November 2018 • Volume 27 • Number 4 Nevada …

[Pages:20]November 2018 ? Volume 27 ? Number 4



Nevada

RNFORMATION

Inside

articles

2 Changes to NNA Website! 4 Nevada State Board of

Nursing FAQs 5 Nurses in the News 5 Incivility, Bullying, and Workplace

Violence 6 NNA Environmental Health 8 NNA District 1 Report 8 The Rise of Men in Nursing 9 Research & EBP Corner 10 Antibiotic Stewardship 12 Creating and Implementing a

Veteran to BSN Pathway 13 Honoring our Veterans 14 Healthcare in the Hapi Isles 16 Legislative Update 18 Dragon vs. Snake

regular features

3 The President's Corner 19 NNA Membership Application

THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION The Nevada Nurses Association is a constituent member of the American Nurses Association Quarterly publication direct mailed to approximately 37,000 Registered Nurses and Licensed Practical Nurses in Nevada

Nurses Day at the Legislature - 2/26/19 Advocacy: The Power of Nursing

Page 3

Animal Bites: Risk, Care & Reporting

Page 6

Honoring our Veterans ? Read about Lee Springer who spent time on the Guadalcanal in 1943-1944.

Page 13

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? February 26, 2019: Nurses Day at the Legislature

Page 2 ? Nevada RNformation

Have you visited the NNA Job Board recently?

Visit our website and click on the Job Board tab to view many available Nevada nursing jobs. If you want to receive email notice when a new job is added, join our Job Board

mailing list! Just send your email address by text message:

Text NNAJOBBOARD to 22828 to get started or email nnajobs@.

If you have a job to advertise, contact Ian at nnajobs@. Our rates are reasonable and

money raised helps to benefit Nevada nursing.

Changes to NNA Website!

The NNA Website team is pleased to announce that the NNA website has undergone a transformation. It has been revised and refreshed. We hope that you will find it easier to navigate when researching information. The website is hosted on a new platform, and as a result, will have a slightly different look. Please take a moment to explore the site. The web team is looking for volunteers to assist with updating and revising the website, as the goal is to provide members with relevant information in a timely manner. This will take the work of a few dedicated volunteers. If you have website experience and would like to join the team, please contact, Linda Bowman at lbowman@.

November, December 2018, January 2019

NNA Mission Statement

The Nevada Nurses Association promotes professional nursing practice through continuing education, community service, nursing leadership, and legislative activities to advocate for improved health and high quality health care for citizens of Nevada.

NNA State Board of Directors

Dave Tyrell, BSN, RN davetyrellrn@ . . . . . . . . . . . . . . . . President Donna Miller, RN donnagmiller@ . . . . . . . . . . . . . Vice-President Nicola Aaker, MSN, MPH, RN, CNOR, PHCNS-BC naaker@.. . Treasurer Rochelle Walsh, DNP, RN rochelleh@unr.edu. . . . . . . . . . . . . . . . . . Secretary Heidi Johnston, MSN, RN, CNE heidi.johnston@gbcnv.edu. . . Director at Large Amie Ruckman, MSN, RN, amieruckman@ . . . . . . Director at Large Peggy Lee, BSN, RN lee.peggy4423@. . . . . . . . . . Director at Large Darlene Bujold, MSN, RN, boomernurse@. . . . . President, District 1 Ruth Politi, PhD, RN, healthccr@ . . . . . . . . . . . President, District 3 Carol Swanson, DNP, RN swansonc89705@. . . . . . . Legislative Chair

Editorial Board

Managing Editor, Linda Bowman, RN

Print Editor, Kathy Ryan, MSN, RN-BC

Layout Editor, Margaret Curley, BSN, RN

John Buehler Garcia, RN, BSN Eliza J. Fountain, RN, BSN Wallace J. Henkelman, Ed.D, MSN, RN Tracey Long PhD, RN, MS, CDE, CNE, CCRN Mary Baker Mackenzie, MSN, RN John Malek, PhD, MSN, FNP-C Lisa Pacheco, MSN, RN

Betty Razor, RN, BSN, CWOCN Denise Rowe, MSN, RN, FNP-C Debra Toney, PhD, RN Christy Apple Johnson, BSN, RN Val Wedler, MSN, RN Bernadette Longo, PhD, RN, FAAN

Are you interested in submitting an article for publication in RNFormation? Please send it in a Word document to us at lbowman@. Our Editorial Board will review the article and notify you whether it has been accepted for publication. Articles for our next edition are due by January 1, 2019.

