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Index

Please be sure to notify us with address changes/corrections. We have a very large list to keep updated. If the nurse listed no longer

lives at this address – please notify us to discontinue delivery. Thank You!

Please call 877-810-5972, extension 701 or email to office@nhnurses.org with Nursing News in the subject line.

Florence Nightingale (1820-1910)

Official Newsletter of New Hampshire Nurses Association Quarterly publication direct mailed to approximately 1,250 Registered Nurses and LPNs and deliveredelectronically via email to 16,500 Registered Nurses and LPNs in New Hampshire.

June 2020 | Vol. 44 No. 3 www.NHNurses.org

Year of the Nurse 2020Year of the Nurse 2020New Hampshire Nursing NewsNew Hampshire Nursing News

2020 STUDENT NURSEOF THE YEAR

The student nurse of the year award is given to a student nurse in a pre-licensure entry program who embodies the finest qualities of nursing. Unable to celebrate nursing students in the state of New Hampshire with our Annual Student Nursing Conference in the midst of the COVID-19 closure, NHNA felt it was important to recognize excellence. Graduating students were unable to celebrate traditional graduations but will soon be on the front lines caring for New Hampshire citizens and communities.

The Student Nurse Award was bestowed virtually. Five deserving students were nominated and judged by the NHNA Commission on Nursing Practice based on qualities include caring, professionalism, advocacy, leadership and involvement. 2020 nominees were:

Shadane Davis, St. Joseph School of NursingDevon Fortier, University of New HampshireEmily Galasyn, Rivier University Laura Howard, University of New Hampshire

Adam Therrien, Manchester Community College

The recipient of the 2020 Award is Laura Howard from the University of New Hampshire. Laura was described by her professors as mature, curious, responsible, patient, and focused. Early in her schooling Laura began to define her philosophy of nursing which expressed an understanding that nursing was more than just treating an illness but involved, “treating the entirety of a person in body, mind, and spirit.” In addition to her majoring in nursing, Laura is minoring in Gerontology to improve her readiness to care for this complex population. During her time at UNH, Laura served as both a Student

Nurse Ambassador and Student Nurse Mentor. Laura’s peers have described her as compassionate, professional, always on time, and a leader.

NHNA, the Commission on Clinical Practice and the nurses of New Hampshire offer their congratulations to Laura Howard and the excellent nominees.

Laura Howard with her senior capstone preceptor at Littleton Regional Hospital,

Riley Vashaw RN

2020 NURSE PRACTITIONER OF THE YEAR

The New Hampshire Nurse Practitioner of the Year Award is typically announced during the Annual Spring meeting and banquet. This year, the NP Association joined many others in education, religion, and business by celebrating the honoree virtually in an online ceremony on April 9. The recipient of the 2020 honors is Mary Vigeant MSN APRN. Vigeant has practiced in the Emergency Department of Memorial Hospital in North Conway for almost 20 years.

Memorial Hospital Chief Medical Office Dr. Matthew Dunn noted that Mary “serves as a role model to us

all for what it means to be dedicated to your profession, your organization, and community. She is tireless in her efforts to continuously improve all of what we do. Mary is an excellent clinician and it is a pleasure to work with her.”

Vigeant was recently elected President of the Medical staff by her colleagues, a responsibility that recognizes the role nurse practitioners play at Memorial and honors her ability to lead and represent her medical colleagues. “Years ago, Memorial

recognized we needed everybody if we were going to move forward,” she says. “The medical staff bylaws were

changed to fit that culture. We were the first in the state to recognize everyone who was practicing within their capabilities. We made everyone equal.”

The former college English major began her nursing career working as a nurse’s aide during summer vacation. “I thoroughly enjoyed it.” Vigeant was an LPN while she attended Salve Regina College for her BSN. She obtained her Masters at Simmons College. She established her focus in emergency care at St. Luke’s Hospital, near Boston, while preparing for her NP exam. “I always knew that emergency medicine was in my heart.” At that time, she says most NP programs prepared graduates for primary care roles. She was the first NP hired in the St. Luke’s

emergency department where one of her research projects was exploring the medical and financial benefits of using nurse practitioners in emergency medicine. St. Luke’s today, she says, has an emergency staff of half medical doctors and half nurse practitioners.

By the late 1990s, Vigeant and her husband had a second home in the Conway area. She inquired at Memorial about working as a per diem but Memorial was not interested in hiring nurse practitioners at the time. A few years later a full-time job was worked out.

In accepting the award Vigeant noted “This really is an award to be accepted on behalf of my medical staff. It’s a culture that is warm and welcoming. I’ve been blessed and fortunate to work with wonderful clinicians on medical staffs my entire career.”

In the Next Issue:• Winners of the 2020 Excellence in Nursing Awards• Florence Nightingale: The Later Years

President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

From the ED’s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2020 Graduating Student Conference Cancelled . . . . . . . . . . . 4

Management Minute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Littleton Hospital Acquires New Sim Lab . . . . . . . . . . . . . . . . . 4

In My Opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Board of Nursing Responds to State of Emergency . . . . . . . . . 6

NHNA in Alliance to Support Senior Facilities . . . . . . . . . . . . . 7

APRN Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

KUDOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Loon Chocolates Deliver Joy to Nurses . . . . . . . . . . . . . . . . . . 8

Family Centered Maternity Care and COVID-19 . . . . . . . . . . . . 9

Past, Present and Future of Nurse Anesthetists . . . . . . . . . . . 10

Home Care Nurses Caring for Recovering Patients . . . . . . . . 11

Board of Nursing News . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Nurses on the Web . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

From the Bookshelf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Humor Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Welcome New and Returning NHNA Members! . . . . . . . . . . . 14

Nurse in Key Role in New Geriatric Program . . . . . . . . . . . . . 14

NCLEX Reconsidered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

NH Nurses Make It Happen . . . . . . . . . . . . . . . . . . . . . . . . . 15

Be Part of Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

School of Nursing News . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Florence Nightingale – Lamp of Scutari . . . . . . . . . . . . . . . . 17

In Memory of Our Colleagues . . . . . . . . . . . . . . . . . . . . . .18-19

Page 2 • New Hampshire Nursing News June, July, August 2020

New HampshireNURSING NEWS

Vol. 44 No. 3Official publication of the New Hampshire Nurses’ Association (NHNA), a constituent member of the American Nurses Association. Published quarterly every December, March, June, and September. Library subscription rate is $30. ISSN 0029-6538

Editorial OfficesNew Hampshire Nurses Association, 25 Hall St., Unit 1E, Concord, NH 03301. Ph (877) 810-5972, E-mail office@NHNurses.org

Editor: Susan Fetzer, RN, PhD

NHNA StaffJoan Widmer, RN, Nurse Executive DirectorPaula MacKinnon RN, Executive Assistant/ Communications SpecialistBeth Dow RN, Event Coordinator

NURSING NEWS is indexed in the Cumulative Nursing Index to Nursing and Allied Health Literature (CINAHL) and International Nursing Index.

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. NHNA 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 New Hampshire 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. NHNA 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 NHNA or those of the national or local associations.

MISSION STATEMENTNHNA, as a constituent member of the American Nurses Association, exists to promote the practice, development and well being of NH nurses through education, empowerment and healthcare advocacy.

Adopted 10-20-2010.

VISION STATEMENT Empower New Hampshire nurses as leaders in advancing the profession of nursing and the health of New Hampshire.

NH Nursing News (NHNN) is the official publication of the NH Nurses’ Association (NHNA), published quarterly – and available in PDF format at our website: www.nhnurses.org. Views expressed are solely those of the guest authors or persons quoted and do not necessarily reflect NHNA views or those of the publisher, Arthur L. Davis Publishing Agency, Inc. NHNA welcomes submission of nursing and health related news items, original articles, research abstracts, and other pertinent contributions. We encourage short summaries and brief abstracts as well as lengthier reports and original works. An “article for reprint” may be considered if accompanied by written permission from the author or publisher. Authors do not need to be NHNA members.*

Manuscript Format and Submission:Articles should be submitted as double spaced WORD documents (.doc format vs. .docx, please) in 12 pt. font without embedded photos. Photos should be attached separately in JPG format and include captions.

Submissions should include the article’s title plus author’s name, credentials, organization / employer represented, and contact information. Authors should state any potential conflict of interest and identify any applicable

commercial affiliation. Email as attachments to office@nhnurses.org with NN Submission in the subject line.

Publication Selection and Rights:Articles will be selected for publication based on the topic of interest, adherence to publication deadlines, quality of writing and peer review. *When there is space for one article and two of equal interest are under review, preference will be given to NHNA members. NHNA reserves the right to edit articles to meet style and space limitations. Publication and reprint rights are also reserved by NHNA. Feel free to call us any additional questions at 877-810-5972.

Advertising:Product, program, promotional or service announcements are usually considered advertisements vs. news. To place an ad, contact: Arthur L. Davis Publishing Agency, Inc. Email sales@aldpub.com or call 800-626-4081. Ad sales fund publication and mailing of NH Nursing News and are not paid to NHNA.

Guidelines for Submissions to NH Nursing News

Nurses, once again, are asserting their place in history. The past weeks have challenged you and yet, you have remained strong and dedicated, committed to facing the COVID-19 pandemic head-on and with sleeves rolled up. In my role as NHNA president, I’ve had the privilege of seeing the global New Hampshire nursing response to the call to duty and the advocacy of patients and peers. Here is but a snapshot of what the NHNA has seen and heard about what nurses are doing throughout the state:• Working on the frontlines in Emergency

Departments, ICUs, and COVID-19 dedicated units, accepting the risks to themselves and their families.

• Taking care of and protecting the most vulnerable in our population: the elderly and those with special needs.

• Signing up, in large numbers, for volunteer opportunities.

• Coming out of retirement to contribute to the need for nursing expertise.

• Thanking first responders, recognizing that healthcare truly is a team sport.

• Cross-training, learning new skills to take on roles needed to address this novel pandemic.

• Innovating to provide much needed supplies.• Supporting one another, keeping each other

strong.

Witnessing this level of dedication has been awe-inspiring and I thank you for all that you are doing. Information regarding the NHNA activities of the past several weeks is readily available on the website. There is a lot behind the scenes that the NHNA is doing to advocate for the nursing profession. Please read the Executive Director’s column for all the details, activities and accomplishments.

On a national level, the ANA and Johnson & Johnson created a series of podcasts on the nursing profession for 2020, the Year of the Nurse called See You Now. They have since paused their regularly scheduled programming to produce and broadcast stories from nurses serving in various roles during the pandemic. Storytelling conveys important information, concepts, and cultural mores in a way that no written word can. The stories in these podcasts will leave you feeling inspired, humbled, and proud. I encourage you to listen – they are brief yet powerful.

As difficult as the past several weeks have been, never have I seen greater respect for the nursing profession. The collective power that you wield has consistently been used wisely and for the greater good of all people and our world is responding in kind, turning to you for care and guidance. When called upon during the most challenging of times, you have answered without hesitation. You are honorable people with a solid foundation of ethics and a love of mankind that serves as your moral compass.

With gratitude for the privilege of being a nurse among you,Janice DezielPresident, NHNA

PRESIDENT’S MESSAGE

Janice Deziel

Do you have a news item to share with the nurses of

New Hampshire?Deadline for the next issue of Nursing News is

August 1, 2020

Send all contributions to office@nhna.org with NHNN in the Subject.

Faculty Positions in NursingSchool of Nursing & Health Sciences

We celebrate diverse undergraduate and graduate academic programs, outstanding faculty and a strong community partnership

with Dartmouth-Hitchcock Health.

We are seeking multiple innovative, energetic nurse educators to teach in both the classroom and clinical setting. Applications for tenure-track and non-tenure track, full-time faculty positions beginning September 1, 2020 are now being requested.

Qualifications: 1. A doctoral degree is preferred; a Master of Science in Nursing

is required. 2. Demonstrate and possess a strong record of collegiate teaching. 3. A philosophy of education consistent with Colby-Sawyer’s

programs and mission is required.4. Expert-clinician who has a strong desire for an academic

appointment focused on advancing knowledge through integrating teaching, clinical practice, scholarship and service.

5. Strong interest in mentoring and advising undergraduate and graduate students.

To ApplyTo apply, submit a current CV, letter of application, statement of teaching philosophy, sample syllabi if available, and names and telephone numbers/e-mail addresses of three references to CSCjobs@colby-sawyer.edu.

June, July, August 2020 New Hampshire Nursing News • Page 3

The world has changed dramatically. How we work, how we learn, how we live has changed markedly over the past three months. And the work of New Hampshire Nurses Association (NHNA) has changed as well.

NHNA’s single largest fund raising event of the year, the Graduating Student Conference & Career Fair, was cancelled in late March due to campus closures and social distancing directives. Meetings of the NHNA Board of Directors and the various Commissions were cancelled between mid-March and mid-April and then transitioned to teleconferencing platforms as the new norm is established.

