Utah Nurse

Utah Nurse: The Official Publication of the Utah Nurses Association. Utah Nurse has been published quarterly since 1946 for the Utah Nurses Association, a constituent member of the American Nurses Association. Sent to RNs and LPNs throughout Utah, Utah Nurse provides a forum for members to express their opinions and become aware of healthcare issues in the state of Utah.

ll3lf l1115 i~JI iiiD~ll10526 liili~li8469 l~iill Utah l\lurse Official Publication of C" wr"' .-~ £CCLE--- · -'"' ~e Ll- .- ~ v SC\EhCc:.o n ..... , Utah Nurses' Association JUL 2 6 'l76 UN\VERS\TY Or - , ~H SALT lAKE CIT ( IN THIS ISSUE: \ I HOW ACTIVITIES ON CAPITOL HILL AFFECT YOU, THE NURSE- A BASIC ISSUE by CONSTANCE HOLLERAN, Dep uty Executive Director, ANA CERTIFICATION PROGRAM FOR REGISTERED NURSES THE PROFESSIONAL NURSE IN PRIMARY CARE B.Y.U. NURSE PRACTITIONER PROGRAM KE N ROBBINS , B.Y.U. PERSPECTIVE ON THE GROWTH PROCESS IN NURSING EDUCATION JOSEPH L. PRICE, Assista nt Professor of Nursing, Univ. of Wyo. RONA LD E. DRAKE, Assista nt Professor of Nursing, U. of U. DR. KROEPSCH PRESENTATION TITLED "EDUCATING HEALTH PROFESSIONALS FOR THE FUTURE" DR. ROBERT H. KROEPSCH , Executive Director Western Interstate Commission for Higher Education JOB SATISFACTION AMONG NURSING SERVICE PERSONNEL DR . EDNA LEE NEUMA.NN, Director, St. Mark's Hospital School of Ba ccalaureate Nursing at Westminster College . SUMMER AND FALL, 1973 Vol. 24 Nos. 2 and 3 Editorial Utah l\lurse Vol. 24 Nos. 2 & 3 SUMMER & FALL, 1973 OFFICIAL PUBLICATION of the UTAH NURSES' ASSOCIATION 1058 E. 9th South Salt Lake City, Utah Phone [phone] Executive Editor . . . CORALLENE Mc KEAN 1058 Eas t 9th South Salt Lake City, Utah 84105 Assistan t ANNETTA J. BILGER 11 " A" Street Apt. 36 Salt Lake City, Utah 84102 Table of Contents pag e 3 Editorial How Activities on Capitol Hill Affect You , Th e Nurse - A Basic Issue . . 4, 5, 6 Certifi cation Program For Reg istered Nurses . .... . . . .. ... . . .. .. .. .... 7, 8 9 Th e Professional Nurse in Primary Care A Continuum of Servi ces for th e Developme ntall y Disabl ed 10, 11 , 12, 13, 14 Col leg e Health Nurse Practiti oner Program Initiated at BYU . . . . . . . . . . . . 15 Nursing Contribution and Commitment to Care of People . . ..... .. . . . . 16, 17 The IRMP Emergency Nurse Training Program . . . . . . . . . ...... 18, 19 Perspective on the Growth Process In .... .. . 20 , 21 Nursing Education Educating Health Profess ionals for th e Future . . . . . . . . .... 22 , 23, 24, 25 In The Mailbag . . . . . . . . . . . . . . . . . 26 26 District 2 News . . 27 Welcom e to Utah . . Job Satisfa cti on Among Nursing Service Person nel . ... .. 27, 28, 29, 30, 31 UNA-USMA Joi nt Practi ce Comm . . . 32, 33 The Emergency Nu rse Conference Group . . . . . . . . . . . . . . . . . . . . . . . . . 33 Ella Frand se n Retires After 48 Years 33 34 All About Th e VA Nurses . . In App reciation . . . . . . . . . . . . . . 35 My Than ks to You . . . . . . . . . . . . . . . . 35 Congratu lati on s . . . . . . . . . . . . . . 35 Convention Tim e Winn ers . . . . . . . . . . . 35 UNA Headq uarters Has A New Face 35 J\dverti§ers Am eri can Fork Hospital . . . . . . . . . . . . Blue Cross -Blu e Shi eld . . . . . . . . . . . . Coca-Cola Company . . . . . . . . . • . . . . Cottonwood Hospital . . . . . . . . . . . . . . Health Services Corp . . . . . . . . . . . . . Holy Cross Hospital . . . . . . . . . . . . . . . Hyland Pharmacy ......... . Mutual of Omaha .............. Payson Hospital ................. Quality Press . . .. ........ Robinson 's . . . . . . . . . . . . . . . . . . . . . . . UNA-ANA . . . . . . . . University Hospital . . ......... . Valley West Hospital . . . . . . Wasatch Villa Nursi ng Home . . . . . . SUMMER AND FALL, 1973 14 36 2 20 33 27 6 26 5 15 10 22 35 25 19 Each working hour, eac h cla y of every year, each indi vidua l registered n u rse makes d ecision s w hi ch in flu ence variou s aspec ts of th e nurses' li fe. So me d ecision s are rela ted to the person al a nd social en vironm e n t. Profess ion a ll y, the registered nu rse not on ly mak es d eci ~ i o n s which a ffect the heal th and welfare of those entr usted to the R. N.'s care, but also, d ec ision s wh ich errect th e future of a professio n a l nurs i n ~ career. Id eas don't kee p, th ey mu st b e explored an d d eve loped . !\ !thou gh Lh c m a jority o f Uta h '~ registe red nu rses ha ve b : e n ecluca ted to uph old trad ition, t hey ha ve always acce pted th e cha ll en ge of new id eas. The restru cturin g of the Utah N urses' Associa t io n a nd the adoption of the certifica tion prog ra m are just two exampl es. Jt sho uld h ave b een self evid ent to every UNA memb er th at the selected members w ho served on the sub-co mmittee for the ref i n ~ m e nt of the ce rtifi ca tion progr am had thoro ugh ly researched, studi ed a nd eva l ua ted th e issue as they developed the revised recom m end a ti o n . Urla .Jea n Maxfi eld , chairm an , shou ld b ~ g ive n pe rso nal comm end a ti o n for the o u tsta n d in ~. professio nal, a nd ex pe rt mann er in which she co ndu cted eac h cert ifi ca· tion sess ion . UNA members h ad th e opport uni ty to parti cipate a nd ver· ba lize the ir feelings. T here was hea l th y in teraction a nd excha nge o r id eas. T he memb ers who were presen t at these sessions ca n b e proud of the va l uab le co ntribut io ns, forthrig h t discussions and d ec ision s. T h e adopLion of the refi ned program is a tribute to all the p a rti cipants. At the Vetera n 's Admi nistration Hospita l, con cerned staff nurses have been actively in volved in the decision m aki ng process. They not o nl y elected UNA to act as their excl usive representa tive, b u t also d eveloped a contract which they presented to the d irector a nd oth er representatives of the manageri al staff. During the week of Jun e 18, 197 3, elected staff nurse represen ta ti ves sat clown across th e ta ble from man ageme n ts' a ppointed re presen tatives a nd n ee-o ti a ted their lirst co n tract. M utu al ';-espect, tr ust, a n cl good co mmuni cat ion existed throu ghout the process. On June 21 197 3, th e contrac t was signed and submitted to ' 1\Tashing ton D .C. for fina l approva l. Th is wa s not only th e first con tract n egotia ted by th e VA staff nu rses but also it was UNA's first official contract. A n ew cha llen ge had been accepted and m et. Those UNA members who do not attend conventions, or a ny other d ecision making meetings decided to trust and a b ide b y the d ecisions of their profess ional coll eagu es. Basically these n on-a ttenders d elega te to the <lttend ers the ri ght of "vote by prox y". Th e " Voi celess Welfare" registered nurse population in Utah, which h as chose n to con tinu e riding on the backs of their professio n al colleagues, h as also decid ed to allow others to m ake decisio n s whi ch affect the profession al li fe of all nurses. In thi state, du e to a variety of circumstan ces, those "VW" nurses con sisten tly reap the sam e eco no mi c, educationa l a nd professio nal b en efits that their dedicated, committed, involved, and a uth en tic profession::d colleagues strive to atta in . As Theodore R oosevel t so g ra phi ca ll y stated , "The cred it b elo ngs to the m a n who is actually in the arena, whose face is marred by cl ust a nd swea t and b lood - who knows th e great en th usiasrrliS,i the great d evotion s, w ho spe nd s him self in a worth y ca use . . . w ho at least knows in the end the tr iumph of hi g h achi evement, and , wh o at worst fails whi le daring gTeatly, so that hi s p lace shall never b e with those cold a nd timid souls wh o know neither victory n o r defeat. " Th e sa lvation of these "Voiceless v\Telfare" nurses, "the cold and timi d sou ls", rests w ith each UNA m em b er. Each " V \V" nurse will cont inu e in the sa me lethargic state as long as UNA m embers willin gly work alo ngsid e thi s nurse and make n o effort to i nform , or edu cate that "Voiceless v\Telfare " nurse to the va lue and pri vilege of belonging to the UNAAN A, o ur profession al association s. A successful assoc iation is dependen t upon adaptable, flexable, and sincere committed m embers discussin g, deciding, implem enting, and acce ptin g n ew ch allenges. The destiny of every registered nurse an d the professio n of nursing in Utah rests .i n the ha nel s of those creative leaders who proud ly step forward to d eclare " I am a U AANA member " and then ask "Are YOU ? D o you belong? Cora llen e McKean, Executi ve Director * A VOI CELESS - WELFAR E" nurse is an active registered nurse who h as chosen n ot only to clisrega rcl the profess ional orga n izations, UNA-ANA, but also, willingly accepts the benefits h er com mi tted profession al colleagu es strive to attai n . PAGE 3 How Activities On Capitol Hill Affect You, The Nurse- A Basic Issue Depu ty E xecutive Director, Am erican Nurses Association Presen ted May , 1973, UNA Convention vVhat ha ppens in ·w ashington affects everyone in this co untry - probabl y to a far greater d egree than man y peopl e rea li ze. During the 92nd Congress, which ended last October, more than 25,000 bills and resolu tions wer e introduced ·r anging in subj ect matter from agriculture and air pollution to weapons and weather. About 275 to 300 bills were signed in to law b y the President after wending their way through Congressional subcomm ittees, committees and the fu ll House and the Senate. Nineteen bills were vetoed. It is h ard to say how many of the bills introduced related directly or indirectly to h ea lth, but it was a goodly percentage. (We weren't counting; we were just trying to keep up !) It is necessary to check all bills for implica tions that they ma y have for nurses, nursing and h ealth, even though, as you can tell from the figures, most of them never make it through the legislative process to become a law. ANA tes tified 20 times during the 92nd Congress. \Ve submitted 12 sta tements - that is, presenting the association's official views on the proposed legislation in writing to the appropriate committee. vVe sent some 14-2 other letters or telegrams to members of Congress providing information or m:ging ac tion on specific bills. That, plus many, m an y visits to the Hill, and uncounted telephone calls to representatives, senators and congressional staff. The Congressional Quarterly lists some 700 lobbyists that registered last year, but the total number is doubtless mu ch higher because of the somewhat vague provisions of the lobbying law. And that means business companies, trade associations, professional associations a n d other groups, most representing a large number of people, and toge ther r epresenting a tremendous vari ety of in terests. I don' t want to go too far with this numbers game, but this does give you some idea of the magnitude of congressional activity. \'\Tithout knowing anything more, you would probably have a suspicion that some of thi s might just possibly affect you. PAGE 4 We all are very mu ch aware that some act ions of the government affect us. Tax laws, for example, and activities of the Internal R evenue Service have made a deep impression on most of u s! This is p arti cul a rly significant this year, because of the battle of the budge t. The President says that the Congress is irresponsible in its spending bills, and the Congress, which has se t its own spending cei ling, responds that it is a ma tter of priorities. Some members of Congress feel that the budget ca n be kept under the ceiling set by the Presiden t b y cutting d efe nse spending ra ther than health and welfare programs. As you kno w, appropriations for nursing education and other health manpower programs have b een cut drastically in the Administration's proposed budge t. Funds for schools of nursing and students h ave been cut from $144.8 million appropriated in 1972 to $51.3 million proposed for fiscal 1974 . Appropriations hearings are going on now in the House of Representatives. W e are scheduled to testify next Monday. HEW officials already have presented their testimony. So far as nursing education is concerned, they sa id, it should be supported as it h as been in the past - b y states and local ties, priva te sources and patient fees! We thou ght we had gotten away from the concept that patient fees should support nursing education, but apparently not. In fact, one of the congressmen asked an HEW spokesman why the cos t should b e paid just b y those unfortunate enough to land in a hospital b ed rather than all citizen s. And the only answer was, "I think you have a good point there. " The question of federa l support for health programs is certainly one issue that affects nursing education and the nursing profession. It has serious implications for the future of health care in this country. A number of programs would be termi nated under the Administration budget - R egiona l Medical Programs, Community Mental Health Centers, aid for allied health and public health training, health services for migrant workers. ANA is support in g a one-year extension of these progra ms to give Congress time to evalu ate each one individually and decide whether it shou ld be ended, continued or modifi ed in some way. Many groups are mounting major campaigns to have these program s continued . The outcome may affec t some of you personally if you're working on any of these program s and all of you - one way or another. But let me talk now about some o ther specific activities on Capitol Hill tha t have very direct implications for h ealth care, for nursing and for each of you as a registered nurse. One of these is professional standards review organizations - PSRO. I t was Senator Bennett of U tah who introduced the amendment to the Social Security Act proposing PSRO 's. It was passed last year. It requires that PSRO 's be