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Inside this IssueCNE Workshops, 2013 . . . . . . . . . . . . . . . . . 4

Follow the Status of Priority Bills

for Nursing . . . . . . . . . . . . . . . . . . . . . . . . 4

Nursing’s Workplace Advocacy Legislative

Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Cancer Control . . . . . . . . . . . . . . . . . . . . . . 8

Texas Health Steps: An Update . . . . . . . . . 13

Helping Caregivers Maintain Their Own

Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

TNA Leadership Conference . . . . . . . . . . . 15

Nurses Taking Action in Texas: A Series . . 17

TNA Membership Application . . . . . . . . . . 18

Texas Women’s Health Care in Crisis Quarterly circulation approximately 303,000 to all RNs, LVNs, and Student Nurses in Texas.

Join theTexas Nurses Association

Today!

Applicationon page 18

by Stacey Cropley, DNP, RN, CPN

Access to preventive health care is critically important to the health and well-being of women and their babies. As nurses, we know that preventive care detects health problems, facilitates early treatment, helps women prepare for a healthy pregnancy, and helps with family planning.

Currently, Texas has two programs that provide these services for low-income women: the Department of State Health Services (DSHS) Family Planning Program and the Women’s Health Program (WHP). In 2011, over 300,000 low-income women received essential health care from the DSHS Family Planning Program and the WHP. For many women, these programs are their only contact with a health care provider.

However, also in 2011, the Texas Legislature deeply cut funding to the DSHS Family Planning Program. As a result, at least 53 women’s health care clinics have closed, cutting off preventive

care to women who previously used the program. In addition, the WHP is at risk due to the state rule excluding specific providers. The programs may no longer have the physicians, clinics, and other health care providers who can meet the growing demand for services.

The WHP also lost its federal designation and along with it, more than $30 million in federal funding each year. The public health consequences for Texas women as a result of these cuts are severe (Table I). Texas must quickly rebuild the women’s health safety net, recognizing that preventive care saves lives and money.

Lawmakers must restore funding to women’s health care in 2013, ensure ample capacity of providers, and rebuild the Texas women’s health care safety net. Swift action is needed to reduce fiscal costs and save taxpayers’ dollars while ensuring the health and well-being of low income women and their babies.

Texas Nurses Association is proud to support the Texas Women’s Healthcare Coalition, a

statewide coalition dedicated to improving the health and well-being of women, babies, and families by assuring all Texas women access to preventive care. For more information or to become involved in advocating for women’s health care, go to www.TexasWHC.org.

Table 1: Health Consequences for Texas

Reduced access to women’s preventive care means more undetected cases of:

• BreastCancer

• CervicalCancer

• Diabetes

• HighBloodPressure

• SexuallyTransmittedInfections

• Depression

• FamilyViolence

Health Consequences for Texas: continued on page 4

Page 3 Page 11 Page 7

Page 2 • Texas Nursing Voice April, May, June 2013

Published by:Arthur L. Davis

Publishing Agency, Inc.

www.texasnurses.org

TEXAS NURSING VoiceA publication of Texas Nurses Association

April, May, June 2013Volume7,Number2

Editor-in-Chief – Ellarene Duis Sanders, PhD, RN, NEA-BCManaging Editor – Joyce Cunningham

Creative Communications – Deborah TaylorCirculation Manager – Belinda Richey

Editorial Contributors

Carol Cannon, BSN, RN, OCN; Stacey Cropley, DNP, RN, CPN; Joyce Cunningham; Laura Lerma, MSN, RN;

Joyce Pohlman; Ellarene Duis Sanders, PhD, RN, NEA-BC; and Joni Watson, MBA, MSN, RN, OCN

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

Thelma L. Davis, LVN, GiddingsAnita 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

Karen Lyon, PhD, APRN, ACNS, NEA,VicePresidentClaudia Turner, MSN, RN, Secretary-Treasurer

Regional Directors of Texas Nurses AssociationJune Marshall, DNP, RN, NEA-BC – 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 DirectorEllarene Duis Sanders, PhD, RN, NEA-BC

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

September; and October, November, December by – Texas Nurses Association, 8501 North MoPac Expy,

Suite400,Austin,TX78759.

Editorial Office TEXAS NURSING Voice, 8501 North MoPac Expy,

Suite400,Austin,TX78759512.452-0645, e-mail [email protected]

Address ChangesSend address changes to

Texas Nurses Association, 8501 North MoPac Expy, Suite400,Austin,TX78759

e-mail: [email protected]

AdvertisingArthur L. Davis Publishing Agency, Inc.,

517WashingtonSt.P.O.Box216,CedarFalls,Iowa50613

800.626-4081, E-mail: [email protected]

Texas Nurses Association and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by Texas Nurses Association (TNA) 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. TNA 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 the views of the staff, board, or membership of TNA or those of the national or local associations.

Copyright © 2013 by Texas Nurses Association, a constituent member of the

American Nurses Association.

Texas Nurses Association Districts and PresidentsPresidents of the 28 statewide Districts of Texas Nurses Association, as well as some District offices, are listed below.

They invite you to contact them with questions or comments about TNA District membership and involvement in your local areas. For specific District locations, please refer to the TNA Tri-Level Membership District map on page 18.

District 1: Laura Sarmiento Phone:915.588-3173 E-mail: [email protected]

District 2: Helen Reyes Phone: 806.651-2631 E-mail: [email protected]

District 3: Dennis Cheek Phone:817.201-3334 E-mail: [email protected]

District Address: Palli Stubbs P.O.Box16958 Ft.Worth,TX76162 Office:817.249-5071 E-mail: [email protected] Website: www.tna3.org

District 4: Frances (Frankie) Phillips

Phone:214.857-1487 E-mail: [email protected]

District Address: Pat Pollock P.O.Box764468 Dallas,TX75376 Office:972.435-2216 E-mail: [email protected] Website: www.tnad4.org

District 5: Jen Collins Phone:512.663-9181 E-mail: jencollinsjencollins@ yahoo.com Website: www.tna5.org

District 6: Paula Stangeland Phone:409.741-1667 E-mail: [email protected] Website: www.tna6.org

District 7: Deborah Daniel Phone:254.982-0057 E-mail: [email protected]

District Address: P.O.Box1475 Belton,TX76513

District 8: Sarah Williams Phone:210.829-6092 E-mail: [email protected] Website: www.texasnurses.

org/districts/08/

District 9: Terry Throckmorton Phone:713.277-9870 E-mail: [email protected]

District Office: Melanie Truong 2370RiceBlvd.,#109 Houston,TX77005 Office:713.523-3619 E-mail: [email protected] Website: www.tnadistrict9.org

District 10: Helen Woodson Phone:254.723-8719 E-mail: [email protected]

District 11: Marcy Beck Phone:940.766-5362 E-mail: [email protected]

District 12: Gerald Bryant Phone:409.212-5006 E-mail: [email protected]

District 13: Vacant

District 14: Joe Lacher Phone:956.882-5089 E-mail: [email protected]

District 15: Andrea Kerley Phone:325.670-4230 E-mail: akerley@

hendrickhealth.org Website: www.texasnurses.

org/districts/15/

District 16: Mimi Baugh Phone:325.659-7427 E-mail: [email protected]

District 17: Eve Layman Phone:361.825-3781 E-mail: [email protected] Website: www.texasnurses.

org/districts/17/

District 18: Mary Anne Hanley Phone: 806.252-1505 E-mail: [email protected] Website: www.texasnurses.

org/districts/18/

District 19: Tara Patton Phone:903.391-1153 E-mail: [email protected] Website: www.texasnurses.

org/districts/19/

District 20: Debbie Pena Phone: 361.212-0355 E-mail: Debbie.pena@

victoriacollege.edu

District 21: Rebekah Powers Phone: 432.685-1111 E-mail: Rebekah.powers@

midlandmemorial.com

District 22: Toni McDonald E-mail: 3tmcdonald@

windstream.net

District 25: Inger Zerucha Phone:903.315-2632 E-mail: [email protected]

District 26: Esmeralda Garza Phone:956.878-6201 E-mail: [email protected]

District 28: Jenny Wilder Phone:903.826-2712 E-mail: [email protected]

District 29: Tina Cuellar Phone:409.772-8217 E-mail: [email protected]

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

District 40: Contact TNA Phone800.862-2022ext.129 E-mail: [email protected]

PROTECT YOUR LICENSE!!

If you have received:• LetterofInvestigationfromthe TexasBoardofNursing• NoticeofPeerReview

Contact Joyce Stamp Lilly RN JD

713-759-6430 or [email protected]

Registered Nurse and Attorney

Call today, delay is not an option!

www.nurse-lawyer.com

April, May, June 2013 Texas Nursing Voice • Page 3

Violence Against NursesNurses from Collaborating Groups Testify for HB 705

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by Ellarene Duis Sanders, PhD, RN, NEA-BC

House Bill 705 is authored by Rep. DonnaHoward (D-Austin), who is also a registered nurse. The bill promotes reducing violence against emergency room (ER) nurses and other ER personnel through enhanced penalties for assaults. The bill was heard April 2, 2013 in the House Committee on Criminal Jurisprudence.