The day-to-day work of the NHNA staff focuses on addressing issues and concerns related to the COVID-19 pandemic. The number of daily calls to the NHNA office and email outreaches through the Contact Us on the NHNA website has increased significantly. Nurses call with concerns regarding personal protection equipment and spreading the virus to their families; retired nurses seek ways to volunteer to help and media outlets contact NHNA with questions.

During March and April you may have seen or heard NHNA representing the nurses of New Hampshire. NHNA representatives were interviewed and featured on WMUR (March 24, March 25), NHPR (April 3, April 9, April 27), Valley News (March 28), Union Leader (April 2, April 13) and the Keene Sentinel (April 4). These represent more media outreaches that I’ve encountered during my four year tenure with NHNA!

NHNA has developed a series of webpages to keep New Hampshire nurses informed about the COVID-19 pandemic with vetted resources from the New Hampshire Department of Health and Human Services, the Centers for Disease Control & Prevention (CDC) and the American Nurses Association (ANA). NHNA developed guidance for nurses on steps to take after their shift to minimize risks associated with transmitting COVID-19 which is posted on the NHNA website.

As the weeks wore on, with no signs of the abatement of the healthcare crisis, we developed a webpage of self-care resources to help nurses cope with the prolonged stress of caring for patients during this crisis and coping with the major societal changes impacting their daily lives. As nurses started to experience reduced hours, reduced pay, furloughs and/or layoffs, we developed a webpage featuring resources to help nurses cope with the financial stressors necessitated by COVID-19 healthcare crisis.

NHNA created a 30-second public service announcement regarding social distancing and handwashing.

FROM THE ED’S DESK

Joan Widmer

“You trusted us when your baby was born. You trusted us when your loved one was sick. You trusted us when your child was at school. Please trust us now. We ask you to please stay at home. We ask you to practice social distancing and stay at least six feet apart. We ask you to please wash your hands. We ask you this to protect the vulnerable. Trust New Hampshire nurses to help us through this difficult time.”

We sought and received the support of the New Hampshire Association of Nurse Anesthetists, the New Hampshire Nurse Practitioner Association, the New Hampshire chapter of the American Association of Women’s Health and Neonatal Nurses, Southern New Hampshire Oncology Nurses and the New Hampshire School Nurses Association for this Public Service Announcement (PSA). The PSA aired ten times on WMUR (between April 10 and April 17). It has over 3,100 views on YouTube (https://www.youtube.com/watch?v=sAbovjqsZ7c).

After receiving numerous calls from nurses seeking to volunteer, we asked DHHS if they would find a list of potential volunteers helpful. We were encouraged to proceed so we sent a survey to our members and followers list serve (about 10,000 names) and received over 600 responses in a week. This information was shared with DHHS and with 10 nursing organizations around the state, as well as the Nashua Department of Public Health.When state Senator Tom Sherman reached out looking for volunteers to help with a project emanating from MIT to provide a daily check-in with New Hampshire nursing homes, we reached out to these potential volunteers again. Over 120 potential volunteers responded to this request and the Covid Alliance Senior Support Team was founded (https://covidalliance.com/sst). Past President of NHNA, Dr. Judy A. Joy, assumed the role of Statewide Volunteer Coordinator. Paula MacKinnon developed the online data collection tool and set-up a website for the project. Traci Fairbanks, Carla Smith and Susan Smith are a few of the volunteers serving as Regional Liaison Coordinators.

When the Red Cross reached out seeking volunteers to help with their blood drives, we sent a follow up email to these 600 survey respondents sharing information regarding how to volunteer with the Red Cross.

NHNA has responded to numerous outreaches from New Hampshire’s Congressional delegation, including Senator Jeanne Shaheen, Congresswoman Annie Kuster and Congressman Chris Pappas. We worked with Senator Shaheen’s office to understand the issues of fingerprinting to register to sit for NCLEX and how to address the closure of the state police office after the stay at home order. The National Council of State Boards of Nursing (NCSBN), which requires an FBI background check to register for NCLEX, issued a waiver for this requirement during the current healthcare crisis.

We spoke with Congresswomen Kuster regarding the issue of hazard pay for frontline workers, particularly nursing staff working in long term care. Congresswoman Kuster indicated she would look into this and shortly after this discussion, Governor Sununu announced his program for a $300 weekly stipend for health care workers in Medicaid approved long term care facilities. The Congress is also considering additional legislation, the Heroes Act, to support essential, frontline workers. We have regularly touched base with Congressman Pappas’s office regarding the ongoing need for PPE.

We have worked with the Board of Nursing and the Office of Professional Licensure and Occupations to address emergent needs related to the COVID-19 pandemic. We discussed issues related to streamlining re-entry into licensure for nurses with retired and lapsed licensees. We discussed the transition of senior nursing students through the licensure process, and encouraging nursing students to seek their LNA license for work in long term care facilities. Nursing students working as LNAs will help ease the dangerous staffing shortages occurring when COVID-19 infections arise in a facility, while giving the students increased experience providing patient care. We worked with a group of stakeholders to develop the Temporary Health Partner role, an unlicensed care aide to work in long term care in nursing teams with license nursing assistants (LNA), to help provide activities of daily living care.

All of us at NHNA are working to support you, our members, during this challenging time. We are all in this together and together we are strong. Together we have a voice.

Visit nursingALD.com today!Search job listings

in all 50 states, and filter by location and credentials.

Browse our online databaseof articles and content.

Find eventsfor nursing professionals in your area.

Your always-on resource for nursing jobs, research, and events.

Page 4 • New Hampshire Nursing News June, July, August 2020

From Left to right: Calyn Brown, LNA; Crystal Kimball, LNA; Susie; Heather Newfield, RN, BSN, CEN, CPAN - Manager of Education and Tammy

Ladd, RNC, BSN, CLC - Clinical Coordinator

An adult manikin named "Susie" can be set up to mimic the various stages of pregnancy. The option will be invaluable not only to maternity staff, but to EMTs in the community. Likewise, clinical staff are able to maintain competencies necessary to care for babies born at LRH. Sim Lab staff can program "Tory," the newborn baby manikin, for any number of conditions arising in a newborn.

Heather Newfield, RN, BSN, CEN, CPAN and Manager of Education and Staff Development states, "We are so pleased to have the Simulation Training Lab available to our staff and local emergency medical service providers. It allows LRH to provide ongoing training to clinical support staff, nurses, and physicians so we can continue to provide quality healthcare to the community."

2020 GRADUATING STUDENT CONFERENCE CANCELLED

Everyone has been touched in many ways by the COVID-19 pandemic, but the Class of 2020 has been particularly challenged. Both from the aspects of completing the academic requirements remotely to enable them to graduate, and from the loss of all the traditional programs that help graduating students celebrate their transition from student to a working member of society. Each year the New Hampshire Nurses Association (NHNA) hosts the Graduating Student Conference and Career Fair for nursing students across the state who are in the final year of their nursing program. This year’s Conference was scheduled to be held on March 29th on the campus of Southern New Hampshire University, our co-host for this wonderful event. Sadly, the event was cancelled and the planned site for this Conference was reconfigured into one of thirteen flex hospitals designed to care for patients during the anticipated surge of COVID-19 patients.

New Hampshire Nurses Association fully refunded all registration fees. However, we received permission

Graduating Student Conference & Career Fair

Co-Sponsor: Southern New Hampshire University

Gold SponsorsDartmouth-Hitchcock

Encompass HealthGranite State College

Southern New Hampshire HealthWentworth-Douglass Hospital

Silver SponsorsCheshire Medical Center

Concord HospitalNorth Country Health

NSORiver Woods

VNA Health Systems of No New England

ExhibitorsBrattleboro Retreat

Catholic Medical CenterChamberlain University

Elliot HospitalFranklin VNA

GenesisLittleton Regional Hospital

LRGHealthcareNew Hampshire Hospital

New Hampshire Veterans HomeNorthern Light

Rivier UniversitySaint Joseph College of Maine

Speare Memorial HospitalUnited States Army

University of New HampshireUniversity of Rhode Island

University of Vermont Medical Ctr.Western Governor’s University

The Littleton Regional Healthcare (LRH) Fundraising Committee approved the purchase of high-fidelity training manikins, and investment of $100,000 for a state of the art Simulation Lab. The funding was supported by large and small donors who had not designated their donation other than an area of greatest need. The Sim Lab will be available to new graduate nurses, nursing assistants (LNAs), medical assistants (MAs), respiratory therapists, and physicians.

Littleton Hospital Acquires New Sim Lab

MANAGEMENT MINUTE

The new normal is likely to include more virtual and fewer face-to-face meetings. With technology allowing for many participants, seeing 10 or more faces at the same time can get distracting. When your mind starts to wander, you have no idea what the last person said. Perhaps you pretend to listen while checking your inbox and answer emails. By the end of the meeting, does it seems like a waste of time?

A recent article in the Harvard Review, Gershman (2020) provides five suggestions for more effective virtual meetings. 1. Before the meeting, determine the purpose of the

meeting and what you can contribute. If you do not have a critical role, determine what you hope to learn.

2. Before you raise a new topic, reiterate what you just heard or the previous point you are addressing.

People are more likely to listen if they first feel they have been heard.

3. Summarize frequently stated comments to guide the conversation.

4. Write down wandering thoughts during the meeting allowing you to be more present and ready to listen.

5. Don’t be afraid to ask a clarifying question “I apologize, I lost track of the conversation for a moment. Could someone help me understand why we are focusing on ……”

Gerhman notes that the bigger the group, the less responsibility each person feels to ensure success. One of the best ways to be heard in a virtual meeting is to be an active listener.

from planned speakers to post their presentations and handouts on the NHNA website. We worked with the planned sponsors and exhibitors to create a Graduating Student Nurse Career Resource Guidebook. The Guidebook lists each of the sponsors and exhibitors with contact information for their human resource department and an information pitch, prepared by the organization, sharing the benefits of working at their organization. Available links to the organization’s online career resource webpages are included. The Guidebook was emailed to every registrant of the Graduating Student Conference & Career Fair and posted to the NHNA website on a specially created webpage: Graduating Student Nurse Conference.

NHNA wishes to extend a thank you to all the planned sponsors and exhibitors for the Graduating Student Conference & Career Fair. We look forward to meeting the Class of 2021 in person!

Glencliff Home is accepting applications for

Registered Nurses I-IIISalary Range: $50,835.20 - $71,052.80

Licensed Practical Nurses I-IISalary Range: $45,177.60 - $57,408.00

Equal Opportunity Employer

L. Todd Bickford, Administrator393 High Street, PO Box 76, Glencliff, NH 03238(603) 989-5203 | Louis.Bickford@dhhs.nh.gov

Applications can be completed and benefits reviewed online at https://das.nh.gov/hr/index.aspx

State of New Hampshire Benefit Package!Health/Dental/Vision/Prescription plan

Single $22/ 2-Person $44/ Family $66 (Bi-Weekly)

To provide professional nursing care to residents within an assigned unit and provide and support medical care as directed by medical staff and pursuant to objectives and policies of the

nursing department and Glencliff Home. Must possess and maintain a current license as a RN/LPN in NH. Salary and Position

determined by years of experience and certifications.

40 hours/week – All Shifts and Part-time Available Direct Care an additional $1,040.00

Add additional 2nd shift diff. at $4,160.00 Add additional 3rd shift diff. at $7,280.00

Additional 15% Enhancement on Salary Base (Not Included)

Full-Time Nurse Trainer Opportunity at One Sky Community Services!

Office-based position at a non-profit agency in

Portsmouth, NH, supporting individuals with DD, ABD/ABI, and their families. Must be an RN licensed to practice in NH and will be required to become a Nurse Trainer through the NH Bureau of Developmental Services. Job responsibilities

include trainings and monitoring the quality of services and supports provided through One Sky and our service

provider partners. Prior experience working with individuals with DD or ABD/ABI is ideal, but not required.

Email HR@oneskyservices.org for more information.

June, July, August 2020 New Hampshire Nursing News • Page 5

The 2020 IronyIt is ironic. The 2020 outbreak of COVID-19 parallels the Year of the Nurse commemorating the 200th birthday of Florence Nightingale. Nightingale’s experience during the Crimean War has been repeated exactly 200 years later. Florence felt overwhelmed by the seemingly impossible situation of having only 38 nurses to care for over 2,500 injured and sick men. Florence was frustrated with the lack and inability to obtain needed supplies. Florence felt sorrow at the inability of medical care to cure disease or prevent a death. Florence felt discouraged when necessary medications were not available and men had to undergo amputations without chloroform anesthesia. Florence had to be resourceful to create areas that were safe and clean for her patients. Florence demonstrated quiet heroism, she did not feel the need to exploit her successes. She left a legacy which we commemorate today and still learn about nursing from her writings.

While the celebration of Florence Nightingale’s birthday marks the end of National Nurses Week, this year, National Nurses Month continued with the theme “Nurses Make a Difference.” Even the public service announcements on radio and television have acknowledged nurses’ contributions

and the difference we are making. I have never seen as many nurses profiled on media as I have in 2020.

