INA Annual ConferenceSeptember 29-30, 2011

current resident or

Presort StandardUS Postage

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Princeton, MN55371

Official publication of the Idaho Nurses AssociationQuarterly circulation approximately 20,000 to all RNs, LPNs, and Student Nurses in Idaho.

Volume 34, • No. 1 May, June, July 2011

Page 11

Page 4

Member Spotlight

Dorothy M. Witmer, RN, BSN, MS, EdD Coordinator,Parish Nursing/Faith Community Nursing, St. John’s CathedralINA Member since 1977

A Century of Public

Protection and Professionalism: The Idaho Board

of Nursing 1911-2011

Inside This Issue

Michelle Pearson-Smith

from the President...by Michelle Pearson-Smith, RN, BSN, CCRN

It has been a busy and fulfilling couple of months since the last time I reported to you. I had the pleasure of attending my first ever American Nurses Association (ANA) Constituent Member Assembly in March. This meeting gathers the Executive Director and President of every state nurses association to review policies and procedures, discuss legislation, provide pertinent reports, and address issues at both the State and National level regarding Nursing. This was an informative session for me regarding how INA connects to other CMA’s nationally and how truly abundant are the resources available from ANA. It was a valuable opportunity to network with nursing professionals from every state working in a variety of settings. Always interesting to me are the similarities of issues facing our profession regardless of any other unique identifier. Whether your practice setting is long term care, mental health, or a clinical agency, you are supported in the multiple roles the nursing profession requires by both INA and ANA when you become a member.

In addition to the CMA, I attended the Idaho Nurse Educator Conference (INEC) that took place right here in Lewiston, Idaho. One of the speakers was Donna Ignatavicius, MS, RN, ANEF, (better known as “Iggy”) who provided useful teaching strategies for both the clinical and classroom setting based on the Quality and Safety Education for Nurses (QSEN) competencies. Information on QSEN can be located at: http://www.qsen.org/ and on Iggy’s website at: www.diassociates.com.

Cindy Clark RN, PhD, ANEF from Boise State University School of Nursing spoke on incivility in nursing

with a presentation titled: Why Civility Matters in Nursing Education: Creating a Culture of Regard. Dr. Clark has presented information and written several articles related to personal and professional relationships and interactions to practicing nurses, students, and educators. Her goal is to increase awareness and enhance practice environments at all levels. You can find more information on these topics at: http://nursing.boisestate.edu/civility/.

Although the conference was education focused, I would encourage you all to visit the websites provided by each of these inspiring ladies. These issues are just a few of those I mentioned above that span the profession and can be applied to any practice setting.

At both meetings, as usual, I was warmly welcomed as the novice among experts, clearly supported and encouraged by every single person in attendance regardless of position or background. I appreciate that these motivating lectures, positive networking experiences, and the emerging sunshine have encouraged me in every aspect of life just as I was getting weary. I am in the final stretch of my third pregnancy, and am feeling both my age and my ever changing body take their toll on my energy. By the time you all read this I should be snuggling my newest addition and taking a much anticipated summer break. Of course I say “break”; however, it will probably not be all rest and relaxation!

Until next time,Michelle

The Idaho Nurses Association, Idaho Public Health Association, Idaho Rural Health Association and Idaho Student Nurses Association will hold their joint conference September 29 and 30, 2011 at Boise State University in Boise, Idaho. Karen Daley, PhD, MPH, RN, FAAN, President of the American Nurses Association, will be the keynote speaker. Ted Epperly, MD, FAAFP, past president and current board chair, American Academy of Family Physicians and CEO of Family Medicine Residency of Idaho, will be the plenary speaker.

INA workshops and facilitators are scheduled to include:

• “Addressing the Health Needs of the Somali-BantuPopulation in Idaho”

Cathy Deckys, RN, MS, Clinical Instructor, Boise State University School of Nursing

• “PromotingaGreenerIdaho”–Update Ingrid Brudenell, RN, PhD, Professor Emeritus,

Boise State University School of Nursing

• “SexualHealthinIdaho” Annabeth Elliott, RN, MS, STD Program Coordinator, Idaho Department of Health and Welfare

•“WhyCivilityMattersinNursingEducationand Practice” Cindy Clark, RN, PhD, ANEF, Professor, Boise State University School of Nursing

6.0 contact hours for this continuing nursing education activity have been submitted to the Washington State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. You must

register through INA and attend all INA educational sessions on Friday, September 30, to be eligible for continuing nursing education contact hours. Contact hours are not available for those who register through, or attend sessions presented by, ISNA, IPHA or IRHA. Please contact Lynne Weil at ed@idahonurses.org for more information about continuing nursing education contact hours.

Idaho Public Health Association workshop topics are scheduled to include:

“Access to Health Care” “Healthy People 2020” “PublicHealthandLaw–PolicyandAdvocacy”“Health Information Technology”

Additional workshop topics will be announced in the near future.

The conference begins with an INA GeneralMembership meeting on September 29, followed by an evening reception. On September 30, conference activities begin at 7:30 a.m. and conclude at 4:15 p.m. Hotel accommodations have been reserved at the Town Place Suites hotel near the BSU campus.

For more information and to register, visit http://idahonurses.org, or contact INA at ed@idahonurses.org or toll-free888-721-8904.

Keeping Your Eye on the TIGER: Technology

Informatics Guiding Education Reform

Pages 8-10

Page 2 • RN Idaho May, June, July 2011

RN Idaho (RNI), the official publication of the Idaho NursesAssociation(INA), isapeer-reviewedjournal thatis published quarterly. Views expressed are solely those of the authors or persons quoted and do not necessarily reflect INA’s views or those of the publisher, Arthur L. Davis Publishing Agency, Inc. The RNI Editorial Board oversees this publication and welcomes 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 are not required to be INA members.

Manuscript FormatArticles should be submitted in APA

style(6thedition)asadouble-spacedWORDdocument using 12 point font. Acceptable file formats for documents are:

• WORD files in .doc format without embedded photos (please save “down” to .doc instead of .docx if .docx is your default file format)

• .jpgor.tiffforphotographsSubmissions should include the article’s title and

the author(s) name, credentials, organization/employer and contact information. Authors must address any potential conflict of interest, whether financial or other, and also identify any applicable commercial affiliation. Submissions should be emailed as attachments to INA at ed@idahonurses.org.

PhotographsPhotographs of high resolution (300 dpi preferred)

may be submitted digitally as a separate file in .jpg or .tiff format. Submit a signed photo release form (available online at http://idahonurses.org/displaycommon.cfm?an=1&subarticlenbr=21) and supply a caption and photo credit for each photo. Photo release forms should be submitted by FAX or scanned and emailed in the same manner as manuscripts. Photographs should be emailed in the same manner as manuscripts. All photos become the property of INA.

Publication Selection and RightsArticles will be selected for publication

based upon the topic of interest, adherence to publication deadlines and guidelines, the quality of writing, and peer review by members of the RNI Editorial Board. When there is space

for one article and two of equal interest are under review, preference will be given to INA

members. RNI reserves the right to edit articles to meet styleandspacelimitations.One-timepublicationrightsarereserved by RNI.

AdvertisingProduct, program, promotional or service

announcements are usually considered advertisements. To place an advertisement, please contact our publisher, Arthur L. Davis Publishing Agency, Inc., at sales@ALDpub.comorbyphone800-626-4081.

For further questions about submission of content, please contact the INA at ed@idahonurses.org or by phone 1-888-721-8904.TheFAXnumberforsignedphotoreleaseformsis404-240-0998.

Guidelines for Submissions to RN Idaho

RN Idaho is published by the Idaho Nurses Association

3525 Piedmont Road Building 5, Suite 300

Atlanta,GA30305

Toll-free Phone:888-721-8904Direct Dial:404-760-2803Extension:2803Email: ed@idahonurses.orgFAX:404-240-0998Website: www.idahonurses.org

Editorial Board: Tracy Flynn, RN, MSNMaryRuthHassett,PhD,RN-BCAnnaHissong,MSN,RN-BC,CCCEBarbaraMcNeil,PhD,RN-BCDeanna Mitchell, RN, BSN, MAEd, MS (Nursing)Ann M. Voda, PhD, RNLynne WeilDorothy M. Witmer, EdD, RN

RN Idaho welcomes comments, suggestions and contributions. Articles, editorials and other submissions may be sent directly to the INA office via mail, faxore-mail.Pleasecall the INAoffice ifyouhave any questions.

Join INA TodayWe need you!

Membership applicationhttp://nursingworld.org/joinana.aspx

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. INA 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 Idaho 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. INA 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 INA or those of the national or local associations.

RN Idaho is published quarterly every February, May, August and November for the Idaho Nurses Association, a constituent member of the American Nurses Association.

Check OutOur Website:

www.IdahoNurses.org

May, June, July 2011 RN Idaho • Page 3

Membership Corner

ANA/INA Member Benefits

One low membership fee provides national (ANA) and state (INA) level benefits and international professional connection (ICN).

