses and care givers) and that we all make a difference. This is the spirit of caring by nursing and other caregivers as we support one another!

Caring Experience #2: Musing of Caring and Being Human & Perspective Summer Stout, BSN, RN

I made sure to put my mask on prior to entering the room. I hadn’t met the patient yet, but I was told this was his second time on the bone marrow transplant unit. He was discharged one week ago, in hopes he could spend time with his wife for Christmas, but he was admitted again this morning after coming down with a fever. It was the beginning of night shift and as I entered the room I noticed the dull glow of Christmas lights hanging from every corner where an outlet could be found. He lay in the hospital bed, his arms wrapped around his wife. They’d just been married four months prior.

A week after their vows, he’d fallen quite sick. The blood work in the ER showed elevated white counts and he was diagnosed with Non-Hodgkin’s Lymphoma. They’d spent their honeymoon on the BMT unit and here they were again for Christmas. Everyone in his family had been tested, no one was a viable bone marrow donor. I hung platelets on the IV pole next to his bed and made sure to leave the lights off in the room, to not ruin their Christmas ambience. I introduced myself to both him and his wife. They were both in bright spirits, despite having such bad news that morning.

I was a young nurse. My mentor knew the patient well. I asked her afterward how someone could be in such a delightful mood after being admitted for such a horrible disease on Christmas Eve. She indicated she had worked with this patient since his admission four months prior and his mood never changed. He was always in good spirits and kind. He was just 22 years old. As a nurse without children, I’ve worked many Christmas’s and Christmas Eve’s. I would always volunteer my time on the unit, so another nurse could stay home with her children. This sort of scenario seems to repeat itself again and again, each year on the trauma units of hospitals all over the country. Many of the patients in bright spirits while the nurses attempt to make the holiday special in their own way for each patient.

This for me is a reminder of what the holidays, and particularly nursing is all about. Nursing gives you constant perspective. It helps you understand what matters – what is a big deal and what isn’t. I’ve learned if you have a financial issue, then your problems are minuscule compared to the young patient being admitted for cancer or trauma. I am constantly humbled at an individual’s ability to be kind despite a horrible situation. This young man stays with me in the back of my mind, as I care for patients. I’ve found the most important thing you can be as a nurse is ~ human ~ especially during the holidays.

ConclusionsAs nurses create caring relationships in shared experiences with patients, families

and others, they influence patient care outcomes, satisfaction, and build lasting memories of care delivered and received for their patients/families and themselves. Heath and Heath (2017) ask a provocative question, “What if every patient was asked what matters to you?” Musings of Caring are nurse reflections of their practice long remembered and perhaps are some of the most remembered defining moments of their nursing practice.

Selected References: Dingman, S. K. (2018). Musings of caring self-reflective moments by nurses, Nurses enhance

patient care interactions in moments of connection. Utah Nurse, 27 (3) August, September, October ed. Utah Nurses Association, SLC, Utah, 5.

Dingman, S. K., Williams, M., Fosbinder, D., & Warnick, M. (1999). Implementing a caring model to improve patient satisfaction. Journal of Nursing Administration, 29(12), 30-37.

Dingman, S. K. (2012). Nurse caring enhancements of The Caring Model©™. Unpublished Doctor of Nursing Practice Project, Department of Nursing, Texas Christian University.

Heath, C. & Heath, Dan (2017). The power of moments: Why certain experiences have extraordinary impact. Simon & Schuster: New York, NY.

“MUSINGS OF CARING” SELF-REFLECTIVE MOMENTS OF NURSES”

Thank you for all you do and please share your stories with us. NOTE from UTAH NURSE Editor and ‘Musing of Caring Author. We look forward to reading your “Musings of Caring” stories. We extend an invitation to Utah nurses to share their “Musings of Caring” stories for publications in future issues of UTAH NURSE. In 300 words or less please submit your stories. Guidelines for Article Development and submission are available on page 2 listed under “Publication.” Submissions due dates are listed in the UTAH NURSE. Questions may be directed to the editor or author. All questions and submissions should be sent to: editor@utnurse.org or ATTN: Editorial Committee, Utah Nurses Association, 4505 S. Wasatch Blvd., Suite 330B, Salt Lake City, Utah 84124 / Phone: 801-272-4510

The Utah State Hospital, a cutting-edge 325 bed psychiatric inpatient treatment facility on a 300-acre campus in Provo, Utah located at

the base of the Wasatch Mountains, is seeking Registered Nurses, Licensed Practical Nurses, and Psychiatric Technicians. Flexible

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Practical Nurses, $4,000 to full time RN’s. Apply online at https://statejobs.utah.gov. Hover over Job Search and click on  Job Listings. Under locations, select Provo, and then click Apply Search. You will then see the links to the job applications, click on

the one you are interested in. If you have any questions contact Human Resource Office at 801-344-4271.