Two hundred years ago Florence used her letters to generate interest about the contributions of nurses. Today, it is technology. Even the use of technology during the past three months has provided a new normal for how individuals communicate. We would have never thought 12 months ago of having a virtual birthday party, a virtual wedding, or a virtual hospital visit. The amount of information available on the internet has exploded, from videos, interviews, opinions and scientific research. I would predict that 2020 will be regarded as the Year of Virtual Communication.

As I do before every issue of the New Hampshire Nursing News, I virtually scan hospital, long term care, school of nursing and specialty organization websites for ‘news’ about nurses and nursing. The results are typically very disappointing. Few organizations have a section of their website dedicated to the nursing department that is available to the public. It is as though nurses are invisible. While press releases are put out about new providers at an institution, there is no press release about new nurse employees and what they will bring to the organization. Websites post newly developed programs or technology, but fail to even mention that nurses will be managing the program or learning and operating the new equipment. In

Susan Fetzer

IN MY OPINION

my opinion, this failure to demonstrate how we make a difference reflects on both institutional administrations and the willingness of nurses to allow for virtual invisibility. Nursing departments should invite their Public Relations Department to key meetings and expect a monthly ‘profile’ article. Nurses must step up and inform others of their accomplishments.

The accomplishments in sports, school or non-health care news over the past three months has been replaced by front page health care news. Seemingly to fill newspaper space and television time a few nursing stories related to how the public has honored nurses have been publicized. But nurses in masks and scrubs outside facilities waving to cars or planes going by is not how we make a difference. It only makes one wonder who is left inside to care for patients.

Nurses have demonstrated a Nightingale brand of heroism. While Florence did not accept accolades easily, she did use her accomplishments to further her mission. Heroism is in your story that must be shared. We need to take a lesson from Florence’s play book. She wrote to the politicians, army generals and even the Queen to explain the positive impact of her actions. It is time for nursing to have virtual visibility, and not just on the back page.

Page 6 • New Hampshire Nursing News June, July, August 2020

Board of Nursing Responds to State of EmergencyOn Friday, March 13, 2020, Governor Chris Sununu signed Executive Order 2020-04 declaring a state of emergency in response to COVID-19. Section 3 of the Executive Order stated:

Beginning at 11:59 p.m. on Sunday, March 15, 2020 all assisted living facilities, long term care facilities, nursing facilities, residential care facilities, as those terms are defined in RSAs 151-151-H, or any other similar facilities providing residential care to elderly or infirm patients, shall prohibit visitor access to reduce facility based transmission of COVID-19. This prohibition shall not apply to medically necessary personnel, visitors for residents receiving end of life care, or visitors necessary to provide for a residents psychosocial needs as determined by a licensed medical care provider.

In effect, the governor's executive order caused nursing assisted living facilities, long term care facilities, nursing facilities, residential care facilities, and any other similar facilities to be "locked down" to all visitors. Visitors included nursing students. The Board of Nursing Rules require that programs that prepare LNAs must require that each LNA student obtain 60 hours of clinical experience in a skilled nursing facility (Nur 704.09(i)). Yet, the majority of locations that provide such clinical experience are closed to all visitors, including nursing students, for the duration of the state of emergency. For pre-licensure LPN and RN programs, the rules currently require that the program's curriculum be approved by the Board of Nursing, and that any changes to the curriculum also need to be approved, including any changes to requirements for clinical experience (Nur 602.16).

The Board of Nursing’s Chair, Vice-Chair, Administrator along with the Director of the Office of Professional Licensure requested an emergency rule to address the concerns related to the current state of emergency in New Hampshire. A rule related to clinical experience during a state of emergency was drafted (see Box Nur 101.04). In an emergency meeting on March 16, 2020 the Board

of Nursing passed the rule, which was submitted and accepted by the State of NH, and is now in effect until September 12, 2020.

Nur 101.04 "Clinical Experience" means practice in an inpatient, ambulatory care, or community setting where the student provides care to patients under the guidance of a nursing instructor or preceptor.

(a.) Clinical Experience may be substituted with simulation and lab work during a State of Emergency Declared by the Governor that impacts clinical site availability; provided, however, the Board of Nursing is notified within twenty-four (24) hours of such substitution. "Simulation" means a technique, not a technology, to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.

The rule relaxes the requirement for clinical experience during the course of a declared state of emergency, and allows the 60 hours of clinical experience to be substituted with 60 hours of simulation and lab work during the state of emergency. Nursing programs may substitute in-person clinical with virtual simulation. The Board must be given 24 hours’ notice of such substitution.

RN and LPN programs needing to affect changes in curriculum delivery as a result of the transition from in-person to online learning are also impacted by Nur 602.16. The rule relates to notification requirements for curriculum changes, which requires three months prior written notice when changes occur in more than 10% of [entire program] credit hours. However as most of the curriculum revisions necessitated by transition from in-person to online learning relate to the last six weeks of the Spring 2020 term the rule is less likely to be applied.

For example a two-year nursing program, with two 16-week terms for each of two years and one 8-week summer term has a total of 72 weeks in the program. If this program changes from in-person instruction to online instruction for six weeks (of the 72 weeks) only 8.33% of the total curriculum hours are affected. Only a Board of Nursing notification is required if the 10% threshold is not met.

The relaxation of in-person clinical experiences have implications for potential employers of Board of Nursing licensees. Licensed Nursing Assistants that were trained during the state of emergency may not have received a comprehensive clinical experience with direct patient care. They may require extended orientations specifically in care needs of patients with dementia or cognitive impairment. The Board of Nurses has also enacted an amendment to Nur 303.02 (d) pursuant to Emergency Rule on March 23, 2020, to extend the time period for taking the NCLEX exam.

Nur 303.02 (d) Registered and Practical Nurse Examinations. (d) For graduates of programs within the US or Canadian Provinces where the NCLEX is required, the NCLEX shall be taken within six months of graduation from an approved school of nursing. Notwithstanding, during a State of Emergency declared by the Governor, the Board shall allow Registered and Practical Examinations to be completed within 90 days of the Expiration of the State of Emergency to complete this requirement.

The Governor’s Executive Order called for the temporary authorization for out of state medical providers to provide medically necessary services and provide services through telehealth. The temporary licenses authorized under this emergency order are issued to any healthcare provider who can demonstrate a license in good standing in another State jurisdiction. The temporary licenses are being provided at no charge and remain valid during the declared state of emergency. As of May 1, 2002, 1633 temporary licenses were issued to APRNs, 39 to RNs, four to LPNs and one to an LNA.

The Executive Order declaring a state of emergency concerns meetings of public bodies. Therefore public sessions of the meetings of the New Hampshire Board of Nursing are being conducted by teleconference and/or video teleconference. Information on how to connect and listen to the Board of Nursing meeting is posted on the website (nhbon.org) under Board Meetings.

Staffing of nursing homes and assisted living facilities has been dramatically impacted by COVID-19 transmission. Senator Tom Sherman, Representative Polly Campion RN, Lindsey Courtney, Interim Director of the Office of Professional Licensure and Board of Nursing Administrator Bonnie Crumley-Aybar met to develop a streamlined process to encourage LNAs with licenses that had lapsed within the past three years to reenter the workforce. An outreach to nursing students who had passed Fundamentals of Nursing was created to secure an LNA license and practice in long term care facilities. The $35.00 licensing fee is being waived to encourage nursing students to become LNAs.

Bonnie Crumley-Aybar, RN, MSN is the Administrator of the New Hampshire Board of Nursing.

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June, July, August 2020 New Hampshire Nursing News • Page 7

The New Hampshire Nurses Association (NHNA) was a critical partner for the SST on volunteer recruitment and organization. “We are proud that NHNA Past President, Dr. Judith Joy, has been appointed the Statewide Coordinator for the COVID Response Liaison volunteers. Paula MacKinnon (President-Elect, School Nurses Association) has also played a critical role developing the team’s data collection tools,” said NHNA Nurse Executive Director Joan Widmer. Nearly all of the volunteer Liaisons of the SST have some level of healthcare training, and a majority are current school nurses or retired nurses recruited by the NHNA. Also represented on the all-volunteer SST team are MIT student EMTs and graduate students, professors and physician assistant students from MCPHS, Dartmouth medical students, political campaign operations and data experts, and volunteers from the NH business and nonprofit sectors.

The SST has developed a menu of resources to ensure the volunteer liaisons are always aware of the latest guidance for their calls. “I’ve worked closely with nurse educators from around New Hampshire to create a searchable FAQ/reference site where SST liaisons and senior care facilities alike can quickly find answers to their questions and links to authoritative public health information,” Deb Baker, Library Director at Manchester Community College, who also serves as the Chief Librarian for the SST.

The Medical Advisory Group vetting the materials used by the SST includes State Rep. Dr. Jerry Knirk, Dr. Paul Friedrichs, Dr. Karl Singer, Dr. Apara Dave, SST Chairman and NH State Senator Dr. Tom Sherman, Dr. Daniel Stadler, Dr. Bruce Bartolini, Dr. Kim Perez, and Prof. Linda Martino.

“We intend to be ready to serve all of the over 200 licensed senior care facilities in New Hampshire,” said SST Executive Director Daniel Curtis. “We have the structure and the amazing volunteers to do it, and we’ve already made a big impact to help get the senior care facilities of New Hampshire the support they need.” To learn more about the SST, visit our website at covidalliance.com/sst.

NHNA in Alliance to Support Senior Facilities

Each participating facility began by filling out a survey to evaluate its potential exposure to COVID-19 and to inform the facility’s Liasons on its risks and needs. The SST also operates an automatic text messaging tool, developed by MIT graduate student Jackie Baek, to quickly and easily document new cases and new needs at each participating facility each day. This has become a critical technical tool for the SST and its partners.

The SST first contacted residential facilities to see if they were interested in participating through a number of associations, including the New Hampshire Association of Residential Care Homes (NHARCH), the New Hampshire Healthcare Association (NHHCA), LeadingAge ME & NH, and the NH Association of County Nursing Homes. The SST collaborates with these associations to share knowledge and resources, advocating for the needs of participating senior living and long-term care providers. With the consent of participating facilities, the SST provides data on facility status to the associations each day.

“Given the nature of this pandemic, our usual support systems have been stretched beyond their capacity. The importance of collaboration with other associations and organizations has increased a great deal. We welcome the Alliance’s expertise in data collection, as well as volunteer coordination, to help our members, and the members of our industry partners,” said Kelly Adams, Vice President of the New Hampshire Association of Residential Care Homes (NHARCH).

Lisa Henderson, Executive Director of LeadingAge Maine & New Hampshire, says “LeadingAge Maine & New Hampshire is grateful for our partnership with the COVID Alliance. Their rapid development and deployment of a daily texting program to help us check in with our members on the frontline is helping us direct resources to them and continue to advocate for their most urgent needs including PPE, staffing and testing.”

A newly formed statewide network of volunteers has now been working for three weeks to provide help and guidance to senior residential facilities in New Hampshire, including assisted living and nursing homes, to enable them to better handle the health crisis caused by COVID-19. As of May 4, the network, known as the COVID Alliance Senior Support Team (SST), had more than 60 volunteer COVID Response Liaisons serving 65 facilities. The Liaisons are available daily to gather information about the facilities’ needs and connect them with state, federal, and private resources that can help them. The most common issues Liaisons discuss with facility staff are personal protective equipment (PPE), staffing and testing needs.

The effort launched on April 13, after having consulted with residential industry associations, state government officials, university leaders, medical experts and the New Hampshire Nurses Association. The impetus for the program came from the COVID-19 Policy Alliance, founded by faculty at the MIT Sloan School of Management to help reduce the impact of the virus, particularly on the elderly.

SST Chairman and NH State Senator Tom Sherman, who is also a practicing physician, points out that the age, comorbidities and close proximity of the residents of senior residential facilities put them at especially high risk of COVID-19 outbreaks. “Experience in Italy, Spain, Washington State, and a growing list of locations around the world, shows that COVID-19 can spread quickly among the residents and staff of senior residential facilities, and the evidence is clear that older COVID-19 patients are more likely to require hospitalization or die. This makes senior care facilities a critical front line in the fight against COVID-19. The volunteers of the Senior Support Team intend to do everything they can as remote volunteers to support senior care facilities through this crisis.”

Page 8 • New Hampshire Nursing News June, July, August 2020

Loon Chocolates Deliver Joy to

NursesLoon Chocolates, the small local chocolate maker in New Hampshire, located at seven different locations in the state is delivering chocolate to health care workers on the front lines of the Covid-19 pandemic. The company has delivered over 500 of their Hero Bars to Healthcare Heroes in the state with a goal of 800 Hero Bars by June 1, 2020.

Loon’s goal is to provide some joy to Healthcare Heroes while fighting the battle for all of us. They have donated chocolate bars at Catholic Medical Center, Parkland Medical Center, Dartmouth Hitchcock Medical Center, Exeter Hospital, Concord Hospital, NH State Hospital, Primary Care of Milford and several retirement communities in southern New Hampshire. Their website provides an avenue for public support of the project.