Staying Informed Benefits

The American Nurse Value = $20.00; current issues and trends

The American Nurse Today Value=$18.95;newsyoucanuseinpractice

Online Journal of Issues in Nursing (OJIN) 24/7 access

ANA Smart Brief (sign-uptoreceive) Electronicdailynewsfeed–issuesandresearchonhealthcare,illnesstowellness,nursing

Capitol Update(sign-uptoreceive) Political/legislativenewsandadvocacyoptions

Nursing Insider Currentnewsonnursingandhealthcaredirectlytoyoure-mailinbox

www.nursingworld.org Resources, news, publications; members only content

RN Idaho Quarterly publication for all Idaho nurses

http://idahonurses.org Resources, news, member directory

http://www.icn.ch ANA is the only official US member of International Council of Nurses (ICN)

Promoting Professional Nursing Quality Benefitsand Safety

Code of Ethics and Interpretative Statements* Longstanding code for nursing and model for other professions

Nursing’s Social Policy Statement*; Nursing: Guidingdocumentsforprofessionalpractice;membersgiveinputScope and Standards of Practice* into revisions(generic+28specialties)

National Database on Nursing Quality Data links nurse staffing levels to quality nursing careIndicators (NDNQI)

Workplace safety Advocacy, information and legal briefs (e.g. bodily injury from lifting, latex allergies, safe needle practices, workplace violence)

*read only versions available to members at www.nursingworld.org/members/foundation

Advocating for Nurses and Patients/Clients Benefits

Lobbying at state and federal level to congress Aims to improve nursing and health care (e.g. safe staffing, workforce development, overtime pay,and regulatory bodies access to care, rights of nurses); assists with lobby strategies

Legislative committee (INA) Aims to safeguard the Nurse Practice Act (see also lobbying benefits above)

Represents nurses and nursing practice Acts as a voice for you at high level agencies and places where it matters (e.g. White House); provides information and stories to the media to influence outcomes and shape realistic, positive views of nursing

Collective bargaining ANA supports the rights of all nurses to decide if they want to be advocated for in their employment setting by a union. ANA has not engaged in any direct collective bargaining for nine years. CMAs** each decide if they wish to offer collective bargaining services to their members; Idaho members have not requested collective bargaining.

** Constituent Member Associations

Developing Professionally Throughout BenefitsCareer

ANA is only organization for all registered ANA is first and foremost in providing guiding documents for professional practicenurses

Nurse’s Career Centers (ANA and INA) Sign up to find career oriented positions

ANANurseSpace Online social network

Certification Documents your expertise

Conferences, educational events Contributes to lifelong development

Opportunities for state and national committees Develops you and contributes to profession; influence association’s agenda. You decide on level and time commitment; benefits available to both active and less active members.

Networking at organization events & Connects one professionally; Facebook; Twitterelectronically

Staying informed (see first section) Issues that matter are your key concern

FlorenceWhipplescholarships-INA GivessupporttostudentsinADorBSNprogramsinIdaho

Saving Dollars and Time Benefits

Member discounts •AlamoandBudgetautorental Membershipsavesdollarswhenyoutravel•WaltDisneyWorldSwanandDolphinHotel•ANACashRewardsMall Brandsyouknowandlovecostless•Crocs,DellComputers….andmore•Nursesbooks.org Booksforprofessionaldevelopment

ANCC certification Value = up to $140 savings

Online continuing education (CE) Discounts or free

New full members to INA receive a 25% Value = $70 savingsdiscount on year one dues

Onestopshopforinsurance Professionalliability,life,majormedical,dental,disability,long-termcare,MedicarePartD,Medicare supplemental, cancer

Join today at http://nursingworld.org/joinana.aspxAll new INA full members receive a 25% discount on your first year of dues!

(offer subject to change–please visit http://idahonurses.org for details)

INA Membership Committee

The Benefits of Joining Your Professional AssociationWikipedia defines a professional association as a

non-profit organization seeking to further a particularprofession, the interests of individuals engaged in that profession, and the public interest.

As the ANA explains,The American Nurses Association, along with

over 80 specialty nursing organizations, serves avital role in advancing the role of nursing and the health care of this nation. ANA works to develop policies, set standards, advocate in government and private settings, provide education, maintain the Code of Ethics for Nurses and shape the future of the profession. It is members that allow associations to accomplish what needs to be done. Member dues provide the necessary funding and member volunteers provide the guidance and expertise to move the profession forward. Members make the difference–in the nursing profession and the health care of the nation.

Membership in ANA/INA is an investment in your professional and personal development, providing many opportunities for growth. Membership shows you hold yourself to a higher standard. It allows you to stay connected with nursing colleagues, and ensures a stronger voice for you, your profession and your patients.

If you are not currently an ANA/INA member, please visit both idahonurses.org and nursingworld.org for more information on member benefits and to join today. Don’t forget to take advantage of the special INA 25% discount for all new, full members (details are available at idahonurses.org). If you are a member, visit the same websites and learn more about the benefits that are already yours, and the many ways you can get involved.

ReferencesWikipedia. Retrieved on March 17, 2011 from http://

en.wikipedia.org/wiki/Professional_association.American Nurses Assocation. The Importance of Belonging

to Your Professional Organization. Retrieved on March 17, 2011 from http://www.nursingworld.org/EspeciallyForYou/StudentNurses/YourProfessionalOrganization.aspx.

Page 4 • RN Idaho May, June, July 2011

Member Spotlight

Jean AmoryClaire AskewNikki AustinJason BlomquistAmanda BurgessAnn ButtJana FeldmanMollie FlerchingerAleeceGeislerJanice HammondChristopher JenkinsMarshall JewellD’Nicole LivingstonChristopher LoweMichael Murrell

Mary OlsenFaith PetersonDonna RaynerBeth Ann ReeceTamara SandmeyerRobert SchillerSandra StemrichJeanette WelkerSara Youman

INA welcomes the following new members who joinedDecember1,2010–February28,2011:

Dorothy M. Witmer, RN, BSN, MS, EdD Coordinator

Parish Nursing/Faith Community Nursing, St. John’s Cathedral

INA Member since 1977

My experience includes over 50 years in nursing including acute care, military flight nursing, home health, long term care, and healthcare education (nursing and allied health) throughout the United States and overseas. I have a BSN, MS (Community Health), and EdD (Education). In the past I have served as INA District 31 committees’ chair, president and state board member. I currently serve on the RN Idaho Editorial Board.

Dorothy Witmer

In what ways has membership in INA been valuable to you?

Membership in INA offers continual opportunities to network with other nurses, provides opportunities to develop a variety of skills in teamwork, and leadership by participating on committees and offers nurses knowledge about current trends in the profession through timely publications. Membership in INA also reflects the nurse’s wish to remain active in professional development so necessary in meeting the constant challenges facing nursing today. As a member of the Editorial Team of the RN Idaho, I feel privileged in having an opportunity to share in the mission of providing Idaho nurses with information that not only speaks to Idaho issues but also issues that are of national concern.

Why would you encourage other RNs to join INA?By nature nurses have strengths to be shared that

will help other nurses and areas that may need to be further developed. By joining INA, each nurse will have opportunities to do both, helping other nurses and learning to improve one’s skills. INA is a professional development organization. I know that my early activity as a committee member and later as president of the local district provided me with professional skills in management and leadership that I probably would not have developed anywhere else in my early years of nursing in Idaho. Join, participate and find that you are not only contributing to other nurses but are also finding skills you did not know you had. You will become a better professional nurse, better informed, and more confident as you grow and learn from other nurses.

May, June, July 2011 RN Idaho • Page 5

Mary Ruth Hassett

Computing Corner:E-Book Reader for Nursing References

Mary Ruth Hassett, PhD, RN-BC

Mary Ruth Hassett, PhD, RN-BC, is a member of theRNI Editorial Board and a Board Certified Informatics Nurse (ANCC). Hassett retired from Lewis-ClarkState College where she was Professor and Chair, Division of Nursing & Health Sciences, and taught Nursing Informatics.

I decided to get an e-book reader around MemorialDay last year. The primary purpose would be for travel; to carry a number of books that would weigh only few ounces in toto. At first, I thought these books would be mostly novels. Then last summer, I served as Camp Nurse for a five-day church youth conference. I lugged somenursingreferencebookstothefirst-aidroombuttheoneIneededwas pharmacology (it was still at home). So I became determined to expandmy e-book library plan to includenursing references.

Selecting which e-book reader topurchasewasanon-trivial task. My most important consideration was support for several e-book formats. I perused reviews (e.g.,Arar,2009; Newman, 2009) and chose the Sony Reader PRS-600. It weighs 10.1 ounces, uses a nice electronic paper display (in portrait or landscape), can be viewed in direct sunlight, has a touch screen, and requires no power to maintain a static image. The Reader can display Adobe PDFs, ePub, RSS newsfeeds, JPEGs, andBBeB formats.This will allow me to acquire a variety of e-books,including some borrowed from lending libraries. MP3 and unencrypted AAC audio files also play on the Reader.

I was surprised to see several newANAe-books(AdobePDF1) and purchased four of them (American Nurses Association, 2010 and 2010a; Fowler, 2010; Neuman & Dixon, 2010). I had looked for a current drug reference but found only out-of-date e-books. Finally I located a newpharmacology e-book in ePub format (Barberio, 20112) thatcompletedmye-library’sinauguration.

An e-book reader does help, whether one is headingfor the backyard, going on a trip, or just driving across town. I have only begun a collection of nursing reference e-booksbutknowtheywillbeeasytofind,lighttocarry,searchable, and dust-free. I will continue to e-shop andwatchmynursing e-librarygrow. (Also, I can slip in theoccasional novel with no sweat).

1 Adobe Acrobat Reader is required to view; download available from http://get.adobe.com/reader/

2 Adobe Digital Editions® is required to view; download available from http://www.adobe.com/products/digitaleditions/

ReferencesAmerican Nurses Association. (2010). eBook–Nursing

informatics: Scope and standards of practice. Available from Nursesbooks.org.

American Nurses Association. (2010a). eBook–Nursing:Scope & standards of practice (2nd ed).. Available from Nursesbooks.org.

Arar,Y. (Nov2,20098:45pm).Thebestof today’se-bookreaders.PCWorld.RetrievedonJune28,2010fromhttp://www.pcworld.com/article/181226/the_best_of_todays_ebook_readers.html

Barberio, J. A. (Ed.). (2011). Nurse’s pocket drug guide 2011 (7th ed).. Available fromMcGraw-HillMedical at http://www.mhprofessional.com/product.php?cat=116&isbn=0071739297.

Fowler, M. D. M. (Ed.). (2010). eBook–Guide to the Code of Ethics for Nurses: Interpretation and application. Available from Nursesbooks.org.

Neuman,C.E.,&Dixon,J.F.(2010).eBook–Nursing’s Social Policy Statement: The essence of the profession. Available from Nursesbooks.org.