If you wish to contact the author of an article published in RNFormation, please email us and we will be happy to forward your comments.



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November, December 2018, January 2019

The President's Corner

Dave Tyrell, BSN, RN President, Nevada Nurses Association (2016-2018)

As I prepare to hand over the leadership reigns of the Nevada Nurses Association I am reminded of one of my favorite quotes;

"Service to others is the rent you pay for your room here on earth." Muhammad Ali

It has been my greatest honor these past two years to serve the nurses of Nevada as president of NNA. I look forward to continuing to be an active member of NNA by finding a place at the table and staying off of the menu.

I owe a great deal of gratitude to District 1, District 3 and the State Board members for all of their selfless dedication to building and supporting NNA towards being a meaningful and influential nurses organization here in Nevada and across the nation. In addition, my deepest gratitude and respect go out to Margaret Curley, retiring Executive Director for NNA. Without her dedication and full commitment NNA would not be the vibrant, growing organization that it is today.

Thank you all for putting your faith and trust in me to lead this organization over the past two years and always remember, if you're not at the table, you will probably be on the menu.

See you at the table, Dave

Nevada RNformation ? Page 3

Page 4 ? Nevada RNformation

November, December 2018, January 2019

Nevada Nurse Portal Frequently Asked Questions

The following information was provided by the Nevada State Board of Nursing. For more information, please contact: nursingboard@nsbn.state.nv.us or call 888-590-6726.

Can I come in to the office to submit a paper application and payment?

No, all applications must be submitted via the Nevada Nurse Portal.

When should I create my account? Initial applicants must create their account to apply for licensure.

Renewal applicants are encouraged to create their account well before their renewal date to ensure that the renewal application is received prior to expiration. You can renew up to 60 days prior to your license/ certificate expiration.

I didn't get the verification email? The verification email is valid for 24 hours only. If it has been over

24 hours you must begin the process again. If it is within 24 hours please check your spam, junk and trash folders in your email. Many work/school email addresses have privacy settings that will not allow the verification email to be received. You are strongly encouraged to use a personal email address that you will have continuous access to and check regularly. If you are using a personal email address and have checked all your folders, you can click into the Nurse Portal and request to "Resend Verification Email". If you have completed all these steps and still have not received your verification email, please contact the Board at 888-590-6726 for additional assistance.

I received "The profile information is associated to an existing license" message when I tried to create my account

This message appears when you have or have had a license/ certificate with Nevada and you did not select "yes" to the question "Do you or have you ever held a license/certificate with the Nevada State Board of Nursing." You must click cancel, restart the registration processes and answer that question correctly. It is recommended that when you are completing this process that you search for your information by your license/certificate number.

I received a "Finger Print value is not valid" error when making the payment.

If you received the above error while attempting to submit your payment the payment processor has denied your transaction for mismatched information. The error could be that your address does not match the address you have with your credit card provider or the account number and/or security code are incorrect. You must close

your browser, return to your nurse portal account and click on "make payment" again.

Can I submit my application on my mobile device? No, the Nevada Nurse Portal only works on a laptop or desktop and

it works best in Internet Explorer 11.

My payment was processed but my application was not submitted.

If you did not click on "continue" after your payment was approved your application was not submitted. You will need to contact the Board office at 888-590-6726 and speak to accounting to confirm that your payment was received. Once your payment is confirmed staff will direct you how to submit your application without being required to remit payment again.

Do I need to request a fingerprint card? If you are fingerprinting in Nevada, you are strongly encouraged to

submit your fingerprints via electronic submission and will not need a fingerprint card from the Board. A list of fingerprinting locations can be found on our website under important links. If you are fingerprinting in another state, you can request that a fingerprint card be mailed to you during the application process.

I am submitting my renewal application but the education in my account is incorrect.

Please send a copy of your nursing diploma or transcripts via the message center. Once we received the required documentation staff will correct your account. You may continue your renewal application prior to the information being updated.

I have been selected to fingerprint on renewal, but I have already fingerprinted within the previous 5 years.

Please send a message to the Board via the message center asking that your account be reviewed to determine if you must fingerprint. Once staff confirms that you have fingerprinted within the previous five years your account will be updated and if all other requirements are met you will be given a full renewal.

Why do I have to add my employment information for my renewal?