set up to review the care in those institutions receiving funds under Medicare and Medicaid. Rules and regula tions for the establishment and operation of PSRO 's are being d eveloped in the office of the assistant secretary for H ealth in HEW. The PSRO Office is head ed b y D r. \1Villiam Bau er, a n internist from Greeley, Colorado. At present the PSRO requirement is for review of m edical ca re only, but I feel sure that all h ealth care providers will be included in the near future. Nursing had better be read y! In fact, there are rumors now that medical care will be interpreted as all care provided under the direction of a physician. The ways in wh ich these review units can opera te varies a great deal. A few months ago I visited a computer project ce nter in one state where a review process had been developed for reimbursement under Medicaid. In reality, it was merely a system of computer r eview of treatm ents and medica tions ordered, but the reviewer was reading a screen on the computer and would identify those items tha t did not fit the norm for care for a particular diagnosis. As an example, you would compare trea tment by one physi cian with tha t of others treating a similar diagnosis in that community a nd do comparisons in terms of how Drs. X, Y and Z ca red for those patients. Numbers of office or home visits, cost of medication ordered, numbers of days in hospital if req uired, numbers of followup visits in the home by other personnel, and so on. A ll of those things ca n be compared . I think that you ca n see that th e potential here is that UTAH NURSE there will be a great deal of sort-of generalized programming of c~re for a particular diagnosis. The~e I S danger, of course, that a very Impersonalized kind of medical and h ealth care will resu l t. Orga nized medicine was right to raise many qu ~st ion s about this development, ye t It has real potential to improve practice and promote more effective continued ed uca tion of Medical Doctors. Amendments last year we did not object to the PSRO con cept, per se, but we did in sist that if, in fact, the health profession involved should b e a participa nt. 1n other words, we were saying, m edicine should n o t be the reviewe r of the quality of care provided by all h ea lth professionals. When 1 visited that computer center, I kept thinking - how would nursing fit into this kind of system ? When I raised that qu es tion with the project director, h e sort-of lau gh ed and sa id "Well, what is it that nurses do a n yway that is truly professional a nd ca nnot be done by ot her p eople?" My question i s, " I s nursin g ready to pull its own weight in dealing wi th su ch issues?" Perhaps there are possibilities for interdisciplinary review of care, in fact, su ch review systems exist already in some leading h ealth institutions. 1 kno w t hat you have a PSRO project going on here in Utah und er a grant from the Department of HE't\1 - and that nurses are in volved in it, this illu stra tes the controversy that surrounds this world issue. As you m ay know, the America n N urse carried an article abo ut the Uta h PSRO and that prompted some letters to the editor in the May issu e. You should read them if you h aven 't. One is highly critica l. The writer notes that the nurse's role is defined as a "ci a ta collector" a nd says it is not a proper nursing function to collect medica l d ata for physician's review. I und ersta nd th a t nurses h ave been involved from the very beginn ing from the planning stage, and that is good. But evidently you still do n ot have a vo ice as equals at the policy level on the Board. I hope you ca n pursue thi s all the wa y. H ealth care is not just medica l, so more than doctors h ave to review it. On the n ational level, we are stressin g with those concerned with developing PRSO guidelin es that nurses mu st be involved on th e policy level. W e are h aving as mu ch trouble th ere as you a re h ere, I assure you. I understa nd th a t one of the concerns in settin g up the Utah PRSO SUMMER AND FALL, 1973 was health care costs. I will b e interes ted to learn more a bout what is being done in this respect and wh a t results are being achieved. The pu sh for PRSO 's is part of the larger increasing effor~ to p~om?te cost controls and effective uttliza twn of h ea lth services. The strong emphasis on controlling costs of h ealth services is evident both in the Administration and in the Congress. In fact, a t a recent lunch eon th a t Secretary ' Veinberger h ad with some W ashington newsmen h e said that in considerin g a n y pl an for national health insu ra n ce "the most important factor is gettin g control of health costs." vVho is going to make the decisions abo ut how su ch controls and more effec ti ve utilization will be achieved? Who is compe tent to d etermine, for example, whe ther a patient needs to be in a nursi n g horne? O r whether home health services, such as visits m ade by third party reviewers! N ursing must make a stronger case for h avin g competent, up-to-elate nu rses participate in the review of the utilizat ion review comm ittees in every care setting and, in so me cases, sho ul d orga ni ze such committees if necessary. '1\Te also must ge t nurses on the Board of Directors of Health In suran ce Exports - sta rting with the Blue Cross & Blue Shield Companies. I might say that cost controls is an area in which all h ea lth workers sh ould develop m ore awareness a nd expertise. At a recen t confere nce in "\!\lashington on medical ethics, one of the sp eakers, a physician, said that too often doctors have seem ed to be totall y unaware an d un concerned abo ut the costs of tests and proced ures that they were ordereing - and the fact that they were prohibiti ve to som e p a tients. H e said that those in medicine ca n no longer ignore su ch matters or consider them outside their realm of responsibility. N ursing could certainly take the blame for some extra costs too, although in gen eral, nurses are fairly cost con scious. The governm ent programs to control inflation - Ph ase I, Phase II and now Phase Ill - h as made a p articular point of the n eed to control h ealth costs. Jn fact, there is a sp ecial committee just to oversee h ealth industry costs. That should tell us so ~ e­ thing. We h ear a great deal about Imp roving productivity and about cost effectiven ess. We cannot ge t b y forever b y merely pointing out the complexiti es of produ c ti~ity m eas u~e­ ments in the health held. We will have to work out realistic m easures. There are some things we could do better now. Some of them are things nurses have talked about for years, su ch as providing services around-theclock in hospital departments other than nursin g, assigning unit manager ta sks to m a nagers on all shifts, more effective utili za tion of nursing aides, a nd so on. Surprisingly, such things move slowl y in som e se ttings. P erhaps nursing directors h ave to b e able to show dollar and cents differences in various ways in which p a tient care units are pl a nned, con stru cted , a nd m an aged. The real clue h ere is that nurses have to become more cost consciou s, be comfortable with the topic and talk confidently along those lines. Improving productivity is possible, yet some of the attempts we see being m ad e b y administrators lower qu ality as well as costs a nd that is not the true m eaning of increased; ,productivity. My point in all this I think is pre tty obvi o us. The federal government is deeply involved in the matter of h ea lth care in this cou ntry and in aspects of that care that reach right down to and affects each one of you on the job. Certa in vita l decisions a ffectin g t he practice of nursing are being a nd will be made. It is up to us whet her they are made with or without nursing involvement. (Co ntinu ed on page 6) PROGRESSIVE AccREDITED YouTHFUL SKILLED CARE OPPORTUNITIES NuRSING AT ITS BEST! HOSPITAL BEVERLY DIXON Director of Nursing Phone: Payson 465-2535 PAGE 5 Capitol Hill Issue (Continued from p age 5) The recent re port of the Secretary of HEW's Commission on Medical M alpractice is another case in point. This group has made some far-reaching recommend a tions regarding legal, med ical, insura nce and h ealth care pra ctices in this country and the kinds of pre pa ration n eed ed b y health care prac titioners One of the recomm enda tions - for exampl e, is tha t states revise th eir li cen sure laws to require p eriodic re-registration of physician s, dentists, nurses a nd other .-health professionals, based on proof of participation in approved continuing ecluca tion . I would make no specifi c comments on thi s report except to note tha t i t includes m an y criticism s of the h ealth ca re sys tem a nd is a nother governm ent acti vity direc ted toward bringing about changes whe ther those in the fi eld like it or n ot. The Ameri ca n M edi cal Associa tion ha s publicly and empha tica lly sta ted tha t it does not like the report. A sep ar a te statem ent also was clone b y H elen Creighon, a nurse m e mber of the Commi ssion, disse nting on some of the conclu sions. Doub tless the r eport will be a resource and influ en ce some congressional activiti es, and HE't\T is now studying it to d e te rmine wha t federal action might be taken . Spea king of continuing education, I know that you sta rted a program h ere, partl y at least, in a nticipation of some of the pressures for continuing eel. An item in the American Journal of N ursing, wh en the p rogTam was announced quotes your executive ~~hec tor as saying tha t: " In the future, if th is is no t clone within the profession, legisla tors are going to m ake dem a nd s. ' Ve want to b e able to say, 'you don ' t reall y need to d o this fo r nursing in o ur state; we've already done it.'" Other states are b eginning to d o the sa me . You ought to be congra tula ted for leadin g the wa y. The ad vent o f a national h ealth insurance progra m, of course, would h a ve a bi g impact on nursing as it would on other h ealth professions. However, a t the moment, it does not seem likely tha t there will b e any d efinitive action on NHI in the very n ear future. A s I mentioned earlier, the Administration is in no hurry to introdu ce a bill, and Wilbur Mills of the House ' t\Tays and Mean s Committee, seems in no hurry to start any h earings. But Senator Long, chairman of the Senate Finance CommitPAGE 6 tee, has introduced two NHI bills a nd plans to b egin, perhaps later this year, h earings in the Senate if the House side does not. R e member that your own Senator Bennett is Very important on that committee and we will be looking to all of you to help interpret our interes ts to him. There is a greate r possibility for some kind of Health Maintenance Orga nization legisla tion this year. At present time, a bill has b een reported out of the House Sub-Committee but has not come out of the full committee. The Sen a te committee approved its bill, S. 14, and se nt it to the floor of the Sen a te. On Tuesd ay of this week, a compromise (Kenned yJ avits - Schweiker - substitute) was approved b y the Sena te. The m ajor cha nge from th e original S. 14 was in money. The bill went from $1.8 billion to its final version of $805 million, in three year s. The sen a te and House bills differ grea tly, so if p assed, they could b e lost in conferen ce. T he cost of each ha s b een a m ajor factor in the d elayed acti on this year. ' t\Te have been success ful in ge tting nursing included in the bill and in the repor t la ngu age but it was slow go in g. Thi s is ve ry importan t, b ecause it is essential that nurses b e included in pla nning and policy-m aking for h ealth mainten a nce organi zation s - but we also n eed to b e sure tha t we are prepa red to provide the kind of con stru cti ve contributions tha t will make HMO 's effec tive m echanism s fo r bringing good h ealth care to p eopl e. Nursing al so should he pre pared with its own system of peer reviewin g. D o we have worka ble m ean s of doing p eer r eview of nursing care? In h ow many units do you participa te in r egula r, careful, nursin g a udits? A re the outcom es of nursing ca re clearl y identified a nd evalu a ted ? Is pee r practi ce policed by the profession? W e h a ve to be accounta ble. If the profession does not provide effective poli cing of nursing prac ti ce, the public will demand it. What I have been trying to say in thi s talk is tha t more a nd more nursing is going to h a ve to justify its own existence - to prove its own worth. This is true not only of nursing, but of the whole health care field, but it is nursing that we a re concerned with right now. In working with Congress and with the Executive Branch of government, we have to show that what we advocate will con tribute to improved health care - not just to nursing. In oth e r words, if we believe that fed- era! funds shou ld help to support nursing education, the question we must ask is not if nursing students need this kind of help or if nursing schools need this a iel, but is nursing care of people going to be improved, be more available or more readily accessible and b e o f b e tter quality as a resu lt of these expe nditures of federal funds. If not, then wh a t right do we have to ask for them ? P er sonally, I h a ve no qualms about saying, "Yes, d efinitely it h as m ade a differen ce a nd it will m ake a d ifference." But thi s is not enough. We must a lso have the fa cts to prove what we are sayin g a nd to demonstrate to Con gress tha t wha t we are saying is acc ura te. The topi c assign ed to me today was " How Activities on Capitol Hill Affect You, the N urse." I would like to turn that around and m ake it a question: How do you , the nurse, affect activities on Ca pitol Hill? There is no doubt tha t action s of the national government a ffect yo u. The issu e is: wha t are you doing a nd wha t is nursing doing to make sure tha t acti vities on C<1 pi to! Hi II a re b e nefi c i<~l for nursin g a nd for improved health car e for all people of this country. Each nurse mu st b ecom e politi ca lly as tute n ot on! y as a profess ional but also in the ro le as a n· in form ed citizen . HYLAND PHARMACY 3291 Highland Drive 485-9281 or 466-0787 11 The Store With Prescriptionality'' DOUG ROTH Registered Pharmacist UTAH NURSE CERTIFICATION PROGRAM FOR REGISTERED NURSES The Utah Nurses' Associa tion recognizes the role of contin uing education as an essential contribution to qua lity patie nt care. As a means of recognizing such efforts by members of th e Association, a certifi cation program was adopted effective January I, 1972. Certification is designed to give recognition to those nurses who strive to provid e a high quality of nursin g care by improving their skills through continuing educa tion and nursing practice. Initi al Certification may be obtained within a one yea r period. It is effective for a period of five year s; during which time an individual may work toward re-certification. Certification is a recognition of the individual's efforts and h as no significa nce in th e issu a nce or renewal of the R egistered Nurses' li cen se in Utah. UNIT EVALUATION FOR JNJTJALAND RE-CERTIFICATION AFTERJUNE I, 1973 T he following Criteria must be met for: A. I) Current License to pra ctice Nursing 2) Membership in the Utah Nurses' Association and The American Nurses' Association. 