Newman, J. (Aug 26, 2009 7:59 am). Sony’s e-Reader vs.Kindle: 5 reasons Amazon should worry. PCWorld. Retrieved on June 28, 2010 from http://www.pcworld.com/article/170828/sonys_ereader_vs_kindle_5_reasons_amazon_should_worry.html

Page 6 • RN Idaho May, June, July 2011

Happy 100th Birthday, Idaho

Board of Nursing!!by Sandra Evans, RN, MAEd

On March 9, 1911 Idaho’s first Nursing Practice Act was signed into law, and the State Board of Examination and Registration of GraduateNurses, whichwas to laterbecome the Idaho Board of Nursing, was charged “to regulate the examination and registration of graduate nurses.” The first Board included 2 nurses and 1 physician, appointedby theGovernor tostaggered threeyear terms.To be eligible, Board members had to be “actual residents of the state and engaged in professional work.” The Board was to meet immediately upon their appointment and organization and as needed after that, to include at least one meeting in Boise for the purpose of holding the nurse registration examination and at least once “in the northern part of the state” for the same purpose. Board members were to receive $4.00 for each day they were “actually engaged in attendance upon meetings of the Board, and in going to and coming from their place of meeting.” All costs of the Board were to be paid from fees received by the Board. A fee of $10.00 was assessed for initial nurse registration. Additional fees of up to $100 were assessed for false representation in applying for a license and for violating any provision of the law.

Over the last one hundred years, the Act has been amended a total of 24 times, most recently in 2010. Today’s NursingPracticeAct establishes the9-membergovernor-appointed Board whose members include 1 advanced practice nurse, 5 licensed professional/registered nurses, 2 licensed practical nurses and 1 consumer. Member terms are for four years and a “per diem” of $50 per day is paid to Board members for each day “spent in the actual performance of duties.” The Board meets at least quarterly for the conduct of business. Nurses are assessed a fee of $75 for LPNs and $90 for RNs and APPNs for initial licensure by examination; a fee of $110 is assessed for initial licensure by endorsement; and a fee of $110 is assessed for biennial licensure renewal. Additional fees of up to $1000 can be assessed for violations of provisions of the law, including practicing nursing without benefit of licensure.

TheBoardofNursingcontinues tobe self-supporting,receiving no monies from Idaho’s General Fund toaccomplish its current purpose to “safeguard the public health, safety and welfare.” The Idaho Board has received recognition for excellence in nursing regulation from Nurse Practitioners of Idaho, the American Academy of Nurse Practitioners and the National Council of State Boards of Nursing. Congratulations and Happy 100th Birthday, Idaho Board of Nursing!

by Sandra Evans, RN, MAEd

The members of the Board of Nursing met November 4and5,2010,andagainJanuary27-28,2011,toconsiderissues related to licensure and certification, practice, education, discipline, communications, governance and operations, consistent with their 2011 strategic goals and objectives.

At the November meeting, Board members:• Reinstated one previously disciplined RN license

and issued one LPN license by equivalence • Took disciplinary action against seven licenses as

a result of violations of the Nursing Practice Act, including imposition of terms of probation on one RN license; suspension of two LPN licenses; and revocation of one LPN and three RN licensees

• Adopted temporary rules related to medicationassistant certification to remove the examination requirement and to allow for Board determination of MA-C initial competence through processesother than standardized testing. The temporary rules, which became effective December 1, 2010, authorize issuanceofa temporaryMA-C license toallow time for successful completion and receipt of a competency evaluation, when other certification requirements have been satisfied.

• Adopted a Board interpretive statement on thepractice of midwifery by nurses other than certified nurse midwives (included at the end of this report)

• Supportedtheuseofnurselicensurefeesfornursingworkforce initiatives, including nursing workforce data collection and analysis, and directed staff to further explore feasible models for implementation

In addition, Board members appointed Philippe Masser, MD, Boise, to an unexpired term on the Advanced Practice Professional Nurse Advisory Committee ending June 30, 2011. They appointed Charles Aasand, RN, Pocatello, John Brannen, RN, Twin Falls, and Anita Havey, LCSW, Boise, to continuing 2-year terms on the Program forRecovering Nurses Advisory Committee ending January 1, 2014. They granted continued full approval for eight years to the professional/RN program at Boise State University and for four years to the associate degree professional/RN program at the College of Western Idaho.

AttheirmeetingonJanuary27-28,2011, themembersof the Board adopted the timeline for implementation of the “Consensus Model for APRN Regulation” by July 1, 2015; took disciplinary action against one LPN and four RN licenses; reinstated one LPN and one RN previously disciplined licenses; issued one LPN license by equivalence; and removed non-practicing restrictions onRN and APRN licenses of one nurse.

Among other significant actions resulting from the meeting, the Board adopted its philosophy statement on Board governance, establishing the foundation for accomplishment of a strategic goal to “cultivate a governance framework and culture to support accomplishmentoftheBoard’sVision,MissionandGoals.”The philosophy sets forth the following six principles:

The Board of Nursing supports a model of governance that will most effectively shape and uphold the Mission, articulate a compelling Vision and ensure major decisions and day-to-day activities are guided by core values and beliefs.

The governance structure should promote fulfillment of responsibilities and accomplishment of strategic goals and objectives. It should allow for flexibility in modifying and refreshing priority initiatives and operations as the climate and environment shift and change and asmid-course adjustments becomenecessary.

The Board believes it governs best in close collaboration with the Executive Director, recognizing its separate but interdependent roles.

The Board’s relationship with the Executive Director should be based on principles of mutual trust and forthrightness and a common commitment to Mission. The Board, Executive Director and staff

Update on Activities of the Idaho Board of Nursing

should together face and resolve problems, share insights on pressing issues, discover new ways of reframing challenges and opportunities and generate strategic ideas.

The Board is committed to devoting the majority of time and energy to matters of substantial consequence, to meaningful discussion of key issues, and to articulation of strategic priorities.

The Board should reserve for itself responsibility for organizationalpolicy-settingandvigorousoversight–for setting organizational course. The Board should delegate responsibility for implementation of Board policies and decisions and management of operations and resources to the Executive Director.

The Board maintains the Mission is best supported by independent thinking and shared judgment.

The Board endeavors to function within a culture of inquiry, mutual respect and constructive debate where individual ideas lead to collective decisions. The soundest decisions will result when members rely on thorough deliberation to uncover all facets of an issue and then work together to arrive at an educated opinion. To this end, the Board is committed to policies and processes that reinforce collaborative decision-making rather thanpredetermined conclusions.

The Board strives for processes that protect the privacy of individuals while honoring the right of the public to remain informed.

The Board must remain cognizant of the extent government practices and outcomes are to be made public. The Board should also recognize the importance of distinguishing between the desire for transparency and the need for confidentiality.

The Board believes continuous measurement of performance fosters public accountability and achievement of desired outcomes.

Internal and external appraisal of performance should assist the Board in managing and continually improving effectiveness and ensuring accountability and sufficient controls. On-going Board self-assessment, overall performance measurement and periodic retroactive audit should be designed to protect against unethical behavior and conflict of interest and should serve to assure the Board acts consistently within its own adopted governance policies.

Also included on the agenda was ongoing discussion of several key initiatives, including Board fundamental beliefs about governance, discipline and pain management; implementation of the concept of ‘Just Culture’ in addressing incidents of substandard nursing practice; and strategies to determine the continued competence of nurses applying for licensure renewal.

IDAHO BOARD OF NURSING INTERPRETIVE STATEMENT

Statute:§54-1413(1)(h),IdahoCode(DisciplinaryAction)Rules:IDAPA23.01.01.100.09(GroundsforDiscipline)

IDAPA 23.01.01.101.04 (Standards of Conduct)IDAPA 23.01.01.400.01 (Determining Scope of Practice)

Background: The Board of Nursing (BON) regulates three (3)

levels of nurses: licensed practical nurse (LPN), professional or registered nurse (RN), and advanced practice professional nurse (APPN). One of the four (4) roles of advanced practice nursing is nurse midwifery. A licensed RN who has graduated from a nurse midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), passed a qualifying examination recognized by the BON and holds current certification from a BON recognized national organization, is qualified to be licensed by the BON asa“CertifiedNurse-Midwife” (CNM).ACNMiseducated at the BSN level or higher in the disciplines

Update continued on page 7

May, June, July 2011 RN Idaho • Page 7

of both nursing and midwifery. A CNM provides primary healthcare to women of childbearing age and beyond, including before, during and after pregnancy and birth. A CNM’s practice includes the authority to diagnose and prescribe.

The Board of Midwifery regulates non-nursemidwives under the provisions of title 54, chapter 55, Idaho Code. A person issued a license by the Board of Midwifery is known as a “Licensed Midwife” (L. M.). Under these statutes, an L. M. is not required to have the special education, training or qualifications of a nurse. The scope of practice for an L. M. is severely restricted by statute and an L. M. is strictly prohibited from performing nursing functions.

Whilestatute(§54-5508)allowsaCNMtobecomelicensed as an L. M., Idaho statutes are silent on the question of whether an LPN or RN can become an L. M.

Issue/Concern: Is allowing an LPN or an RN, who is not also

a CNM, to become licensed by the Board of Midwifery as an L. M., consistent with the intent and purposes of the BON’s statutes and rules?

Interpretation/Conclusion: The BON’s primary statutory charge is to safeguard

and protect the public from, among other things, “acts or conduct which may endanger the [public’s]

Update continued from page 6 health and safety.” Section 54-1401, Idaho Code.Conduct that tends to deceive, mislead or endanger a patient or the public is grounds for discipline of a licensed nurse. Section 54-1413(1)(h), Idaho Code,and BON Rule 100.09. A nurse shall not assume any duty or perform any act within the practice of nursing for which she has not been adequately trained and qualified. BON Rule 101.04.a Finally, a nurse must evaluate her conduct and determine whether or not each particular act is within the legal scope of her license, including whether the act is limited to the scope of practice of an advanced practice nurse. BON Rule 400.01.