Nurses always appreciate a little chocolate to sweeten their day.

Jennifer Pitre receives Loon chocolates for Catholic Medical Center Healthcare Heroes

Post-Graduate Advanced PracticeTraining Programs

Jillian Bellmont,New Hampshire Nurse Practitioner Association

Advanced practice providers (APP) are qualified medically licensed health care providers, who can function independently or alongside a physician, in population centered care models, disease management, care coordination, and direct patient care. This professional umbrella term includes nurse practitioners (NP) and physician assistants (PA) among several other subgroups of non-physician health care providers. In the United States, there are very few APPs who have undergone formal postgraduate training. Post-graduate APP educational programs are becoming more popular and are typically designed for new graduates and experienced clinicians interested in change of practice specialty.

The Institute Of Medicine (IOM) has recommended that “state boards of nursing, accrediting bodies, the federal government, and healthcare organizations should take actions to support nurses’ completion of a transition-to-practice program (residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioned into new clinical practice areas.” Many APPs have limited orientation programs as they enter practice and are expected as new graduates to perform at an advanced level with minimal support. Fellowships and residencies are not required for NPs or PAs as these professionals have met all training requirements needed for licensure during their graduate programs.

Programs to facilitate APP transition-to-practice programs have been developed with continued growing numbers of public and private institutions across the US. Added support and mentoring after graduation is fundamental to an effective transition from new grad to expert. Bush and Lowery (2016) opined that postgraduate education has demonstrated statistically significant positive influence on NP job satisfaction. Influence on professional growth, autonomy and more valuable collegiality in early years of career development are key factors identified. Post-graduate programs should complement formal education with a goal to promote autonomy, aid with adjustment of role transition and support productivity within a rapidly changing and demanding healthcare system. Leading programs provide learning environments that stimulate professional growth and include mentorship, lectures, supervision, assigned readings, online courses, active critiques on performance and case presentations.

Residency and Fellowship programs for APP can also have drawbacks and may not be the right path for everyone. Most post-graduate APP programs are not widely standardized. However, there are several notable accrediting bodies who have developed guidelines and formal standards which are becoming increasingly appreciated and used. There are no dual-accreditation options available to include both NPs and PAs. The value of accreditation for individual programs is still being evaluated and uniquely dependent on each organization. Supplemental education is expensive and there is no published evidence supporting improved patient outcomes related to these programs. Post-graduate training programs can cost organizations up to $100,000 per trainee including support needed to supplement lost preceptor productivity. Post-graduate training programs typically offer decreased salaries and have one or two year employment agreement. There are also inconsistencies among titles of programs (i.e. residency vs fellowship) which may obscure trainee choices and contributes to confusion.

As leaders, educators and clinicians, we have a professional obligation to guide our nurse practitioner and physician assistant colleagues with the ongoing development of post-graduate education and training. It is important we avoid terminology that may indicate or promote downstream regulatory implications or mandatory requirements, or suggest APPs are not prepared to enter the workforce upon completion of formal graduate education. Post-graduate training programs help promote creative models to bridge gaps in our rapidly changing health system and add leadership opportunities for NPs and PAs. It is important to be aware of novel and growing programs which may help provide the support and structure a colleague, a graduating student or even yourself, may need for a successful and supported transition in clinical practice.

References:American Association of Nurse Practitioners. The NP roundtable’s

discussion paper on NP education and postgraduate training. Updated 2013. Retrieved at http://www.aanp.org/component/content/article/82-legislation-regulation/policy-toolbox/np-policy-essentials/445-aanp-and-the-np-roundtable-joint-statements/. Accessed Feb 13, 2020.

Bush, C. & Lowery, B. (2016). Postgraduate Nurse Practitioner Education: Impact on Job Satisfaction. The Journal for Nurse Practitioners. 12(4). April 2016.

Institute of Medicine. The future of nursing: leading change, advancing health. 2011. Retrieved at http://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed Feb 13, 2020.

APRN COLUMN

“To every nurse throughout our state and beyond, our gratitude is as deep as your courage, and we thank you for your dedication to keeping your community healthy, and for the bravery, compassion and empathy you provide to your patients every day.” Steve Ahern, President of the New Hampshire Hospital Association, May 2020

Congratulations to UNH Graduate student Susan Gonya RN and faculty mentor Pam DiNapoli, RN, PhD awarded 3rd place for Student Poster by the Eastern Nursing Research Society. The poster was titled: Do We Really Know What's in Our Food? The Connection between Dietary Mycotoxin Exposure and Pediatric Crohn's Disease. Unfortunately, the Annual meeting of ENRS, March 26-7, to be held in Boston was cancelled though posters were judged virtually.

Dr. Jillian Belmont was recently elected President of the New Hampshire Nurse Practitioners Association. Belmont received her BSN from St. Anselm’s, MSN from UNH and DNP from Northeastern University. Her focus is neurology which she practices as an assistant professor and associate provider at DHMC. Belmont is also

serving as President of the Green and White Mt. Chapter for American Academy of Neuroscience Nursing.

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June, July, August 2020 New Hampshire Nursing News • Page 9

Since the model of family centered maternity care (FCMC) was first recommended in the late 1970’s, hospitals and birthing centers have moved toward a model of care that focuses on the needs of the family unit as whole during an important life transition. While not always a perfect model, FCMC techniques have been linked to positive outcomes across the spectrum of perinatal and infant care. Supportive family interventions such as the rooming-in of infants with their parents on postpartum care units reduces hospital costs, decreases infant infections, supports early initiation of breastfeeding, encourages bonding, and increases patient satisfaction. Although the mother-infant couplet is often the focus of the provision of inpatient care, maternity nurses are experts at supporting mothers, their partners, and extended family on obstetric and neonatal care units, in the community setting, and in patient’s homes.

Until recently, the FCMC framework was actualized in many ways in New Hampshire hospitals. Family waiting rooms allow supportive friends and family to gather in anticipation and support expectant parents before and after their deliveries. Whenever possible, patient rooms are single rooms, warmly lit and decorated to appear more like a welcoming home environment, with a place for supporting partners to stay overnight. Childbirth preparation classes welcome pregnant patients and their partners to the hospital in the weeks before delivery to tour the unit and learn about their options from nurse childbirth educators. Partners are admitted into the OR for C-section deliveries, a practice not usually seen in surgical settings. Hospitals offer sibling and grandparent preparation classes, recognizing that the family unit extends beyond the parents and provide postpartum care home visits to continue to support families after discharge. Nurses bring infants to bond with their mothers through skin-to-skin on adult ICU units, or help mothers separated due to maternal illness to pump their breastmilk and bring it to the NICU to give to premature or ill neonates. These recommended practices were all flourishing before COVID-19 changed the face of obstetrical care.

The CDC, WHO, and professional organizations have been quick to establish guidelines for safely providing care to patients and families in the time of COVID-19. Family care units and providers across New Hampshire have swiftly put in place protocols to reduce risk to staff and patients. Of primary concern is the transmission of the virus, but also to find ways to provide safe, supportive, and affirming care across the perinatal year. Recommendations include spacing out prenatal visits for low risk pregnant patients and increasing exposure screenings at prenatal visits and hospital intake, as well as increasing testing for women who are symptomatic. Under some circumstances an infant may be separated from their mother, if the birth mother has tested positive for COVID-19 and the status of the infant is unknown. Pregnant women have been encouraged to avoid gatherings and remain physically distanced whenever possible. Other recommendations impact everything from C-section protocols to hospital visitors.

Precautionary measures have resulted in the provision of perinatal and infant care in NH that looks very different than just a few months ago. In many cases, nurses and other care providers are making phone calls or using tele-practice visits to provide additional assessments, education, and support. Group prenatal exercise and education classes have been canceled with some organizations recommending online resources or offering virtual classes.

During their hospital stay pregnant patients are limited to one support person, support groups have gone virtual. Support partners may not be permitted in the operating room or in other areas of the hospital. These restrictions have required nurses providing perinatal care and education to adapt.

Nurses at Monadnock Community Hospital created a virtual hospital tour and make personal phone calls to all expectant families to establish support and trusting relationships one-on-one with families. Perinatal education at Catholic Medical Center has gone virtual, with overwhelmingly positive responses to Zoom and virtual classes developed by their perinatal education coordinator. Although the use of popular labor support techniques like nitrous oxide are not currently allowed due to guidelines, nurses at Wentworth-Douglass Hospital created shared decision-making documents to use with COVID positive moms and their support partners. They are also using virtual platforms for postpartum support groups.

Patients report that this time feels stressful and uncertain, but they are being well supported by their nurses and providers. For some, the time to bond alone with their newborns without expectations to entertain numerous hospital visitors has been a welcome side-effect of changes to family visiting policies. How COVID-19 will change FCMC practices in the long term is still unknown, but for now all across New Hampshire perinatal nurses continue to deliver high-quality FCMC to their pregnant and postpartum patients, newborns, and their families.

Family centered maternity care and COVID-19Tenants of family centered maternity care (JOGNN, 1978, p. 55)• The family is the basic unit of society.• The family is viewed as a whole unit within which each member is an

individual enjoying recognition and entitled to consideration.• That childbearing and childrearing are unique and important functions of the

family.• The childbearing experience is an experience that is appropriate and beneficial

for the family to share as a unit.• That childbearing is a developmental opportunity and/or a situational crisis,

during which the family members benefit from the supporting solidarity of the family unit. (p. 55)

Alyssa O’Brien, PhD, RN is an Assistant Professor of nursing at UNH and member of the NH AWHONN Steering Committee.

Family Center nurses at Exeter Hospital in April

2020 (Photo courtesy Michelle

Savoie)

Women and Children’s Center

nursing staff at Wentworth-

Douglass Hospital (Photo courtesy

Diane Proulx)

Page 10 • New Hampshire Nursing News June, July, August 2020

Past, Present and Future of Nurse AnesthetistsJanelle Pickering

In this time of extreme uncertainty, the ingenuity and versatility of the nursing profession has never been more important. As COVID-19 ransacks not only our supply lines, but our healthcare staff, nurses have consistently risen to the challenges associated with working during a pandemic. These challenges do not solely revolve around patient care, in fact, some of the greatest challenges have surrounded the uncertainty of personal protective equipment (PPE) and appropriate utilization. PPE shortages, combined with frequent changes in protocols regarding the appropriate level of PPE, have left all healthcare providers nervous. Despite this concern, nurses everywhere have shown their ability to adapt to these rapidly changing circumstances, and selflessly share information on current best practices when treating COVID-19 patients. Social media has allowed for the quick dissemination of information and has brought into focus the immense value we bring to the healthcare team. This truly is the ‘Year of the Nurse’!

“Patients come to the hospital and stay the night, not because they need a doctor, but because they need a nurse. If they only needed a doctor, they could go to a doctor’s office. They come to the hospital and spend the night because they needed a nurse.” This quote, by Carol Rauen MS, RN-BC, highlights the value of nurses. During the COVID-19 pandemic, nurses have been on the frontlines in many capacities. As units attempt to limit contact with COVID-19 positive patients, bedside nursing assessments have become even more critical in directing patient care. Nursing intuition takes years to develop. It is acquired not by rote memorization, but by countless interactions with patients and their families. This hard to define nursing intuition is often described as the “art of nursing,” and nothing is more alarming than a nurse saying she has a “bad gut feeling” about a patient’s condition. In a time when all medical providers are inundated by data, nursing intuition provides an additional tool for decision making. This reflexive thought is what allows a nurse to meet the constant, sometimes unexpected needs of the patient. The vast majority of the public are aware of the advance role of the Nurse Practitioner, but the role of the certified registered nurse anesthesiologist (CRNA) is not well understood. This lack of knowledge has created a situation in which some hospitals do not utilize the CRNA to their fullest potential at a time when every member of the nursing community is greatly needed.

To understand a specialty, it is important to review its history. The first successful demonstration of an anesthetic was performed by William T.G. Morton on October 16, 1846, however, due to poor aseptic practices in the operating room (OR), lack of antibiotics, and high anesthetic mortality rates, anesthesia did not gain instant success (Ray & Desai, 2016). During the Civil War, 1861-1865, Catherine S. Lawrence is credited as the first ‘nurse’ to administer anesthesia in the form of chloroform to wounded soldiers needing emergent operations on the battlefield (Ray & Desai, 2016). Due to its characterization as a “subordinate role,” anesthesia was often delegated to medical students or younger physicians

more eager to observe the surgical technique than administer the anesthetic. Despite its “subordinate role,” surgeons recognized the need for highly trained professionals to monitor and administer anesthesia to the patient, and were the earliest supporters of additional training for nurses to fulfill this role (Ray & Desai, 2016).