3) The criteria must b e m e t within one year after applica tion has b ~ e n submitted. a. Seven (7) total units required. Four (4) un its from group A. Three (3) units from group A or B. ( B. A new graduate can b e Certified upon satisfactory compl e tion of the State Board examinations and membership in the Utah Nurses' Association. The nurse ha s five yea rs to m ee t th e requirem ents for re-certification . Specific requirem ents are d escribed und er Group A and Group B on the certifi ca tion requirements. THE CERTIFICATION UNIT: Activities of nurses parti cipatin g in the cer tifica tion program are recorded in units . . . One (I) Unit represents ten (10) Contact Hours of activity or participation in a n y of the suggested activities. (Min imum and M aximum contact hours and units h ave been assigned to some activities.) If an individual is not able to m ee t the requirements because of extenuating circumstances, a formal written request for extension may be submitted to the certification committee. A two year extension period (without certification) m ay b e granted b y the committee. During the extension p er iod , in addition to completing the necessary 35 units for certification, the applicant will be required to complete a n additional seven (7) units from either group A orj and group B for each additional year the extension is granted. SUMMER AND FALL, 1973 I Re-Certification I) Thirty-five (35) units are required to b e accumulated over each five (5) yea r p eriod of tim e. As professional practitioners, we have an obliga tion to continue to improve our nursing expertise in order to m ee t th e present and future health needs of our society. To ass ist us in m ee ting this respon sibility, two ca tegori es of criteria h ave been establi shed . One group is required a nd one is optional. Any registe red nurse who is licensed m ay submit an application for initia l certification. Once the applica tion is m ade, th e nurse must comple te the n ecessar y requirements within a one year period from the elate of applica tin . Applications ma y be obtained from the Utah Nurses' Association H ea dquarters. Initial Certification 2) Twenty (20) units must b e selected from Group A. 3) The remainin g fifteen (15) units m ay be selected from Group A or B. NOTE : Units can b e co unted or recorded only in the p eriod in which they are earned . The d a te of initia l certification or re-certifica tion is the point at which tabu la tion begins for the next re-certification p eriod. Un its ca n not be carried over. C. New Graduates Qua lify for certification upon approved membership in Utah Nurses' Association and American Nurses' Association, a nd satisfactory completion of State Board Examination. D. Extension Period 1) A maximum of two (2) yea rs extension can b e gra nted upon request for extenu a ting circumstances. 2) An additional seven (7) un its will b e required for each year of the ex ten sion p eriod. The units ca n be acc umulated from Group A or Group B. TEN (10) CONTACT HOURS equal One Unit. GROUP A (Required) 1 - Continuing Education a. Workshops b . Seminars c. Conferences d. Certifi ed training program s, e tc. to whi ch education units have been assigned b y the education committee b y request of the sponsoring agency. 50 CONTACT HOURS - 5 UNITS - Minimum number of units required in a 5 year period is 5. (Continu ed on page 8) PAGE 7 Certification Program c. 1000 work hours (1/ 2 time) 2 Units per year - Minimum Units required within 5 years - 10. (Continued from page 7) EXAMPLE : 1-An approved one wee k short course usually a pproximates 30 conta ct hours or three (3) units. 2-An approved two (2) day program usuall y approximates 10- 12 contact hours or 1 to 1.2 units. 3-An approved five (5) session program meeting for two (2) hours per session would approximate ten (10) contact hours or one (1) unit. 4-Ac tivities of groups such as ACOG, AORN, Association of Critical Care Nurses, H eart Associa tion, AAIT, Public H ealth Assoc ia tion etc., would be record ed in this section if edu ca tional units have been assigned , if not, they would be recorded under Group B as Inservice Programs. 2 - Formal Academic Study Relevant To Nursing Your field of employment or fulfilling a requirement for a degree in nurs ing a. Three (3) semester hours of five (5) quarter hours of credit will be equal to the five (5) uni ts req uired in a five year p eriod. d. 500 work hours (1/ 4 time) 1.5 Units per year - M inimum Units required within 5 years - 7.5. e. 250 work hours (1 day; week) I Unit per yea r - Minimum Units req uired within 5 years - 5. 2 - Appropriateness of the ac tiVIty mu st be evaluated by the nurse for p ersonal gain toward competence in practice. Clarifica tion of recorded information may be requested by the committee at the time of appli cation for re-certifica tion. CLARIFICATION: Careful descriptions of co ntent and relation to yo ur work exp erience should be kept at time of attendance in case clarification shou ld be requested. 10 CONTACT HOURS equals One (I) Unit. 3 - b. Workshops c. Conferences MINIMUM NUMBER OF UNITS REQUIRED IN A 5 YEAR PERIOD - 5. CONTINUATION OF GROUP A (Required) 4 - d. Seminars for nurses or allied health professional Membership In UNA And ANA Fu ll membership or associate membership. ONE (I) UNIT PER YEAR- Minimum number of Units requ ired in a consecutive five (5) year period- 5. Holding An Elective or Appointive Office Acii ~e l y participating on a agency, district, state, or n a tional committee related to health services. Definition Active parti cipation on a committee is defined as being present at the mee tings and contributing to the business and the decisions m ade by the group - according to UNA By-L aws, Article I Section 3. FIVE (5) CONTACT HOURS (.5 Units) All owed for each presentation 4 - 50 CONTACT HOURS (5) Five Units allowed for each publica tion 5 - EXAMPLES: !-Career Da ys 2-Health Council s 3-Clinics 4-Board of Directo rs of Health Agencies 5-PT A H ealth Chairman 6-Menta l H ealth Groups 7-School eye exams 8-etc. Actively Engaged in Nursing b. 1500 work hours (3/4 time) 2.5 units p er year - Minimum Units required with in 5 years - 12.5. PAGE 8 Volunteers In Community Service must be r elated to H eal th Services. 10 CONTACT HOURS equ als One (1) Unit GROUP B (Optional) a. 2000 work hours (full time) 3 units per year Minimum of Units required within 5 years - 15. Publication Of An Article Must be related to health services. Absence of a member without good cause from three (3) meetings of a committee shall constitute a resignation and the vacancy shall be filled as provided for in Article VII Section 4. 1 - Presentation of Papers or Research Projects at: a. Meeings b . Audit of academic co urses will be given 1/ 3 the educa tional units the course would originally earn. 3 - lnservice Programs 6 - Voluntary Teaching Of Classes Must be without remunerat ion ! -Related to the H ealth Services (Other th an job rela ted teach ing) 10 CONTACT HOURS equ a ls One (l ) U nit UTAH NURSE The Professional Nurse In Primary Care Prep ared by th e U tah Nu rses' Association joint Practice Com m ittee M embers in consu ltation with mem bers of th e U tah M edica l A ssocia tion N ursin g L iaison Commi ttee Adopted and App roved fo r Publica tion by th e U tah N urses' Associat ion, Bonrd of Directors PROFESSION AUSM The definition of a professional role in a society of r apid technological change, requi res recogni tion , not only of th e u sual a nd cu stomary practice for a professional di scipline, but also an opportunity and an expectation for professional growth and innovation associated with experien ce an d additional trammg. Overly strict definition s and limitations serve less to p rotec t the public than to impede progress and improvemen t. Professional roles must vary with community n eeds and the tem p eram ent of individuals working toge ther. A helping p erson relates to a recipien t with all the competence, knowledge, skill, and judgment he possessses. H e p erform s, to the limit of his ability under no more d irec tion than is n eeded and wi th all the available support and consultation he desires. When h e can perform n o fu rther servi ce, h e m ay refer the recipien t to more appro priate assistan ce, if su ch is available. P erfor man ce is formally evalua ted by p eers, consultants and supervisors an d is influenced by consumers. A technician p erform s an assigned task del ega ted to him b y a professional. A professional is pre pared to assume resp on sibility and accountability for independent judgment regarding hi s p erformance. A profession al is respon sible within the limits of his ability, to m ake appraisa ls and assess impairments, liabilities, asse ts and resources. H e records hi s findings and recommend ations. H e evalua tes, formul a tes, and implements appropr ia te plan s. H e provides coun sel con cerning resources and m an agemen t. H e executes procedures to alleviate stress and p ain and promotes growth and developm ent within the sphere of his competen ce. H e collaborates with other professionals who assist by accepting responsibility and delegating other responsibilities to lesser trained persons. H e sh ares his knowledge by teaching SUMMER AND FALL, 1973 and supervising others including p a ti ents and their families. H e continues his own growth and education and evaluates his exp ertise under supervision when appropria te. T h e profession al is resp on sible for improving the standard s of his profession . Although he u su ally performs in a manner similar to hi s professional coll eagu es, h e will sometimes devia te fro m this p rac tice to m eet unu sual n eeds. H e m ight also p ractice in a new and more enlightened man n er wi th addi tion al training and under supervision or with appropriate con sultation from specialists in the area of service. T h e profession al encourages evalua tion of competence in all training program s. He fur ther en courages, su pp orts, and p articipates in continuing educa tion, evalu ation of competen cy and efficacy of service. (statem ent on nursing as a p rofession from D r. Goates) T H E PROFESSIONAL NURSE The Professional N urse functi on s with the same gen eral r ights, pnvJleges, and responsibiliti es as o ther professionals. More specificall y, the Profession al Nurse function s in seven areas:* Observati on of symptoms and reac tions Supervision of the pati ent Supervision of those p articipating in care, except physician s THE PROFESSIONAL N URSE I N PRIMARY CARE Secures and evalu ates a h ealth hi story from th e pa tient andj or his famil y and records finding in a system a ti c, accura te and su ccinct form . Perform s a b asic physical assessment, u sing techniques of observa tion, inspection, ausculta tion , palpation and percu ssion and u sing such instrum ents as the o toscope and ste thoscop e, a nd be able to discriminate between n orm al and abnormal findings. Discriminates between n ormal variati on s and abn orma l deviation s of growth and developmen t, u tili zing specifi c screening tes ts. Ma kes decision s inde penden tly and collaboratively with the p hysician , specifi cally knowing wh en to refer the p atien t to the physician for evaluation or supervision. R ecogn izes and man ages specific minor common condition s. Orders and adjusts selec ted medications, th erapies, and d iagn ostic p rocedures. Ad vises and counsels con sumers con cerning m en tal a n d physical h ealth. Provides anticipatory guidan ce to consum ers co ncerning problem s of growth and d evelopment, expected outcom e of ther api es and th e implications of m ental/ physical h ealth problems to the p atien t and hi s famil y. Applica tion and execution of nursin g procedures and techniques Provides p a tients and j or family m embers with the opportunity to increase their knowled ge and skills n ecessary for m ainten ance or improvement of their h ealth. Promotion of physical and emotion al h ealth by direction and teaching Identifies resources available within the community to h elp fa mili es, and guide p a tients in their u se. Appli ca tion and execution of physicians' legal orders. Coopera tes with other professionals and agen cies invol ved in providing services to a family and, when appropriate, coordin a tes the hea lth care given . R eportin g and