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June, July, August 2009AUM NursingAdministrators atthe Top of StateOrganizationsAuburn Montgomery School of Nursing graduates Dr.Debbie Faulk, ’94, and Carol Stewart, ’92, not only lendtheir expertise to their alma mater, but also to nursingcolleagues statewide. They serve as presidents for twoAlabama professional nursing organizations.Faulk, coordinator of the Educational Advancement forRegistered Nurses program at AUM, is president of theAlabama State Nurses Association for 2008-10.“ASNA’s mission is to promote excellence in nursing,”said Faulk. “This year, ASNA is advocating for funds forscholarships for nurse educators. We are also striving toeliminate smoking in public places, supporting the NursePractitioner Alliance of Alabama in their endeavors andsupporting the school nurse bill.”In addition to legislative issues, ASNA promotesexcellence in nursing through continuing educationprograms.“In an attempt to increase membership, a task force isdeveloping a membership video with production supportfrom the AUM Information Technology department,” saidFaulk. “We believe this endeavor will help us to bring aconsistent message about ASNA, its mission, goals andbenefits.”Faulk also plans to utilize the technology that sheemploys regularly in the EARN program for ASNA, asshe plans for the association’s first virtual board meetingin April.Faulk’s personal goals as president of ASNA areto introduce more technology into the functioning ofthe association, increase membership and advocate forlegislative issues that are of interest to members of ASNAand Alabama nurses.Carol Stewart, director of Student Health Services atAUM, is president of the Nurse Practitioner Alliance ofAlabama for 2009.The purpose of the NPAA is to represent the regionalnurse practitioner groups in practice and educational issueseffecting nurse practitioners.“Legislation (SB 483) has recently been submitted in thestate Senate that would help eliminate some of the practicebarriers NP and certified nurse midwife practice withinthe state,” said Stewart. “Our primary goal is to increaseaccess to care, focusing on the uninsured or under-insuredand rural areas of Alabama.“There is a shortage of primary care providers inAlabama and NP’s are one source to help alleviate thisproblem. NP’s are underutilized because of the barriersthat exist. One of the issues addressed in our bill is forNP’s and CNM’s to have direct reimbursement for theservices they provide. Most states have already mandatedthis but not Alabama,” Stewart said.Because of the national economic crisis, funds are shortfor meeting health needs in Alabama, and it’s not expectedto improve for some time, Stewart said.“I meet people everyday who have recently lost theirjobs and health insurance. It’s time for us to join forcesto seek new and creative ways to solve our health careproblems.”Dr. Debbie Faulk and Carol Stewart lead twostatewide nursing organizations.The Alabama Nurse Page 3The President’s Messageby Debbie Faulk, PhD, RNASNA PresidentAs I began reflecting onwhat I wanted to convey toAlabama nurses in this thirdmessage as YOUR presidentof the Alabama State NursesAssociation, I thought aboutendings. A number of eventswill have ended as you read thismessage. The current sessionof the Alabama Legislaturewill have ended; many nursingstudents will have finishedFaulknursing programs across thestate and will have attendedgraduation ceremonies. Many of these former students willbe anxiously preparing for, or awaiting, NCLEX results inorder to assume the roles of nurses and to take their placeas the future of the nursing profession. Finally, NationalNurses Week will have come and gone. As I think aboutthis last event, National Nurses Week and this year’sslogan: Nurses: Building a Healthy America, I would liketo focus on this for the first part of my message.I was personally excited about the slogan for the firsttime in a number of years. Why? I believe the sloganeffectively reflects what nurses have been doing for avery long time focusing on preventive health issues.I believe preventive health efforts are key to building ahealthy America. About a month ago, I was the keynotespeaker at IOTA Chapter of Sigma Theta Tau ResearchDay for Troy University School of Nursing. The themewas focused on healthy behaviors. Using the AmericanNurses Association’s slogan for National Nurses Weekas my central theme, I talked about how important it isfor nurses to continue to focus on preventive health care,but the primary thesis of my keynote was that nursesmust role model healthy behaviors and accept individualaccountability for their health. This is the second reasonwhy I believe nurses are instrumental in building ahealthy America. Nurses must role model self-care. If weas nurses do not practice prevention activities, we mightfind ourselves living with the repercussions of the verychronic diseases that we see every day in our practicesettings. Consumers of health care trust nurses and theyare watching US!Although a number of events will have ended asyou read this message, a huge event will have begun.I am referring to health care reform. A few days ago theCongress began debating