Employment information is gathered for statistical purposes only. The information in this step is not related to your requirements for renewal or your renewal application. The information gathered is used for workforce studies which are critical to evaluating and ensuring a safe and effective nursing system.

Can I get a copy of my license/certificate? The Board of Nursing does not issue hard card licenses/certificates.

You can verify your license/certificate status in your Nevada Nurse Portal account or through the online verification system. You can print a report of your licensure/certificate status from the online verification system.

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November, December 2018, January 2019

Nurses in the News

Nevada RNformation ? Page 5

Incivility, Bullying, and Workplace Violence

By Tracey Long PhD, RN

Nurses continue to stay in the news. One nurse at a time can bring about healing and compassion, but when nurses band together they can change a community, culture and even legislation. Led by the Massachusetts Nurses Association President Donna KellyWilliams, nurses banded together to create and lobby for a proposal to impose nurse staffing requirements at hospitals. Voters will decide on the law to limit nurse to patient ratios for departments and specialty units. Spokeswoman Kate Norton for the Committee to Ensure Safe Patient Care said, "It's crazy to think that there are no limits on the number of patients that managers can assign to a nurse at one time, and the negative consequences are so clear." Like any ballot issue, there are two sides to the issue and hospitals claim that by mandating a firm nurse to patient ratio, there will be a nursing shortage of 6,000 beyond what already exists, which will cost the hospital industry almost $1 million annually. Spokesperson for the hospital coalition Dance Cense stated, "Nurses know that providing great care is not as simple as a rigid ratio, and that staffing must be based on the dynamic needs of each individual patient." This November Massachusetts could lead the nation in establishing a legal precedence, but regardless of the outcome, the conversation about appropriate nurse to patient ratios is becoming visible to the general public.

School is in, and bullying is out, or so hope school faculty and staff. Positive "Be Kind" campaigns are promising for children, but what about bullying education for nurses? International attention was given after a Welsh nurse committed suicide in March 2018 after declaring she had been bullied at work and given the worst patient and shift assignments. Rhian Collins, was known to have been "run down and exhausted and was being sworn at and bullied" in the weeks before she died, according to investigator reports. A new study looking at the impact of aggression in the workplace correlates violence and bullying at work with reciprocal bad behavior

towards others, which is no excuse for nurses. Bullying within nursing is defined as "repeated, offensive, abusive, intimidating, or insulting behaviors and abuse of power" and has no place in nursing. In a 2012 study, as high as 65% of nurses at a large medical center said they frequently observed horizontal bullying behaviors among coworkers, which caused 70% of victims to leave their jobs, creating a further nursing shortage and financial burden of rehiring and training to start the cycle anew of "nurses eating their young." The first step in breaking the cycle is recognizing and admitting there is a problem, and it may even be you. Having a zero-tolerance policy, like many public schools, requires managers to step up and create a kinder culture on their units. Individual kindness and patience with coworkers and even patients begins with you on your next shift. Go to American Nurses Association's recent campaign to end bullying and violence in the workplace for more information and strategies.

A picture of 150 nurses and hospital staff standing in a line extending down a long hospital corridor honoring an organ donor went viral in August 2018. When a simple dinner turned to a respiratory arrest from choking, Cletus Schneider III became an organ donor that saved three lives and helped 50 other people needing a donor's tissues. The Facebook post from his wife with the picture brought national attention to the important need for organ donation. Currently over 114,000 people are on an organ transplant waiting list and one person is added to the competitive list every 10 minutes. Nurses can help teach the general public of the simple method of registering as an organ donor when they register at the local DMV. To learn more about organ donation, visit .

References Center for American Nurses. Position Statement:

Lateral violence and bullying in the workplace. 2008. Townsend, T (2012) Break the bullying cycle. American Nurse Today. Jan (7) No. 1. Retrieved 24 August 2018 from . break-the-bullyingcycle/

Beth A. Hock RN, BSN, MSA, NE-BC, FACHE Chairperson for the Incivility & Anti-Bullying

Committee for NNA

The Nevada Nurses Association believes that every nurse deserves to work in a civil and respectful environment. The NNA Incivility, AntiBullying, and Workplace Violence committee has been providing education and awareness for the nurses of Nevada for the past many years.

Too often lateral violence and bullying in the workplace leads to an unprofessional stressful culture in the workplace. This negatively impacts nurses and their delivery of quality of care for their patients, who entrust their recovery in our hands.

NNA is committed to preventing and reducing lateral violence among and toward nurses. The committee launched an "Incivility, Anti-Bullying, and Lateral/Vertical Violence," survey September 1, 2018. The survey is evaluating our current state on this topic. The committee wants to hear from you and understand your needs. The survey results will be used by the committee to develop a plan of action to better serve our nursing professional colleagues.

We are committed to addressing the issues around incivility, bullying, and workplace violence with education, developing a tool box with policy templates and codes of professional practice, skill development education on "How to speak up," and finally, how do you investigate and address an allegation without it being a punitive event?

So, we ask you, will you take the survey? We encourage you to take the anonymous survey and let us know your reality.

Stay tuned as we review the result and share the committee's action plan to address this very important topic.

Committee members include: Bernie Longo, Peggy Drussel, Darlene Bujold, Nancy Brewster-Meredith, Lori Candela, Sandy Olguin, Salli Vannucci, Margaret Curley, Susan Growe, Amy Pang, Judith Elkins, and Chairperson-Beth Hock.

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November, December 2018, January 2019

NNA Environmental Health Committee

Animal Bites: Risk, Care & Reporting

By Bernadette M. Longo, PhD, RN, FAAN & Dustin Boothe, MPH

Human-Animal Interaction The bond between humans and their

animals has stood the test of time because it is mutually healing. For many, the pet is part of the family system - worthy of giving and receiving love. In the United States, humans and animals interact on a daily basis through contact with pets, farm animals, rodents, to occasional contact with wild animals. Therefore, it's not surprising that animal bites are indeed common. Domestic dogs are the most predominant mammal to bite humans accounting for 80-90% of total bites, followed by cats (5-15%) and the third most common are pet ferrets. An average of 4.5 million Americans are bitten by dogs each year with nearly 885,000 seeking medical care. In addition, there are annually about 400,000 cat bites with roughly 66,000 emergency department visits. Moreover, an estimated 27,000 plastic surgery repairs occur from dog bites each year.

Figure 1. The human-animal bond. Animals often bite in response to being

afraid, hurt or ill. Humans can also be injured unintentionally from pets when they break

open skin while scratching or nipping during play. Most of these wounds are minor injuries and go unreported because patients selfadminister first aid and often do not seek medical attention. Types of wounds from animal bites range from abrasions, lacerations, punctures, and additional injuries from mauling (avulsion, crush, fracture, dislocation, or amputation). Infection with bacteria can manifest as an acute, intense, localized inflammatory response. If left untreated, it can progress to severe sequelae, including sepsis. Latent sequelae from an animal bite can include disfigurement, functional disability, and mental health and infectious complications.

Various injuries occur from different mammalian bites. Dogs have strong jaws and blunt broad teeth that together cause injury by crushing and shearing resulting in significant soft tissue damage. Cats can both intensely bite and scratch resulting in fine puncture wounds that can entrap bacteria and mild-to-deep lacerations. A cat's teeth can efficiently inoculate pathogens into small joints, deep spaces, or tendon sheaths of the hand. These wounds appear initially benign but then develop hidden infection. A ferret's teeth are also small and sharp, and their style of attack is rapid fire bites. It is common to have to pry the ferret from their victim.

In addition to care for puncture wounds and lacerations, the major concern is infection. Bacteria in bite wounds reflects the oral flora of the biting animal, both their own normal flora and that of their food source including ingested prey. In a few cases, pathogenic bacteria can come from a victim's own skin or from the physical environment at the time of the injury. Dog bite wounds are polymicrobial, with a broad combination of aerobic and anaerobic microorganisms. The most common aerobic bacteria genera isolated in dog bite wounds are Pasteurella, Streptococcus, Staphylococcus and Neisseria, whereas the most common anaerobic bacteria include Fusobacterium, Porphyromonas, Prevotella, and Propionibacterium. Pure anaerobic bacterial growth is rare in dog bites and is almost always accompanied by aerobic organisms. Cat-bite wounds have similar microbiology for infections with additional concerns. Cats are the main reservoir of Bartonella henselae, the causative agent of cat scratch disease. Cat bites have also been associated with transmission of Francisella tularensis resulting in tularemia.