recording * Nursing Audit by Mari a C. Phaneuf. PAGE 9 .. The following quote from a meeting of the Association of Volunteer Services Coordinators in St. Louis is very apropos to our considerations: "A Continuum of Services for the Developmentally Disabled" by Marjorie H K irkland MARJORIE H. KIRKLAND, Deputy Chief, UAFTA Branch, Division of Developmen tal Disab ilities, USDHEW, Washington, D .C. Th is paper was Mrs. Kirkland's key note address at a Serninar on Community R esources, September 28, 1972, in Salt L ake City, Utah. . The confere nce b eginning tonight is on the continuum of services. Wha t this m ean s to m e in every day language, especially in terms of the past a nd of th e h a nd icapped people involved , is alternatives. That they ar e n ot faced with one single so-called solution to the problem of h a ndica p . In m y ea rl y days in the field, the institution was a lmost th e only so lu tion to the prob lem of m enta l r e tardation or any o( the h a ndica p s associated with that. There we re fa mi lies w ho obj ec ted very strenuou sly and , at very gTea t cost to them selves, refused to acce pt this solution. But those families were scatte red e nough and their vo ices were weak enough, that they would not h a ve had much effect if it had not been for the enormous waiting list for admission into institutions that d eveloped over the years when the n eed for institutional care, or again when there was nothing else, far outstripped the d evelopment of the resources. And so the waiting lists grew by the thousands, a nd those voices b egan to b e heard, and the need beca me recognized for other solutions. " It's not what we don' t know that ge ts us into trouble, it's what we know tha t isn't so" . As we look back over the history of mental retardation, what we have known that isn' t so has ca used untold financial a nd human wastage. The idea that MR was a hopeless condition, that retarded p ersons cou ld not learn, that they were a danger to society and themselves, that they were happier with their own kind, that their mere presence in a family con stituted a clear and present danger to the fami ly automatically and- one of m y p et p eeves as a social worker- the notion that the family's g uilt feelings because of their a mbivalence towards this handicapped child was the real problem , and that if they would just go home and quit feeling n egative toward their child, their problem s would go away. Wha t they really n eeded was services, and then their feelings wo uld ch a nge. So, it's these things that we knew that weren' t so, as we are finding out tocla y - now that we are trying alte rna- At first, in some places it was seen as a temporary solution, a kind of a holding action, until we could get them a ll into the institutions. But we bega n to find out th a t the peo ple dicln•t need to go into the institution a t all , and so it b ecam e a matter of a development of alternatives, so that fami lies that h ad h andicapped members could find the solution that most n early fit their n eeds rather than having to acce pt one plan . It's as though we all tri ed to ge t into the same size shoe. It ju st wou ldn ' t work . TAKE IT FROM CAL .. I ~ So he can't whistle! From th e gleam in h is blu e eye, yo u KNOW he r unifo rm is right. Th e fit perfect! Th e material fantastic! Absolute ly machin edunkabl e and no-iron . Th e style? " Right on!" SHE BOUGHT IT AT ROBINSON'S ROBI NSON'S also supplies everythin g the chic woman needs to underscore her beau ty: Bras I Girdles I Slips Fit to individual measurements by expert fitt ers for co mplete co mfort and w earab ility. Yes, you ' ll be happy if you do and sorry if you don' t. Visit Robinson's Right Away. Famous " Naturalizer" shoes also ava ilable. Phone [phone] ~ ljobinson's t' 409 EAST 4TH SOUTH ~ PAGE 10 o SALT LAKE CITY, UTAH 84111 o FREE STORE-SIDE PARKING Hrs: 9 to 6 Monday t hru & including Saturday UTAH NURSE tive solutions- that kept us back for so many years. Now let's look at some of the services that are n eeded throughout the lifetime of the h andicapped person and his famil y. First, of course, is casefinding - earl y case finding. Thi s is b eginning to b e more a nd more a concern to th e communities, and there are variou s m ech ani sm s b eing d eveloped . I don' t know how many of you know these resources. For example, under one of the several federal m edical services program is th e early screening, diagnosis a nd treatment program fo r p eople who are candid a tes for publi c assistan ce. Those screening, diagnosis and treatm ent servi ces can b e p aid for under the m edi ca l services p rogram . W e need to develop am ong th e family doctors the recognition tha t closing their eyes to th e condition will not make the condition go away and, at th e sa m e tim e, taking a hopeless a ttitude towards it will not h elp the famil y a nd th e child. So we n eed to d evelop a mong fa mily doctors - who a re usuall y th e first con sulted - the recognition tha t with ea rl y intervention and a va ri et y of servi ces, much ca n be d one. In oth er words, wh a t th ey know tha t isn ' t so mu st be cha nged . I would like to tell you of some of th e thin gs th a t are b ein g d one in other parts of th e co un t ry, for exa mple, th e a ttempt to ge t inform a tion to famili es in the sp a rsely populated ar eas of th e country. In one sta te, they were u sin g Hom e D emonstra tion Agents. They brought the agents in for short-term training program s on mental re tardation . They w en t out a nd dealt with farm famili es, wh en they di scovered problems tha t were similar to m ental re tard a tion , they kn ew what to tell the famili es and how to h elp th em ge t to th e proper agen cy to m ake the proper diagnosis a nd evaluation . To m e, thi s is a ver y inge niou s and via ble way to spread inform a tion into an area tha t is very eli ffi cult to spread the word an y other way. Th e gen eral publi c n eed s to know. I don ' t know how m an y of you saw J ackie Nokes on T.V. when she was a nnouncing thi s morning. She rai sed the question of how much people know and how mu ch attitud es h ave changed. A survey wa s don e several years ago b y the National Adverti sing Association of p eople's attitudes and there wa s a m easureable change in what they said. Ma ny, man y more people agreed tha t the m entall y retarded belonged SUMMER AND FALL, 1973 in the community, but I'm sure that many of you have found that meant someone el se's community - not theirs! There is still a great deal to b e done to change the public's attitude. But one of the best ways to do this is to give them exposure to h andi capped p eople. As long as the re tarded are hidden off in the boondocks, the publi c is no t going to change its a ttitude. After you h a ve found cases, you n eed to know what to do with them. Tradition all y, the expecta tion was tha t an y child tha t was handica pped would b e seen b y a whole string of pr ofession als, and the more professi onals you could line up a nd run the child p ast, the b etter the program was going to b e. W e ar e b eginnin g to recogni ze tha t thi s is a wa ste of time - fo r the professional s, for the fa mil y a nd fo r th e child - a nd it's rea ll y a gru esom e experien ce. M an y places are d evelopin g eva luation progra ms in whi ch a sm all tea m of knowled geabl e p eople go o ut to the variou s places whe re these p eople are - hi gh ri sk area s, rural areas, schools, p overty a reas, e tc. - and screen p opul ation s. In m an y in sta nces, they ca n ma ke ver y sa ti s f<~c tory pla ns on the b as is o f th ese rather simple scree nin g opera tion s, whe ther sp ecial school s, publi c schools or wha teve r; and in other cases, pi ck out those tha t n eed il rather more thorou gh di agnosis <~ nd a m ore ca reful workup, and refer them to the di agnosi s facilities th a t are always overburden ed . In tha t way, b etter u se ca n b e m ad e of the hi ghly skilled professionals' tim e. The eva ! uation team is a very useful d evi ce, and is being u sed in va riou s p a rts of the A n earb y facility, the Univer sity of D en ver, is doing some r a ther innova tive things in trying to extend the team expertise into di stant a reas where travel would b e a real expense to everyone involved. They h ave a udio-visu al hookups with, say, a fa mil y doctor in th e country in Arizona, and they can film the doctor doin g hi s examin a tion of a p arti cular child. They mail it in to the center ; the tea m wa tch es the eva lua tion, ta p e their comments, send their com ments b ack to the doctor, a nd h e follows up on wh a tever the suggestion s th e team h as made. In this way, they edu cate th e doctor to som e of the specifi cs of a particular cone! i tion ; and th ey extend the team's efforts over wide di sta n ces in a much shorter p eriod of tim e th an it would take th em to travel. Then com es trea tm ent. On ce you h a ve don e a dia gnosis or evalu a tion and made a pl an, wha t is b eing done in the wav of trea tm ent? Thi s is the reall y ex~i ting part of thi s fi eld. Treatm ent of all kind s - a nd I 'm speakin g of treatment as more tha n just m edi cal trea tment - all kinds o f n ew techniqu es are bein g d eveloped th a t are h avin g fabulou s results. Thi s i s where we a re learnin g how mu ch we knew that just wasn ' t so. On e o f the inn ovation s is not bra nd n ew, but I sa w a ver y ni ce example of it in H a waii wh ere parents a re brought in and train ed , alon g with their children, to d o th e stimula tion ta sks tha t ca n h elp th eir child re n d evelop, a nd th en th ey go hom e a nd carry these on durin g th e week with th eir children and come in on Sa turd ay aga in. They also com e in one ni ght a week for di sc ussion groups and parent educa tion cl asses. Th e use of parents is <1 growin g pr<~c ti ce and cert3\i n1 y one th a t m akes all kind s of sen se. Some of the services n eed ed are: D ay Ser vices. We are ta lking a bout a lternatives to lon g-term, large, overcrowd ed , und ersta ffed , res idential faciliti es. On e of th ese is a group of d ay servi ces to m ee t th e n eed s o f the va ri ety of p eopl e. T hese program s in clud e stimula ti on program s on up through adult rec r e <~ti o n , work p rogram s, pl aces to li ve, th e whol e gamut of th e sa me kind of life servi ces that yo u a nd I n eed . The C hild D evelopment Associa te Program, d evelop ed und e r th e Offi ce of C hild D evelopment is on e o f th e progra ms that hold s promi se. P eopl e wh o will work direc tl y with children a re m ad e knowl edgeable a bout h a ndica ps a nd lea rn how to d eal with th e h andi ca pped child as well as with a normal child . Thi s is one d evelopm ent. The P arent-Child Cen te rs. Generall y speakin g, parent-child center s are n eighborhood ce nters where, in a poverty n eighborhood , on e or two mothers are pi cked out who are p arti cularl y skillful in ca ring for chi!-' ch-en , a nd th ey are train ed and supervised to ca re for not onl y th eir chilch·en but also th e children of oth er p eopl e in the n eighborhood while those parents go to work. These are in high risk n eighborhood s, whi ch mean s tha t som e of those children are going to be h andica pped , whi ch m ea ns th a t we n eed to train those p are nts to care for the h andi capped child. H ead Start. Some H ead Star t program s exclud e th e h andi ca pped . The (Continu ed on page 12) PAGE 11 Continuum of Ser~ices (Continued from p age II ) fed eral government is trying to encourage H ead Start progra m s to include h a ndi ca pped people, either along with th e norm al or, in som e cases, in separa te progra ms for handica pped themselves. Kinderga rten . For all children, n ot just norm al children . D ay ca re to be given in either group clay care centers or in family d ay ca re, according to the n eed s of the indi vidu al child . Training and educati on : The same ki nds of opportunities tha t everyone n eed s in order to develo p hi s talents a nd hi s knowl edge so th at h e can b ecom e a useful citi zen . For too long, we h ave sa id t he re tard ed co uldn't lea rn so we ha ven ' t given them th e ch a nce to lea rn. It's a grea t sa ti sfaction to m e to see tha t the D ep a rtm ent of Educa ti o n has taken over the clay care centers here in U ta h b eca use thi s is a responsibility of the public educa tion syste m. In D ela wa re, they h ave b een do ing thi s fo r yea rs. Their constitution does not put an IQ limit on the responsibi liti es of the education d epartme nt for the children , and the Dep artm ent of Educa tion said years ago, " vVe d on ' t know how to care fo r the profoundl y a nd seve rely handicapped p eop le, those who a re n ot toile t-trained , can ' t feed t hemse lves, a nd so on . Bu t, we h ave a charge to look after them ." So the D epartm ent o f Educa ti o n pays the D epartmen t of Institutions to run d ay ca re centers for those severely a nd profound ly h andica pped p eo ple througho ut the state and the 1 oost comes fro m the Public Edu cation' money. In som e sta tes, parents pay their taxes to t h e publi c sch ools bu t t heir chil d ren ca nno t go to the public school, so they h ave to pay ex tra fo r a p riva te school. In Dela ware, their tax m on ey is used to take care of: their child t he sam e as an y other p erson 's ch il d. It is also impor ta n t that these tra ining and edu cation p rogra ms sta rt earlier tha n the n orm ra the r than later. 