Registered nurses are on the frontlines of our health care system and will play a critical role in preventing and treating the spread of influenza this flu season. As nurses, we spend a lot of time with patients who are sick and at increased risk for severe disease complications. When you get the flu, you expose your family, patients and coworkers to infection.

The role that you and other health care workers play in helping prevent influenza-related illness and death—especially in high-risk patients—is invaluable.

Which Vaccine Should You Get?

There are two types of flu vaccine: (1) the “flu shot” – a vaccine with killed virus given by needle injection and (2) the nasal-spray vaccine (Live Attenuated Influenza Vaccine or LAIV) – a vaccine with weakened live viruses.

• The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

• The nasal-spray vaccine (LAIV) is approved for use in healthy people 2 to 49 years of age. Nearly all healthy, non-pregnant health care workers, may receive LAIV if eligible, including those who come in contact with newborn infants (e.g., persons working in the neonatal intensive care unit, or NICU), pregnant women, persons with a solid organ transplant, persons receiving chemotherapy, and persons with HIV/AIDS.

However, health care providers should not get LAIV if they are providing medical care for patients who require special environments in the hospital because they are profoundly immunocompromised, for example if they work in bone marrow transplant units. This is intended as an extra precaution and is not based on reports of vaccine virus transmission in those settings.  The flu shot is preferred for vaccinating health care workers who are in close contact with severely immunocompromised patients who are being cared for in a protective environment. These health care workers may still get LAIV, but they must avoid contact with such patients for 7 days after getting vaccinated.

No special precautions (e.g., masks or gloves) are necessary for health care personnel who have been vaccinated with LAIV and who do not work with patients undergoing bone marrow transplantation.

Flu vaccines CANNOT cause the flu. The flu vaccines work by priming your body’s defenses in case you are exposed to an actual flu virus. Serious problems from the flu vaccine are very rare. The most common side effect that a person is likely to experience is soreness at the injection site.*

Comprehensive Flu Prevention

While it is critically important that nurses, health care providers and other hospital personnel choose to be vaccinated for their own health and health of patients, a voluntary vaccination program is only one aspect of a comprehensive flu prevention strategy. To be consistent with the updated CDC guidelines, an influenza prevention program must include a comprehensive approach – any influenza prevention program that relies solely on vaccinations (mandatory or voluntary) is inadequate.

The following core components of a comprehensive influenza policy are recommended for any influenza policy adopted by hospitals and health care facilities in Washington State:

1. Voluntary efforts that aim for 100% vaccination rates, including annual education and implementation of comprehensive influenza vaccination programs for all health care providers.
2. Employers must ensure that influenza vaccines are available and offered to every health care worker annually at convenient times and locations.
3. Employers must ensure that appropriate protection and safety measures are in place to provide a safe workplace environment for nurses and health care workers including following the Centers for Disease Control (CDC) and Occupational Health and Safety Administration (OSHA) requirements for influenza prevention and hierarchy of controls.
4. Masking policies must follow CDC guidelines for all workers, not just those unvaccinated (currently required when within 6 feet of patients) and not be used as a retaliation or punishment for unvaccinated workers.
5. If a declination form is required for vaccination, the employee must be able to sign the form confidentially; that is, the health care worker must not be required to divulge personal health information or declare the reason(s) for refusal of a vaccine. The employer must not discriminate against or discipline a nurse or health care worker for opting out.
6. The employer must not discriminate against or discipline nurses or health care workers for the appropriate use of sick time due to influenza.

In addition to getting vaccinated, there are several other ways for you to keep yourself and your patients healthy this flu season. Hand hygiene remains one of the most effective ways to prevent the spread of disease. Be sure that you, your colleagues, patients, family and friends wash their hands often using soap and water or alcohol-based hand sanitizer. Other effective prevention strategies include covering your cough or sneeze, staying home when sick, avoiding touching your face, and using social distancing.