Historically, the BON has interpreted its statutes and rules to prohibit an LPN or an RN not also licensed as a CNM, from performing the practice of midwifery. This was because the discipline of midwifery exceeded the education, training and qualifications of either an LPN or an RN, and exclusively fell within the scope of practice of a CNM. The enactment of title 54, chapter 55, Idaho Code, in 2009 authorizing licensing of non-nursemidwives by the Board of Midwifery does not change or alleviate this concern. Indeed it heightens the concern. A nurse/L. M. will, either intentionally or unwittingly, exceed the scope of her nursing practice while performing as a midwife because of inherent disparities between the two disciplines. Furthermore, allowing an LPN or an RN to also be licensed as a non-nurse midwife (that is, a L.M). creates the real and substantial potential that the public will be misled, deceived or confused regarding the qualifications of the nurse, to the

extent that the public may reasonably believe that the nurse/L. M. is in actuality a CNM.

For the forgoing reasons, the BON is of the opinion that allowing an LPN or an RN, who is not also a CNM, to become licensed by the Board of Midwifery as an L. M., is inconsistent with the BON’s philosophy on nursing practice, could potentially compromise the nurse’s license specific to role and scope of practice and could potentially lead to the public misinterpreting the nurse’s role. It is also inconsistent with the apparent intent of the legislature in passing the non-nurse midwiferylegislation to authorize an alternative to traditional licensed health care (but only under carefully defined limits, restrictions and circumstances), and not for the purpose of enabling providers of traditional licensed health care (i.e., nurses licensed by the BON) to circumvent the regulatory oversight of the Board.

Adopted: November 5, 2011

Page 8 • RN Idaho May, June, July 2011

Changing the Culture of Precepting

by Sharon Kensinger, RN, MSN, NEA-BC and Buffie Main, MPA

In the summer of 2006, nursing leaders from ten Idaho hospitals shared a common concern; hospitals in Southern Idaho were having a hard time recruiting and then retaining great nurses. The largest nursing shortage in Idaho’s history was looming. It was predicted that, between 2006 and 2016, health care would be the state’s fastest-growing, largest and highest-paying industry, andgrave concerns existed that hospitals, both urban and rural, would not be able to keep up to the task of on-boardingthe large number of new employees. Through dialogue and data review, Rural Connection leaders identified the dearth of competent preceptors and organized preceptor education and curricula as the primary gaps in the on-boardingexperience, particularly for new nurses. Preceptors, feeling less than optimally prepared for their important role, were increasingly becoming burnt out and the ‘cycle’ of nurses eating their young seemed to be a very real repeating pattern.

This emergent need compelled Rural Connection to partner with Boise State University and Rural Connection hospitals to better prepare preceptors through a project called Nurses as Teachers©. The program’s intent was to standardize preceptor skills and competencies in all facilities and welcome new nurses into the profession or to our facilities in a manner that would sustain and retain them.

Four years later, the program has gone far beyond its original intent to become a part of the culture of recruitment and retention of nurses in hospitals throughout Idaho. Nurses as Teachers© has been providing a foundation for supporting the development of nurses along the continuum from novice preceptors to expert mentors and leaders. The program’s core components live in the belief that preceptor and mentorship skills can be taught and developed through competencies such as critical thinking and clinical judgment, communication, storytelling, prioritization, delegation, and team building. In January, Nurses as Teachers celebrated changing the experience of and preparation for precepting for over 500 preceptors and over 2500 new nurses.

In 2011, Rural Connection will continue to provide a toolkit for teaching, leadership, mentorship and communication through Nurses as Teachers© workshops offered at sites throughout Idaho. These workshops would not be possible without the support of clinical instructors from each of these sites as well as from Boise State University who have helped to transform the culture of precepting in hospitals statewide.

Rural Connection incubated the Nurses as Teachers Preceptor Program with the recognition that a collaborative plan of action was necessary to aggressively recruit and retain nurses in all practice settings and a desire to standardize the competency and professional development of those in the important preceptor role. The organization is proud to tell the story of ‘mission accomplished’ and looks forward to continuing to serve nurses statewide.

For more information about Rural Connection or upcoming Nurses as Teachers workshops, please visit www.ruralconnection.org.

Barbara J. McNeil, PhD., RN-BC (Informatics) Professor Emeritas, Lewis-Clark State College

Adjunct Instructor, Gonzaga Universitymcneilb@gonzaga.edu

With the publication of the Institute of Medicine (IOM) Future of Nursing report (IOM, 2010) and the initiation of the Robert Wood Johnson Campaign for Action, every nurse across the U.S. is challenged to move forward and commit to implementing the IOM recommendations for transforming our healthcare system. The Technology Informatics Guiding EducationReform (TIGER) Initiative is a key guidepost forimplementing action steps that are directed at individual nurses, nursing education, clinical practice, healthcare agencies, and professional nursing organizations.

Recent federal legislation for healthcare reform (The Affordable Care Act, 2010) and the national goal to adopt the EHR by 2014 have in part stimulated healthcare initiatives including the National League for Nursing’s (NLN) Informatics Agenda, TIGER, and the Institute ofMedicine’s (IOM) Future of Nursing report. Warren and Connors (2007) reminded us that nurses must be prepared for “practice in a complex, emerging technologically sophisticated, consumer-centric, global environment”(p.58). It has never been more urgent or more critical for nurses to be able to use technology to improve the quality and safety of our healthcare system.

The purpose of this article is to describe the 10-yearvision and action plan for the TIGER Initiative. Theauthor’s intent is to create a greater awareness of this initiative which could then stimulate further action by Idaho nurse educators, nurse leaders, nurses in practice and the Idaho Nurses Association regarding preparation of nurses for the use of information technology tools; knowledge-based clinical decision making; technology-enabled communication; mitigation of healthcare errors; and the documentation/monitoring of care using the Electronic Health Record (EHR).

The TIGER Enters–Phase 1 The TIGER Initiative (TIGER, 2007, p. 2) was

developed in 2004 as a means to develop a vision and generate strategies “for improving nursing practice, education and the delivery of patient care through the use of health information technology (IT).” The first TIGERSummit convened in 2006 and included 120 invited nursing and non-nursing stakeholders from nursingpractice organizations, academia, government agencies, informatics/technology corporations and others. Seventy organizations participated including the American Nurses Association (ANA), Sigma Theta Tau International, the National League for Nursing (NLN), the National Council of State Boards of Nursing. The American Organization of Nurse Executives (AONE) and the American Association of Colleges of Nursing (AACN).

TIGER’s VisionDuring the 2-day TIGER Summit, participants

generatedashared10-yearvision(inTable1)fornursing’sfuture. It is built upon seven pillars or critical conditions (see Table 2) thatwere prioritized by attendees (TIGER,2007). Participants then developed a 3-year local andglobal action plan that would bridge the quality chasm through the use of IT. In the TIGER vision, note theemphasis on providing safe and quality care through the use of information technology.

Table 1

10-Year TIGER VISION• Allow informatics tools, principles, theories and

practices to be used by nurses to make healthcare safer, effective, efficient, patient-centered, timelyand equitable.

• Interweave enabling technologies transparentlyinto nursing practice and education, making information technology the stethoscope for the 21st century.

TIGER Expected Outcomes• Publish a Summit report, including Summit

findings and exemplars of excellence.• Establishguidelinesfororganizationstofollowas

they integrate informatics knowledge, skills, and abilities into academic and practice settings.

• Set an agendawhereby the nursing organizationsspecify what they plan to do to bridge the quality chasm via information technology strategies.

Note. Retrieved from http://www.tigersummit.com/

Table 2

Seven Pillars of the TIGER Vision 1. Management & Leadership: Revolutionary

leadership that drives, empowers and executes the transformation of health care.

2. Education: Collaborative learning communities that maximize the possibilities of technology toward knowledge development and dissemination, driving rapid deployment and implementation of best practices.

3. Communication & Collaboration: Standardized person-centered, technology-enabled processes tofacilitate teamwork and relationships across the continuum of care.

4. Informatics Design:Evidence-based,interoperableintelligence systems that support education and practice to foster quality care and safety.

5. Information Technology:Smart,people-centered,affordable technologies that are universal, useable, usefulandstandards-based.

6. Policy: Consistent, incentives-based initiatives(organizational and governmental) that support advocacy and coalition-building, achieving andresourcing an ethical culture of safety.

7. Culture: A respectful, open system that leverages technology and informatics across multiple disciplines in an environment where all stakeholders trust each other to work together towards the goal of high quality and safety.

TIGER 3-Year Action StepsUtilizing the seven pillars and the TIGER vision as a

framework, a 3-Year Action Plan was generated. Sevenkey actions that nursing must take were delineated and are listed in Table 3. Of note is that these actions address the role of individual nurses, healthcare organizations, academia and professional organizations. and prioritized by participants for each pillar to ensure the transformation ofnursing(TIGER,2007,p.5).

Keep Your Eye on the TIGER:Technology Informatics

Guiding Education Reform

Keep Your Eye on the TIGER continued on page 9

Barbara McNeil

May, June, July 2011 RN Idaho • Page 9

Table 3

3-Year Action Plan Toward the 10-Year TIGER Vision

1. Promote the TIGER vision of nursing as usinginformatics technology to provide safer, higher quality care. Use the vision to bring one voice to the profession and increase its power, influence, and presence in the national health IT initiative.

2. Integrate informatics competencies into the nursing curriculum and the learning process. Foster faculty development through funding and incentives. Nurture innovation via collaborative partnerships with practice and industry.

3. Share the TIGER initiative at international andnational meetings in health care, informatics, and nursing. Work with nursing organizations to disseminate the vision among their membership. Encourage regional and local efforts and partnerships among practice, education, research, and informatics.

4. Take an active role in the design and integration of informatics tools that are intuitive, affordable, useable, responsive, and evidence-based. Createtools that serve nurses and other professionals as membersofmulti-disciplinarycareteams.

5. Integrate industry standards for IT interoperability with clinical standards for practice and education. Educate practice and education communities on IT standards. Establish standards, and set hard deadlines for adoption.