'We used to sa y that the ed ucab le m en ta lly retard ed person was not read y to lea rn to rea d a nd write u n til h e was 8. So, if yo u p u t sch ooling off 2 years, then yo tt pu sh h im ou t 3 or 4 year s ea rl y, he is n o t going to learn ve ry m uch . T he va ri o us teaching-lea rn in g tec hni q ues- edu ca tional technology - th a t h ave b een develo ped to improve our tra ining an d education programs are of vital importa nce and we need a great deal of PAGE 12 experimenta tion. \Ve n eed a great d eal of m eas urement, we need a great dea l of obj ec tive eva l uation a nd programs to learn whi ch ones work under whi ch circum sta nces. I would like to include in training and education - the vocational edu ca tion programs. I don 't know wha t the condition is here in th e Sta te of Utah . I do know tha t fed erally the voca tion al education progra m money is supposed to have, I believe, 10% earm a rked for the voca tion al educa tion of the handicapped child, yet in ver y few sta tes is one cent o f tha t mon ey b eing used for tha t purpose. U ntil the people of the Sta tes d ema nd it, it won 't b e u sed for that purpose. Thi s voca tional educa tion should also reach into employm ent, and I don' t mea n just busy work - I mea n use ful work : Hom ebound emplo yment fo r t he p erson who cannot ge t out of hi s home for an y one of m a n y reason s; sh eltered workshop employm ent over a long peri od of time, if n eed s b e; or tran sition al sheltered worksho ps where they learn to work in regul a r situations. Wha t I a m trying to ge t a t is th e grada tions ra ther tha n single solutions. One of the grea tes t d eficits I 've seen in sheltered wo rk shops fo r the severely ha ndi ca pped is the lack of im agina tion on the pa rt o f th e sta ff. I saw a Mongoloid boy, proba bly 15 or 16 yea rs old, who could not or h ad not lea rned to count to 10, but he had th e task of sorting 10 sa nding discs a nd putting th em into a plastic b ag whi ch the n ex t p erso n wo uld seal. But since th ey co uldn't teach him to count to 10, what di d th ey do? T h ey painted 10 spots on the table in front o f him a nd h e covered each sp ot with a sanding d isc, then he put them toge ther, a nd h e had 10. Now, that's no t beca use he was tau gh t there were 10 b u t beca u se someone on the staff h ad some im agin a tion. Thi s is what I call job e ngineering. I'm not sure what the voca tional peo ple called it. I also saw a hyperactive gro up of boys in a n in stit u tion, ages 10 to 12, who were pu tting togeth er electron ic equipm en t wh ich would ha ve cost the Psychology D ep a rtm en t a large sum of m oney; but b y having each boy assign ed a p a rticu lar job that he co uld m an ;-t ge, the pi ece o f eq ui pmen t moved along. Each k id d id the sam e job on each m achine. T h ey p u t toge ther a ve ry compl icated piece of equ ipm en t. Besides p u tting together a ve ry expe nsive pi ece of eq u ipm en t, thi s activity ta ught these kids to si t still, to a ttend a nd to be u seful, and they wo uld make money on it. Another problem is to get contracts to keep p eople bu sy. One of the greatest compla ints of clients in workshops is the tim e they spend twiddling their thumbs waiting for the n ext job. Another problem I found from talking with some of the workshop p eople, is tha t most of them a re priva tely run and each one is a little n ervou s about a compe titor over in a nother town . R ela tively few of them are la rge enough to employ a skilled Contract Procurem ent Officer a ll their own - they don' t have that mu ch of a job - but they a re afraid to share on e with somebody b ecau se he might favor the other workshop. Workshops shou ld ge t together to share highl y ski lled sta ff. Where a re these people going to live when they a re workin g in the workshop? Some times their homes are lon g dista nces a way from the workshops or the d ay ca re ce nters or where ver it is they a re ge tting their training and edu ca tion . Ma n y, m an y thousands of people have b een sent to institutions because they've h ad nowhere to li ve a nd go to sc hool. This is a terrible traged y. v\Te shou ld h ave the same vari e ty of resou rces for the ha ndicapp ed tha t we h ave for everybod y else. Orph a n ages went out of style long ago. Just because a famil y co uld not m a intain a child in hi s own home did n ot mea n tha t he was sent to a big institution . H e was gen erall y put in to a foster horn e so tha t h e had as n ea rl y a norm al situ a tion as possible, espec ia ll y teen age, and a t certain ages they wen t to group hom es becau se some h a ve a problem identifying wi th a nother se t of parents. Then, what ha ppens when a " normal" person grows up . R ela ti vely few live with t heir p aren ts when t hey a re 25 or 30 or 60 years old. And ye t, b eca use a person m ay be ha ndicapped, society e ncourages t he h a nd ica pped person to stay home, which is not a n orma l experience for the fa mily nor for t he h a nd ica pped perso n. He should b e able to move away fro m home, li ve in as n early norm al circumsta nces as h e is capa ble of man agi ng. This makes for a mu ch more n orm al sit ua tion - also for fami lies. Boa rd ing ho uses, a partment ho uses, group homes, hote ls- all a re needed. N eb ras ka is d o ing mar velou s things with a partment houses fo r •hand ica pped peop le. And, incid entl y, mixing up peop le with vario us hand icaps som e tim es wor ks; also mixing them with n orm a ls. For exa mple, a person in a wh eelch air who is n ot mentall y retarded m ay b e able to provide some j udgme n t in mak ing a deUTAH NURSE oswn for a mentally handicapped person who can, in turn, help the physically handicapped person with his physical problems. Thus, they can be mutually supportive. So that resources that mix people up together, normal and various types of handicaps, may b e much more effective than a program for a single type. Now, what are some of the resources available here. Again, in terms of federal programs, there are the intermediate care facilities. Retarded people are now eligible for intermediate care faciliti es payments by their medical programs, either in or outside the in stitution. The skilled nursing homes are available for those who need skilled nursing homes. HUD, th e D epartm ent of Housing and Urban D evelopment has funds for building a partm ents or housing for handicapped people. There are a growing number of resources for these p eople. Then, th ere's the old bu g-a-boo as to what do you do in your off hours) Anyone who works with the retarded knows that, gen era lly speaking, their failures come not from 9 to 5, but after 5 o'clock, when they don't know how to h andle their spare time. I rem ember one girl who had lived for many years in an institution - a model patient; sh e went through the whole rehabilitation prog-ram and did very well; sh e got a job; was liked very well by h er em ployer; and every evenin g she went home to her little one-room ap;1rtm ent. But she didn't like T.V., and in th e in stitution the only kinds of recreation she had was going to dances, goi ng bowling, goin g to th e movies, go ing to ch urch, going to the circus, go in g to parties. All of these were group activities, and h ere was one lon e girl. In the first place, she didn ' t have enough money left over from the m eager littl e salary she was getting to go to those places. She finally complain ed to h er co unselor. She said, "Look, I've scrubb ed the paint off all my walls, I've washed m y clothes until they're threadbare. Now what can I do?" It seems to m e that in working with the reta rded we need to recognize that they do not spend their li ves in groups 24-hours a day. They need to learn the kinds of things you do when you're by yourself, playing solitaire maybe, putting puzzles togeth er, some simpl e knittin g or croch eting, some of the arts and crafts that don't cost a fortune (and some of them do! Some of the things I've seen in the schools for the retarded for their residents to do, I SUMMER AND FALL, 1973 couldn't afford to buy. And the people that are earning the salaries that these people usually do, couldn't begin to afford them.) Transportation. If you can't get to a service, it might as well not b e there. This means partly a matter of training when you're dealing with the mentally retarded; and when you're dealing with those who are physically handicapped, it may be some kind of physical alteration or special arrangements for getting people to and from the services. Now, I've b een listing off the services that are named in the I 970 Developmental Disabilities Services and Facilities Construction Act. Suppose you have this whole array of services that we hope you'll develop, how in the world will the family know about it and how will they get to them? There are four services that we have seen to mak e up a very nice package, which may make a very nice package, which may make a verv good beg·innin g. The first is information and referral, with wide publicity so that anybody in the community can find out easily where they ca n get information. This can start with just a cata log of resources: everyth ing you can think of - not just those that are especially for the retarded - but those that other agencies provide: fo ster homes that don't exclude the retarded, health services, recreation programs, etc., where you can get hospital eq uipm ent, where you can find baby services, any of the services that people need. Such a catalog is not entirely adequate though because parents often think they need something but the child is not really ready for it, so we advise that you build into this service a counseling service. Counseling goes along with practically ever y other one of the services I've mention eel, but it can also sta nd alone, and we feel it should be built into the information andreferral serv ice so that the counselor can find out whether the child has been accurately eva luated and diagnosed, what the plan was, whether it has b een followed, what the success has been, wh ether they need to go back and start over again or whether they are really ready now for whatever it was the family asked the in formation and referral service to provide. "Do you have a clay care center that takes a girl, age 8, in such and such a neighborhood so that I can get her on my way to work?" Those are two of the services - information and referra l, and counsel- ing. Now, if you have those two, you have the beginning of a very important coordinating program to pull all the bits and pieces of this other continuum of services that I've been talking about together, and if you add one other little ingredient, you have a third - that's called "follow-along" . How many of you have known of a handicapped person who was in a school program and for some reason wa s thrown out or dropped out; then, three years later someone finds he's been sitting at home all this time doing nothing. The school didn't know wh ere to send him or they didn't send him , and the family didn't know what to do, and so he had been sittin g at hom e. So, you need some kind of a ti ckler file so that every so often you ch eck up on Johnny and b e sure that he is where he belongs and that h e hasn't fallen through the cracks. The fourth service in t~1e : package, we call protective services. 1This is for th e person who is really irresponsible, does not have anyone to act as a respon sibl e guard ian for him , so an agency provid es that guardianship along with the other three services. 'il\'h en you really look at the continuum of services, the interesting thing is it' s not really different from what you and I need , h ave needed, as we went through life. And yet, people h ave addressed it as though we were talking about som ebody from Mars or somethin g, who really h ad a different set of n eeds. These are the same things we n eed; they should b e provided for th e retarded by the same agencies that provid e for us. Now, I don' t mean that there is no room for specialized services. I do m ea n that the responsibility for supporting, for setting standards, for seeing that they are provided. These responsibilities sho uld lie with the sa m e agen cies as those that see to it that we, as normal people, have three services: the public schools, the publi c health, the public we lfare, th e private agen cies. It should not be ' a separate but parallel system of services. Yet, we act as though th ey were not hum a n b ~ in gs along with all the rest of us . That brings up on e of m y favorite topics, th e human rights of th e retarded. I am very fortun a te that n ex t week I'm going to b e abl e to go to the international co nference in Mon treal that will deal with the human rights of the retarded. The United Nations has issu ed a declara tion of th e hum an r ighc of the m entally re(Conti nu ed o n page 14) PAGE 13 Continuum of Ser"ices (Continu ed from page 13) tarded. There have been concurrent resolutions i ntrodu cecl in both houses of Congress setting forth the human rights of the retarded. T here's a bill introduced by Senator J avitts that not only sets forth, in rather abstract terms, the hum an rights of the retarded, but then proceeds to describ e how to guard those rights, I.tow those rights are to be handl ed on a day-toclay basis. If it passes, it will be a difficult program for a federal agen cy -to adm inister. In the meantime, the Department of Health, Education and 'Nelfare has a department-wide policy govern in g the protection of human subjects. (I object to the title of that policy because our people are subjects too often.) It was really started to protect research subjects and by executive action or adm ini stration action, the Division of Developm enta l Disabilities extended to all of its funding programs this same policy. vVe 're the only age ncy in the Department of Health, Education a nd ·w elfare that uses this poli cy and requires its grantees to follow it, except in the areas of research and demonstration. The state formula gra nt program that Dr. McGarry re presents, has a responsibility to protect the hum a n rights of the developmentally disabled in Utah. That is one