Catherine Lawrence, Civil War

In 1877, Sister Mary Bernard was the first nurse to rise to the challenge of specializing in the delivery of anesthesia (Ray & Desai, 2016). Catholic nuns played an important role in training nurses to administer anesthesia, but Alice Magaw is credited as the true “Mother of Anesthesia.” In 1906, Alice Magaw published “A Review of Over Fourteen Thousand Surgical Anesthesias” which highlighted the benefits of a trained anesthesia provider (Ray & Desai, 2016). Her innovation and dedication to providing anesthesia safely, led to the Mayo Clinic being regarded as the best place for nurses to train in the delivery of anesthesia. With the beginning of World War I, the educational requirements and demand for trained anesthesia providers increased. Mayo Clinic and Pennsylvania Hospital responded to this increase by developing a six-week course focused on safely administering anesthesia.

Alice Magaw providing anesthesia circa 1906

It was not until 1931 that a professional organization for nurse anesthesiologists was founded by Agatha Hodgins (Ray & Desai, 2016). The National Association of Nurse Anesthetist’s (NANA) name was changed to the American Association for Nurse Anesthetists (AANA) in 1939 which

coincided with World War II, and another increase in educational requirements for nurse anesthesiologists (Ray & Desai, 2016). This brief overview of the anesthesia specialty shows not only the importance of nurses in its evolution, but also highlights that during times of chaos, nurses have continued to innovate and adapt to provide the safest care possible.

The proud history of nursing innovation and versatility may be practiced to its fullest extent in New Hampshire where advanced practice nurses can provide exemplary care to their patients independently, without physician supervision. This is important as 37% of NH residents live in rural and underserved areas (2(Hub, 2020). Historically, it has been difficult to recruit and retain healthcare providers in rural areas, and APRNs are more likely to provide care for underserved populations (Patel, Petermann, & Mark, 2018).

Like their Nurse Practitioner counterparts, NH CRNAs licenses are not restricted, and CRNAs can practice independently, without physician supervision. Unfortunately, not all hospitals recognize the full scope of practice of the CRNA, not to mention the versatility, efficiency, accountability and high level of care that the CRNA provides.

The AANA (2020) issued a statement at the beginning of the COVID-19 pandemic stating that “CRNAs should be given full authority to practice to their highest level of education and training…and their roles should reflect their high degree of clinical skill and expertise.” Across the country, individual hospitals’ responses to this statement have varied. CRNAs have found themselves furloughed or laid off, as elective case numbers significantly decreased. Some institutions decided to utilize their CRNAs as critical care nurses, but this approach diminishes the ability of the hospital to efficiently react to COVID-19. A CRNA working as an ICU nurse provides care to a single patient. In NH, CRNAs are recognized as APRNs, and this distinction makes it far easier to utilize CRNAs in the ICU. As APRNs, CRNAs can rapidly assess patients, provide advanced airway management, oversee ventilator management, place central lines, and order and assist in the titration of vasoactive medications and volume resuscitation. This list is far from inclusive, and shows the utility in the CRNA as part of the healthcare team, not simply as a one on one provider.

Times of crisis are also times of great innovation, and COVID-19 is no exception. The value of nurses has never been more appreciated, and once again we have shown our versatility. We do not yet know what the new “normal” will be for us in the community and in the hospital. We have seen a crisis that has changed the very fabric of society and day to day functioning of our nation. Moreover, it has redefined what is meant by “essential” in both service and providers. Although we were able to “flatten the curve” we cannot be fooled into believing we are safe. It is my hope that we, as a nursing community, will use the lessons learned during this pandemic to forge a larger role in our communities, hospitals, and legislation. Our unique perspective will be invaluable, and it is important that we advocate not only to improve patient care, but to secure a future that values all nurses, in every specialty.

ReferencesAANA (2020). CRNAs as advanced practice providers in critical care settings. https://www.

aana.com/, accessed 05/01 2020.Hub, R. (2020). https://www.ruralhealthinfo.org/states/new-hampshire, accessed

05/01/2020.Patel, E., Petermann, V., & Mark, B. (2018). Does state-level nurse practitioner scope-of-

practice policy affect access to care? Western Journal of Nursing Research, 41, 488-518.Ray, W. T., & Desai, S. P. (2016). The history of the nurse anesthesia profession. Journal of

Clinical Anesthesia, 30, 51–58. https://doi-orrg.unh.idm.oclc.org/10.1016

Janelle Pickering, DNP, CRNA is a nurse anesthetist at Dartmouth Hitchcock in Lebanon, New Hampshire.

Ed Note: The News welcomes NHANA as a NHNA Organizational Affiliate and looks forward to their future contributions to the News.

June, July, August 2020 New Hampshire Nursing News • Page 11

Home Care Nurses Caring for Recovering Patients Home Healthcare, Hospice and Community Services nurse Kristina McGuirk visits patients who have returned from the hospital after battling COVID-19. Staff photo by Ben Conant (reprinted with permission from Monadnock Ledger-Transcript)

TIM GOODWIN

Originally published by Monadnock Ledger-Transcript on 5/4/2020. Reprinted here with permission from Monadnock Ledger-Transcript

When patients infected with coronavirus first made an appearance on Kristina McGuirk’s case load, it was hard not to be concerned.

As a nurse with Home Healthcare, Hospice and Community Services, McGuirk’s job is to go into people’s homes to provide care for those dealing with a variety of conditions and medical concerns. But the addition of COVID-19 brought on that question of “what if?”

“You have to assume everyone has it and that’s really the best way,” McGuirk said. “I obviously don’t know what I was expecting. It’s something we’ve never seen before.”

She’s worried about being infected herself or bringing it home to her fiance. For those on her weekly caseload who had contracted coronavirus, her visits have so far come after the patient returned home from hospitalization.

“The acute phase has already passed,” McGuirk said. She said that some patients’ symptoms still remain like a cough and shortness of breath.

“Little things like holding a conversation can be difficult,” she said. “They’re feeling shortness of breath just talking.”

But as the weeks have gone by, McGuirk said she has seen progress from those patients who tested positive for the disease, like being able to walk up stairs and go outside.

“It’s been really nice to see the recovery phase,” she said. “But the weekly progress I’ve seen was pretty gradual.”Each trip into someone’s home that has been diagnosed with COVID-19 – as well as everyone else – comes with a heightened sense of precaution. For patients who have tested positive for the virus, that means an N95 mask with a secondary cloth mask on top, double gloves, gowns and extra sterilization of the equipment.

“Sure you think about it when you’re at work and on the way to their house for a visit,” she said.

McGuirk said that HCS was unable to supply her with booties or a hair covering due to shortages, but that if they were available, she would wear those too.

Prior to a visit, HCS conducts screening calls, McGuirk said, and a lot of what she has done since the pandemic changed the way of life in New Hampshire has been to answer questions and educate.

“Just doing our best relaying the information,” McGuirk said.

While there is concern, McGuirk knows she has a job to do and can’t let fear or reluctance creep in.

“I’m a nurse and I like helping regardless of their diagnosis,” McGuirk said. “At the end of the day they’re still a patient and need care.”

McGuirk said early on the nurses at HCS were asked if and when they got patients with COVID-19 who would be willing to add them to their case loads.

“I volunteered because they’re patients that need a nurse, they need care,” she said.

She did so because she considers herself young and healthy at the age of 27, and knows there are some older nurses on staff that have conditions or are immunocompromised.

When McGuirk goes home for the day, she changes into clothes she leaves in the garage before heading out for her shift, uses hand sanitizer, and washes her hands thoroughly once inside.

Branden Howe spends two or three days a week going into homes in his role as residential supervisor for Monadnock Worksource. He used to conduct in home visits every day before transitioning into a managerial role.

While the threat of COVID-19 is on Howe’s mind, he’s more concerned with the individuals he and the staff work with on a weekly basis. After the pandemic, Monadnock Worksource reduced the number of hours it spends with individuals, which ranges from 11 to 30 hours each week, executive director Janis King said.

They put a stop to transportation because “we can’t provide that safe distance,” King said, and a number of the places where individuals held jobs or volunteered were suspended for the time being. And that kind of disruption to the routine is concerning for Howe – even more so than the looming threat of coronavirus.

But at the top of his priority list is making sure he takes the proper precautions to keep from getting sick.

“I’m doing everything I can to maintain my health,” Howe said. “Because keeping myself healthy is part of this.”

Howe said in certain instances they would use PPE during in home care, but now it is used with every visit.

“It’s been working, but every day is different and has challenges,” Howe said.But for Howe, it’s just the nature of the job.

“Our job is challenging, but people who do direct care are really invested in the individuals they support,” Howe said.

The New Hampshire Board of Nursing considered the following practice questions posed by licensees.

Question: Is an LPN able to administer cosmetic injectable (dermal fillers, Botox) under an APRN who is authorized to practice in New Hampshire.BON Response: Yes, an LPN may administer the cosmetic injectable medication with a valid written order from a provider Physician APRN, or DDS who is authorized to practice in NH.

Question: Can an RN remove a spinal catheter? BON Response: Yes, an RN can remove spinal catheters under the direct order of a physician or APRN, after training and demonstration of competency.

Question: Can an LNA apply a tourniquet?BON Response: Yes, an LNA can apply a tourniquet based on training and demonstration of competency.

Question: Is it within nurse’s scope of practice to calculate a CMADVASC Score? BON Response: Yes, it is within the scope of practice of registered nurses to calculate screening exam scores.

Question: Can a school nurse provide over-the-counter medications without a provider’s order?BOD Response: Yes, the school nurse does so in accordance with nursing knowledge, judgment, and skill and 2. The school nurse in public schools must follow the NH DOE administrative rule, Ed 311 which states “non-prescription medication shall be given only with the written request and permission of the parent and/or guardian” and must follow local policy and procedures.

Question: Is it within the scope of practice of a RN to remove pins post-operatively from a patient with a ligament construction?BOD Response: No, the Board found no research to support the removal of pins from a site status post ligament reconstruction and tendon interposition skill as part of the RN scope of practice.

The Board of Nursing is now requiring nursing programs to provide an analysis of student retention rates and steps to improve retention rate in their annual reports to the Board.

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Page 12 • New Hampshire Nursing News June, July, August 2020

Cheshire Nurses InterviewedAshley Thompson, RN and Chastity Hodgson, RN in Cheshire’s Emergency Department were interviewed for the Cheshire Medical Centers magazine Health and Wellness.

Elliot Nurse InterviewedMary Seigle RN, a Resource Nurse, in the CICU at Elliot Health System was interviewed for the Elliot Hospital website. Regarding caring for COVID-19 patients she noted “It’s

extremely hard and wonderful all at the same time. I will now forever cry when I hear ‘Here Comes the Sun’ by the Beatles. That song is played when a COVID-19 patient is discharged from the hospital and nurses line the hallway to say goodbye.

Memorial Hospital Pins New Graduates While the COVID-19 pandemic has caused many school graduations to be cancelled, the nursing staff at Memorial Hospital made sure to honor their graduating student nurses with a traditional ceremony welcoming these new nurses to their profession. “A pinning ceremony is an invitation to graduates to join the nursing profession,” said Shauna Ross, RN, a member of the Memorial staff. “These students have all done their clinical rotations here and have worked hard.” Each of the students was awarded a pin. Usually, the nursing pin represents the student’s nursing school. Since their school pins were not available,

Nurses on the WebMemorial awarded pins usually presented to recognize outstanding service by employees. Students also recited the Nightingale Pledge, promising to “practice my profession faithfully.” Joining them were a dozen or so other hospital nurses gathered to congratulate these new professionals and also reflect on their own service as nurses. Memorial Hospital Chief Nursing Officer Kris Dascoulias noted “Nursing is a profession that requires extreme knowledge and a willingness to put others above yourself. As you start your journey, remember you are not alone. As a nursing graduate, you have earned the right to wear a nursing pin.”

Memorial has extended job offers to all of their graduating student nurses, an acknowledgement of the quality of this class and the way they have handled the extraordinary circumstances of their final semester.

Graduates from White Mountains Community College included Natalie Harmon, Paige Lautenschlager, Emily Fournier, Nicholas Dukehart, David Frankowski, Amy Lindgren, Chelsea Schribner and Michael Kane. Elizabeth Hockmuth was a student at the University of Southern Maine:

SNHMC NurseIrene Arevalo BSN RN was recently highlighted on the Rivier University website. An alumnus, she practices at Southern NewHampshire Medical Center. “Never would I have thought I would be part of a pandemic let alone working on the very front line. But here we are. I must say we are doing a decent job in New Hampshire flattening

Danielle Finn and DHMC co-workers.

the line. The only thing we as healthcare providers can ask is for people to hang tight, continue staying home, and please pray and support your front line workers because although now called heroes, we are people just like you. Working directly with COVID patients has been challenging in many ways, but also rewarding in many others. I feel that nursing care has become more essential than ever in the care of patients, as things change quickly and unexpectedly. It brings me so much joy when a patient finally begins to improve, especially when we can celebrate the little things such as going for a short walk or taking a much-needed shower on their own. But the biggest cheers come with the discharge paperwork and the wheelchair ride to the car.”

Maternity NurseHollyann DeCarteret, BSN, RN, a maternity nurse at Elliott Hospital, was profiled on the River University website. “It’s an ever-evolving situation and we are all trying to roll with the punches. I am a nurse and I absolutely love what I do. It’s a scary and emotional time, but in healthcare, we all have each other’s back and we are helping to rally each other. We are a family. We smile with our eyes (because you can’t see our mouths) and continue to care with every bit of our hearts.”

Public Health Nurse on the Front LineRivier University alumna Bobbie Bagley, RN is the Director of Public Health and Community Services in Nashua. In her profile on the school’s website they note that Bagley has been on the front line of the COVID-19 pandemic for weeks, working with City officials and others to keep the community informed, prepared, and safe. “My job is to promote, preserve, and protect the health of our community and to lead the community response to emergent public health issues. The joint response to COVID-19 has been absolutely phenomenal. Everyone is working together including the City of Nashua, the Office of Emergency Management, hospitals, schools, and faith-based organizations. Together, as a community, we can stop the spread of COVID-19.”

NHNA NurseNHNA’s own Executive Director Joan Widmer, RN was profiled on the Rivier website. Joan has been keeping New Hampshire nurses informed regarding the COVID-19 pandemic. “The NHNA is addressing concerns raised from nurses around the state, staying informed on COVID-19 updates from the CDC, NH Department of Health and Human Services and the American Nurses Association and communicating this information through e-flashes and our website.”

DHMC NurseDanielle Finn, RN of DHMC was interviewed by ABC news. She speaks Portuguese and recently translated for a patient in the COVID-19 unit in addition to preparing language signs to assist in communication. Fenn, who is originally from Brazil, was living in Germany before she came to the United States in 2004 to be with her late husband. Now, her international roots are playing an instrumental role in caring for her patients.

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June, July, August 2020 New Hampshire Nursing News • Page 13

Reviewed by Anita Pavlidis RN MSN

For seventy years the name Saranac Lake was synonymous with tuberculosis. It meant mortal dread and at the same time transcendent hope. The only treatment available for the disease was both researched and dispensed in the isolated village in New York State’s Adirondack Mountains.

Between 1873 and 1945, Saranac Lake, New York became a world-renowned center for the treatment of tuberculosis, using a treatment that involved exposing patients to as much fresh air as possible under conditions of complete bed-rest. In the process, a specific building type, the "Cure Cottage" was created.

As a young man Dr. Edward Livingston Trudeau (1848–1915), watched his elder brother die of tuberculosis over a period of three months– at the time, the disease was incurable. He subsequently trained as a doctor, and, three years after completing his studies, was himself diagnosed with tuberculosis. Conventional thinking of the time called for a change of climate, and he went to live in the Adirondack Mountains, spending as much time as possible in the open, and he subsequently regained his health. In 1876 he moved to Saranac Lake and established a medical practice. In 1882, Trudeau read about success in treating tuberculosis with the "rest cure" in cold, clear mountain air. Following this example, Trudeau founded the Adirondack Cottage Sanitarium in February, 1885.

With the fresh air treatment a whole technology developed and a building type known locally as a “cure cottage” developed. The requirement for fresh air lead Trudeau to avoid large institutional settings, feeling that a cottage-like structure would maximize the patient's exposure to light and air, and avoid the sanitation difficulties of a large institutional setting. Consequently, as the town's increasing fame drew more and more invalids, "cure cottages" began to spring up throughout the town. Many were created by simply adding glassed-in porches to existing houses. Others were built as cure cottages and/or apartment buildings, but all had "cure porches" with sliding glass windows, in which patients spent at least eight hours a day resting on special day beds or reclining chairs.

The discovery that tuberculosis was contagious further contributed to Saranac Lake's importance as a cure center, as many other venues in the Adirondacks began to turn "consumptives" away. As a result, the village grew rapidly, from 533 in 1880 to 1,582 in 1890 to a peak of more than 6,000 by 1920. A number of different types of institutions developed: boarding houses and cottages, for relatively ambulatory patients; cottages that did not provide board, in which case meals would be provided by a nearby boarding cottage; "nursing cottages" for patients too weak to get around. Tuberculosis did not respect wealth or position; all levels of society were represented, from the first factory girls to scions of nationally prominent families.

World War I caused another major increase in patients— the stress of war and the damage caused by mustard gas provided fertile ground for the tuberculosis bacillus. In 1944, an effective drug, streptomycin, was developed, and by the mid-1950s, sanatorium treatment of tuberculosis was nearly entirely supplanted by drug treatment. Many of the cure cottages were converted into apartment houses, and some were torn down; some have been lovingly restored, and some badly renovated.

Christy Mathewson "Cure Cottage" in Saranac Lake, New York. Taken by Mwanner.

This book is of interest to history buffs, researchers wishing to understand the outdoor life once lived at Saranac Lake, and to architectural historians tracing the influence of that life on buildings all over the United States. The book was an interesting read however, the writing was methodical and detailed. Considerable space was devoted to the architecture and history of many of the cottages. It is a book that you can pick up and read and put down over a period of time, reflecting on the dark thread of tuberculosis throughout the fabric of American Life.

The exploits of Saranac Lake parallel those of New Hampshire. The Glencliff Home for the Elderly, located in the White Mountains, was formerly the Glencliff Sanatorium, which opened in the summer of 1909 for New Hampshire residents infected with tuberculosis seeking respite and cure in the fresh mountain air.

The New Hampshire State Sanatorium was located at Glencliff because the site's elevation of 1,650 feet would provide the fresh mountain air that was then thought to be therapeutic for tuberculosis patients. Glencliff was a self-sufficient community, designed to maintain the isolation that was part of the sanatorium concept. Its medical facilities included a hospital unit, an open ward, an x-ray facility, an operating room, and a microbiology laboratory. The campus encompassed 500 acres and included a farm with pigs and cows and a vast vegetable garden. Electricity, water, and sewage disposal were all provided by the nearby town of Glencliff. Coal was brought to the base of the mountain by train until the

railroad was discontinued in 1952. The sanatorium even had its own shortwave radio station. The sanatorium treated more than 4,000 TB patients during its first 50 years. When the outlook for patients with tuberculosis changed due to drug therapy Glencliff sent its last active tuberculosis patient to the Mary Hitchcock Hospital in Hanover, ending the sanatorium movement in New Hampshire.

In 1970, the Glencliff Sanatorium was converted into the Glencliff Home for the Elderly. Many of the unique architectural features of the original facility have been preserved. The main patient building still has its floor-to-ceiling windows that admit ample light. The sturdy columns that used to support the screened porches which were used for the open-air treatments have now been framed in to create patient rooms.

Fresh air porch at Glencliff Sanatorium

The themes of both the book and story of Glencliff Sanatorium are much the same as the COVID-19 world we live in today. Patients experienced isolation, sickness, loneliness, separation from family and friends, fear of never recovering, and loss of income/jobs. For many years, there was no effective treatment and worry about the patients returning to society as their health improved but were not cured of tuberculosis. But this period did end and although there was a tremendous loss of lives, people survived this time and met the challenges of that terrible time. We shall too.

Anita Pavlidis, RN MSN was the former Director of Nursing at the NHTI, Concord’s Community College and Program Specialist at the New Hampshire Board of Nursing.

From the Bookshelf

CURE COTTAGES OF SARANAC LAKE: Architecture and History of a Pioneer Health Resort

by Philip L. Gallos, 1985

Regularly exercising our sense of humor improves resiliency, positivity and balances anti-negatively. Laughter may not solve problems but can change your chemistry allowing you to face them anew. In this issue we present one-liners related to the COVID-19 pandemic.

• What should you do if you don’t understand a coronavirus joke? Be patient.

• If you need 144 rolls of toilet paper for a 14 day quarantine you probably should have seen a doctor long before COVID-19.

• With hair salons, nail salons, waxing centers, tanning places and barbershops closed, it’s about to get ugly out there.

• What’s the best way to avoid touching your face? A glass of wine in each hand.

• Sign on a dating site: Single man w/TP seeks single woman w/Purell for good clean fun.

• Grocery shopping has become a real life version of PAC-Man. Avoid everyone, get the fruit, and take any route to avoid contact.

• Man looking at his calendar: Can’t wait until tomorrow. I have another big day of hand washing and looking out the window planned.

• Nobody thought I’d amount to anything. But here I am lying on the couch, saving the world.

• In 2021: Human Resources: I see a gap in your resume. What were you doing in 2020? Job hunter: Looking for toilet paper.

• We are about three weeks away from finding out what everyone’s real hair color is.

• Thinking a mask is going to stop COVID-19 is the same as thinking that your underpants will protect everyone from a fart.

• Half of us are going to come out of the quarantine as amazing cooks. The other half will come out with a drinking problem.

• Some of us need to practice social-distancing from the refrigerator.

• Public Service Announcement: Every few days try your jeans on, just to make sure they fit. Pajamas will have you believe all is well in the kingdom.

• Day five of homeschooling: Which one of you called in a bomb threat?

• A dog owner: Now I know why dogs are so excited to go for walks.

• A cat owner: My cat is still trying to figure out why I’m in his house after 8 AM.

HUMOR ME

Page 14 • New Hampshire Nursing News June, July, August 2020

Dartmouth-Hitchcock Medical Center (DHMC), in partnership with West Health of Lebanon, has launched a three-year effort to build a hub and spoke model Geriatric Emergency Department (GED) aimed at keeping most geriatric patients in their communities through telemedicine. A key player in the development of this innovative approach to caring for geriatric patients in northern New Hampshire is Hilary Hawkins, BSN, RN, Geriatric Emergency Department Manager at DHMC. Hawkins is responsible for developing care protocols and implementing screening tools to assess the needs of the geriatric patient. “The idea behind [the

Nurse in Key Role in New Geriatric Program

Hilary Hawkins, BSN, RN, Geriatric

Emergency Department Manager

at DHMC.

WELCOME NEW and RETURNING NHNA MEMBERS!NHNA welcomes these new and returning members. Thank you!!! What do these 67 nurses and over 1,100 NHNA members know that you don’t?

If you are not a member ask your neighbor on this list why they joined! Go to nhnurses.org where joining is easy and one of the best professional values for your money! We want to see your name here in the next issue of the NH Nursing NEWS!

Allenstown, NHTiffany Hutchins

Atkinson, NHCharlotte Dimaggio

Auburn, NHAngela Diorio

Bedford, NHJulia Duquette

Boscawen, NHBrooke McLain

Bow, NHSally J. Jenkins

Brentwood, NHSarah Dinneen

Claremont, NHOdalie Bernash

Concord, NHSusan BryantMary Elizabeth CahanDorothy Michelle DeLisa

Derry, NHDawn LaPorteStephanie RussoBarbara Sullivan

Dover, NHJeanne SpurlinLaura Willett

Elkins, NHShari Goldberg

Goffstown, NHJulianne M. Ashton

Hampton, NHNicole Susan Leibundgut

Hooksett, NHSabrina Bolianites

Hudson, NHElizabeth DuffyElizabeth Martell

Intervale, NHJennifer Leigh Grise

Keene, NHMargo Helen BanksRachel Hough

Laconia, NHDeborah E. Bossey

Lebanon, NHNadine Nicola BrownDayhna Pamela Marti OjedaJanice E. Morton

Lee, NHSuellen Olson Drake

Lisbon, NHSean Destephanis

Littleton, NHBailey Dammen

Manchester, NHMelinda Daigle BennetMartha DerkachMirline EstiverneKathleen FantozziKathleen Bridget ForbushJessica GluekPamela Lee GomesCindy T. LouxayJessica McCardellClaude MuaKim OzunaHannah PirozzoliMelissa Vitagliano

Merrimack, NHJulie Brady

Nashua, NHTammi BoudreauMellony CudeAlana EvansEmily MadisonLily Roselin Raja

New Boston, NHEmma Angeline Pinard

New Hampton, NHJaimie N. Walton

Newton, NHTina Greenwood

Northfield, NHMichele Ann MurphyTaylor Thompson

Penacook, NHCynthia Bergeron

Peterborough, NHBrittany Stokes

Plainfield, NHSunshyne June Rice

Plymouth, NHPaula Michelle Hurvit Moulton

Rindge, NHDonna J. Babb

Salem, NHBrittany Burke Bethany A. Pelletier

Stratham, NHEricka J. McCarron

Sunapee, NHArlene M. Halsted

Thornton, NHKimberly Ann Thibault

Wolfeboro, NHDara St. Sauveur

Woodsville, NHDina Quinn

GED] is DHMC (the hub) has many resources such as case managers, social workers, pharmacists and geriatricians that can help community hospitals (spokes) with the geriatric population, to keep them in their community hospitals or their homes,” states Hawkins. Research has demonstrated that admitting geriatric patients can often lead to additional risks versus maintain them in their home or community. Of course, if these patients need to be at DHMC they will be welcomed.