6. Participate visibly and vocally in the national health IT agenda. Offer congressional testimony on issues relatingtotheTIGERinitiative.Takeanactiverolein policy decisions at all levels to ensure ethical, safe patient care.

7. Launch a national marketing campaign to promote a culture that values health IT and supports its use to benefit patients and those who care for them. Integrate technology into the strategic plans, missions, and goals of nursing organizations.

TIGER–Phase 2 After 2007 and building upon the work from TIGER

Phase 1, nine collaborative teams (see Table 4) were created to accelerate TIGER’s 3-Year Action Plan. Eachcollaborative generates specific recommendations and a targeted timeline for adoption. Each collaborative conducted extensive research and used the frame, “What does every practicing nurse need to know about this topic?”{TIGER(2007),CollaborativeTeamssection,para2}. An overall timeframe for achieved competencies was set at 2013.

Table 4

9 TIGER Collaborative Teams in TIGER Phase 21. Standards & Interoperability2. National Health Information Technology (IT)

Agenda3. Informatics Competencies 4. Education & Faculty Development 5. Staff Development6. Usability & Clinical Application Design 7. Virtual Demonstration Center 8. LeadershipDevelopment9. Consumer Empowerment & Personal Health

Records

Informatics Competencies Collaborative Each TIGER collaborative has published a summary

report with resources to support recommendations. The summary reports are available via the TIGER Website.Nurses are encouraged to submit recommendations or commentstoanyTIGERcollaborative.Ofmajorrelevanceto this paper is the work of the TIGER InformaticsCompetencies Collaborative (TICC). Accomplishments of this collaborative have been foundational to the work of severalotherTIGERcollaboratives.

Of importance, TICC has developed a set of minimum informatics competencies for all practicing nurses and graduating nursing students (see Tables, 5, 6, and 7). TICC has proposed three categories of minimum informatics competencies: basic computer literacy, information

management and information literacy. For each informatics category, specific competencies and a targeted timeframe have been identified. The target dates for adopting initial computer literacy and information literacy competencies have expired but the overall target date of 2013 for adopting these competencies is approaching.

Computer literacy competencies recommendations. For computer literacy (Table 5), the TICC recommended that all practicing nurses and graduating nursing students must demonstrate proficiency on specific content modules from the European Computer Driving License (ECDL). Further information about the ECDL is available through TIGER or the European Computer Driving License(ECDL), Foundation http://ecdl.com.

Table 5

Computer Literacy Competencies Timeline forRecommendations AdoptionAll practicing nurses and graduating By January 2011nursing students gain or demonstrateproficiency in ECDL modules 1, 2and 7, as well as ECDL Category 3.1*

All practicing nurses and graduating By January 2013nursing students become ECDL certified or hold an equivalent certification. From TICC, 2009

Information literacy competencies recommendations. For the category, information literacy, the timeline and recommendations for competencies are listed in Table 6. The steps of information literacy referred to in the TICC recommendation are adapted from those presented by the American Library Association (2000):

1. Determine the nature and extent of the information needed

2. Access needed information effectively and efficiently

3. Evaluate information and its sources critically and incorporates selected information into his or her knowledge base and value system

4. Individually or as a member of a group, use information effectively to accomplish a specific purpose

5. Evaluate outcomes of the use of information

Table 6

Information Literacy Competencies Timeline forRecommendations AdoptionAll practicing nurses and graduating By January 2011nursing students will have the ability to demonstrate Information Literacy steps 1 through 3.

All practicing nurses and graduating By January 2013nursing students will have the ability to demonstrate all 5 Information Literacy steps. From TICC, 2009

I n for m at ion m a n a gement comp et enc ie s recommendations. Information management is defined as the” process of 1) collecting data, 2) processing the data,

Keep Your Eye on the TIGER continued on page 10

Keep Your Eye on the TIGER continued from page 8 and 3) presenting and communicating the processed data as information or knowledge” (TICC, 2009, p. 7). The nursing informaticsconcept,data-information-knowledge,is foundational to information management. .According to TICC, the information management competencies refer to clinical information management skills and knowledge as well as the use of the EHR. All practicing nurses and graduating student nurses are expected to use the EHR for:

• Communication• Decisionsupport• Documentationofcare• Order/Resultsmanagement• Planningofcare• Medicationmanagement• Consents/Authorizationsand• ObtainingandenteringDemographic/Patient

information

The information management recommendations for competencies and timeline are found in Table 7. A more detailed list of specific competencies is located in the TICC Final Report document (TICC, 2009). The proposed adoption date for these recommendations is 2012 reflects the complex nature of information management and reliance on attainment of computer literacy and information literacy competencies.

Table 7

Information Management Timline forCompetencies Recommendations AdoptionSchools of nursing and healthcare By January 2012delivery organizations will implement the information competencies listed in Appendix (see Summary Report).

Schools of nursing and healthcare By January 2012delivery organizations will implement thetransformedECDL-Healthsyllabus items *

*European Computer Driving License From TICC, 2009

TIGER Continues–Phase 3 For its next steps, TIGER is continuing to involve

volunteers and input across the U.S. as the nursing community integrates TIGER’s recommendations. TheTIGERWebsite reports over 1500nurses are involved inthe TIGER Initiative. Plans are in-progress for a futureinvitational TIGER summit and for a Virtual LearningCenter. To keep current, stay tuned to the Website and join theTIGERemaillist.

Partnering with TIGERTIGER has provided many directives for nursing

practice, academic healthcare agencies and professional organizations. Its collaboratives are dynamic and energized to reach TIGER’s 10 year vision. There aremany opportunities to contribute to TIGER’smomentumand success.

Join INA Today,We Need YOU!

Apply online at

http://nursingworld.org/joinana.aspx

Page 10 • RN Idaho May, June, July 2011

Keep Your Eye on the TIGER continued from page 9

• As members of our professional nursing organizations, we can disseminate information about TIGER’s work, including its 10-year visionand action plans. TIGER goals could be integratedinto the organization’s strategic plans. The organization could sponsor nursing informatics-related conferences and workshops for organizational members and the healthcare community.

• Nurse faculty and administrators in academia must implement the informatics competencies developed byTIGER,eveniftheinitialtimelineshaveexpired.Curricula at all levels need to be revamped to include informatics competencies. Nursing students must be equipped with technology and hands-on learningexperiences that mirror innovative technology in the work setting. Academic institutions must utilize

resources from the TIGER Virtual DemonstrationCenter (VDC) that will house resources and best practice exemplars in use of technology for healthcare delivery,

• Healthcare agencies must collaborate with academia and IT enterprises to ensure students, faculty and nursing staff are prepared to use the EHR. Nursing informatics expertise and success in using IT in healthcare must be shared. Strategies must be prioritized for training agency staff to meet informatics competencies..

• As individual practicing nurses, we must create plans to reach minimum informatics competency levels and work toward achievement of these goals. Informatics-prepared nurses must be mentors toother nurses.

As TIGER continues to actualize its vision fortransforming nursing and healthcare, we must keep our eye onTIGER and do our best to runwith this empoweringinitiative.

References American Library Association. (2000). Information literacy

competency standards for higher education. Retrieved from http://www.ala.org/ala/mgrps/divs/acrl/standards/standards.pdf.

IOM. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf.

National League for Nursing. (2008). Board of Governorsstatement: Preparing the next generation of nurses to practice in a technology-richenvironment:Aninformaticsagenda.Retrievedfrom www.nln.org.

TIGER. (2007). The TIGER Initiative: Evidence andinformatics transforming nursing: 3-Year action steps toward a10-year vision. Retrieved from http://tigersummit.com/uploads/TIGERInitiative_Report2007_Color.pdf

TICC (TIGER Informatics Competencies Collaborative).(2009).TIGERInformaticsCompetenciesCollaborative(TICC):Final report. Retrieved from http://tigercompetencies.pbworks.com/f/TICC_Final.pdf.

Warren, J. & Connors, H. (2007) Health information technology can and will transform nursing education. Nursing Education, 55(1),58-60.

May, June, July 2011 RN Idaho • Page 11

Located in Boise provided both Lillian Long and Gertrude Cragin opportunities to know and lobbyinfluential leaders of the time. In addition to pushing for the establishment of a Board of Health and eliminating the common drinking cup from public water barrels, these pioneers positioned the INA and members of the physician community to support legislation to establish a board of nursing. Establishing BONs was a common national movement before World War I, and Miss Long and Mrs. Cragin utilized their connections in the East to guide the process in Idaho.

On March 9, 1911, the Idaho Legislature passed the “Nurses Bill” which was signed into law by newly elected Governor James Hawley, a Boise attorney. He appointedtwo nurses, Miss Lula Sweet and Miss Sawyer, and one physician, James Taylor, to compose the first Idaho State Board of Nurse Examiners. Miss Sweet and Miss Sawyer both graduated from St. Luke’s in Boise. Dr. Taylor’s wife was a nurse, Alice Whitman, who graduated from Johns Hopkins and served as INA president during WWI.

The Board of Nurse Examiners’ sole responsibility was to monitor training schools and administer a test to graduates. The nurse practice act also called for graduates who passed the test and who were given a certificate by the Board to be identified on the register of nurses that was maintained by the Association. Thus began the mutually dependent relationship between the Association and the BON that lasted 40 years. Nurses on the registry were identified as registered nurses and allowed to place the letters R.N. after their name. The $10.00 licensing fee was optional.

1920-1930 Napina Hanley, became

the first registered nurse licensed in Idaho. She later became the nursing school inspector for the state in addition to being the Boise school nurse for more than 30 years. She maintained her license until her death in 1964atage84.Duringhercareer, she served multiple two-yeartermsontheBONin the 1920s and 1930s.