The hearing on this bill began with Rep. Howard explaining the bill intent for the committee. She emphasized that in the course of doing their work in the ER, nurses are often verbally or physically assaulted by patients and their family members. Currently, if police officers, emergency medical services (EMS) workers, firefighters, and other public servants are assaulted, the perpetrator receives higher-level criminal charges than when nurses are assaulted. HB 705 would add nurses andemergency room personnel to that list so that the charges and penalties would be the same for everyone. The enhanced penalties would not apply in the event that the patient has a mental illness and the assault occurs as a result of the illness or if the emergency room nurses and personnel have not been trained in de-escalation techniques.

A total of nine people testified in favor of HB 705; three testified against, two spoke onthe bill, and one resource witness appeared. These witnesses provided more than two hours of testimony and responded to a number of questions asked by committee members.

Testimony 1The first witness was Mary LeBlond, MSN,

RN, CEN, CA-SANE, CP-SANE of the Texas Emergency Nurses Association (ENA). During her introduction, she noted that there are more than 3500 members of her association. She is employed as an emergency nurse. LeBlondidentified four key outcomes of passing the bill:

• Sendamessage to thepublic that violenceagainst caregivers will not be tolerated;

• Enable thoseworking in health care to de-

escalate situations by informing aggressors that further action may result in felony prosecution;

• Encourageindividualstoreporttheseeventswith the knowledge that it will receive appropriate review; and

• Provideprosecutorswith anadditional toolin plea bargaining these events.

Inaddition,LeBlondsharedstartlingstatisticsabout the incidence of violence against nurses in recent years. A survey of ENA members conducted in 2006, 2010 and 2011 found that 86 percent of respondents reported being a victim of violence during the preceding three years, with 20 percent reporting that workplace violence is a frequent occurrence. The perpetrators of the violence were equally divided between patients, family members, and visitors.Verbalabusehasbeenreportedbyupto 100 percent of nurses in some emergency rooms.1

LeBlond emphasized that what the TexasEmergency Nurses Association is asking for by supporting the bill is, “equality of protection already shared by other public service professions. Nothing more and really nothing less.”

Testimony 2NormaBroadhurstofCorpusChristitestified

as a victim of assault. She is a registered nurse who had worked in emergency rooms for a number of years prior to her assault. During Spring Break of 2011, an intoxicatedand disruptive patient bit off her right ring finger. She has not been able to work since the incident. She pressed charges against the patient and reported the incident within her facility but to her knowledge, the patient spent only a couple of days in jail and the charges have not been pursued.

Testimony 3Sally Gillam, RN, member of the Texas Nurses

Association and the Texas Organization of

Nurse Executives, is the chief nursing officer at St. David’s South Austin Medical Center. She has been employed there for 25 years. That St. David’s emergency department cares for over 100,000 patients each year. Gillam shared some additional statistics:

• Nurses working in the emergencydepartment are the most likely of all health care providers to be assaulted;

• Nurses account for four percent ofworkplace violence in the United States.2

• Nurses are injured more frequently byviolent events than any other role in health care settings.3

Gillam testified that nurses and nursing staff who work in emergency departments are typically educated on de-escalation techniques but have limited self-defense training compared to police and other public servants. She responded to several questions from committee members including one about why hospitals don’t do more to protect their staff. Gillam emphasized that hospitals do have many strategies in place to improve workplace safety but that violence is very unpredictable so even to add security staff, as an example, may not prevent violence unless the security staff is right next to the patient/family/visitor as they explode into a violent act.

Testimony 4Jeff Scott, an emergency medical technician,

spoke for the bill. He reported that while some patients are mentally ill or intoxicated, “some people are just mean.” Scott said that it isn’t right that first responders in the field have more protection than nurses in the emergency room.

Testimony 5Elizabeth Sjoberg, JD, RN of the Texas

Hospital Association (THA) testified for the bill. According to Sjoberg, the bill would address

Violence Against Nurses continued on page 14


Reduced access to highly effective contraceptives increases unplanned pregnancies, which increases the number of:

• Pregnantwomenreceivinglateornoprenatal care

• Birthdefects,duetofewerwomentakingfolic acid early in pregnancy and fewer women controlling their diabetes before pregnancy

• Fetalexposuretotobacco,alcohol,drugs,and medications

• Prematureandlowbirthweightbabies,with increased risk of infant mortality, lifelong health problems, and high medical costs

• Childrenwithpoorphysicaland/ormentalhealth

• Womenandmenunabletocompletetheireducation

• Familiesunabletoriseoutofpoverty

• Babiesborntounmarriedwomen

ResourcesAnanat, E., & Hungerman, D. (2007). The power of the pill

for the next generation. National Bureau of Economic Research Working Paper 13402.

Bloom, D., & Greenhill, R. (2012, July 10). Invest in Family Planning, Escape Poverty. Retrieved August 26, 2012, from Bill and Melinda Gates Foundation, Impatient Optimists: http://www.impatientoptimists.org/Posts/2012/07/Invest-in-Family-Planning-Escape-Poverty

Conde-Agudelo, A., Rosas-Bermudez, A., & Kafury-Goeta, A. (2006). Birthspacing and risk of adverse perinatal outcomes: A metanalysis. JAMA, 295 (15), 1809-1823.

Gipson, J., Koenig, M., & Hindin, M. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39 (1), 18-38.

Guttmacher Institute. (2012, May). Facts on Publicly Funded Contraceptive Services in the United States. Retrieved August 26, 2012, from http://www.guttmacher.org/pubs/fb_contraceptive_serv.html#14

Piepert, J., & al, e. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology , 120 (6), 1291-1297.

Texas Department of State Health Services. Fiscal Year 2012 Operating Budget.

Texas Health and Human Services Commission. (n.d.). Women’s Health Program Enrollment as of August 2011. Retrieved December 15, 2012, from http://www.hhsc.state.tx.us/research/wh-final-count.asp

Texas Health and Human Services Commission. (2011). State of Texas. 1115 Research and Demonstration Waiver Renewal Application.

Texas Women’s Healthcare Coalition. (2013). Texas Women’s Healthcare in Crisis. San Antonio: MHM.

The National Campaign to Prevent Teen and Unplanned Pregnancy. (2008, May). Fast Facts. Retrieved January 12, 2013, from http://www.thenationalcampaign.org/resources/pdf/fast-facts-consequences-of-unplanned-pregnancy.pdf

Zhu, B. (2005). Effects of interpregnancy interval on birth outcomes: Findings from three recent US studies. International Journal of Gynecology and Obstetrics, 89 (Supplement 1), S25-S33.

About the Author: Stacey Cropley, DNP, RN, CPN, is director of practice, Texas Nurses Association. ★

Health Consequences for Texas: continued from page 1

Follow the Status of Priority Bills for NursingWhile the Texas Legislature is in session,

Texas Nurses Association provides for daily tracking of the bills important to nursing.

At texasnurses.org, TNA invites you to follow the

status of Priority Bills for Nursing. ★

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CNE Workshops, 2013

Texas Nurses Association’s spring 2013 continuing nursing education (CNE) calendar of Individual Activity workshops and Approved Provider workshops has been finalized and is listed below. Get all the details and register at texasnurses.org > CNE Calendar.

Individual Activity Workshops

Tuesday,May7Wednesday,May29

Thursday, June 13Friday, June 28

Approved Provider WorkshopsFriday,May17

Thursday, May 23Wednesday, June 5

Tuesday, June 18Tuesday, July 2

Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing

education by the American Nurses Credentialing Center’s Commission on Accreditation. ★


The date is fast approaching for the last-in-the-Spring 2013-series of FREE, Health Information Technology CNE Webinars, provided by

Texas Nurses Association and Texas Organization of Nurse Executives.

Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing

Center’s Commission on Accreditation.

F I N D D E T A I L E D I N F O R M A T I O N a n d R E G I S T E R a t t e x a s n u r s e s . o r g

HAVE YOU REGISTERED YETFOR THE APRIL 25 HIT

CNE WEBINAR?

April 25 – Optimizing Communication with Information Technology: Creating the Environment Conducive to True Progress, presented by Mary Beth Mitchell, MSN, RN, BC and Donna Montgomery, BSN, MBA, RN-BC. 12 noon to 1 p.m. CDT (webinar access begins at 11:45 a.m.)

You’ll learn about:•strategies for communicating the needs

of a clinician to IT development teams, •common barriers to good communication

between nursing and IT,•ways to measure and evaluate the

success of a project through ongoing communication.

1.0 contact hours will be awarded for successful completion. Still FREE to pre-registrants.

FREE Webinars for Nursing Faculty On Teaching in a Concept-Based Curriculum

Compliments of Texas Team Action Coalition’sAcademic Progression in Nursing Education Grant

The Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action, received an Academic Progression in Nursing Education (APIN) grant in 2012 from the Robert Wood Johnson Foundation. With the two-year grant funding, Texas Team intends to build for Texas a more highly educated, diverse nursing workforce by increasing thenumberofADN-preparedRNswhoreturntoschoolforaBSNdegree.

Streamlining education by developing a concept-based curriculum that both associate degree nursing programs and baccalaureate programs across Texas can adopt is a key strategy of the APIN grant. It is believed it would allow nurses to more easily and seamless transition to higher levels of education.

Free WebinarsImplementing a concept-based curriculum requires a change in

perspective and teaching-learning strategies. As part of the APIN grant, Academic Consulting Group: A Service of Elsevier will be providing free webinars to Texas nursing faculty to implement the grant’s concept-based curriculum.

