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The Official Voice of VA NorCal Health Care System
www.northerncalifornia.va.gov
Summer 2019
In This Edition…
» VA NorCal Launches New Health Care Options Under MISSION
Act
» Spotlight on the VA Post-Baccalaureate Nurse Residency
Program
Meet Jacob Nur: Chief Nurse by Day and
World-Class Runner by Night page 4
www.northerncalifornia.va.gov
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2 The Northern – The Official Voice of VA Northern California
Health Care System
CONTENTS
3 VA NorCal Launches New Health Care Options Under MISSION
Act
4 Meet Jacob Nur: Chief Nurse by Day and World-Class Runner by
Night
5 NorCal Veterans Bring Their Best at Golden Age Games 6 East
Bay Institute for Research & Education 7 Spotlight on the VA
Post-Baccalaureate
Nurse Residency Program
8 Addiction and Nutrition Patient Experience
Office
About the Publication William Martin Chief Public Affairs
Officer Jon-Nolan Paresa Publisher/Photographer Darren Ebbing
Webmaster/Graphic Design Produced by Forte Information Resources
LLC
The Northern | SUMMER 2019The Northern is an authorized
publication of the Department of Veterans Affairs. All photographs
are the property of VA, unless otherwise indicated.
VA NorCal Health Care Facilities to Go Smoke-FreeAs a health
care system devoted to the well-being of Veterans, VA NorCal is
always exploring ways to improve the settings in which our patients
receive their care. As part of that effort, each of our facilities
will become smoke-free by October 1, 2019.Although VA NorCal has
permitted patients to smoke in designated areas in the past, study
after study proves that smoking—and exposure to secondhand
smoke—creates significant medical risks. These risks are in direct
opposition to the VA NorCal mission: providing high-quality,
compassionate care to Veterans. As of October, VA NorCal will
prohibit smoking by patients, visitors, volunteers, contractors,
and vendors at its health care facilities. VA NorCal’s smoke-free
policy applies to cigarettes, cigars, pipes, as well as electronic
smoking devices, such as e-cigarettes, e-cigars, and vape pens. VA
NorCal is not alone in this move to smoke-free campuses. Not only
are VA health care facilities across the nation adopting the same
smoke-free policy, but more than 4,000 health care facilities and
four national health care systems in the U.S. have already
implemented smoke-free grounds. The well-being of our Veterans
demands that we do the same.In closing, let me encourage those
Veterans ready to quit smoking to visit VA’s extensive list of
no-cost and proven resources at www.mentalhealth.va.gov/
quit-tobacco/. — David Stockwell
Letter from the Director
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SUMMER 2019 – www.northerncalifornia.va.gov 3
VA NorCal Launches New Health Care Options Under MISSION Act
“We’re committed to providing not only high-quality,
compassionate health care to Northern California Veterans, but also
providing that care at the right time and place,” said VA NorCal
Director David Stockwell.
The VA MISSION Act (officially titled, “VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of
2018”):
• Strengthens VA’s ability to recruit and retain clinicians
• Statutorily authorizes “Anywhere to Anywhere” telehealth
provision across state lines
• Empowers Veterans with increased access to community care
• Establishes a new, urgent care benefit that eligible Veterans
can access in the community
Veterans can now work with their VA NorCal health care provider
or other staff to determine if they are eligible to receive care in
the health care community outside of VA NorCal. (It is important to
note that eligibility for community care does not require a Veteran
to receive that care in the community; Veterans can still choose to
have VA NorCal provide their care.)
Veterans are eligible to choose to receive care in the community
if they meet any of the following six
eligibility criteria:
1. A Veteran needs a service not available at any VA medical
facility.
2. A Veteran lives in a U.S. state or territory without a
full-service VA medical facility. Specifically, this would apply to
Veterans living in Alaska, Hawaii, New Hampshire, and the U.S.
territories of Guam,
American Samoa, the Northern Mariana Islands, and the U.S.
Virgin Islands.
3. A Veteran qualifies under the “grandfather”
provision related to distance eligibility for the Veterans
Choice Program.
4. V A cannot furnish care in a manner that complies within
certain designated access standards. The specific access standards
are described below.
• Average drive time to a specific VA medical facility:a.
30-minute average drive time for primary care, mental
health care, and noninstitutional extended care servicesb.
60-minute average drive time for specialty care
• Appointment wait time at a specific VA medical facility:a. 20
days for primary care, mental health care, and
noninstitutional extended care services, unless the Veteran
agrees to a later date in consultation with his or her VA health
care provider
b. 28 days for specialty care from the date of request, unless
the Veteran agrees to a later date in consultation with his or her
VA health care provider
5. The Veteran and the referring clinician agree that it is in
the best medical interest of the Veteran to receive community care
based on defined factors.
6. VA has determined that a VA medical service line is not
providing care in a manner that complies with VA’s standards for
quality.
For more information on the MISSION Act and its impact on VA
health care across Northern California, visit
www.missionact.va.gov.
If you have been paying attention to news in the Veteran
community lately, you have probably noticed a lot of talk about
something called the MISSION Act. Locally, the MISSION Act will
empower the more than 100,000 Northern California Veterans that VA
NorCal serves each year to have more options for their health care
decisions.
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4 The Northern – The Official Voice of VA Northern California
Health Care System
Jacob Nur is a master’s-prepared registered nurse and has worked
for the VA for over 27 years, most of those years spent right here
at VA Northern California Health Care
System. Jacob has worked in various specialties including spinal
cord injury, medical surgical units, hematology/oncology, and the
intensive care unit. He currently serves as chief nurse of acute
care at the Sacramento VA Medical Center.Since taking it up as a
hobby just 10 years ago, Jacob has totally refined the craft of
running. In that short amount of time and at the tender age of 63,
he has become a world-class age group champion! He competes at a
variety of distances ranging from cross country, 5K, 10K, and half
marathons, while excelling in full marathons. Since December he has
run three full marathons: the California International Marathon,
the Boston Marathon, and most recently, the Rock ‘n’ Roll San Diego
Marathon. It was after running the San Diego Marathon that he made
his mark by becoming one of the top-ranked runners in the
world for his age group (60–64). That means he runs faster than
nearly all of those similarly aged runners worldwide. Prior to this
most recent accomplishment, Jacob was recognized by the Sacramento
Running Association the last three years in a row with an annual
achievement award: in men’s cross country, marathon, and road
racing; he has been inducted into their Hall of Fame as well. He
has also won the Buzz Oates Race Series for the last three
years.
Due to his exemplary accomplishments, he will be invited to
compete at the London Marathon in
Meet Jacob Nur: Chief Nurse by Day and World-Class Runner by
Night
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NorCal Veterans Bring Their Best at Golden Age GamesBy Coralee
“Corkie” CelliniVA NorCal Occupational Therapist and Coach
April 2020 in a race against other qualifiers
in his age group from around the world. We
hope to see him emerge victorious as one
of the overall top-ranked world champions!
Locally, he has won many awards as the top
age-graded runner in the Sacramento area.
What an amazing accomplishment considering
that he works full-time and has a family to
whom he is deeply devoted.
Congratulations, Jacob, and best of luck in
London! Keep running!
The National Veterans Golden Age Games (NVGAG) is the premier
senior adaptive rehabilitation program in the United States, and
the only national multievent sports and recreational seniors’
competition program designed to improve the quality of life for
older Veterans.
This is the tenth year that VA NorCal patients from across
Northern California participated in the VA National Games. The
Veterans who competed in Anchorage, Alaska, identified how their
involvement and training support their recovery and contributes to
a healthy lifestyle.
“The 2019 National Veterans Golden Age Games was for me the
culmination of a personal treatment plan to fend off a severe case
of depression and anxiety,” said Joe Passarelli.
VA NorCal encourages senior Veterans to be proactive in
embracing a healthier lifestyle, thus achieving the NVGAG “Fitness
for Life” motto. The Games are open to Veterans aged 55 or older
who receive health care from the Department of Veterans
Affairs.
Veterans representing VA NorCal in this year’s games include:•
Charles Morphy, silver medal in boccia doubles and horseshoes
• Richard “Woody” Wright, silver medal in boccia doubles
• Joe Passarelli, bronze medal in 100-meter sprint and several
ribbons
• Nelson Martinez, bronze medal in basketball free throws
• Armand Alfred, competed in golf, boccia, air rifle, and air
pistol
• Jimmie Wynn, competed in air rifle, air pistol, and boccia
The team would like to thank VA NorCal Voluntary Services for
its support in providing donated funds to assist Veterans with
travel and lodging expenses for this year’s event in Anchorage.
SUMMER 2019 – www.northerncalifornia.va.gov 5
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There are two ways that VA NorCal can receive and administer
medical research funding: (1) Through Veterans Health
Administration, funded
by Congress. These funds are administered entirely through the
VA NorCal Research Service Office.
(2) Through a nonprofit corporation established to serve VA
NorCal. Funding sources include non-VA federal funding entities
(for example: National Institutes of Health; Department of Defense)
as well as private pharmaceutical companies, foundations, and
philanthropic entities.
East Bay Institute for Research & Education (EBIRE) is one
of about 80 nonprofit corporations affiliated with a VA medical
center, established as a 501(c) (3) organization for purposes
of supporting medical research. EBIRE collaborates with VA NorCal
leadership, research scientists, and staff to maximize
research-related opportunities. The Board of Directors provides
executive-level oversight in accordance with VHA Handbook 1200.17
and EBIRE’s by-laws. Staff manage EBIRE’s infrastructure,
including: board of directors; reporting and audit requirements to
both the IRS and VA’s Nonprofit Program Office; application and
administration of grant funding that aligns with the needs
of VA NorCal Veterans; employing personnel to support the actual
research effort; and recordkeeping.Current specialties targeted for
VA NorCal Veterans include:
6 The Northern – The Official Voice of VA Northern California
Health Care System
East Bay Institute for Research &
EducationBy John C. Johnson, PsyD, MSW
Chief Executive Officer VAMC WOC Affiliate
Name Title VA FunctionDavid Stockwell Statutory VA Director
DirectorWilliam Cahill Statutory VA Director Chief of StaffRaja
Jagadeesan Statutory VA Director ACOS - EducationDawn Schwenke
Statutory VA Director ACOS - ResearchVacant Secretary/Treasurer
Chief Financial OfficerHarry Moos Statutory Non-VA Director Veteran
& VAMC ConsumerVacant Statutory Non-VA Director Community
MemberRegina Godbout Voluntary Director Deputy Chief of
StaffParamita Ghosh Voluntary Director Professor & Researcher
Siba Raychaudhuri Voluntary Director Professor &
Clinician-ScientistJohn Johnson Chief Executive Officer WOC
AffiliateNote: WOC is Without Compensation.
VA Northern California Health Care System (VA NorCal)
consistently strives to provide outstanding medical care to
Northern California’s Veterans, including access to cutting-edge
research opportunities.
• Abdominal Aortic Aneurysms
• Cancer Therapies• Cardiovascular Disease• Clostridium
Difficile Colitis
“C. Diff”• Cognitive Studies• Colonoscopy Advancements•
Diabetes• Emergency Medicine• Inflammatory Bowel Disease
• Pulmonary & Sleep Disorders
• Post-Traumatic Stress Disorder
• Psoriasis & Rheumatoid Arthritis
• Speech Disorders• Stroke• Traumatic Brain Injuries• Women’s
Health• Wound Healing
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SUMMER 2019 – www.northerncalifornia.va.gov 7
Spotlight on the VA Post-Baccalaureate Nurse Residency ProgramBy
Neftali Cabezudo, PhD, MSN, RN-BC, CNLVA Program Co-Director &
Faculty, VANAP USFNursing Education & Professional
Development
One of the initiatives that has transformed how we prepare our
future VA nurses has been the implementation of the
Post-Baccalaureate Nurse Residency (PBNR) program.Now in its fourth
year, the PBNR experience is a 12-month transition for newly
graduated nurses to prepare them for the clinical and professional
expectations of the registered nurse role through immersion in the
entire VA Northern California Health Care System (VA NorCal).
Residents not only receive classroom instruction on VA nursing
practice and Veteran-centric health issues but also spend clinical
time exploring all of the services that we provide for Veterans.
This spectrum includes units such as Home Health, Emergency
Department, Quality Improvement, Infection Control, Primary Care,
and many other areas in which nursing plays a major role in the
Veteran’s health care. The goal of the program is to develop
nursing leaders who are well versed with the services we have
available for our Veterans and better serve them by ensuring that
they receive the services they require as their needs arise.
To date, the PBNR program has graduated 18 nurse residents, 16
of which were hired into the VA, one of whom is working with
Veterans at UC Davis Medical Center, and one of whom was
commissioned into the United States Air Force. Currently, we have
six nurse residents who are actively involved in three-week
hospital rotations through all of our inpatient departments and
will start their two-month intensives on July 28, 2019. This
“home unit” experience will be their final clinical rotation before
they transition
into independent practice. They will graduate the program on
October 9, 2019.
