tercap extends to peer review · apply in person, call, email or mail/fax resume to: san marcos...

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Inside this IssueSocial Media: A Nurse’s Friend or Foe? . . . . . . 4

Ovarian Cancer: A 2011 Snapshot . . . . . . . . . 6

New Resources to Aid Clinicians in Fight Against Tobacco Addiction . . . . . . . . . . . . . . 7

Thumbs Up to Comments from Readers . . . . . 7

11th Annual Nursing Leadership Conference of Texas Nurses Association . . . . . . . . . . 8-10

Texas Team Named an Official Future of Nursing Action Coalition to Advance the Health of Texans through Nursing . . . . . . . 11

Partners in Recovery Ceremony at 25th Anniversary Gala to Highlight TPAPN’s Spring Advocate Workshop Days . 12

Membership Application . . . . . . . . . . . . . . . . 14

TERCAP Extends to Peer ReviewQuarterly circulation approximately 284,000 to all RNs, LVNs, and Student Nurses in Texas.

Join theTexas Nurses Association

Today!

Applicationon page 14.

By now, most nurses probably know of TERCAP®; maybe not precisely what the acronym stands for but certainly that TERCAP began as a national research initiative to gain new knowledge about the causes of nursing practice breakdown and the sources of nursing error.

Taxonomy of Error, Root Cause Analysis and Practice – Responsibility (TERCAP) is intended to be a more proactive way to promote safe practice and better protect the public by preventing errors.

In the early 2000s, the Institute of Medicine (IOM) was focused on patient safety. Keeping Patients Safe, Transforming the Work Environment of Nurses was released in 2004. It followed an earlier IOM report on patient safety released in 1999, To Err is Human: Building a Safer Health System. Both reports dealt with inherent problems in existing health care environments that threaten patient safety because they affect nursing care delivery. To Err is Human brought into national consciousness the staggering number of patients at that time

who died in hospitals each year (as many as 98,000) because of errors in their care that could have been prevented.

As the IOM defined it in 1999, medical errors are the “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.”

In the 2004 Keeping Patients Safe IOM report, one of the recommendations (7-2) was for the National Council of State Boards of Nursing (NCSBN) to undertake an initiative with health care leaders and patient safety experts to design uniform processes across states that would better distinguish human errors from willful negligence or intentional misconduct along with guidelines for their application. What began as a national research initiative became an intake instrument for capturing data from state boards of nursing on practice breakdown cases and a data collection strategy for boards of nursing to learn the root causes of the breakdowns.

NCSBN TERCAP 2007 identified the practice breakdown categories where data would be captured in its national database as:

• SafeMedicationAdministration

• Documentation

• Attentiveness/Surveillance

• ClinicalReasoning

• Prevention

• Intervention

• Interpretation of Authorized Provider’sOrders

• ProfessionalResponsibility/PatientAdvocacy

TERCAP Initiative in TexasAs of early 2011, there were 21 boards of

nursing contributing data to the national database, with Texas being one of them. As the project became more well known in Texas and more widely publicized, it moved from beinga research study to becoming classified as an

TERCAP continued on page 3

Pages 1 & 3 1 Page 4

• Texas Nursing Voice October, November, December 2011

TEXAS NURSING VoiceA publication of Texas Nurses Association

October,November,December2011Volume 5, Number 4

Editor-in-Chief – Clair B. JordanManaging Editor – Joyce Cunningham

Creative Communications – Deborah TaylorCirculation Manager – Belinda Richey

Editorial ContributorsJoyce Cunningham; Juan G. Posada, Jr., MD, FACP;

Ruthie Robinson, PhD, RN, FAEN, CEN; Barry Sharp, MSHP, MCHES; Sheri L. Stevens, RN, OCN; Cynthia Kellam

Stinson, PhD, APRN, BC; Mary Beth Thomas, PhD, RN; Lisa Watson, MLA; and Mike Van Doren, MSN, RN

Editorial Advisory BoardStephanie Woods, PhD, RN,Dallas

Jose Alejandro, MSN, RN, MBA, CCM, DallasPatricia Allen, EdD, RN, CNE, ANEF, Lubbock

Sandra Kay Cesario, PhD, RN, C, PearlandJennifer D.M. Cook, PhD, MSN, RN, San Antonio

Anita J. Coyle, PhD, RN, CHES, SangerThelma L. Davis, LVN, Giddings

Anita T. Farrish, RN, MHSM, NE-BC, WacoPatricia Goodpastor, RN, The Woodlands

Patricia Holden-Huchton, RN, DSN,DentonTara A. Patton, BSN, RN, Palestine

Dianna Lipp Rivers, RN, CNAA, BC, Beaumont

Executive OfficersMargie Dorman-O’Donnell, MSN, RN, President

Victoria England, RN, MBA, Vice PresidentClaudia Turner, MSN, RN, Secretary-Treasurer

Regional Directors of Texas Nurses AssociationJune Marshall, MS, RN – North Region

Eve Layman, PhD, RN, NEA-BC – South RegionKim Belcik, BSN, RN-BC – Central RegionViola Hebert, MA, BSN, RN – East RegionJo Rake, MSN, RN, CNAA – West Region

Executive DirectorClair B. Jordan

TEXAS NURSING Voice is published quarterly – January, February, March; April, May, June; July, August, September;andOctober,November,Decemberby–

Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX 78757-1292.