Upcoming Webinars• April 17 – Integrating Concept-Based Curricula into Class,

Laboratory and Clinical Experience, 2-4 p.m. CDT, Speaker: Kristin Oneail, MSN, RN, assistant professor, Lourdes University School of Nursing

• June12–Evaluation in a Concept-Based Curriculum, 2-4 p.m. CDT, Speaker: Linda Miles, EdD, RN, chair, School of Nursing, Daytona State College

• August14(tentative date) – Helping Preceptors Work With Students in a CBC Curriculum

Previously Recorded Webinars (access at texasapin.org)• Implementing Concept-Based Curriculum: A Practical Approach,

presented by Dr. Nelda Godfrey, associate dean, University of Kansas Medical Center School of Nursing. ★

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HB 2361/SB 1375: Self-Directed,

Semi-Independent Status of Certain

Health Care Regulatory Agencies

If granted self-directed, semi-independent statusbytheTexasLegislature,theTexasBoardof Nursing would gain more flexibility in making budget outside of the current appropriations process which sets two years in advance the budgets and numbers of FTE employees that can be hired. The two-year budget cycle makes effective response to changing constituent needs very difficult.

HB 2361 authored by Rep. Drew Darby(R-San Angelo) would grant SDSI status to the Texas Board of Nursing, Texas State Board ofPharmacy, andTexasMedicalBoard.The threeagencies undergo Sunset Review in 2017 sothe Legislature could evaluate the application of SDSI to health care licensing agencies since currently, none of the nine agencies with the status are health care professional licensing agencies.

SDSI statuswouldallow theBON,TSBPandTMB to set their budgets on an annual basis,operate more like a business with flexibility to manage resources as needed and enhance responsiveness to licensees and the public. ★

Nursing Practice Act Amendments

Besides the workplace advocacy issuesbeing addressed this 83rd Legislative Session, nursing is addressing several needed changes to the Texas Nursing Practice Act that have been identified. The changes will be addressed in SB1058bySen.NelsonandcompanionbillHB2358 by Rep. King.

Deferred Disciplinary Action – makes permanent the Texas Board of Nursing’spilot authority to take deferred disciplinary actions. The pilot permits the BON to delayfinal disciplinary action for a relatively minor violation, place the nurse on probation and dismiss the action if probation is successfully completed.TheBON’sauthoritytoconductthepilot will end after this legislative session if the Nursing Practice Act is not amended.

Student Criminal Background Checks – would make criminal background checks mandatory for students at the time they are accepted for enrollment rather than at the time of licensure.

Confidentiality of TPAPN Orders – would makeconfidentialBONorderssendinganurseto participate in the Texas Peer Assistance Program for Nurses to address a problem with chemical dependency or mental illness. Boardorders are currently public record and normally include details about the problem. ★

SB 406/HB 1055: APRN Prescriptive

Authority LegislationIn this 83rd Texas Legislative Session, a long-

sought agreement between nursing, medicine, physician assistants and lawmakers was reached and resulted in the filing in early February of legislation that will expand prescriptive authority for advanced practice registered nurses (APRN). A joint press conference held at the Capitol on February 6 by Sen. Jane Nelson (R-Flower Mound), chairwoman of the Senate Health and Human Services Committee, and Rep. Lois Kolkhorst (R-Brenham), chairwomanof the House Public Health Committee, announced the agreed-to legislation – Senate Bill406/HouseBill1055.

SB 406 will continue a delegated model forAPRNs but will eliminate site-based, physician supervision requirements that have created barriers to practice. The site-based model will be replaced by a signed prescriptive authority agreement through which physicians will delegate authority to prescribe and order a drug or device to an APRN or physician assistant (PA). SB 406 increases from four to seven thenumber of APRNs and PAs that a physician may delegate prescriptive authority; improves communication and coordination between the TexasMedicalBoard,theBoardofNursing,andPhysicianAssistantBoard;andallowsphysiciansto delegate prescriptive authority for Schedule II controlled substances to APRNs and PAs in hospitals and hospice settings. ★

During a legislative session, Texas Nurses Association serves as the host organization for the Nursing Legislative Agenda Coalition. The coalition consists of nursing organizations that endorse and work to enact the Nursing Legislative Agenda. Coalition members are:

Texas Nurses Association

LicensedVocationalNursesAssociationofTexasAssociation of periOperative Registered Nurses

– Houston

Association of Women’s Health, Obstetrics & Neonatal Nurses

Coalition for Nurses in Advanced Practice

Consortium of Texas Certified Nurse Midwives

Houston Oncology Nurses Association

Houston Organization of Nurse Executives

Society of Otorhinolaryngology & Head & Neck Nurses – Houston

Texas Association of Deans & Directors of Professional Nursing Programs

Texas Association of Nurse Anesthetists

Texas Clinical Nurse Specialists

Texas Council of periOperative Registered Nurses

Texas Emergency Nurses Association

Texas Nurse Practitioners

Texas Nursing Students’ Association

Texas Organization for Associate Degree Nursing

TexasOrganizationofBaccalaureate&GraduateNurse Educators

Texas Organization of Nurse Executives

Texas RN First Assistants Network

Texas School Nurses Organization ★

Nursing Legislative Agenda Coalition

POSITION ANNOuNCEMENTPROGRAM DIRECTOR FOR NuRSING/BUDDY DAVIDSON ENDOWED CHAIR

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by Stacey Cropley, DNP, RN, CPN

Prior to each legislative session, the Texas Nurses Association hosts a series of meetings for nursing organizations in Texas to identify and develop a consensus on significant nursing and health care-related issues that need to be addressed by the Texas Legislature. Identified issues can emphasize nursing, public health or public health policy that is determined harmful either to nursing or the public. This consensus of nursing opinion becomes the Nursing Legislative Agenda for the session. See page 6 for member organizations.

The Texas Nurses Association has historically articulated a strong voice for workplace advocacy, supported by legislation that has improved the nursing workplace environment economic and general welfare of Texas nurses in a variety of nursing roles. The information below will highlight the workplace advocacy issues being addressed this biennium through the 2013 Nursing Legislative Agenda.

HOUSE BILL 581: Provides nurses in public hospitals a limited remedy to recover damages caused by illegal retaliation for engaging in protected patient advocacy activities.

The assertion of sovereign immunity against a nurse employed by a public hospital who seeks a remedy in court for illegal retaliation is not new. In fact, in 1999, theCourt of Appeals forthe First District of Texas found that the Texas Nursing Practice Act did not provide a waiver of sovereign immunity [The University of Texas Medical Branch at Galveston, 6 S.W.3d 767(1999)].

Currently, a public hospital-employed nurse may file suit only if illegally retaliated against for making an external report to a law enforcement or regulatory agency. The nurse cannot file suit if retaliated against for making the same report internally or to an accrediting body. Conversely, a private hospital-employed nurse may seek recovery for illegal retaliation in both instances.

These deficiencies are highlighted by the well-publicized cases of the two Winkler County nurses who were retaliated against for reporting a physician to the Texas Medical Board for unsafe patient care. The reportmade was the culmination of nearly a year of expressed concern by the nurses to the medical staff, the hospital administrator, and the hospital internal reporting processes.

These nurses were terminated and criminally indicted for making a report to the Medical Board.Chargesagainstoneweredismissed.Theother nurse was found not guilty by a jury. The two nurses then filed a civil lawsuit in federal court based on retaliation under state law and violation of their civil rights under federal law. Becausethenurseswereemployedbyacountyhospital, the claim for relief for the retaliation under the Nursing Practice Act was dropped as a defense of sovereign immunity was asserted. However, the nurses were able to state a claim under the Public Employees Whistleblower Law because they had also reported externally to theTexasMedicalBoard. If thenurseshadnotmade an external report, they would not have been afforded these limited protections under state law.

HB 581 by Rep. Donna Howard (D-Austin)addresses this deficiency in patient advocacy protections for nurses. It gives nurses employed by public hospitals the same right as their colleagues in private hospitals to

recover damages suffered because of illegal retaliation for making a protected report, whether reported internally or externally. The bill amends the Nursing Practice Act to permit nurses employed by public hospitals to recover damages caused by illegal retaliation for engaging in protected patient advocacy activities.

The type and amount of recovery would be subject to the limits imposed by the Texas Public Employee Whistleblower Law which prohibits punitive damages and caps future earnings and nonpecuniary damages based on the size of the governmental entity as determined by the number of its employees. The limited waiver of sovereign immunity for state and local entities only affects the right to file a lawsuit for harm suffered when subjected to illegal retaliation and does not extend to nurses employed by other governmental entities. The bill is specific to public hospitals.

As of April, action is pending in the House Judiciary and Civil Jurisprudence Committee. There is no companion bill at this time.

HOUSE BILL 705: Reduces Violence Against Nurses in the Workplace by Enhancing Penalties for Assault of ER Personnel

Workplace violence is defined by the National Institute for Safety and Health (2002) as acts of violence committed against those at work or on duty. Workplace violence is common in health care settings, with health care ranked among the most dangerous occupations in regard to risk of workplace assault.

And workplace violence is on the rise. In any given week, 8-13 percent of emergency department nurses are the victims of physical assault while at work. Current law gives explicit protection and enhanced penalties for assault to public servants or police officers, security officers, emergency services personnel, and several other protected classes – excluding nurses. Health care providers in Texas are provided no additional legal protections against workplace violence while engaging in this high riskoccupation.Being assaulted shouldnotbepart of a nurse’s job.

HB 705 by Rep. Donna Howard (D-Austin),makes assault against emergency room personnel a third-degree felony for all non-patients and for patients if the emergency

room personnel has not received training in de-escalation and crisis intervention techniques to facilitate interaction with patients, including patients with mental illness or intellectual disabilities, that meets the minimum standards established by the Department of State Health Services.