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February, March, April 2019 Utah Nurse • Page 13

Leading the Way

NURSES are masters at guiding wise choices and an obvious partner when the American Board of Internal Medicine (ABIM) Foundation expanded its national Choosing Wisely campaign about avoiding unnecessary tests, treatments, and procedures for patients. The American Academy of Nursing launched the Choosing Wisely effort aimed at nurses in 2014. In June 2018, the Academy announced five new recommendations for nursing, bringing the total to 25. Academy President Karen Cox, PhD, RN, FAAN, and Mary Fran Tracy, PhD, APRN, CNS, FAAN, the Academy’s Choosing Wisely chair, talk about the campaign’s progress and next steps.

How have the Academy and nurse experts contributed to Choosing Wisely?

Cox: The Academy accepted ABIM’s challenge to be the nursing profession’s champion of the Choosing Wisely campaign because of its good fit with the Academy’s mission of advancing health policy, practice, and science. Academy fellows represent an unparalleled brain trust of nursing’s most accomplished experts. Many of them are leaders of clinical nursing organizations that also partnered with the Academy to develop our Choosing Wisely statements.

What role do nurse leaders need to play in the campaign?

Cox: Some statements reach across all practice areas. Others are specialized. Clinical leaders need executive leadership awareness and support to implement the statements at the point of care since the statements directly impact quality and safety outcomes.

What do the nursing statements focus on?Tracy: So far we’ve issued 25 statements on things

nurses and patients should question. They span a wide range of clinical situations, including fetal heart rate monitoring, ambulation and restraints for older adults, not waking patients for routine care, and treatment of delirium. Hair removal at surgical sites and unwarranted continuous vital signs monitoring in hospitalized children and adolescents are also included.

How can nurse leaders foster collaboration on these issues with other clinicians?

Cox: Leaders can raise awareness in clinical areas within facilities and across health systems. They can support collaborative initiatives to change practice habits based on the Academy’s Choosing Wisely statements.

NURSES LEAD PROGRESS IN CHOOSING WISELY® CAMPAIGN

What steps are needed for implementation, research, and dissemination of the nursing recommendations?

Tracy: The statements are evidence-based. Now we need evidence to show what works and what doesn’t in implementing these recommendations. For example, a joint effort by 16 advanced practice registered nurse teams

Karen Cox Mary Fran Tracy

Call for implementation and evaluation of evidence-based recommendations

The Choosing Wisely campaign is an initiative of the ABIM Foundation to encourage conversations between patients and their healthcare professionals about what care is genuinely necessary.

• Choosing Wisely: choosingwisely.org

• American Academy of Nursing’s Choosing Wisely statements: aannet.org/initiatives/choosing-wisely

• The Twenty-Five Things Nurses and Patients Should Question: bit.ly/2N3qsJE

Learn More AboutChoosing Wisely

Reprinted from American Nurse Today

Contact us today for more details!

Melissa Blackner: 435-893-2232Or Amber Epling: 435-893-2228

melissa.blackner@snow.edu

www.snow.edu/alliedhealth

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in 13 states implemented high-value care initiatives based on initial recommendations from ABIM’s Choosing Wisely campaign. We need similar projects for the Choosing Wisely statements the Academy has developed for nursing.

Karen Cox is president of the American Academy of Nursing and president of Chamberlain University in Downers Grove, Illinois. Mary Fran Tracy is chair of the Academy’s Choosing Wisely Task Force and associate professor and nurse scientist at the University of Minnesota School of Nursing in Minneapolis.

Utah Nurse • Page 14 February, March, April 2019

SEEKING NURSES FOR COMMUNITY VOLUNTEER

OPPORTUNITIESUtah’s communities need you and volunteering helps you

www.nursinginutah.org/volunteer

Announcing a website just for nurses who want to volunteer and give back to the community. The Utah Action Coalition of Health, Utah Organization of Nurse Leaders and HealthInsight pleased to bring this website to life, your life and the lives of others.

Grab your friends and co-workers, check out the opportunities and make a difference today!

About UACH UONL & HealthInsight:The UACH brings together many of the state’s strongest leaders

in improving health care quality, access, and affordability. The Utah Organization of Nurse Leaders (UONL) and HealthInsight formed a new partnership to lead this important effort in 2008. HealthInsight is a recognized leader in convening and partnering with our communities to improve health and health care by advancing quality, efficiency and value for patients and providers. HealthInsight Utah serves as a catalyst, using collaborative efforts to facilitate and promote the quality and safety of health care to achieve improved outcomes and value for all Utahans. Learn more at healthinsight.org.