*Adapted from the Centers for Disease Control and Prevention website ‘Influenza Vaccination Information for Health Care Workers’, http://www.cdc.gov/flu/HealthcareWorkers.htm

Judith A. Huntington MN, RN is a Washington Center for Nursing Board Member and Executive Director of the Washington State Nurses Association.

Keynote speaker Linda Burnes Bolton

I attended a portion of the recent conference on the IOM recommendations for nursing “Charting the Course” featuring Keynote Speaker Linda Burnes Bolton.  The keynote provided great national perspective and was followed by a Gallery Walk that presented key facts related to the state of nursing in Washington State.  For someone in workforce development, looking to stay informed about the transformations underway in the healthcare industry, the information provided at “Charting the Course” was extremely valuable.

Gallery Walk

It helped me better understand where Washington currently stands relative to the IOM report recommendations, and other national trends and policy changes, as well as current challenges and opportunities related to nursing education and labor market supply and demand.  It also reinforced trends that we’ve been hearing of for sometime in workforce development, notably the need for greater diversity among healthcare practitioners, including nurses, to meet the needs of an increasingly diverse patient population.  As someone who works with programs and projects designed to help low-income and other unemployed individuals access education and employment in high-demand fields, this information reinforced the role that the workforce development system can play as a partner in promoting the nursing workforce of the future.  Thanks for a great event!

Seanna Melchior Ruvkun is a Project Manager at the Workforce Development Council of Seattle-King County.

The annual NWONE fall program and meeting of the membership was held on September 21 – 23, 2011, at the Vancouver Hilton Hotel in Vancouver, Washington.  This event, a highlight of the year for many NWONE members, is an opportunity for nursing leaders at all levels and from every practice arena, to come together in fellowship and support while learning from world class speakers on health care topics of current concern.

This year’s fall program theme, “This Magic Moment: Nursing’s Strategic Leadership in Transforming Health Care Delivery”, capitalized on the tremendous current transitions in health care, as reform is implemented, and also referenced the opportunity for nursing to play a mighty leadership role in the design of a reformed delivery system.  
Attendees were encouraged to not miss the opportunities for nursing leadership inherent in a changing environment – and our high profile non-nursing presenters strongly voiced the need for nursing to step up to local and national leadership during this time.  Speakers at the event included:

• TR Reid, a correspondent, reporter, and the best-selling author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,
• Monique Lambert, a technology expert and medical ethnographic researcher who shared her research on the tribal nature of nursing and our opportunities as entrepreneurs to design the next best products and systems for care delivery,
  
• Edward O’Neil, Professor in the Department of Family and Community Medicine at UCSF, and Director of the Center for the Health Professions created to assist health care professionals, care delivery organizations, and public policy makers understand the challenges and opportunities of educating and managing a health care workforce capable of improving the health and well-being of people and their communities,
  
• Jack Needleman, Professor of Health Services at the UCLA School of Public Health and recent author of research published on the correlation between nurse staffing and patient mortality, and
• Carol Bradley, Joanie Ching, Linda Tieman, and Paula Gubrud-Howe, all from our membership, speaking about their work to advance nursing in this climate of change.

In dialogue with the audience, Monique Lambert and the NWONE leadership encouraged the development of an “incubator” where nurses, as entrepreneurs, could test and market patient care products and models of care design.  Additionally a reframing of our domain from hospital “centricity” to nurses as leaders of the movement toward health care outside the walls of the hospital was emphasized.  Using the feedback from our dialogue with the audience and NWONE membership, the organization plans a strategic retreat in November of this year focused on nursing leadership in ambulatory care and is in communication with Dr. Lambert on the possibility for forming an entrepreneurial “incubator” to develop and launch nursing innovation.

Evaluations from the program and its three pre-conferences communicated appreciation for a valuable and enjoyable event for our local nurse leaders.  We look forward to being together again for the NWONE Spring conference and meeting of the membership, March 15 – 16, 2012, at the waterfront Marriott in downtown Portland, Oregon.  All nurses are invited to attend.

Gladys Campbell is the CEO of the Northwest Organization of Nurse Executives (NWONE).

