President s Message Save the Date!!! September 27, 2014 It s a Birthday Party and You re Invited!!! Page 3

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Quarterly circulation approximately 22,000 to all RNs, LPNs, and Student Nurses in Maine. Maine Lupins Photo courtesy of Juliana J.

!! Page 3 Susan Henderson and Margaret Hourigan Joint Resolution Recognizing the Centennial of Maine Nursing Page 4 State Senator Emily Cain for Congress Page 15 Let s Celebrate!

27, 2014 planned at two locations, thanks to interactive technology support!

Thanks to her diligent work with the Program Committee s support, they created a Birthday Party and program celebrating a 100 year partnership with ANA, along with an early

Begin the event at a Friday evening, September 26 membership-only reception in Portland for the newly elected ANA-President; concurrently, members from the north-central region

Yes, the birthday celebration, conference, luncheon with awards and annual meeting will be at two sites with link by teleconference.

The keynote speaker at the Portland site with the featured speaker at the UMO site will be concurrent sessions; each site will also feature local speakers.

Our compliments and profound gratitude to Ann Napier and her team, inclusive of Donna Policastro, Executive Director for this superb program and celebration!

Recent reports from the American Nurses Association indicate that at least 50% of the new members joining are at or under 35 years of age! Awesome!

Membership dues are only $13/month. Join now at http://www.anamaine.org/ Attend our Annual Meeting, Conference and Birthday Party September 27th. Contact us at info@anamaine.

Led by Representative Erik Jorgensen of Portland and Representative Anne Graham of North Yarmouth, who is our nurse legislator, the Joint Resolution passed with overwhelming

1 Quarterly circulation approximately 22,000 to all RNs, LPNs, and Student Nurses in Maine. Maine Lupins Photo courtesy of Juliana J. L Heureux Journal Highlights SPRING 2014 President s Message Save the Date!!! September 27, 2014 It s a Birthday Party and You re Invited!!! Page 3 Susan Henderson and Margaret Hourigan Joint Resolution Recognizing the Centennial of Maine Nursing Page 4 State Senator Emily Cain for Congress Page 15 Let s Celebrate! by Irene Eaton Sing, skip, stretch out your arms and twirl! We made it through that challenging winter and chilly start to spring. Enjoy the summer skies and gentle evenings. Grab each moment as a gift. While you experience the spring into summer, also take a few moments to check our new ANA-Maine website and Irene Eaton browse through the important events of September 26 and 27, 2014 planned at two locations, thanks to interactive technology support! Ann Napier, Chairperson of the planning committee, provided a vision for expanding the meeting state wide. Thanks to her diligent work with the Program Committee s support, they created a Birthday Party and program celebrating a 100 year partnership with ANA, along with an early celebration of the Maine State Board of Nursing s Centennial, next year! Begin the event at a Friday evening, September 26 membership-only reception in Portland for the newly elected ANA-President; concurrently, members from the north-central region are invited to a reception for Past President Mary Foley. Yes, the birthday celebration, conference, luncheon with awards and annual meeting will be at two sites with link by teleconference. We re walking our talk in efforts to shorten travel distance and facilitate member participation. The keynote speaker at the Portland site with the featured speaker at the UMO site will be concurrent sessions; each site will also feature local speakers. This is only the tip of the iceberg. Our compliments and profound gratitude to Ann Napier and her team, inclusive of Donna Policastro, Executive Director for this superb program and celebration! See the Website for details and registration. Please register early! Recent reports from the American Nurses Association indicate that at least 50% of the new members joining are at or under 35 years of age! Awesome! We need you, your energy, your vision, your in-this-age communication savvy! Join us in leadership as we develop and expand ANA s programs in Maine. Membership dues are only $13/month. Join now at Attend our Annual Meeting, Conference and Birthday Party September 27th. Contact us at info@anamaine.org to become a part of the action. Moreover, our ANA-Maine historic centennial Joint Resolution passed in the Maine Legislature! Led by Representative Erik Jorgensen of Portland and Representative Anne Graham of North Yarmouth, who is our nurse legislator, the Joint Resolution passed with overwhelming bi-partisan support. In the preamble, the resolution reads, Be it RESOLVED: That We, the Members of the One Hundred and Twenty-sixth legislature now assembled in the Second Regular Session, on behalf of the people we represent, that this opportunity to recognize the 100th Anniversary of nursing practice and education in the State of Maine; and be it further RESOLVED: That a suitable copy of this resolution, duly authenticated by the Secretary of State, be transmitted to ANA-MAINE. Thank you, Juliana L Heureux, chair of the ANA-Maine legislative committee, for bringing this to fruition! Kudos for picking up the ball and running with it! Researching our ANA-Maine centennial and the launch of the Maine State Board of Nursing, an initiative that was President s Message continued on page 14 current resident or Presort Standard US Postage PAID Permit #14 Princeton, MN A Nurse Comments on Nursing... 2 Editor s Opinion... 3 Save the Date!... 3 Joint Resolution Recognizing the Centennial of Maine Nursing... 4 Nurses in the News A Vision Becomes a Reality... 7 CE Calendar... 8 Index Nurses Work: Keeping Patients Safe Parts I and II Burnout and the Registered Nurse: The Implications of Leadership Style Nursing Summit Membership Application Poetry Corner State Senator Emily Cain for Congress... 15

Page 2 ANA Maine Journal May, June, July 2014 A Nurse Comments on Nursing by Annelle Beall, MSN, RN, CNN, NE-BC As a master s-prepared, certified nurse executive, I am familiar with nearly all

This experience proved to me that competent, compassionate nursing care is being practiced Annelle Beall routinely in Maine hospitals.

I found it difficult to keep track of time.

Graduate Certificate Program in Gerontology is designed to strengthen the knowledge, skills, and abilities of health care and human service professionals who provide care to older adults in a variety

). Spring semester GRN 502: Interventions for Care of Older Adults in Diverse Settings (3 cr.). Summer 2014 GRN 503: Health Policy Issues of an Aging Population (2 cr.). Fall semester Integrative Seminar in Gerontology (1 cr.

2 Page 2 ANA Maine Journal May, June, July 2014 A Nurse Comments on Nursing by Annelle Beall, MSN, RN, CNN, NE-BC As a master s-prepared, certified nurse executive, I am familiar with nearly all aspects of acute care. Nevertheless, I lacked experience from the perspective of an acutely ill patient until a recent 23-day hospitalization in Portland. This experience proved to me that competent, compassionate nursing care is being practiced Annelle Beall routinely in Maine hospitals. In early January, transient eschemic (TIA) symptoms took me to the emergency department. It was discovered that I had thrombotic thrombocytopenia purpura (TTP). I found it difficult to keep track of time. From my admission to the community hospital to the first several days at the large academic medical center, much of the time is accessible to me as only brief moments, seemingly as in a dream, or that time is totally lost. I became unresponsive early in my hospitalization at the medical center and required several days in the critical Interprofessional Graduate Certificate Program in Gerontology The Interprofessional Graduate Certificate Program in Gerontology is designed to strengthen the knowledge, skills, and abilities of health care and human service professionals who provide care to older adults in a variety of settings. This 12-credit certificate program, consisting of five (5) courses, is offered online. GRN 500: Opportunities and Challenges of Aging (3 cr.). Fall semester GRN 501: Life Transitions and Health in Aging (3 cr.). Spring semester GRN 502: Interventions for Care of Older Adults in Diverse Settings (3 cr.). Summer 2014 GRN 503: Health Policy Issues of an Aging Population (2 cr.). Fall semester Integrative Seminar in Gerontology (1 cr.). Course in development; first offering planned in Spring For more information, please go to: and The University of Maine is an equal opportunity/affirmative action institution. care unit. In addition to necessary plasma exchanges, as often as twice a day, I received red cell transfusions, chemotherapy with rituximab and high-dose intravenous steroids. As if the other effects of the TTP were not enough, I had a lacunar stroke while hospitalized. (Cognitive deficits and complications are not uncommon with TTP.) Truly remarkable were the many encounters with nurses along every step of this journey to recovery. An initial assessment of my illness in the emergency department was professional, and the nurse not only cared for me but for my spouse as well. He also was sensitive to the fact that as a hospital employee, I was concerned that I might receive special treatment when admitted (something I discouraged). There is little I remember about the next 24 hours, but I remember a nurse talking with me about how my blood pressure medication would need to be changed while hospitalized and why. Upon my transfer to the academic medical center, the nurse introduced himself and provided a clear and simple explanation of what would happen next. This was helpful as my cognition was less than adequate. He also let me know that my spouse was on the way up, which was a huge concern to me at the time. There was a night nurse in critical care that I remember very well, however. She did something that was truly remarkable. My spouse had gone home that night. It was early the following morning, and I wanted to speak with my spouse. The nurse dialed the number and gave me the phone. Having me alert and asking for a specific cola beverage was one of the most meaningful things that could have happened for my spouse. The relief of my being responsive was monumental. It is very likely that the nurse had no idea how important that was to the two of us during this terrifying time. It is also likely that she does this kind of thing every day. We particularly connected with one of the floor nurses when I was transferred out of critical care. She explained the therapies I would be receiving from a nursing perspective, and never assumed that she shouldn t explain. Furthermore, she made it clear that our participation was crucial to the treatment plan. My opinion mattered. Even if I was not assigned as her patient, she followed my progress when she was on duty. When I had the stroke, in a matter of seconds, it seemed, multiple individuals came into the room. I remember seeing the words nurse practitioner on neurology s nametag. I was unable to voice anything but the word stroke, but I was trying to tell my spouse that this was the stroke team. Oddly, I did not feel scared because the Nurse Practitioner was so competent. Other nurses during my hospital stay understood how I wanted to receive my medications was important. One nurse reassured me that he would interrupt me only if it were required by regulation, because he knew I had experienced little sleep the previous night. He emphasized that sleep was essential to my recovery; therefore, all care would be concentrated around any necessary interruption. During plasma exchanges, the nurses made sure I was comfortable and taught me about the process whenever I was awake enough to receive information. Never did I feel I was a burden (although there were times when I likely was an unplanned addition to their schedules). Advocacy, education, clinical competency, and compassion these are all expectations of us as nurses. How rewarding it is to see, even if it was from the other side of the delivery model. Annelle Beall, MSN, RN, CNN, NE-BC, is Nurse Manager of 2B Inpatient Surgical, CCU and Dialysis, at Mercy Hospital. She also serves as Secretary of ANA-MAINE. She is the Secretary of the Board of ANA-Maine. Published by: Arthur L. Davis Publishing Agency, Inc. Volume 10 Number 2 Published by the American Nurses Association-Maine a constituent member association of the American Nurses Association info@anamaine.org Web Site: P.O.Box 1205, Windham, ME ANA-MAINE BOARD OF DIRECTORS Irene J. Eaton, MSN, RN, CS President, Kennebunk irene.bancroft@anamaine.org Patricia Boston, MSN, RN, RRT First Vice President, Biddeford Juliana L Heureux, BS, RN, MHSA Second Vice President, Topsham Rebecca Quirk, MSN, RN IV, CNL, CPON, CPSTI Treasurer, Scarborough Annelle Beall, MSN, RN, CNN, NE-BC Secretary, Scarborough Jill Bixby, APRN, MS, CHPN Director, Oakland Patricia Boston Director Joyce Cotton, DNP, APRN-BC Director, Kennebunk April Giard, PMH-NP Director, Orland Rosemary Johnson, PhD, APRN-BC Director, South Portland Catherine Lorello-Snow, PMHRN-BC Director, Portland Contents of this newsletter are the opinion of the author alone and do not reflect the official position of ANA- MAINE unless specifically indicated. We always invite leaders of specialty organizations to contribute. ANA-MAINE EDITORIAL COMMITTEE Juliana L Heureux, BS, RN, MHSA (Editor) Rosemary Henry, MS, RN Millicent G. Higgins, EdD, RN Sue McLeod, BSN, RN, BC Terri Matthew, RN, BSN Paul Parker, BSN, RN Jenny Radsma, PhD, RN Nancy Tarr, MSN, ANP, FNP We welcome submissions, but we reserve the right to reject submission of any article. Send to publications@anamaine.org. CE calendar listings are without charge. Attribution: We do not knowingly plagiarize. We encourage our authors to fact check their material but we do not assume responsibility for factual content of ads or articles. For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) , sales@aldpub.com. ANA- Maine 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. Published quarterly every February, May, August and November. Acceptance of advertising does not imply endorsement or approval by ANA-Maine 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. ANA-Maine 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 ANA-Maine or those of the national or local associations. Postal Address corrections: This list of addressees is obtained from the Maine State Board of Nursing (MSBON) each issue. To keep your address current for these mailings, simply notify the MSBON of any needed changes in your postal mailing address. Permission must be obtained from ANA Maine to replicate or reproduce any content from ANA Maine Journal.