One of our residents, Zachery Bohn, has found his PBNR
experience thus far to be extremely valuable in shaping his nursing
career: “The PBNR is unique compared to other residencies or
first-time jobs because I have had the opportunity to rotate
throughout the VA health care system, learning from all the experts
in outpatient and inpatient departments. In my rotations, I have
become oriented to the entire hospital, built rapport with nurses
and nurse leaders in all departments, and acquired knowledge from
doctors and other multidisciplinary teams.”
Zachery, much like his colleagues, embraces this program
experience not only as a development of professional nursing skills
but also as an opportunity to learn about the scope and essence of
Veteran-centric care: “I feel that the PBNR has set me up for
success in my nursing career. I have a much deeper understanding of
the VA health care system and all its resources. Knowing all the
resources available helps me give the best care I can to our
Veterans. I also have a deeper appreciation for all of the work
that happens away from the bedside by nurses in health care. The
PBNR has helped me see and understand the big picture of health
care, and has provided me with the tools to become a great nurse
and health care leader.”
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FEEL FREE TO TAKE THIS MAGAZINE HOME!
8 The Northern – The Official Voice of VA Northern California
Health Care System
Addiction and Nutrition
Good nutrition is crucial for everyone, from infancy throughout
one’s life span. However, our nutritional status may occasionally
become compromised; at times like this, increased focus on proper
nutrition is key. For people who are recovering from addictive
substances, drugs—whether prescription or illicit—can affect
behaviors surrounding food and fluid, taste preference, and body
weight.
Malnutrition is common as well, because appetite can be
suppressed or increased, leading to cravings of less healthful
foods. Micronutrients including iron, folate, and B vitamins (B6
and B12) are important to mental health. When these nutrients are
deficient, symptoms mimicking mental health problems may occur,
such as depression, fatigue, poor attention, and altered sleep
patterns. Ensuring proper nutrition by eating three well-spaced
balanced meals, with
no more than four to five waking hours between meals, is
recommended. To maintain a healthy weight, consume meals composed
of complex carbohydrates, protein, and fiber with low-moderate fat
intake.
If appetite is diminished, smaller, more frequent meals should
be considered. Limiting added sugar intake can help with mood
fluctuations and avoid excessive weight gain. Curbing caffeinated
beverages can also aid in mood stability. Diarrhea and constipation
can occur during recovery, making adequate hydration—specifically,
water during and between meals—an important focus. The VA has many
resources to aid in the recovery process. Your primary care
physician can send a referral to a Registered Dietitian to assist
Veterans in achieving optimal nutrition.
Patient Experience Office
The Patient Experience Office oversees the Patient Advocacy
Program for VA NorCal. At times, communication between Veterans and
their health care team can be complex and may lead to
misunderstandings. As well, there may be concerns that seem
difficult to resolve. Whenever a Veteran has a health care concern
or disagreement with the health care provider or team, he or she
has the right to ask questions. The Patient Advocate serves as the
liaison between the Veteran and their health care team.
VA NorCal employs Patient Advocates to help Veterans resolve any
such issues. Patient Advocates provide services that support the
ability of VA to improve the health and well-being of Veterans. Our
Advocates work closely with the health care teams to find a
resolution by active listening, asking questions, ensuring clear
communication, and assisting in finding solutions. Patient
Advocates document and monitor concerns raised by Veterans so that
if the same issues are brought forth by several people, those
concerns can be communicated to senior leaders at the facility.
Finally, Veterans may wish to compliment an employee or discuss
something that is going well with their health care.
Patient Advocates are not clinical providers and are not
qualified to interpret clinical data or recommend treatments. Most
of the VA NorCal sites have an Advocate in place to assist Veterans
on a drop-in basis. Advocates also offer telephone service and
respond to secure messaging through MyHealtheVet and Inquiry
Routing & Information System (IRIS) inquiries. Our team stands
ready to assist with any concerns that you may have regarding your
care at VA Northern California Health Care System. Thank you for
choosing the VA for your care!
By Lynne Skaggs, MAAssistant Chief, Patient Experience
Office
By Dana Beattie, MS, RD, CNSCInpatient Dietitian