This bill has been referred to the Criminal Jurisprudence Committee and action is pending. No Senate companion bill has been filed at this time. See related story page 3.

SENATE BILL 418: Assures Parents Know if a School Nurse is Assigned to Child’s School

Children with special health care needs are on the rise and it has never been more important for parents to know whether a school has a nurse to care for these children. Currently, schools are not obligated to inform parents if their child’s school has a full-time nurse assigned. Parents have a right to know when a full-time nurse is not assigned to their child’s school so they may take steps to ensure their child’s health care needs are met while at school.

These steps may include giving specific instructions to the teacher on how to respond to any special health condition their child may have, instructing the school to call them immediately if something happens, and making special arrangements at work to be able to respond. Parents may not take these additional steps if they believe a full-time nurse is present on the school campus.

SB 418 by Sen. Rodney Ellis (D-Houston)requires public schools or open-enrollment charter schools to notify parents if a nurse is not assigned to the campus during all instructional hours. The bill mandates nothing more than notification and full disclosure to the parents.

This bill was referred to the Education Committee for consideration.

About the Author: Stacey Cropley, DNP, RN, CPN is

director of practice, Texas Nurses Association. ★

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by Carol Cannon, BSN, RN, OCN

April is Cancer Control Month. As outlined by the World Health Organization, cancer control involves addressing each step along the cancer continuum: prevention, early screening/detection, diagnosis/treatment, and palliative care/survivorship.1

Nurses play major roles in each of these phases but perhaps the areas where nurses are most effective in reducing the cancer incidence are prevention and early screening/detection, or primary and secondary prevention. While providing everyday care, nurses are able to interact with patients, form trusting relationships, and educate and empower patients to address cancer-causing habits early before the disease ever occurs.

While some cancers are genetic and not due to modifiable behaviors, the American Cancer Society states that a substantial proportion of cancers can be prevented. These include all cancers caused by cigarette smoke and heavy alcohol consumption, overweight or obesity, poor nutrition, as well as cancers due to infections: human papillomavirus (HPV),hepatitisBvirus(HBV),hepatitisCvirus(HCV),human immunodeficiency virus (HIV), andHelicobacter pylori (H. pylori).2 This long list of modifiable risk factors represents a gap in patient knowledge that can be closed with education from the nurse.

Screening offers an additional defense against cancer. The National Comprehensive Cancer Network currently recommends screening for breast, cervical and colorectal cancers; it also recently added lung cancer screening guidelines to its list of recommendations.3

According to the Texas Cancer Registry, cancer is the leading cause of death for Texans aged 85 years and younger. It is the leading cause of death from disease among Texas children aged 1 to 14 years. In 2012, it was estimated that 110,135 Texans would be newly diagnosed with cancer and 39,072 will die ofthe disease. Additionally, the estimated cost of cancer in Texas for 2010 is $25.3 billion.4

These statistics bring to light Texas’ desperate need to more effectively control cancer and its human and economic burden. Fortunately, the Cancer Prevention Research Institute of Texas (CPRIT) plays a key role in cancer prevention in the State of Texas. Ten percent of the total amount of money CPRIT awards each year is specifically devoted to delivering cancer prevention programs and services in Texas.

Cancer Control

Nurse Oncology Education ProgramThe Nurse Oncology Education Program

(NOEP), which receives funding from CPRIT’s prevention category, is a nonprofit project of the Texas Nurses Association/Foundation. The long-term vision of NOEP is to reduce the burden of cancer in Texas and beyond by providing education to nurses in cancer prevention, detection, treatment and survivorship. Thanks to CPRIT funding, NOEP is creating and launching two free continuing nursing education modules on its website, noep.org. The modules are titled, Nursewise: Nutrition & Physical Activity and Tobacco Cessation: What the Nurse Needs to Know. Nurses across Texas and nationwide are in positions to effectively reach vulnerable populations.

Nurses bring so many dimensions to the table: knowledge of the pathophysiology of cancers, ability to navigate the complex systems of health care and insurance, compassion for newly diagnosed patients and long-term survivors, just to name a few. NOEP offers oncology education to all nurses, because every nurse should know the risk factors and screening recommendations, no matter his or her field of practice. It is the hope at NOEP that in educating nurses, we are empowering patients, and ultimately reducing cancer incidence, morbidity and mortality.

Texas A&M AgriLife ExtensionThe Texas A&M AgriLife Extension, a prime

example of secondary prevention and another CPRIT prevention grantee, involves a largely collaborative effort between local nurses and other health care providers, clinics and hospitals, The University of Texas at Austin School of Social Work faculty, and the expert AgriLife Extension network to increase access to cancer prevention services. Dr. Carol Rice, RN leads the enormously successful screening and diagnostic service project which targets women living in frontier, rural and border areas of Texas, who are less likely than their urban counterparts to have had a mammogram or Papanicolau (Pap) test within the past two years.

Dr. Rice’s project has become so successful that enrollment for its events is often capped due to lack of sufficient meeting space. And if the participation in the project is not enough to validate its success, the positive outcomes certainly do. Dr. Rice recalls that earlier this winter, a participant utilized the project to have a routine check-up and an abnormal finding was discovered. With the funding from CPRIT, the Extension project was able to pay for a diagnostic follow up, as the woman did not have health insurance. She was diagnosed with cervical cancer and was scheduled for surgery almost immediately at a discounted rate with a payment plan for the physician and the hospital, all coordinated through the project. Dr. Rice attributes the success of the program largely to the Extension Network, which boasts 251 offices in 254 counties in Texas, as well as experts on the ground who have relationships with the regional patient populations and health care providers. Dr. Rice looks forward to making the initiative statewide in the future, because Extension is a statewide network.

Previously, Dr. Carol Rice was awarded a fellowship from the Nurse Oncology Education Program to study at MD Anderson Cancer Center. From that experience, she was able to gain tools and skills that would later be crucial in her ability to operate a large project such as the Texas A&M AgriLife Extension screening and early detection program funded by CPRIT. Fortunately for Texans, cancer control is a goal shared by educational institutions, nonprofits, and other agencies across the state. Becauseof this, partnerships, collaborations or other relationships among these groups—like the one between NOEP and Dr. Rice—are common and beneficial to the people of Texas. Nurses play a paramount role to lead the state in controlling cancer through primary and secondary prevention, but collaboration of nurses with other stakeholders is what will ensure a successful attempt in the cancer control battle. ★

References1. World Health Organization. (2013). Cancer Control:

knowledge into action. Retrieved from http://www.who.int/cancer/modules/en/

2. American Cancer Society, Inc. (2013). Cancer Facts and Figures.Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf

3. National Comprehensive Cancer Network. (2013). NCCN Guidelines for Detection, Prevention and Risk Reduction. Retrieved from http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection

4. Texas Cancer Registry: Texas Department of State Health Services, National Program of Cancer Registries-Centers for Disease Control and Prevention, and Cancer Prevention and Research Institute of Texas.2012 Texas Selected Cancer Facts. Retrieved from http://www.dshs.state.tx.us/tcr/statisticalData/Texas-Fact-Sheets-2012.aspx

About the Author: Carol Cannon is an Oncology Certified Nurse who is new to Austin, Texas. She worked previously as a clinical research nurse on the Oncology/Hematology/Stem Cell Transplant Unit at the National Institutes of Health in Bethesda, Md. She began her nursing career in the cardiac ICU, and feels she has found her passion since working in oncology.

Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

The Nurse Oncology Education Program (NOEP) is part of Texas Nurses Association/Foundation Provider Unit.

This initiative was supported by Cooperative Agreement Number u55/DP624967 from the Centers for Disease Control and Prevention. Its contents, findings, and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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by Joni Watson, MBA, MSN, RN, OCN®

While colorectal cancer (CRC) deaths have declined slowly over the last 20 years, deaths from CRC still make up close to nine percent of all cancer deaths, making it the third most prevalent cancer among both men and women (AmericanCancerSociety[ACS],2013a;Centersfor Disease Control and Prevention [CDC],2012). According to the American Cancer Society and the U.S. Preventive Services Task Force (USPSTF), both men and women at average risk for colorectal cancer should begin routine screening at age 50 (ACS, 2013b; USPSTF, 2008).

With a wide variety of CRC screening tests and procedures available today, which one should patients choose? Screening proponents argue, “The best CRC screening test is the one that gets done.” Nurses should speak with patients and their families about the recommended, evidence-based screening guidelines, follow-up test(s) that may be

needed if screenings come back with positive or suspicious findings, and any attitudes or beliefs that may lead to non-adherence to recommended screening guidelines. In order to be effective, nurses in all fields of practice must remain current on evidence-based CRC screening guidelines.

The American Cancer Society divides CRC screening tests into two categories: (1) those that primarily find colorectal polyps and cancer and (2) those that primarily find colorectal cancer (ACS, 2013). Colonoscopy – the gold standard of CRC screening, flexible sigmoidoscopy, double-contrast barium enema, and CT colonography/virtual colonoscopy can find CRC as well as polyps, which are often precursors to CRC.