Only 100 nurses had obtained the optional nursing license by 1921. As a result, the law was revised and licensure became mandatory. By 1931, there were 534 licensed nurses and 1,000 nurses in 1940. Between 1925 and 1945, the reoccurring themes of the BON and the INA were that:

(1) INA was supporting the work of the board even though not all nurses belonged and paid dues to the INA,

(2) the BON needed the state to support office space and administrative staff, but the state never allocated funds,

(3) no one had control over unlicensed practical nurses who could be hired for private duty or by physicians in their offices instead of R.N.s, and

(4) hospitals continued to rely on the free labor of nursing students with increasing numbers of programs and students who were minimally supervised by R.N.s. From 1931 until 1943, Sister Mary Alphonsus Mulryan, R.S.M., R.N., administrator of Mercy Hospital in Nampa, served as chairman of the BON. She remains the longest serving chairman in BON history. The last physician was appointed to the BON in 1941. After that time, only nurses were appointeduntilconsumerswereaddedinthe1980s.

1940s-1970The late 1940s posed a nursing crisis in Idaho. Nurses

returning from military duty did not return to hospital nursing. The polio epidemic not only filled the majority of hospital beds, but many nurses stayed away due to fear of contracting this disease. The new Idaho governor was a physician who began a statewide public health service that attracted nurses away from hospitals. To meet the statewide nursing manpower need, the BON worked to recognize a new category of nurse, the licensed practical nurse (LPN). A short course was developed that allowed recognition of existing practical nurses for licensure. Within several

by Randall Hudspeth, MS, APRN-CNS/CNP, FRE, FAANP

Co-author, Charting Idaho Nursing History(Available at: www.IdahoNursingHistory.com,

Hastings Bookstores and eBay)

The Idaho Board of Nursing (BON) marked its 100th anniversary on March 9, 2011. When we were researching and writing Charting Idaho Nursing History, we knew that the work and impact of the BON was integral to the profession’s development throughout the state over the past century. Today the BON enforces standards of nursing education, licenses nurses who meet qualifications, monitors ongoing changes in practice and uses the disciplinary process to remove from practice those nurses who fail to meet standards and to help bring their practice back into compliance for safe return to work. Today’s BON has a much greater role than the BON of 1911 which only served to monitor nursing education programs. This article provides an overview of the BON’s significant contributions to Idaho nursing over the past 100 years.

Birth of the Idaho Board of Nursing

1909-1919How did the BON come into existence and what was its

purpose? Only the Idaho Nurses Association (INA), founded in 1909 and initially called the Idaho State Association ofGraduateNurses, hasbeen in existence longer than theBON. The same nurses were responsible for the formation of both groups between 1909 and 1911. After the Association was established to provide a communication network for trained nurses and to support the betterment of their working and living conditions, hospital nurses noted an increasing number of patients coming for care and treatment who had not been cared for appropriately in their homes. Many patients were suffering from lingering illnesses and had hired home nurses, women without any training, to take care of them. Many home nurses failed to recognize deteriorating care conditions and did not notify the physician in a timely manner. Trained nurses saw this situation as a public health risk and wanted to control those who were presenting themselves as nurses and taking private duty assignments. By following the lead of other states that had established nurse practice acts, Idaho nurses felt they could standardize nurse training programs, maintain a list of appropriately trained nurses and inform patients and physicians about who could and could not work as nurses. These strategies were aimed at providing better and safer care to the public.

The credit for moving Idaho into an era of formal nursing regulation belongs with two nurses: Miss Lillian Long and Mrs. Gertrude Cragin. MissLong was the hospital superintendent and director of the nursing school at St. Luke’s Hospital in Boise. Mrs. Cragin was a young nurse from Chicago who moved to Boise after her physician husband died and she needed to be closer to her family to help care for her young son. Mrs. Cragin later became Boise’s first school nurse. Miss Long was an 1893 graduate of the Good Samaritan Hospital School ofNursing in Portland and also attended the Boston School of Cooking, a necessary nursing skill of the time. After 7 years at St. Luke’s, working to establish a nursing association and serving as its first president, and observing hospitals and nursing schools opening in other Idaho communities, Miss Long understood the need to establish common standards for nursing education and to maintain a registry of nursing graduates.

A Century of Public Protection and Professionalism:The Idaho Board of Nursing 1911-2011

Lillian Long

Napina Hanley

years, the BON recognized formal LPN programs in Idaho hospitals that were 11 months long and prepared LPNs to work under the supervision of an R.N. or physician.

The public need for nursing care had changed by 1951. Hospitals were increasingly complex and new medicines and procedures were being performed. These developments required that the nurse practice act be totally updated. Responsibilities of the BON had evolved to require much more than monitoring schools of nursing. A new act was in place in 1952 and the first executive secretary of the BON was hired, Florence Miles, M.S.N., R.N.

Between 1952 and 1970, the BON was heavily involved with the transition of education from hospitals to the state’s colleges and universities. During the long tenure of GovernorRobert Smylie, his sister,DorothySmylie,R.N.,served on the BON and kept nursing issues on the political radar. As a result, nursing’s influence expanded. By 1969, all diploma schools in Idaho were closing and associate degree nursing programs were approved for Lewiston, Rexburg, Twin Falls, Boise and Coeur d’Alene. The state began allocating more funds to nursing. Since 1952, Idaho State College (later Idaho State University) in Pocatello had offered a baccalaureate nursing program, which expanded over time to satellite programs in Boise, Lewiston and Twin Falls.GovernorSmylieapprovedestablishmentoftheIdahoCommission on Nursing and Nursing Education (ICNNE), to address statewide nursing needs. The BON was made a standing member.

The composition of the BON membership has been ever changing. Although members are political appointees, governors have worked with BON staff to maintain equal geographic representation across the state, a mix of educators and nurses in practice; over time, advanced practice nurses, LPNs and consumers became identified as BON members.

1972 to PresentThe Idaho BON has provided significant national

leadership in the past 40 years. Idaho became the first state to formally recognize nurse practitioners in statute in 1972. Later, the Idaho BON became one of the first to have a formal agreement with the attorney general’s office for legal counsel.Bytheearly1980s,Idahobecameoneofthefirststates to introduce an alternative to discipline program for nurses suffering from addiction or substance abuse. That program, called the Program for Recovering Nurses (PRN), continues to this day and although it has been modified, it remains one of the most sustained programs nationally.

When regulatory boards separated from the American Nurses Association in 1978 and formed the NationalCouncil of State Boards of Nursing (NCSBN), Idaho BON Executive Director Phyllis Sheridan served as a director and vice president of NCSBN and chaired the committee that developed the NCLEX exam. This exam is used today as the national licensure exam for both R.N.s and LPNs. Over the past 25 years, Idaho nurses have participated in multiple national committees and task forces sponsored by NCSBN. The BON has utilized many of the national programs and guidelines such as best practices for state BONs. In 2005, NCBSN recognized the Idaho BON with its Regulatory Achievement Award and in 2009, the American Academy of Nurse Practitioners recognized the Idaho BON for its advocacy work. Sandra Evans, Executive Director of the BON, and Randall Hudspeth, BON member, have recently served on the NCBSN Board of Directors.

The Idaho BON’s mission is public protection. Today much of the daily work is accomplished by the Executive Director and eight board staff with the board members meeting four times yearly to address key regulatory issues and establish policy directives. The sophistication of nursing regulation includes implementing and monitoring systems that both protect the public and the rights of individual nurses. Maintaining ongoing communication with other nursing jurisdictions and organizations has resulted in the recognition of the Idaho BON as a national leader in nursing policy. Nursing education programs and individual nurses, as well as the nursing profession in general, have benefited from a proactive BON; Idaho citizens can be assured that the BON is working to maintain public safety and will respond to frequent requests to meet the public’s needs.

Page 12 • RN Idaho May, June, July 2011

example of family support, parental leave is provided for one year after the birth or adoption of a baby, with full pay and job protection. The leave may be shared between parents.

Informatics is a new nursing specialty and promotes improved quality of care, and the move toward the electronic health record is gaining momentum and use.

We were so pleased to provide a warm welcome for Dr. Honey and for the opportunity to learn more about nursing in New Zealand. A number of partners made the reception possible, including: Dr. Jeri Bigbee, Dr. Val Greenspan,membersofINADistrict31,membersoftheMuGammachapter of Sigma Theta Tau International, St Luke‘s Health System and the Boise State University, School of Nursing which sponsored Dr Honey’s visit from New Zealand. Thanks to all these partners. A very special thank you goes to Dr. Michelle Honey for sharing her valuable insights and knowledge about the strong impact nurses have on health care in New Zealand.

Dr. Honey during her presentation.

by Betty Heaton, RN, BA and Dorothy Witmer, EdD, RN

In1987,theNationalCouncilonAlcoholismandDrugDependence (NCADD) first sponsored April as the month to educate Americans about alcoholism as a treatable and preventable disease. Since then the Substance Abuse and Mental Health Services of the U.S. Department of Health and Human Services, plus many other public and private national groups, have joined the effort to create awareness of a growing problem (NCADD, 2011). Alcoholism is a progressivediseasethatcutsacrossgender,raceandsocio-economic background and impacts the entire family, not only the behavioral and physical health of the alcoholic (Meara, 2011). In more recent years the NCADD has been urging all citizens, organizations, law enforcement, media and others to help stop underage drinking that has increased steadily. A recent national survey showed that nearly 11 million persons 12 to 20 years of age reported drinking the prior month. When these teenagers become high school seniors, thirty percent of them are drinking heavily once a month (NCADD, 2011, p. 3).

The Effects of AlcoholAlcoholism is a chronic disease in which one’s

body becomes dependent on alcohol. The alcoholic is characterized by excessive drinking, inability to stop drinking, and continued drinking despite social and occupational consequences that hurtfully impact oneself and one’s family (Mayo Clinic, 2011). The negative impact of teenage drinking can carry into adulthood (NCADD, 2011).

The Mayo Clinic (2011) staff states, “It’s possible to have a problem with alcohol but not have all the symptoms of alcoholism. This is known as “alcohol abuse,” which means you drink too much and it causes problems in your life although you aren’t completely dependent on alcohol. If you have alcoholism or you abuse alcohol, you may not be able to cut back or quit without help. A number of approaches are available to help you recover from alcoholism, including medications, counseling and self-help groups” (Mayo Clinic, 2011).