NSWS Board 2011-12

Hello, my name is Amber Anderson and I am the President for Nursing Students of Washington State (NSWS), the only statewide student nursing association in Washington. Being a member of NSWS provides students many ways to grow and improve their opportunities as a future nurse. One of the greatest benefits of being active in NSWS is that you have the chance to learn how to be a leader.

As the new academic year starts, we are looking forward to serving more nursing students in Washington State. Currently, we are working on contacting RN programs all over the state to talk to their students about getting involved with us on a pre-professional level. One of the challenges we are facing are our out-of-date contacts for the schools. We want to get in touch with every RN nursing school; however we need the new information. If you would like to send us contact updates, or if your school would like to have a NSWS board member come speak with your students, please send us an email.

This academic year, we are looking forward to hosting our own state convention at The Great Wolf Lodge in Olympia on March 10^th, 2012. We are looking for sponsors for this event and signing up members over the next few months. I am particularly looking forward to speaking at different colleges and universities to increase the state involvement. This is a big push we are trying to do for the upcoming year and we hope we have great success!!

Over the course of the year, we will be working on bringing a variety of annual awards to nursing programs, including, for example, awards for the school with the best community service activity and the school with the largest increase in membership for NSWS/NSNA.

We are also revamping our webpage and adding current information, new opportunities and ways to network with other students and schools in our state. NSWS is still growing, and as a board we are learning more and more each year. We are looking forward to the upcoming changes and the growth that Washington State will be making over the next few years!

Amber Anderson is the President of Nursing Students of Washington State and a nursing student at Pacific Lutheran University.

Lower Columbia School Garden’s entry into the Go Fourth Parade (7/4/11), Longview, WA

In the spring of 1993, I found my passion: public health nursing. I was a senior at USF and starting my last semester and my student nurse placement was community health nursing. It was one of the two student nursing courses where I was not required to be in scrubs or my lovely white dress uniform. I was extremely fortunate; I was placed at a great health department in the San Francisco Bay Area and able to try a little of everything. After I made my first solo home visit to a pregnant teen, I was hooked.

So exactly what is public health and what do nurses do there? Most days, public health is the behind-the-scenes entity, usually a government one, which ensures that your food is safe to eat, water is safe to drink, and someone lets you know if you were exposed to an infectious disease. It is no longer the place to get your shots – most preventive health care services are offered at primary health care clinics. We want everyone to have one location to get their medical care when they are sick and well so all of their needs are met and care is well coordinated.  Public Health Nurses are the nurses who meet clients where they are – in a shelter, on the street, in their home to assess needs, provide education and help strategize how to make them healthier than they are now. While some of our public health nursing services still happen on a patient-by-patient basis, much of our work now has moved to changing policies and shifting whole systems to make the entire population healthier. Public health nurses take what they learn from their client (an individual, family, school, or the community) and translate that into important messages for leaders: breaking down barriers to health care, championing policies that support health, which could be as simple as making sure that school playgrounds are available afterschool for families to play at. It is a career that satisfies every desire to help people and remains challenging at every turn.

Here is a great video that neatly summarizes public health.

Public Health Nurse Beatriz Rush and dental hygienist (Shelley Guinn) performing oral health screening at Lower Columbia Head Start preschool program

If you are looking for the ultimate challenge, how to get 100,000 people to eat their fruits and vegetables, seek preventive care and make informed decisions about their reproductive health, public health nursing will provide that. My community health rotation allowed me to design a care plan for the pregnant teen I mentioned earlier, promote healthy pregnancies and track infectious disease cases.  One essential role for public health is to stop the spread of disease, therefore it’s our job to ensure that persons with communicable diseases are treated, stay home when they are contagious and that people exposed to these diseases get preventive treatment if available.  When I started out, a typical day for me was finding people diagnosed with things like hepatitis B or pertussis, running an immunization clinic, and providing STD and HIV services in a rural health department. Later on, it meant providing clinical oversight to active TB cases, making sure that patients were being treated right and were taking their meds, or starting a drop-in pregnancy clinic for teens adjacent to a high-school in the afternoons. Sometimes it is days on end of outbreak investigations, other times, it means participating in primary research, working with law enforcement – at the end of the day, I am a satisfied nurse and the community is my patient, edging towards a healthier future step-by-step.