Hilary Hawkins, BSN, MBA, RN, CEN, CPEN, TNRN always knew she wanted to be in health care. Her father was a nursing home administrator and she spent time there growing up. “I first started in healthcare in EMS and then obtained my BSN. As a nurse, I have worked in the adult intensive care unit, the emergency department, trauma performance improvement and then running trauma programs. Statics show that trauma in NH is predominantly 65 years and older which led me to work closely with palliative care, hospice and ethics committees,” remarks Hawkins. Hawkins is certified in Geriatric Emergency Nursing Education (GENE), as designated by the Emergency Nursing Association, the leading professional organization for emergency nurses.

“We’re delighted to have Hilary’s insight, experience and expertise so tightly woven into the development of our GED,” says Karen Clements, RN, FACHE, D-H Chief Nursing Officer. “This investment will have a lasting positive impact on our patients and our communities, and for that reason it’s absolutely imperative that we have qualified nurses, like Hilary, so closely engage in what we’re creating.”

GED nurses are aware of the nuances in care required by geriatric patients, including the need for additional assessments to detect underlying issues with mental health, physical health or in need of additional resources. “They work closely with care management to ensure that the patient has the appropriate resources or equipment at home and that they understand their discharge plans or

follow up,” notes Hawkins. GED nurses also ensure that the patient is receiving the care that matters most to them. Most often that care is at home.

The goal of the GED is to recognize those patients who will benefit from inpatient care, and to effectively implement outpatient care to those who do not require inpatient resources. The GED utilizes additional staffing, equipment, education, policies and procedures, follow-up care, and performance improvement measures. When implemented collectively, the GED hopes to see improvements in patient care, customer service, and staff satisfaction. Improved attention to the needs of this challenging population has the opportunity to more effectively allocate health care resources, optimize admission and readmission rates, while simultaneously decreasing iatrogenic complications and the resultant increased length-of-stay and decreased reimbursement.

Developing the care protocols the GED will use has been a multidisciplinary team approach based on evidence. These disciplines include and are not limited to pharmacists, nurses, physicians, care managers, social workers, physical therapists, occupation therapists, as well as community resources and experts in the area of aging. Additionally, the team is developing a robust data analysis process that will guide much of the work going forward and help to identify quality measures and understand related outcomes.

“The Geriatric Team at DHMC is still working on developing and refining their processes and the application,” comments Hawkins. The spoke and hub implementation has slowed down as resources are needed to focus on COVID -19. The Geriatric Team continues to be a presence in the ED during the pandemic and is live-time providing support to our older families. The Geriatric Team is also adding their collective experience to the Nursing Home Collaborative which is meeting to discuss how nursing facilities can maximize the use of their resources in the best interest of all patients, and still protect their residents who are some of our most vulnerable.

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June, July, August 2020 New Hampshire Nursing News • Page 15

NCLEX ReconsideredFocus on IV

TherapyEd Note: Where it has been a year or years since you took the NCLEX (AKA “Boards”), how well would you do now?

1. A patient is receiving an infusion of lactated ringer’s solution at 100 ml/hr. The IV site appears red with moderate swelling. The infusion is sluggish as the pump keeps alarming. The nurse recognizes these findings as:A. ExtravasationB. InfiltrationC. PhlebitisD. Occluded catheter

2. The nurse reports a patient’s central venous pressure as 1mmHG. Which provider order for fluids should be questioned by the nurse? (Select all that apply).A. 0.9% NaClB. 0.45% NaClC. 3% NaClD. Lactated RingersE. D5LR

3. For which patient would a colloid be administered?A. A patient with chronic heart failure with slight JVD

and BP 96/50B. A patient with chronic anemia and Hg/Hct report of

9/31C. A patient with cirrhosis and pitting edema of the

extremitiesD. A patient requiring volume replacement for chronic

diarrhea

4. A home care nurse is conducting a follow-up home visit to a patient who has been discharged with a parenteral nutrition (PN). Which of the following should the nurse most closely monitor in this kind of therapy?A. Blood pressure and temperature.B. Blood pressure and pulse rate.C. Height and weight.D. Temperature and weight.

5. A patient that has been receiving parenteral nutrition at 80 ml/hr has been cleared to begin a liquid diet. The nurse expects that which of the following orders? A. Decrease parenteral nutrition to 40ml/hr.B. Start 0.9% normal saline at 30 ml/hr.C. Maintain the present infusion rate.D. Discontinue the parenteral nutrition.

Answers on page 17

Elliot ICU nurse Heidi Kukla, right, decided to take the need for vital PPE into her own hands. She and

other volunteers were working around the clock in a making-marathon of protective gowns she

designed. (Photo courtesy Elliot Hospital)

Personal protective equipment or PPE has been in been in short supply in New Hampshire and across the country. While Elliot Hospital and Southern New Hampshire Medical Center, both part of Solution Health, have been managing supplies and orders in advance of the surge, isolation gowns have been of particular concern. With a mix of talent and innovative spirit, some inspired nurses at Elliot Hospital took on the challenge of enhancing supplies.

Heidi Kukla, RN, who practices in the Intensive Care Unit at Elliot developed a pattern for a disposable, detachable gown. Working with colleagues who volunteered their time, Kukla developed prototypes that went to Infection Prevention staff for testing and review.

A socially-distant but unified volunteer crew has taken over AR Workshop on Elm Street to make

the gowns. (Photo courtesy Elliot Hospital)

Once the teams landed on a design and material that met the necessary clinical standards, Kukla reached out to fellow ICU nurse, Stephanie Joyce who had a strong connection at AR Workshop on Elm Street in Manchester. Joyce helped AR owner Laura McKelligan set up the shop, which has been closed because of the “stay at home” order. McKelligan was more than happy to open her doors and transformed the crafting workshop into a gown-making shop. SolutionHealth

NH Nurses Make It Happenpurchased materials for the group to create more gowns to be used at Elliot Hospital and Southern New Hampshire Health, and McKelligan was able to bring back some of her staff to help.

“Stephanie asked if the space was being used, and I told her they were more than welcome. One day turned into a weekend, and now we are planning for the whole week,” McKelligan said on Monday.

Kukla says the disposable gowns will cost less than 25 cents/each and the washable gowns will cost about $10/each. She says volunteer labor was key to keeping costs down. The group spent the weekend cranking out gowns at the AR Workshop.

Be Part of Research

Ed Note: The Nursing News receives requests from researchers to solicit study subjects or participants. All studies must demonstrate evidence of Institutional Review Board approval.

Cynthia Horton Dias RN, a PhD Candidate at the University of South Carolina is seeking participants for a research study to understanding of the experiences of hospital nurses with free food in the workplace. Qualified participants for this study are registered nurses (RN), working at least 50% of the time inside a U.S. hospital and participation will involve filling out a survey taking no more than 15 minutes. Participants will be entered into a raffle for one of two US $100 Amazon gift cards. Once the drawings for the raffles are completed, email address collected for the drawing will be deleted. No other personally identifiable information will be collected in this study, other than certain demographic measures.

Nurses who meet the study criteria can take the research survey at this link: https://is.gd/RNfreefood<https://protect2.fireeye.com/v1/url?k=0d6c147a-51a42f15-0d6c5abb-86ad9e8057e6-bcccd135a33191d8&q=1&e=14676f3d-35a6-42e5-9ff3-3acd838326be&u=https%3A%2F%2Fis.gd%2FRNfreefood

Page 16 • New Hampshire Nursing News June, July, August 2020

ED Note: News from nursing schools, faculty, students or alumni are welcome. Please direct

submissions to office@nhnurses.org with NHNNin the subject line.

Due to the coronavirus pandemic, Plymouth State

University (PSU) senior nursing students quickly adjusted

to virtual simulations and other alternative methods to

complete their final semester of clinical training. The nursing

students graduated early – a full month ahead of schedule.

The combination of earlier graduation and the New

Hampshire Board of Nursing issuing temporary licenses to

new graduate nurses allowed healthcare facilities to start

the onboarding process weeks earlier than usual. “This is

especially important now,” said Kim Force, Clinical Director

of Inpatient Services at Littleton Regional Hospital. Seventy

percent of PSU’s nursing graduates expect to become

licensed in New Hampshire, and many will begin working

at the hospitals where they completed their senior capstone

semesters.The Salter School which offers a program to prepare practice nurses among other non-licensed health careers was renamed the American School of Nursing and Medical Careers. The campus remains in Manchester, New Hampshire. The American School of Nursing and Medical Careers is owned by Premier Education Group, L.P.; registered limited partnership in the Commonwealth of Pennsylvania.St. Joseph School of Nursing, with approval of the NH

Board of Nursing, has added an evening cohort of 24 students to their associate degree nursing program.

Shannon Murdock a graduating senior nursing student at the University of New Hampshire was honored as a 2019-20 America East Winter Scholar-Athletes. This was Murdock’s second year as a Scholar-Athlete. She earned her BSN with a 4.0 GPA in nursing and 3.72 GPA overall. Murdock won the 5,000 meter track event at the America East Championship and also placed second in the mile.

June, July, August 2020 New Hampshire Nursing News • Page 17

Ed Note: This is the third in a four part series celebrating the 200th birthday of Florence Nightingale and the Year of the Nurse

Sue Fetzer

In March 1854, England, France and Turkey declared war on Russia to protect themselves against the Russian expansion, marking the beginning of the Crimean War. England had not been in a foreign war for 40 years and the 27,000 English troops had gone to Turkey with little support from a Medical Department.

After accepting, Sidney Hebert’s request, Florence recruited nurses from the Irish Catholic Sisters of Mercy (10), Anglican Sisters of Mercy (8), St. John’s House of the Church of England (6) and 14 lay nurses from hospitals around London. Together with Florence and her housekeeper from Upper Harley Street and Mr. and Mrs. Bracebridge, 41 members of her group departed London on October 21, 1854. The travelled to Paris then to Marseilles where they boarded the cargo ship Vectis. Despite nearly all developing seasickness, they arrived at Constantinople (today known as Istanbul) on November 4. Constantinople is divided by the Bosporus, a strait of water connecting the Black Sea to the Mediterranean and Atlantic Oceans. The French Hospitals were on the west side, while the British wounded had been taken to Scutari, on the Asiatic, or east side of the Bosporus.

Florence was given the nursing responsibility of Superintendent of Hospitals in the East of eight hospitals, but she spent most of her time at the Barracks Hospital on the hill overlooking the town of Scutari. The hospital had been created out of a Turkish army barracks, and the large square building was nearly a mile in circumference, three stories tall with towers on each corner. In the central court up to 12,000 men could exercise. There was over four miles of corridors for wounded and sick men to inhabit, up to 2,500 men at a time. The Hospital was located over a network of cesspools, the sewer lines were blocked and overflowing into the hallways. Windows were closed against the cold.

The reception provided to Nightingale and her nurses was nonexistent. Soon after her arrival Florence approached the medical officers to offer her services. Dr. Hall, Inspector General of the Hospital declined. Most of the medical staff believed the intruders would be a hindrance. The environment, rats, vermin, the lack of bedding, clothing, no kitchens, provision for washing, or medical supplies, they believed was not appropriate for women. The Nightingale party was quartered in two floors of one of the Towers.

Twenty-four hours after their arrival, more wounded arrived from the Battle of Inkerman, across the Black Sea

from Scutari. Wounded men would have to be carried to the docks, transported by boat, unloaded onto the docks and transported to the Barrack Hospital. The ordeal could take up to two weeks. There was little nourishment during the trip, and little upon arriving at the hospital. Nightingale’s nurses first set up a kitchen, and the smell of soup was enough to prompt the medical officers to allow the group to feed the wounded.

Obtaining and storing supplies was one of Nightingale’s ongoing efforts. Medical supplies were often rerouted, not unloaded or stolen. Three different government agencies were responsible for supplies with little communication. Food preparation was primitive, boiled in huge copper pots. Vegetables were rare. There were no laundry facilities as the boiler had broken. She wrote home, to the English newspaper Times and to the officials that had sent her, proclaiming the lack of supplies and conditions. Soon, supplies were sent to her directly, and she maintained a ‘warehouse’ in the tower.

Sash worn by one of the Nightingale nurses. From the beginning, Florence kept track of the wounded, those suffering from disease, and the dead. She hunted down cleaning supplies, created kitchens, got the boilers fixed and created a laundry. An oft repeated story relates

that one night, the surgeons triaged five soldiers aside to die, deeming their condition hopeless. Nightingale got ‘permission’ to care for the men through the night and by morning they were fit for surgery. She would reply ‘we must’ to medical officers who would say ‘we can’t.’

The winter of 1855 recorded temperatures at Scutari of –10 degrees C. The hospital was full of cases of frostbite, gangrene, and dysentery. Nightingale calculated the mortality rate of 1,000 per 1,174 men. Nightingale’s letters to her benefactor in England, Sidney Herbert, were shared with Queen Victoria who responded. Nightingale would administer the hospital during the day and make rounds after the surgeons had retired for the night. She would carry a small lamp in her hand and would pause for anyone in need. The practice would be responsible for her reputation as the “Lady with the Lamp.”