big job. If we give a gra nt to a n Association for R etarded Children for a clay care program, they have to sign that they will look after the hum an rights of th e retarded . I was n ot surprised, but neither was I pleased, when I did a little sample survey and fo und how few people know what a hum a n right is when it app lies to a retarded. I attended a work shop on the hum an rights of the retarded, at which people li sted the rights of the retarded and then they got up to li st their own, and yo u'd be surprised how different they were. An interesting developm ent is the number of laws uits that are now coming forth estab li sh in g, without an y furt her doubt, the rights of the retarded. (I think in a short time there's going to be a group of superintendents who h ave been sued that will be so large that a n yone who hasn ' t been sued is goin g to feel uncomfortable a nd left out!) Each lawsuit deals with a slightly different facet from the other. One has to do with the right treatment: that you ca nnot involuntarily incarcerate someone a nd stick him on the back ward, a nd give him three meals a day and clothes to pu t on, a roof over his PAGE 14 head, a nd call th at treatment. Another d ea ls with the right to sta nda rd s of se rvi ce: the right to have minimal sta ndards upheld. One institution was give n 30 days to hire 300 personnel. They had b een saying for years they co uldn't find peo ple to hire, but under co urt order, in ten days they h ad their p ersonnel! I'm not saying they were all good on ~ s. but the ones they were hiring before were not all good ones eith er. Another co urt decreed the ri ght to education . There are several suits on that. These mean the right of everybody to schooling, without a breaking point of a n IQ of 75 or 50 or 45 or 30 or 10 or 5. It means everybody. Jow, these ideas aren ' t n ew. \ '\That is n ew is the grow ing recognition on the part of people who have n ever been involved that the handicapped have these rights. A right is not something that somebody gives you . At a meeting on human rights, spon soreel by the Nat iona l Assoc iation of R etarded C hildren, the superintendent of one of: our b etter institutions got up a nd very unctuo usly said, "\ Vh y I give my chi ldren their righ ts". A lawyer jumped up a nd sa id, "Yo u don't give an ybody thei r ri ghts, you can only take them away. " But that's not the way we h ave bee n approaching it. vVe "give" them their rights to this or that. That's a privilege, no t a right. What must be establish ed is that these are rights. We have been depriving p eople of their rights and that m ea ns that we are wrong, not they. Juclg·e Joseph C. Waddy, the U.S. District Judge in the District of Columbi a, summed this up beautifully in a recent co urt case wh ich was one of the educational suits against the District of Columbia public schools. He ordered the public schools to provide educa tiona! programs for a ll h a ndi ca ppecl children, including the emotionally disturbed, within 30 days. The school board claimed they could not do this with their insuffi cien t funds. They would have to ha ve massive a ppropri ation s from Congress. Judge Waddy would Promote have none of this. He rejected it immedi ately by stating, "The inadequacies of th e Distri ct Public School System, whether occasioned by insuffi cient fundin g or administra tive ineffi cien cy, ca nnot be permitted to affect the exceptional or ha ndi capped child a n y more than the norm al child". This is what we have done for years. vVhatever was left over, we gave to the handicapped child. T he child welfare agen cies agree wholeheartedly that, yes, they should have foster care for the retarded children but they just don't h ave enough foster hom es for all the n orma l ch ildren they have, so they dump all the ha ndi ca pped ch ildren i nto institutions so that the norm al ones can have the good placements. Judge V\Tadcly sa id we can' t get by with that now. For too long, groups who differ from the norm h ave borne the brunt of insufficiencies, whatever they were - in schools, in health services, in alternative livi ng arrangements, in employment - a nd these insufficiencies have resulted in the detriment and the astronomica l costs in fiscal a nd human terms, both to the handicapped a nd to society. Let's see that they have their right fro m now on. W elcome to AMERICAN FORK HOSPITAL E xpert nursing care C oncern for patients A ware of individual needs R ehabilitate to patient's potential E ndorses continuing education for staff Irene B. Evans , R.N. Director of Nursing UNA -ANA AMERICAN FORK HOSPITAL Membership 350 East Third North American Fork, Utah 84003 UTAH NURSE ca me evident that nurses could b e used to good advantage in a more expanded role than h ad previously been clone. College Health l\lurse Practitioner Program Initiated at HYU A progra m to expand the role of the student health nurse was undertaken b y th e Brigham Young U niversity M cD on ald H ea lth Center und er the titl e, College H ealth u rse Practitioner Co urse. One of the first programs of its kind in the nation , the course was o rigina ll y d es ign ed b y Dr. Clovcl H ofhein s, Director of the McDon~ ld H ea lth Center, to provide additional training for the R .N. with the goal of stren gth en in g the ca pa city of the Health Center. The progra m is accompa n ying its purposes of greater studen t services a nd is a lso sparkin g interest in sim il ar nurse prac titi oner training programs in other areas. A giant step in expanding the program was taken as 26 nurses from 13 sta tes and one foreign country gath ered on campu s to a ttend the initi al core of a 12 month Prac titioner Program und er the coordin a tion of Sp ecial Cou rses and Conferences. Program Director is Marlyn Morris who is the Direc tor of N ursing at the McDonald Health Center at Brigham Young U ni versity. The initial core gro up m e t fro m June 4 through Jun e 29 in an inten sive di dactic curriculum with formal lectures, demonstrations, a nd discussions. The facu l ty for the program is derived from physicians of the Health Ce nter, gradu ate nu rse practi tioners, and various speciali sts from the community. The nurses are then assigned to four areas of trai n in g on a rotating basis. These areas are m edicine, gyn ecology, orthopedics, and counseling. Their experience in each area of rota tion is under the direction of a physician and is prac ticum oriented . SUMMER AND FALL, 1973 N urse p ractiti oner students are also assigned gra nd ro unds of the b ed patients at their hom e b ase o f operati on at whi ch time they participate in the analysis of the various cases, physical exami nation histories, etc. A process of weekly in -service meetin gs a nd instr u ction al p eriods continu es throughout th e year. At various points in the year·s cou rse, the nurses are requ ired to demonstrate their proficiencies in each of the selected areas of training to the preceptor physician. This m ay consist of a n actual physical demonstration a nd written eva luations. Each nurse pra ctitioner is also required to choose an area in which sh e b ecomes a resource p erson in h ealth teachin g at the hea lth center. Sh e keeps up-to-d ate on the la tes t work in that field and makes available to others p ertinent information concerning health education. Upon compl etion of the cou rse, the nurses are known as nurse practitioners a nd are in a position to function in ac tivities not previously op en to them. T h ey now help with the screening of patien ts, taking histories, trea tment of minor problem s, referring p atients to the physici an s, e tc. They may also be ca ll ed upon from time to time, to give talks to resid en ce hall groups or to other gatherings. The Brigham Young University program to ex p and the role of the nurse fi rs t began in the winter of 1968, when a severe flu epidem ic occuned , flooding the H ealth Center with large numbers of ill students. At that time, nurses were call ed upon to h elp in variou s capaciti es to meet th e grea t d em a nd for services. It be- Trainin g n u rses for such a rol e bega n immediately. Initiall y the training was give n on an informa l ba sis wi th phys icians providing inservice in stru ction in various areas as n eeded. The effort gradu all y became more soph isticated as the con cept crvstali zed. In the summ er of 1970 th~ first form al in-service training program to tra in nurses in a n expanded role was initi ated. At th a t tim e, the cu rriculum was organ ized a nd a facu lty assembled. The scope of trainin g focused on the age group in volved in the coll ege community. These nurse practitioners serve as excell ent resource p eople for talks and discussions on various health subjects. I Eva lu ation of th e program sh owed severa l positive reac ti on s. A survey of students and fac ul ty was made to determine their reactions I ' toward nurse practitioner services. The responses were favorab le. Further evalua ti o n indi cated that the program was adva ntageous in terms of job satisfact ion for th e nurses and also fewer demands were made on the physician s. Jt is further anticipated that the Brigham Young Un iversity College of Nursing will ad opt portions of the nurse practitioner training progTam in a n effort to qualify the nursing st ud ents as nu rse practitioners upon gra duation. It is hoped that ca mpu s R eli ef Socie ties, M IA groups, resid en ce halls, clubs and o ther gro ups wi ll take adva nta ge of the special lectures and demonstrations available throu gh the nurse practitioner program at Brigham Young Un iver sity. Ken Robbin s BYU PRINTING TYPOGRAPHY LITHOGRAPHY RULING Quality Press 52 EXCHANGE PLACE SALT LAKE CITY 363-57 5 1 PAGE 15 Nursing's Contribution and Commitment to Care of People PrefJaTed by Ad Ho c l\'ursing Impact Committee Appointed by American Nu rses' Asscia tion National L eague For Nu rsing AmeTican Association of Dea ns of Universi ty Schools of Nursing Ba ckground l nfonnnt ion This pa pe r is add ressed to the hea lth n eed s of people. Significant data point to the conclu sion that the h ea lth n eeds of p eople a re not b eing me t a t present, and that there is opport unity for ch ange a nd for reorga nization of the present health care deli very system. The reorganization a nd changes which should be brought abo ut in the present system must focus upon (l ) more comprehen sive service, (2) more co ntinuity of service, (3) more accessibility to services, (4) qu ality control with regard to se rvices, an d (5) services at reasonable cost. One of the cru cial points of dissatisfaction wi th the system today i.s the citizen's n arrow point of entry into it. Due to the fact tha t the present entry point or the key to entry is the physician, it is not surpri sin g that the h ea lth care system is primarily sickness oriented. This is understanda ble that the prime in terest a nd fun ction of the phys icia n is focused in differenti a I medical el i:1 gnosis a ncl med ica I trea tm ent. greater role. These primary h ealth ca re servi ces must b e coord in ated with hom e care services a nd institutional health care serv ices to ass ure continuity of care. This change will take unnecessary strain from institution al heal th services, so that these services can then more adequataly dea l with the illness oriented acute care programs which they are prepared to d eliver. A key to the overa ll pla n is that the h ea lth care serv ices be high in qual ity a nd available to all people within reasonable economic param e ters. To accompli sh this, it is essential tha t these services b e planned a nd impl emented to u se fully th e skills of all h ealth professionals so that the expertise of each group can provide the n eeded health services to the peopl e. I t is with this backgTotmd of projected framework, problem s, a nd goals that the following sta teme nt is m ade of nursing's contribution a nd commitment to the delivery of comprehen sive health care services. Nursing's Conribution and Commitment Unless the potenti al for nursing's contribution to the h eal th an d wellbeing of p eople is full y integrated from the planning stage through implem enta tion a n d evaluation of hea lth ca re, it will not b e possible to deliver quality h ealth services. Nursing services are the keystone of hea lth care del ivery. Nursi ng's contribution to h ealth care b ecomes evident at the participant-pla nning level of d etermination of h ealth sys tems a nd subsystem s. Studies of th e compre he nsive h ea lth n eed s of p eople (in wh ich the consumer h as participa ted) indicate tha t ther e is grea t need for multiple options of entry into a nd implementation 9~ a variety of h ealth services. These 'services should recognize diverse cultural, soci al, reli gious, a nd economic gro ups and should accom moda te their n eeds. The reorganization of these health se rvices sho uld preserve the b est features of existing models, while at the same time crea ting constructive avenues for innova tion, change, a nd improvement. T h e varietv of services must embrace th e entire' sp ectrum from promotion of h ealth through the end of life's span , and should provid e ways for entrance to these services which do not n ecessitate overcrowding insurmoun ta ble barriers. Another contribution of nursing is the coordination of h ealth services within the health system a nd its subsystems in order that p eople m ay h ave accessible movement into the sys tem a nd quality comprehensive health services can b e realized. Since the health needs of the majority of people are not of an acute n a ture, but are clearl y ones of m aintaining h ea lth a nd clea lin~ with Ion~ term di sa bling h ealth problems, it is evident that prima r y communitybased hea l th services must assum e a The major contribution of nursiRg is the delivery of