current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

INSI

DE

President's Message . . . . . . . . . . . . . . . 3Congratulations . . . . . . . . . . . . . . . . . . 4Dear Nurse Melissa . . . . . . . . . . . . . . . . 4Seeing Through the Mask . . . . . . . . . . . . 5AzNA PAC . . . . . . . . . . . . . . . . . . . . . . 5Creation of a Prone Team to Improve Outcomes with COVID-19 Patients . . . . 6Do You Need a Dissertation Coach? . . . . 7To Dilute or Not to Dilute Adult Intravenous Push Medications… That is the Question? . . . . . . . . . . . . . 8

In Memory Of . . . . . . . . . . . . . . . . . . . . 8Betty Mitsunaga, RN, PhD, FAAN— An Oral History of a Resident of a Japanese Intern Camp . . . . . . . . . . . . 9Pediatric Care Coordination for Student Health and Safety . . . . . . . . . . . . . . 10Welcome New & Returning Members . . 12Well-Being Initiative . . . . . . . . . . . . . . . 14AzNA Superstars . . . . . . . . . . . . . . . . 15Two Year Anniversary Members . . . . . . 15

Quarterly Publication distributed to over 58,000 Registered Nurses in ArizonaVol. 73 • Number 3JULY 2020

One Profession. Many Roles.

Arizona NurseWe’re Working for You! JOIN US TODAY

Brought to you by the Members of AzNA . For more information on the benefits of membership, please visit www .aznurse .org .

The Official Publication of the Arizona Foundation for the Future of Nursing

Mark S. shares his plate, “Proud RN, VA-BC with a true love for Vascular Access!”

Haley H. is proud to be an ICA Nurse.

Valerie V. shares, “I am a neonatal flight nurse / NICU nurse 35+ years with more than 1200

neonatal transports completed.”

Arizona’s state school nursing programs create proud nurses with unique stories.

NURSE PRIDE

Do you have a nurse pride license plate you want to share? Send it to info@aznurse.org. You might be on our next front page!

The Nurse: The PhoenixRita Wermers RN & Tammy Ostroski RN

phoe· nix | \ ‘fè-niks: a legendary bird which according to one account lived 500 years, burned itself to ashes ... and rose alive from the ashes to live another period.

No matter where you serve as a nurse, we are facing unprecedented times. Each of us has been asked to draw on limited resources to meet the needs of our patients, our colleagues, our families, and ourselves. This was a challenge before the pandemic. Now we are faced with greater demands and sparse resources often leaving us feeling burnt and exhausted.

We are surrounded with the buzzwords resilience and adversity, however, defining these terms for ourselves is challenging (Smith & Ho Cheung Li, 2020). How do we build on resilience and adversity while combating misinformation and the conspiracy theories? As nurses, we are trained to push forward, ask difficult questions, and stand firm in the best interest of our patients. Now, as we face a global pandemic these skills are essential. We know current times are not permanent, and yet, we cannot conceive when things will feel settled. Perhaps they never will, perhaps they never have. Our nursing journey does not have an endpoint, it has the next point. During this time, how do we rebuild and rise again? We return to our nursing process: assess, diagnosis, plan, implement and evaluate.

Assess then diagnose. There is power in naming what we are feeling (Beranito, 2020). For many of us it is a mix of emotions: grief, loss, fear, anxiety, apprehension, danger, frustration or even resignation. It is the recognition we are in the ashes. This assessment and then diagnosis takes time and reflection. Where are we? What are we

feeling? What is our body telling us? As with any nursing diagnosis, taking the time to assess and

diagnose now, prevents the pile of ashes from becoming too large and overwhelming.

Plan. Complex situations require simple plans. In order to make sense of the whole, we often have to take one step at a time. On a personal level this plan includes well researched self-care activities: sleep (Magnavita & Garbarino, 2017), exercise (Anderson & Shivakumar, 2013), cultivating rest and play (Brown, 2010), healthy eating, and taking steps to limit media consumption (Garfin, Silver & Holman, 2020). On a professional level it includes having

the proper PPE, boundary setting (Brown, 2010) and ensuring a safe practice environment.

The Nurse: The Phoenix continued on page 2

Page 2 • Arizona Nurse July, August, September 2020

Implement then Evaluate. Our goal is not perfection; we strive to be better. We try and then critically evaluate. The evaluation plan becomes our next assessment, and the cycle begins again. We reflect, we grow, we change and like the Phoenix we are reborn from the ashes. The burning days are not beautiful, these days are necessary. Without the burning days we cannot grow, we cannot learn.

phoe· nix | \ ‘fè-niks: a legendary bird which according to one account lived 500 years, burned itself to ashes and rose again. See also: NURSE.

Rita Wermers, DNP, ANP-BC & Tammy Ostroski, DNP, MBA, FNP-BC

References: Anderson, E. & Shivakumar, G. (2013).

Effects of exercise and physical activity on anxiety. Frontiers in Anxiety.https://doi.org/10.3389/fpsyt.2013.00027

Chair: Rhonda Anderson, DNSc, RN, FAAN, FACHE

Vice Chair: Pat Mews, MHA, RN, CNOR

Secretary: Chloe Littzen, BSN, RN

Scholarship Chair: Sharon Rayman, MS, RN, CCTC, CPTC

Elected Trustee: Carol Stevens, PhD, RN

Elected Trustee: Kimberly Behrens-Grieser

Elected Trustee: Phillip Guarrera

Executive Director: Robin Schaeffer, MSN, RN, CAE

Board of Directors

President: Selina Bliss, PhD, RN, CNE, RN-BC

Vice President: Heidi Sanborn, DNP, RN, CNE

Secretary: Amanda Foster, BSN, RN

Treasurer: Beth Hale, PhD, RN

Government Affairs Officer:Denice Gibson, DNP, RN, CRNI, BMTCN, AOCNS

Director-At-Large:Janice Bovee, MSN, CNM

Director-At-Large:Jason Bradley, PhD(c), MSEd, RN, CCRN-K, LPC

Past President: Carol J. Stevens, PhD, RN

StaffRobin Schaeffer, MSN, RN, CAE,

Executive DirectorDebby Wood, Office Manager

Wendy Knefelkamp, Communications ManagerDebbie Blanchard, Administrative Assistant

The Arizona Nurse (ISSN 0004-1599) is the official publication of the Arizona Foundation for the Future of Nursing (AzFFN), peer reviewed and indexed in Cumulative Index for Nursing and Allied Health Literature. Arizona Nurse Author Guidelines are available at www.aznurse.org. Call 480.831.0404 or info@aznurse.org for more information.

No material in the newsletter may be reproduced without written permission from the Executive Director. Subscription price: included in AzNA membership or $30 per year. The purpose of the Arizona Nurse is to communicate with AzNA members and non-members in order to 1) advance and promote professional nursing in Arizona, 2) disseminate information and encourage input and feedback on relevant nursing issues, 3) stimulate interest and participation in AzNA and 4) share information about AzNA activities.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Advertisements do not imply endorsement nor approval by the Arizona Foundation for the Future of Nursing (AzFFN) of the product advertised, the advertisers or the claims made. AzFFN shall not be held liable for any consequences resulting from the purchase or use of advertised projects. AzFFN, AzNA and Arthur L. Davis Publishing Agency, Inc. reserve the right to reject advertisements. Rejection of an advertisement does not imply that the offering or product for advertisement is without merit, lacks integrity, or that this association disapproves of the offering or product.

The Arizona Nurses Association is a constituent member of the American Nurses Association.