health care reform and what itwill entail. The debates are in the early stages. I wouldlike to appeal to you as advocates for the profession andfor clients to keep informed as the dialogue takes shape.Remember in my second President’s message I said“nursing no longer has an option related to becominginvolved in the political arena. It is now a mandate.”Fortunately YOUR American Nurses Association is a keyplayer and has been invited several times to the WhiteHouse to participate in health care reform conversations.The decisions that will be made about health care willimpact you as a citizen, as a consumer of health care, andas a provider of care. Please stay informed and pleaseparticipate in the process by writing, calling or meetingwith your legislators. Please do not let others speak fornursing.My final point within this third message is to give youan update on ASNA’s strategic plan for 2009-2010. Ourinitiatives include: Provide leadership for health policy andlegislative activities Joe Decker has done a phenomenal job oflobbying for the nursing scholarship bill, nursepractitioner bill and other issues impactingAlabama nurses. Advocate for Alabama nurses on professionalpractice issues ASNA’s lobbying presence in the legislature Nurse’s Day at the Capitol–21 January, 2010. Provide for the continuing professionaldevelopment for Alabama nurses FACES was held the last of April and over 600nurses and student nurses attended excellentoral presentations and poster presentations. Commission on Professional Issues isdeveloping information related to best practicesfor retaining the older Alabama nurse. Thisreport will be provided to the membership andshared with all Alabama nurses in the nearfuture. Improve the visibility and image of nursing The ASNA membership video is within a weekof being completed and ready for approval bythe board of directors. Nurse’s Day at the Capitol-21 January, 2010. Evaluate organizational effectiveness, relevancy,and efficiency On-going process.I will end with my promised continuing message thatin order to make a difference in health care, nurses mustbe united. While we have many voices and diverse values,we can dialogue, agree to disagree, and yet show othersthat we speak with one strong voice when it comes toproviding quality access to care for Alabama citizens andto promoting excellence in nursing. We at ASNA stronglybelieve that this advocacy can be best accomplishedthrough membership in ASNA.Thank you for your time and attention. I want ALLnurses in Alabama to know that ASNA is working withyou, for you. If you are a member of ASNA, thank you! Ifyou are not, JOIN us in promoting excellence in nursing.

Page 4 The Alabama NurseJune, July, August 2009The E.D.’s Notesby Joseph F. Decker, IIExecutive DirectorAs the third annual session(of four in the quadrennium) ofthe Alabama Legislature closes,we should review the resultsof actions (or lack of same) onissues we have followed thisyear. The Alabama Board ofNursing sunset legislation didpass without incident, extendingthe ABN for four more years.No adverse changes to thelaw were involved. We werealso successful in garnering atotal of 257,000 for nursingDeckerCondolences:Jean McLain in thedeath of her mother.Edith Shaw, long-timeASNA member ofDistrict 5.scholarships in the Education Trust Fund Budget for2010, despite a bleak budget forecast and initially havingonly 57,000 set aside for that purpose. However, ourNursing Scholarship Bill (HB50) sponsored by Rep. (Dr.)Bentley again failed to even get scheduled for a hearingin committee in the House. We’re very disappointed inthat lack of progress. The Senate version (SB51) sponsoredby Sen. Benefield did clear committee but not the fullSenate. We must redouble our efforts next year, andincrease our profile to get this bill passed. Sen. Figures’bill prohibiting smoking in public places (SB130) clearedcommittee in the Senate, but was voted down twice in theupper body. It made no progress at all in the House. Wewere pleased that the School Nurse Bill (HB47/SB186) byRep. (Dr.) Bentley did pass this year. This bill establishesa maximum of 5 LPNs to 1 RN supervisor in the schoolsystem; establishes an RN consultant in each district tooversee the school nurse program and report directly to theSuperintendent; and establishes a state consultant.The introduction by Sen. Coleman this session of theNPAA Nurse Practitioners bill (SB483) to improve practiceprivileges marked a major milestone. This bill wouldeliminate the requirement for a written CollaborativeAgreement between nurse practitioners and physicians;set the Board of Nursing as the sole regulatory authorityfor NPs; restructure the current Joint Committee (ABNand BME) by retaining physicians in an advisory capacityonly; declare NPs as Primary Care Providers and includethem in direct reimbursement; and extend NP prescriptiveauthority to Class II-V. While very little progress throughthe system was made amid heavy opposition by MASA,this important issue has now been put on the table forfuture debate and action. The core issue is access toquality health care for Alabamians, especially those inunderserved or rural communities. Nurse Practitionerscan definitely fill this need. And