SO WHAT IS CLIMATE CHANGE?

At a recent nursing meeting I attended I asked nurses to pair up and role play the following: “Your neighbor has just asked you - so what IS climate change?” Each nurse had to take a turn with a partner and answer that question, as though she/he were telling her neighbor the answer. After completing the role play, I asked how many of the nurses were able to answer that question with a high level of confidence and only about 10% raised their hands. When I ask how many could answer with reasonable confidence only another 10% raised their hands. How about you, would you feel confident answering the question? What everyone discovered from this activity was how unprepared many nurses are to talk about what climate change is. While nurses are more familiar with what climate change seems to be causing, such as more extreme weather events, sea level rise, and extensive wildfires, a large portion are unable to explain what climate change is in simple terms.

So here is a little primer:The earth’s temperature has historically been modulated by the sun’s rays

beating down, warming the land and water, and then radiating heat back out beyond the earth’s atmosphere. This process has kept the earth at a livable temperature for humans and other lifeforms to flourish.

However, we now have a “blanket” of gases that are surrounding the earth, gases created substantially by human activities such as transportation, energy production, industry, cooking/heating, and agriculture. (See the image below) These gases are called greenhouse gases because they create the same warming effect as a greenhouse and are slowly warming the earth – both the land and particularly the oceans. And in the process, they are changing our climate. Climate is distinguished from weather in that weather is what occurs from day to day or week to week, but climate is what occurs over longer periods of time, month to month and year to year.

Barbara Sattler, RN, DrPH, FAAN, Professor, University of San Francisco, bsattler@usfca.edu and Cara Cook, MS, RN, AHN-BC, Climate Change

Program Coordinator, Alliance of Nurses for Healthy Environments, cara@enviRN.org

February, March, April 2019 Utah Nurse • Page 15

The process is a bit like what happens to your car when you leave it outside in the sun with the windows up. The sun’s rays heat the inside of the car and that heat cannot adequately escape, so the car heats up.

Just as there is a small range of body temperatures at which humans can be healthy, the same is true for all species on earth. When human temperatures rise from 98.6 to 100.4 degrees it means the difference from feeling fine to having a fever and not feeling well. When our temperatures get even higher we begin to see bodily system distress and damage. What happens when the earth has a fever?

As the earth warms, we are beginning to see shifts in climate which are resulting in some areas seeing much more rain and others much less, some colder winters, some hotter summers.

As we encounter more extreme heat days and extended heat waves, we are going to see many more heat-related illnesses and even deaths in humans. People who work outside in agriculture, utilities, construction, gas/oil, and many other fields will be at higher risk for hyperthermia. And, of course, extreme storms and wildfires have been taking an enormous toll on human and ecological health

Changes to the earth’s climate can have irreversible effects on plants, including our agricultural food crops. Rising ocean temperatures is affecting plankton which is the foundation of the food chain for fish and sea mammals. An estimated billion people are dependent on fish as their main source of protein. In addition to interrupting the world’s food supply, there are many other health threats associated with the changes we are seeing. For an extensive list of how climate change affects human health, visit https://bit.ly/2qNLNtW.

While there are some natural sources of greenhouse gases, the ones we have the most capacity to reduce are those that are manmade. As individuals we can assess our household’s contribution to greenhouse gases by using a “carbon footprint calculator,” such as this one from the U.S. Environmental Protection Agency: https://bit.ly/1XIc9pa. As nurses, we can help promote climate healthy purchasing and practices in our health care facilities, K – 12 schools, faith-based organizations, universities, and any other settings in which we have influence.

The new International Council of Nurses (which ANA is a member of) announced its new position statement on climate change in September 2018 and calls on all nurses to help address climate change (see: https://www.icn.ch/sites/default/files/inline-files/PS_E_Nurses_climate%20change_health.pdf) It calls for us to heed the scientific evidence which, in the case of climate change, is abundant.

We must be able to talk about this issue with a degree of confidence and we must engage both individually and as a profession to advocate for policies and practices that will decrease greenhouse gas production from a wide range of its sources. The truth is climate change is a health issue and that’s what we nurses are all about.

For more resources on climate change and health, including nurse-focused guides and webinars, visit the Alliance of Nurses for Healthy Environments Climate and Health Toolkit: climateandhealthtoolkit.org. To join our free monthly calls on Climate Change and Nursing please email the authors.

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