Arizona Nurse Editorial Board

Alicia Shields, MSN, RN, CENP (Chair)Kimberly A. Callahan, MS, APRN, FNP-C

Anna Hustin, MSN, RN, NE-BCMelisa Salmon, RN, MSN, MBA, CCRN

Sherry Ray, Ed.D., MSN, RN | Melissa Zuber, BSN, RN

The editorial board of the Arizona nurses is comprised of members of the Arizona Nurses Association, who review all submissions, provide expert advice on content, attract new authors, and encourage submissions.

If you are interested in serving on the editorial board, please contact info@aznurse.org for more information.

The Nurse: The Phoenix continued from page 1 Berinato, S. (2020, Mar 23). That discomfort you’re feeling is grief. Harvard Business Review. Retrieved from: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

Brown, B. (2010). The gifts of imperfection; Let go of who you think you’re supposed to be and embrace who you are. Hazelden Publishing.

Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel coronavirus (COVID-2019) outbreak: Amplification

of public health consequences by media exposure. Health Psychology. Advance online publication. https://doi.org/10.1037/hea0000875Magnavita, N., & Garbarino, S. (2017). Sleep, Health and Wellness at Work: A Scoping Review. International journal of environmental research and public health, 14(11), 1347. https://doi.org/10.3390/ijerph14111347Smith, G. & Ho Cheung Li, W. (2020). COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity. Journal of Clinical Nursing, 29, 1425-1428. DOI: 10.111/jocn.15231Hedy S. Wald (2020) Optimizing resilience and wellbeing for healthcare professions trainees and

healthcare professionals during public health crises - Practical tips for an ‘integrative resilience’ approach, Medical Teacher, DOI: 10.1080/0142159X.2020.1768230

Call for Article SubmissionSubmit your article or research for publication in AzNA’s quarterly print publication.

The Arizona Nurse is distributed to over 58,000+ RNs in the state.

AzNA welcomes submission of nursing and health related news items and original articles. We encourage short summaries and brief abstracts for research or scholarly contributions with an emphasis on application.

To promote inclusion of submitted articles, please review the article guidelines available on the AzNA website at www.aznurse.org/Guidelines.

An “article for reprint” may be considered if accompanied by written permission from the author and/or publisher as needed. Authors do not need to be AzNA members.

Submission of articles constitutes agreement to allow changes made by editorial staff and publishers. See article guidelines for more information.

Submit your article to info@aznurse.org.

To access electronic copies of the Arizona Nurse, please visit

http://www.nursingald.com/publications

July, August, September 2020 Arizona Nurse • Page 3

PRESIDENT’S MESSAGEWe Stand on the Shoulders of Giants

We stand on the shoulders of the giants who go before us. From Florence Nightingale to the new graduate nurses who are brave, eager, and ready to serve, what we do today as a profession is built upon the work and ideas of those who came before us and those who are yet to come.

In the presence of the global COVID-19 pandemic, now more than ever the Arizona Nurses Association (AzNA) supports and recognizes you for your contributions during this crisis and for your ongoing roles in meeting the needs of patients in their communities. You do what you do best and that is care for the patients and families thrust into the healthcare system during this uncertain time.

We are a profession built upon caring. Caring is an interesting concept as it is part of our fiber, yet it is difficult to measure. I always felt the presence of caring becomes more obvious when it ceases to exist. Sister Simone Roach’s 5 C’s of caring – commitment, conscience, competence, compassion, and confidence - are highly applicable to the nursing profession. Commitment to your patients, yourself, and your career allows you to constantly improve the level of care you deliver. Being guided by your conscience helps you make the best decisions, even in challenging times. For competence, holding yourself to a standard of excellence on even the most simple tasks improves your performance. Compassion is essential for providing patients with a positive experience. Finally, confidence in your personal abilities gives you the power to act on all of the previous elements.

To care for others, make sure to take care of yourselves. Personal and professional self-care is

becoming increasingly important as we are asked to do more and more for our patients, oftentimes with limited resources. Our mental health is becoming increasingly important in addition to our emotional and physical health. At times like this, relationships at work and at home become increasingly important. Look to your strengths and support systems that give you resiliency.

We are halfway through the Year of the Nurse and we still have much left to celebrate. I invite you to check out the American Nurses Association Year of the Nurse website where you will find inspiration and enrichment through a variety of sources including podcasts, contests, videos, and webinars. These resources remind me of how far I have come as a nurse both professionally and personally while motivating me to do better as a leader.

Let’s celebrate where we have come from and anticipate what is to come as our profession presses on.

Looking forward to seeing you at our Annual Membership Meeting (be it face-to-face or virtual) on October 2nd!

Until next time,Selina Bliss, Ph.D., RN, CNE, RN-BC, ANEF

Selina Bliss, RN

AzNA Board of Directors Meeting Highlights - April 2020

The AzNA Board of Directors meets monthly. The following are highlights from the February, April, May, and June 2020 meetings.

• Creation of Nurse Rapid Response Team to facilitate coordination of efforts regarding COVID-19; including communication with state officials, healthcare groups, hospital administration, and other key stakeholders. Visit aznurse.org for more info

• Multiple Op-Ed, Letters of Support or Concern, Approval of Statement regarding actions taken during COVID-19 by state officials and other key stakeholders

• Approval of Statement regarding Nursing Code of Ethics and Racism

• Selection of AzNA CEO Search Committee, approval of updated Job Description

• Voted to shift AzNA events to virtual through 2020

• Updates on Arizona Suicide Prevention Group and ability to DACA students to take NCLEX

• Letter of Concern regarding LaJuana Gilette, AzBON Public Board Member crafted and approved for submission to state bodies

• Adoption of Standardized bylaws for AzNA Chapters

For a complete copy of the approved minutes, please contact info@aznurse.org or call 480.831.0404.

Page 4 • Arizona Nurse July, August, September 2020

Congratulations to the following nurses who have taken advantage of the Success Pays offering by ANCC to AzNA Members!

• Lisa A Miller-Brody, RN-BC; certified Nursing Executive, Advanced

aznurse.org/SuccessPays

AzNA partners with the American Nurses Credentialing Center (ANCC) using the Success Pays Program to support professional development of nurses, increase the number of certified nurses in the workforce, decrease test-taking anxiety and reduce financial burden for our members.

Take the exam up to two times and pay the reduced rate of $260 only if they pass the exam.

Save time, money and anxiety.

Certifications with ANCC can also be renewed through AzNA at a reduced price of $250.

Success Pays is offered to all AzNA Members. Not a member? Join today aznurse.org/JoinToday

Dear Nurse Melissa

DEAR NURSE MELISSA:

My supervisor has asked that I start doing injections of medications, but there is no physician or NP at my location. Is this within my scope of practice? Does this put my license in danger?

Sincerely, Nervous Injector

Dear Nervous Injector,

I completely understand your fear of losing the license you worked so hard to earn. And let’s be real, the last thing any of us want to do is to work outside our scope and put our patients at risk. If you have not taken the aesthetic certification course to do cosmetic injectables, then you cannot administer these medications.

I reached out to a registered nurse that has completed the training and passed the competency to administer cosmetic injectables. Sarah Lansford, owner of Inspired Injectionista, informed me that, “In order to do injections as an RN you have to work under a NP or MD. The provider and you have to be trained in injections. The provider also needs to have training to be a medical director.” The role of a medical director in this format allows standing orders, protocols, insurance, and ordering the medication to be in place. The provider has to be available for any side effects and worse case, emergency intervention. The provider/medical director does not need to be on site for a RN, that is certified in aesthetics, to administer injections, but they do need to be within a four hour radius. Sarah, let me know that if her medical director goes out of town, another medical director needs to cover her area. The medical director should also audit charts, provide up to date training, education, and ensure compliance.