Turkish lamp of style used by Nightingale

Cholera, a bacterial infection from water or food contaminated by human waste, was rampant during the Crimean War. Diagnosed by watery diarrhea, vomiting, and muscle cramps, the dehydration and electrolyte imbalance resulted in a blueish tinge to the skin. There

was no cure, only care. Throughout 1855, typhus fever also ran rampant. Typhus, caused by bacteria transmitted by flea, mite, louse, or tick bites, results in a severe headache, fever over 102, rash, hypotension and photosensitivity. Unfortunately the medical staff and Florence’s nurses were not immune.

On May 1855, Florence set out across the Black Sea for Balaclava to determine how the sick and wounded were cared for near the fighting front and to inspect the hospitals. Arriving at the dock was a much different scene than when she arrived in Scutari six months previously. Her successes at the Barracks Hospital were well known, and some of the men she had cared for had returned to the front lines. While on this trip, Florence is stricken with Crimean fever. While historians have debated the cause, it was most likely brucellosis, a bacterial infection transmitted from animals by ingestion of raw milk, infected food or contact with an infected animal. Symptoms include fever, sweats, headaches, back pains, and physical weakness. One form of the illness may also cause long-lasting symptoms, including recurrent fevers, joint pain, and fatigue, complaints that Florence would manifest for the rest of her life.

After a month being cared for by her own nurses, Nightingale returned to Scutari for additional recuperation, by August she was back administering the Barracks Hospital. Her recovery was heralded in England as a heroic. In November, Florence received a letter and gift from Queen Victoria. Designed by Prince Albert, the brooch with the inscription “Blessed are the merciful,” the word “Crimea” and a St. George cross surmounted by a crown of diamonds. A Crimean Peace was declared in March, 1856, but the hospitals did not close until the summer. Florence left Turkey late in July traveling as ‘Miss Smith;’ she arrived at Lea Hurst unnoticed.

The Florence Nightingale brooch bestowed by Queen Victoria in 1855 served as the inspiration for the current nursing pin bestowed on nursing schools graduates.

Despite her success during 20 months in Scutari, Nightingale felt

she had failed to reform the Medical Department of the Army. Although, she was comforted in the thought that she met her calling to do “God’s work.” At 36 years old, she saw her achievements as starting point for her future work.

Upon returning from the Crimea, Nightingale’s hair has started to grow back after being cropped short during her experience with Crimean Fever.

Next Issue: Florence Nightingale – Shaping the Profession

Florence Nightingale – Lamp of Scutari

Answers to NCLEX Reconsidered from page 151. C 2. B,C 3. C 4. D 5. A

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Page 18 • New Hampshire Nursing News June, July, August 2020

IN MEMORY OF OUR COLLEAGUESThe New Hampshire Nurses Association honors the memory of and acknowledges the work of deceased nurses who have graduated from New Hampshire nursing schools or who have actively practiced in New Hampshire during their career. Sharing the names and information about these nurses is one way we honor their contribution to the profession. Brief submissions are welcome.

Navy NurseBarbara A. Cirincione, 86, formerly of Manchester and Holderness, died on Februrary 14, 2020. She proudly served in the U.S. Navy as a nurse. Before retiring, Barbara worked as an APRN for Elliot Hospital. She was especially proud to serve as the parish nurse at

her local church for many years. Barbara was also a camp nurse for the American Diabetes Association

Insurance NurseLouise C. Marchand, passed away February 14, 2020, After high school she was a manager of dental offices and at age 40 decided to change her career path. She graduated from NHTI with her AD degree and practiced in Manchester area hospitals. Later, after

earning her National Case Management Certification, Louise became an administrative insurance nurse first for Cigna and later for Alicare Medical Management, where she worked at the national level managing complex cases.

Sacred Heart GradMarlene Eudora (Cilley) Eddy, 72, died February 19th, 2020. She was a native of Concord, graduating from Sacred Heart Nursing School. With a 40+ year career as an RN, she retired from Havenwood Heritage Heights in 2011.

LPNRachel M. (Snow) Crane, 82, of Hillsborough, passed away on February 22, 2020. As an LPN she worked for Hillsboro House Nursing Home and Hillsboro Visiting Nurses Association.

Gero NurseRita A. Latham, 91, died on February 22, 2020. She obtained her nursing diploma in Massachusetts and as a Concord native practiced at Concord Hospital. For many years she was a nursing supervisor at McKerly’s Nursing Home, and in 1992 opened the first

Adult Medical Day Care center in NH where she practiced for nearly 20 years.

Public Health ExpertKathleen A. (Katie) Dunn 61, died on February 20, 2020 after a courageous three year battle with brain cancer. She obtained her nursing diploma at the Concord Hospital School of Nursing where she graduated as valedictorian. She earned a BS from New England

College in Psychology and Sociology and a MPH from Boston University School of Medicine, School of Public Health. She practiced at Concord Hospital for twenty years as an ICU/CCU, PACU RN. She supervised ER Admitting. She opened the New Hampshire office of the New England Organ Bank. She spent 23 years employed by the State of New Hampshire. Beginning in Maternal and Child Health as a nurse consultant, bureau Chief of Communicable Disease, and Director of Public Health. She was Associate Commissioner of Health and Human Services. One of her career highlights was writing the CHIP (Children’s Health Insurance Program), a pilot program for the country, under then Governor Jeanne Shaheen. She was a compassionate advocate for the disabled and their families. Her career concluded as Senior Program Director for the National Academy of State Health Policy in Portland, Maine and Washington, DC. She was a Robert Wood Johnson Medicaid Leadership Fellow.

Gero NurseRita P. Annicchiarico died peacefully on March 8, 2020 She earned a nursing diploma in 1951 and practiced in private duty as well as a nurse at the former Centennial Home.

Mary Hitchcock GradEthel Amy (Norcross) Crane, 86, died on March 11, 2020 after a long hard-fought battle with dementia. She received her nursing diploma in 1955 from Mary Hitchcock Memorial School of Nursing. She practiced at the State Hospital and Concord Hospital in

Concord, the Newport Hospital in Newport, NH, Hillsboro House Nursing Home and the Office of Dr. Richard Douglass in Hillsboro, NH.

Sacred Heart GradMaryanna (Casey) Commerford, 85, died March 12, 2020 at the CRVNA Hospice House in Concord surrounded by her children. She obtained her nursing diploma from Sacred Heart Hospital School of Nursing. She had a

long career as a Registered Nurse, practicing at Concord Hospital and St. Paul’s School.

Founding Nursing EducatorBarbara “Ann” Manchester Kelley, 85, died on March 14, 2020. Ann received her nursing diploma in 1955 from Peter Bent Brigham Hospital School of Nursing in Boston and her master’s degree in nursing education from Boston University. She moved to the University

of New Hampshire in 1964 to help develop a new baccalaureate nursing program. As a founding nursing

faculty member, she remained on the faculty until her retirement in 1998. Ann was a highly esteemed colleague serving terms as Interim and elected Department Chair. In recognition of her contributions, the Department of Nursing established the Ann Manchester Kelley Nursing Inquiry Day, a research presentation day for UNH undergraduate and graduate nursing students. She served as President of the New Hampshire Nurses’ Association and founding member of Eta Iota Chapter, Sigma Theta Tau International Honor Society of Nursing. Ann received the Joseph D. Vaughn Award in 2011 for 29 years as a founding volunteer of the NH Long Term Care Ombudsman Program. A fond memory was the summer she crossed the US in a camping trailer with her husband, visiting schools of nursing to study their nursing simulation laboratories. After returning to UNH, she wrote and received a federally funded grant to develop and direct the first nursing simulation laboratory at UNH.

A Tribute to Ann KelleyMy fondest memories of Ann Kelley were from the time that I served on the leadership team for New Hampshire Nurses’ Association (NHNA). This was back in the late 80’s and through the 90’s. During this time, I served as a board member, then an officer, and eventually from 1994-1996, as the Association’s president. I recall that Ann was a constant presence in the NHNA leadership, having herself been the NHNA president in a prior decade. She was a constant source of wisdom, support and guidance, not only for me, but for the many NHNA presidents that would come after me. Well after her formal retirement, I would always see Anne at NH nursing gatherings......always invested and interested in what was happening with nurses in our state and how the work of the profession was evolving. Never without an opinion, she was one of nursing’s greatest advocates.

This said, I believe the pivotal role she played was as the steward of NH nursing’s and the Association’s history. She meticulously archived materials, documents and artifacts that she personally collected over the many years of her nursing career spent in NH. It would always amaze me when Ann could produce a sentinel document from years past that would actually help to inform a current dilemma. Preserving our history was truly a passion for Ann.

Ann reigns among the many unsung heroes of New Hampshire nursing for her perpetual efforts to help us preserve our history. She will be greatly missed. – Susan Reeves, EdD, RN, CENP, Chief Nurse Executive, Dartmouth-Hitchcock Health

School NurseDiane Brown McClintock, 79, died on March 18, 2020. She was a diploma graduate of the Elliot Hospital School of Nursing in Keene, obtained a BSN from Saint Anselm College, a degree in Psychology at New England College and earned a Masters in Education from Antioch University. She practiced as a

school nurse for 28 years at ConVal High School in Peterborough, NH.

Home Health NurseNancy A. (Perry) Leppanen, 84, passed away March 19, 2020. She practiced at Home Health and Hospice, Merrimack, N.H., for over 30 years.

Keene NurseJoyce Winnette Sawyer, 83, passed away on March 19, 2020. A Keene native she obtained her nursing diploma from the Elliott Community Hospital

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June, July, August 2020 New Hampshire Nursing News • Page 19

IN MEMORY OF OUR COLLEAGUESConcord Hospital Nurse

Brian J. Trombly Sr., 68, passed away on April 26, 2020. Brian’s first career included participating in the construction of the Seabrook Nuclear Power Plant in Seabrook, NH. Brian changed careers and as a RN practiced at Concord Hospital where he was a

member of the staff for over ten years.

Gero NurseClaire D. (Ouelette) Provencher, 85, passed away April 30, 2020. After obtaining her nursing diploma she practiced at Notre Dame Hospital as well as several nursing homes.

School of Nursing in Keene. She practiced as a head nurse in the Emergency Department at Cheshire Medical Center.

Day Surgery PioneerJoan (Jamrog) McCann, 85, died on March 27, 2020, after a period of declining health. She received her nursing diploma from the Elliot Hospital School of Nursing in Manchester and practiced as a registered nurse at the

New Hampshire State Hospital and Concord Hospital. Joan also provided private duty nursing care and in the mid-1970s, she was asked to open the Day Surgery Unit at Concord Hospital. Joan successfully took on the challenge ran the unit with another nurse. Upon her retirement, Joan worked for the Department of Health and Human Services for the State of New Hampshire, using her nursing skills to oversee the Katie Beckett Medicaid program and the Children’s Prosthetics Program.

Seacoast NurseNancy Jean (Collopy) Ferris, 76, passed away March 29, 2020 at home surrounded by family. After obtaining a nursing diploma in 1964 she practiced in Connecticut and New Hampshire.

Mary Hitchcock GradHazel Howe McNamara, 95, passed away on April 1, 2020. She graduated from Green Mountain College in Vermont and went on to pursue her nursing degree at Mary Hitchcock School of Nursing, graduating in 1947. She had a long nursing career, finishing

it as a visiting nurse for the town of Hanover.

Nurse EducatorNancy Bradley Chandler, 85, died May 5, 2020. She obtained her BSN and MSN from Boston College. She practiced in Boston, and New York and taught nursing in Massachusetts including as the Director of Lawrence General Hospital School of Nursing.

Relocating to New Hampshire she taught nursing at St. Anselm College and NHTI. She was a pioneer in childbirth education, teaching classess in Laconia, and Franklin, NH. She established Prenatal Programs at Concord and Franklin Hospitals. Later in life she found great joy as a school nurse in Winnisquam and Warren schools and then as a camp nurse at Camp Walt Whitman and Camp Moosilauke.

Nurse EducatorMarjorie Lillian Allen, 87, passed away April 2, 2020. She obtained a BA from Fitchburg State University and then her nursing diploma. She taught nursing at St. Joseph Hospital in Nashua. She also practiced at the Derry Medical Center for nearly eight years and coordinated the community’s visiting nurse and home-makers program.

North Country NurseCynthia L. (Brown) Griffin, 61, of Berlin, died on April 10, 2020. She was a diploma graduate of the Concord Hospital School of Nursing. She practiced for many years at Littleton Hospital, North Country Home Health and Coos County Family Health Services.

UNH GradRhonda Irene (Knapp) Hebert, 69, passed away in Texas April 29, 2020. She graduated Cum Laude from the University of New Hampshire with a Bachelor of Science degree in Nursing.

• Emergency Room• Maternal Child Health• Inpatient Medical Surgical Unit

• Office RN• PACU