the fact is that fewer andfewer physicians opt for primary care fields, preferring tospecialize. This leaves an increasingly larger hole to fillin primary care providers. Because Alabama is arguablythe most restrictive state in the union for NP practice, weabsolutely must turn that around if all Alabamians are tohave access to care. In addition, by taking that route thepossibility of substantial cost savings to programs such asMedicaid are clearly evident. While this fight has only justbegun, we believe that it is a fight we will eventually win,if for no other reason than the facts on the ground willdemand it.Our 2009 Elizabeth A. Morris Clinical EducationSession–FACES on 21 April at the Eastmont BaptistChurch in Montgomery was another huge success. We sawanother 600 nurses/nursing students in attendance, witha terrific lineup of speakers and educational tracks. Thelineup included NCLEX prep for students, three differentclinical tracks, a research track, geriatrics, pediatrics,women’s health and parish nursing. A wonderful lunchwas available at the church as well. The folks in attendancereally enjoyed the day. If you missed it, you’ll get anotherchance next spring. Keep an eye out for the announcementsin The Alabama Nurse and on our website at www.alabamanurses.org.Finally, ASNA has recently completed work on aninformational/recruiting DVD. Our President, Dr. DebbieFaulk of AUM took the lead in the development of thisinnovative idea, and many of our members played a part.We hope to field the finished edition by June at the latest.We look forward to sharing it with all nurses in the state.Dates to Remember:ASNA State Convention1-3 October 2009Marriot Shoals HotelFlorence, ALFACES 2010Spring 2010MontgomeryNurses at the Capitol Rally21 January 2010MontgomeryASNA State Convention30 Sep-2 Oct 2010Riverview Plaza HotelMobile, AL

June, July, August 2009The Alabama Nurse Page 5Legal Cornerby Don Eddins, BS, MS, JDASNA AttorneyAs attorney for the AlabamaState Nurses Association, Ibecome aware all too often ofnurse licensure disciplinaries thatcould have been avoided had thenurse simply used good commonsense.The state’s registered andlicensed practical nurses generallyknow the rules and regulationspromulgated under the AlabamaNurse Practice Act. Sometimesthey just fail to follow them.EddinsTaketheissueofdocumentation. Nurses know that they must record that theyhave performed a particular task, such as administering aphysician-prescribed drug when a patient is due medication.That type documentation is elementary, but sometimesnurses take short-cuts that can have disastrous results. They“pre-chart” that a particular medicine has been given at aparticular time–several hours in advance.What if the patient goes home that day? Or has to berushed from the nursing home to the hospital? What if thenurse takes ill and has to go home?LPN CornerThe Nursing ShortageWho Are We TalkingAbout?by Gregory Howard, LPNFor my entire nursing career,which spans more than 25 years,I can remember the emotionalroller coaster of either too manyor not enough nurses. And oncein a while the issue seemednot to exist. The newspapers,magazines and media have giventheir view on this reoccurringproblem. And now I would liketo share my perspective on thisdilemma.HowardIt is not always clear whetherthe reports are biased, or that thepeople reporting assume that everyone is on the same pagewhen we use the term nurses. There are levels of nursesand it would be helpful to use their name so that everyoneis clear on what’s needed. Because the literature onlyaddresses the Registered Nurse, readers may think thatis the only level of nurse we are short of. So my questionwould be, do we need Nurse Practitioners, AssociateDegree or Licensed Practical Nurses?What is very clear is that we have a shortage ofqualified Nursing Instructors and Clinical sites to meet theneeds of our current pool of students.Historically nursing facilities have used creativesolutions as a quick fix / band aide for our nursing shortagewhich included: encouraging current employees at medicalcenters etc. to enter the field of nursing, asking nurses toadvance to the next level in their nursing career, recruitingForeign Nurses, to creating an unlicensed health careworker to perform nursing tasks. Facilities have done thiswith their” pocket books open and the money showing”.In my web search / goggle search, which was limited,should I assume that the only shortage of nurses is theRegistered Nurse? Because this is the only level of nursethat’s referenced, does this mean there are enough of theother levels of nurses?The positive aspect of the nursing shortage is that thejob outlook is very bright. And it’s likely a job is awaitingthe graduates. I feel the shortage will continue to exist andincrease with the coming of age of the Baby Boomers andfuture generations that will saturate the health care market.Until all parties get together to address strategies andformulate partnerships to eliminate this ongoing supplyand demand dilemma, we will continue to have what wehave always had, a nursing shortage.In those cases, the nurse has signed documentationindicating that a drug has been administered, but in realityit has