I found through the Arizona Board of Nursing (BON) website that RNs must be able to provide proof of their certification and education in aesthetics. Also, injectables must be ordered by a qualified provider. According to the Arizona Board of Nursing (BON), in the Advisory Opinion of Medical Aesthetic Procedures performed by licensed nurses, what specifically a RN can perform is based off of their three tier format. Injectables fall under level III: Advanced Procedures. In Level III, RNs are required to complete training and prove competence through a formal esthetic program. Not only does Level III include cosmetic injectables, but also microneedling, microdermabrasion, and light and laser therapy. I appreciated the detail the BON provided in what to look for in a certification course. If you are interested, you can read more to help you reach your nursing goals. https://www.azbn.gov/scope-of-practice/advisory-opinions, listed in alphabetical order, look for “Medical Esthetic Procedures Performed by Licensed Nurses”

Keep sending me questions and thoughts! Stay Healthy, Stay Safe.

Melissa, RN

Have a question for Nurse Melissa? Email info@aznurse.org with

“Nurse Melissa” in the subject line.

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July, August, September 2020 Arizona Nurse • Page 5

Saturday, July 25 - Sunday, July 2632nd Annual Southwestern Regional Nurse Practitioner SymposiumLocation: Virtual Event Friday, October 2, 2020AzNA Annual Membership MeetingLocation: Virtual Event

Registration and event information can be found at www.aznurse.org/events

AzNA/AzNF Calendar of Events

Seeing Through the MaskL. Charles Martinez, RN

A couple of years ago a group of nurses embarked on what was at the time called the attunement challenge. The challenge was for the nurses to take practical steps to be more “in tune” with their patients. The challenge was broken into 12 different approaches that were to span a year. The first and springboard into the challenge was to “see patients as people.” It goes without saying that patients are people, right? The problem lies in the busyness (or business, if preferred) of health care and that patients can sometimes be looked at as a diagnosis, an assignment, or sadly, just a pain.

That brings us to 2020 and COVID-19, people with whom we have no relation or understanding of who they are, are shrouded behind veils or masks. What we are missing are the faces, the smiles, the laughter, and hidden expressions that sometimes give us clues into what people are really going through. What we all must remember is that under the mask is a living, breathing, laughing, crying individual with something to offer the world. It is so easy to overlook a complete

stranger, even more so when you don’t see their face.

Today we can choose to see through the mask and see the person as we see ourselves. An individual with needs, wants, and concerns who is uncertain, anxious, and if we are not afraid to admit it, a little scared at what the future holds. As we see through the mask and deeper into the soul of the person we see that there is a spirit within each of us to overcome, have meaningful relationships, share life, and live life to the fullest.

So today, I challenge each and every one of us to see past the mask and see our future as one of hope and of deeper understanding of those around us.

At first sight we see that today we are not who we used to be. Today holds us between where we were and where we want to be. What we must remember is that today, not tomorrow, is what we have and the rest is not guaranteed. So today I choose to see you through your mask as a person, body, soul and spirit...forever thankful for this day, that together we can live it. -LCM

AzNA PAC Announces Primary Candidate Endorsements for 2020 Elections

AzNA PAC has announced its 2020 Primary Candidate Endorsements. With the Primary election two months away, the AzNA PAC has screened, surveyed, and interviewed both Republican and Democrat candidates for the AZ House of Representatives and the AZ Senate and has produced a list of candidates that align with AzNA’s policy agenda. To view the list, go to www.aznurse.org/.

Significant to the 2020 elections, is the exciting early endorsement of two registered nurses: Selina Bliss, RN (running in LD1 for the House of Representatives) and Felicia French, RN (running in LD6 for the Senate). Getting nurses into the AZ legislature will be a significant accomplishment, one that will benefit all Arizonans, but this can only be done with your help.

There are multiple ways to contribute to Selina’s and Felicia’s campaigns. Here are few;

• Donate money to c a n d i d a t e w e b s i t e s (Selinabliss.com; frenchforaz.com) OR consider donating to the AzNA PAC through

their monthly recurring donation program (aznurse.org/PACdonate).

• Canvass from the couch (Contact Felicia French campaign – they train you & its FUN!).

• Attend rallies & events sponsored by the candidates (many are now virtual).

• Put a yard sign in your yard (Selina will deliver!).• Network with friends and family about the

candidates and why a Nurse in the Legislature is a good idea.

• Contact Selina Bliss, SelinaSBliss@gmail.com and Felicia French, frenchforaz.com/ and find out what You Can Do specifically for their campaigns.

In addition to the two early nurse candidate endorsements, AzNA PAC endorsed 21 Senators and 39 House of Representatives. Here’s how you

can help them!• Know your Legislative District

(www.azredistrciting.org).• Learn who your legislators are in your

District - each district has one Senator and two Representatives (https://www.azleg.gov/findmylegislator/).

• Check to see which legislators the AzNA PAC has endorsed in your District (www.aznurse.org).

• Contact your incumbents (those already in office) and/or the new candidates running in the Primary (August 4, 2020) and get to know them! Let them know you are a RN in their District.

This election year is faced with many unique challenges due to the coronavirus, and some election processes may be uncertain – but what

is certain is, Nurses have a chance to greatly influence who will be Arizona’s elected officials. Won’t you do your part?

Carol Stevens, PhD, RNAzNA PAC Secretary

AzNA PAC

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Page 6 • Arizona Nurse July, August, September 2020

Creation of a Prone Team to Improve Outcomes with COVID-19 Patients

Heather Przybyl, RN; Dana Lauer, RN; Charlotte Ciudad, RN; and Aza Maltai, HR

The Coronavirus (COVID-19) pathogen has been attributed to causing a global pandemic, affecting over five million people and responsible for over 300,000 deaths globally (Johns Hopkins University & Medicine, 2020). Many COVID-19 patients present with acute respiratory distress syndrome (ARDS) leading to severe hypoxemia with variable lung compliance, increased negative inspiratory intrathoracic pressure, increased lung permeability due to inflammation, and potential to develop interstitial lung edema (Huang et al., 2020; Gattinoni et al., 2020; Ghelichkhani, P & Esmaeili, M, 2020; Rothan & Byrareddy, 2020). In addition to ventilator management strategies, early initiation of prone therapy has been effective in the treatment of COVID-19 patients. It was necessary to develop a strategy to provide this treatment for the large volume of patients expected to receive care at a large academic medical center facility located in Phoenix, AZ.

Prone positioning was first used as an adjunct rescue therapy for treatment of ARDS and hypoxemia in the 1970s (Scholten et al., 2017). Positioning patients prone will move organs off the lung field easing the work of breathing thus increasing the amount of available lung volume to improve the patient’s oxygenation. The positioning also improves dependent aeration by recruiting alveoli. Manual proning was determined to be the best solution to reposition patients due

to limited availability of prone specialty beds. Several resources were available by the American Association of Critical Care Nursing and were utilized to determine best practice guidelines. The creation of a dedicated prone team, consisting of four to five staff members was required to safely reposition patients (Vollman et al., 2016).

Collaboration in the development of the team occurred with the Associate Chief Nursing Officer, Director of Nursing for Critical Care, RN Certified Specialist for Critical Care, and Human Resources. There were several staff on redeployment assignments in response to the COVID-19 pandemic; therefore, it was this pool of employees that would be utilized to form the prone team. Each team member needed to be familiar with basic body mechanics and have had recent experience moving patients. Training consisted of pre-learning and a tip sheet created to describe common lines, tubes, and drains in the intensive care unit. Team members were paired with two superusers who worked with the team for the first week. Team responsibilities include positioning prone and supine, repositioning at minimum of two hours while patient is proned, and as time allowed routine positioning of all patients on the COVID unit.