Local and state public health officials working together to provide post-exposure hepatitis A vaccination at Oregon Jam Band festival.

Hilary Gillette-Walch RN MPH is a Washington Center for Nursing Board Member and Clinical Services Manager at Cowlitz County Health Department, Longview. 

Last month, Heritage University and the Washington Center for Nursing collaborated to present a Summer Symposium titled the “Institute of Medicine Recommendations on Nursing: The Yakima Valley Responds.”

Over 45 people, nurses, CNO’s, CEO, directors, nurse educators, and administrators attended (in rural Toppenish, Washington in the middle of summer!).  Feedback on the event was extremely positive.  All attendees are interested in taking a more active role in our community and continuing the Institute of Medicine’s Recommendations on Nursing within our community.  The energy and motivation in the room was tremendous.  It was a fun day of networking and meeting new people.

Linda Tieman, Executive Director of the Washington Center for Nursing and Greg Vidgor, CEO of the Washington Health Foundation, presented the Future of Nursing: Campaign for Action slides.  Afterwards, there was a rich dialogue followed by breakout sessions.  I thought it may be helpful to share some of the notes from that IOM meeting.

1) Education Priorities

First, we need to compensate our nurse educators better.  Presently, the pay for quality nurse educators and leaders is inadequate. Another education priority was to reestablish residency or transition to practice support for new and continuing nurses.  Another theme was to provide incentives for nurses to increase their education (advanced degrees) and to stay at the bedside and provide patient care.

2) Access and Practice Priorities

We need to emphasize the economic value of nursing, i.e., community health education, sustaining health, and shift accountability back to the patient.  Educate patients about preventative care by having a collaborative community.  We also need to bring our resources together and have partnerships so that we all can afford the best models etc. (e.g., sim labs).

3) Leadership Priorities

Start annual nursing leadership meetings in the Valley so we improve social networking and the visibility of nursing within the Yakima County and can influence legislation.  Add mentorship programs, and professional development around leadership.   Mobilize Latinos and minorities in the healthcare industry to help assure that we will have enough nurses for the future and to care for our diverse community.

I believe the event was a wonderful opportunity for all communities.  If you have the ability, I would suggest having one in your community/region.   We at Heritage University look forward to continuing this work in the Yakima Valley and having more meetings and dialog regarding the upcoming changes of our medical communities.

Thank you Linda and Washington Center for Nursing!  It was a lot of fun!

Michelle R. Bartholet, RN, MSN is the Director of Nursing at Heritage University in Toppenish, Washington.

Did you happen to watch last week’s episode of “Hot in Cleveland” (8/17/2011) or see the preview clip to NBC’s new sitcom “Whitney”?

Despite 91 years of progress since women gained the right to vote and years of struggle to gain wage parity and equal rights, why is the media still stooping to images of “sexy” or “naughty” nurses to sell  TV shows and newspapers?  Some might find these antiquated stereotypes to be amusing or clever, but the truth is that they do nothing to help our state and our nation in the midst of a serious nursing shortage.

As nurses, we didn’t pursue this profession for glamour or fame, and reducing nurses to sex objects simply to attract viewers and readers is just plain cheap and trivializes our work. It comes at the expense of the hard work and dedication we put into our profession.

With healthcare reform front and center, nurses are needed more than ever to deliver quality and cost-effective care in all of our communities. We are the glue that holds together a disjointed and chaotic healthcare system, and that’s why the role of nurses as key practitioners in the delivery, planning and policy work of healthcare needs to be promoted.  It is imperative that we highlight our role as healthcare professionals who excel in prevention, wellness, chronic, and emergency care, and that our image is free from belittling stereotypes.

More so, responsible journalists, TV and movie producers, and others in the media should be elevating the important work of nurses, not denigrating our role. It is our expertise, our attention to patient needs and our advocacy on behalf of our patients that puts the “quality” into “quality care”. Accordingly, we carry a reasonable expectation that we will be treated with respect for our skill, knowledge and professionalism.

What should that respect look like?

We need better funding for nursing education, scholarships, and faculty salaries, adequate nurse staffing to insure safe care, and a diversified workforce that reflects the patients in our care.

We need to attract new nurses and retain those with years of experience, and portray them as the highly qualified professionals we are.

This is long overdue, and journalists and popular culture should respect our contributions to the health and well-being of our communities by changing the dialogue and image that have, for decades, continued to lag behind the rest of the progress we make.

Diane Sosne RN MN is a Washington Center for Nursing Board Member and the President of SEIU Healthcare 1199NW.

The Washington Center for Nursing’s mission is to “contribute to the health and wellness of Washington State by ensuring that there is an adequate nursing workforce to meet the current and the future healthcare needs of our population.”

Many Registered Nurses (RNs) live and work in rural communities. I would like to share with you the story of a rural health nurse, Debbie Perrault, RN, CCP, who works for a Community Health Center with clinics in Yakima, Naches, and Ellensburg, Washington. In her own words, Debbie describes her role and access challenges to continue her education.

I am a RN/Care Manager at Community Health of Central Washington (CHCW), a community health center with a residency program for family physicians. I have worked at CHCW for 17 years.  The last two years, I have been in case management and working as a diabetic educator.  Even though I mainly work with diabetics, I also care for a number of patients who are obese and in need of nutritional education and exercise management.  In addition, I work with patients in our pain management program, which is currently being modified to fit the unique needs of our patients and providers. In 2009, our facility became part of the Washington State Patient-Centered Medical Home (PCMH) Collaborative. This has been a very challenging process for our practice as we attempt to transform primary care in our rural clinics.

When I was first approached with the challenge of developing a care management program, I had already completed an online program in case management.  I was working as a staff nurse, so I spent much of my after-hours time on developing a care management program that would fit within the PCMH model of primary care. I completed my research and purchased many of my own resources, not only on my own time but also out of my own pocket book since the facility did not have the start-up funding for the program. It was only through hard work and the help of my clinic manager that the program was successfully launched and I was hired as a full-time Care Manager.

Meeting my continuing education requirements has been challenging. Most of our administration staff recognize the need for a care management program in order to meet the needs of our patients. My clinic manager has been great at letting me attend conferences and trainings, as our budget allows. I also read many articles and books on my own time. In the rural health setting, when much of the clinic’s revenue are Medicare and Medicaid patients, and these programs continue to be cut back, this will always be a challenge for me and my patients.

 Zena Kinne MN RN is a Washington Center for Nursing Board Member and Director of Quality at Peninsula Community Health Services.

I am an ICU nurse at a large metropolitan hospital here in the Seattle area. Before I go into work, I try to prepare myself for the demanding shift that lies ahead. This may include caring for a child that has a head injury and doing neuro checks every hour, doing wound care and making sure the patient is as comfortable as possible, supporting the family by explaining what I am doing and what care I am providing to their family member, explaining the different procedures that the patient may have to go through and the reason why, and possibly mentoring a new nurse in the process. The level of complexity increases when my “standard nursing care” is for patients and their families who are unable to communicate their needs effectively due to physical, cultural, or language differences. Attracting nurses from diverse backgrounds is essential to the future of nursing given the growing diverse populations that we care for.

For example, an event that recently happened at work involved a rapid response call from the acute care floor to the ICU. The patient was a young woman from a French-speaking region in Africa. She was approximately 5-6 months pregnant and had been admitted for continued nausea/vomiting for the past week. When I arrived to assess her, she had been pointing to her mid chest repeatedly and moaning/crying out in pain. The acute care nurse and the charge nurse were in the room, attempting to place IVs, do an EKG, and send labs to check for a cardiac event per the doctor’s orders since the patient was complaining of chest pain. The patient was highly distressed with the invasive procedures that were being done, and it was clear that she needed an explanation of what we were doing and what was going on. I used to work on the acute care floor the patient was currently on, so I knew that there was a nurse working that night that came from the same region as this patient and spoke the same language as her. I asked him to come in and help interpret her needs, and what he said made the nurses and the doctors stop what they were doing. He explained that she was pointing to her upper GI area, in the middle of her chest, but it was gastric pain she was complaining of not chest pain. Once she was able to express her needs, we were able to treat her symptoms appropriately and decrease much of her distress and anxiety. We were lucky to have a nurse who was from the same region as the patient that could communicate with her effectively.

Language is not the only barrier I’ve come across with nursing diverse populations. We recently took care of siblings from Israel whose family practiced orthodox Judaism. They were here to undergo a complex neurosurgical procedure that was necessary for life. Not only did we need an interpreter, but we also had to be familiar with their Sabbath practices, their food preferences, and their ideas on personal space. We were again, fortunate to have a nurse who was familiar with orthodox practice, and could assist us in trying to better care for these patients. Having a diverse nursing workforce allowed us to give care that was appropriate and safe to our diverse patient populations.

At a recent Washington Center for Nursing Board meeting, we discussed the question of diversity in nursing and were asked to reflect on our own experiences and to look at the institutions we work for and how we lead to improve the diversity of our workforce. Bringing best practice regarding diversity to nursing is at the forefront of our ideas. We discussed successes, such as having a mentor/mentee committee and actively trying to pair people of similar ethnicities with each other on the units they work for, and the minority mentorship programs at the different universities that allow college students to go into high schools and tutor minority students so that they can be better supported academically. We were also asked to look at the makeup of our different organizations and see how many persons of color were in leadership positions or in middle management as well as ask the question if there were programs in place that allowed for the mentoring or education/leadership development of people of color who were in nursing or interested in nursing in our different institutions. The answers were definitely mixed.

What have you experienced at your institution that has helped increase diversity in the nursing workforce or improve diversity for the future nursing workforce?

Grace Yang RN, BS is a Washington Center for Nursing Board member and a staff nurse at Harborview Medical Center, Seattle.

Recently, my co-lead for the implementation in Washington of the Institute of Medicine (IOM) Recommendations to transform nursing, Linda Tieman and I spent several days with Action Coalitions from 14 other states in Washington, D.C. The Robert Wood Johnson Foundation/AARP collaboration to ensure that we have improved healthcare access, a better healthcare system, and nurses to lead that work, gave organizations the opportunity to apply to become an action coalition in their state.  We are putting our Steering Committee together now and are planning a fall session to launch the work statewide.

Our goal in D.C. was to meet with members of Washington State’s congressional delegation. D.C. was hot, busy, exciting, and beautiful! We brought information about the Washington Nursing Action Coalition and Washington State’s problem of not having enough nursing faculty to respond to the need for more capacity in our schools. We explained that without more faculty, we won’t be able to educate enough nurses to care for our growing population: we now have 14% more people than at the 2000 census. In addition, healthcare reform will give about 300,000 more people access to healthcare in Washington. The members of our congressional delegation and their staff were well aware of our challenge already, and eager to support our work. Several have already signed the “pledge” we brought to support implementing the IOM Recommendations, and also assigned a key staff member to be our contact person from their office. They recognize that this shortage is not a nursing issue but a societal issue that will take all of us to solve.

It was great to hear stories from other state teams after our days of visits on “the Hill.” We learned about effective stories and approaches, shared ours, and heard about some unexpected conversations that some had. All of us were exhilarated! Washington State has a lot of work to do, but we’re ahead of many states because of years of working together to reach the goal of being “the healthiest state in the nation.” We all know that nurses are crucial to that happening.

You can keep up with the Washington Nursing Action Coalition on WCN’s website or send WCN your ideas.

Greg Vigdor is CEO of the Washington Health Foundation and co-lead of the Washington Nursing Action Coalition.