humani stic care to people based on person al h ealth n eeds. Nursing's ex pertise (in addition to the traditional restorative care provided in acute ca re settings) is care of people with respect to PAGE 16 health assessme nt, health mainten a nce, care of p eo ple with problem s of long- term disab il ities (both in a nd out of institutions), a nd the provision of coordination and co ntinuity of health care services. In a re port released b y the Sen·etary of the D ep artm ent of H ea lth, Edu ca tion a nd Welfare in 197 1, on the extension of the scope of nursing practice, exa mples of how nurses currently function and how they ca n funct ion in the future in the areas of primary, ac ute, a nd long-term care were cited. This docum ent can be referred to for specifi c d eta il s with respec t to nursing's major co ntributi on to the h ealth care of p eople. Summ ary I t is clea r that full u ti lization of nursing's expertise will result in the d elivery of comprehen sive hum a nistic health care services. Present gaps in the provision of h eal th maintenance a nd long-term care ca n be bridged by nurses. N urses ca n provide n eeded continuity in services by tak ing responsibility for surveill a nce of cl ient popula tions a nd by making a ppropriate referra ls. Accessibility to the h ea lth care system can be increased by m a king is possible for individu als to enter the system via clinics, primary care centers, or o ther facilities staffed by nu rses. Nurses ca n assume respon sibility for monitoring the qu ality of home ca re a nd primary care as well as for the comprehensiveness of services r eceived , thus providing a nother avenue for exercising quality control. The fu ll and effective utilization of nurses wi ll . exert positive force upon the enti re health care system. Some of the Ad hoc Nu rsing I mpact Committee R ecommendations include : That a ll three nursing organizations (NLN, ANA, and AACN) endorse the broad statement of the Ad Hoc Nursing Impact Committee titled "Nu rsing's Contribution and Commitment to Care of People." That nursing must con centra te its efforts on au gumenting the numbers of nurses prepared as sp ecialist UTAH NURSE practitioners, as administrators, educa tors, and researchers. There currently exists an imbalance between the numbers of leadership p ersonnel in nursing and the large numbers of workers in th e fi eld who need guidance by those competent to assess the n eeds of p eo ple for programs of humanistic care, and to plan and execute such programs. That an interorganization pobli c affairs campaign be mounted with a view toward enhan cing a favorable public image for all of nursing, recognizing that efforts to promote the publi c image of each organization wi ll be continued. T hat coll abo ra tive efforts between a nd among nursing's organizations should lea d to concen su s with regard to broad policy issues. That in all efforts m ade to promote nursi ng's favorable public image, articulate and able sp okesmen should be relied upon who have particular expertise in the field which is being discussed. T h a t a I t h o u g h con siderable communi cation h as been had with regard to curtailm ents of federal funds in support of nursing, little eviden ce exists to date that alternative sou rces have been identified and commu nicated. Immediate search should be made to identify existing sources which might provide alternatives to the fu nds previously appropriated for nursing (Exam ples: Soc ial Security amendm en ts, can cer legisla ti on , etc.). That immediate ex ploration b e m ade to identify biparti san support for new legisla tion whi ch wou ld give recognition to nursin g. A p art icular potential are services providing for the chroni ca ll y ill an d those req uiring humanistic lon g-term care. (This has grea t potential for bei ng particularl y attractive to legislators eager to demo nstrate their con cern s for a group of people long neglected. It also h as potential for demonstrating the values and cost effectiven ess of nurse-directed program s.) That inasmuch as high visib il ity has been given to the existi ng eli scri min a tion agai n st women , it sh ould be politicall y ex pedient to stress the point that nursi ng is predominantly a wom an 's profession (although the profession has m ad e a vigorous attempt to recruit men). Thi s fact wou ld be p ar ti cul arly powerful as a point of n egotia tion for ad equa te support for nursin g and nurses. SUMMER AND FALL, 1973 That the nursing profession should continue to reaffirm its opportunities, rights, and support for women a nd al l minority groups in accordance with the Affirmative Action orders. Further, additional efforts to recruit and retain all minority group m embers should go forward. specialty practices be carefull y delineated as guides for programs of nursing education and for employers. Qu ality control of p erform an ce should b e effected through progra m s of p ee r review. Similarly, quality con trol of educa tional progra ms should b e assured through effec tive accredi tation processes. That d ecisions that rightfull y should be the prerogative of nurses are sometim es made b y others or by nurses in colla boration with others. Surveillan ce by organized nursing should assure that the outcomes of legislation wi ll m aximi ze the contributions that nurses can and should make to the health care system. (Example: Support of educational progra m s to prep are nurses as practi tioners are sometimes under the di rection of physician s.) That survelli ance of all nu rsing support personnel should b e the respo nsibility of the generali st and speciali st nurse practiti oners whose program s of ed uca tion have prepared th em for the res pon sibility. That ways and m ean s b e provided for the meetin g together of recognized leaders in nursing (special ties, research, ed ucation , and administration) who ca n influ en ce su ccessful impleme ntation of N ursing's Plan which h as been proposed. This colleagu esh ip effort should b e sp onsored through the nati on al nursing orga n izai ton . That there 1s a n eed tp de1 lineate competencies to be demonstrated by grad u ates of all types of programs. This presumes that educators will endorse the widest possible use of valid procedures to permit adva n ced placement of students who demonstrate atta inment of expectations. Long Range That nursing's contribution to the h ealth care system must continue to be remarkably enhan ced through scientific inquiry. Emp irica l investigations that enl arge nurs in g's data base and p rovide data about h ealth seeking prac ti ces and beh aviors of nursing's diverse clientele should be pursued and supported. Investigations that test a nd va lidate theoretical constru cts shou ld also b e supported as a means to adva n ce, stru cture, and con ti nu ously restru cture nursi ng's service. Because the use of valid knowledge provides the basis for effec ti ve practice, research en deavors must be au gm ented and supported. That an ex ploration be made of the structure and fu nctions of the national nursin g organizations in the interest of facilitating the achievement of the d esired goals of the profession, red ucing the duplication of effort and maximizing the resources (human and other) of the profession in m ee ting the h ea l th n eeds of p eople. That competen cies of practitioners prep ared to enter general and That the complexity of care to be provided b y support personnel with the guidan ce of nurses requires that th e trai nin g program s be adequ a te to assu re their technica l comp eten ce. That, for those already in the field, opportunities s h o u I d be thoroughly exploited to expedite their attainm ent of professional goals. financial programs of T h at support should recognize the needs expressed above in recommending con cern in g educa ti on al priorities. T h a t accreditation a nd a pp roval m echani sm s should be effective in eliminatin g programs not n eeded and those of inferior quality. T h a t a represen ta ti ve gro~p of administrators in nursing service and nursi ng edu cation convene on a n a tional level to discuss the requirem ents for preparation of nursing administrators. T h a t every pract1tJOner h as responsibili ty for his or her own continu ed learning as one means to maintain a nd enh an ce competence. Continuing edu ca tion is looked upon as short term and is not con sidered a substitu te for education that leads to degrees. Sources of opportunity for con tinuing ed ucation includ e selfstudy and practi ce as well as programs offered by higher edu cation in stitu tion s, employing agencies, and nursin g and other organizations. PAGE 17 THE IRMP EMERGENCY NURSE TRAINING PROGRAM The quality and accessibility of emergency m edica l care in most of the United States is inadequ ate in severa l respects. Defi ciencies occur in care rendered at the site of accidents, in transport and communication sys. .tems, and in treatment provided in hospital emergency departments. In the intermo untain region, great distances and low population densities compound these problems. T his region, comprising Utah a nd parts of Idaho, Wyoming, Colorado, Monta na, and Nevada, has a population of over two million. Tourism is a m ajor indu stry and swells the popul ation considerably during the sum mer months and winter sk i seasons. A shortage of physicians in rural areas exists. R ecent surveys have shown that few area hospitals have 24 hour physician coverage. Those that do are located alm ost exclusively in the largest citi es. Most small hospitals do not have the facilities or m anpower to handl e the more seriou s emergency cases and mus t transfer them elsewhere. Of course, not all hospitals should offer a full-range of emergency services. This is more properly left to the larger fa cilities which have the n eeded p ersonnel and resources. All emergen cy departments should, however, have the ~ capabi lity to initiate lifesavi ng m easures. In addition, they should be able to stab ilize the p atien t's condition insofar as possible prior to transfer to an other facility . The key to maintaining these capabilities lies with the emergency department personnel. They must be both knowledgable and well trained. This is by fa r the most important com ponen t of emergency care, being more signifi ca n t in reducing mortality and mobidity than are physical facilities or equipment. Programs to train ambu lance and rescue personnel, limited and few in the past, are now receiving increased emphasis and support through federal and sta te agencies. The role of this vital group is being expa nded to include critica l ski lls which were previously the exclu sive domain of the medi cal or nursi ng professions. Adva n ced emergency medica l techniPAGE 18 Cla n co urses include instructions and prac tice in cardiac defibrillation, endotrachea l intubation, intrave nous therapy, a nd other ski li s. The medical profession is a lso giving increased attention to emergency care. Steps have been taken to recognize emergency medici ne as a specialty that requires specific edu cation and clinica l ex perience. Many physicians now enter emergency medicine as a full-time job and contact with hospitals to staff the emergency departments. There are many postgraduate co urses and semin ars each year devoted to training and updating the skills and knowledge of emergency department physicians. vVhere does nursing stand in this regard ? There is a growing movement n a tionally to recognize emergency nursing as a specialty, but a specialty must by definition be based upon adva nced education and performance at a n adva nced level. Short workshops or inservice ed ucation programs do n ot fill this n eed. Basic nursing ed ucation provides only a brief introduction to emerge ncy care. There simply has been n o means to provide such specialized tra ining. Yet if nursing does not prepare itself to meet the publi c's need for improved emergency department care, then another health worker will do so. The trend of u sing non-professionals or n ewly created categories of personnel is evident in emergency care as in other segments of our health care delivery system. Ambulance attendants, corpsmen, emergency medical technicians and others are being staffed in hospital emergency rooms to care for trauma patients. With proper supervision these people provide a very real contribution. However, the person who seeks emergency care has a right to expect that he will be given concern, attention, clinical assessment and treatment from a professional nurse andj or physician. T he In termountain R egional Medica l Program received requests from nurses, physician s, and hospital administrators for a course in emergen cy nursing designed for the practicing emergency department nurse. Most of these individuals expressed the hope that the role of the professional nurse would be expanded to encompass a broader responsibility for patient care. In August 1971, the lRMP nursing sta ff, und er the direction of .Jea n Osborne, R .N., conducted a stud y of two local hospital emerge ncy departments, one rural and the other urban . To help establish the need for such a co urse, the data was coll ected to id entify nursing actions and to es ta blish how the nursing actions might be ex panded to improve the qu a lity of patient care. Several observations reported by the nurse-observe rs have implications for the nursin g profession. It was found tha t only twice in 136 observations did a registered nurse make an independent judgment - both times in the rural hospital when she assessed the enteri ng patients and suggested that they co ntact the physician in his office the following day. In addition, the R .N.'s generally did not report back to the patients' families in the wa itin g rooms, did no patient teaching, permitted medical advice to be given over