At time of writing there were a total of 24 patients that have had orders for pronation therapy, four patients had prone orders prior to team formation and were repositioned with the bedside staff. Average number of daily patients requiring prone therapy has had exponential growth since the formation of the team. Average number of patients that were proned in April was 3.46 patients which doubled in May to 7.85 patients. There were four patients extubated with an average (range) ventilator days of 6.55 (1.3-17.0) and six patients required a tracheostomy. Of the cohort there were two patients who expired and two who were discharged to acute rehab, average (range) length of stay (LOS) was 32.2 (17.5-39.9) days. There were no workplace injuries reported by members of the team since joining.

One obstacle encountered included a learning curve for those who did not have critical care experience. There were a few incidents where the endotracheal tube was dislodged requiring reintubation. For this reason, there was a member from respiratory therapy assigned with a modified workload to assist with all prone and supine movements. There was also collaboration with the wound team to prevent pressure injuries as

well as making modifications to positioning aids based on their expertise.

The creation of a multidisciplinary team focused on repositioning and movement of patients during the COVID-19 pandemic has been pivotal to the success of the management of this population. The facility was able to establish a team with collaboration from many departments. Financial support from the CFO and other members of administration was key to the success of the team. Leadership was able to establish a foundation of training with use of superusers and reference materials using best practices. The facility will continue to monitor ventilator days and hospital length of stay to determine the team’s success.

Heather Przybyl DNP, RN, CCRN, Dana Lauer MS, RN, NEA-BC, Charlotte Ciudad MSN-L, RN, NEA-BC, and Aza Maltai, HR

Reference:Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y.,

Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395, 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5

Gattinoni, L., Chiumello, D., Caironi, P., Busana, M., Romitti, F., Brazzi, L., & Camporota, L. (2020). COVID-19 pneumonia: Different respiratory treatments for different phenotypes? Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06033-2

Ghelichkhani, P., & Esmaeili, M. (2020). Prone position in management of COVID-19 patients; a commentary. Archives of Academic Emergency Medicine, 8(1),e48.

Johns Hopkins University & Medicine. (2020). COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Retrieved from www.coronavirus.jhu.edu/map.html

Rothan, H.A., & Byrareddy, S.N. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 109,102433. https://doi.org/10.1016/j.jaut.2020.102433

Scholten, E.L., Beitler, J.R., Prisk, G.K., & Malhotra, A. (2017). Treatment of ARDS with prone positioning. CHEST, 151(1),215-224. https://dx.doi.org/10.1016/j.chest.2016.06.032

Vollman, K., Dickinson, S., & Power, J. (2016). Pronation Therapy. In Wiegand, D.L. (Ed.), Procedure manual for high acuity, progressive, and critical care (7th ed., 142-163). American Association of Critical-Care Nurses.

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Do You Need a Dissertation Coach?Dennis Ondrejka, RN

A major deficit in academic outcomes is the way the PhD student is left to complete their dissertations. The American Association of Colleges of Nursing (AACN) does not report the All but Dissertation (ABD) percentile for those students who have gone five years beyond all course work and have not completed their dissertations.

What is reported by the AACN are the number of admissions and graduations by year. All that is needed is to look at the completion rates for those admitted seven years earlier for the PhD students even if this is not the exact number of years in process. The time between enrollment and completion could be longer, but the data would show similar ABD results at 10 years. The seven-year interval will provide a close representation for completion outcomes as seen in Table 1. (University of Nebraska Medical Center, 2014)

Table 1

Looking at the range of admissions from 2004-2018, there have been differing peaks but the lowest was 3439 in 2004 and the highest was 5122 in 2013. Completions by year range from a low of 412 in 2004 and a high of 802 in 2018. This average ABD rate is 83%. The seriousness of this failure in many graduate programs has been studied by other researchers (Bair & Haworth, 1999: and Kelly & Salisbury-Glennon, 2016). There is a host of research looking at why this might be the case, but I am suggesting that the model for self-regulating study on such a significant project is full of personal and academic barriers.

I have personally worked with nine PhD students, and most have been told by their dissertation chairs they were at serious risk for not being able to complete in time as most programs have a limit of seven years for the dissertation. Historical data would suggest this was true, and my interviews with them had a variety of reasons why they were completely exhausted with the process.

I used a coaching method that allowed the student to be vulnerable about their failings, and how they had come to this ABD completion block. In

addition, I offered them help in clearing up any of their writing and feedback from their committees as to what was wrong with their writing to that point. Once it was clear they would move forward with this type of assistance, I asked them for two things: 1) they needed to give me everything they were writing most recently that stopped them, and 2) they needed to help me understand how they were thinking about their inquiry. I never spent more than 20 hours on one student and all these students completed in 12-20 months except one. The one who did not finish found the entire process was not important to her in any way and was just paying semester fees perpetuating her confusion. She decided this was not what she wanted. The other students needed four to six hours of coaching to clear up the student’s thinking process of the question, and then helping with resources on methodology that would answer that question. Many students in doctorate programs only understand a percentage of methodologies and how they might be used. Once they were certain of their question, which could take a couple of hours alone, it was possible to provide a method and the resources for how to use it. I asked to see the next piece of writing to provide additional guidance on keeping the question and methodology congruent, and confirmed this was what they were after.

My experience is anecdotal, but it has a 100% outcome to prevent a permanent ABD, which certainly needs to be explored. Our current model to support PhD students is not working. Maybe coaching methods, to promote internal strength and how to break barriers, are the perfect first step? The second step requires knowledge of questions and question revisions that will match the method and inquiry thinking of the student. With a current failure rate of 83%, we have little to lose.

Dennis Ondrejka, PhD, RN, CNS lives in Vail, Arizona and is a member of AzNA Tucson Chapter 2.

References:AACN, (2020), The PhD landscape (2009-2018), www.aacnnursing.org/News-

information/Research-Data-Center/PhD (retrieved May, 2020). Bair, C. & Haworth, J. (1999, November). Doctoral student attrition and persistence:

A meta-synthesis of research. Paper presented at the annual meeting of the Association for the Study of Higher Education, San Antonio, TX.

Kelley, M. J. M. & Salisbury-Glennon, J. D. (2016). The role of self-regulation in doctoral students’ status of all but dissertation (ABD). Innovative Higher Education, (41).pp 87-100.

University of Nebraska Medical Center (2014), Using AACN data, from 2014, Enrollment and graduation data for DNP and PhD programs: 2004-2013. Presented at John Hopkins 2014 called: From Start-up to Impact: A DNP Conference.

Page 8 • Arizona Nurse July, August, September 2020

To Dilute or Not to Dilute Adult Intravenous Push Medications…That is the Question?

Candy Cross RN; Denise Dion RN; and Monica Hulsey RN

This article is a follow-up to an article published last July titled “Evidence Based Guidelines for Intravenous (IV) Push Medications.” Our team has been hard at work to bring the Institute for Safe Medication Practices (ISMP) safe practice guidelines to nurses and nurse educators across Arizona.

Our initial survey to clinical faculty educators (n40) revealed 98% of nurse faculty teach IV push medication administration in nursing skill lab. The bad news is that 50% are teaching further dilution of IV push medications by drawing up ready-to-administer (RTA) sterile medication and transferring into a prefilled syringe of 0.9% normal saline. As nurse educators, it is important to understand that these prefilled syringes of 0.9% normal saline are approved by the Federal Drug Administration (FDA) as flush devices only. They are not intended for the dilution or reconstitution of medication and using them in this manner is considered “off label” use. This type of syringe-to-syringe transfer is most concerning for the possibility of unlabeled or mislabeled syringes as well as the potential for contamination.