The most notorious infection transmitted through animal bites is rabies, which is usually always lethal without appropriate and timely postexposure treatment. Sadly, about 59,000 people die of rabies every year around the world, primarily from infected dog bites. Although rabies infection is rare, it occurs in the United States with only about 1 or 2 cases per year in people who fail to seek medical assistance, usually because they were unaware of their exposure. According to the U.S. Centers for Disease Control (CDC), properly administered postexposure prophylaxis has proven nearly 100% successful. Because of the severity of the disease, and the public health implications for transmission, laws are in place for the reporting of animal bites.

Vulnerable Populations Children

The largest percentage of victims of dog bites are children. Boys are more likely to receive a dog bite than girls. The risk of injury to the head and neck is greater in children than in adults, adding to increased severity with a necessity for medical treatment, and higher death rates. Many children are emotionally traumatized by an animal bite and need timely professional mental health care.

Chronic Conditions including Persons with Diabetes

Patients with chronic conditions that may affect the immune system, such as alcohol or drug dependency, asplenia, rheumatoid arthritis and diabetes mellitus, have a higher risk for developing infections from animal bites. Patients with peripheral circulatory disorders, such as diabetic peripheral neuropathy, are particularly vulnerable because the scratch or bite may go unnoticed or ignored leading to delayed presentations for care and complications.

Pets Transmission of rabies and other infections

from one infected animal to another animal can occur from bites, scratches and bodily fluid exchange (e.g. saliva) between the animals. According to the CDC "Any animal bitten or scratched by either a wild, carnivorous mammal or a bat that is not available for testing should be regarded as having been exposed to rabies."

International Travelers According to the World Health Organization,

dog bites account for more than 50% of animal-related injuries in people who are travelling. The second most common bite injury to tourists is from monkeys!

Nursing Care General Medical Care

First aid for an animal bite includes controlling the bleeding, cleansing, covering and elevating the wound. Also, identifying and having access to the animal incase quarantine and testing is indicated. Medical care for the victim is recommended. If the presenting patient is unstable, priority is to maintain airway, breathing, and circulation by managing any profuse bleeding from a wound or amputation. General nursing care

November, December 2018, January 2019

Nevada RNformation ? Page 7

NNA Environmental Health Committee

of most animal bite wounds begins with emotional support to the victim, obtaining a detailed account of the incident, description of the wound, proper localized care of the wound, followed by possible administration of a tetanus toxoid booster, and discharge education for any prophylaxis antibiotics and signs of developing infection. The bite wound should be washed vigorously and irrigated with water, normal saline, or dilute povidone-iodine solution for adequate cleaning to reduce inoculation of the oral flora from the biting animal (check your agency's protocol). Medical examination will determine if debridement or closure/suturing of the wound is indicated. Closure should only be considered in wounds that are well cleansed. Bite wounds with a delay in presentation of over 8-12 hours, or in immunocompromised victims, generally are left open or have a delayed closure. Examination is also indicated for neurological injuries that could lead to functional disability and disfigurement. Diagnostic X-rays often indicated for patients with bone or joint involvement. Moreover, gram stain and wound cultures are not indicated for every bite; however, cultures are helpful in diagnosing and treating infection during follow-up care. Inpatient admission is rare (50% of dog bites occur on the head and

neck. Facial wounds have a low risk of infection even when closed primarily due to their increased blood supply.

Emotional Supportive Care Animal bites affect patients physically and emotionally. It is common

for them to have anxiety, fears and even nightmares after an animal attack. Research has found that most children display emotional signs and symptoms (acute stress reaction, depression, anxiety) within days following a significant mutilating injury. Like other traumas, parents may not recognize the emotional distress signs in their children. Therefore, it is imperative to include assessment and if necessary referral for mental health counseling for victims of animal bites, regardless of their age.

Animal Bites in Nevada In Nevada, (NRS 441A.120) the definition of "animal bite" means

breaking of the skin by the teeth of an animal. Between 2015-2017, there were 4,554 reported animal bites from rabies-susceptible animals in Nevada excluding Clark County (data were unavailable). The most reported number of animal bites came from healthcare practitioners in Washoe County and Carson City, with the lowest number reported from the rural Nevada counties of Lincoln, Mineral and Storey.

Bats are the primary reservoir for rabies in Nevada. Data from testing bats in Washoe County during 1998-2012 found that 12-18% of the bats were positive for rabies. Infected bats may not show any signs of rabies, so infection can only be confirmed in a laboratory. Rabid bats may act erratic due to disorientation and difficulty flying. Nationally, the CDC reports that the number of rabid bats is increasing.