the phone by the clerk, and did no effective " triaging" or screening of patients. This again seemed to be delegated to the admitting clerk. N urses functioned in effect as "fetch-and-carry" personnel, operating below the level expec ted of a professional nurse possessing such an ed ucation and preparation or backgro und and clearly below the fullest potential of a highly-trained professional. The emergency departments reflected clear exa mpl es of unmet pati ent needs and unused nursing judgme nts and skill s. A course was plainly needed to acquaint emergency department nurses with the opportunity to assume more res ponsibility and to provide them with the ski ll s and knowledge n eeded to do so. The IRMP initiated its Emergency Services Nurse Training Program in September, 1972. As the nurse specia list responsible for developing and implementing the curricu lum, I was most concerned that the course serve to stimulate those nurses who for one reason or another could not, or would not, assume more responsibili ty for assessing and training the emergency patient. This I felt was critical in meeting the main objective of the course, i.e., the improvement of emergency health care in this region. It was proposed to train 100 nurses from this region within three years. Enrollment was limited to 10 stuUTAH NURSE ~ 1 l 1 ] dents in each class with priority given to nurses from rural areas who worked without the benefit of physician coverage. A total of four weeks time was required for completion of the course. This time was divided into two-week sessions with a three-month interim period. Most of the content dealt with physical assessment, nursing diagnosis, and critical life-support skills, and about 50 percent of the time was spent in local hospital emergency departments. epinephrine as a li fe-support meas ure. For the nurse working without psysician coveraged, the ab ility to make the necessary judgments in such cases, and to institute treatment when warranted, is absolutely essential. The nurses must also be able to recognize and comm unicate to the appropriate physician when medical intervention is urgently needed, such as in the deteriorating h ead injury, the complicated delivery, the acute abdomen , or the card iac tamponade. Emergency nurses must make assessments of the medically ill, the pediatric patient, the obstetric patient, with a psychiatric disturbance, and the trauma patient, including those who are multiply injured. The nurse must be able to recognize most injuries, determine priorities of care, and initiate andj or assist with whatever therapy is indicated. While the nurse is not responsible for definitive treatment, she is responsible for that treatment which is necessary to preserve life and function. The skiils necessary for this are many, and the more important ones were covered in the course. Upon comp let ion of the course, students were tested both in theory and in emergency nursing skill s. A minimal score on both components was required. Because of the limited time available for teaching and clinica l experience, proficiency in all critical skills could not be expected. However, the student was instructed in the procedures and given the opportunity to practice each under supervision. Additional practice and proficiency will develop as the nurse returns to her hospital , equipped with the basic knowledge and preparation necessary to become a more competent and responsible emergency care provider. Airway management is of first importance in all patients, regardless of other presenting problems. Among the skills included here were manual maneuvers to relieve obstruction, the use of airways and ventilation devices, and endotracheal intubation. Cardiopulmonary resuscitation, including defibrillation was a required skill, as was identification of selected arrythmias, cardiac monitoring, and placement of intravenous catheters. Other skills of a non-critical nature such as superfi cia l wound suturing: were not taught due to time restrictions. The emphasis throughout the course was placed on (a) determining. the presenting problems of the patrent. and (b) initiating the nursmg actwns that must be undertaken (without the assistance and advice of a physician if necessary). For example, if the nurse determined that a ratient had a rapidly developing tenSIOn pneumothorax, she must decompress it immediately using a needle ?r venous catl:eter. If the patient is m hypovolemic shock, intravenous fluids shou ld be started, and block drawn for blood studies. The cause of the shock must be determined and appropriate treatment begun. A nurse who makes the diagnosis that a patient is suffering a potentially fatal allergic reaction shou ld administer SUMMER AND FALL, 1973 . ~espouse to the course from phySICians was supportive and gratifying They have almost uniformly been in agreement with our goals and have given their time for purposes of instruction or clinical assistance. The nurses themselves we re most enthusiastic and eager to learn. Many expressed the wish that similar continuing education courses were offered which demanded more of the nurse than mere attendance and which pro- vided practical experience ca l setting. 111 a clini- By June 15, 197 3, 40 nurses completed the training program. They came from Utah and the five surrounding states, and from both rural and urban hospi tals. With the tennination of funding on June 30, the Emergency Services Nurses Training ProgTam ended. Because the number of nurses completing the program was small, it will be difficult to assess the impact of such a program. Success in initiating changes in emergency department poli cies and procedures will be a crucial measure of success. The most important factor in accomplishing needed attitudinal and administrative changes will b e the individual nurse. The nurse who demonstrates that she can provide quality emergency care, making knowledgeable decisions and assuming responsibility for theil' outcome, will succeed in improvir\g patient care and nursing services. It is hoped that another institution wiii be able to carry on and continue with a program in emergency nursing. A beginning has been made; it has been demonstrated that the professional nurse wants and is able to learn skills necessary to provide mdependent emergency nursing care for the public. It remains to b e seen whether this becomes an established pattern or is merely a passing experiment. Susan M. Williams, R.N ., M.S. Former Nurse Specialist, Emergency a nd R es piratory N ursing of I.R.M.P. WASATCH VILLA CONVALESCENT NURSING HOME 2200 EAST 33rd SOUTH SALT LAKE CITY, UTAH -486·2096 RESTORATIVE CARE FOR THE CONVALESCING and CHRONICALLY I LL MRS. HARRIET PET ERSEN, R.N. ADMINI,STRATOR PAGE 19 PERSPECTIVE 01\1 THE GROWTH PROCESS 11\1 I\IURSII\IG EDUCATION ] oseph L. Price Assistant Professor of Nursing Universi ty of Wyoming, Laramie R ona ld E . Dra ke Assistant Professor of Nursing Univrrsi ty of Ut ah Person al growth, seen as a primary goal that emerges in the nursing curri culum , m ight b e defined as the capaci ty to respect, possess and con currently give of th e self. T h e student nurse comes to gradually achi eve this throu gh t he experience of being genuinel y res pec ted, regarded and unders tood by his nursing in str uctors. The educator must, to some su bsta nti al degree, have acquired simil ar knowledge of his own n eeds and ten dencies so that he ca n truly give of him self to th e student in the educa tional relationship. To b e effec ti ve, the educator, too, must have exp ::rien ced a simil ar kind of growth. The maturation process th at is spoken of h ere is not ju st a n abstract definition or an idea l norm , whi ch ca n b e dra sti ca ll y misleading if not well un derstood. Maturity is something which must b e built upon each student's awareness of himself, to in- elude h is ca pabil ities and h is limitations, sense of pe rsona l identification , co n fiden ce and es teem . The process establi shes a wi ll ingness within the student to ass um e responsibility for his own per sonal growth and development through self-awareness and an examination of the influences of self on pati ents, h ospital staff, p eers and faculty . This, it seems, is consistent with the student's on-going state of maturing and becoming a nurse. It is throu gh the maturational process that the in structor and the student alike are forced to a d etailed understa ndin g of the actual condition of them selves and of each other. The balance of this article will pursu e three aspects of th e student-instructor re lat ion ships as th ey regard the goal of achieving a n in creased level of maturity. Investing Oneself Invariably, nursing students seem to ar rive at the conclusion that in lea rning to accept them selves and to give themselves to patients, they mu st first h ave acqui red a sense of selfworth . Therefore, if the student considers him self worthless, h e owns nothing tha t is worth giving and, thu s, sh aring him self with others is HAPPINESS IS .. . NURSING AT THE COTTONWOOD LOS HOSPITAL • A 154-bed progressive, dynamic acute hospital • A suburban setting located at 5770 South Third East- Murray, Utah • A friendly place to work Rewarding and challenging Opportunities in Medical, Surgical and Obstetrical Nursing including Specialty Units • You'll love belonging to the- HOSPITAL with a PAGE 20 an impossible task. For love and acceptance to have any meaning to the student, h e must see himself as h aving some d egree of p ersonal value. Th ese feelings of worthwhilen ess are a prim e necessity for any honest rela tion ship with one's instructor, boyfri end , girlfriend, fratern al sibling or, u ltima tely, a pati ent. The self appraisal that one is worthwhile is the product of a long m a turing process - a process wherein significant others in the student's life reflect appraisa ls that are uncr itica l and esteem promoting. These a ppra isa ls of the stud ent from infancy through childhood to adu l thood are adopted and incorporated b y him and b ecome his views of himself. To receive in formation from others tha t one is valued, loveable and cared a bout becomes a b asic n eed for the maintenan ce and development of one 's psychological integrity. This n eed is ultimately fulfill ed in relationship with other p eople who are significa n t in an individual's life. T h e student who appraises him self as worthless does not escap e this state unti I someone firs t lo ves and accepts him. H e comes out of hi s state of worthl essness or gai ns a state of worth through another p e rson a nd tha t p erson 's con cern for him . When the nurs ing student is loved , h e begin s to build a reservoir of va l ue for h imself, and h e can then start to communi cate some love a nd acceptan ce to other people. This love of self is one o f the basic axioms in the gro wth process. The more mature nursing student, becau se h e is secure in bein g loved , can plunge i nto life and the busin ess of becomin g a nurse a nd provide skiiHul and comprehen sive pa tient care. The less m ature student, feelin g him self to h ave little worth, feels threatened, defe nsive, a nd so withdraws into a struggle of only attempting to become a nurse. What is important, the n, is that the nurse ed uca tor mu st help the student move out of his state of worthlessn ess into a mature, hea lh y sta te of self-accep tan ce. Possessing Oneself If love and accepta n ce ca n be considered to b e the h arbinger to investing the self, then a root d efi cien cy to in vesting oneself is the lack of possessing oneself. The student nurse who feels that h e is worthless and views the world as threatening, subsequently h as no ownership or control over him self. To offer him self as a gift would onl y b e an empty, meanUTAH NURSE ingless gesture. H e can only give the appearance of loving rather than making an hones t gift of himself to others. The nursing student must be helped b y his instructor to garner some level of understanding and control over his basic n ega tive feelings, anxieties and need s b efore he is abl e to possess himself enough to make an investment in others. student is and wha t his ca pabilities are. He learns to judge in relation to hi s personal limita tions and capabilities and to feel sa tisfaction in achieving as much as he can in resp ect to his own abilities and in a continual a ttempt to do better. H e experiences a positive recognition o f his self in relation to others and a deeper sense of self-regard. The imm a ture condition d escribed would suggest that the student's apparent love for another p er son may rea ll y be a fonn of subtle manipul ation, rece iving from the individu al more tha:n giving. Ju st as in m akin g a credit purcha se, in the course of tim e the consum er m ay pay b ack the actual valu e of the purchase several tim es over. The student nurse m ay do a sincer e service in the n ame of love; but, in fact, the d em ands he fin ally makes on the other person m ay ultimately outweigh the initial act of k indness. This m ay account for som e of the ra ther bizarre d emands some student nurses as well as gradu ate nurses pl ace on pa tients. For example, consider the nurse who subconsciou sly says to the p atient: " Look what I h ave done for you ; see how I've h elped you - you must get well ; you cannot die!" The student's inves ted identifica tion with other people makes it difficult to disentan gle himself and r egard each other separa tely in their own uniqu eness. This movement towa rd elf-regard initiall y m anifests itself with the a ttit ude, " I am disgusted with m yself." It then moves toward the ambivalen t attitude o f, " I am still unha pp y with m yself in som e ways, but in other ways I feel be tter about m yself. " Sometim es the p rocess reach es th e apex stage when the stude n t can reflect, " I am pl eased w ith m yself." