current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

February, March,April 2017

Brought to you by the Indiana Nurses Foundation (INF) and the Indiana State Nurses Association (ISNA) whosedues paying members make it possible to advocate for nurses and nursing at the state and federal level.

Quarterly publication direct mailed to approximately 106,000 RNs licensed in Indiana.

The BulleTin

Message from the President

Page 9

Page 4

Page 15

northeast indiana Coalition Makes an impact on improving

Mental health

2017 Year of the healthy nurse

A Year of nursing Advocacy:A Personal Journey

Volume 43, No. 2

BECOME A MEMBER of the 2017-2019 Board of Directors

Candidates Needed | Nomination Forms DUE May 1, 2017

For positions available and forms: www.IndianaNurses.org

Your career as a registered nurse is one continuous journey. I ask, is your journey taking you toward your dream? Is your journey professionally satisfying? What steps can you take to enhance your journey?

Step one of your journey was your in-depth perusal of multiple instruction manuals (nursing theory textbooks/procedure manual/clinicals)—your nursing school program. You obtained your license to travel when you passed the NCLEX exam. Then you were ready to travel.

Journey options within our profession are boundless—med-surg, peds, adults, mother child, perioperative, psych, ICU, neonatal, community health, APN, education, management, school nursing, industrial, etc. Travel schedules are extremely flexible: 8, 10, 12 hour shifts, days/night shifts, weekends, full-time, part-time. Essentially, you are in control of your journey. What other profession allows an individual so many options to match their desired life style.

Need a challenge, change your specialty. Need a break, change your specialty or your schedule. Want to share the highlights of your journey, precept a student or an orientee. Tired of the repetitiveness of the scenery within your journey, change your work location. Want to expand the impact of your journey on others, become involved in your professional organization or become legislatively involved.

Regardless of your journey, the ease of your travel will be determined by your physical and mental resilience to change. Hopefully, when you decided to make a change in your journey, you would have weighed the pros and cons of the change. You should have developed a mental map of how your journey would commence. The assessment skills you acquired in nursing school and throughout your career will enable you to continually make minor adjustments in your journey as a nurse.

If you encounter road blocks, detours or when you need to stop for directions in your journey, your nursing peers and your professional organization (ISNA, ANA, etc) are there to assist. In particular, ANA’s Healthy Nurse: Healthy Nation 2017 Grand Challenge is focused on enhancing the resilience of all RNs. The mentally and physically healthy nurse is more resilient and will have a smoother journey throughout his/her career. Take time to delve deeper in the Healthy Nurse: Healthy Nation challenge. Each issue of the ISNAbler electronic newsletter will contain highlights of the challenge.

I encourage you to take that single step into your journey of becoming a healthier, more resilient nurse. Every journey begins with a single step. Make your 2017 nursing journey personally and professional rewarding.

Every Journey Begins with a Single Step

Page 2 • The Bulletin February, March, April 2017

Published by:Arthur L. Davis

Publishing Agency, Inc.

www.indiananurses.org

The BulleTin

An official publication of the Indiana Nurses Foundation and the Indiana State Nurses Association, 2915 North High School Road, Indianapolis, IN 46224-2969. Tel: 317/299-4575. Fax: 317/297-3525. E-mail: info@indiananurses.org. Web site: www.indiananurses.org

Materials may not be reproduced without written permission from the Editor. Views stated may not necessarily represent those of the Indiana Nurses Foundation or the Indiana State Nurses Association.

ISNA StaffGingy Harshey-Meade, MSN, RN, CAE, NEA-BC, CEOBlayne Miley, JD, Director of Policy and Advocacy

Marla Holbrook, BS, Office Manager

ISNA Board of DirectorsOfficers: Diana Sullivan, President; Angie Heckman, Vice-President; Barbara Kelly, Secretary; and Ella Harmeyer, Treasurer.

Directors: Emily Edwards, Lorie Brown, Denise Monahan, and Amy Pettit.

Recent Graduate Director: Audrey Hopper

ISNA Mission StatementISNA works through its members to promote and influence quality nursing and health care.

ISNA accomplishes its mission through unity, advocacy, professionalism, and leadership.

ISNA is a multi-purpose professional association serving registered nurses since 1903.

ISNA is a constituent member of the American Nurses Association.

Address ChangeThe INF Bulletin obtains its mailing list from the Indiana Board of Nursing. Send your address changes to the Indiana Board of Nursing.

Bulletin Copy Deadline DatesAll ISNA members are encouraged to submit material for publication that is of interest to nurses. The material will be reviewed and may be edited for publication. To submit an article mail to The Bulletin, 2915 North High School Road, Indianapolis, IN. 46224-2969 or E-mail to info@indiananurses.org.

The Bulletin is published quarterly every February, May, August and November. Copy deadline is December 15 for publication in the February/March/April The Bulletin; March 15 for May/June/July publication; June 15 for August/September/October, and September 15 for November/December/January.

If you wish additional information or have questions, please contact ISNA headquarters.

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. ISNA 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 Indiana Nurses Foundation 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. ISNA 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 ISNA or those of the national or local associations.

Certification Corner

Sue Johnson

Meghan Johns recently obtained her AWHONN Certification as a Maternal-Newborn nurse and I asked her to discuss what certification means to her as well as sharing some tips for preparing for a certification exam. Here are her responses:

“I wanted to be certified because I’m a NCAT (unit leadership team) co-chair and we talk about importance of certification and bettering our personal career. I wanted to sort of prove to myself my competencies in my specialized area of maternal-newborn. I bought the review book and flipped through that and

concentrated on the case studies in the back. I previously went to a review course offered by our educators and reviewed their PowerPoint presentations.”

Certification “has made me a better nurse and a more confident nurse. Other co-workers congratulated me and asked what I did to prepare and if I had any tips for them when they choose to take the exam. Tips would be to study a little bit of everything because some questions are general and others are very specific. If you go in with confidence and don’t second guess your answers because your first response is usually the correct one.”

Thanks, Meghan for sharing your story and your tips for certification success with us!

Now, it’s YOUR turn! Use Meghan’s tips and succeed in your own certification journey!

Note: I’ve received a request about certification preparation and need help addressing it. “It would be suggestions/pointers on the best way to begin studying for your CCRN. I have worked in a small hospital’s Critical Care for the last 18 years. I have 6 years before I retire and a real goal that I have for myself before I retire is to get my CCRN. Lori Shipley, RN”

If you are a CCRN and can share study tips for that examination, please send to my email and I will share them with Lori.

Do you want to share your certification story with your colleagues? It may encourage them to join you! Please contact me at SueJohn126@comcast.net to share your experiences!

Certification Tips

CHOOSE TO MAKE A DIFFERENCENow hiring for our Marion County Jail in Indianapolis, IN•HealthServicesAdministrator - Clinical Management Experience Required. •ClinicalSupervisor •RNs- Full Time, Part Time, PRN •LPN- Full TimeBenefits: • Payforexperience&ShiftDifferential • Medical,dental&visioncoverage • Life&disabilityinsurance • 401(k)retirementsavingsplan • Advancementopportunities • Paidtraining • UnlimitedCEUsthrough CEUDirect

Newly licensed graduates welcome!For questions contact Cyndy McClimate, MedicalRecruiterat615-263-3148.

Join our heroes at jobs.corecivic.comDrug Free Workplace and EOE

Family Nurse PractitioNer

& NursesRegional Health Clinic is a Federally Qualified Health Center (FQHC) with two locations in Hammond, IN and the one location in East Chicago, IN. Our goal is to provide the community with affordable, accessible healthcare. We offer primary health care and dental care to women, men and children.

Family Nurse Practitioner requires a Bachelor’s degree in Nursing (Master’s degree in Nursing is preferred) and Nurse Practitioner Certification. Candidate must have an active, unrestricted Indiana Registered Nurse License; eligible for Prescriptive Authority through application to Indiana State Board of Nursing. Shift: Days, some Evenings and Saturdays.

Nurses: LPN requires a Practical Nursing Degree and Licensed Practical Nurse in the State of Indiana. RN requires a minimum of an Associate’s Degree in Nursing and Licensed RN in the State of Indiana. Shift: Days, some Evenings and Saturdays.

Bilingual Spanish candidates are preferred.

Please email your resume to: rita.risner@geminus.orgwww.geminus.org

February, March, April 2017 The Bulletin • Page 3

Taking Ownership for thePracticeofNursing

As we move into the new year, advocacy is something we should all be thinking about. After all, decisions are made by those that show up, so now is the time to show up! Who do you want to determine the practice of nursing? You or your friendly banker who also happens to be a legislator? Get involved, get active. It all starts with membership in the Indiana State Nurses Association (ISNA). Nurses supporting Nursing. The next step is getting involved in ISNA. Call us and we will get you involved. Contact ISNA at 1-317-299-4575 or email info@indiananurses.org.

If you have interests other than working with legislators. ISNA has other membership opportunities also:

1. INDIANA Nurses Foundation Board of Directors

2. Research Grant Committee – the committee that selects the winning grants.

3. Abstract Committee – the committee that selects the abstracts for the Annual Convention.

4. The Bylaws Committee

5. The Editorial Committee for the “Bulletin”

6. The PAC – Political Action Committee

7. And finally and most important Members of ISNA’s Board of Directors, the applications, job descriptions and time commitment is all on line

All of these ISNA opportunities can be started by contacting us at 1-317-299-4575 or email info@indiananurses.org.

If you would like to discuss these opportunities contact me at gingy@indiananurses.org so we can arrange a call.

CEO Note

SILVER SPRING, MD – The American public has again ranked nurses as the professionals with the highest honesty and ethical standards, according to a Gallup poll released December 19. The annual poll marks the 15th consecutive year that nurses have been ranked the most trusted out of a wide spectrum of professions, including medical doctors and police officers.

“Every day, millions of nurses are on the front lines in the fight to improve the health of all Americans,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American

NursesRank#1MostTrustedProfessionfor15thYearinaRow

Nurses Association. “Whether nurses are by the bedside or in the board room, we continue to be a trusted resource and a vital part of our nation’s health care system. This poll reflects the trust the public has in us, and we’ll continue to work hard to keep that trust.”

According to the poll, 84 percent of Americans rated nurses’ honesty and ethical standards as “very high” or “high.” The next closest profession, pharmacists, was rated 17 percentage points behind nursing.

“Trust plays an important role in the relationship between nurses and the patients we serve,” said Cipriano. “ANA encourages nurses to draw on that trust to engage with consumers to improve their health and to advocate for patients and for the quality of care in this country. Additionally, I challenge those charged with making health policy at the facility, local, state and national levels, to include the trusted voice of nurses at the decision-making table. No other profession is held in as high regard by the public, and given nursing’s frontline perspective on health care delivery we offer a point of view that is unmatched.”

In 2017, ANA will continue its longstanding efforts to advocate for health system reform. The association is committed to working with the new administration and Congress to advance policy that aligns with its four principles for health system reform: access to care, affordable and equitable care, quality of care and workforce.

Page 4 • The Bulletin February, March, April 2017

Cheryl Griffith

I will always remember 2016 as the year I learned about what it meant and what it took to advocate for nursing practice at the state level and at the national level. My journey started with a humbling experience as a doctoral nursing student going over a checklist to assess how much about health policy I already knew and have participated in doing. What I learned was that I knew very little about how laws are made and this process was far more complicated than Schoolhouse Rock’s little ditty about how a bill becomes a law. First of all, I had never been to Indiana’s statehouse even though I live less than 30 minutes away. I didn’t know who my senators were and the house representative for my district, much less know the difference between the two. On closer reflection, I learned my problem did not necessarily revolve around my not knowing but in my attitude. I learned I was indifferent to the processes that affected my chosen profession and my livelihood. I believed membership and paying my annual dues to ANA and ISNA were enough and left the “fighting” for others to do.

Advocacy is “any action that speaks in favor of, recommends, argues for a cause, supports or defends, or pleads on behalf of others.”1 In 2012, Karen Tomajan, wrote on Advocating for Nurses and Nursing, that nurses in today’s healthcare environment are experiencing unprecedented changes and challenging times…but it has also created emerging opportunities for nurses to positively impact care in many practice settings.2 Advancing the nursing profession is not to be left to who we think are the called few but rather a call-out to individuals to understand it takes a united many to move the proverbial mountain that impacts changes which affect our profession.

This summer, I had the wonderful privilege of attending the American Nurses Association’s 2016

Membership Assembly in Washington, D.C. with the current and previous Indiana State Nurses Association presidents. The 4-day assembly started bright and early at 7:30 in the morning through 9:00 in the evening and even later for those who held office. The Membership Assembly was a formal process that began with a call to order, introductions, establishing a quorum, adoption of standing rules for conduct of business, and adoption of meeting agendas. Microphones were set up in various locations in the meeting room so members would be able to voice their opinions and/or concerns on each agenda item before it was voted on by eligible members using clickers. Each ANA entity (ANCC, ANF, and AAN) also provided a report on their activities and financial status.

Lobby Day was perhaps one of the many highlights of my experience. It began with an early morning briefing of the healthcare bills we would bring to the forefront during our discussions with the office aides from Indiana’s Senators and Representatives. Lobby Day 2016 focused on the following bills: The RN Safe Staffing Act (H.R. 2083/S.1132); Title VII Nursing Workforce Reauthorization Act (H.R. 2713); and The Home Health Care planning Improvement Act (H.R. 2713/S.578). One of the more specific requests for support were changes to the IHSAA bylaws to permit Nurse Practitioners and Physician’s Assistants to be able to continue performing sports physicals which in July, 2016, was amended to reflect the requested changes. Nothing opens one’s eyes more, I think, than experiential learning. Walking up and down Capitol Hill in DC’s summer weather wearing business attire is an experience in itself. The purpose, of course, is to go from office to office and have a brief moment of a senator/representative aide’s time to communicate as succinctly as possible what you want them to act on and why. It takes the nurse’s

presence and the sum of his/her experiences and knowledge to tell stories that frames the importance of a bill in such a way and gives perspective to what it is we are advocating for.

This September, ISNA packed the room with members, students, and guests at the annual state convention held at IU Kokomo. The purpose of the annual convention is to increase awareness of health policy needs at the state level and to further communicate activities being done at the national level. The theme that was impressed upon me this year after attending both gatherings is there is power in numbers. Did you know there are 4,011,911 professionally active nurses to 926,119 physicians in the U.S.3,4 Imagine what could be accomplished!

There are three things I learned as I reflected on my own journey of becoming a more active advocate of the nursing profession. The first is nurses need to be mentored on how to become advocates. It isn’t enough to invite someone to a meeting nor to join. Someone needs to invest a little time to show you the ropes and demystify this process. The second requires an action plan. It isn’t enough to feel warm all over after an uplifting experience because eventually, the feeling goes away. That plan of action should, at the very least, include membership to ANA/ISNA. Membership has its perks along with getting information that keeps you up-to-date on healthcare issues and agendas like ISNAbler or ANA’s Nursing Insider. The third, is to establish and/or maintain relationships with elected politicians/officials—whether you voted for them or not. One site you may find helpful as you explore advocacy is https://www.usa.gov/elected-officials. Election 2016 is over but the nurses’ work of advocating for patients, population health, and the profession is ongoing. What about you? Will 2017 be the year you embark on your own personal journey of nursing advocacy?

References:1) Alliance for Justice. (n.d.). What is advocacy?

Definitions and examples. Retrieved from https://mffh.org/wordpress/wp-content/uploads/2016/04/AFJ_what-is-advocacy.pdf

2) Tomajan, K. (2012). Advocating for nurses and nursing. The Online Journal of issues in Nursing, 17(1). Retrieved from http://nursingworld.or g /Ma i n MenuCategor ies/A NA Ma rket place/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocating-for-Nurses.html

3) Kaiser Family Foundation. (2016, September). Total number of professionally active nurses. Retrieved from http://kff.org/other/state-indicator/total-registered-nurses/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

4) Kaiser Family Foundation. (2016, September). Total professionally active physicians. Retrieved from http://kff.org/other/state-indicator/total-active-physicians/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

AYearofNursingAdvocacy:APersonalJourney

•RN’sbecomeBachelorprepared

in as few as 16months

•$350.00 percredithour

•100% online

http://nursingonline.pnw.edu

At Parkview, you can experience:

We are looking for APNs, RNs, LPNs.All shifts available. Inpatient and outpatient. 8 and 12 hour shifts.

Plus a Director of Nursing for our inpatient unit, must be Master’s level.

www.fourcounty.org

Amy Coplen, Employment Coordinator, 574-722-5151 ext 2403

February, March, April 2017 The Bulletin • Page 5

Indiana Nurses Foundation

Indiana State Nursing Association (ISNA), through the charitable arm of the Indiana Nurses Foundation (INF) is back and more dedicated than ever to bring the power of nursing to the development and innovation of Indiana healthcare. INF has a long and proud history of providing educational, scientific, and charitable opportunities to Indiana nurses. Our organization recognizes the power of the nursing lens and our ability to use our experiences as nurses to address complex issues,

offer pragmatic solutions, and holistically implement those solutions through interpersonal relationships to achieve specific goals. If you feel like you are not using your specific nursing gifts to their full potential, if you crave opportunities for mentored leadership, and if you want a place to network with others who understand what nurses are capable of, join me at ISNA. In the last two years, I have made significant advances in the development of my individual voice and have realized the powerful implications of our collective nursing voice. It is an exciting time to take advantage of opportunities and research grants through INF that were established by brave and forward thinking nurse leaders who came together to improve health through the power of nursing. Come be part of making history and transforming our future.

AudreyHopperRecentGraduate

Director

Did you know theINFBulletin goes to all

registered nurses in Indiana for FREE?

Arthur L. Davis Publishing Agency, Inc. does a great job of contacting advertisers, who support the publication of our newsletter. Without Arthur L. Davis Publishing Agency, Inc. and advertising support, ISNA and the INF would not be able to provide the newsletter to all the nurses in Indiana.

Now that you know that, did you know receiving the INFBulletindoes not automatically provide

membership to the Indiana State Nurses Association?

ISNA needs you! The Indiana State Nurses Association works for the nursing profession as a whole in Indiana. Without the financial and volunteer support of our members, our work would not be possible. Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels. The ISNA works hard to bring the VOICE of nursing to the Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education.

At the national level, American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/ regulators, supports continuing education and provides a unified nationwide network for the voice of nurses.

Now is the time!

Now is the time to join your state nurses association!

Visit www.indiananurses.org to join or call 1(800)923-7709.

Be comfortable at work!The perfect scrub pant for those who live in yoga pants.

Available now at

Yoga scrub pants by MC2 are so comfortable you’ll need a pair for home

and for work. They have the same EZ-FLEX fabric you’ve come to love from

the rest of Med Couture’s line, with the added comfort of a knit waistband.

Front side pockets, double cargo pockets and an extra accessory pocket

mean these pants aren’t just stylish, they’re highly functional.

Try a pair today!

Page 6 • The Bulletin February, March, April 2017

Policy Primer

Blayne Miley, JDISNADirectorofPolicy&Advocacy

The General Assembly is back in session, and once again there is a flurry of legislative activity that impacts you. ISNA represents you at the Statehouse. ISNA members receive weekly updates through the ISNAbler, our e-newsletter, and action alerts through our voluntary Grassroots Advocacy Network. I encourage all of you to be involved in the discussions that shape your world by contacting your state legislators!

2017 Indiana General Assembly SessionLegislation

First and foremost, two bills have been introduced to retire the collaborative practice agreement requirement for Indiana advanced practice nurses (HB 1474 & HB 1409). HB 1474 also changes the title terminology in Indiana from advanced practice nurse to advanced practice registered nurse, and makes both graduate education and national certification eligibility requirements for qualifying as an APRN (with a grandfather exception). You can read the full text of these and all the other bills mentioned below at iga.in.gov. You can help by contacting your state legislators to express your support.

Here are some other areas of emphasis this session.

CBD/Hemp Oil/Medical MarijuanaTwelve bills have been introduced to expand

access to either cannabidiol, hemp oil, or medical marijuana. Generally, the bills take one of three approaches: (1) disease specific access for epilepsy, Dravet Syndrome or Lennox-Gastaut Syndrom (SB 15, SB 327, HB 1177, HB 1347, HB 1475); (2) allowing research or clinical trials (SB 132, SB 255, HB 1316); or (3) broad-based authorization of the substance (HB 1050, HB 1252, HB 1303, HB 1356). The mechanics of this allowance is to grant criminal immunity to those involved. Some bills have an additional regulatory step of creating a registry or government board with oversight authority of authorizations. The introduced versions of all of the bills limited any participation of providers to physicians. ISNA is working at the Statehouse to expand inclusion to nurses, otherwise if these treatments are delivered to patients through provider offices, nurses would have to be shielded from the process.

Opioid EpidemicIndiana legislators are very focused on

combatting the opioid epidemic in our state and are taking a multi-faceted approach to find solutions. State Senator Jim Merritt has announced a goal to kill heroin in five years, and he is championing many bills aimed at addressing the drug problem. A sampling of all of the bills related to drug treatment and prevention is below:

Allow Those Convicted of Drug Offenses to Receive SNAP Benefits - SB 9: Indiana currently prohibits those convicted of any drug offense from receiving supplemental nutrition assistance program (SNAP) benefits. SB 9 removes that prohibition through a federal opt out.

Requires Coroners to Perform a Comprehensive Drug Panel and Report Overdose Deaths - SB 74: Establishes the forensic toxicology reimbursement program to fund the cost of the panels.

Health Insurance Plans Must Cover an Abuse Deterrent Opioid Analgesic - SB 11 & HB 1544: The coverage cannot be subject to dollar limits, copays, deductibles, coinsurance, or step therapy (requiring an individual to try another drug and have it not work before the insurer will reimburse for the abuse deterrent opioid analgesic).

Add Pain Management to INSPECT - SB 151: Adds an available INSPECT entry for when a patient is participating in a pain management contract with a designated practitioner.

Report on Indiana’s Rehab Treatment Capacity - SB 153: Require the Health Department and FSSA to report to the legislature the number, location, and availability of beds in Indiana used for drug and alcohol detox, treatment, and rehab, as well as the location and description of state owned buildings available for conversion to provide more beds.

More Reporting Requirements for Opioid Treatment Programs - SB 156: Requires opioid treatment programs to report the number of patients who are receiving behavioral health services in addition to medication, the average mileage a patient travels to receive treatment, and the patient relapse rate or average time an individual is in the program. 

Workgroup on Overdose Intervention Drug Data Collection - SB 157: Requires the Professional Licensing Agency to assemble a workgroup of emt’s, law enforcement, RNs, paramedics, pharmacists, and physicians to evaluate the cost and feasibility of using INSPECT to catalog each administration of an overdose intervention drug by an emergency medical services provider and to catalog data related to law enforcement investigations involving both a non-opiate controlled substance and death, overdose, forgery, fraud, or theft.

Limit Opioid Prescriptions to 7 Days for Certain Patients - SB 226: If a patient is being prescribed opioids for the first time or is a minor, the prescriber may only issue a seven day supply unless the prescription is for pain management, cancer, or palliative care. Also allows a pharmacist to dispense less than the prescribed amount at the request of the patient, parent or guardian.

Controlled Substance Prescribers Must Participate in INSPECT - SB 247: Requires any prescriber of controlled substances to be certified to receive information from the INSPECT program.

More Drug Testing of Opioid Treatment Program Patients - SB 375: Currently, the programs must “periodically and randomly” test their participants. SB 375 mandates that the patients must be drug tested at least 16 times every 12 months.

Prescribed Schedule II Drugs Must Be Dispensed in a Blister Pack - SB 403: Requires schedule II controlled substances to be distributed or dispensed only in a blister pack.

INSPECT Checks & Data Entry - SB 408: Practitioners must check INSPECT before prescribing ephedrine, pseudoephedrine, or a controlled substance. Requires INSPECT entries to be entered on a real time basis.

More Emergency Medications in Schools - SB 392 & HB 1542: Currently, schools may have stock auto-injectable epinephrine. These bills add albuterol and naloxone, and changes auto-injectable epinephrine to epinephrine. It also provides civil immunity for any healthcare provider training school employees in the administration of the emergency medications, and requires the school to report all administrations to the Department of Education.

Regional Opiate Addiction Treatment Pilot Programs - SB 445  & SB 446: Both bills create a pilot program for opiate addiction treatment. SB 445 is targeted at high-need underserved regional areas. Only abstinence-based programs that do not treat with methadone are eligible to apply for grants, which will be administered by the Division of Mental Health and Addiction. SB 445 is assigned to the Health & Provider Services Committee. SB 446 is for expectant mothers, and could support programs such as Nurse Family Partnership and Fresh Start Recovery Centers.

Medicaid Reimbursement for Inpatient Detox - SB 489: The Medicaid reimbursement for inpatient substance abuse detoxification services will be at a per diem rate that factors in the average length of stay for a patient for the reimbursed diagnosis related group.

Medicaid Reimbursement for Addiction Treatment Teams - HB 1541: The team must consist of at least (1) an APN or PA, (2) an addiction counselor or licensed therapist, and (3) a recovery coach. HB 1541 is assigned to the Public Health Committee. 

Healthcare Workplace No bill has been introduced yet this session

to increase the criminal penalty for assaulting a nurse in the workplace, however there have been bills introduced to provide that protection to sports officials and utility workers. Here are the bills related to the healthcare workplace:

Study Committee on the Nursing Shortage - SB 538: Recommends an interim study committee on the shortage of healthcare providers in Indiana, specifically nurses and nursing faculty.

Expand Hospital Police Departments - SB 112: Hospital police departments currently must operate on the property of a hospital. SB 112 expands property to include surrounding grounds and hospital satellite offices and facilities. It also allows them to function at a health system, which is defined as any entity affiliated with the parent corporation of a hospital or any entity affiliated with the hospital through ownership, governance, or membership.

Limit Use of Air Ambulance Services - SB 119: Requires the Indiana Emergency Medical Services Commission and the Department of Health to evaluate the use of air ambulance services in Indiana and implement statewide standards with the goal of preventing the overuse of air ambulance services. This does not apply to transfers between health facilities. 

Mandatory Hospital Employee Immunizations - SB 133: This bill is very similar to the immunization bill from last session, and it has the same problems: allows hospitals to overrule an individual’s healthcare provider regarding whether an immunization is needed or medically contraindicated, allows hospitals to overrule an individual’s determination of whether the individual’s religion precludes immunizations, and provides hospitals immunity for wrongful termination of employees. Moreover, nurses are not even included in the bill’s definition of “health care professional.”

Ask Patients About Organ Donation Upon Admission - HB 1068: Requires hospitals to ask admitted patients or their healthcare representative whether the patient wants to be an organ donor as soon as practicable following admission and before any transfer to another facility. Requires the answer to be documented in the patient’s medical record.

Whistleblower Protection at Nursing Homes - SB 134: Prohibits retaliatory actions against a health facility employee who in good faith files an allegation that the facility has breached their regulatory duties.

Criminal Background Checks for Nursing Home Employees - SB 147: Requires nursing home employees to have the same criminal background checks as home health employees, and prohibits those convicted of certain crimes from working at a nursing home.

Registry of Nursing Home Complaints - SB 388: Requires the Health Department to create a statewide database for substantiated complaints against nursing homes.

Central Registry for Healthcare Worker Misconduct - SB 509: Requires the Health Department to establish a database of substantiated reports and allegations under investigation of misconduct by any healthcare facility employee (licensed or unlicensed) with direct patient contact. Includes hospitals, nursing homes, home health agencies, and more. Requires healthcare facilities to check the registry before hiring an employee and allows facilities to disclose information to other facilities regarding potential hires.

Home Health Agencies Must Drug Test Employees - SB 513: Requires home health agencies to drug test all applicants, and to test all employees at least annually, as well as when the agency has reasonable suspicion the employee is engaged in the illegal use of a controlled substance. Allows the agencies to discipline or terminate employees for a positive result or a refusal.

Home Health Must Give 15 Days Notice Before Stopping Services - HB 1443: The notification must be in writing.

Longterm Care Omnibus - HB 1493: Requires a home and community based services program for individuals who are aged or disabled to include reimbursement for assisted living services.

February, March, April 2017 The Bulletin • Page 7

Prohibits Medicaid from including individuals who receive nursing facility services in a risk based managed care program or a capitated managed care program. Expands home and community based services.

Public HealthEasier Authorization for Needle Exchange - HB

1438: Allows a county or municipality to approve a needle exchange program for up to two years. This eliminates the requirement of state health commissioner approval.

Food Desert Pilot Program - SB 277: Creates a $2 million pilot grant program to assist entities that offer fresh or unprocessed foods to an underserved area. The grants must be distributed in each part of the state. A very similar bill was introduced last session, which passed the Senate then was converted to an interim study committee recommendation in the House. The material differences in the new version are the requirement of geographic diversity and double the amount of appropriation.

Healthy Food Grant Program - HB 1060: HB 1060 establishes a fund to be administered by the Indiana Housing and Community Development Authority to increase the availability of fresh foods in underserved communities. It appropriates $10 million over two years to the

fund. This bill is similar to the food desert bill from last session.

Food Desert Grants - HB 1425: Establishes the food deserts fund for the Health Department to award grants to increase access to fresh and unprocessed foods in food deserts. Unlike SB 277 and HB 1060, this bill does not make an appropriation to fund the grant.

State to Develop Cervical Cancer Plan - HB 1278: Requires the Health Department and FSSA to develop a strategic plan to identify and significantly reduce morbidity and mortality from cervical cancer. The introduced version of the bill recommended medical and dental schools participate in the workgroup. ISNA secured an amendment to add nursing schools to this list.

Increase the Cigarette Tax - HB 1320: Increases the cigarette tax by $2 per pack and earmarks the additional revenue for tobacco cessation/prevention and medical residency.

Tax E-Liquids - HB 1476: Imposes a 10 cents per milliliter tax on e-liquids, which are used for vaping. Appropriates half the colelcted revenue to the general fund and half to the addiction services fund.

Increase Cigarette Tax by $1 - HB 1490: Also redistributes the apportionment of cigarette tax revenue by providing more for Medicaid reimbursements and less for other areas. 

I welcome input from any nurse or nursing student on any of the pending bills. If you have any comments, please send them my way: bmiley@indiananurses.org.

Policy Conference

The 2017 ISNA Policy Conference on February 20th will be a CNE opportunity for you to learn more about the pending healthcare bills, discuss the session with state legislators, and hear from Indiana’s new drug czar Jim McClelland on our state’s multi-agency approach to drug treatment, prevention, and enforcement. Registration is still open at www.indiananurses.org!

ISNA DNP InternshipI want to extend my gratitude to Leah Schalf,

MSN, RN, NE-BC, who was ISNA’s first DNP policy intern last fall. Her contributions to ISNA were extremely valuable, especially in making the 2016 ISNA Convention such a great event! She laid the foundation for the success of those that follow her in the program. Our current participant is Stephanie Baranko, MSN, RN, who is pursuing her DNP at IU School of Nursing, and who will be writing an article for your reading pleasure to appear in the next edition of the Bulletin.

Page 8 • The Bulletin February, March, April 2017

ISNA Welcomes Our New and Reinstated Members

The ISNA is a Constituent Member of the American Nurses Association

APPLICATION FOR RN MEMBERSHIP in ANA / ISNAOr complete online at www.NursingWorld.org

PLEASE PRINT OR TYPE

_____________________________________________________________________________ ____________________________________Last Name, First Name, Middle Initial Name of Basic School of Nursing

______________________________________ ____________________________________ ____________________________________Street or P.O. Box Home phone number & area code Graduation Month & Year

______________________________________ ____________________________________ ____________________________________County of Residence Work phone number & area code RN License Number State

______________________________________ ____________________________________ ____________________________________City, State, Zip+4 Preferred email address Name of membership sponsor

1. SELECT PAY CATEGORY

_________ Full Dues – 100%Employed full or part time.Annual – $281Monthly (EDPP) – $23.92

_________ Reduced Dues – 50%Not employed; full-time student, or 62 years or older. Annual – $140.50Monthly (EDPP) – $12.39

_________ Special Dues – 25%62 years or older and not employed or permanently disabled. Annual – $70.25Monthly (EDPP) $6.85

2. SELECT PAYMENT TYPE

_________ FULL PAY – CheCk

_________ FULL PAY – BANkCARD

_________________________________________________________ Card Number

_________________________________________________________VISA/Master card Exp. Date

_________________________________________________________Signature for Bankcard Payment

_________ ELECTRONIC DUES PAYMENT PLAN, MONTHLY

The Electronic Dues Payment Plan (EDPP) provides for convenient monthly payment of dues through automatic monthly electronic transfer from your checking account.

To authorize this method of monthly payment of dues, please read, sign the authorization below, and enclose a check for the first month (full reduced $12.38).

This authorizes ANA to withdraw 1/12 of my annual dues and the specified service fee of $0.50 each month from my checking account. It is to be withdrawn on/after the 15th day of each month. The checking account designated and maintained is as shown on the enclosed check.

The amount to be withdrawn is $ _______________ each month. ANA is authorized to change the amount by giving me (the under-signed) thirty (30) days written notice.

To cancel the authorization, I will provide ANA written notification thirty (30) days prior to the deduction date.

_________________________________________________________________Signature for Electronic Dues Payment Plan

3. SEND COMPLETED FORM AND PAYMENT TO: Customer and Member Billing American Nurses Association P.O. Box 504345 St. Louis, MO 63150-4345

✁

GETYOURPROFESSIONALTOOLKIT LICENSE–BOARDOFNURSING

MEMBERSHIP–INDIANASTATENURSESASSOCIATION(ISNA)

ISNAISCARINGFORYOUWHILEYOUPRACTICEWWW.INDIANANURSES.ORG

✁

Pamela Azad Alexandria, KYDebbie Bagley Martinsville, INStephanie Baranko Whiting, INJeanine Bardoczi Dyer, INMary Barrett Richmond, INDeborah Barton Selma, INVictoria Bean Millersburg, INTracee Boyles Lebanon, INTammy Bradford Avon, INPaula Brinkley Boonville, INKellie Cearing Cedar Lake, INL Kathleen Cerbin South Bend, INShirley Comer Griffith, INCarolyn Cook Cannelton, INTeresa Dobrzykowski South Bend, INCassandra Farmer Indianapolis, INSheilah Ferguson DuPont, INNancy Gallagher Zionsville, INRebecca Granger Noblesville, INIrina Green Fort Wayne, INChristina Hall Rushville, INTonya Head Evansville, INStephanie Heckman Indianapolis, INAgnes Hobson Brownsburg, INRhonda Jackson Indianapolis, INCassandra Karney Cedar Lake, INKathy Kasper Valparaiso, IN

Karen Kautz Carmel, INRon Kraus Fishers, INJennifer Krohn Harlan, INElizabeth Linden Meridian Hills, INYvonne Lu Indianapolis, INJessica Luegers Holland, INKathy Lynch Kouts, INHillary Marcum Dunkirk, INWendy McClure Knightstown, INMichelle McPeak Franklin, INAmy Meek Spencer, INYvonne Miller-Borsadi Mishawaka, INJeannie Moon Columbus, INToni Morris Indianapolis, INCharlene Phelps Indianapolis, INKathleen Pickrell Terre Haute, INKatheryn Plankenhorn Hagerstown, INLindsay Plummer Bloomington, INCara Popenhagen Hobart, INCs Riggle Richmond, INJean Ross McCordsville, INCarol Rozelle Merrillville, INHeidi Self Indianapolis, INDiana Shenefield Huntington, IN

Judy Sieg Corydon, INCarol Skaggs Martinsville, INSusan Slawson Richmond, INAmy Spencer Demotte, INJason Straw Westfield, INMaureen Stroka South Bend, INWilliam Sudlow Cutler, INJudy Swigart Kokomo, INSamantha Tiede Churubusco, INRebecca Timberman Russiaville, INSharon Tobin Indianapolis, INCindy Trubey Cicero, INAnn Uhar Carmel, INCaitlin Vlaeminck Granger, INAngelett Wells South Bend, INDonna West Evansville, INLaura Wheeler Goshen, INJ. Whitacre Fort Wayne, INChristina Wiebke Fort Wayne, INKelly Williams Saint John, INSusan Wissing Syracuse, INJudy Wonning Seymour, INBrandee Wornhoff Danville, INHolly Young-Reese Fort Wayne, IN

Br and new State- of-the-art facil it y

One location that provides all healthcare needs. A new, 350,000 sq. ft. state of the art facility, conveniently located with easy access just off Interstate 74, about 25 miles SE of Indianapolis, will be home to nearly all of our physicians. Patients will have their doctors appointment, lab work, and imaging all completed in one location.

All healthcare needs on one campus.The new MHP Medical Center will be home to 30 Primary Care providers and 27 Specialist Physicians.

56 private inpatient rooms.Each room has been designed to provide the patient with new treatment technologies and to promote shorter patient stays - which equals a cost savings to the patient. Also included in the new MHP Medical Center are 38 outpatient rooms in our newly designed Ambulatory Care Center.

For more information on open positions or to apply, visit our website

www.mymhp.org

Our programs focus on:•extensiveclinicalexperience•provenstudentoutcomesonlicensure/certifications•nationallyrecognizedfaculty

We are currently offering the following degrees: •BachelorofScienceinNursing •PostMSNCertificate•RNCompletion(RN-BSN) •DoctorofNursingPractice•MasterofScienceinNursing

USI nursing promotes:•highlysoughtworkplaceskills •flexiblecoursedelivery•onlineeducation •valuableclinicalexperiences

For more information about these programs, please visit our website at http://USI.edu/health

Knowledge for Life

February, March, April 2017 The Bulletin • Page 9

MindyYoder,DNP,RN,FNP-BCandKristina Johnson, MBA

People living with a mental health condition pay a hefty price with the stigma of mental illness and the emotional rollercoaster they often face as they deal with symptoms. But insufficient mental health resources mean that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates that benefits for those who cannot support themselves, cost of care and lost productivity cost the U.S. economy more than $444 billion each year.

One in five adults in America will experience a mental health condition each year. Yet, according to the National Alliance on Mental Illness (NAMI), nearly 60 percent of adults with a mental health condition didn’t receive mental health services in the previous year. Some don’t know where to go for help, and others won’t seek help because of stigma.

According to Indiana University Richard M. Fairbanks School of Public Health, drug addiction is taking an increasing severe toll on the health of many Hoosiers. Poisoning is now the leading cause of injury death in Indiana, and drug overdoses cause more than nine out of ten poisoning deaths. In 2014, more than 1,100 Hoosiers died from drug poisoning, marking a 500% increase since 1999 and placing Indiana 15th nationwide for drug overdose fatalities.

Indiana University has also published in their Report on the Toll of Opioid Use in Indiana and Marion County that prescription drug misuse is having a significant impact on Indiana employers, with 80 percent of Indiana employers having observed misuse by their employees. Opioid use disorder in Indiana resulted in $31.9 million in costs for nonfatal ER visits, $64.1 million

for hospitalizations of babies with Neonatal Abstinence Syndrome, $350 million for related hospitalizations, and $1.4 billion from drug overdose fatalities, which includes medical costs and lost lifetime earnings for victims. Indiana also leads the nation in pharmacy robberies for opioids.

Indiana leads the nation in youth suicide statistics. In a national survey conducted by the Indiana Youth Institute, Indiana had the nation’s highest rate of students who have contemplated suicide (19%), and the country’s second-highest rate of high school students who have attempted suicide (11%). Suicide has been the second-leading cause of death for young Hoosiers between the ages of 15 and 24 since 2009.

Because of the mental health situation in Indiana and across the nation, The Lutheran Foundation, located in Fort Wayne and serving ten Northeast Indiana counties, has focused their efforts on mental and behavioral health and wellness. This has led to the creation of LookUpIndiana.org, a web-based resource designed to provide mental and behavioral health information, two crisis connections (providing a 1-800# and text-to-chat options), and campaigns to reduce the stigma associated with these serious mental health issues. At LookUpIndiana.org, visitors can search for providers throughout northeast Indiana, read relevant information, browse recent news and blog posts, check for upcoming events and find help 24/7, 365 days a year. Plans are underway to expand the website state-wide.

Additionally, The Lutheran Foundation founded a regional mental health coalition, serving Northeast Indiana. This Coalition is led by a 25-member leadership council consisting of area experts representing many segments of our community. The initiatives of the Coalition are directed by this leadership team. Some initiatives involving the medical community include:

1) Getting help for expectant mothers who are living with a substance use disorder. We seek help for these mothers, but also to lessen the negative effects of neonatal abstinence syndrome (NAS). This initiative includes input from OB/GYN doctors, neonatologists, and the department of child services (DCS). The hope is for mothers to not fear seeking help for their addiction, and for doctors to have the pathways to care and resources they need for their patients.

2) Recruiting primary doctors and their medical team to help with medication-assisted treatment for patients living with substance use disorder. There are not enough mental health facilities to handle the epidemic alone.

3) Educating primary care doctors and their medical team on the importance of administering mental health screenings for their patients, and providing them with the most efficient assessment tools, and with pathways to guide them on where to send patients with positive screenings.

4) Educating primary care doctors, dentists and oral surgeons on the risks of over-prescribing opioids for pain.

5) Working with higher education to ensure mental health and opioid education is included in healthcare majors.

Lastly, LookUpIndiana and the Coalition are focused on campaigns to reduce suicide, and

the stigma associated with mental illness and substance use disorder. Understanding that a mental health condition should not be viewed any differently than any other chronic health condition is critical. The majority readily seek treatment for diabetes, or heart disease, and yet many are hesitant to seek help for conditions like depression, anxiety, or substance use disorder.

Substance use disorder is a chronic brain disease that can happen to anyone. Perceptions about what an ‘addict’ looks

like, and how people become addicted, couldn’t be further from reality. As an example, people can become addicted to prescription painkillers, often unintentionally with the help from a well-meaning healthcare provider. It is important for people to know they are not alone. There is help. There is hope. There is a resource available called LookUpIndiana.org.

Northeast Indiana Coalition Makes an Impact on Improving MentalHealth

MindyYoder Kristina Johnson

Gallup Indian Medical Center Hiring New Graduate & Experienced Nurses.

79 Bed Facility, Baby Friendly Certified, Trauma III designated hospital bordering the Navajo Reservation.

Positions available within ER, Medical/Surgical, OB/L&D, ICU, Ambulatory Care & Specialty Nurse Positions.

We offer:Up to 25% Relocation and Recruitment Incentives

Competitive Salaries | Loan Repayment Program

Contact:Myra Cousens, BSN, Nurse Recruiter

505.726.8549 | myra.cousens@ihs.govI.H.S. is required by law to give absolute preference to qualified

Indian applicants. Equal Opportunity Employer.

Page 10 • The Bulletin February, March, April 2017

Independent Study

This independent study has been developed for nurses to better understand the Indiana Physician Orders for Scope of Treatment (POST) and how nurses can be involved. 1.1 contact hours will be awarded for successful completion of this independent study.

The Ohio Nurses Association (OBN-001-91) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Expires 12/2017.

DIRECTIONS:1. Please read carefully the article entitled, “Indiana Physician Orders

for Scope of Treatment (POST): Implications for Nurses” and watch the video imbedded in the article.

2. Complete the post-test, evaluation, and registration form.3. When you have completed all of the information, return the

following to the Indiana State Nurses Association, 2915 N. High School Road, Indianapolis, IN 46224:a. The post-testb. The completed registration formc. The evaluation formd. A $20 check for processing.

The post-test will be reviewed. If a score of 70 percent or better is achieved, a certificate will be sent to you. If a score of 70 percent is not achieved, a letter of notification of the final score and a second post-test will be sent to you. We recommend that this independent study be reviewed prior to taking the second post-test. If a score of 70 percent is achieved on the second post-test, a certificate will be issued.

If you have any questions, please feel free to call Marla Holbrook at Indiana State Nurses Association, 2915 N. High School Road, Indianapolis, IN 46224, 317-299-4575 or mholbrook@indiananurses.org.

OBJECTIVES:1. Learn about the history of Indiana Physician Orders for Scope of

Treatment (POST).2. Understand the application of Indiana POST and the role of the

nurse in working with patients and families.3. Apply knowledge to case studies.4. Increase comfort level in having POST discussions.

This independent study was developed by Kathleen Rathke, MSN, MBA, NP-C, IU Health Physicians/OPTIMISTIC Project and Susan Hickman, PhD., Indiana University School of Nursing/OPTIMISTIC Project/Indiana Patient Preferences Coalition. The authors and planning committee members have declared no conflict of interest.

Disclaimer: Information in this study is intended for educational purposes only. It is not intended to provide legal and/or medical advice.

KathleenRathke,MBA,MSN,NP-CTheOPTIMISTICProjectIUHealthPhysicians

SusanHickman,PhDTheOPTIMISTICProject

IndianaUniversitySchoolofNursingIndianaPatientPreferencesCoalition

Acknowledgement:JennaConstantino,EstherEisman,RussEvans,MelanieParks,andLisaParobekprovidedcontent,editing,andfocusgroupsupport.

SummaryThe Indiana Physician Orders for Scope of Treatment (POST) is an

advance care planning tool that aids patients and families in decision-making about end of life care.

The tool is used to document treatment preferences as medical orders that are valid throughout the healthcare system. POST-eligible patients have advanced chronic progressive disease or frailty, terminal conditions, or are unlikely to benefit from cardiopulmonary resuscitation, making decisions about the life-sustaining treatments timely and important (Indiana State Department of Health, 2013). Nurses can play a key role in ensuring that patients’ preferences for end of life care are known and honored across all care settings. This is consistent with the vital element of nursing practice calling for “advocacy in the care of individuals, families, groups, communities, and populations” (American Nurses Association, 2016, para. 1).

OverviewThe Indiana Physician Orders for Scope of Treatment (POST) is an

advance care planning tool designed to provide standardized medical orders for patients with life-limiting illness. This form transfers with the patient from facility to facility and serves as an actionable order in the patient’s chart. Nurses can and should perform a key role in ensuring that patients’ preferences for end of life care are known and honored across all care settings. This is consistent with a vital element of nursing practice, which is “advocacy in the care of individuals, families, groups, communities, and populations” (American Nurses Association, 2016, para.1). Advocacy in this context can be accomplished by becoming familiar with and encouraging the use, communication, and implementation of advance care planning tools.

Although both advance directives and POST are voluntary advance care planning tools, they are different in nature. An advance directive can be obtained by anyone over the age of 18. These tools provide instructions for future treatment and allow individuals to appoint a legal representative. In Indiana, an individual can specify future treatment preferences using either the Living Will or the Life Prolonging Procedures Declaration. A legal representative can be appointed through either the Health Care Representative or Health Care Power of Attorney (POA) appointments. However, advance directives do not guide medical personnel in an emergency (such as emergency medical technicians [EMTs], paramedics, nurses, and physicians) because these documents require interpretation in order to be acted upon. In contrast, POST is for individuals with life-limiting illness at any age and “whose death within a year would not be a surprise to the patient’s physician,” as well as for individuals for whom CPR is unlikely to benefit (Indiana Patient Preferences Coalition, 2016.-a, para. 3). POST medical orders are for current—not future—treatment and provide direction to medical personnel. This tool is valid in all settings and health care providers are required to honor it. POST orders also provide more details about the goals of care than Out of Hospital DNR orders, which are only useful to document an order to withhold cardiopulmonary resuscitation. Table 1 shows the differences between POST and Living Wills.

Table 1POST versus Living Wills

POST vs. Living WillsPOST Paradigm Living Wills

Population: Advanced progressive illness

All adults

Timeframe: Current care/current condition

Future care/future conditions

Where completed: In medical setting In any settingResulting product: Medical orders Advance directiveSurrogate role: Can consent if patient

lacks capacityCannot do

Portability: Provider responsibility Patient/family responsibility

Periodic review: Provider responsibility Patient/family responsibility

Watch an 8-minute overview of Indiana POST at http://www.indianapost.org

BackgroundExperienced nurses will not be surprised that less than 50% of severely

and/or terminally ill patients have an advance directive. However, it may be a surprise that even when patients do have an advance directive, 65-76% of those patients’ physicians are not aware of the existence of the directive (Agency for Healthcare Research and Quality, 2003). The Institute of Medicine (IOM), perhaps best known by nurses for its groundbreaking 2010 “Future of Nursing” report, has also tackled public education and engagement with regard to advance care planning and informed choice (2014). The report, “Dying in America: Improving Quality and Honoring

IndianaPhysicianOrdersforScopeofTreatment(POST):Implications for Nurses

You won’t need an X-ray.The savings are clearly visible.Sprint offers healthcare employees a 23% discount on select Sprint monthly data service. Take advantage of the savings today!

#MoveForwardsprint.com/healthcarediscounts

Discount for Healthcare ProfessionalsApplies to select regularly priced Sprint monthly data service.

Sprint

DiscountProgram 23%

Bring this code to the closest Sprint store along with proof of employment, such as your work badge or paystub to receive your discount. Corporate ID: HCVRT_ZZZ

Activ. Fee: $30/line. Credit approval req. SDP Discount: Avail. for eligible company employees, org. members or agency employees (ongoing verification). Discount subject to change according to the company’s, org.’s or agency’s agreement with Sprint and is avail. upon request for select monthly data svc charges. Discount only applies to data svc for Better Choice Plans, Sprint Family Share Pack and Unlimited, My Way plans. Not avail. with no credit check offers or Mobile Hotspot add-on. Other Terms: Offers and coverage not available everywhere or for all devices/networks. Restrictions apply. See store or sprint.com for details. © 2016 Sprint. All rights reserved. Sprint and the logo are trademarks of Sprint. Other marks are the property of their respective owners.

N155651CA

February, March, April 2017 The Bulletin • Page 11

Independent Study

Individual Preferences Near the End of Life,” indicated that most individuals at the end of life do not have the physical, mental, or cognitive ability to make their own care decisions and “the majority...receive acute hospital care from physicians who do not know them” (Institute of Medicine, 2014, p. 1). Acute care is provided despite the fact that most individuals want only relief from pain and suffering at the end of life (Institute of Medicine, 2014).

There are several issues involved in end of life care and patient preferences. Traditional advance directives also have polar limitations – too much or too little specificity. Once an individual has an advance directive, it is often not incorporated into an overall plan of ongoing care (Hickman, Hammes, Moss, & Tolle, 2005). It is this ongoing care that is particularly important given that only approximately 10% of deaths are considered sudden (Lunney, Lynn, Foley, Lipson, & Guralnik, 2003). A majority of people die from conditions where planning is possible and needed in order to help ensure treatment preferences are honored. Nairn (2013) discussed three illness to death trajectories that are relevant to the advance care planning discussion. The first is a long period of adequate functioning and then a short period of rapid decline; certain cancers might fall into this category. The second is long-term illness and disability from conditions such as heart failure or COPD. In these cases, there is cyclical worsening of health, multiple hospitalizations, and death may seem unexpected despite an ongoing pattern of decline. The third scenario is long-term, progressive diminishment of function as in dementia or chronic frailty. The Indiana POST is helpful because it addresses the multiple decisions required over time and decreasing benefits of acute care treatment. The POST goes beyond “Full Code versus DNR” and anticipates questions around medical interventions, use of antibiotics, and artificial nutrition. Clearly, having a legal document that is part of the medical record

and reflects the values, beliefs, and wishes of the individual and/or the surrogate is critical to ensuring that wishes are honored.

Indiana POST HistoryThe Indiana POST is based on the Physician

Orders for Life Sustaining Treatment (POLST), which originated in Oregon in the early 1990s. A national task force was formed in 2004 to support and encourage the growth of POLST across the United States (Hickman, Hammes, Moss, & Tolles, 2005). Although there are some minor differences in the forms and program names from state to state, the intent is the same – to provide continuity of care as patients transition from care locations and to make sure patients’ wishes are known and/or followed when making end of life decisions. The forms may be used in all types of healthcare institutions including hospital, assisted living, long-term care, hospice facilities and home care settings. POST completion is especially encouraged for individuals in nursing homes, those being discharged from the hospital to a nursing home or from a hospital to their own home with hospice or home health care services (Indiana Patient Preferences Coalition, 2016-a).

The Indiana Patient Preferences Coalition (IPPC) was established in 2010. This coalition of professionals in healthcare, ethics, law, and senior services led the way for the development and implementation of the Indiana POST. The state of Indiana’s POST form became legally valid on July 1, 2013 (Indiana Patient Preferences Coalition, 2016). It is Indiana Code IC 16-36-6 (http://iga.in.gov/legislative/laws/2015/ic/titles/016/articles/036/chapters/006/).

Putting POST into PracticeAs previously stated, POST medical orders

are for current—not future—treatment and are designed to guide medical personnel. Because it is a medical order, POST should be filled out by a health care provider or physician designee such

Independent Study continued on page 12

as a social worker or nurse with the patient and/or the patient’s legally appointed representative (e.g., health care representative, power of attorney for health care, guardian) during a conversation about goals of care and treatment preferences. It is important to emphasize that POST requires completion by a legal representative if the patient is not capable of making choices for himself/herself. Simply being a family member does not fulfill the legal requirements—the family member must be the legally appointed representative of the patient with authorization to make health care decisions. Although Indiana POST must be reviewed and signed by the treating physician in order for the POST order to be valid, nurses and other team members such as social workers and advanced practice providers play an important role in starting the discussion and preparing the form for physician review. They can do this by exploring the patient’s values, culture, desires, and goals of care, as well as determining who will speak for the patient when he/she is no longer able to communicate (Methodist Health Foundation, Indiana University Health and Encompass, 2016). These conversations require skill, sensitivity, patience, and a focus on the patient’s goals.

The original POST form should stay with the patient to cover various medical situations that might arise (National POLST, 2012). Multiple copies may be made but the original is the property of the patient. A copy of the POST should go with the individual whenever transferring between healthcare facilities or from home to a facility. The POST form is “typically not appropriate for persons with early stage progressive illness or functionally disabling problems who have many years of life expectancy” (Indiana Patient Preferences Coalition, 2016). The POST form is a two-page document, which is filled out by a health care provider in consultation with the patient and/or the patient’s legal representative. An example of the form may be viewed in Figure 1.

Figure 1 – Indiana POST

Page 12 • The Bulletin February, March, April 2017

Independent Study

Independent Study continued from page 11

Indiana Physician Orders for Scope of Treatment (POST). State Form 55317 (R2 12-16)) Indiana State Department of Health – IC 16-36-6. Retrieved from https://secure.in.gov/isdh/25880.htm.

The Indiana Patient Preferences Coalition recommends that the POST form be printed two-sided on bright pink cardstock (Astrobright’s Pulsar Pink) so that it stands out easily. If the patient lacks decision making capacity, a legally-appointed guardian representative may complete a POST form on behalf of the patient; in addition, the patient may elect a health care representative on the back of the form (Indiana Patient Preferences Coalition, 2016-a). The current version of the form contains the following elements on the front side (page one):

• The first two lines are for patientdemographic information and the date.

• Section A addresses orders forCardiopulmonary Resuscitation (CPR). This section is applicable when the patient has no pulse and is not breathing. Options are either Attempt Resuscitation/CPR or Do Not Attempt Resuscitation (DNR).

• Section B outlines Medical Interventions.The options are as follows: 1) Comfort Measures (Allow Natural Death).

The treatment goal is to maximize comfort through symptom management, use of medication by any route, positioning, wound care, and other comfort measures. Oxygen, suction, and other manual treatments of airway obstruction are only used as needed for comfort. Transfer to the hospital is only indicated if comfort cannot be achieved in the current location.

2) Limited Additional Interventions. The treatment goal is to stabilize the medical condition. The following may be used along with the above Comfort Measures: IV fluids, cardiac monitor, basic airway management, and non-invasive positive-airway pressure. Do not intubate. Transfer to a hospital if needed to manage medical needs or comfort but avoid intensive care (ICU) if possible.

3) Full Intervention. The treatment goal is full interventions including life support in ICU. Along with the interventions in Comfort Measures and Limited Additional Interventions, intubation, advanced airway interventions, and mechanical

ventilation may be used. To meet medical needs, may transfer to the hospital and/or ICU.

If the patient or representative preference is to Attempt Resuscitation/CPR, then the Section B orders must be for Full Treatment in order to allow intubation and maximize the chances that the patient will survive the attempted resuscitation. However, a patient with an order for DNR may have orders for Comfort Care, Limited Additional Interventions, or Full Treatment in Section B. These orders are fully compatible because the DNR order only addresses treatment when a patient’s heart stops and he/she is no longer breathing. The orders in Section B apply in all other circumstances. For example, a patient may refuse CPR but wish to be intubated if they are experiencing a breathing crisis.

• Section C, Antibiotics outlines two options:1) Use antibiotics for infection only if comfort cannot be achieved fully through other means; 2) Use antibiotics consistent with treatment goals. This section may be confusing for patients and their families, but examples can be helpful. An example of antibiotics for comfort might be treating a painful urinary tract infection where the goal is not necessarily to prolong life but to ensure comfort by addressing the source of the dysuria. Conversely, if the individual develops a lower respiratory infection and comfort may be maintained with breathing treatments and oxygen, antibiotics would not be ordered. Nurses play a key role in helping both the family and care team understand what comfort care is and what it is not.

• Section D addresses ArtificiallyAdministered Nutrition. There are three options: 1) No artificial nutrition 2) Defined trial period of artificial nutrition by tube (with a space to indicate the length of trial and goal) 3) Long-term artificial nutrition. Although use of artificially administered nutrition is not an emergency decision, it can be helpful to explore preferences for artificial nutrition in advance. If a trial period of artificial nutrition by tube is selected, the goals and decision should be re-evaluated when the designated time period is up. For example, a patient who has a stroke may request a 30-day trial of artificial nutrition to see if she can regain her swallowing ability. After 30 days, she may wish to continue use of the tube if she is making progress on improving her swallowing, meaning the order should be rewritten.

• Section E is the documentation of thediscussion and signature of the patient or legally appointed representative.

• Section F contains contact information forthe legally appointed representative.

• Section G allows the person who preparesthe form to document with whom the orders were discussed.

• Section H is for the physician’s signature.In Indiana, a nurse practitioner (NP) or physician assistant (PA) may not sign a POST form. A telephone order from the physician is acceptable as long as he/she signs the POST form as soon as possible thereafter.

Nurses should be on the alert for POST forms where the orders appear incompatible such as Attempt Resuscitation/CPR in Section A and Comfort Measures (Allow Natural Death) in Section B. Such incompatibilities need to be discussed and resolved with the patient, family, and physician.

The Indiana State Department of Health offers two educational sheets about POST: One for health care professionals, the other for patients.

Implications for NursingAlthough the State of Indiana requires a

physician to sign the POST, nurses can be and are at the forefront of having these conversations and preparing the POST with patients and families. Nurses have significant face-to-face interaction with patients and are well equipped to answer

questions regarding the medical issues relevant to POST decisions. They can also play a role in paving the way for providers and ensuring that those providers have quality discussions with patients and families who are grappling with the burdens of illness and mortality. Additionally, nurses often develop strong relationships with the patient and/or patient’s family, which further facilitates an open dialogue about the POST and its implications for the patient. Because of these relationships, frequent conversations about the patient’s medical condition, treatments, prognosis, and decisions can occur. Addressing end of life decisions over a period of time rather than having one long conversation may decrease stress for the patient and/or family members and ultimately lead to decisions with which the impacted parties are more comfortable.

It is also important to be familiar with the various types of advance directives and advance care planning tools described earlier. Nurses should emphasize that the Indiana POST form is a legal physician order that reflects the patient’s preferences for end-of-life care (Indiana Patient Preferences Coalition, 2016). Nurses can encourage the use of POST for seriously ill patients and also assure patients and family members that the form is completely voluntary. Nurses can convey the positive benefits obtained when health care providers know what medical treatment a patient desires–or does not desire–at the end of life. Finally, nurses can take the initiative to ensure that POST is reviewed when there is a change in condition, care plan meeting, or the patient/family member requests it. This includes confirming with the patient or their legal representative that the POST orders still reflect the patient’s current preferences. For nursing home residents, nurses can ensure that there is a quality POST discussion when the resident is admitted and review the plan of care at 30-day, quarterly, and annual care planning meetings to help ensure the orders reflect current preferences and that everyone is aware of the POST orders on file.

Below are some questions to help guide nurses during these sensitive and important discussions:¨ What discussions have you had so far about

your condition/illness and with whom?¨ What is your understanding of your

condition/illness and prognosis? ¨ Can you tell me in your own words what you

have heard?¨ What gives your life meaning? What brings

you joy?¨ How has your condition/illness impacted

your quality of life? ¨ What are your goals for treatment? ¨ Do you understand the treatments described

on POST and how these apply to your particular situation?

¨ Do you know the risks and benefits of each decision? Alternatives?

POST ScenariosConsider the following scenarios:

1. A new long-term care (LTC) resident and her husband are talking in the lobby when the resident suddenly slumps over and stops breathing. The resident’s code status when she was admitted from the hospital was full code. Her husband is distraught. When a nurse starts CPR, the husband tells him that the resident has a living will and does not want heroics.

Key points from this case include:• Should the nurse start CPR? Yes. The

resident’s code status was listed as full code. The nurse cannot honor the verbal request from the husband.

• Would it matter if there were a copy of the living will present? No. There needs to be a physician order to withhold CPR. A living will is inadequate.

• How would a POST have helped? If the resident and family had elected DNR on the POST form, the nurse would be able to stop CPR and honor the POST form.

February, March, April 2017 The Bulletin • Page 13

Independent Study

2. A 79-year old woman is admitted to the ER. Her family says she has complained of back/shoulder pain and shortness of breath. The patient goes into cardiac arrest shortly after she arrives. She has a POST, which is signed by the patient and her MD in Southern Indiana.

¨ POST Form Orders¨ Section A: DNR¨ Section B: Limited Additional

Intervention¨ Section C: Antibiotics consistent with

goals¨ Section D: No Artificial Nutrition

Key points from this case include:• Is the POST form valid? The POST order is

valid even if MD does not have admitting privileges or is unknown to the staff. Follow the POST unless it appears that for some reason the POST is not valid (e.g., only contains a patient signature, physician signature missing) or the patient has requested alternate treatment.

• Which order is most relevant in the patient’s current medical state? If she has no pulse and is not breathing, the DNR order is most relevant. CPR would be withheld. If the patient has a pulse and/or is breathing, look to Section B orders. The goal of these orders is stabilization of the medical condition. For example, these orders direct no intubation but permit non-invasive airway management and cardiac monitoring.

3. A nursing facility resident with advanced chronic heart failure has a massive stroke. She requires a feeding tube because she is unable to safely swallow. Her daughter does not want the feeding tube placed.

• POSTFormOrders:ú Section A: Full Codeú Section B: Full Treatmentú Section C: Antibiotics Consistent with

goalsú Section D: Long-Term Artificial Nutrition

Key points from this case include:• Which orders are relevant? Section D is the

section most relevant in this case. The orders are for long-term artificial nutrition.

• Can the daughter revoke the POST form? It depends on some additional details. The daughter can revoke the POST form if she is the legally authorized representative (health care POA or health care representative). However, even if she is legally appointed, the daughter should be asked to explain her understanding of her mother’s preferences and why she thinks they are no longer valid. From an ethical and legal perspective, she cannot change the orders if the change is inconsistent with the patient’s known preferences unless there is reason to believe these preferences would be different in this new situation.

• What if the resident goes into cardiac arrest? Attempts should be made to resuscitate her.

4. A home hospice patient with advanced dementia, osteoporosis, and a history of falls and fractures is found on the floor, crying in pain. She is unable to stand and it appears she may have broken a hip.

¨ POST form orders¨ Section A: DNR¨ Section B: Comfort Measures

Key points from this case:• Should the potential fracture be addressed?

The patient is in pain, so an effective intervention must occur.

• Should the patient be transported? It is unlikely the pain can be managed in the home setting, so the patient likely will be transported to the hospital for evaluation and treatment such as x-rays and likely

fixation of the broken hip. A copy of the POST should go with her.

Nurses and other interested individuals are encouraged to visit the following sites for more information:

• Indiana POST website: www.IndianaPOST.org

• Questions may be submitted here: http://www.indianapost.org/contact-us/

• State of Indiana Advance DirectivesResource Center: http://www.in.gov/isdh/25880.htm

• NationalPOLSTParadigm:www.POLST.org

ConclusionPOST is designed to provide standardized

medical orders for all patients who qualify by having either a chronic frailty or an advanced progressive illness. This form follows the patient from facility to facility and becomes an actionable order in his/her chart. The nurse is an essential professional in ensuring that individuals’ voices are heard at the end of life. The American Nurses Association provides an eloquent summary of this responsibility in their position statement entitled, Registered Nurses’ Roles and Responsibilities in Providing Expert Care and Counseling at the End of Life. “Nurses have always been at the bedside of dying patients. Their role in providing the highest quality of remaining life and support at the end of life for both patients and their loved ones is traditional, accepted, and expected. The nurse’s fidelity to the patient requires the provision of comfort and includes expertise in the relief of suffering, whether physical, emotional, spiritual, or existential. Increasingly, this means the nurse’s role includes discussions of end-of-life choices before a patient’s death is imminent” (2010, p.1). Having knowledge of advance care planning tools and specifically, POST, will aid nurses in advocating for their patients. Nurses who have worked extensively with POST reflect that while initiating the discussion can be challenging, patients and families are often very thankful that someone has taken the time to explore this most personal of topics with them in advance of a crisis (personal communication, April 27, 2016).

ReferencesAgency for Healthcare Research and Quality. (2003).

Advance care planning, preferences for care at the end of life (Research in Action Issue 12). Retrieved from http://archive.ahrq.gov/research/findings/factsheets/aging/endliferia/endria.html

American Nurses Association. (2010). Position statement: Registered nurses’s roles and responsibilities in providing expert care and counseling at the end of life. Retrieved from

http://nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Posit ion-Statements/etpain14426.pdf

American Nurses Association. (2016). What is nursing. Retrieved from http://nursingworld.org/EspeciallyForYou/What-is-Nursing

Chapter 6. Physician Order for Scope of Treatment. Indiana Code. (2015). IC 16-36-6 http://iga.in.gov/legislative/laws/2015/ic/titles/016/articles/036/chapters/006/

Hickman, S.E. (n.d.). OPTIMISTIC and the new Indiana POST program. [Powerpoint Slides].

Hickman, S. E., Hammes, B.J., Moss, A.H. & Tolle, S.W. (2005). Hope for the future: Achieving the original intent of advance directives. Hasting Center Report.

Indiana Fire Chiefs Association EMS Section. (2013). Physician orders for scope of treatment (POST): What it means for Indiana. Retrieved from https://secure.in.gov/dhs/files/Indiana_EMS_POST_Educational_Packet.pdf

Indiana Patient Preferences Coalition. (2016-a). FAQ’s. Retrieved from http://www.indianapost.org/faqs/

Indiana Patient Preferences Coalition. (2016-b). History. Retrieved from http://www.indianapost.org/history/

Indiana Physician Orders for Scope of Treatment (POST). State Form 55317 (6-13) Indiana State Department of Health – IC 16-36-6 . Retrieved from http://www.indianapost.org/wp-content/uploads/2013/10/55317-fill-in.pdf

Indiana State Department of Health. (2013). Advance directives: Your right to decide. Retrieved from http://www.in.gov/isdh/files/advanceddirectives.pdf

Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Retrieved from ht tp://w w w.iom.edu/Repor t s/2014/Dying-In-A mer ica-I mprov i ng- Q ua l i t y-a nd-Honor i ng-Individual-Preferences-Near-the-End-of-Life.aspx

Lunney, L.J., Lynn, J., Foley D.J., Lipson, S. & Guralnik, J.M. (2003). Patterns of functional decline at the end of life. Journal of the American Medical Association. 289(18), 2387-92.

Methodist Health Foundation, Indiana University Health and Encompass. (2016).The Indiana POST form in action [Video File]. Retrieved from http://www.indianapost.org

Nairn, F. T. (2013). Polst: A portable plan for care. Health Progress, 94(6), 87-89.

National POLST. (2012). POLST and advanced directives. Retrieved from http://www.polst.org/advance-care-planning/polst-and-advance-directives/

State of Indiana. (2016) Out of hospital do not resuscitate declaration and order. Retrieved from http://www.in.gov/isdh/files/49559.pdf

Tharpe, G. & Rathke, K. (2015). Increasing awareness of Indiana Physician Orders for Scope of Treatment (POST). Unpublished manuscript. Department of Nursing, University of Indianapolis, Indianapolis, Indiana.

We Offer Accredited Continuing Education Programs including:•Anticoagulation*•CaseManagement•Lipid*•Diabetes*•FaithCommunity Nursing

•HealthPromotionsandWorksiteWellness

•HeartFailure*•OncologyManagement*•PainManagement*•WoundManagement*

* Designated hours of Pharmacology

Education in Your Own Time and PlaceUSI.edu/health/certificate

877-874-4584

ONLINE convenience, QUALITY education

Page 14 • The Bulletin February, March, April 2017

Independent Study

IndianaPhysicianOrdersforScopeofTreatment(POST):ImplicationsforNursesPost-TestandEvaluationForm

DIRECTIONS: Please complete the post-test and evaluation form. There is only one answer per question. The evaluation questions must be completed and returned with the post-test to receive a certificate.

Name: _____________________________________

Date: ___________________ Final Score: _______

Please circle one answer.

1. A POST form is only valid ifa. It has been printed on bright pink paperb. Next of kin have witnessed the formc. It has been signed by a physiciand. It has been signed by a physician, NP, or

PA

2. Which of the following is not a section in the POST?a. Antibioticsb. Medical interventionsc. Mechanical ventilationd. CPRe. Artificially administered nutrition

3. An 84 year old female nursing home patient with advanced dementia, CHF, and COPD is found lying in her bed without a pulse. There is a copy of the POST form in the chart indicating DNR/comfort measures but it is not on pink card stock. The nursea. Calls the family to find out where the

original pink form isb. Follows the instructions on the POST

copyc. Calls a code and begins CPR

4. Which patient is most appropriate for a POST?a. 35 year old female with recently

diagnosed multiple sclerosisb. 70 year old male who had a CABG at age

60 c. 60 year old male with metastatic lung

cancer d. 20 year old female with lupus

5. Who can fill out a POST form on behalf of a patient who lacks decisional capacity?a. Any family memberb. The spousec. A legally appointment representative d. A nurse

6. Ms. G. is a 60 year old patient with ALS. She tells you that she does not want artificial nutrition if she loses the ability to safely swallow. This information should be recorded on Section__ of the POSTa. Ab. Bc. Cd. D

7. It is recommended that a POST be updateda. When a patient has a change in conditionb. When an individual or Health Care rep

requests itc. a & bd. None of the above. It cannot be updated.

8. A 55 year-old fully cognitive female with end stage renal disease, heart failure, and multiple other comorbidities has filled out a POST with her physician. In section B, the form indicates that she would like to be Comfort Measures. The nurse’s action is toa. Explore what the patient needs to maintain

comfort.b. Tell her she should not call 911 since she is

Comfort Measures.c. Suggest that the patient get a second

opinion.d. Explore whether the patient is depressed.

9. The POST form is valid in the following settingsa. Assisted livingb. At homec. Hospital d. Ambulancee. All of the above

10. The POST form is the property of the patient.a. Trueb. False

11. The only person who should talk about the POST with a patient is the treating physician.a. Trueb. False

12. When a long term care (LTC) resident is sent to the hospital or any medical appointment, a copy of the POST form should go with the resident.a. Trueb. False

13. A long-term care (LTC) facility resident with advanced dementia, osteoporosis, and a history of falls and fractures is found down, crying in pain. She is unable to stand and it appears she may have broken a hip. The POST form orders:• SectionA:DNR• SectionB:ComfortMeasures

The resident cannot be sent to the hospital because she has elected only Comfort Measures in Section B

a. Trueb. False

Use the following scenario for the next two questions:

A 79-year old woman is at your clinic in northeastern Indiana for a simple outpatient procedure. A nurse finds her in on the floor in cardiac arrest 1 hour after she arrives. She has a POST, which is signed by the patient and her MD in southern Indiana. The POST orders are:

Section A: DNRSection B: Limited Additional InterventionSection C: Antibiotics consistent with goalsSection D: No Artificial Nutrition

14. Which order is most relevant in the patients’ current medical state? a. Section A - DNR order b. Section B orders – Limited Additional

Interventions c. Section C: Antibiotics consistent with

goalsd. Section D: No Artificial Nutrition

15. As the physician is in another Indiana city and does not have admitting privileges to your clinic or health system, the POST is invalid.a. Trueb. False

Evaluation1. What one strategy will you be able to use in your work setting?

2. Was this independent study an Yes No effective method of learning? If no, please comment: o o

3. How long did it take you to complete the study, the post-test, and the evaluation form?

4. What other topics would you like to see addressed in an independent study?

RegistrationFormName: ________________________________________

(Please print clearly)

Address: ______________________________________Street

______________________________________________City/State/Zip

Daytime phone number: ________________________

_____ RN _____ LPN

Please email my certificate to: _______________________________ Email address

Fee: ($20)

ISNA OFFICE USE ONLY

Date Received: Amount:

Check No. ____________

MAKE CHECK PAYABLE TO THE INDIANA STATE NURSES ASSOCIATION (ISNA)

Enclose this form with the post-test, your check, and the evaluation and send to:

Indiana State Nurses Association2915 N. High School Road

Indianapolis, IN 46224

ShelbyvilleGreensburgRichmond

New Castle

Heritage House, your leading rehab and long-term care community is hiring dependable, enthusiastic Nurses

at all four of its locations! Please apply online at www.heritagehouseIN.com

and join our team today!

• Mental Health Nursing Instructor (Full-time)• Adjunct Instructors Certified Nursing Assistant Mental Health Clinical Nursing Health Services

For more information, contact Becky Jellison, DeanPhone: 269-782-1241 | rjellison@swmich.edu

https://swmich.peopleadmin.com/

February, March, April 2017 The Bulletin • Page 15

Do you want to eat healthier, be more active, get better sleep, and have more joy? This is your year! ANA is declaring 2017 to be the Year of the Healthy Nurse! Join us as every month we tackle specific wellness issues that all of us can improve.

ANA defines a healthy nurse as someone who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing. We feel that nurses are ideally positioned to be the best role models, educators, and advocates of health, safety, and wellness. So come participate with us fully this year as we focus on YOU! Visit this page every month to see what is being offered as resources, events, and activities for that specific month. Join us on ANA’s Facebook and Twitter pages to interact with other nurses to share recipes, success stories, challenges, and useful tips. Take our newest health survey. Engage in the Healthy Nurse, Healthy Nation™ Grand Challenge. This

year, let’s improve the health of the nation’s 3.6 million

registered nurses and in turn improve the health of the nation!

W a t c h o u r w e b s i t e : w w w.I n d i a n a N u r s e s .org for monthly activities and join us

for our annual convention which will have more on this topic.

Monthly Topical Focus

Month Topic

January Worksite Wellness and Worker Well-Being

February Cardiovascular Health

March Nutrition

April Combatting Stress

May Women’s Health National Fitness and Sports Month

June Men’s Health Cancer Awareness Skin Health

July Healthy Sleep

August Happiness

September Recovery Work-Life Balance

October Infection Control Immunizations Moral Resilience/Moral Distress

November Mental Health Wellness

December Healthy Eating/Healthy Holidays

ThisMomisHIV+

Thisbabyissafe

Knowwhy?

Mom was tested.Babyisprotected.

Find your career today!Search job listings in all 50 states,

and filter by location and credentials.

Browse our online database of articles and content.

Find events for nursing professionals in your area.

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

www.nursingALD.com

Page 16 • The Bulletin February, March, April 2017