May, June, July 2014 ANA Maine Journal Page 3 Editor s Opinion Creating Tomorrow s Nursing History by Juliana L Heureux A nursing history group meets regularly at the Maine State Board of Nursing in

In documenting and writing about the past, these historians are also creating a baseline for the future.

This was the beginning of registered nurses in Maine. Over the past 100 years, many historic nursing heroes have spoken to those of us who are documenting their interesting stories.

3 May, June, July 2014 ANA Maine Journal Page 3 Editor s Opinion Creating Tomorrow s Nursing History by Juliana L Heureux A nursing history group meets regularly at the Maine State Board of Nursing in Augusta for the purpose of putting together a retrospective Centennial of professional nursing in Maine. In documenting and writing about the past, these historians are also creating a baseline for the future. In 1914, the American Nurses Association incorporated in Maine, where the leaders launched the legislation in 1915 to create the Maine State Board of Nursing. This was the beginning of registered nurses in Maine. Over the past 100 years, many historic nursing heroes have spoken to those of us who are documenting their interesting stories. Listening to nurses who are Juliana L Heureux teaching us about the past reminds us about how nurses today are creating our generation s history. What will nurse historians report when the Bicentennial history of Maine nursing is being assembled? Notably, the legislative Joint Resolution to celebrate the Centennial of Maine Nursing will be included in future annals. (A copy of this resolution is included in this newspaper) Appreciation will be extended to Maine State Rep. Erik Jorgensen of Portland and Rep. Anne Graham of North Yarmouth, a nurse practitioner, who both led the legislative initiative recognizing the first 100 years of Maine s registered nurses. Moving forward, history will recognize 2014 as the year when Ann Sossong, PhD, RN, received recognition as the first professor of nursing at the University of Maine in Orono. She is also the Maine nursing leader who is coordinating the Centennial committee. Most important, future historians will applaud Maine s nurses for continuing to provide expert quality care to our patients, while the challenges of transitioning from traditional hospitals to high technology are changing the way health care is managed. On September 27, 2014, the Centennial ANA-MAINE annual meeting being planned at two locations at University of New England in Biddeford Pool and at the University of Maine in Orono, will launch nursing s future with a celebratory theme titled Innovation, Integration, Influence. Leadership from Anne Napier will certainly be applauded when future nurse historians reflect on the accomplishments of today s professional leaders. Included in the futuristic planning is the use of interactive technology (ITV) allowing for statewide participation. Certainly, today s nursing leaders will be celebrated by future generations. We want those who write our bicentennial stories to recognize how nursing s success was built upon the dedication and caring of extraordinary and inspirational leaders of the past and the present, who were challenged to earn the public s trust. To that end, all nurses are cordially invited to celebrate at our Centennial birthday party. Be sure to clip the save the date announcement published in this newsletter and make a point of participating and becoming a part of nursing history! The Nursing Centennial Committee members are: Ann Sossong PhD. RN, Susan Henderson, MSN RN, Juliana L Heureux, BS RN MHSA, Myra Broadway, JD MS RN, Elizabeth Clark PhD RN, Valerie Hart EdD APRN PMHCMS-BC, Martha Eastman PhD MS BS and Marla Davis, MSN RN. SAVE THE DATE!!! IT S A BIRTHDAY PARTY AND YOU ARE INVITED!!! WHAT: CELEBRATING 100 YEARS OF NURSES LEADING THE WAY IN MAINE ANA-Maine Conference, Birthday Party and Annual Meeting WHEN: SATURDAY, SEPTEMBER 27TH, 8:00 AM-4:30 PM LOCATION: Attend at either of two sites at University of New England in Portland or at University of Maine in Orono. Watch the ANA-ME web site for more details. PROGRAM: Watch for more details. For 100 years, Maine nurses have been leaders in health care and patient care, providing skills, knowledge, leadership, inspiration and innovation to Maine residents and patients. In honor of our past leaders and to learn from our current leaders and colleagues, ANA-Maine is sponsoring a conference for all Maine nurses. So that we may more fully appreciate our past, take pride in our present, and be inspired for our future: Presenters will focus on Leadership, New Ideas and Initiatives, and Interdisciplinary Collaboration. We want nurses from all over the state to be able to attend presentations by nationally- known nurses, Maine nurses, and nursing students who represent our future, so: The conference will be held at two sites simultaneously at the University of New England-Portland campus, and at the University of Maine-Orono campus. Sites will be connected by interactive video conferencing. Live speakers will be at both locations. Morning Keynote speaker, at UNE, will be the incoming ANA President. Afternoon Featured Speaker, at UMO, will be past-ana President Mary Foley. CNEs will be available at both sites. At the provided luncheon, Annual Awards will be presented to outstanding Maine nurse leaders. AND.we will have a birthday cake to help us celebrate. So save the date: Saturday, September 27, and share in the journey as nurses continue to lead the way in Maine for the next 100 years. To our compassionate, dedicated nurses Happy Nurses Week! Full-Time Night ER RN Visit our website at for all nursing opportunities! Tracy L. Bonney-Corson, MSN, Director of Nursing Charles A. Dean Memorial Hospital and Nursing Home P.O. Box 1129, Greenville, ME NURSE PRACTITIONER (CWON) REGISTERED NURSES Mid Coast Hospital Join a progressive team of outstanding nursing colleagues in a collaborative practice environment. Be part of a MAGNET Hospital. The following positions are available: ADULT NURSE PRACTITIONER (CWON) 32 hr/wk, days APRN with certification in Wound, Ostomy and Incontinence Care to work in a busy wound clinic. This role will also provide consultation and treatment recommendations for inpatients. INTENSIVE CARE UNIT 36 hr/wk, 7p-7a, every 3rd weekend 24 hr/wk, 7p-7a, every 3rd weekend EMERGENCY/BEHAVIORAL HEALTH UNIT 24 hr/wk, 7a-3p, 3p-11p or 11p-7a shifts available 32 hr/wk, 7a-3p, 3p-11p or 11p-7a shifts available Mid Coast Hospital offers a competitive salary and benefits package; compensation commensurate with experience. We invite you to explore the opportunities for professional growth at Mid Coast Health Services by applying online at An affiliate of MID COAST HEALTH SERVICES AN EQUAL OPPORTUNITY EMPLOYER

Page 4 ANA Maine Journal May, June, July 2014 State of Maine In the Year of Our Lord Twenty Fourteen JOINT RESOLUTION RECOGNIZING THE CENTENNIAL OF MAINE NURSING Representative Anne Graham and Erik

settings; and WHEREAS, Maine nurses provide their services in hospitals, in hospice, public health and emergency settings, in homes, in educational, governmental, industrial and private facilities,

4 Page 4 ANA Maine Journal May, June, July 2014 State of Maine In the Year of Our Lord Twenty Fourteen JOINT RESOLUTION RECOGNIZING THE CENTENNIAL OF MAINE NURSING Representative Anne Graham and Erik Jorgensen WHEREAS, Maine nurses provide professional and high-quality health care for people in all parts of the State when and where it is needed, including in urban, rural, island and wilderness settings; and WHEREAS, Maine nurses provide their services in hospitals, in hospice, public health and emergency settings, in homes, in educational, governmental, industrial and private facilities, in long-term care, mental health, surgical care and obstetrical services settings, in physicians practices and in community health centers; and WHEREAS, quality health care provided by Maine nurses has long been supported by the American Nurses Association of Maine, or ANA-Maine, which before 2001 was known as the Maine State Nurses Association; and WHEREAS, ANA-Maine has been a constituent of the American Nurses Association since 1914, and nursing practice in Maine has been registered by the State Board of Nursing since 1915; and WHEREAS, it is the mission of the State Board of Nursing to protect the public health and welfare in the area of nursing practice, and it is the mission of ANA-Maine to work for the improvement of health standards and the availability of health care services for all Maine people; and WHEREAS, it is also the mission of ANA-Maine to foster high standards for nursing and to promote the professional development of nurses; and WHEREAS, ANA-Maine advocates for nurses and promotes the recruitment and retention of nurses in Maine; and WHEREAS, nursing education has grown and expanded to meet the needs of a changing health care system to include certified registered nurse anesthetists, certified nurse midwives, nurse practitioners and clinical nurse specialists; now, therefore, be it RESOLVED: That We, the Members of the One Hundred and Twentysixth Legislature now assembled in the Second Regular Session, on behalf of the people we represent, take this opportunity to recognize the 100th Anniversary of nursing practice and education in the State of Maine; and be it further RESOLVED: That a suitable copy of this resolution, duly authenticated by the Secretary of State, be transmitted to, ANA-Maine. Susan Henderson and Margaret Hourigan with the Nursing Centennial Exhibit at the 13th Annual Maine Nursing Summit held on March 19, 2014, at the Augusta Civic Center H.P.1288 ATTEST: Picture Credit: Juliana L Heureux House of Representatives Read and Adopted March 4, 2014 Sent for Concurrence Ordered Sent Forthwith Millicent M. MacFarland Clerk of the House In Senate Chamber Read and Adopted March 5, 2014 In Concurrence Darek M. Grant Secretary of the Senate Mark W. Eves Speaker ofthe House of Representatives ATTEST: Justin L. Alfond President of the Senate

May, June, July 2014 ANA Maine Journal Page 5 Sponsored By: Rep. Erik C. Jorgensen of Portland Cosponsored By: President Justin L. Alfond of Cumberland Rep.

Black of Wilton Rep. Andrea M. Boland of Sanford Rep. Sheryl J. Briggs of Mexico Rep. Joseph E. Brooks of Winterport Rep. James 1. Campbell, Sr. of Newfield Rep. Katherine W. Cassidy of Lubec Rep.

Matthea Elisabeth Larsen Daughtry of Brunswick Rep.MichaelGilbertDevinofNewcastle Rep. James F. Dill of Old Town Rep. Mark N. Dion of Portland Rep. Ann E. Dorney of Norridgewock Rep.

5 May, June, July 2014 ANA Maine Journal Page 5 Sponsored By: Rep. Erik C. Jorgensen of Portland Cosponsored By: President Justin L. Alfond of Cumberland Rep. Henry John Bear of the Houlton Band of Maliseet Indians Rep. Paulette G. Beaudoin of Biddeford Rep. Roberta B. Beavers of South Berwick Rep. Seth A. Berry of Bowdoinham Rep. Russell 1. Black of Wilton Rep. Andrea M. Boland of Sanford Rep. Sheryl J. Briggs of Mexico Rep. Joseph E. Brooks of Winterport Rep. James 1. Campbell, Sr. of Newfield Rep. Katherine W. Cassidy of Lubec Rep. Kathleen D. Chase of Wells Rep. Justin Mark Chenette of Saco Rep. Benjamin M. Chipman of Portland Rep. Tyler Clark of Easton Rep. Janice E. Cooper of Yarmouth Rep. Dale J. Crafts of Lisbon Rep. Matthea Elisabeth Larsen Daughtry of Brunswick Rep.MichaelGilbertDevinofNewcastle Rep. James F. Dill of Old Town Rep. Mark N. Dion of Portland Rep. Ann E. Dorney of Norridgewock Rep. Jeffrey Evangelos of Friendship Speaker Mark W. Eves of North Berwick Rep. Richard R. Farnsworth of Portland Rep. Joyce A. Fitzpatrick of Houlton Rep. Lori Fowle of Vassalboro Rep. Kenneth Wade Fredette of Newport Rep. Aaron M. Frey of Bangor Rep. Drew M. Gattine of Westbrook Rep. Sara Gideon of Freeport Rep. Paul E. Gilbert of Jay Rep. Adam A. Goode of Bangor Rep. Anne P. Graham of North Yarmouth Rep. Gay M. Grant of Gardiner Rep. Scott M. Hamann of South Portland Rep. Denise Patricia Harlow of Portland Rep. Lance Evans Harvell of Farmington Rep. Craig V. Hickman of Winthrop Rep. Barry J.. Hobbins of Saco Rep. Brian L. Hubbell of Bar Harbor Rep. Dennis L. Keschl of Belgrade Rep. L. Gary Knight of Livermore Falls Rep. Victoria P. Kornfield of Bangor Rep. Chuck Kruger of Thomaston Rep. Walter A. Kumiega III of Deer Isle Rep. Karen Kusiak of Fairfield Rep. Michel A. Lajoie of Lewiston Rep. Thomas R W. Longstaff of Waterville Rep. W. Bruce MacDonald of Boothbay Rep. Joyce A. Maker of Calais Rep. Richard S. Malaby of Hancock Rep. Donald G. Marean of Hollis Rep. Timothy r.marks of Pittston Rep. Andrew T. Mason of Topsham Rep. Anne-Marie Mastraccio of Sanford Rep. Paul D. McGowan of York Rep. Kimberly J. Monaghan-Derrig of Cape Elizabeth Rep. Matthew W. Moonen of Portland Rep. Stephen W. Moriarty of Cumberland Rep. Catherine M. Nadeau of Wins] ow Rep. Mary P. Nelson of FaLmouth Rep. William F. Noon of Sanford Rep. Ann E. Peoples of Westbrook Rep. Matthew J. Peterson of Rumford Rep. Joshua R. Plante of Berwick Rep. Jane P. Pringle of Windham Rep. Helen Rankin of Hiram Rep. Megan M. Rochelo of Biddeford Rep. Margaret Rotundo of Lewiston Rep. Diane Russell of Portland Rep. Deane Rykerson of Kittery Rep. Linda F. Sanborn of Gorham Rep. Deborah J. Sanderson of Chelsea Rep. Robert J. Saucier of Presque Isle Rep. John C. Schneck of Bangor Rep. Stanley Byron Short, Jr. of Pittsfield Rep. Heather W. Sirocki of Scarborough Rep. Madonna M. Soctomah of the Passamaquoddy Tribe Rep. Peter C. Stuckey of Portland Rep. Charles Kenneth Theriault of Madawaska Rep. Ryan D. Tipping-Spitz of Orono Rep. Sharon Anglin Treat of Hallowell Rep. Beth P. Turner of Burlington Rep. Arthur C. Verow of Brewer Rep. Windol C. Weaver of York Rep. Joan W. Welsh of Rockport Rep. R. Wayne Werts of Auburn Rep. Alexander Reginald Willette of Mapleton Sen. James A. Boyle of Cumberland Sen. David C. Bums of Washington Sen. Emily Ann Cain of Penobscot Sen. John J. Cleveland of Androscoggin Sen. Ronald F. Collins of York Sen. Margaret M. Craven of Androscoggin Sen. David E. Dutremble of York Sen. Patrick S.A. Flood of Kennebec Sen. Stanley J. Gerzofsky of Cumberland Sen. Geoffrey M. Gratwick of Penobscot Sen. James M. Hamper of Oxford Sen. Anne M. Haskell of Cumberland Sen. Dawn Hill of York Sen. Troy D. Jackson of Aroostook Sen. Christopher K. Johnson of Lincoln Sen. Roger J. Katz of Kennebec Sen. Colleen M. Lachowicz of Kennebec Sen. Brian D. Langley of Hancock Sen. Garrett Paul Mason of Androscoggin Sen. Edward J. Mazurek of Knox Sen. Rebecca J. Millett of Cumberland Sen. John L. Patrick of Oxford Sen. Gary E. Plummer of Cumberland Sen. Thomas B. Saviello of Franklin Sen. Roger L. Sherman of Aroostook Sen. Michael D. Thibodeau of Waldo Sen. Douglas A. Thomas of Somerset Sen. John L. Tuttle, Jr. of York Sen. Linda M. Valentino of York Sen. Eloise A. Vitelli of Sagadahoc Sen. Rodney L. Whittemore of Somerset Sen. Richard G. Woodbury of Cumberland Sen. Edward M. Youngblood of Penobscot In Testimony Whereof, I have caused the seal of the State to be hereunto affixed, GIVEN under my hand at Augusta, this fifth day of March in the year twenty fourteen. Matthew Dunlap Secretary of State The members of OMNE extend a heartfelt thank you to all nurses who just celebrated Nurses Week. Your Strength, Commitment, and Compassion Make a difference! To learn more about OMNE membership, please visit Registered Nurse Skilled Unit Must have acute or Med/Surg experience, able to perform in a team environment in a 40 bed skilled unit. Comprehensive benefit package includes 90% employer paid premium health insurance. Employer paid: dental insurance, group life insurance, short-term and long-term disability insurance. Additional benefits include 403(b) retirement savings plan and earned time plan. Apply to: Jonathan Dahms, HR Generalist, jdahms@sjm-me.org 1133 Washington Ave., Portland, ME Visit our website: At CORRECT CARE SOLUTIONS our care providers spend their days doing what they re best at, serving patients. With less administrative work to do, you can focus on why you got into the healthcare industry. caring for patients. We have opportunities now available in Maine. Sites include: Auburn, Charleston, Machiasport, South Portland, Warren, Windham, and Wiscasset. Opportunities include: Nurse Practitioner, LPN, and RN. If you are looking for an exciting opportunity please join a team that supports you professionally and personally. We invite you to take a look at our career opportunities and the benefits of working at CCS. Please apply online at /careers or fax to: We are proud to be an EOE.

Page 6 ANA Maine Journal May, June, July 2014 Nurses in the News Special Thanks to our very Dedicated Nurses for the Excellent Care You Provide to Our Residents Each and Every Day!

This is a great opportunity to earn a competitive wage and make a difference for our residents as you work with an effective and committed team of healthcare professionals.

Also hiring per diem RNs, LPNs, CNAs & CNA-Ms Please send resumes to: 335 Stillwater Ave, Bangor, ME 04401 Or call (207) 947-1111 donstillwater@firstatlantic.com Stillwater-healthcare.

For Colleen Hilton of Westbrook, this trust transcended into community leadership.

6 Page 6 ANA Maine Journal May, June, July 2014 Nurses in the News Special Thanks to our very Dedicated Nurses for the Excellent Care You Provide to Our Residents Each and Every Day! Full Time Licensed Nurse positions in our 63 bed Skilled Nursing facility. This is a great opportunity to earn a competitive wage and make a difference for our residents as you work with an effective and committed team of healthcare professionals. New Graduates encouraged to apply for our new Preceptor program which includes tuition reimbursement. Also hiring per diem RNs, LPNs, CNAs & CNA-Ms Please send resumes to: 335 Stillwater Ave, Bangor, ME Or call (207) donstillwater@firstatlantic.com Stillwater-healthcare.com Nursing Leader Colleen Hilton RN Mayor of Westbrook Maine by Juliana L Heureux Nursing is ranked by the public as the most trusted profession. For Colleen Hilton of Westbrook, this trust transcended into community leadership. In addition to being the CEO of the VNA and Hospice of South Portland, she is the mayor of the city of Westbrook, which is also her hometown. Colleen Hilton Mayor Colleen Noyes Hilton grew up in Westbrook. She comes from a large family. The daughter of Malcolm and Mary Jane Noyes, Hilton has two brothers and four sisters, several nieces and nephews and great-nieces and nephews. She has been married for 31 years to William Hilton and together they have three children William N., Emily and John, all graduates of Maine colleges. This year, they welcomed their first grandchild, Colleen Mary. When asked about her public service commitments, Hilton acknowledges her parents great influence, instilling the values of public service that place the needs of others before self and make a difference in the community. Her father, Malcolm, was a city councilor when they were called aldermen. He also served on the Westbrook Housing Authority Commission for 20 years. Her siblings serve on other boards and committees in Westbrook. Hilton says her family taught her the importance of helping others. My family has always had a rich tradition of commitment to the city of Westbrook, she says. As the CEO of the busy VNA and Hospice, she also serves as the Vice President for Home Health and Hospice for Mercy Health System of Maine. Hilton completed her Bachelor of Science in Nursing at the University of Southern Maine. She holds a Certificate of Graduate Studies in Health Policy and Management from the Muskie Institute of USM. She is a graduate of the 2008 class of Health Leadership Development, a partnership between the Daniel Hanley Center for Health Leadership and the Institute for Civic Leadership. In 2011, Hilton was recognized a one of five Maine Women to Watch by Mainbiz Magazine. More than 85 Maine business leaders from across the state were nominated for this honor, and she was selected to represent the dual role of healthcare provider and the Mayor of Westbrook. As a passionate advocate for home health and hospice, she has served on the Home Care Alliance of Maine Board of Directors in several capacities. She s a member of the Organization of Maine Nurse Executives (OMNE) and ANA-Maine, and she serves in several healthcare professional advisory roles. She also served on the board of directors for a local nursing home. Hilton continues to serve as the vice chair of the Cumberland District Public Health Council, advocating for public health along with 30 other member organizations. In her local community, Hilton has served as a member of the Westbrook School Committee for 10 years and as its chair. She was a 2007 recipient of the Department of Education Commissioner s Recognition award for her work in Truancy, Dropout and Alternative Education. She continues to stay involved with advocacy for children and education and currently serves as a member of the Westbrook Children s Cabinet, a joint effort with United Way of Greater Portland and area business and civic leaders to further enhance programs to ensure children are successful in our community and schools. In 2009, Hilton was first elected mayor of Westbrook and is currently serving her third term. She is the first female elected to this office in the city s history. She enjoys hearing from nurses who might be considering a role in public policy leadership. Feel free to call her at or her at chilton@westbrook.me.us. Check the website for more information. The extraordinary dedication of our nurses is evident from day 1. With so many outstanding professionals working together, it s no wonder our nursing staff is one of the country s best. Because at our core, excellence in patient care is what matters most. It s why for the past eight years, the Maine Medical Center nursing staff has held Magnet status, the nations highest mark for quality patient care.

May, June, July 2014 ANA Maine Journal Page 7 A Vision Becomes a Reality: Recollections in Honor of Sister M.

When Sister Consuela retired as the founder of the nursing program at Saint Joseph s College, she gave me, a nursing faculty member, a box of pictures Susan Henderson from a drawer in her office.

college. Sadly, Sister Consuela died that May. Over the summer, I thought a lot about Sister Consuela and looking at the pictures. There were pictures of the first capping and pinning.

Carol Seavor, who replaced Sister Consuela as department chair, got together and realized that they wanted to do something to remember Sister.

With editing by Charmaine Daniels and graphic design by Renee LeBrun, they wrote A Vision Becomes a Reality: Recollections in Honor of Sister M. Consuela White (2012/2013.

Saint Joseph s College has published this story and a copy will be given to individuals who donate $20 or more to the Sister Consuela White scholarship fund at Saint Joseph s College.

To participate, please contact Heather Plati in the Office of Institutional Advancement at Saint Joseph s by emailing hplati@sjcme.edu or call 207-893-7898.

7 May, June, July 2014 ANA Maine Journal Page 7 A Vision Becomes a Reality: Recollections in Honor of Sister M. Consuela White by Susan Henderson, MSN, RN There s an opportunity to recognize the leadership of Sister M. Consuela White and to participate in the Sister Consuela White Scholarship Fund. When Sister Consuela retired as the founder of the nursing program at Saint Joseph s College, she gave me, a nursing faculty member, a box of pictures Susan Henderson from a drawer in her office. I put the box away and when she retired, gave it to her department chair, who had the pictures scanned into a PowerPoint presentation that was given to me at my May 2011 retirement party at the college. Sadly, Sister Consuela died that May. Over the summer, I thought a lot about Sister Consuela and looking at the pictures. There were pictures of the first capping and pinning. Fran Linehan, a nursing faculty member, who was hired before the first class started its sophomore year, Barbara Malonson Daggett, who graduated in the class of 1982, and Dr. Carol Seavor, who replaced Sister Consuela as department chair, got together and realized that they wanted to do something to remember Sister. We wanted to have something published that would tell future nursing students and faculty about the history of the nursing department and Sister Consuela. With editing by Charmaine Daniels and graphic design by Renee LeBrun, they wrote A Vision Becomes a Reality: Recollections in Honor of Sister M. Consuela White (2012/2013. Barbara Malonson Daggett 82, Susan Henderson, Francis Linehan and Carol Seavor). Saint Joseph s College has published this story and a copy will be given to individuals who donate $20 or more to the Sister Consuela White scholarship fund at Saint Joseph s College. It is hoped that you will order a copy and find this history meaningful and your generous support will help to grow the scholarship fund for current and future nursing students at Saint Joseph s. To participate, please contact Heather Plati in the Office of Institutional Advancement at Saint Joseph s by ing hplati@sjcme.edu or call The Summer Camp, a nonprofit residential summer camp, provides girls from low-income families and foster homes with the opportunity to experience a sleep-away camp. Our summer sessions for 2014 will be held at a private camp in Washington, Maine, located 20 minutes from Augusta. We are an American Camp Association accredited camp celebrating our 29th season this summer. We are seeking to hire a nurse for the following dates: June 21st June 30th and August 4th August 16th. Travel allowance provided. If you are interested in MAKING A DIFFERENCE this summer, please contact: Tracy St. Onge-May, 8 Church Street, Bridgton, ME (800) thesummercamp.org info@thesummercamp.org Nurses in the News Donna DeBlois Appointed CEO of Home Health by Juliana L Heureux Donna DeBlois, RN, BSW, MBA, MSB, has been appointed as President and CEO of HomeHealth Visiting Nurses in Saco ME. DeBlois served as interim President and CEO of the agency since October Judith Stone, the chair of the HomeHealth Visiting Nurses said the Board of Trustees Donna DeBlois search committee worked with an independent firm to find a permanent candidate for the position. After an extensive search, the Board clearly expressed confidence and enthusiasm for Donna s leadership abilities, her engagement with staff, and the visionary path she has set forth for HomeHealth Visiting Nurses she said. DeBlois has more than 30 years of experience in the home health field, mostly in Maine. Prior to accepting No Campus Visits Liberal Credit Transfers Competitive Tuition Classes That Fit Your Schedule AMHC provides competitive pay and a supportive team environment. Our mission is to provide comprehensive mental health, substance abuse treatment services to Aroostook, Washington and Hancock County communities. Psychiatric Nurse Practitioners Recruitment is underway for Master Level Psychiatric Nurses who are independently licensed in the State of Maine. Primary responsibilities are to provide psychiatric assessments and medications management, as well as consultation to multidisciplinary care teams. This position requires a Masters Degree that represents study in advanced clinical practice in a selected area of psychiatric nursing, and passing of a national certification examination. This position requires the individual to be independently licensed as an Advanced Practice Nurse by the Maine State at time of hire. AMHC is also NHSC approved employer. Salary commensurate with experience. Assistance also available for interview, relocation and licensure expense reimbursement. Please submit a letter of interest, resume to: Brittany Haines Human Resource Specialist AMHC P.O. Box 1018, Caribou, Maine to: bhaines@amhc.org AMHC is a non-profit organization and an Equal Opportunity Employer. the interim CEO role at HHVN, she served as executive director of Kno-Wal-Lin Homecare and vice president of Community Health for Pen Bay Healthcare in Rockland. Her professional leadership experience includes positions with Homecare and Hospice Alliance of Maine, OMNE Nursing Leaders of Maine and the Board of the National Association for Homecare and Hospice. Moreover, she served in leadership positions with healthcare industry associations both on a state and national level. She earned both her MBA and MSB degrees from Husson College in Bangor, her BSW from the University of Maine and her nursing degree from CMMC School of Nursing. Contact DeBlois at the website org/. 5th Annual Patient Safety Academy Friday, September 5, am - 4 pm University of Southern Maine, Portland Campus, Abrombson Center All persons interested in or engaged in patient safety are invited to attend the Patient Safety Academy. ANA continuing nursing education credits will be provided for eligible participants. Registration is $50 (with a discounted rate of $25 for students). For more information, please visit: or contact: Judy Tupper, DHEd, CHES, CPPS, at jtupper@usm.maine.edu Director of Nursing If you have an adventurous spirit and a yearning to live the simple and good life, come join us in paradise! We are searching for a Director of Nursing who will embrace our Mission to provide personalized service to support the health and well-being of all people through their journeys in life according to our core values of Integrity, Respect, Compassion, Stewardship and Excellence. Cordova Community Medical Center is a 23 bed Critical Access Hospital that includes a Family Practice Clinic, Emergency Department, Inpatient, Long Term Care, and Swing Care/Rehab. The Medical Center is a warm, friendly and caring work environment with a very capable and knowledgeable staff. We have between 8-12 geriatric residents living in our Long Term Care facility; we all love and care for them as members of our family. We also serve a close-knit community of approximately 2100 people year round that can boom to around 5000 between May and September every year during the fishing season. Cordova Community Medical Center (CCMC) may be the career opportunity you are looking for. In addition to accruing paid time off, regular employees enjoy access to health insurance and life insurance. CCMC is a participant in the State of Alaska s Public Employees Retirement System (PERS) and we offer employees the option to voluntarily enroll in a 403b Tax Sheltered Annuity. Employees are eligible for membership with Denali Alaskan Federal Credit Union and receive a discount in the cafeteria and on annual passes for the Bidarki Recreation Center and Bob Korn Swimming Pool. Please contact: Tim James, HR Coordinator tjames@cdvcmc.com

Page 8 ANA Maine Journal May, June, July 2014 Although we attempt to be as accurate as possible, information concerning events is published as submitted. We do not assume responsibility for errors.

Send items to publications@anamaine.org. Please use the format you see below: date, city, title, sponsor, fee and contact information. There is no charge to post an educational offering.

Not all courses listed here provide ANCC-COA credit, but they are printed for your interest and convenience. For more CNE information, please go to www.anamaine.org.

USM/PCE indicates the class is offered through University of Southern Maine/Center for Professional and Continuing Education. For course descriptions, visit http://usm.maine.

8 Page 8 ANA Maine Journal May, June, July 2014 Although we attempt to be as accurate as possible, information concerning events is published as submitted. We do not assume responsibility for errors. If you have questions about any event, please call the event planner directly. If you wish to post an event on this calendar, the next submission deadline is June 20, 2014, for the Summer 2014 issue. Send items to publications@anamaine.org. Please use the format you see below: date, city, title, sponsor, fee and contact information. There is no charge to post an educational offering. Advertising: To place an ad or for information, contact sales@aldpub.com. ANA-MAINE is the ANCC-COA accredited Approver Unit for Maine. Not all courses listed here provide ANCC-COA credit, but they are printed for your interest and convenience. For more CNE information, please go to To obtain information on becoming an ANCC-COA CNE provider, please contact anamaine@gwi.net. USM/PCE indicates the class is offered through University of Southern Maine/Center for Professional and Continuing Education. For course descriptions, visit muskie/continuing-education. (The previous website address no longer works) or call or for a catalog. Most classes are held at the new Abromson Community Education Center in Portland, conveniently located just off I-295. Free parking nearby. CCSME indicates class is held by the Co-Occurring Collaborative Serving Maine. For PESI HealthCare seminars in Maine, visit Visit the ANA-MAINE Calendar of Events at: for more information for additional upcoming events. Are you passionate about nursing education? Do you have experience in adult learning and nursing education, as well as a baccalaureate or graduate degree in nursing? If so, ANA-MAINE has a spot just for you on its Continuing Nursing Education Committee! ANA-MAINE is an Accredited Approver of Nursing Continuing Nursing Education by the American Nurses Credentialing Center s Commission on Accreditation (ANCC-COA). Make use of this wonderful opportunity to facilitate the ongoing education of your peers, and to become involved in your nursing organization. For more information, contact Dawn Wiers at , or cne@anamaine.org. Looking for cutting edge training in the management of STDs and HIV? Visit to view the latest course offerings and register for a course that is convenient for you. Many courses offer free CME/CEU credit. Opening for CNE Program Reviewers RN to Bachelor of Science Degree. Blended online and classroom program, University of Southern Maine, College of Nursing and Health Professions. Contact Amy Gieseke, Program Coordinator for USM s Online/Blended Programs, or agieseke@usm.maine.edu. RN-BSN distance education for licensed RNs wishing to complete the BSN degree; exclusively online program of study. University of Maine at Fort Kent. Contact Professor Diane Griffin, coordinator, or dgriffin@ maine.edu. USM/ONLINE. Certificate Program in Gerontology (15 undergraduate credits). Students may complete the five courses in the program in one year by taking one course in each 7-week session or they may proceed at their own pace. For more information, visit usm.maine.edu/online/online-certificate-programgerontology or call or May PESI/Portland. Treatment Resistant Anxiety, Worry & Panic: 60 Effective Strategies. 8 a.m.-4 p.m. Speaker: Jennifer L. Abel, Ph.D. Early Registration: $189.99, available until April 26. For additional information, call or visit pesihealthcare.com. 19 PESI/Portland. Autism and Other Neurodevelopmental Disorders: Practical Strategies to Improve Processing. 8 a.m.- 4 p.m. Speaker: Patricia McGuire, MD FAAP. Early Registration: $189.99, available until April 29. For additional information, call or visit University of New England. Sigma Theta Tau Kappa Zeta 26th Annual Induction Ceremony. 2 p.m., Finley Recreation Center, Portland Campus. For more information, go to home. 28 PESI/Portland. The Orthopaedic Patient: Musculoskeletal Concepts for Acute and Chronic Disorders. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after May 8. For additional information, call or visit PESI/Portland. Rehabilitation Strategies for Cognitive-Communication Disorders. 8 a.m.-3:30 p.m. $ single advanced registration or group rate; $ single after May 10. For additional information, call or visit June PESI/Bangor. Non-Medication Treatments for ADHD. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after May 14. For additional information, call or visit pesihealthcare.com. 4 PESI/Portland. Breastfeeding Success: Supporting the Journey. 8 a.m.-3:30 p.m. $ single advanced registration or group rate; $ single after May 15. For additional information, call or visit PESI/Portland. Non-Medication Treatments for ADHD. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after May 15. For additional information, call or visit pesihealthcare.com. 8 USM/PCE/Portland. Patient Safety Course (100 contact hours/10.0 CEUs) Class meets online for 10 weeks, June 8-August 16 with faculty member Judith Tupper. $800. For more information, visit usm.maine.edu/pdp or call or PESI/Portland. Preventing Post-Operative Complications Seminar. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after May 22. For additional information, call or visit Sylvie Ratelle STD/HIV Prevention Training Center of New England Cutting edge training since USM/PCE/Portland. Using Motivational Interviewing with Chronic Illness (12 contact hrs/1.2 CEUs). Class meets two days, May 19 & 20. Instructor-led training by Stephen Andrew. $295. For more information, visit usm.maine.edu/pdp or call or PESI/Portland. Cognitive Behavioral Therapy and Mindfulness. 8 a.m.-4 p.m. Speaker: Richard Sears, PsyD, MBA, ABPP. Early Registration: $189.99, available until May 22. For additional information, call or visit

May, June, July 2014 ANA Maine Journal Page 9 16 PESI/Portland. Understanding the Needs of The Dying. 8 a.m.-4 p.m. $149.99 single advanced registration or group rate; $199.99 single after May 27.

5 CEUs) Class is offered online or on-site, June 18-20 led by Psychology faculty member William Gayton. The cost depends on your registration selection- $175- $475. For more information, visit usm.

Early registration: $99.99, available until June 5. For additional information, call 1-800-843-7763 or visit http:// www.pesihealthcare.com. 27 PESI/Portland.

For additional information, call 1-800-843-7763 or visit http://www.pesihealthcare.com. 30 USM/ONLINE. CON 390 Evaluation & Assessment of the Older Adult (3 undergraduate credits).

30 USM/ONLINE. SWO 375 Gender and Aging (3 undergraduate credits). Class runs June 30-August 15 with faculty member Susan Fineran. For more information, visit usm.maine.

m. $199.99 single advanced registration until June 20. For additional information, call 1-800-843-7763 or visit http:// www.pesihealthcare.com. 11 PESI/Portland.

For additional information, call 1-800-843-7763 or visit http://www.pesihealthcare.com. 16 USM/PCE/Portland. Childhood Psychopathology Institute (15 contact hours/1.

maine.edu/pdp or call 207-780-5900 or 1-800- 787-0468. 23 PESI/Portland. Survival Spanish for Healthcare Professionals. 8 a.m.-4 p.m. $189.99 single advanced registration or group rate; $199.

m.-4 p.m. $189.99 single advanced registration or group rate; $199.99 single after July 9. For additional information, call 1-800-843-7763 or visit http://www.pesihealthcare.com.

9 May, June, July 2014 ANA Maine Journal Page 9 16 PESI/Portland. Understanding the Needs of The Dying. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after May 27. For additional information, call or visit pesihealthcare.com. 18 USM/PCE/Portland. Health Psychology Institute (15 contact hours/1.5 CEUs) Class is offered online or on-site, June led by Psychology faculty member William Gayton. The cost depends on your registration selection- $175- $475. For more information, visit usm. maine.edu/pdp or call or PESI/Portland. Using the DSM-5 for Revolutionizing Diagnosis & Treatment. 8:30 a.m.-4 p.m. Speaker: Martha Teater, MA, LMFT, LCAS, LPC. Early registration: $99.99, available until June 5. For additional information, call or visit PESI/Portland. Infectious Diseases: Reduce, Eliminate, Prevent. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after June 6. For additional information, call or visit 30 USM/ONLINE. CON 390 Evaluation & Assessment of the Older Adult (3 undergraduate credits). Class runs June 30-August 15 with faculty member Susan Moore. For more information, visit usm.maine.edu/online/ online-certificate-program-gerontology or call or USM/ONLINE. SWO 375 Gender and Aging (3 undergraduate credits). Class runs June 30-August 15 with faculty member Susan Fineran. For more information, visit usm.maine.edu/online/online-certificate-programgerontology or call or July PESI/Bangor. Ethical Principles in the Practice of Maine Mental Health Professionals. 8:30 a.m.-4:30 p.m. $ single advanced registration until June 20. For additional information, call or visit PESI/Portland. Ethical Principles in the Practice of Maine Mental Health Professionals. 8:30 a.m.-4:30 p.m. $ single advanced registration until June 21. For additional information, call or visit 16 USM/PCE/Portland. Childhood Psychopathology Institute (15 contact hours/1.5 CEUs) Class is offered online or on-site, July led by Psychology faculty member William Gayton. The cost depends on your registration selection- $175- $475. For more information, visit usm.maine.edu/pdp or call or PESI/Portland. Survival Spanish for Healthcare Professionals. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after July 3. For additional information, call or visit PESI/Portland. Respiratory Emergencies: Key Interventions in a Crisis Seminar. 8 a.m.-4 p.m. $ single advanced registration or group rate; $ single after July 9. For additional information, call or visit August Congrès mondial acadien Conference - The Nursing Profession: History, Analysis of the Present and Looking Towards Future Directions. August 21 and 22, Nursing Faculty Position Full-time tenure track position available in the Department of Nursing for Fall The successful candidate will be able to teach across the undergraduate curriculum, and demonstrate recent teaching and clinical experience. Areas of teaching expertise sought include maternal child health, evidence based practice, leadership, and/or mental health nursing. Qualified candidates must possess an earned doctorate or doctoral candidacy, have a research agenda, university level teaching experience and eligibility for RN licensure in the state of Maine. Faculty rank and salary are commensurate with qualifications. The Department of Nursing is located on two campuses in Portland and Biddeford, Maine. The primary location of this position is Portland. The University of New England offers a competitive salary. To apply please submit a letter of interest and CV to careers@une.edu. The number 620 must appear in the subject line of the . For information, contact Human Resources University of New England 716 Stevens Avenue Portland, ME Review of applications will begin immediately and search will remain open Happy Nurses Week In recognition of the heartfelt passion you display all year long, HomeHealth Visiting Nurses wishes you a Happy Nurses Week 2014! Care at a higher level Care Our online program provides: A career-focused education Flexible courses designed for working adults with busy schedules Tuition rates on average 15 20% less than major for-profit online universities Supportive advisors who understand your needs Rolling admissions and monthly start dates BEGIN TODAY BACHELOR S AND MASTER S IN NURSING Visit online.sjcme.edu/menurses or call for more information. For over a century, we have brought the best in home health to our patients and families in Southern Maine. As the leading home health care agency in the region, we proudly deliver comprehensive care with compassion, commitment and the highest standards of excellence. Our services are available throughout York, Cumberland and southern Oxford Counties. RN Opportunities in most areas. Requires at least one year of hands-on nursing experience. For employment opportunities, please visit EOE Proud Member of the MaineHealth Family

Page 10 ANA Maine Journal May, June, July 2014 Nurses Work: Keeping Patients Safe Parts I and II by Cheryl M. Roberts, BSN, MS, RN, CPHQ Editor s note: This is a two-part article.

In the 1990s, general satisfaction with and confidence in healthcare providers and institutions was relatively low among the public.

10 Page 10 ANA Maine Journal May, June, July 2014 Nurses Work: Keeping Patients Safe Parts I and II by Cheryl M. Roberts, BSN, MS, RN, CPHQ Editor s note: This is a two-part article. Part I was first published in the fall Now, the entire article is printed, with Part I and Part II appearing side-by-side. In the 1990s, general satisfaction with and confidence in healthcare providers and institutions was relatively low among the public. Stories abounded of substandard care, including medication overdoses, amputation of the wrong limb, missed cancer diagnoses, dead babies, botched transplants, and other serious adverse occurrences. Medical malpractice premiums skyrocketed. In 1996, the Committee on Quality of Healthcare in America was formed by the National Academy of Sciences Institute of Medicine (IOM), and its members, forward thinkers from health care, science, and business, were charged with identifying strategies to achieve substantial improvement in the quality of health care delivered to Americans. In 1999, the committee released its initial report, published a year later as the part of the Institute of Medicine s Quality Chasm series, entitled To Err Is Human: Building a Safer Health System. The report focused on the fact that human beings are inherently error-prone, that errors could be prevented by designing systems that To Err is Human By the Institute of Medicine, National Academy of Sciences make it easy to do the right things and hard to do the wrong things, and that we could no longer overlook the issues of quality and safety staring us in the face. The publication was not only a groundbreaking summary of mistakes that occur across the healthcare landscape and that had often been accepted as one of those things that happen. It also addressed needed changes in the systems and processes in health care and the strategies to facilitate these changes, which if undertaken could prevent errors. The committee concluded that between 44,000 and 98,000 Americans died every year from preventable medical errors and that many more experienced, or barely escaped, non-fatal errors and injuries. In 2001, a follow-up report was published by IOM, entitled Crossing the Quality Chasm: A New Health System for the 21st Century. This report acknowledged that patient safety, while extremely important, provided only a piece of the puzzle. This report issued recommendations for healthcare providers and institutions to adopt a new perspective about the purpose and aims of the healthcare system. Widespread system flaws were acknowledged Crossing the Quality Chasm: A New Health System for the 21st Century By the Committee on Quality Healthcare in America that ultimately affected millions of Americans and their treatment, dignity, comfort, satisfaction and finances. The ideas were revolutionary, involving changes in the structure and processes of healthcare delivery, including setting new national priorities for improvement, creating better ways to disseminate and encourage evidence-based practice, fostering use of information technology, implementing payment policies that would reward improvements in performance, and improving the education of the healthcare workforce. Since that time, extensive work has been done in the field of patient safety. Initially, few facilities were able to consistently track their performance, but there were no universal nomenclature and no agreement on what could or should be measured. Over the course of a few years, organizations such as The Joint Commission (TJC) and large third-party payers such as the federal Center for Medicare and Medicaid Services (CMS) worked with other groups such as the Leapfrog Group and the National Quality Forum to standardize measurement concepts, quality and safety improvements, and reporting requirements. Public reporting of quality and satisfaction data became the norm through TJC and CMS. In Maine, a group of large, self-insured employers organized with a few interested healthcare partners to create the Maine Health Management Coalition (MHMC). The MHMC utilized the already-reported CMS measures and the Leapfrog Group s survey information, created some measures of their own regarding medication safety and invited healthcare providers to join them in demonstrating the provision of safe, quality care. The MHMC has continued to be a leader in the state and nationally regarding public reporting of comparable data. Some organizations (like the state of Maine and University of Maine system) use this information to rank hospitals and providers and offer incentives to those insured to seek care at those facilities or providers who are ranked the highest. Nationally, financial incentives have been successfully used by CMS to focus attention on areas of concern such as hospital readmissions, never events, care of patients with heart conditions, community-acquired pneumonia, and surgical infection, using evidence-based care to steer necessary changes. Nurses are at the forefront of many of these initiatives. Although many of the efforts are and have been driven by attempts to address the high cost of health care, many healthcare providers, especially nurses, are inherently interested and invested in safe patient care. Whether this means assuring that patients diagnosed with communityacquired pneumonia receive their initial antibiotic within six hours of diagnosis or making sure the right patient has surgery on the correct body part, nurses play an important role in overseeing the collaborative care that is regularly provided. Nurses role as patient advocate guarantees them a place in the forefront of quality and safety improvement initiatives. In addition to these examples of collaborative care, there are multiple areas of patient safety that any nurse can independently address, such as proper patient identification, medication administration safety, prevention of serious injury from falls, prevention of healthcareassociated infections, and understandable patient education. Let us briefly examine what is meant by medical error and adverse event. There are two main distinctions. First, because patients do regularly experience adverse outcomes, distinguishing between those outcomes that occur as a result of medical care and those events that happen as a result of underlying medical conditions is necessary. The first is considered a medical error or patient harm. The Institute for Healthcare Improvement (2006) defines medical error or harm as unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization or that results in death. The second distinction, since patients may experience harm in the absence of error, patient safety literature separates into preventable and non-preventable adverse events. Evolution in the area of patient safety has occurred since the time prior to 1998 when it was not uncommon to see staff punished if they reported an error. When Betsy Lehman, a reporter for the Boston Globe, died at the Lahey Clinic as a result of a chemotherapy overdose (Allen, 2004), the nurse and pharmacist lost their jobs and their professional licenses. This punitive philosophy gave way to that of a blame-free culture to encourage reporting of errors so the risk for making errors could be addressed. The philosophy of the blame-free culture gave way to that of an accountable culture and evolved into what is now referred to as a just culture. A just culture is one in which systems that predispose to error are identified and remedied, which is distinct from errors of accountability involving human error (e.g., slips ) or risky behavior (taking shortcuts), or even reckless behavior (forgoing safety precautions), which is contrasted with a no-blame approach (Agency for Healthcare Research and Quality, n.d.). Wachter (2012) states that just culture contributes to an atmosphere of trust in which people are encouraged, even rewarded, for providing essential safety-related information. But, a just culture is also one in which the providers are clear about where the line must be drawn between acceptable and unacceptable behavior. Healthcare administrators and providers of care now recognize that the most common contributor to error is the process or system that allowed the error to occur. Generally speaking, the individuals involved are not unintelligent or bad or negligent, nor are they the actual cause of the error. Clarification of this premise in recent years encourages accountability such that individuals who practice consistently risky behavior or consistently violate policy or protocols, should indeed be held accountable for the behavior that puts others patients and colleagues in harm s way. The method by which processes and systems are dissected to identify the flaws in a system and any other factors that influenced an error is known as a Root Cause Analysis. This analysis is carried out, usually over the course of several meetings, by having all parties associated with an occurrence discuss what happened and ask one simple question: Why? If a process is examined prior to an error occurring, it is called a Failure Mode Effects Analysis. This approach is preferable to waiting until after an error or adverse event has occurred and is widely practiced in organizations where near-misses are regularly reported. A near-miss event is an error that is caught or stopped before it reaches the patient. Part II Following are two scenarios involving patients and highly competent caregivers where serious or potentially serious adverse events occurred. These caregivers intended to provide (and thought they had provided) exceptional care to their patients. Nonetheless, their actions missed the mark for what is considered to be safe, competent practice, and consequently, the individuals involved were personally changed, as were the patients and their families, by the event. Scenario 1: In the late 1990s, the quality/infection control department of a small hospital worked collaboratively with surgeons, nurse anesthetists, the pharmacist and surgical nurses to assure that patients having surgery in which a prophylactic antibiotic was indicated received the appropriate antibiotic in a timely fashion. The recommendation was that the antibiotic be given within one hour prior to incision. Since this practice often occurred two or more hours prior to the incision, improvement was needed in the process. The system in place was fairly complex, involving many people, each with different expectations and functions. The surgeon generally ordered the antibiotic on call to the OR, the OR nurses went to the med-surg unit to get the patient, and the nurses on the med-surg unit thought it was their job to give the antibiotic before the patient left the unit for the OR. After examining the process, the decision was made that it would be better if the antibiotic was given after the patient arrived in the OR area. This change had not been completely adopted (some nurses found it hard to give up their usual task), nor had the change been particularly well communicated (that it was not a choice) and the nurses on the floor still considered it to be helpful to give the antibiotic before the patient left the floor. Nurses Work continued on page 11

11 May, June, July 2014 ANA Maine Journal Page 11 Nurses Work continued from page 10 On one particular day, the OR called for the patient. The floor nurse had mixed the antibiotic but did not have time to hang it; rather, she handed the bag to the one of the nurses who had arrived from the OR to get the patient. The OR nurse and floor nurse exchanged a few words that were subsequently recognized as misunderstood. The patient went to the OR, had the scheduled surgical procedure, and returned to the floor with epidural analgesia. Pain control was an issue for the patient over the course of the day and before leaving for the day the CRNA came up to re-evaluate the patient. She opened the epidural analgesia box and found the bag with the patient s pre-op antibiotic infusing, not the fentanyl mixture she had anticipated and thought she had used. Fortunately, the antibiotic, although administered intrathecally, caused no damage. This medication error was able to be classified as not causing patient harm. A review and investigation ensued that identified that the CRNA thought the prepared I.V. bag contained fentanyl and did not examine the bag or label, even though it did not fit easily into the box. The bag had been assumed to contain fentanyl but was plainly labeled as the antibiotic. The antibiotic in the OR was premixed in the pharmacy and labeled with the same size and color label used for any I.V. admixture. While she thought she identified the contents of the bag she had been handed, the CRNA had given it only a cursory glance and never considered that a mistake had been made. The nurse on the med-surg unit thought she was being helpful when in fact she complicated the new procedure. The areas identified as problematic were: Staff members who did not follow protocols for Administering a medication mixed by someone else Identifying a medication prior to administration Inconsistent practices regarding preoperative antibiotics Process changes not communicated to all involved staff members as mandatory What changes do you think should have been made? Would you be more heavy-handed in the implementation of a new procedure? In the real world of multiple departments caring for the same patient, how could this problem have been foreseen and prevented? The following changes were made in the process to prevent recurrence: The prophylactic, preoperative antibiotic was never again given on the med-surg unit prior to surgery unless specifically ordered as such. The label used for epidural analgesia was changed so it was different from that used for other medications. The epidural analgesia box was double checked by a second nurse before it was closed and whenever reporting off to another caregiver. Scenario 2: The second case occurred in It was a late evening in early June. A husband and wife had been out to supper together and had consumed seafood, nothing unusual. The husband began feeling unwell and was brought to the hospital. The nurse who triaged the patient (Patient A) determined he was having an allergic reaction to the seafood he had eaten, which she termed anaphylaxis. Thinking a written protocol allowed for and covered her actions, the nurse administered 0.3 ml of 1:1000 epinephrine subcutaneously. Patient A began to feel better. A change of shift occurred, and the nurse who triaged the patient left to go home after giving report to the remaining nurse. The ED started to get busy and because the ICU was closed, the ICU nurse was floated to the ED to help. The nurse who gave the epinephrine at the time Patient A arrived found herself caring for a patient (Patient B) with psychiatric needs, a patient who was well known in the ED and prone to violence. Patient B insisted only one particular nurse could come into his room. The ICU nurse reassessed Patient A (with the allergic reaction) and reported to the physician that Patient A was starting to feel unwell again. The physician told her to give 3 ml of epinephrine. The nurse drew up the medication but was not quite sure about it for some reason she could not pinpoint. Twice she asked the physician if the dosage was 3 ml of epinephrine and she was told yes ; in fact, the physician quickly wrote it down as he was being distracted by other things. The nurse tried to look up epinephrine in the drug book and the page was missing. When asked, the nurse who had given the first dose, said only, Gee, that s a hefty dose, and continued to talk to Patient B. The nurse went into the patient s room and administered 3 ml of epinephrine, which as you have likely surmised by now, was a dosage error 10 times the usual dose. Within an hour, Patient A had a cardiac arrest. When reviewing the patient s chart, the physician recognized his error. In speaking with Poison Control personnel, he learned there is no antidote for epinephrine. Autopsy showed a heart with changes likely caused by epinephrine. The patient who died was my neighbor; his family, my friends who were closely associated with the hospital. I was there with the physicians to talk to this family, to explain what we thought might have happened and assure them we would know more after an autopsy. I have the family s permission to share this fatal event with you so that others might be spared a similar event. Also, let me say that the nurses and physician were experienced and very competent; they were not prone to or expected by any of their colleagues to make serious mistakes. They were personally and professionally devastated by this occurrence. Although no formal disciplinary action occurred, this event was examined within our institution. Consequently, many multiple system issues that contributed to this devastating error became revealed: Although the nurse was experienced in working with epinephrine, she was accustomed to the dosage indicated during cardiac arrest, which is more dilute and used for a different purpose. No protocol existed that allowed the nurse to administer medication for an allergic reaction without an order. Because the patient was medicated prior to being seen by the physician, the physician never saw Patient A in his initial condition. Having staff attend education sessions and to adhere to department policies rather than their own posed a challenge at times. The drug books in the ED had not been updated because the intention was to shift to computerized resources; education in this area had not been completed by the ICU nurse by the time of the error. Orientation of nursing staff to the ED did not include anaphylaxis and treatment. Neither was a checklist included in the Mosby nursing resource manual used by the facility. The epinephrine came in multi-dose vials, a decision made prior to this event as a way to keep costs down. The nurse felt as though she had pestered others enough even though she remained uncomfortable with the order. She did not believe she should continue to question the physician or the other nurse. What do you think should have happened? Were these individuals personally and solely responsible for this patient s death? Should they have lost their jobs or licenses? What steps would you take to prevent this sort of error from happening to anyone else? What lessons do you take from this occurrence? Several changes were made as a result of this event, a few of which included: The nurses were informed that in absence of a protocol for allergic reaction, a physician was required to evaluate the patient before medication was given. All nursing staff was educated and required to be proficient in using the computerized resources. Epi-pens were supplied for the ED and the multidose vials were removed from service. Anaphylaxis and allergic reaction were added to the orientation checklist. Medical staff and the board of directors approved a new communication policy of tolerance for questions from nursing staff and setting forth ways to assure staff that their questions had been correctly heard. The circumstances of this occurrence were truthfully disclosed to the family, to the hospital personnel, and then the greater community. In short, the family expressed their appreciation of the way the situation was handled and communicated their forgiveness to the nurse and physician involved. Other far-reaching changes that occurred included: Many hospitals across the country removed the multi-dose vials of epinephrine from their emergency departments and replaced them with Epi-pens, at a cost of $50 per pen compared to pennies for the multi-dose vial. However, had these injectables been available to the nurse in the ED, she would have needed 10 epi-pens to administer the dose she gave, a signal that would have forced her continued questioning of such a lethal dose. The labeling of epinephrine and the similarity of appearance of vials with varying dosages was again brought to the attention of the manufacturer. Mosby recognized the gravity of omitting anaphylaxis treatment from its materials. Accident Some holes due to active failures HAZARDS Other holes due to latent conditions SUCCESSIVE LAYERS OF DEFENSES From these two incidents, you can better comprehend the Swiss Cheese Theory, described by Wachter (2012). This theory developed by James Reason, a patient safety expert, posits that the contributing factors to most errors in complex organizations relate to the organization s incomplete layers of protection, which allow the errors to pass through on their way to causing terrible harm. Thus, you can see how during simple, everyday tasks we can be distracted, or give up questioning too easily, or side-step ingrained procedures. Instead, we all need to be vigilant every day, all the time, to keep safe the people who trust us and come to us for help. Cheryl M. Roberts, BSN, MS, RN, CPHQ teaches nursing at University of Maine of Fort Kent. She has 30 years of experience in risk management and nursing administration. References Agency for Healthcare Research and Quality. (n.d.). Patient safety network: Safety culture. Retrieved from: ahrq.gov/primer.aspx?primerid=5 Allen, S. (2004). With work Dana Farber learns from 94 mistakes. Boston Globe. Retrieved from: com/news/local/articles/2004/11/30/with_work_dana_ farber_learns_from_94_mistakes/?page=full Institute for Healthcare Improvement. (2006). IHI launches national campaign to reduce medical harm in U.S. hospitals, building on its landmark 100,000 lives campaign. Retrieved from IHIPressRelease_IHILaunchesCampaigntoReduceHarm_ Dec06.pdf Institute of Medicine. (2000). To err is human: Building a safer health system. National Academies Press. Available fulltext online: Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press. Available fulltext online: php?isbn= Wachter, B. (2012). On swiss-chees and patient safety. Wachter s World. Retrieved from: org/2012/06/12/on-swiss-cheese-and-patient-safety/

Page 12 ANA Maine Journal May, June, July 2014 Burnout and the Registered Nurse: The Implications of Leadership Style by Denise Worcester, RN Burnout threatens the health of nurses and contributes to

The registered nurse experiences one of the highest prevalence rates of burnout and has been one of the most studied professions in this subject area Denise Worcester (Leiter & Maslach, 2009).

12 Page 12 ANA Maine Journal May, June, July 2014 Burnout and the Registered Nurse: The Implications of Leadership Style by Denise Worcester, RN Burnout threatens the health of nurses and contributes to workforce shortages (Edward & Hercelinsky, 2007; Kravits, McAllister-Black, Grant & Kirk, 2010). The registered nurse experiences one of the highest prevalence rates of burnout and has been one of the most studied professions in this subject area Denise Worcester (Leiter & Maslach, 2009). Therefore, it is fundamentally important to incorporate strategies that promote a healthy work environment and professional satisfaction, thereby diminishing the effects of work-related stressors leading to burnout. Nursing leadership has an inherent responsibility to create and maintain healthy work environments, with leadership style serving as a significant contributing factor towards this endeavor (Malloy & Penprase, 2010). This paper explores the impact of (a) burnout on nursing, (b) distinguishes several styles of nursing leadership (c) investigates the correlation between various leadership styles and burnout within the research and (d) reflects upon potential holistic leadership approaches to address the issue among registered nurses in the workplace. Workplace Issue: Burnout Nursing s future is challenged by the potential for burnout that often results from the intrinsic nature of the caring and healing (Edward & Hercelinsky, 2007). The concept of burnout was introduced in the 1970s as a way to describe adverse reactions to work in human services (Kanste, 2008). Burnout is defined as a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that results from continual exposure to workplace stressors (Kanste, 2008; Leiter & Maslach, 2009). Emotional exhaustion can occur from feeling overwhelmed and emotionally overextended (Fearon & Nicol, 2011). Depersonalization ensues when nurses lose interest in their job and the quality of the care they deliver; it is often referred to as compassion fatigue in the medical community (Borysenko, 2011). Reduced personal accomplishment arises from dissatisfaction with achievement and productivity at work, or simply feeling ineffective in providing the high level of quality desired in an optimal caring-healing environment (Fearon & Nicol, 2011). Ultimately, burnout may simply evolve as a result of the imbalance between what nurses give and receive in the workplace (Fearon & Nicol, 2011). Burnout is not only a debilitating condition that severely affects the health of nurses, but also contributes to organizational concerns like decreased work performance and productivity, increased errors, less than optimal patient outcomes, absenteeism and turnover (Leiter & Maslach, 2009; Milliken, Clements & Tillman, 2007). The incidence of burnout among nurses in the U.S. has reportedly been as high as 54 percent with associated costs of an approximated $250 billion to $300 billion annually (Kravits et al., 2010; Milliken et al., 2007). An estimated one in five nurses will actually leave his or her job due to job dissatisfaction and burnout (Milliken et al., 2007). Online Associates Degree Health Information Technology Today s fastest growing health career For more information call or visit us on the web: Many factors inherent within the daily demands of the registered nurse contribute to workplace fatigue, stress, job dissatisfaction and subsequently burnout. Nursing leadership style is a factor affording a significant contribution to the incidence of burnout among nurses in the workplace (Cummings et al., 2010; Kanste, 2008; Malloy & Penprase, 2010). Whitehead, Weiss and Tappen (2010) identified leadership as a key source of job stress leading to burnout through the way managers relate to and communicate with their staffs. Therefore, nursing leadership has been tasked to examine its role in bringing health and well-being back to the nursing workforce through healthier work environments and improved job satisfaction (Cummings et al., 2010). Leadership Styles Definitions of leadership include common key elements: leadership is a process, leadership involves influence, leadership occurs within a group setting and leadership involves pursuit of a shared goal (Cummings et al., 2010; Whitehead et al., 2010). Successful leadership expands upon these elements to include concepts such as effective adaptation, skillful communication, and self-awareness (Whitehead et al., 2010). There are numerous leadership styles prevalent in the workplace and often a combination of styles may be observed in practice to achieve organizational goals (Cowden, Cummings & Profetto-McGrath, 2011). Regardless of the particular style, a shared commonality may be discerned within a task-focused or relationship-focused framework (Cowden et al., 2011). Task-Focused Leadership Style Task-focused leadership focuses on completion of the necessary tasks within the expectations of the organizational and unit workflow aimed at achieving certain goals (Cowden et al., 2011). Task-focused leadership includes transactional and laissez-faire styles (Cowden et al., 2011; Cummings et al., 2010). Transactional leadership is characterized by rewarding achievement and reprimanding mistakes (Malloy & Penprase, 2010). The reward/reprimand continuum is used in exchange for follower compliance (Malloy & Penprase, 2010). Alternatively, laissez-faire leadership is a lack of leadership involving passive management by exception and avoidance of involvement (Malloy & Penprase, 2010; Whitehead et al., 2010). Laissez-faire leaders tend to react to problems only when they become too serious to ignore, and often avoid situations warranting decisive action (Cummings et al., 2010). Relationship-Focused Leadership Style Relationship-focused leadership focuses on people and relationships, instead of tasks, to achieve shared goals (Cummings et al., 2010). Relationship-focused leadership includes transformational and participative styles. Transformational leaders motivate others to engage in problem solving, shared decision making, and their own professional development through coaching, mentoring and simply being present (Bjarnason & LaSala, 2011). Ability to build trust, inspirational motivation, demonstrated integrity, intellectual stimulation, and individualized consideration are attributes of the transformational leaders (Kanste, Kyngas, & Nikkla, 2007; Malloy & Penprase, 2010). This style demonstrates an ability to communicate a vision in a way that is meaningful, exciting, and inspires commitment and The Mission of the Maine Association for Healthcare Quality is to improve the quality of healthcare by advancing the theory and practice of quality management in healthcare organizations and to support the professional growth, development, and education of healthcare quality management professionals. Find us on enthusiasm (Whitehead et al., 2010). Participative leadership, also known as democratic leadership, is another relationship-focused style (Whitehead et al., 2010). This style is characterized by shared leadership within a team setting and given guidance by a leader (Whitehead et al., 2010). Important initiatives and decisions are agreed upon within the team environment (Whitehead et al., 2010). This style of leadership encourages motivation and creativity (Whitehead et al., 2010). Leadership Style and Burnout: The Research Research has investigated the implication of leadership style towards the significant workplace issue of burnout among registered nurses. A distinct relationship emerges, revealing a correlation between leadership behaviors and burnout (Cummings et al., 2010; Kanste et al., 2007; Malloy & Penprase, 2010). Work environments with low levels of nurse burnout had managers who emphasized the relational aspects of work, such as individual well-being and job satisfaction (Kanste, 2008). Alternatively, a taskfocused leadership style, such as transactional or laissez-faire leadership, resulted in heightened job dissatisfaction and burnout (Cummings et al., 2010; Kanste et al., 2007; Malloy & Penprase, 2010). A 2008 study surveyed 627 nurses to investigate the association between leadership behavior and burnout (Kanste, 2008). Leadership behavior was measured utilizing the Multifactor Leadership Questionnaire and burnout was measured with the Maslach Burnout Inventory-Human Services Survey (Kanste, 2008). The study substantiated the premise that relationship-focused leadership behaviors, such as those of transformational leadership, protected individuals from burnout as defined by emotional exhaustion, depersonalization and reduced personal accomplishment (Kanste, 2008). Another study published in 2009 analyzed the data obtained from a questionnaire completed by 667 Canadian nurses (Leiter & Maslach, 2009). The goal was to investigate the role of burnout in predicting the intention of nurses to leave their positions (Leiter & Maslach, 2009). Burnout was measured by the Maslach Burnout Inventory General Scale which included the three dimensions of burnout: exhaustion, depersonalization/cynicism, and inefficacy or reduced personal accomplishment (Leiter & Maslach, 2009). The results of this study demonstrated that burnout was a predictor of turnover intention among nurses surveyed (Leiter & Maslach, 2009). The study also showed that the primary reason for turnover was related to the extent to which the nurses were involved with their work (Leiter & Maslach, 2009). Essentially, the psychological withdrawal of cynicism, a dimension of burnout, has a direct correlation with social withdrawal and nursing career choices that include leaving a position or even the profession in its entirety (Leiter & Maslach, 2009). This study reinforces the necessity for nursing leadership to create and maintain a healthy work environment incorporating optimal leadership style, such as transformational leadership, that builds relationships, engages staff, and minimizes depersonalization or cynicism as it relates to burnout (Leiter & Maslach, 2009). A Holistic Leadership Approach to Burnout Among Registered Nurses The research recognizes the importance of relationshipfocused behaviors, as an aspect of leadership style, to be protective measures against burnout within nursing (Kanste, 2008). As such, leadership programs must emphasize an integrated approach to teaching successful and inspirational leaders (Wright, 2012). The most important tool a leader carries in his or her repertoire is the tool of self-awareness (Wright, 2012). In fact, self-aware, contemplative leaders are able to recognize the potential for burnout among their staffs and subsequently take steps to prevent it (Sayre-Adams & Wright, 2012). Burnout and the Registered Nurse continued on page 13

May, June, July 2014 ANA Maine Journal Page 13 Burnout and the Registered Nurse continued from page 12 Emotional intelligence is likewise integral to the prevention of burnout (Fearon & Nicol, 2011).

As a leader, knowing how to handle a situation involves recognizing one s own feelings along with understanding the deeper meaning behind those feelings (Fearon & Nicol, 2011).

Self-reflection is both a self-care and a therapeutic clinical practice that integrates the critical thinking abilities of the mind with the compassion of the heart (Dossey & Keegan, 2013).

(Akerjordet & Severinsson, 2010). Erie Chapman (2011) reflects on seven practices of high purpose leadership within the book, Radical Loving Care.

13 May, June, July 2014 ANA Maine Journal Page 13 Burnout and the Registered Nurse continued from page 12 Emotional intelligence is likewise integral to the prevention of burnout (Fearon & Nicol, 2011). Emotional intelligence refers to the ability to process, understand, and manage emotions with particular emphasis on relationships with others (Fearon & Nicol, 2011). As a leader, knowing how to handle a situation involves recognizing one s own feelings along with understanding the deeper meaning behind those feelings (Fearon & Nicol, 2011). The use of reflective practices and a holistic approach assists in the development of self-awareness and emotional intelligence (Fearon & Nicol, 2011). Self-reflection is both a self-care and a therapeutic clinical practice that integrates the critical thinking abilities of the mind with the compassion of the heart (Dossey & Keegan, 2013). Emotional intelligence represents the relationship between emotion and reason, a meshing of the heart and the mind, to create a caring-healing work environment that reduces the potential for burnout (Akerjordet & Severinsson, 2010). Erie Chapman (2011) reflects on seven practices of high purpose leadership within the book, Radical Loving Care. These practices align with the holistic, relationship-focused behaviors of the successful nurse leader and include the practices of personal commitment, passion, the exploration of personal potential, presence, positive attitudes, persistence, and meditation (Chapman, 2011). These practices are achieved through adoption of a holistic approach to leadership style involving self-reflection, self-awareness, meditation, and the development of emotional intelligence (Chapman, 2011; Dossey & Keegan, 2013; Wright, 2012). Chapman speaks of success as being grounded in personal commitment to the highest possible purpose in our lives (Chapman, 2011). For leaders, this not only involves a commitment to patient care and optimal patient outcomes, but also a commitment to staff satisfaction and well-being (Dossey & Keegan, 2013). Passion is a practice of loving the people with whom we work as well as loving the environment where we are engaged (Chapman, 2011). Presence requires that we work our way out of our personal needs so that we may hear and realize the needs of others (Chapman, 2011). Persistence speaks to the power that motivates us to persevere, even when we may momentarily lose sight of our purpose, and therefore requires reflection to remind us what is important (Chapman, 2011). The holistic practice of meditation is essential for self-healing (Chapman, 2011). Allowing time for contemplation and reflection through meditation practices may enhance healing, and prevent the risk of incurring new wounds or the inclination to unintentionally wound others (Chapman, 2011). This speaks to the importance of self-reflective holistic leadership and emotional intelligence as protective measures against workplace burnout (Dossey & Keegan, 2013; Kanste, 2008). Conclusion Burnout is a significant workplace issue affecting the health of nurses and contributes to a number of organizational issues with substantial financial repercussions. Leadership style has significant implications for this issue. Leadership development emphasizing relationship - focused behaviors is essential to the prevention of burnout among our nursing workforce. Furthermore, holistic approaches incorporating self-reflective practices may assist in the development of emotional intelligence within the nursing leadership community. With improved self-awareness, and balance between emotion and reason, nursing leaders will foster strong relationships with their nursing staffs. Moreover, leadership styles will promote healthier work environments, and improve job satisfaction and individual well-being. Leadership may be instrumental in successfully minimizing the effects of burnout inherent in the caring-healing practices of the nursing profession. Nursing Summit Student nurses from the University of Maine Augusta (UMA) attending the Nursing Summit Nurses Leading Change Through Innovation on March 19, 2014 at the Augusta Civic Center. From left: Sophie Starrett, Allison Maxwell, Maria Goslin, Samantha Healey, Danica Simmons, Trisha Cote and Jenna Caswell; back row: Shirley Uges. Picture Credit: Juliana L Heureux Fully accredited by the Accreditation Commission for Education in Nursing University of Maine at Augusta s Bachelor of Science Nursing Completion Degree UMA s RN-BSN program is designed to accommodate the schedule of working registered nurses who wish to earn a baccalaureate degree in nursing by offering online and hybrid courses. For more information: (207) UMAADM@maine.edu Denise Worcester, RN, is a student at University of Maine at Augusta currently enrolled in the RN to BSN program. She is a nurse at Maine General Medical Center in Augusta. School of Nurse Anesthesia Master of Science in Nurse Anesthesia 27- month program 8-month didactic phase comprised of science and anesthesia courses 19-month clinical anesthesia training at health care facilities throughout New England and the U.S. Participation in more than 550 anesthesia cases working with all kinds of techniques and agents Milk is nutrient-rich, with nine essential nutrients. It is the #1 food source of three of the four nutrients the 2010 Dietary Guidelines for Americans (DGA) identify as falling short in the diets of both children and adults calcium, potassium and vitamin D. Motivate parents to be role models. Parents are important influences on children s behavior, including eating right and being physically active. So encourage them to eat fruits and vegetables and drink milk. Their actions speak louder than words. The DGA recommends low-fat or fat-free milk and milk products daily 3 cups for 9 years or older 2 1/2 cups for 4-8 year olds By the age of 4 2 cups for 2-3 year olds children do not consume the recommended number of servings from the Dairy Group State-of-the-art educational resources with high-tech Clinical Simulation Program Learn more about UNE s MSNA program! GradAdmissions@une.edu (800) ext Visit nationaldairycouncil.org for the latest scientific research, resources and educational tools. June is Dairy Month

Page 14 ANA Maine Journal May, June, July 2014 President s Message continued from page 1 launched by nursing leaders 100 years ago, has taken an extraordinary amount of diligence by a committee led

Among the projects the committee is engaged in includes meeting with nursing leaders to record their oral histories and having these interviews transcribed.

and other locations to obtain as many written records about Maine s nursing history as possible.

Participating in the nursing history project with Professor Sossong are nurses Susan Henderson, Myra Broadway, director of the Maine State Board of Nursing, Beth Clark, Juliana L Heureux, Martha

All of you are cordially invited to our celebrations! Looking to make a difference? Come and be part of our friendly and competent staff. Are you a recent Registered Nurse Graduate?

We are also seeking dynamic, results-oriented RNs/LPNs for Full Time and Part Time on our Day and Evening shifts We have per diem opportunities for RNs and LPNs on all shifts.

14 Page 14 ANA Maine Journal May, June, July 2014 President s Message continued from page 1 launched by nursing leaders 100 years ago, has taken an extraordinary amount of diligence by a committee led by Ann Sossong, professor of nursing at the University of Maine in Orono. Among the projects the committee is engaged in includes meeting with nursing leaders to record their oral histories and having these interviews transcribed. Additionally, the committee accessed the nursing archives at the Maine State Board of Nursing (MSBON), at the University of Southern Maine (USM) and at the Boston University Gottlieb Archival Center and other locations to obtain as many written records about Maine s nursing history as possible. A call was issued in this journal, and at meetings throughout Maine to ask nurses to submit their stories for the oral and written history collection. Participating in the nursing history project with Professor Sossong are nurses Susan Henderson, Myra Broadway, director of the Maine State Board of Nursing, Beth Clark, Juliana L Heureux, Martha Eastman, Valerie Hart and Marla Davis. There are 25,000 Maine nurses who will join us for the Centennial celebrations and our September historic annual meeting. All of you are cordially invited to our celebrations! Looking to make a difference? Come and be part of our friendly and competent staff. Are you a recent Registered Nurse Graduate? Ross Manor, a 93 bed Skilled & Long Term Care facility, is proud to offer an exciting preceptor program for recent RN graduates. We are also seeking dynamic, results-oriented RNs/LPNs for Full Time and Part Time on our Day and Evening shifts We have per diem opportunities for RNs and LPNs on all shifts. Shift hours are Days 6:00am to 2:30pm Evenings 2:00pm to 10:30pm We offer a comprehensive benefits package for all our full time positions 30 hours or more including generous earned benefit time, competitive pay, 401K, Health and Dental benefits, flexible spending accounts, and voluntary short term and long term disability. Please apply in person to Ross Manor 758 Broadway, Bangor, ME Or hrross@firstatlantic.com Acadia Hospital is a full service Psychiatric Hospital located in Bangor, Maine. Competitive Wages and Benefits offered. Currently seeking: Psychiatric Mental Health Nurse Practitioners (PMHNP) Family Psychiatric Nurse Practitioners (FPNP) Psych RNs (ANCC Certified) Member of an interdisciplinary team Earned time-off Vacation/Holiday/Sick Time Plan Loan/Tuition Reimbursement Programs American Psychiatric Nurses Association membership Educational opportunities Mentorship and teaching opportunities Research Committee and assistance with publications Wellness Program Medical/Dental Insurance, Short Term/Long Term Disability, Medical/Dependent Care Reimbursement Accounts, Retirement Plans, and Life Insurance For more information about joining our team log on to our website at 87th Annual Maine Safety & Health Conference Cross Insurance Center, Bangor, Maine October 21-23, 2014 For more information call , melissaw@shcnne.org, or check out our website at Safety & Health Council of Northern New England

May, June, July 2014 ANA Maine Journal Page 15 Poetry Corner TAKE HEART A Conversation in Poetry Edited and introduced by

political action committee (PAC) has endorsed Maine State Senator Emily Cain of Penobscot District 30.

Photo Credit: Juliana L Heureux Little wrinkle from my flesh, eyelid curling down at my fool s prattle; child before whom I m

Poem copyright 2003 Wesley McNair. Reprinted from the Maine Poets, Down East Books, 2003, by permission of Wesley McNair.

at mainepoetlaureate@gmail. com or 207-228-8263.

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15 May, June, July 2014 ANA Maine Journal Page 15 Poetry Corner TAKE HEART A Conversation in Poetry Edited and introduced by Wesley McNair, Maine Poet Laureate A short lyric by the late Maine poet David Walker greets the arrival of a newborn with both praise and wisdom. A Prayer, A Welcome by David Walker State Senator Emily Cain for US Congress 2nd District The American Nurses Association political action committee (PAC) has endorsed Maine State Senator Emily Cain of Penobscot District 30. Senator Cain is running for election to replace Congressman Mike Michaud who is now a candidate for governor. Photo Credit: Juliana L Heureux Little wrinkle from my flesh, eyelid curling down at my fool s prattle; child before whom I m the more child your future older than my past Forgive the father I ll be, become all I can never know; teach me to hold you for a while, and then to let go. Take Heart: A Conversation in Poetry is produced in collaboration with the Maine Writers & Publishers Alliance. Poem copyright 2003 Wesley McNair. Reprinted from the Maine Poets, Down East Books, 2003, by permission of Wesley McNair. Questions about submitting to Take Heart may be directed to Gibson Fay-LeBlanc, Special Consultant to the Maine Poet Laureate, at mainepoetlaureate@gmail. com or Take Heart: Poems from Maine, an anthology collecting the first two years of this column, is now available from Down East Books. Looking for the perfect career? Look no further than... nursingald.com Find the perfect nursing job for you! Department of Nursing Learn more today! For more information: Contact the Office of Undergraduate Admissions admissions@une.edu (800) Earn your BSN Choose a curriculum that meets your needs and fits your schedule. RN to BSN Enrolling Fall 2014 For working RN s Convenient scheduling 12-month completion program Accelerated Second Degree Bachelor (A-BSN) Enrolling Spring 2015 For students with a non-nursing bachelor s degree 16-month completion program 4-Year BSN Enrolling Fall 2014/Spring 2015 For first-time freshmen only 8-semester course work and clinical experiences Our state of the art online learning management system is fully narrated by a clinical instructor, self paced and available for most certifications. ALDME

Page 16 ANA Maine Journal May, June, July 2014 Maine

Maine Opportunities for nurses to lead collaborative

health Increase proportion of nurses with BSN to 80% by

healthcare issues by serving on public/corporate boards

16 Page 16 ANA Maine Journal May, June, July 2014 Maine Action Coalition Strengthening the Future of Nursing in Maine Opportunities for nurses to lead collaborative improvement Preparing nurses to lead change, to advance health Increase proportion of nurses with BSN to 80% by 2020 Empowering and encouraging nurses to influence healthcare issues by serving on public/corporate boards Get Involved! For more information, call (207) or visit a campus in Augusta, Lewiston, or South Portland.

An Invitation to Apply: East Tennessee State University College of Nursing Associate Dean for Academic Programs

An Invitation to Apply: East Tennessee State University College of Nursing Associate Dean for Academic Programs THE SEARCH The East Tennessee State University (ETSU) College of Nursing invites applications,