Stucki et al (2009) conducted a study to assess the possibility of microbial contamination of prefilled syringes. The study was conducted in three different hospital environments. They used four different high risks manipulations with the filling of syringes: “simple filling, 3-second contact with ungloved fingers on the hub of the syringe, 3-second contact between a nonsterile object and the hub of the syringe, and exposure of the filled syringe to ambient air for 10 minutes.” The study

concluded manipulation of syringes in an unsterile environment outside of the sterile pharmacy had a higher risk of contamination (Degnan, Bullard, & Davis, 2020).

According to our frontline nurse survey (n393) 40% report diluting IV push medication by withdrawing the medication from a sterile RTA syringe and transferring into a prefilled syringe of 0.9% normal saline. Our survey results demonstrate a variety of reasons why nurses further dilute adult IV push medication and none of them are done with the intention to inflict harm. In fact, nurses primarily dilute medications with the intent to protect the patient from adverse outcomes and harm. There is a misconception that dilution will make the IV push injection less painful for the patient and reduce the risk of extravasation. Nurses also believe this practice provides for greater control of the rate of administration of the drug. Fifty-one percent of respondents chose dilution as the primary reason. Forty-two percent state that they were taught this practice in nursing school and only 11% replied that they do not dilute IV push medications. Seventy-one percent of frontline nurse respondents report further diluting opioid IV push medication. This is most concerning given the fact that most opioids are dispensed in RTA cartridges. Our survey also reveals nurses are unnecessarily further diluting a wide range of IV push medications such as cardiac medications, heparin, and even insulin.

In addition, our team has discovered that many of the nursing drug reference guides nursing programs and students are expected to use have conflicting and outdated information related to the dilution of IV push drugs. The two most prominent organizations who have done extensive work around best practice for the preparation

and administration of IV push medications are the Institute for Safe Medications Practice (ISMP) and the Infusion Nurse Society (INS). To effect change we encourage frontline nurses and nurse educators to visit their websites: https://www.ismp.org/ and https://www.ins1.org/about-us/.n s1.org

At this time, the Arizona Safe Medication Collaborative Team once again requests nurse faculty and frontline nurses to assist us in our follow-up surveys regarding the preparation and administration of adult IV push medications. Please click the appropriate link below or scan the QR code with your smartphone to complete our brief survey. Thank you.

Faculty survey link and QR Code: https://www.surveymonkey.com/r/

Q22J5ND

Frontline nursing survey link and QR Code: https://www.

surveymonkey.com/r/28G7QBB

Candy Cross MSN, RN, Denise Dion MSN, RN, CNE, PCCN, and Monica Hulsey MSN, RN, CCRN

For questions or concerns please email CandyCross@cox.net or Denise.Dion@centralaz.edu.

References:Degnan, Daniel D. PharmD, MS, CPPS, FASHP; Bullard,

Tacia N. MSN, RN, CNL; Davis, Mary Beth Hovda MSN, RN, VA-BC Risk of Patient Harm Related to Unnecessary Dilution of Ready-to-Administer Prefilled Syringes, Journal of Infusion Nursing: May/June 2020 - Volume 43 - Issue 3 - p 146-154 doi: 10.1097/NAN.0000000000000366

Infusion Nurses Society (2016). Infusion therapy standards of practice. (39) 1-169

Institute for Safe Medication Practices. Guidelines for safe practice of adult IV push medications. Retrieved from https://www.ismp.org/sites/defaul t / f i les /at t achment s / 2 0 17-11/ ISM P 9 7-Guidelines-071415-3.%20FINAL.pdf

Stucki C, Sautter AM, Favet J, et al Microbial contamination of syringes during preparation: the direct influence of environmental cleanliness and risk manipulations on end-product quality. A direct influence of environmental cleanliness and risk manipulations on end-product quality. Am J Health Syst Pharm. 2009;66(22):2032–2036.

In Memory Of...Judi Crume, RN – AzNA Member

Ann Van Slyck, RN – AzNA Member

July, August, September 2020 Arizona Nurse • Page 9

Betty Mitsunaga, RN, PhD, FAAN— An Oral History of a Resident of a Japanese Intern Camp

Shannon E. Perry

Betty Mitsunaga is a retired nurse, teacher, administrator, and researcher with clinical expertise in public and mental health. As a Japanese-American teenager, she was sent with her family to an internment camp during World War II.

Following the Japanese attack on Pearl Harbor on December 7, 1941, life changed for the Japanese and Japanese-Americans living on the west coast of the United States. In their panic after the attack, many people believed that the United States was in danger from these Japanese, any of whom could be a spy. President Franklin D. Roosevelt signed Executive Order 9066 in February, 1942, which moved almost 120,000 Japanese and Japanese-Americans from the west coast into relocation centers. Two of these centers were located in Arizona.

Betty’s parents were born in Japan. Masafuni Kono came to the U.S. in 1908 and settled in Los Angeles. Betty’s mother, Taka, arrived in 1914 and entered into an arranged marriage with Mr. Kono. They moved to Santa Barbara where many Japanese lived and jobs were available in housekeeping and gardening. The Konos had two daughters, Ruth, born in 1922, and Betty, born June 7, 1926. Betty lived with her family in Santa Barbara until the outbreak of World War II when she was a sophomore in high school.

In March 1942, the Konos were notified that they must go to a relocation camp. After disposing of their belongings and selling their car, they were sent to a temporary home in the Tulare County Fairgrounds, about 200 miles north of Santa Barbara.

Four months later, the internees were transported to the Gila River Relocation Center on the Gila River Reservation in Arizona. The Konos arrived

August 21, 1942, the first day the camp was open, and settled in Butte Camp, the larger of the two camps on the reservation. The camp was patrolled by armed guards and surrounded by barbed wire which was soon taken down.

The camp was unfinished and there was no running water or toilets. At first, the Konos lived in a room which was shared with another family. People worked to build furniture, plant gardens, and dig trenches for toilet waste. A school was started with both Caucasian and Japanese teachers. There was a hospital, police and fire department, canteen, shoe repair shop, and five churches. Social activities and sporting events were held.

Internees could leave camp if they went east and had someone to sponsor them. When Betty completed her junior year, the Konos left the camp, September 14, 1943, traveling east to Chicago.

Betty read Sue Barton books in high school and decided she wanted to be a nurse. After graduation from the University of Minnesota, Betty worked as a public health nurse, earned master’s degrees in nursing and sociology, and a PhD in Sociology

from the University of Washington in Seattle, WA. Among many other positions, she taught nursing at UCLA and public health nursing and introductory research methods at the University of Colorado in Denver where she was one of my teachers.

Betty, now 94, lives in Tempe. She and I visited Butte Camp on April 12, 2017. Betty remembered the barracks where they lived was near the hospital. She spoke about conditions in the camp and the internment of her family. While her comments about the camp included negative situations in which they found themselves, she seems to harbor no bitterness from the experience.

In the camps, internees made works of art out of materials available. They were to “Create Beauty and Affirm Life.” These were called the art of gaman which is loosely translated to mean “to bear the unbearable with patience and dignity” and that describes Betty.

Based on a presentation at the 35th Annual AAHN Nursing & Healthcare History Conference, San Diego, CA, September 14, 2018.

Page 10 • Arizona Nurse July, August, September 2020

Pediatric Care Coordination for Student Health and SafetyOverview: The purpose of this article is

to discusses the importance of developing partnerships with multidisciplinary care teams for the coordination in support of children with medical complexities and their families These care teams includes our medical specialists, insurance groups, home health agencies and durable medical equipment companies, parents, school nurses, nursing agencies and other agencies or specialties identified by the family. Our specific focus is on the safety of the student while at school. In order to achieve this goal, there must be effective communication between the school and the medical community.