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Copyright © 2011 by Texas Nurses Association, a constituent member of the American Nurses Association.

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District 35: Kim Gatlin Phone: 903.466-6982 E-mail: [email protected]

District 40: Contact TNA Phone: 800.862-2022 ext. 129 E-mail: [email protected]

Texas Nurses Association Districts and PresidentsPresidents of the 28 state-wideDistrictsofTexasNursesAssociation,aswell

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October, November, December 2011 Texas Nursing Voice •

adverse events reporting database. According to Mary Beth Thomas, PhD,

RN, director of nursing for the Texas Board of Nursing, “the project became of interest to Texas nurses in that several phone calls were received at the Board inquiring about permissiontoutilizetheTERCAPinstrumentasa template for conducting nursing peer review.”

In response to the inquiries, a board-sponsored initiative to promote TERCAP as a template for nursing peer review was discussed with the Texas Nurses Association and the Texas TERCAP Project was underway. TNA went into action as a result of Senate Bill 193, authored by Sen. Jane Nelson and sponsored in the House by Rep. Susan King, the Texas Board of Nursing wasauthorizedby the201182ndLegislature todevelopaconfidential, standardized,voluntary,error classification reporting data system for use by nursing peer review committees to evaluate the conduct of a nurse.

TERCAP continued from page 1

In what one West Texas news reporter termed, “the trial of the trial,” a jury of Howard County citizens in Big Spring found ScottTidwell guilty of all charges against him. Tidwell is the now former Winkler County attorney who criminally prosecuted Anne Mitchell, RN, in 2010 for reporting a physician for unsafe practice concerns.

AfterTidwell’sjuryofpeersfoundhimguiltyof retaliation, official oppression and misuse of official information, Judge Robert Moore decided his sentence. After asking Tidwell more than once, “What were you thinking?,” the judge sentenced him to 10 years of probation, 120 days in the Crane County jail and ordered him to pay a $6,000 fine.

In a from-the-courthouse report filed by CBS 7 News reporter Shelley Childers, Judge Moore was quoted as saying to Tidwell, “Lives have been altered and changed in a way that there is no undoing …the ones most profoundly and permanently effected are of course Anne Mitchell and Vicki Galle.”

Dr. Rolando Arafiles, the physician at thecenter of the Winkler County saga, awaits trial. No trial date has been set. ★

Another One Going to Jail

Thomas Recognized by NCSBN

In a special awards ceremony held during the NCSBN annual meeting last August, Mary Beth Thomas,PhD,RNwaspresentedtheExceptionalContribution Award and recognized for her“exceptional commitment to ensuring patient safety in nursing practice.” The award and honor is given to a board of nursing staff member who hasmadeasignificantcontribution. IndeedDr.Thomas has.

As member and current chairman of the NCSBN TERCAP Committee, Dr. Thomas hasbeen a leader in gathering TERCAP data in her state by training Texas Board of Nursing (BON) staff in the data collection process and increasedutilizationof the tool.Anurse for30years, spending time in nursing administration and health policy, Dr. Thomas is currently thedirector of nursing for the BON and an expert on patient safety in the regulatory arena.

TEXAS NURSING VOICE congratulates Dr. T homa s on he r ou t s t and ingaccomplishments. ★

Peer review is statutorily required under the Texas Nursing Practice Act and is a process of “fact-finding, analysis, and study of events by nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event.” Any person or entity that employs, hires or contracts for the services of 10 or more nurses (RNs, LVNs or any combination thereof) must have a Peer Review Plan.

TERCAP provides the template for this fact finding and analysis by reviewing individual nurse, patient, system and health care team factors that may have been involved in an error event.