The first three tests are invasive, while virtual colonoscopy utilizes noninvasive imaging. The fecal occult blood test (FOBT) and fecalimmunochemical test (FIT) are also noninvasive tests that involve stool sampling. Stool DNA testing, or sDNA, was formerly included in

Colorectal Cancer Screening Methods at a Glance

Test Pros Cons

Colonoscopy Done every 10 years. Can miss small polyps. Can usually view entire colon. Full bowel preparation needed. Can biopsy and remove polyps. More expensive on a one-time basis Can diagnose other diseases. than other forms of testing. Sedation of some kind is usually needed. Will need someone to drive you home. You may miss a day of work. Small risk of bleeding, bowel tears, or infection.

Flexible Done every 5 years. Viewsonlyaboutone-thirdofthecolonsigmoidoscopy Fairly quick and safe. Can miss small polyps. Usually doesn’t require full bowel Can’t remove all polyps. preparation. Verysmallriskofbleeding,infection, Sedation usually not used. or bowel tear. Does not require a specialist. Colonoscopy will be needed if abnormal.

Double-contrast Done every 5 years. Can miss small polyps.barium enema Can usually view entire colon. Full bowel preparation needed.(DCBE) Relativelysafe. Somefalsepositivetestresults. No sedation needed. Cannot remove polyps during testing. Colonoscopy will be needed if abnormal.

CT colonography Done every 5 years. Can miss small polyps.(virtual Fairly quick and safe. Full bowel preparation needed.colonoscopy) Can usually view entire colon. Some false positive test results. No sedation needed. Cannot remove polyps during testing. Colonoscopy will be needed if abnormal. Still fairly new - may be insurance issues.

Fecal occult No direct risk to the colon. Should be done every year.bloodtest(FOBT) Nobowelpreparation. Maymissmanypolypsandsome Sampling done at home. cancers. Inexpensive. May produce false-positive test results. May have pre-test dietary limitations. Colonoscopy will be needed if abnormal.

Fecal No direct risk to the colon. Should be done every yearimmunochemical No bowel preparation. May miss many polyps and sometest (FIT) No pre-test dietary restrictions. cancers. Sampling done at home. May produce false-positive test results. Fairly inexpensive. Colonoscopy will be needed if abnormal.

recommended CRC screening guidelines, but testing intervals were uncertain and now this testing is no longer available within the United States (ACS, 2013). Each test has benefits and risks, pros and cons. Nurses can educate patients and families about the various CRC screening methods, providing support and encouragement for patients’ evidence-based screening choices.

Learn more about colorectal cancer and the ways you can make a difference with free Continuing Nursing Education at www.noep.org. ★

ReferencesAmerican Cancer Society. (2013a). Cancer Facts and

Figures 2013. Atlanta, GA: American Cancer Society.American Cancer Society. (2013b). Colorectal Cancer Early

Detection. Retrieved February 3, 2013, from http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used

Centers for Disease Control and Prevention. (2012). Prevalence of Colorectal Cancer Screening Among Adults — Behavioral Risk Factor Surveillance System, United States, 2010. Morbidity and Mortality Weekly Report, 61(2), 51-56. Retrieved February 3, 2013, from http://www.cdc.gov/mmwr/preview/mmwrhtml/su6102a9.htm

United States Preventive Services Task Force. (2008). Screening for Colorectal Cancer. Retrieved February 3, 2013, from http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm

About the Author: Joni Watson, MSN, RN, OCN is a clinical nurse manager at Seton Healthcare Family in Austin, Texas, and previously worked as director of the Nurse Oncology Education Program.

Source (Adapted): American Cancer Society, 2013b

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A special resolution “prepared in honor of the nursing profession” and read aloud in Senate Chambers by Sen. Jane Nelson welcomed nurses visiting the Capitol, commended all nurses for their “invaluable service to this state” and

proclaimed February 26, 2013 as Nurse Day at the Capitol. ★

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During Nurse Day at the Capitol, February 26, 2013, Senate Resolution No. 264 “prepared in honor of the nursing profession” by The Senate of the State of Texas was read aloud in the Senate Chamber by Sen. Jane Nelson (R-Flower Mound), chairwoman of the Senate Health and Human Services Committee. The resolution commended all nurses for their “invaluable service to this state” and proclaimed the day as Nurse Day at the Capitol. Nearly 300 nurses from across Texas came to Austin for the event, presented by Texas Nurses Association and the TNA Governmental Affairs Committee. Many of the Nurse Day participants were present in the Senate Gallery which overlooks the Senate floor for the reading by Sen. Nelson of the special resolution – and for the loud cheers that followed.

Immediately following the reading of the resolution, nurses were invited to join Sen. Nelson for a commemorative photo on the steps outside of the Chamber. In the photo, in the middle of the first row, Martha Myer, RN of Austin and Sen. Jane Nelson proudly share in displaying the resolution folder for the camera.

Photo is provided courtesy of Texas Senate Media Service.


On January 30, 2013, the Texas Nurses Association (TNA) attended the Alzheimer’s Disease 2013 Partnership Meeting – “The State of the State Plan.” The Texas state plan was developed two years ago under the auspices of the Texas Council on Alzheimer’s Disease and Related Disorders and the Alzheimer’s Disease Program at the Texas Department of State Health Services. It addresses four key areas of concern related to Alzheimer’s Disease (AD) – Care, Disease Management, Prevention, and Science. Each key area of concern has an assigned work group charged with meeting the goals and objectives established by the state plan. The partnership meeting was an opportunity for the partners and stakeholders to gather for an update.

The meeting began with a review of the Interim Report to the 83rd Texas Legislature of the Joint Interim Committee to Study Alzheimer’s Disease. The impact of AD on Texas and Texans is staggering. AD is defined as a progressive, age-related, currently irreversible, terminal disease that affects the brain and is manifested by problems with memory, thinking and day-to-day functioning. Those impacted by the disease demonstrate a decline in cognitive, behavioral and physical abilities that often renders victims totally dependent upon caregivers. The Alzheimer’s Association reports that more than 5,000 Texans die annually from AD, that approximately 340,000 Texans are currently living

with the disease with that number expected to reach470,000by2025.Currently,thereisnocurefor AD and no proven treatments to prevent its development or slow its progression.

AD also has a significant economic impact. The economic impact can be seen in health care-related costs incurred in the care of an individual with AD – costs associated with acute care, long-term care, and hospice care – and caregiver costs.

Texas has a variety of programs that support AD care and research. These include:

• TexasAlzheimer’sDiseaseProgram

• Texas Council on Alzheimer’s Disease andRelated Diseases

• Texas Alzheimer’s Research and CareConsortium (TARCC)

• MedicaidServices

• MedicareServices

• In-HomeandFamilySupportServices

• Community-BasedAgencyServices

• Caregiver Services for Respite and FinancialSupport

The interim report on Alzheimer’s Disease recommends increased AD research funding at the state level, the pursuit of additional funding sources to support research and implementation of the five-year AD state plan, circulation of written and online materials that clearly outline TARCC’s significant accomplishments, and the establishment of a statewide clearinghouse for all news stories related to AD research and treatment.

Meeting attendees were privy to presentations by Robert Egge of the National Alzheimer’s Association and George Vradenburg of USAgainst Alzheimer’s. Mr. Egge brought the national perspective to the meeting and statistics that are staggering:

• Five million Americans are currentlydiagnosed with AD.

• One person every 68 seconds is diagnosedwith AD.

• OneinthreepeopleintheU.S.currentlyhasa loved one with AD.

• AD is the 6th leading cause of death inAmerica.

• In 2012, the economic impact of ADon thecountry was $200 billion.

• AD with other co-morbid diseases likediabetes and coronary heart disease will continue to drive health care costs up.

• It is estimated that by 2050, 16 millionAmericans will be diagnosed with AD.

The national Alzheimer’s Disease plan that was published in 2012 outlines five goals:

1. Prevention and treatment

2. Enhancing the quality and efficiency of care

3. Expanded support to individuals with AD and their caregivers

4. Increased public awareness

5. Improved data tracking

It was reinforcing to meeting attendees to see how the national plan goals match fairly closely to the Texas state plan.

Mr. Vrandenburg spoke on behalf of USAgainst Alzheimer’s, an Alzheimer’s advocacy organization not affiliated with the Alzheimer’s Association. US Against Alzheimer’s is a collaborative group of philanthropists who are “enraged and engaged.” Their purpose is to “fix the broken status quo” by encouraging political, business and civic leaders to devote the resources needed to stop AD by 2020. In order to reach that goal, organizations and states – like Texas – need to think big and think differently in the areas of controlling health care costs, new models for funding, and the use of technology.

A truly eye-opening experience for the attendees was the opportunity to hear from some of the AD researchers working here in Texas. AD research is going on in all corners of the state. The areas of research are broad based – genetics, biomarkers, amyloid, tau, oligomerization, metabolism, lifestyle, infection agents, environmental toxins, inflammation, oxidative stress, head trauma, and apolupoprotein E. In his presentation, George Perry, PhD, dean of the College of Sciences, University of Texas at San Antonio, stated that there are 30,000 researchers currently involved in AD research.

Time was allotted at the end of the meeting for the four, state plan workgroups to meet to discuss the progress being made towards their identified plan goals and objectives. Since the meeting, both the Care Goal Group and the Disease Management Goal Group have completed one of their goals. Both havepublished guidelines: Understanding Residential Care Options for People with Alzheimer’s by the Care Goal Group; Clinical Best Practices for Early Detection, Diagnosis, and Pharmaceutical and Non-Pharmaceutical Treatment of Person with Alzheimer’s Disease by the Disease Management GoalGroup.Bothpublications are available at –dshs.state.tx.us/alzheimers.

TNA was/is an active member of the Disease Management Goal Group and participated in the development of the clinical best practices document. It is designed for health care professionals – physicians, registered nurses, advanced practice registered nurses, and physician assistants – as a guide and reference to assist in the early detection, medical management, diagnosis, and pharmacological/non-pharmacological treatment of AD. The document also includes a section on Mild Cognitive Impairment (MCI). The Disease Management Goal Group’s next charge is to develop a plan for disseminating the clinical best practices to physician practices/clinics, hospital-based practices/clinics, community associations, health care provider associations, and rural health care providers.

There is still much to be done. This is an exciting time in the fight against Alzheimer’s in Texas, as elements of the state plan start coming to fruition in an effort to enhance the health and well being of all Texans but especially those impacted by Alzheimer’s Disease. ★

About the Author: Laura Lerma, MSN, RN, is CNE program manager for Texas Nurses Association and the TNA and nursing’s representative to the Alzheimer’s Disease Partnership.

Alzheimer’s Disease Partnership: The State of the State Planby Laura Lerma, MSN, RN

Involvement in CoalitionsBy partnering in coalitions, Texas Nurses

Association achieves more for nursing than it would by standing alone. Through its participation in various coalitions, workgroups and state advisory groups, TNA supports health policy that improves the health of Texans and their access to quality health care, and represents the perspective of nursing when health care decisions are made in Texas.

From time to time, TEXAS NURSING VOICE reports on the activities and progress of various coalitions and workgroups. In this issue, guest columnist Laura Lerma, MSN, RN, offers three reports on the coalitions and workgroups where she represents TNA and nursing: Alzheimer’s Disease 2013 Partnership Meeting, Texas Health Steps Advisory Panel, andHealthyTexasBabies.

Other groups where TNA represents its members and nursing include:

• Texas ImmunizationStakeholderWorkingGroup – established by the Texas Legislature to improve state immunization rates with a focus on children.

• TexasPublicHealthCoalition–createdin2006 to improve the health of Texans by advancing core public health principles at the state and community levels.

• Texas HIV/Aids Coalition – founded toadvocate for HIV/Aids programs funding,to expand access to quality care and treatmentforpeoplelivingwithHIV/Aids,and to advocate for public policies that promote the health, welfare and civil rights ofTexansaffectedbyHIV/Aids.

• Texas Women’s Healthcare Coalition –formed to improve the health and well being of women, babies and families by assuring all Texas women have access to preventive care (see page 1).


by Laura Lerma, MSN, RN

In January 2011, the Texas Nurses Association (TNA) was asked to be a member of an expert panel (EP) established by the Texas Department of State Health Services (DSHS) in partnership with the March of Dimes. The Healthy Texas Babies (HTB) initiative was launched in aneffort to develop a comprehensive plan to reduce infant mortality in Texas. The EP was comprised of a wide range of subject-matter experts and stakeholders from across the state with the purpose of providing input into the development and implementation of a coordinated, strategic plan to guide the future actionsoftheHTBinitiative.

The objectives for this inaugural EP meeting were:

1. Outline the public/private partnerships for this initiative;

2. Review the U.S. and Texas data on infant mortality and preterm births;

3. Review the March of Dimes Healthy Babies are Worth the Wait program;

4. Review the current Texas interventions/practices to reduce infant mortality;

5. Begin development of a coordinated effortto reduce infant mortality;

6. Strengthen initiatives to continue the reduction of infant mortality; and

7. Identifyadditionalactivitiesandnextsteps.

Infant mortality rate is defined as the number of deaths to infants less than one year of age per live births. The infant mortality rate has been used as an important indicator of the overall health of a community and of the access to health care by pregnant women and infants.

The leading causes of infant mortality in the U.S. and Texas are birth defects, pre-term and low birth weight related disorders and sudden infant death syndrome (SIDS). Based on datafrom the Centers for Disease Control and Prevention (CDC) in 2007, the infant mortalityrate in Texas was 6.2 deaths per 1,000 live births as compared to the U.S. rate of 6.8 deaths per 1000 live births. This rate has remained relatively consistent. Risk factors contributing to infant mortality include no prenatal care, maternal smoking and/or alcohol use, and inadequate maternal weight gain. {Maternal and Infant

Texas Nurses Association and Healthy Texas BabiesHealth Research: Preterm Birth, Centers for Disease Control and Prevention (CDC)}.

At the conclusion of the January 2011 meeting, the EP narrowed down the specific areas of interest to address the infant mortality issue in Texas to include:

1. Guiding principles for the initiative;

2. Overarching themes to be considered;

3. Identification, collection, and use of data elements for interventions;

4. Identification of potential interventions;

5. Opportunities to implement interventions;

6. Opportunities for including more partners on this initiative;

7. MethodstocommunicateinformationaboutHealthyTexasBabies.

A Year LaterWhen the EP met again in February 2012, it

celebrated many successes that had occurred over the past year related to the Healthy Texas Babiesinitiative.

• The release of 2009 CDC infant andmaternal health data reflecting a rate of 6.0 deaths per 1,000 live births in Texas as compared to 6.8 in the U.S. (The EP identified that although the numbers were better, there was still room for improvement so it re-committed to the goal of reducing infant mortality in Texas by eight percent by 2014).

• TheEPexpandeditsstakeholderstomakeitmore diverse both culturally and in terms of disciplines represented.

• Ten local coalitions were established andfunded. The coalitions are charged to implement evidenced-based interventions that will impact poor birth outcomes, and will be reporting back to the EP periodically on their progress.

• Great strides were made through variousmethods of education and communication in raising the awareness of the public and providers on issues related to infant mortality.

• Research began on the development of astatewide communications campaign on HTB.

• The HTB website – healthytexasbabies.org – was launched. It will serve as a hub of information and resources for parents, providers and communities.

• DSHS and the Texas Health and HumanServices Commission (HHSC) began conducting surveys of Texas hospitals to determine where Neonatal Intensive Care Units (NICU) and obstetrical (OB) unitsare within the state in an effort to improve access to care for high-risk pregnancies.

• A Medicaid policy change that went intoeffect October 1, 2011, allows for non-paymentofpre-39weekelectiveinductions/C-sections.

• ANeonatalIntensiveCareUnitCouncilwasestablishedbyHouseBill2636.TheCouncilis to develop standards for operating NICUs in Texas, develop an accreditation process for NICUs, and make recommendations regarding best practices to lower admissions to NICUs.

• An increase in the statewide outreach of“text4baby” as a vehicle for public health announcements, outreach activities, and promotional materials was reported.

• Additional work was accomplished in thefollowing strategic areas:

• MaternalTransferProtocols

• TexasHealthStepsModule Development

• FatherhoodTools

• LifePlanningTools

• MaternalMortalityReviewBoard

• HealthyTexasBabiesHospital Certification

• Baby’sFirstYearToolkit

However, the times they are a-changin’. In June, 2012, theHTB’sSteeringCommittee (SC)met to consider the success and the future of theHTB initiative. The SC performed a SWOTanalysis – strengths, weaknesses, opportunities andthreats–oftheHTBinitiative.Basedonitsanalysis, the SC recommended the creation of a collaborative organization that will expand the reach and efforts of the group to reduce infant mortality in Texas. It was also recommended that maternal health be added to the scope of the collaborative effort recognizing that infants have better outcomes when they have a healthy mother.

In July 2012, the expert panel was called together to consider the recommendations of theHTB’sSteeringCommittee.Panelmemberswere assigned to one of four topical discussion groups – based on the member’s area of expertise – to discuss activities and issues related to the development of a collaborative. The topical discussion groups were:

1. Organizational Structure and Governance

2. Communications

3. Provider Education, Links to Professional Organizations, and Research/Publications

4. Work Groups and Practice Committees

At the conclusion of the July 2012 expert panel meeting, the steering committee was charged with taking the information generated by the topical discussion groups and developing a transition plan for the new Collaborative for discussion and feedback at the next expert panel meeting.

Now, in 2013An expanded steering committee has

been meeting over the past six months to perform research and content develop recommendations related to transitioning the initiative to a collaborative. Throughout this process, DSHS has been and will remain a committed partner to the new collaborative whilemaintainingDSHS-specificHTBactivities.The proposed transition plan will be presented to the EP on March 22, 2013.

Since its beginning, Texas Nurses Association has been a proud member of the Healthy Texas BabiesExpertPanelandisnowamemberoftheexpanded Steering Committee. We are proud of theworktheHealthyTexasBabiesinitiativehasaccomplished and look forward to the work that the collaborative will be involved in, in an effort to promote healthy Texas mothers and babies. ★

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by Laura Lerma, MSN, RN

Texas Health Steps provides medical and dental check-ups and case management services to babies, children, teens and young adults – from birth through 20 years of age who have Medicaid – at no cost. On February 15, 2013, the Texas Nurses Association (TNA) was included in a meeting of the Texas Health Steps Advisory Panel which provides the Texas Health Steps program with feedback and guidance on various topics of concern to the program.

The meeting’ agenda was full with topics ranging from activity in the current Texas Legislature to lead poisoning. Highlights included:

• Online Provider Modules Update: Texas Health Steps currently has 40 online modules that address various topics of importance to Texas Health Steps providers. It was reported that three modules were being added to the menu: child abuse and neglect, safe sleep, and motivational interviewing.

It was suggested that a module be developed on ADHD (Attention Deficit Hyperactivity Disorder) as more and more primary care providers are seeing/treating children with ADHD. The Texas Health Steps staff is looking for ways to increase the utilization of the modules. The modules were accessed 24,000 times last year, mainly by registered nurses and social workers. Advisory Panel recommendations included promoting the modules through the various state professional publications. All of the modules offer continuing education and are free.

• Medical Transportation Program Overview: One of the services provided though Texas Health Steps is non-emergency medical

trips. The program provides three million trips per year, the majority of which involve children under the age of 15 years. There has been some confusion regarding parental accompaniment of their children during a medical transport. Effective January 1, 2013 – with full enforcement by May, 2013 – a parent /legal guardian or a parent-identified adult must accompany their child on medical transports. The program has sent out 42,000 letters to involved parents and held parent forums in an effort to get the word out about the new rule and process. Similar information also went to the 15 transport services that the program uses. In the future, the program will report monitoring information back to the Advisory Panel.

• Childhood Lead Poisoning PreventionProgram: In 2012, the Centers for

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Disease Control and Prevention (CDC) recommended revising from 10 mcg/dL to 5 mcg/dL the capillary and venous blood level for lead at which a child should be referred for further testing. The Advisory Panel is considering this recommendation. In addition, the Texas Health Steps staff is analyzing targeted testing data from select areas of the state in an effort to identify through data mapping those zip codes within the state that are at highest risk for lead poisoning, while understanding that the focus for the health of the children of Texas must be on lead poisoning prevention.

The Texas Nurses Association was honored to be part of these vital conversations and looks forward to a continuing relationship with Texas Health Steps. ★


workplace safety which would lead to better retention of nursing staff. She stated that THA is in full support of the bill as are their many hospital members. She believes that health care overall will benefit from this bill becoming law.

Testimony 6Linda Wagner, RN testified for the bill. She

was a victim of a brutal assault by a patient who was brought in handcuffs to the emergency department by the police. Upon his arrival, Wagner asked him multiple questions about his history and why he was there and he did not indicate any specific reasons to be seen as a patient. He was asked if he could behave appropriately if the handcuffs were removed and he indicated that he would.

The police officer removed the cuffs and left. The patient waited until Wagner was alone in the room with him and then exploded off of the stretcher, punching her in the face and beating her on the head. When she retreated to a fetal position, he continued to punch and hit her on the back and torso. It took nine people to pull the patient off of her and restrain him. She received multiple sutures for facial lacerations and had bruises all over her body. She is no longer working in the emergency room. The patient was charged with a Class C misdemeanor with minimal consequences.

Testimony 7Cindy Zolnierek, PhD, RN, a member of the

Texas Nurses Association, testified for the bill on behalf of TNA. Zolnierek has advanced practice clinical specialization in psychiatric-mental health nursing. She also has experience in hospital administration and is a former director

of practice for TNA. She is currently an assistant professor of nursing at Texas State University. She spoke about some specific circumstances where patients are not responsible for their actions, e.g., persons with Alzheimer’s Dementia who are aggressive due to confusion and persons with paranoid psychosis.

Zolnierek also emphasized that mental illness does not give people carte blanche for violent behavior as many persons can still be held accountable for their actions. She said that only five to nine percent of perpetrators are arrested while 11 percent are transferred to a psychiatric facility. According to Zolnierek, “knowledge of an enhanced penalty for assaultive behavior will reduce the occurrence of violence.” She classified HB 705 as “one step in the rightdirection” for emergency department staff.

Even More Testimony Speakers against the bill included Christian

Edward of the Texas Criminal Defense Association, Greg Hansch of the National Alliance of Mental Illness of Texas, and Gyl Switzer of Mental Healthcare of Texas. Their concerns have to do with how this could affect patients with mental illness. Edward also asserted that nurses are covered under current law so this bill is not needed.

Anna Gray with Texas Catalyst of Empowerment spoke on the bill. She stated that she has extreme respect for emergency room staff but has concerns about the mentally ill. She believes that this bill will not help the situation.

Meagan Longley with the Heart Foundation spoke on the bill. She said that the safety of emergency personnel is paramount but that the bill is nonspecific about the de-escalation training and how it will be provided. Patrick

Violence Against Nurses continued from page 3 Waldron with the Texas Department of State Health Services was present as a resource witness. There were no questions for him. James Willmann, JD of the Texas Nurses Association spoke in support of the bill and clarified that current law only covers field personnel. StevenT.ofBexarCountyEmergencyPlanningCommittee spoke for the bill and reiterated that current law only covers field personnel. At the end of the hearing, the Criminal Jurisprudence Committee members were overall supportive of the concept of this bill after several of them had asked repeatedly why a change was needed because they felt existing law should cover this.

The testimony by nurses demonstrates how being part of the Nursing Legislative Action Coalition (NLAC) can strengthen the delivery of the message. Texas Emergency Nurses Association and Texas Organization of Nurse Executives are members of NLAC which is hosted by the Texas Nurses Association. The coalition has been collaborating on this issue the past year during its meetings to craft the message and be consistent in the delivery of the message. An important thread in the dialogue was to increase penalties for those who deliberately and intentionally assault nurses and nursing staff in the emergency room while excluding patients who have assaulted someone as a result of their illness.

References1 Gacki-Smith, J., Juarez, A.M., Boyett, L., Homeyer, C.,

Robinson, L., & MacLean, S.L. (2009). Violence against nurses working in US emergency departments. Journal of Nursing Administration. 39:7/8, 340-349.

2 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Special Report: Workplace Violence, 1993-2009, National Crime Victimization Survey and the Census of Fatal Occupational Injuries, March 2011.

3 Bureau of Labor Statistics, U.S. Department of Labor, 2011.

About the Author: Ellarene Duis Sanders, PhD, RN, NEA-BC is currently interim executive director, Texas Nurses Association.

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by Joyce Pohlman

To address health and other issues often faced by caregivers, the Texas Respite Coordination Center, in collaboration with the Texas Department of Aging and Disability Services (DADS), has created the Take Time Texas website, www.taketimetexas.org.

Take Time Texas is the first statewide clearinghouse of information for caregivers and providers of respite services in Texas. The website includes an inventory of more than 1,000 respite care providers that makes it easier for caregivers to find respite care. Caregivers

can search the inventory by name, county served, type of respite provided, age group served or type of provider.

The website also provides a wide range of caregiver education and training materials, including self-assessment tools, information on identifying and managing stress related to caregiving, disease-specific information, and educational programs. Health professionals can benefit from outreach and marketing materials included on the website. These materials include downloadable high quality brochures that can be distributed to clients to inform them about the value of respite care.

Theestimated2.7millioncaregivers inTexasplay a significant role in helping people who are older and those with disabilities remain at home. Their support with daily tasks, such as meal preparation, transportation, bathing and dressing helps seniors and persons with disabilities maintain their well-being and delay or forgo institutionalization.

However, the physical demands of caregiving – lifting and turning, bedding changes, bathing and moving the care recipient from the bed to a chair – cause caregivers to have more health problems than non-caregivers.1, 2 Since beginning their caregiving roles, more than 80 percent say their sleeping is worse, more than 60 percent say their eating habits are worse and 70 percent report not going to the

Helping Caregivers Maintain Their Own Health

doctor as often as they should.3 Additionally, 20-50 percent of caregivers report depressive disorders or symptoms.4

Respite care gives caregivers a break from their responsibilities and allows them to restore and strengthen their ability to continue providing care. A recent survey by the Texas Health and Human Services Commission found thatmorethan90percentofcaregiversagreedthat respite care would reduce their stress. However, more than half had not used respite care. Another 32 percent had tried to use respite care but were unable to find it.5

References

1. Texas Department of Aging and Disability Services. (2009). Informal Care in Texas: Aging Family Caregivers and their Need for Services and Support.

2. Shultz, R., O’Brien, A. Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, Correlates, and Causes. The Gerontologist, 35, 771-191.

3. National Alliance for Caregiving and Evercare. (2006) Evercare Study of Caregivers in Decline. As referenced in, Texas Department of Aging and Disability Services, Informal Care in Texas.

4. National Family Caregiver Alliance. (n.d.) Selected Caregiver Statistics. As referenced in, Texas Department of Aging and Disability Services, Informal Care in Texas.

5. Texas Health and Human Services Commission (2013) Unpublished Results of Caregiver Survey.

About the Author: Joyce Pohlman is a Grants Coordinator at the Texas Department of Aging and Disability Services. In this capacity, she oversees state and federally funded programs designed to improve the delivery and coordination of respite care in Texas. ★


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Just 13 years ago, Texas Nurses Association held its first Annual Nursing Leadership Conference. It was 2001 and nursing was on the brink of huge transformation. Over two full days, TNA offered conference attendees knowledge – updates on new legislation and regulations that would soon impact daily practice. And it brought to Austin well known, highly regarded national speakers to share new research and perspective on the issues and factors soon to influence nursing in Texas.

It’s now 2013. Today’s nursing environment has shifted from exploration and contemplation to

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This year, Texas Nurses Association is changing the format of its Annual Nursing Leadership Conference. This year, it’s going on the road and headed to a city near you. Whether you’re a seasoned practitioner or new to practice; the CNO of a huge hospital system or mid-sized city hospital or mid-manager of a smaller rural facility, Forces and Factors, Issues and Influencers: Knowledge Nurses Need to Lead is a must-attend, one-day CNE activity for all nursing leaders practicing in today’s Texas environment. Plan now to attend and get the knowledge you need to lead!

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Two of TNA’s most popular, pocket-sized resources are updATed for 2013 and available for order online at texasnurses.org.

The Texas Hospital Safe Staffing Law contains useful information on how to best question a patient assignment and advocate for patient – and nurse – safety. Included is simple, direct guidance on when and how to request Safe Harbor – Texas’ formal mechanism for resolving patient safety concerns when a nurse fears duty to patient is at risk.

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Nurses Taking Action in Texas: A SeriesCommander James L. Dickens,

DNP, RN, NP-C, FAANP

by Alexia Green, PhD, RN, FAAN

So how does a day start for a senior program officer, U.S. Public Health Service, Office of Minority Health Service in the Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services? Ninety days ago it started with a phone call that he was being deployed to Saipan and needed to leave within 24 hours. Saipan?

You might wonder as I did, where is Saipan? Well, Saipan is a Pacific island, the largest of the three islands (Saipan, Tinian and Rota) in the Commonwealth of the Northern Mariana Islands, and a U.S. territory. The islands are north of Guam by 100 miles or so. Relevant to Commander (CDR.) Cmdr. Dickens’ deployment, Saipan has a public hospital.

Even though CDR Dickens says of himself, “I’m just a public servant,” he is a unique Texas nurse. He serves in the U. S. Public Health Service Commissioned Corps which focuses on protecting, promoting and advancing the health and safety of our Nation. Yes, that includes territories such as Saipan. The Public Health Service Commissioned Corps is one of the seven Uniformed Services (five armed forces - Army, Marine Corps, Navy, Air Force, Coast Guard; and two other - Public Health Service Commissioned Corps and National Oceanic and Atmospheric Administration Commissioned Corps) that responds to national disasters and public health needs and provides leadership in public health practices.

In the case of Saipan, CDR Dickens served as a subject matter expert advising senior leaders of the 100-bed hospital on plans for correcting patient care delivery problems and on monitoring the hospital for future sustainability. He called upon earlier career experience working for the Centers for Medicare & Medicaid Services (CMS), when he taught state surveyors best practices for hospitals and the expectations of CMS.

Wearing a different career hat, CDR Dickens is also the Minority Health Consultant for Region VI (Dallas) in theOffice of the AssistantSecretary for Health. He and his wife – also a nurse and a practicing midwife – have two grown children who were raised in this unique household of “nurse parents.” In his second role, CDR Dickens focuses on minority health issues across America’s Southwest region. His responsibilities might take him to a Hopi Indian Reservation in New Mexico or Arizona or to the U.S. border areas where he focuses on assuring border health issues are addressed.

Another Call to ActionJust as a phone call deployed him to Saipan, another phone call thrust

CDR Dickens into an unexpected leadership role in moving forward what hasbecomekey legislation (SB 406/HB 1055) this session for advancedpractice registered nurses (APRN). CDR Dickens recalls that phone call. “I was pulled off the bench,” he said, “and put in the starting rotation.” It seems a disabled aircraft left one leader stranded and resulted in CDR Dickens being “called into action” to facilitate an important meeting of a number of APRN groups working in concert with Texas Nurses Association and the Texas Team Advancing Health through Nursing Action Coalition, convened to advance the Future of Nursing: Campaign for Action.

As an APRN and a member of the Texas Team Strategic Advisory Committee, CDR Dickens was a natural for the facilitator assignment and an obvious choice. Modestly he recalls, “Efforts had already begun to bring the APRN groups together on unified legislation that could clarify the roles and responsibilities, and relationships with physicians in the advanced practice nursing model. I just picked up the torch.”

Actually, efforts over recent legislative sessions hadn’t progressed much or yielded any passed legislation. In fact, the last significant legislation for APRNs was passed in 2003 when agreement was reached with medicine on expanding prescriptive authority for APRNs. That was followed by a two-session moratorium (2005, 2007) and two sessions(2009,2011)ofanunsuccessfulattempttoachieveauthoritytoprescribewithout physician delegation.

What has happened since CDR Dickens received his phone call to leadership nearly 18 months ago is that advanced practice nursing has tirelessly worked together – and with medicine – to collaborate on legislation that all sides can endorse. Said CDR Dickens, “If no one’s completely satisfied with the pending legislation, we at least believe we have a product that will effectively work.”

The problem that has existed, relayed CDR Dickens, is that the existing model of APRN practice was difficult to understand and the expectations weren’t clear. SB 406/HB 1055 clarify roles and responsibilities. CDRDickens calls it, “a consolidated model for clarity.”

As CDR Dickens summarized it, “We have a strong chance of moving this legislation forward. The most important thing is that at the end of the day, it’s really about the beneficiaries of our APRN services – the patients and the citizens of Texas.”

About the Author: Alexia Green, PhD, RN, FAAN is associate professor and dean emerita at Texas Tech University Health Sciences Center School of Nursing. She is also co-chair of Texas Team Action Coalition executive committee, and co-leader of its Tactical Support & Operations Team. She was appointed by Gov. Perry in 2012 to serve on the Texas Institute for Healthcare Quality and Efficiency and is currently the only nurse on that board.

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Oscar San Miguel’s office is in Austin where all board of nursing hearings are held. You don’t have to pay travel expenses when you hire

Oscar San Miguel.

Reasonable rates. Payment plans available on all cases.

“The Nursing Board wanted me to give up my license for at least a year. I hired a Houston lawyer who quoted me as much as $15,000.00. After a phone call with her cost me $200.00, I found Mr. San Miguel in the Texas Nursing Magazine. His fees were reasonable and affordable and ended up being less than ONE THIRD of the first lawyer. Most importantly, Mr.

San Miguel saved my license and I am practicing what I love doing today thanks to him. I say to any nurse in Texas with a Board matter,

hire Oscar NOW!” ~G.S., RN, San Antonio, TX

OSCAR SAN MIGUELwww.osmlaw.com

[email protected] West 12th Street, Suite 204, Austin, TX 78701

512-228-7946 • fax: 512-949-5061


You’re a nurse because you care. You want to make a difference. Malpractice claims could possibly ruin your career and your financial future. You always think of others. Now it’s time to think about yourself. Set up your own malpractice safety net.

• You need malpractice insurance because . . . - you have recently started, or may soon start a new job. - you are giving care outside of your primary work setting. - it provides access to attorney representation with your best interests in mind. - claims will not be settled without your permission. • ANA recommends personal malpractice coverage for every practicing nurse. • As an ANA member, you may qualify for one of four ways to save 10% on your premium. This is your calling. Every day you help others because you care. You’re making a difference. Personal malpractice insurance helps protect your financial future so you can go on making a difference.

800.503.9230 for more information

www.proliability.com/60484

Administered by Marsh U.S. Consumer, a service of Seabury & Smith, Inc. Underwritten by Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance, 55 Water Street, New York, New York 10041. May not be available in all states. Pending underwriter approval.

CA Ins. Lic. # 0633005 • AR Ins. Lic. # 245544 d/b/a in CA Seabury & Smith Insurance Program Management

PATIENT CARE IS YOUR PRIORITY.PROTECTING YOUR FUTURE IS OURS.

60484, 60501, 60504, 60522, 60525, 60537, 61225, 61235, 61238, 61239

(4/13) ©Seabury & Smith, Inc. 2013

Now you can choose the time and place to take the courses you need and want. We’ve

made it easy to take free CNE courses online. We offer 24/7 access to more than 40

courses, including when to refer to a pediatric specialist. And even when you’re

not taking a course, you can access the latest references and resources you need.

The CNE courses are developed by the Texas Department of State Health Services

and the Texas Health and Human Services Commission. All courses are

comprehensive and accredited.*

*Accredited by the American Nurses Credentialing Center, Texas Medical Association, National Commission

for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council

of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy

of Nutrition and Dietetics, Texas Academy of Audiology, and International Board of Lactation Consultant

Examiners. Continuing Education for multiple disciplines will be provided for these events.

CNE Courses Include:

• When to Refer to a Geneticist

• Children with Diabetes

• Children with Asthma

• Newborn Screening

• Case Management

• Developmental Screening

• Many others

Referral Guidelines

• Pediatric Depression

• High Blood Pressures in the Office

• Atopic Dermatitis

• Gastroesophageal Reflux in Infants

• Exercise-Induced Dyspnea

• Referral Guidelines Overview

Taking New Steps

To view courses online, visit www.txhealthsteps.com.

Free CNE credits. Available 24/7.

STEPS-0467_TxNursing_10n25X7n5_MAY_JUNE.indd 1 4/4/13 9:56 AM

Take care of your patients AND your career with a CCNE-accredited* nursing degree from WGU Texas!

• Relevant and Accredited—CCNE-accredited degree programs designed to produce

highly qualified nurses, educators, and administrators.

• Competency-based—Challenging programs that measure your learning rather than

your time spent in class.

• Affordable—One of the best values in higher education, WGU Texas tuition is among

the most affordable in the entire country.

• Flexible—Log in and learn anytime, anywhere before, during, and after rigorous

nursing shifts.

Educationis a journey.Discover yours...

Online.

Programs begin the first of every month. Your future can start right now! RN Prelicensure programs available in select areas!

WGU.edu/StudyWGU 1.800.620.8946

texas.wgu.edu/texasnurse 1.888.549.2992

*Through Western Governors University, WGU Texas offers nursing programs that are accredited by the Commis-sion on Collegiate Nursing Education (One Dupont Circle, NW, Suite 5380, Washington DC 20036, 202-877-6791).

Texas Nurses Association -

Documents