Dr. Wendy Bernatavicius, MD, Division Chief of the Division of Primary, Complex Care and Adolescent Medicine at Phoenix Children’s Hospital in partnership with Arizona Department of Health Services, and Dawn Bailey, Family Engagement Specialist/Parent to a child with medical complexity, presented a training curriculum; which was developed and implemented through Boston Children’s Hospital and The National Center for Care Coordination Technical Assistance (NCCCTA) and supported through The National Resource Center for Patient/Family-Centered Medical Home within the American Academy of Pediatrics to a variety of partnering agencies and specialists here in Arizona with the goal of informing others on how this process and the development of these care teams can support our medically complex children and families. The multiple training sessions included group discussions, break out groups and strategies to make impactful changes towards improving our systems for children, families, providers, and schools. The training goals are directed towards having families feel supported, valued and respected as partners in the care of their child. Education and schools play a large role in the lives of these children and families, this type of collaboration supports parents with training, resources and continuity of care at school.

Partners in Actions: Christine (Tina) Mahoney, MSN-Ed, RN and Nadine Miller, MSN, RN, both from Mesa Public Schools (MPS) and board members (Secretary and President) of the School Nurses Organization of Arizona (SNOA) participated in the training. At the training, a common thread evolved highlighting the issue that Arizona schools have no uniformity of oversight, requirements or roles for the school health offices. Due to the number of schools and districts in Arizona, there is a lack of consistency in processes, expectations and communication between the schools and the medical community. In MPS, Tina, the District Resource Nurse, decided we could improve the process of communicating with the medical community, which ultimately would lead to better student health and medical prover satisfaction. In addition, improved communication would result in orders received in a more timely fashion which would lead to improved school attendance.

With the support of our SNOA board members and our MPS nurses, medical orders for specific diagnosis were developed according to the following needs, enabling them to be student specific:

• Feeding orders were updated to include the necessary specific information that the school nurses need: type of feeding (i.e. G-tube), frequency, amount, volume, rate, consistency, etc. (see attached document)

• Trach care/O2 with specifics for nurses as well as training others in the classroom including equipment, time, transportation concerns, activity restrictions, length of day tolerated, O2 continuous/intermittent, titration order, etc. (see attached documents)

• Seizure care orders to include emergency medications, treatments to include VNS guidelines, and care (see attached documents)

• Pulse oximetry guidelines to be utilized with a fillable O2 titration guide (see attached)

We met with the Arizona group on a number of occasions and received feedback and support, not

only from the physicians but specialists, partners in care and parents as well.

Challenges: The state of Arizona has no recommendations for school nurses therefore the support is provided by individual districts. SNOA has provided support to Arizona School Nurses with a website, recommended policy statements, training resource forms, newsletters, an annual conference, and now suggested physician’s order forms. This program will be presented to the nurses and provide awareness of the materials listed on the website to begin uniformity in the use of forms for our medical providers throughout Arizona. An emphasis will be placed on accountability and the need for the nurses to appropriately complete the forms and follow-up with the physician in obtaining the information needed.

Moving forward and in summary: – Having direct conversations with our school nurses and nurses across the state during our summer conference and adding the forms to our webpage for access by nursing staff and physicians will enhance uniformity in requests made to health care providers and provide clarity in specifics of orders for training and safety in care. These forms also improve the continuity of care between both school and home, thus supporting the students with medical complexity and their families across the continuum, while also enhancing communication and collaboration with partners on the care team.

Collaborators:Nadine Miller, MSN, RN, Director of Health

Services Mesa Unified School DistrictChristine Mahoney, MSN-Ed, RN, Resource/

Education Nurse Mesa Unified School District Dr. Wendy Bernatavicius, MD, Division Chief

of the Division of Primary, Complex Care and Adolescent Medicine at Phoenix Children’s Hospital

Dawn Bailey, Family Engagement Specialist/Parent to a child with medical complexity

July, August, September 2020 Arizona Nurse • Page 11

Page 12 • Arizona Nurse July, August, September 2020

New & Returning AzNA MembersMarch – May 2020

Apache JunctionJeffery Cooper

Arizona CityLeslie Hawking

AvondaleKimberly EvuleochaSusannah HiralezAlexandrea KellyShonnita LanierChristy MoncadaPaul OkoronkwoKrystle ReedStarla ScofieldMichelle Stollsteimer

BellemontCandace Tallis

BensonSarah Bivens

Bimhall, NMAndrea Cadman

BuckeyeBrandi BenjaminIvette CaroAmy CookVanessa EnlowSimone JamesJoshua SantoAnthony Siotos

Bullhead CitySheilkeela Howard

CarefreeDeborah Dollmeyer

Casa GrandeNatisha Clark

Cave CreekMarti Jo CaldwellLyda Velez

ChandlerLeticia CarmonaPetula CoreJody DruheTanya FettersDesirae FlandersBarbara HalleJennifer HensleyAbby LavigneIvy LopezKeisha MasonRobyn OlsonVanessa SlaughterJessica StrangShaun TorrezBridgette VallejosOlimpia WalicaJanna WeinbergHeidi White

Chicago, ILNewcolow Slaughter

ChinleJohanna BaheNettie Davis

Chino ValleyMeagan Coomer

ConchoKim Fore

DeweyMelissa KellyDhyana Landa

DragoonOpal Stone

EagarMarian BigelowEileen Furman

El MirageDanny DennisChristina GurnickMelina SimsAnuli Uzoukwu

FlagstaffCarmen GiovaniniKari LentzSusanne One LoveOlivia RoseTiffany Waldrop

FlorenceDereck Smith

Fort ApacheVerna Hastings

Fort DefianceOmayra Colon

GilbertAntwonisha BerryHeidi BrewerMishna CazeauTonia CorriganSiara EscobedoErin EthingtonHeidi GillShannon HallLaura JonssonLori KellerLorybing KhoonsrivongLindsie KielasMegan KirschnerAmber LewellynNicole MarquardtAna McNabbKayla MeyersAmanda MiklusJoleen ParkerDiane RichardsonLori RobertsMisty SilvaRiza Sunbury

GlendaleNicholas FisherKimonnie GarbuttRanara KingiTiffany KirbyAmanda O’DellM PerezMardeisha PowellKendall RomigKathy Tropea

GlobeValerie Garrett-ReyesJenna Johnson

Gold CanyonMarilyn Bates

Roberta DrakeAmir Raad

GoodyearAshton ConnerRebecca CromerCatherine Rosette DelgadoCorrin DragonRogelio Feliciano IIMelissa MillerNatasha SotoPeter TebohSusannah WinsleyAndrea Wisdom

KaibetoBrianna Smith

KayentaJimmienesha Williams

KingmanMaria BejarJoseph ReidMichael Serrano

Lake Havasu CityAudrey FullerShannon PlaneDebra Serr

LakesideAlyson LarsonChantelle Remenak

LaveenTekel AbrahaRachel DonovanAmanda LupejkisHazel VasquezJody Wolfe

Litchfield ParkLisa ChelstromAmber CochranMaritza Santamaria

MaranaCynthia Post

MaricopaJennifer GeniacThomas HlebaskoMichael PeprahChristine Trejo

MesaKathryn AshbyMaria BabbChristina BasileJessie CumminsBarbara CutoloAlexander DecotSandra DevitaAnnette DuretteAlyssa EvansStephanie FloresTroy FultonEva GaborCindy Gaspar-RustNorman GreshamKathryn KrauseMellizza LansangSabrina NorgordClarissa OrtizDean PanessaPatricia Price