not. Where does that leave the nurse on the next shift,who unbeknownst to her is dealing with erroneous records?Pre-charting is something that can get a nurse into troublewith the Alabama Board of Nursing.What if correction on the nursing notes is necessary, due toa mistake or change in circumstances? Of course, correctionsare permissible, as long as they are done in the correctmanner. Nurses should attempt to make any corrections onthe shift for which the care was given, rather than days later.And if a nurse draws two controlled substance tablets, butonly gives one during the shift, then the notes should reflectwhat happened to the second pill. Of course, normally itwould be wasted in the presence of a witness.And registered nurses, advanced practice nurses inparticular, should never depend upon a national credentialingagency to get paperwork to the Board of Nursing showing thatnecessary courses have been completed.The agencies may do the reporting properly, but theadvanced practice nurse should check to ensure that thepaperwork got there anyway. I am aware of several casesin which nurse practitioners have relied upon a nationalcredentialing agency to get the paperwork to the Board (evenpaid the agency a fee) only to learn that the Board had nonotice that the credentialing had been completed.Good registered nurses know these things. They shouldnever get lax and should always follow good common sensepractices to stay out of trouble with the Board of Nursing.Numerous nurses have told me that the people at theBoard seemed to have little sympathy for their unintentionalmistakes. That’s my experience with the Board staff as well,so it behooves us to be especially diligent in ensuring that therules are followed.The good news is that if you’re a member of the AlabamaState Nurses Association, you always have a friend inyour corner. You can always contact ASNA and ask theprofessionals for advice and help.In fact, if you do get a disciplinary notice from the Board(and if you are a current member), the ASNA attorney willaccompany you through any necessary negotiation processand hearing.So if you’ve not joined ASNA yet, now would be a goodtime to do it.CE Corner

Page 6 The Alabama NurseJune, July, August 2009CE CornerSchizophreniaAuthored by: Charlene Roberson, Med, RN, BC.Director of Leadership Services, ASNA and Psych/Mental Assessment Coordinator at Baptist Medical Center,Montgomery, Alabama.Objectives: At the conclusion of this activity the learnershould be able to:1. Contrast various system clusters for schizophrenia.2. List at least 5 types of schizophrenia.3. Describe the disease course.4. Examine nursing management interventions.Directions: Read the article carefully. Return theevaluation form and answer sheet printed at the end of thearticle and complete all sections. Mail to the address providedwith the appropriate fee. A Continuing Education Certificateof Completion will be sent to you upon successful completionof both the post-test and the evaluation form. You mustscore at least 80% to pass. Should you fail the test you willbe notified and offered the opportunity to retake the test. Allretakes will require an additional 5.00 fee.Contact Hours: This 2.08 contact hours (60 minutesequal 1.0 contact hour) or 2.5 contact hours (50 minutesequal 1.0 contact hour)Accreditation: The Alabama State Nurses Associationis an accredited provider of continuing nursing education bythe American Nurses Credentialing Center’s Commission onAccreditationAlabama Board of Nursing (valid through March 30,2013). Approval of this activity expires May 11, 2010.Schizophrenia is best described as a chronic/reoccurringpsychosis coupled with long-term deterioration of functionalcapacity. The disease is fairly common worldwide with anincidence of about one out of every 100 people. There is norelationship among ethnic groups or geographic locations.The actual diagnosis is usually made in young adulthood. Butbefore this diagnosis is made, those around individuals withSchizophrenia notice a withdrawal from reality, disorganizedand regressive behavior, impaired communication andinterpersonal relationships, and acute psychotic episodes.Often a complete personal history reveals subtle functionalimpairments noted at an early age. Many times these subtleimpairments are overlooked or ignored. Those close to theclient say things like, “She has always been a little odd” or“He never was a good student in school”. Examples of thesubtle impairments include communication difficulties,social ineptitude, poor school function, blunted, and/orinappropriate (odd) behaviors. It is important to note thatthis cluster of symptoms is not a precursor to Schizophrenia.Not all children who exhibit these behaviors go on to bediagnosed as a Schizophrenic. For many years the literaturehas stated that Schizophrenics are from lower socioeconomiclevels. In reality they do make up greater numbers of

Montgomery, AL 36104 2009 ASNA Awards Any ASNA member, group or staff may submit nominations. The awards are as follows: Lillian B. Smith Award . Day for Troy University School of Nursing. The theme was focused on healthy behaviors. Using the American Nurses Association's slogan for National Nurses Week .