The Mayo Clinic (2011) also identifies that short-term effects of alcohol include depression of the central nervous system that results in lowering inhibitions and interferes with judgment. Teenagers who drink alcohol are more likely to become involved in crime, car crashes, and assaults along with problems in school (NCADD, 2011). Long-termeffectsofexcessivedrinkingincludebutarenotlimited to liver damage, gastrointestinal problems, bone loss, and high blood pressure.

Faith Community Nurse ExperiencesAlcoholism is an illness that affects all family

members. One of our Faith Community Nurses (FCN) at the Cathedral of St. John the Evangelist in Boise, Idaho reported on her experiences with the disruptions and painful ramifications of an alcoholic family member. Treatment helped the family member to recover. As a result of her experience, she listed on our parish website the key questions that family members should ask of themselves if they are being negatively affected by alcohol. We also included a question on a recent parish survey about the effects of alcohol on families.

In November of 2010 we distributed a parish survey at St. John’s Cathedral. The question was asked: “Is your family negatively affected by alcohol?” Eight hundred and forty-two(842)peopleansweredthatquestion:Sometimesaffected = 21% (N 177); Always affected = 3% (N 25); and Never affected = 76% (N 640). Although the number of families being affected by alcohol seems relatively low, any number of families with affirmative responses presents a concern.

Fortunately, in the same survey we asked if anyone would like to help us with our health ministry. A physician responded who indicated that he has recovered

from alcohol and drug addiction and offered to counsel parishioners who asked for help. He had completed treatment at the Betty Ford Center. This was a great invitation for two parishioners who asked in the survey to talk to a Parish Nurse. They were seeking help for problems with alcohol and drugs. They were referred to the physician who also agreed to start a support group if the need was indicated. He recommended Alcoholics AnonymousandAl-Anonas resources for alcoholicsandfamily members respectively.

Helpful ResourcesPhysical and emotional issues and consequences not

only affect the alcoholic, but also affect people who love them. Relatives and friends must take care of themselves by seeking advice and support. Therapists, doctors, social workers and clergy will help. Information on Alcoholics Anonymous can be found on www.aa.org. Along with professionals, another support source is Al-Anon FamilyGroups. These groups are inmost communities. To findanAL-AnonorAlateenmeeting,onecancall1-888-425-2666Monday–Friday, 8 a.m. to 6 p.m. ET. Or a personmaygotothewebsite:www.al-anon.alateen.org

Challenge for NursesFaith Community Nurses and all nurses working with

families, especially those with adolescents, are in positions where they can spread the words of the National Council on Alcoholism and Drug Dependence: “Together, We Can Stop Underage Drinking.” Alcoholism should not be ignored. It is not only destructive to the alcoholic; it also causes pain and disruption to each person close to the abuser. It is time to create the awareness of the disease and to use our resources to meet the challenge.

ReferencesCathedral of St. John the Evangelist. (2010). Parish Survey.

Boise, ID: Author.Mayo Clinic. (2011). Alcoholism. Retrieved from www.

mayoclinic.com/health/alcoholismMeara, C. (2011) April Alcohol Awareness Month. Retrieved

from www.centraljersey.com/articles/2011/03/25/cranbury_pressNational Council on Alcoholism and Drug Dependence

(2011). Retrieved from http://www.ncadd.org/program/awareness/community_action_guide_2005

The Alcohol Challenge

Submitted by Ingrid Brudenell, RN, PhD

The Idaho Nurses Association (INA) District 31 and the Mu Gamma Chapter of SigmaTheta Tau International hosted a welcome reception for Dr. Michelle Honey, a visiting nurse scholar from the University of Auckland, New Zealand, on March 7, 2011. The reception was held at the St Luke’s Health System Boise campus. Dr Honey’s research focus is international nursing and informatics. All who attended were treated to delicious refreshments and an interesting presentation about health care in New Zealand. Nurses have a strong voice in setting health policy and care delivery in New Zealand.

Dr. Honey described her country of 4.4 million people and over 40 million sheep, and its health care system where nurses are a key element in health care. The nursing workforce is predominantly female and the average age is 43 years. There are workforce shortages and recruitment of nurses is a priority. The Health Ministry determines what the population really needs rather than what it wants and sets health objectives. Many of these objectives focus on prevention of illness and accidents. Prevention is important and, as an example, school nurses direct efforts to keep children healthy and attending school. There is universal access to care that is subsidized but not free, taxes that are high, and services that are prioritized. Dr. Honey quipped that “We believe a fence at the top of the hill is more important than an ambulance at the bottom.” Another

Michelle Honey

“Kia Ora”* Nurses of Boise*Maori for “Be Well/Healthy”

May, June, July 2011 RN Idaho • Page 13

try to provide the excellent holistic care they deserve. My fellow nurses and I feel that our licenses are in danger because of the high patient loads.”

“I did not become a nurse to tell dying patients, I’m sorry, I do not have time to sit with you right now, could you hold off until after my shift? After 17 years, the realization that I just could not do it anymore was heartbreaking.”

“I leave work every day tearful and exhausted because I do not feel I give my patients the care they deserve because we are so short-handed. There have been increasingmedication errors, and it is getting worse. And rather than blaming the system, it is nurses who get blamed.”

Nurse (Dis)satisfactionInsufficient staffing not only is a poor prognosis for

patients. Studies conclude that insufficient staffing causes nurse burnout, job dissatisfaction and turnover, diminishing patient satisfaction and hospitals’ bottom lines.

Nurses owe it to their patients, the U.S. health care system and themselves to heighten urgency and awareness around safe staffing.

ANA encourages nurses to join this advocacy effort to inform legislators, health care administrators and the public that thecurrent trend–nursesworking longer shifts tocarefor larger numbers of sicker patients, with decreased support staffs–isnotacceptable.

For more information on the ANA’s Safe Staffing Saves Lives campaign visit www.safestaffingsaveslives.org

by Tracy Flynn, RN, MSN

Few nurses have had as profound an influence on nursing practice and theory as Patricia Benner, RN, PhD, FAAN. Perhaps best known for her work From Novice to Expert, Dr. Benner is the highly-respectedauthor of numerous books and articles published over the past 25 years and Professor VIII Emerita, University of California San Francisco. She was the featured speaker at a conference at Northwest Nazarene University May 9th, and recently spoke with Tracy Flynn, Editor of RN Idaho.

Q: Dr. Benner, You led the Carnegie National Nursing Education Study, and Educating Nurses: A Call for Radical Transformation is the result of your findings from that study. One of the overriding concepts is that abstract knowledge must be replaced with teaching that integrates knowledge acquisition and knowledge use. Will you please describe how this can be done effectively in the classroom setting?

Dr. Benner: I think there are many ways to do that. It is very helpful to use unfolding case studies in which to scaffold class information. We tend to have a narrow rational technical view of theory, so we recommend unfolding case studies and the NovEx program. Instead of relying on abstract presentation, it goes right to clinical simulation online to practice what you learned. NovEx has 1,000 simulations. One of the problems facing nursing faculty is that they are already overloaded. Developing simulations in addition to their other duties is daunting. NovEx is a wonderful adjunct in teaching help. I also recommend using narrative pedagogies in which students use first-person stories to describe experiences, andclinical debriefing sessions in which students share with one another what they’ve learned that day. This enhances everyone’s learning.

Q: The Carnegie study discovered widespread reliance among educators on slide presentations, with students dutifully making notes in the margins of slide handouts

and collectively turning pages every sixth slide. I’m sure I wasn’t the only educator who chuckled at the image, for youcouldeasilyhavebeeninoneofmyclasses.Granted,it’s an efficient way to deliver a great deal of information, but there is little time for discussion and no time for integration with other content. How can we, as nurse educators, overcome our reliance on slide presentations and still convey all the information we feel the students need?

Dr. Benner: There are three positions one can take as a nurse educator: the “sage on stage,” in which the teacher is a performer; the student-centric approach inwhich thestudent is treatedasaconsumer;and thepatient-centeredphilosophy in which the practice of patient care is at the center. When patient care becomes the focus, nursing education takes on a new level of seriousness, a new level of engagement. Once you switch to this practice it changes the way you teach to situated narrative, unfolding cases, and inviting patients into your classroom to discuss how they’ve managed chronic illnesses. You teach for deep learning, selecting fewer, more salient topics that students will encounter in a deep way. The key is to change your metaphor for teaching to coaching: you’ve learned the field and are now bringing the focus around to helping students practice well.

Q: Among the four transformation recommendations, you propose moving from an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking that include critical thinking. What does that mean in a practical sense?

Dr. Benner: Nursing education is all very situated. In a situation where things are no longer working, where there’s been a real breakdown, creative and critical thinking is most appropriate. But in a clinical practice you always need to have a place to stand and a way to act. This calls for a central form of practical reasoning: clinical reasoning. It requires that you focus on the patient. When we call everything critical thinking it doesn’t work very well because in every clinical situation we need to use multiple frames of reference. The medical model excludes the social model, and we need to use the nursing grasp of the situation, and we need to understand the patient’s life world; all of this requires multiple frames of reference, of clinical reasoning.

Q: You make the distinction between bioethics and ethical comportment, stating that educators need to build on their strengths in developing students’ ethical comportment. What are some strategies for doing this?

Dr. Benner: This is what we found that was very exciting: we found that we were doing very well as the patient’s last line of defense, and that we have a very strong way of teaching students what it is to be very good at this. But when we asked the question what it is, everyone immediately went to critical ethics. But we also need to teach everyday ethical comportment. We actually do a very good job of this in clinical practice, of being a patient advocate, focused on improving our practice. We actually stand out in the professions. So we propose that we enrich our thinking and language around everyday ethical comportment.

Q: You note in Educating Nurses that a stated goal of the U.S. nursing profession is diversity that more closely reflects the U.S. patient population. Idaho nursing schools share this goal. For example, Lewis-Clark State Collegeactively seeks Native American nursing students. What methods have you observed to be most successful in bringing in a diverse student population?