Ivan PrinceJo RawlsBrittny RogersRachel SanchezAmy SchaeferDana ShineRouella SmithTammy TunisCarley VentoAteh WangiaLinda Winters

New RiverWendy Woske

Oro ValleyBelen FierroValentina ScalzulloTaylor Walker

Paradise ValleyElizabeth Lanphar

PeoriaBrittnie AbishalomChristina BuggLisa CheneyBomie DorleyNatalie ElwellJulie EmeryMadison EnricoKara EverhartNolana FosterMelissa GrantJessica HayesSusannamma LijanJeannette McGoughSandra MosleyCourtney RussellAmira SaidJoel SilvaBarbara TaylorCarla ThorpeVictoria TweedyLisa WaltmanSarah Watts

PhoenixMarilyn AbitongTyleana AbuelianHeather AdairMarquis AllenGayle BachelierJonika BakerDenise BanchsCameron BaronwrightVictoria BeggKelli BorgwardtAllyson BorkNecole BrissetteAshley BrownAlexa BurnsRichard BusbyTina BusbyLauren CableHeather CarpenterLori CarsonDesirlee CaseyJoyce CerasaRebecca ColyerBrandy ComptonStephanie CralleyPatrice DanielsMariene Diaz-CruzKathy DoeschotAutumn EastonJacqueline ElamCindy Elliott

Esther FlemingMyra FranciscoTraci FrenchMonica GerdesFelecia GomezTiffany GraybealJoshua HartfordDeborah HawkinsEmily HeineJessica HolmanFlora Issanda StowaterJesse JimenezHannah Jurekovic-ByrdRebecca KinsleyErin KrichJolene LarsonNicole LeeperAllison LewisJerica LimJesse LittlejohnRegina LoveittBrittany LuckyTatevik MakramajanCindy MandIrina ManloveChalsey MartinDarrell McCargoIlissa McDonaldRachael MitchellDanielle MooreMichele MoranLacey MorrisTabita MurzaRachel NagyRachel OconnellHunter OlsonErika OrtizMarilyn OstermanDharshana PalazzolaMadison PalmerDaniel PanopioKaycee ParrilloMelissa PecakJenny PinaDebra Raling-YoungJeffrey ReidheadAyan SaidVictoria SarinanaSuzanne SeryAidan SeryKelsie SharpIngrid SipprellSheila SmithAngie SorensenThomas Stevens, JrCandace StillmanGlenn TownsendJenn Van WieJessica VeasyJoseph WertmanDrew WestLaura WestfallKari WilliamsKendrick WrightKarlyna Yond

PinedaleElaine Dorr

PrescottInge BundchenMichelle “Missy” CraftApril OdorferAngela Price

Courtney RoutsonKaren Soto

Prescott ValleyMary CheneyLanette HannaKrista Harwood

Queen CreekHamda AwaalDavid BauduinSonia BlauCarolyn ChristHeidi HaddowRamon NavaTaylor NelsonNicole NewmanPaula PascarellaKristina RawlingsSarah Zavala

SahuaritaLisa DerryberrySarah HughesRebecca McKeethAimee RamosAndrew Vigorito

San Tan ValleyEllizabeth BryantKrystal CareyJacqueline DavisTravis SeiterJoshua Seiter

ScottsdaleMargaret Anne AldersonThecla AnauCarrie DeweyJessica HainesBrooke HansonValerie HartShantel HerrmannJeremy HodderJackline KithinjiKathy KnudsonBonita LazzeriMichelle MillsSara MossTapera SabeCynthia SearlesMartha SerranoJennifer St. AntoineKathy StinsonKevin WimbrowCassandra Wolf

Show LowMichelle Schmidt

Sierra VistaBellacatalina DvignonDiana EaglinJamie FitzpatrickKarissa KellerLeala MartinezKorina Schulze

SnowflakeAlisha Montejano

Southfield, MIRenee Miller

New Members continued on page 14

*The 2015-2020 Dietary Guidelines for Americans recommends three servings of low-fat or fat-free dairy foods (milk, cheese, yogurt) for Americans 9 years and older.Source: U.S. Department of Agriculture Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference Legacy Release, April 2018. Calculations based on low-fat milk (USDA database #01082). Some milk may be a good source of selenium and/ or zinc. Other foods used: large egg (50 g), whole, cooked, hardboiled (#01129); kale, raw (#11233); beans, kidney, California red, mature seeds, cooked, boiled without salt (#16031); pork, fresh, loin, sirloin (chops), bone-in, separable, lean only, cooked, broiled (#10058); nuts, almonds, whole (#12061); peppers, sweet, red, raw, sliced (#11821); broccoli, raw, chopped (#11090); fish, sardine, Atlantic, canned in oil, drained solids with bone (#15088), mushrooms, large, white, raw (#11260).©2018 National Dairy Council®

Three Servings of Milk Deliver A Unique Nutrient Package

The Dietary Guidelines for Americans recommends three servings of dairy products each day.*

Milk’s essential nutrients can be difficult to replace in a healthy dietary pattern. Three 8-ounce cups provide as much of each nutrient as:

PROTEIN50% DV

4 large (50 g) hardboiled eggs

VITAMIN D45% DV

6.5 oz of sardines (approx. 15 sardines)

NIACIN (B3)35% DV

approx. six large white mushrooms

VITAMIN B12140% DV

approx. 1 lb of pork chops

RIBOFLAVIN (B2)100% DV

0.8 cups of whole almonds

PHOSPHORUS60% DV

approx. 3 cups of cooked red kidney beans

VITAMIN A45% DV

approx. 3 cups of sliced red peppers

PANTOTHENIC ACID (B5)50% DV

approx. 5 cups of chopped broccoliCALCIUM70% DV

approx. 17 cups of raw kale

http://www.arizonamilk.org

Page 14 • Arizona Nurse July, August, September 2020

Because of AzNA nurses can say YES

YESYESYES

YESYESYES

there is a strong state-wide voice for nursing

nurses influence laws, rules and Scope of Practice

collaboration on the local and national level

promotion of a healthy Arizona

nationally accredited continuing education

nurses have access to mentors and role models

www.aznurse.org

aznurse.org/JoinToday

Sun CityValerie Malinsky

SurpriseHeather BensonStacy DoudDorina DuarteMatthew DunnDorreene GallimoreClaire GarganeraTanya GastonCharlene GrittsJeremy JohnsonChristine LyonsKalu OkorieLisa TracyJennifer Wesley

TempeAdam BalzerNicole BoldsAshley CarettoAmy FrigaardAshley GoffKathy GrossDamaris HazellReyanne JimenezKeona JonesBrianna Malmborg

Tinaya MurphyShelby RolfeKady ValdezTraci Wiedmann

TollesonDaniel GarciaJoanna VillaLashandra Wilson

TonopahGail Cross

Tuba CityDeeoni BlakeJennifer DemossXavier DiazRebekah FullerMildred GarciaJennifer GilmoreVictoria GimberHoneytez MoralesEdwin PerezEvithner RuizSusan Sanazaro

TucsonJennifer AbeytaLauren Alexander

Wendia Amicy MayVanessa ArvizuRosalinda BacaparraMelinda Barton-FrancksMelanie BegayeCynthia BerezowskiRochelle CadabunaShelby CaseRichard CasquejoJaymien August CondoyElizabeth CoxRuth CrespoTravis CusterGracezielle DavidDanielle ForcheNancy HenningBethany JacksonRobin KuhlmanStacey LeeLisa LoganMaricar MarasiganAmanda MartinAlexandra MillerNatasha MontoyaHannah NagleAnthea ObrienWilliam OharaAngel OjedaRobyn OlsonSusan PadillaGeorgina ParedesJillian PatulaMorgan PostalLaura PrideJennifer QuagliniAnnabelle QuilacioShiela Dale RadazaAnita RectorJennifer RexAlexis ReyesKristine SauveJessica SheltonLauren Simms