Reporting is our Duty Despite current Nevada law

and the public health impact of animal bites these injuries are underreported. In Nevada, by law, all animal-to-human bites from a rabies-susceptible animal must be reported. In Nevada Administrative Code 441A.225 "report of animal rabies or an animal bite by a rabies-susceptible animal must be made to the health authority or to the rabies control authority, if designated by the health authority, within 24 hours after identifying the case. The report must be made by telephone if it is made during the regular business hours of the health authority or rabies control authority, as applicable, or using the after-hours reporting system if the report is made at any other time." NAC 441A.155 defines a rabies-susceptible animal as "any mammal, including, but not limited to, a bat, cat, dog, cow, horse, ferret, cougar, coyote, fox, skunk and raccoon, and any wild or exotic carnivorous mammal."

Nurses can play a key role in assuring that animal bites are reported to public health authorities and follow county-specific protocols that may also include notifying animal-control authorities. We can't know the extent of the problem if it is not reported and tracked. Nurses can advocate for animal-bite victims and the public at large.

References & Resources Clark County Animal Control:

services/animal-control/Pages/faq.aspx Southern Nevada Health District: .

org/health-topics/rabies.php EPI News from Washoe County:

ephp/epi-news/2013/vol-33-no-15-08-02-13-animal-bite-reporting-andrabies-post-exposure-prophylaxis.pdf W.H.O. Animal Bites: animal-bites U.S. Centers for Disease Control: Lyu C, Jewell M, Kuo T, et al. Burden of Bites by Dogs and Other Animals in Los Angeles County, California, 2009-2011. Public Health Reports [serial online]. November 2016;131(6):800-808. Golinko M, Arslanian B, Williams J. Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution. Clinical Pediatrics [serial online]. April 2017;56(4):316-325. Rasmussen D, Landon A, Powell J, Brown G. Evaluating and treating mammalian bites. JAAPA: Journal of The American Academy of Physician Assistants (Lippincott Williams & Wilkins) [serial online]. March 2017;30(3):32-36. Abrahamian FM, Goldstein EJ. Microbiology of Animal Bite Wound Infections. Clinical Microbiology Reviews Apr 2011, 24 (2) 231-246. Howell RD, Sapienza A. The management of domestic animal bites to the hand. Bulletin of the NYU Hospital for Joint Diseases. 73.2 (Apr. 2015): p156.

The Authors Bernadette M. Longo, Ph.D., RN, APHN-BC, CNL, FAAN Chair of NNA's Environmental Health Committee Emerita Professor at the Orvis School of Nursing, UNR

Dustin Boothe, MPH, REHS Division Manager and Epidemiologist Carson City Health and Human Services

Page 8 ? Nevada RNformation

NNA District 1: Continues

to Provide Educational

and Networking

Opportunities to its

Members.

Darlene C. Bujold BSN, RN, MSHI NNA District 1 President

It's been an active time for District one members. On August 2nd, a breakfast meeting was held in Reno at the Black Bear Diner where attendees were presented with an enlightening discourse on the strides being made in diabetes management. Dr. Jean Lyon, PhD, APRN and nurse educator presented this topic.

The Rural Health Symposium hosted by the NNA Rural Nursing Committee was held on August 18, 2018. Heartfelt thanks go out to Heidi Johnson, DNP and all those who participated in planning and organizing a successful CEU event. Heidi was able to secure the campus theater at Great Basin College in Elko, which provided attendees with a perfect venue.

The day began with a riveting presentation from Dr. Terry Kerns, who is the current substance abuse/law enforcement coordinator for the NV Attorney General's Office. She spoke on the topic of the opioid crisis as a public health emergency, and how it impacts our practice. Attendees were also provided with a train-the-trainer's course on the "Stop the Bleed" initiative by an American Medical Response (AMR) team from Flying ICU, of Las Vegas.

Dr. Scott Lamprecht, DNP, APRN engaged, entertained and educated the crowd on the topics of Sepsis and Sudden Cardiac Arrest in the pediatric population. Disaster management and preparedness were discussed by both Chris Lake from the Nevada Hospital Association relating to the Las Vegas shooting tragedy, and Danel Lipparelly, LSW from the Red Cross, who shared her experiences in "Psychological 1st Aid/Stress Management" after disasters. Dr. Julie Wagner, PhD, MSN, RN was able to instruct attendees on "Starting the Conversation: End of Life Discussion, Understanding Care Options and Nevada POLST." SANE Nurse Norah Lusk, BSN, RN provided an impactful discussion and provided the opportunity for members to "Take the Pledge" to "Start by Believing" (when someone reports they were raped or sexually assaulted).