Currently the Board is working with a group of stakeholders in developing a pilot where peer review committees would utilize TERCAP inevaluating peer review reports. Dr. Mary BethThomas indicated that the Board is planning on putting out a call to employers early in 2012. ★

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by Cynthia Kellam Stinson, PhD, APRN, BC and Ruthie Robinson, PhD, RN, FAEN, CEN

After a long 12-hour shift in the intensive care unit (ICU), you might come home, kick off your shoes, heat your dinner, and open your laptop to catch up on the latest news from friends and co-workers. Innocently, you might mention to your online “friends” in a Facebook post a complicated, sad case of domestic violence you have been dealing with for the last few days. The nextdayyoucouldbecalledintothechiefnurse’soffice and told you had been terminated due to a violation of privacy; and not only that, but the post hasbeenturnedovertotheU.S.DepartmentofJustice Criminal Section of the United States for further review.

Although the above scenario is fictional, the consequences for a nurse in an actual instance are very real.

Background: The Seriousness of it AllFor everyone, online posts using social media

and social networking have implications for long-term consequences. Social media includes online technology allowing people to have interactive communication via the Internet. Social media can include text, audio, video, images, movies, podcasts, blogs, Twitter, Facebook, and other multimedia communications without face-to-face contact. It can also include social networking which allows individuals to communicate with other individuals who might have common goals or interests. In the last five years, online communication and conversations have become increasingly popular with health care providers.

The most popular form of social media is Facebook. Its website was launched in February 2004 and as of August 2011, it had over 750 million active users. Half of those users log onto the site every day. Facebook users spend 700 billion minutes on the site each month. By October 2007, Facebook was estimated to have a worth of $15 billion (most of its revenue comes from advertising). According to Social Media Today, in April 2010, it was estimated that 41.6 per cent of the U.S. population had a Facebook account.

Health care providers have responsibilities

Social Media: A Nurse’s Friend or Foe?to the general public with this increase in the popularity of social media. These responsibilities have both legal and/or ethical considerationsand consequences. Lack of knowledge on use of social media is no excuse for not following recommendations and laws concerning its use. The American Nurses Association (ANA) Guide to the Code of Ethics for Nurses: Interpretation and Application, available to all health care providers, offers guidelines for use of social media including but not limited to the following: respect, commitment, advocacy, protection, accountability, privacy, and confidentiality (ANA, 2010). Health care facilities are increasingly writing, distributing, educating and enforcing policies regarding the use of social media by health care providers. Furthermore, law enforcement agencies have in some instances leveled fines and other penalties affecting health care providers for use of inappropriate social media conduct especially in relation to privacy laws.

Consequences With this increased usage of social media

comes increased risk of liability. Health care providers using social media must be aware of professional boundaries. Nurses must be aware and sensitive to the reality of the risk involved in a post about work-related incidences.

A post of work-related information, even after hours on home computers or mobile devices, can increase the risk of confidentiality breaches and the possibility of unprofessional conduct. Even after hours, a work-related post must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), specifically in relation to patient privacy (Hader & Brown, 2010).

According to HIPAA, a person’s identity andpersonal health information is protected. In January 2011, it was reported that a nurse who had given care to a fatally wounded police officer and the alleged gunman posted on a home computer after hours that she had during the day come “face to face” with a “cop killer” and hoped he “rotted in hell.” The reasons given for her termination from the hospital where she was employed were violations of HIPAA and the hospital’srulesonpatientprivacy(Hellmer,2011).

The U.S. Department of Health and HumanServices, Office for Civil Rights (OCR) investigates HIPAAcomplaints.Ifacitizenbelievestheirhealthinformation privacy rights or someone else’srightswereviolatedbyahealthcareprovider,he/she can file a complaint with the OCR. If a nurse is believed to have committed a HIPAA privacy violation, the nurse will be required to take corrective action which may include removing the offending information and possible written or formal apology. There could be monetary penalties assessed either through a malpractice caseor theU.S.Departmentof JusticeCriminalSection which prosecutes cases involving the violent interference with liberties and rights defined in the Constitution or federal law.

If found guilty of violating HIPAA privacy rights, criminal fines of up to $50,000 could be assessed or imprisonment of up to one year could result. One example of this violation occurred in Lake Geneva, Wisconsin in 2009. Two nurses posted a photographic image of an x-ray showing a sexual devicelodgedinapatient’srectumonaFacebookpage with a discussion. Walworth County Undersheriff Kurt Picknell found that two nurses had photographed the x-ray and at least one of them posted the photograph. The nurses were terminated from their employment and were also referred to the Federal Bureau of Investigation (Hader & Brown, 2010).

Besides breaches of confidentiality claims, health care providers who post items that betray patient confidentiality may also face civil claims for negligence and/or intentional infliction ofemotional distress and invasion of privacy. Any of these claims could lead to discipline by state boards of nursing under applicable practice acts (Hader & Brown, 2010).

Boundary violations appear to be much easier online than in person (Sarver, 2010). Hospitals, like many other businesses and corporations, are writing policies to protect not only employees but also patients. A post from a patient might include derogatory remarks about a health care provider or a post about other patients in the hospital. As mentioned earlier, a health care provider’s postcan violate HIPAA, privacy laws, or have ethical

Social Media continued on page 5

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consequences. Many hospitals’ policies stressthat no post is private and if a post disrupts or causes liability to the hospital, the employee can be terminated (Paradisi, 2011). As this technology becomes more pervasive, health care providers must become educated and informed about the potential hazards associated with onlineresources.

Editors’ Note: In April 2011, authors Robinson and Stinson conducted a descriptive study that focused on perceptions of nurses concerning appropriate social media usage by the professional nurse. The outcome of the study indicated that nurses need more education concerning the appropriate usage of social media as a professional nurse.

Theauthors’overviewofthestudyfollows.

A Descriptive StudyTo explore practicing nurses’ perceptions of

social media use, we conducted a descriptive pilot study using a survey tool designed by the researchers (the authors of this article). A snowball sampling methodology was used with 344 surveys returned in a two-week period. The snowball methodology is a non-probability technique that is similar to a chain referral system. The online survey link was sent out to nurses who were asked to share the link with their nurse colleagues and friends. Table 1 shows the demographics of the survey population.

Table 1: Demographics of the Survey Population

GenderFemale = 95% Male = 5%

Age< 40 = 21% 41-50 = 24% > 50 = 55%

Work SettingHospital = 62% Academia = 25% Other = 13%

The demographics of the population are similar tothosefoundintheU.S.DepartmentofHealthand Human Services, Health Resources and Services Administration’s 2008 National SampleSurvey of Registered Nurses. In that study, 6.6 per cent of U.S. RNs were male and 44.8 per cent of U.S. RNs were over the age of 50.

In the survey tool, nurses were asked which types of social networking sites they were using. Of the over 70 per cent of respondents who noted they were using some form of social media, nearly 66 per cent of those cited Facebook. The most recent statistics reveal that 51 per cent of Americans have a Facebook account.

Despite the large number of nurses in thesurvey who use social media, only 44 per cent of nurses responding to the survey said their facility had a policy on the use of social media and the majority of respondents either did not know about a policy or believed that no policy existed. Additionally, the majority of nurses reported that they had never received orientation or education

on the use of social media and its implications on the workplace.

Although nearly all nurses stated that it was inappropriate to post pictures of patients or discuss patients on social media or social networks even if they were unidentified, 83 per cent stated that they had viewed postings on social media pages that would have potentially been a HIPAA violation. Sixty-one percent stated that some nurses they know, while not posting patient information, have made unprofessional posts on social media pages.

As far as their personal use of social media such as Facebook, over 90 per cent of responding nurses believed they should be able to post anything they want that concerns their personal lives, and they were split fairly evenly on whether it is permissible for employers or potential employers to make decisions about promotions or hiring based upon content on social media pages.

One nurse did note, however, that employees at a former place of employment posted pictures of themselves on Facebook drinking in hospital scrubs with the hospital logo visible. The majority of nurses who responded were “friends” with people they worked with, and 17 per cent indicated it was appropriate to access their social media pages while working.

Privacy on these social networking sites is questionable and security settings may give users a false sense of security. Forty per cent of nurses responding to the survey felt that only their “friends” could access their social media pages, 38 per cent “hoped” that was the case, and 22 per cent felt that there was really no such thing as security.

Nurses also noted that even if they were careful regarding what was posted on their pages that others may not be as discriminating and may post pictures of others without their consent. One nurse stated that Facebook should be called, “Open Book.”

ConclusionAs revealed in this study and in other literature,

the use of social media and social networking is prevalent and growing. A small but significant number of nurses feel it is alright to discuss unidentified patients on their social networking sites. This behavior has caused nurses across

the country to lose their jobs and they have at times, suffered adverse legal consequences. Despite these issues, many employers have notconsistently developed policies to establish clear direction and guidelines for staff.

Social media and social networking sites are not going away. Hospitals, schools of nursing, and other practice settings that employ health care providers need to develop clear policies related to social media. Staff must also be educated on these policies and potential legal implications. Other questions that social networking brings up are: should employers use social media sites for hiring purposes, and can nurses be fired for what they post about their personal lives on social media sites?

As one nurse stated in the survey response, “I don’tthinkwe’vebeguntoseetheextentoftheproblems that the social networks will create in the workplace.”

Comments are welcomed at [email protected].

About the AuthorsCynthia Kellam Stinson PhD, APRN, BC is an

associate professor of nursing, Lamar University Dishman Department of Nursing Beaumont,Texas. Since 1995, she has been a member of the Continuing Nursing Education Committee of the Texas Nurses Association.

Ruthie Robinson, PhD, RN, FAEN, CEN is adivision director and Magnet program director at CHRISTUS Hospital in Beaumont, Texas. ★

ReferencesAmerican Nurses Association. (2010).Guide to the code of

ethics for nurses: Interpretation and application. Washington, D.C.: American Nurses Publishing.

Hader, A. & Brown, E. (2010). Legal briefs: Patient privacy and social media.

American Association of Nurse Anesthetists Journal, 78(4), 270-274.

Hellmer, R. (2011) Facebook folly: Don’t get caught without a policy. Retrieved from http://www.mdnews.com/news/2011_01/05849_jan2011_facebook-folly

Paradisi, J. (2011). Nurses, hospitals, and social media: It depends what business you’re in. Retrieved from http://ajnoffthecharts.com/2011/01/19/nurses-hospitals-and-social-media-it-depends-what-business-you%e2%80%99re-in/.

Sarver, C. (2010). Social responsibility: Social media opportunities and pitfalls. Retrieved from http://news.nurse.com/article/20100809/NATIONAL01/108090045/-1/frontpage

U.S. Department of Health and Human Services Health Resources and Services Administration. (2010). The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved from http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf.

Social Media continued from page 4

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by Sheri L. Stephens, RN, OCN and Juan G. Posada, Jr., MD, FACP

Ovarian cancer accounts for approximately three percent of all cancers in women and is the fifth leading cause of cancer deaths. Ovarian cancer is a cancer that in most cases starts in the lining of the ovary, the epithelial cells. Unfortunately, there are no early symptoms in ovarian cancer, leading to the majority of women being diagnosed at a late stage. Only 20 percent of ovarian cancers are diagnosed at stage I or II, making the mortality associated with ovarian cancer high. The average survival for a woman with stage III or IV disease is 40-50 months. The average age at diagnosis is 63.

Many women do report symptoms–usually gastrointestinal or genitourinary–before diagnosed. It is common for a woman with advanced disease to have bloating, constipation, GERD, decreased appetite and fatigue. When awoman reports these symptoms to her physician, a GI work up including colonoscopy is usually undertaken before other causes are considered. This contributes to delayed diagnosis. Ovarian cancer is diagnosed with a CT scan or pelvic ultrasound. CT findings usually include unilateral or bilateral ovarian masses, ascites and omental implants. These findings prompt a consult with a gynecologic oncologist for evaluation and treatment.

Ovarian cancer is rarely detected early. Studies have not found frequent ultrasounds, CA-125 or other serum markers, or pelvic exams to increase early detection. CA-125 is a protein made by ovarian cancer cells. It is measurable in a peripheral blood sample and is used as an indicator of disease status in the course of treatment. CA-125, however, is not a reliable screening method, as an elevation can be caused by benign disease, such as endometriosis or liver cirrhosis.

Diagnosis and staging is done at the time ofsurgery, normally performed by a gynecologic oncologist. Surgery includes removal of fallopian tubes and ovaries, uterus, cervix, lymph nodes and any suspicious lesions. Once a tissue diagnosis is made and a stage determined, it is necessary for patients with a stage of IC or higher to receive neoadjuvant or adjuvant chemotherapy. Standard treatment currently is IV chemotherapy with a taxane and platinum, such as paclitaxel and carboplatin, for six to eight cycles followed by close monitoring of lab work and pelvic exams.

Cancer research and treatment is changing rapidly. During one phase III clinical trial,researchers found the delivery of chemotherapy via the intraperitoneal (IP) route extends survival in certain women with stage III disease. Bevacuzimab (Avastin) is a biologic drug thatshows promise in ovarian cancer in early clinical trials. It blocks tumor angiogenesis, or new blood vessel formation, inhibiting growth of the tumors while causing minimal side effects to the patient.

Ovarian cancer is often called a silent killer. It is

Ovarian Cancer: A 2011 Snapshot

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•Learntorecognizethesubtlesignsandsymptoms associatedwithovariancancer•Understandthebasicsofovariancancertreatment•Hearstoriespresentedbyovariancancersurvivors

ovarian Cancer CNe: TWo free programs at www.noep.org.

TheseCNEactivitiesaregrantfundedthroughaCentersforDiseaseControlandPrevention(CDC)cooperativeagreementnumberU58/DP000824-04.

TexasNursesAssociation/FoundationProviderUnitisaccreditedasaproviderofcontinuingnursingeducationbytheAmericanNursesCredentialingCenter’sCommissiononAccreditation.

TheNurseOncologyEducationProgram(NOEP)ispartofTexasNursesAssociation/FoundationProviderUnit.

Evidence-Based | Interactive | Earn 2.0 Contact Hours | Printable Certificate

imperative we conduct more early detection and prevention research. We must educate women and providers regarding symptoms and diagnosis to help with earlier detection and treatment. In addition, the National Comprehensive Cancer Network strongly encourages women with ovarian cancer to participate in ongoing clinical trials to advance treatment standards. Remember: ovarian cancer whispers, so listen.

About the AuthorsSheri L. Stephens, RN, OCN is an oncology

nurse at Scott & White Healthcare in Temple. Juan G. Posada, Jr., MD, FACP is a gynecologiconcologist at Scott & White and a member of the Texas Department of State Health ServicesOvarian Cancer Advisory Panel. ★

ResourcesAmerican Cancer Society (ACS). Cancer Facts & Figures, 2011.

Atlanta: American Cancer Society; 2011.Cannistra S. Medical progress: cancer of the ovary. New

England Journal of Medicine [serial online]. December 9, 2004;351(24):2519. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 1, 2011.

Clarke-Pearson, D. (2009). Clinical practice. Screening for ovarian cancer. New England Journal of Medicine, 361(2), 170-177. doi:10.1056/NEJMcp0901926

Guile M, Horne A, Bristow R, et al. Intraperitoneal chemotherapy for stage III ovarian cancer using the gynecologic oncology group protocol 172 intraperitoneal regimen: effect of supportive care using aprepitant and pegfilgrastim on treatment completion rate. Clinical Ovarian Cancer [serial online]. June 2008;1(1):68-71. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 1, 2011.

Markman M, Smoyer L, Burg K, Petersen J ,. An internet survey of symptoms associated with intra-abdominal malignancies: lack of specificity for ovarian cancer. Clinical Ovarian Cancer [serial online]. November 2010;3(2):118-121. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 1, 2011

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Thumbs Up to Comments from

ReadersIn late July, Fran Clark, RN of Austin wrote to

point out what she believed was an inaccuracy in the Quarterly Report: Texas Immunizations Stakeholder Working Group story that appeared in the July, August, September 2011 issue of TEXAS NURSING VOICE. She wrote:

“In the section on pertussis prevention, (the author) writes ‘since a newborn does not receive its first pertussis vaccine until it is six months old…’ and I believe this (information) is incorrect. The CDC recommends that infants receive this vaccine beginning at two months (then four months, then six months).

My understanding of the issue is that though the vaccine is given beginning at two months, full immunity does not occur until after the later doses.”

TEXAS NURSING VOICE editors checked the informationwithitssourceandfoundMs.Clark’scomments to be 100 percent accurate. In fact, the Texas Department of State Health Servicesresponded with additional information and clarity.

“Yes, the schedule is 2, 4, 6 and 12-15 months, then 4-6 years. It is the fourth dose DTaP that forever gives us the missed doses because it should occur as the child nears its first birthday, but with that, parents’ schedules change, parents go back to work, Medicaid babies age out, check-up intervals lengthen; there are a host of reasons why this occurs.”

AndDSHSalsoprovideditswebsiteforfurtherexploration of the topic. It is www.dshs.state.tx.us/immunize/Schedule/schedule_child.shtm.

TEXAS NURSING VOICE always seeks to provide accurate and reliable information, and certainly wants the readership to be aware of any inadvertent inaccuracy in a story. We thank Ms. Clark for bringing it to our attention so that we can bring it to the attention of the readers. ★

Contributed by Barry Sharp, MSHP, MCHES, Texas Department of State Health Services

Clinicians now have access to a new set of resources to help patients who are ready to break their tobacco addiction. The TexasDepartment ofState Health Services (DSHS) introduces the Yes You Can–Health Care Provider Toolkit, an evidence-based, comprehensive package of on-line and print materials designed to help promote tobacco cessation for patients while also streamlining billing. The toolkit is available at www.yesquit.org in the “Healthcare Provider Toolkit” section. The toolkit and resources are available at no cost to clinicians and are in line with guidelines from the U.S. Public Health Service for treating tobacco dependency.

Dr. Philip Huang, medical director for theAustin/Travis County Health and Human ServicesDepartment, says the toolkit can help cliniciansmakeadifferenceintheirpatient’slives.

“Research has shown that the three to 10 minutes a physician or nurse takes to counsel a patient about tobacco use can more than double his or her chancesofquitting,”saidDr.Huang.“TheYes You Can Health Care Provider Toolkit offers evidence-based intervention strategies in a single, user-friendly format that allows for quick reference while enabling the physician or nurse to keep up the pace of a busy schedule.”

Dr. Huang added that the toolkit also providesthe necessary forms and billing codes to ensure reimbursement in a timely manner.

“The toolkit helps provide a simple approach to tobacco intervention,” added Dr. Huang.“It helps provide better health care in a cost-effective manner, which makes your practice more profitable.”

DSHS has designed the toolkit to promotethe three-step approach to tobacco intervention known as “Ask, Advise, and Refer.” The initial ask consultation will help identify the patient’swillingness to quit. There are several brochures available to help gauge where the patient is in the

New Resources to Aid Clinicians in Fight Against Tobacco Addiction

quitting stage (Yes, I’m Ready to Quit; Maybe I’m Ready; or No, I’m Not Ready To Quit) as well as brochures that target pregnant smokers and teen smokers.

The toolkit also provides steps for setting a positive tone for advising cessation and helping provide “teachable moments” that will give the patient a sense of ownership and control over their health.

To help complete a successful tobacco intervention, the toolkit offers information on referring patients to the Texas Quitline, a free phone counseling service offered by DSHS. Confidentialand bilingual, the professional counselors provide regular counseling sessions while also offering nicotine replacement therapy (NRT). Research has shown that NRT and prescription medications can double long-term quit rates.

Tobacco use is the number one cause of preventable death in Texas, claiming more than 24,000 lives each year and costing Texas taxpayers in excess of $6 billion in health care costs. Clinicians across the state deal firsthand with this public health crisis on a daily basis as they treat patients for various tobacco-related health issues including multiple cancers, cardiovascular disease and pulmonary disease.

“Tobacco addiction is an overwhelming health crisis. It is not easy for your patients to quit,” added Dr. Huang. “But research has proven over andover again that a clinician’s influence on a patientcan be profound. By harnessing the resources and implementing the interventions provided in the Health Care Provider Toolkit,apatient’ssuccessratecan be significantly improved.”

About the AuthorBarry Sharp, MSHP, MCHES, is program

coordinator of tobacco prevention & control in the Substance Abuse Services Unit, Mental Health and Substance Abuse Division at DSHS. He overseesthe Texas Quitline and has spent 12 years in tobacco prevention. And, he told TNV editors, he is also married to a nurse. ★

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11th Annual Nursing Leadership Conference of Texas Nurses AssociationSeptember 22 and 23, 2011, Austin, Texas


Announcement Coincides with First Year Progress Since IOM Report Release

The anticipation is over, the news joyous. As of September 26, 2011, Texas Team became official. On that day, the Future of Nursing: Campaign for Action, coordinated through the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation announced that it had selected Texas Team Advancing Health Through Nursing an official Action Coalition, convened to advance the Future of Nursing: Campaign for Action.

The Texas Team Coalition, a diverse, statewide group of nurses, nursing organizations,hospitals, schools/universities, consumerbusinesses and statewide advocacy groups, was one of 21 new state action coalitions announced that day by the Campaign for Action. The others were: Arkansas, Delaware, Georgia, Hawaii,Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nebraska, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, West Virginia, Wisconsin and Wyoming.

With the announcement, which was supported by national media outreach, there is now a total of 36 state-based Action Coalitions to advance the Campaign for Action, the national implementation phase of the 2010 Institute of Medicine landmark report, the Future of Nursing: Leading Change, Advancing Health. The report made recommendations for significantly changing nurses’ roles, responsibilities and education sothey can better contribute to improving the U.S. health care delivery system.

As a way to implement the report’srecommendations, the Texas Action Coalition will function as field operations for advancing comprehensive health care change at the local, regional and statewide levels. It will work to collaboratively address the growing demand for high quality, cost-effective and accessible health care across the state.

“If future demand is to be met for safe, high quality, accessible and affordable health care, the roles of many health care professions must be reconsidered and nursing is certainly no exception,” said Clair Jordan, MSN, RN, executive director of Texas Nurses Association. “Nurses are integral to overcoming our health care challenges. With the highest percentage of uninsured residents in the U.S., and continuing to face a severe nursing shortage in the future, Texas is in dire need of the transformations outlined in the IOM report.”

Two organizations will share the leadershipresponsibilities within the Texas Action Coalition – Texas Nurses Association who represents nursing; and Blue Cross Blue and Shield of Texas who represents non-nursing stakeholders.

Get Involved – Become a Leader in the Texas Team!

Currently, the Texas Team is composed of an executive leadership team, the Advancing Nursing Practice team and the Advancing Nursing Education team. These teams are composed of leaders who are volunteering their time and energy to actualize the IOM recommendationsacross the state. A new, statewide leadership team is also being formed to focus on the “Leadership” recommendations in the IOM report. If you are interested in joining the statewide “Leadership Team,” applications are being accepted until November 15, 2011. The application can be found at texasnurses.org.

The Texas Team Coalition is also forming eight regional leadership teams that will work with the state-level teams to actualize the IOMrecommendations across the entire state. If you are interested in being actively engaged as a leader of the coalition, please access the “Regional Leadership” application at texasnurses.org and apply. Applications are being accepted until November 15, 2011.

Get Involved – Connect to the Texas Team!To learn how to become involved in this

historic campaign, go to texasnurses.org or thefutureofnursing.org. Every nurse can be a part of advancing the future of nursing in Texas. At the end of September, there were over 80 Texas-wideschools,nursingorganizations,andbusinessorganizations who had signed up as a coalitionmemberorganization.

Participation can begin with a “Like” on the Facebook page-search Texas Team Advancing Health through Nursing. When you “like” the Texas Team – and you have a RSS Feed Reader – you can receive information on the campaign in Texas. ★

Texas Team Named an Official Future of Nursing Action Coalition to Advance the

Health of Texans through Nursing

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Texas Peer Assistance Program for Nurses (TPAPN) is hosting a Spring Advocate/FacultyLiaison Workshop on April 13 and 14, 2012, with advocate training sessions held each day for new and returning nurse volunteers and faculty liaisons, and others interested in attending.

On Friday evening, TPAPN will host a special “Partners in Recovery” ceremony as part of its 25th Anniversary gala to recognize thoseemployers who have been supportive of TPAPN during the past two years either through their employment of TPAPN participants or their hosting or sponsoring of TPAPN continuing education activities. One CNO or designee from each of the Partners in Recovery facility listed below is invited to attend the gala as the special guest of TPAPN. Each guest must register online.

If you know that your facility has been supportive of TPAPN but it is not among those on the preliminary list, please contact TPAPN. Supportive employers help TPAPN participants complete their nursing practice requirements, making for a safer workplace, and a more informed and healthy work environment.

The 25th anniversary gala will include a reception, silent auction, dinner and special guest speakers, featuring Reverend Leo Booth. Rev. Booth is an internationally acclaimed author and lecturer on all aspects of spirituality and recovery. He comes to the gala courtesy of the Santé Center for Healing in Argyle, Tex., where heistheirspiritualconsultant/advisor.

TPAPN is also pleased to have Carlton Erickson, PhD, a distinguished professor ofpharmacology, associate dean for research and graduate studies, and director of the Addiction Science Research and Education Center in the College of Pharmacy at The University of Texas at Austin. He will present during the workshop onSaturdaymorning.Dr.Ericksonisoneofthenation’s leading researchers on the physiologyof drug addiction. His research promotes a better understanding of the physical basis of addiction.

TPAPN advocates, faculty liaisons, and Advisory Committee members are invited to attend the 25th anniversary gala as guests of

Partners in Recovery Ceremony at 25th Anniversary Gala to Highlight TPAPN’s Spring Advocate Workshop Days

TPAPN. Additionally, TexasNurses Association/Texas Nurses Foundation staff and board members, and Board of Nursing staff and board members are invited to attend without charge. All other supporters of TPAPN are welcomed to attend the two-day workshop and gala with registration fees of $100 per person for each day of the workshop; $50 per person for the gala. Allattendeesmustpre-registerathttps://tpapn.webconnex.com/20120413.

The entire event will be held at The Renaissance Austin Hotel, 9721 Arboretum Blvd., Austin, Tex. Hotel room reservations can be made by phoning 512.343-2626, or online by visiting Marriott.com. Please make your reservations as soon as possible to be guaranteed a room and refer to group name “TPAPN.” Details are also available online atwww.tpapn.org.

If you would like to make a donation for the Partners in Recovery silent auction or have questions about the workshop or gala, you may contact TPAPN at [email protected] or phone 800.288-5528 ext. 127.

TPAPN’s PARTNERS in RECOVERY

Central TexasAlcoholandDrugAbuse• ProgramAustin Recovery Center•The Heart Hospital of Austin•Meridell Achievement Center•Providence Health Center, Waco•Scott & White Medical Center•La Hacienda Solutions Recovery Center•Seton Hospital, Northwest•TheRightStep,Austin/Wimberley•TravisCountySheriff’sOffice•TexasDept.ofCriminalJustice(TDCJ)•

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As a magnet recognized nursing facility, we are a community of exceptional nurses engaged in extraordinary practice.

or call 713-792-7362Apply Now:

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, gender, sexual orientation, gender identity/expression, disability, veteran status, genetic information or any other basis protected by federal, state or local laws, unless such distinction is required by law.

RN Opportunities in Utilization Management, Disease Management, & Case Management.

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tercap extends to peer review · apply in person, call, email or mail/fax resume to: san marcos...

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