Alicia SmithEva SoliePhillip StensrudLaura SterlingLeslie StreeterHelen SubongOnelia ValdezAngie VargasLindsey WarneCloe Wilford

VailKatherine GrimesMatthew GritisValerie MarineJamie Meriwether

WaddellSherry Addair

Window RockTeshina Cody

WinslowTerri Joe-Crocker

WittmanmBrittany Miranda

YoungtownStephanie McMurdy

YumaCassie BragaYeny Contreras HerreraMaureen JohnsonLisa MagdalenoMichelle MendivilJackielyn Mae PascualDesiree PolodnaChristina WilmasDenise Woolcutt

New Members continued from page 12

Have you heard about the Well-Being Initiative?Every day, across the nation, millions of nurses

are experiencing extraordinary stress and other impacts to their mental health and well-being as the coronavirus pandemic progresses.

The American Nurses Foundation’s new Well-Being Initiative offers free tools and resources designed to help care for nurses like you as you tirelessly care for others.

Visit aznurse.org/WellBeing

Available resources:• Nurses Together: a virtual, judgment-free

space to connect with your nursing peers via voice and video calls

• Happy: a platform providing 24/7, one-on-one access to support team members

• Moodfit: an app for setting and tracking personal health and wellness goals

• Narrative Expressive Writing: a five-week guided narrative writing program to help process your experiences during the pandemic

• Nurses’ Guide to Mental Health Support Services: an informative guide to help you understand when and how to access social and peer support, as well as mental health services and treatment

We hope you’ll visit the Well-Being Initiative page and make use of the resources.

We appreciate all you do every day to keep our communities safe during this time. Thank you.

The Well-Being Initiative resources are available to all nurses—membership in a professional association is not required.

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l Master’s degree in Nursing plus two (2) years of direct patient care experience l OR Master’s degree in related health care field and Bachelor’s degree in Nursing plus

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July, August, September 2020 Arizona Nurse • Page 15

AvondaleRegina Ward

BuckeyeJill Beavers-KirbyNatalie KoronaSiboney NortonElizabeth ParraAlexus Pena

Casa GrandeMelisa Salmon

Cave CreekLaurie ScottJamie Smith

ChandlerCarrie AngeJessie BallPamela BlumeRaeleen DavisShannon Olson

CutchogueBarbara Anderson

FlagstaffNicole AllenDouglas Sutton

Fountain HillsJennifer Roman

GilbertCarol FioccoCara HarrisJoselyn LupoLindy MitchellStephanie PotterNicole RobertsFrank Robison

GlendaleRozlyn BrittonBrittany Smith

GoodyearLorinda BaldwinJodie Hickman

HerefordRise Gold

KingmanChristina BeacomKelsey BurkettGregory CoxStephanie Morgando

KykotsmoviKay Andrews

Lake Havasu CityHanne DolanAmi Hollis

Litchfield ParkRandi Bostrom

Los Angeles, CAZennoma Richardson

LuptonCarol Lauber

Maple Valley, WASAngela King

MaranaAnna BourguetRonda Garrigan

MesaKatherine BrownSilvia CarrilloRebecca KreisDiane McCordMarianela MelendezVictoria SowardsPatricia StenbergDeanna Turner-Garcia

Odenton, MDJennifer Eliot

Two Year Anniversary MembersMarch – May 2020

Oro ValleyStephanie GasserJane Robles

ParkerCheaber Welch

PeoriaKristine DalbecStaci WestJonathan Wieland

PhoenixJane BarnesKristal BonelliElizabeth BryantMartha CarrilloBrian EggenEllen ElyJudith KarshmerJennifer MartensLynne MathieuHarriet O’ConnorPatti OzmentChristina ParksJennifer RoySally SnedigarLisa TurnerJennifer Utan

PrescottElaine Martin-Stomel

Queen CreekBrandi Bushong

Rio RicoLaura Monarque

San Tan ValleyChidozie Eze

ScottsdaleRowena AquinoSadie CardonPatricia CookJill Hecker FernandesLorie Matlick

Katherine PetersonLinda SchwartzElizabeth SpositoTiina Tuuli HaugDoreen ZannisKristina Zimmermann

Sierra VistaJesus ArballoMelissa Wendl

SurpriseXenia AgeeStephanie DaileyDustin HusemannHailey Olson

Tuba CityJudy Clanin

TucsonNancy BowmanCoy CollinsMrs. Danielle EdwardsKyle EstepJeri GarciaJoy MetcalfVanessa NunezVicki PadillaJesus PerezPatricia SkowronLorri Ann Valdez

VailLeslie JimersonShanae Murphy

WaddellSara Ingram

YumaLaura AvenettiSarah BirdDeLora ChristieJulia LuevanosXochitl PimentelSusan RoberstsonAmanda Tapia

AzNA’s Superstars

Happy Anniversary to our dedicated AzNA members celebrating these special

milestones for this past quarter:March – May 2020

5-Year MembersTami AntoniniCasey BrookeyMaureen ButtenhoffJahyra CastroMyra CousensMisty CoxTeresa CurielSherry DanielsEleanor DavisMelissa DavisVerlene DominguezAmanda DuncanTami EckenrodeKim EzrreYvonne FawkesBrenda FloresPiroshka Forster-PriceAnne GannonCynthia GuilmetteEugenia IliseiSusan JohnsonLauren KimJocelyn LabrierDonna LeonardClaire LuketichMary MendienTina MengheJulie MenkeElizabeth NavarreteTammy NelsonMichele PaulMaureen PetridesJessica RanaConsuelo ReedJohn RisiKathleen RoseCaroline RosemondAmy SimmonsLinda SquiresTracy ThomasEbonique ThomsonKirsten TurkingtonKeith UlmVanessa ValverdeZeljka VincicJoy WhitlatchDenise WillardMelissa WilliamsJohn WitwerJennifer WomeldorfKristina YoungDeborah Zeleny

10-Year Members

Mary BieberHeather CarlisleJunya FischerSusan GondaClarke KrugmanJennifer OverturfPam Shields

15-Year Members

Jan HamiltonKatharine KazakaSusan KurzerElizabeth ReifsniderJeannette Yazzie

20-Year Members

Anne AlexandrovAmy CoulterLinda MeinerHector Varela

25+-Year Members

Charlotte BarkhauerCaroline BentleyCarol ChavezJeannine DahlMargaret De VriesMary GriffithIda HeathAda HinshawDavid HrabeNancy JohnsonP. JostTracy KingTerance KranzLoraine LangfeldtLoretta LukensIda MooreBrenda MorrisAna MurphyAllen PrettymanSheryl ShantzColleen SpeidellJean StengelCarmen TraillHelen TullKimberly Vana

• Chief Nurse Executive• Clinical Nurse • PRN Registered Nurse• Clinical Care Coordinator• Public Health Nurse• RN Case Manager• Infection Control Preventionist / Employee Health Coordinator

We are seeking highly motivated nursesExciting nursing opportunities and breathtaking allure of Navajoland await

committed and highly motivated nurses.

Come join us in Winslow! We are located just seven miles from the southern edge of the Navajo Nation, 45 minutes east of Flagstaff and a few hours north of Phoenix. You can go from Standing on

the Corner of Winslow, Arizona to hiking scenic and majestic landscapes.

http://eller.arizona.edu/superpowers