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November, December 2018, January 2019

The Rise of Men in Nursing

By Tracey Long PhD, RN, MS, CDE, CNE, CCRN

"Patients basically think I'm the doctor, just because I'm male" stated one male nurse who admittedly wasn't too concerned about the upgrade in perceived title. Male nurses represent approximately 10% of the nursing workforce in the United States, according to the American Nurses Association. This number has tripled since 1970, when nurses were traditionally all women and some nursing schools actually refused to admit men. The rise of men in nursing has begun.

Men became more attracted to nursing in the past decade during the national recession for several reasons, including the persistent nursing shortage and competitive salaries, flexible working conditions, and expanding job opportunities. In a 2011 report by the U.S. Census Bureau, 78% of employed nurses were Registered Nurses, 19% were LPNs, 3% were nurse practitioners and 1% were nurse anesthetists. Forty-one percent of nurse anesthetists were male and earned $163,000/year. The general salary range for a Registered Nurse in the United States is approximately $61,000/year. The majority of male nurses become Registered Nurses and move into specialty areas such as critical care or management.

Approximately 12% of Nevada's nurses are men, ranking in the top five states with the highest percent of male nurses, according to the Kaiser Family Foundation. Nursing schools are also seeing a rise in male admissions to nursing school, which has climbed from 2% in 1975 to 11% in 2018, according to Roseman College admissions.

Helpful insights for female nurses about men in nursing come from a series of questions asked to a male nursing student, a male nurse in the emergency room (ER), and a high-level male nurse executive.

What is the biggest challenge of being a man in nursing? Nursing student: The stigma from a female dominated industry, and the idea that I may not have what it takes or not be smart enough to accomplish what women have done extremely well since the beginning of nursing. ER Nurse: I wanted to work in the ER as a nurse after I had been a paramedic for many years. I wanted more challenging skills and that was nursing. Nurse Executive: I liked the potential for flexibility and opportunity in the medical field without having to go to years of medical school.

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What is the best thing about being a man in nursing? Nursing student: Relating to other men. I feel that some female nurses don't truly empathize with male patients. Men are the biggest babies when they're sick and I feel their insecurities play a huge part in how male patients act. The role reversal can be taxing on the caregiver regardless of gender. ER Nurse: A male nurse can demonstrate both caring and compassion like women, but when it comes to brute strength with patients, it's always good to have a man around! I like being a part of the pioneering spirit of changing the face of nursing. Nurse Executive: I have my doctorate, so I can be a Doctor Nurse. I actually married a female doctor, and everyone thinks I'm the medical doctor and she's the nurse. I love the irony.

How is nursing different due to more men now in nursing? Nursing student: I feel that nursing needs men just as the workforce needs women. Diversity isn't such a bad thing when it remains unbiased. ER Nurse: Men add different insights and ways of thinking in emergency situations and medicine and when combined with the way women think, the team is stronger. I'll always be grateful for working with such talented and smart women in nursing. They've taught me a lot. Nurse Executive: Men add a new dimension to the field of nursing because we think differently and that can be helpful in discussing new ways of doing things.

What advice do you have for men in nursing? Nursing student: Some older female nurses will dismiss you based on your gender. Keep that in mind and focus on what you need to accomplish. Remember that you're not there to please other nurses, you're there to care for people (not patients, people). ER Nurse: Come join the party because we need more men in nursing. It's a great profession and you get to work with a lot of great women. Nurse Executive: Don't be afraid of being around so many smart and beautiful women!

What do you wish women knew about male nurses? Student Nurse: Don't be so quick to judge or stereotype us. Not all male nurses are gay or trying to sleep with you or are in this profession for the money. Most of us have decided to join such a diverse profession because we either have a healing gift or because of the longevity of a career as a nurse. There are so many options and still more roads being paved. We are not more or less qualified, but we are equals here to assist in offering a different approach or perspective to the field of nursing. ER Nurse: We're not all jerks. Just because we're men, we can still be compassionate and tender with patients. Nursing is a good fit for the modern male who isn't afraid to show that side. It's also a great blend of science and technology in a human profession. We didn't choose nursing because we couldn't get into medical school. Nurse Executive: Even though women and men should be paid the same for the same work, recognize that we have different inherent talents. Be your best selves and we'll all be stronger together.

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