Dr. Benner: We have to do more recruitment at the school-ageleveltoincreasediversityinnursingeducation.The most popular clinical assignment at Villanova was teaching health lessons in the schools. After the students completed their rotations I saw essays posted in the schools that read “I want to be a Villanova when I grow up.” The children really learn what it is to be healthy. We need a more proactive presence in the schools teaching basic community health.

Q: What key roles do you envision nurses playing as we enact healthcare reform?

Dr. Benner: I’m a strong advocate for holding on to Masters-levelpracticerolesevenasweincreaseDoctoral-level roles. In education it means we’re preparing nurses to go on to get their Masters degrees. That’s why we’re advocatingfortheBSNin10years–sowe’llhaveenoughpractitioners to fill roles. I’m also very strong on Clinical Nurse Specialist roles to keep hospitals where they need to be in providing sophisticated, self-improving, self-developing care.

Transforming Nursing Education:An Interview with Dr. Patricia Benner

Patricia Benner

Nurses everywhere rank staffing as their biggest problem. Research shows it is a problem–for patients:Insufficient nurse staffing is linked with poorer patient outcomes, lengthened hospital stays and increased chance of patient death.

ANA’s Solution to StaffingANA advocates solving the problem by requiring

hospitals to set nurse staffing plans for each hospital unit based on changing conditions:

• Patientacuity(severityofillness)• Patientnumbers• Nurseskillsandexperience• Supportstaff• Technology

This approach is the foundation of the Registered Nurse Safe Staffing Act of 2011 (S. 58/ H.R. 876), which empowers direct care nurses to contribute to staffing plan development through hospital staffing committees. Seven states have passed nurse safe staffing laws that mirror ANA’s approach.

It is flexible, encouraging adjustments as conditions on a hospital unit change. In that way, it differs from a more rigid,mandatorynurse-to-patientratiostrategy.

Nurses’ Stories From Across the U.S.“I work on a women’s medical/surgical unit. I frequently

have 8 patients in addition to supervisory duties. It isoverwhelming taking care of their basic needs, let alone

Safe Staffing Stories from Across the USNurses share their stories of why they left direct patient

care in response to staffing crises.

Study: Inadequate RN Staffing Tied to Increased Mortality, March 2011

A new study shows that inadequate staffing is tied to higherpatientmortality rates–aconclusion that reinforcesthe American Nurses Association’s principles.

RN Safe Staffing Act Re-Introduced in CongressThe RN Safe Staffing Act (S. 58/H.R. 876) was re-

introduced for the 2011-12 session of Congress. It wouldrequire hospitals that participate in Medicare to implement staffing plans, established by a committee comprised by amajorityofdirect-carenurses,foreachnursingunitandshift.

Safe Staffing Saves Lives–ANA’s National Campaign to Solve the Nurse Staffing Crisis

Page 14 • RN Idaho May, June, July 2011

Jeri L. Bigbee, PhD, RN, FNP-BC, FAAN, Jody DeMeyer Endowed Chair

Boise State University, School of Nursing

BackgroundHere in Idaho, we have many strengths; particularly

in our rural and frontier communities. In relation to health and health care, however, too often rural/frontier communties are viewed only from a deficit perspective (Wakeman, 2008). Nurses can help shift that view,consistent with our health promotive philosophy, to focus on the health-related strengths in communities. Then, incollaboration with our communities, we can build on these strengths to help make rural communities even healthier.

At Boise State University School of Nursing, faculty and students are engaged in an ongoing study that reflects this perspective, the “Idaho Rural Community Health Assets Study.” This study utilizes the Asset-Based Community Development (ABCD) approach, a partnership model that increases social capital by building on the existing assets found within communities (Kretzmann, & McKnight, 1993). Assets may include skills and capabilities of individuals and groups within a community, along with institutions and physical resources (Pan, Littlefield, Valladolid, Tapping, & West, 2005). The assets approach to community health nursing, particularly in rural communities, has received limited exposure in the literature (Averill, 2003; Gulley, 2006).The Typology of Community Assets for Health Promotion (Stokols,Grzywacz,McMahan,&Phillips, 2003) appliesthe assets approach specifically to health and serves as part of the conceptual framework for our study. This typology includes material resources (economic, natural, human-madeenvironment, and technological capital) andhuman resources (social, human, and moral capital). The Community-as-Partner Model (Anderson & McFarlane,2011), a nursing framework based on Neuman’s System Model, also serves as a conceptual basis for the study. This study, now in its third year, is conducted as part of our rural nursing elective course each summer. The purpose of this study is to describe and compare rural/frontier residents’ perceived community health assets. Results from our first year of data collection are reported here.

MethodologyUsingacross-sectionaldescriptivedesign,apurposive

convenience sample of 123 adult community residents from three Idaho rural/frontier communities was surveyed in 2009. As wide a variety as possible of participants in terms of gender, age, ethnicity, socioeconomic status, and

“newcomer/old-timer” characteristics was included. Thesample included 70 (56.9%) females and 53 (43.1%) males; 13.9% of the sample were health care providers. The mean age of participants was 46.2 years and they reported living in the community for a mean of 16.6 years. Baccalaureate nursing students conducted short anonymous interviews, askingcommunityresidentstoidentifythreehealth-relatedassets in their community. The responses were categoried using the Community As Partner Model Community Assessment Wheel. In this wheel, the community residents (People) constitute the “core,” which is influenced by seven subsystems–the Physical Environment, Education,Safety & Transportation, Politics & Government, Health& Services, Communication, and Economics. This project was approved through the Boise State University Institutional Review Board prior to data collection.

ResultsA total of 356 community health assets were identified

by the participants. The most frequent response categories for these assets were Health & Services (n = 169, 47.5%), People (n = 70, 19.7%), Recreation (n = 49, 13.8%), andPhysicalEnvironment (n=38,10.7%).Within theHealth& Services category, the most common specific responses focused on the quality of the local hospital, health care providers, and emergency services (see Table 1). The most frequent responses related to the People category focused on healthy lifestyles among community residents, community/family support for one another, community support for health, and less stress. Responses related to Recreation focused on varied recreational/exercise opportunities, community support for recreation, and youth sports. Within the Physical Environment category the most frequent responses focused on clean air and water, healthy climate/environment, and outdoor activities.

Table 1. Most Frequently Cited Rural Community Health Assets

Category Specific Responses

Health & Services Hospital Health care providers Emergency services

People Healthy lifestyles Community/family support Community support for health Less stress

Recreation Varied recreational opportunities Community support for recreation Youth sports

Physical Environment Clean air/water Healthy climate/environment Outdoor activities

ConclusionsThese findings, based on information provided from

residents of three rural Idaho communities, suggest that residents highly value their current health care providers and services, along with their healthy lifestyles, community support for health and recreation and their health promoting physical environments. The results suggest that rural residents perceive the health assets of their communities broadly. Nurses and other community health leaders should encourage their communities to build on these broadly defined health assets, rather than just focusing on their health deficits. By building on their strengths, rural residents will effectively promote healthier communities through positive action.

The author wishes to acknowledge all the community residents and Boise State University nursing students who participated in this study.

This project was supported by the Jody DeMeyer Endowment at Boise State University.

ReferencesAnderson, E. T. & McFarlane, J. (2011). Community as

partner: Theory and practice in nursing (6th ed).. Philadelphia, PA: Lippincott Williams & Wilkins.

Averill, J. (2003). Keys to the puzzle: Recognizing strengths in a rural community. Public Health Nursing, 20(6),449-455.

Gulley,T.(2006).BuildingcommunitycapacityinsouthwestVirginia. Online Journal of Rural Nursing and Health Care, 6(1),21-31.

Kretzmann, J. P. & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community’s assets. Chicago, IL: ACTA Publications.

Pan,R. J.,Littlefield,D.,Valladolid,S.G.,Tapping,P. J.&West, D. C. (2005). Building healthier communities for children and families: Applying asset-based community development tocommunity pediatrics. Pediatrics,115,1185-1188.

Stokols, D., Grzywacz, J. G., McMahan, S., & Phillips, K.(2003). Increasing the health promotive capacity of human environments. American Journal of Health Promotion, 18(1), 4-13.

Wakeman, J. (2008). Rural and remote public health inAustralia: Building on our strengths. Australian Journal of Rural Health,16,52-53.

Building on Our Strengths: The Idaho Rural Community Health Assets Study

May, June, July 2011 RN Idaho • Page 15

In MemoriamThis issue of RN Idaho initiates a new section to honor deceased registered

nurses who graduated from Idaho nursing programs and/or served in Idaho during their nursing careers. Included, when known or when space allows, will be the date when the nurse became deceased and the Idaho nursing program from which he or she graduated. The names will be submitted to the American Nurses Association for inclusion in a memoriam held in conjunction with the House of Delegates. When you learn of a deceased nurse, please submit this information to: ed@idahonurses.org.

Berry, Linneta Irene, 07/01/2006

Biggs, Claire Lucille,St.AlphonsusSchoolofNursing,08/26/2010

Blank, Michael C, Boise State University, 07/02/2006

Block, Shirley C, 09/26/2010

Connell, Leona Catherine,St.AlphonsusSchoolofNursing,08/22/2010

Dimico, Gretchen,Lewis-ClarkStateCollegeattheCoeurd’AleneCenter

Gardner, Juanita Irene, Samaritan Hospital, 03/16/___

Hyde, Roberta, Idaho State University, 07/25/2006

Mendiola, Lydia D.,St.AlphonsusSchoolofNursing,08/24/2010

Neto, Joseph A II, Boise State University, 01/29/2011

Orb, Mary F., Mercy Hospital, 12/30/2010

Smith, Krystle Ellen Murdock,RicksCollege,08/27/2010

Stewart, Clorese Lettenmaier, St. Luke’s Hospital US Army Cadet

Nurse Training Corps, 11/27/2010

Ultican, Dortha R., 07/30/2010

Whipkey, Wanda May, St. Alphonsus School of Nursing, 12/23/2007

Wilson, Genevieve Ann, St. Joseph School of Nursing, 2/16/2011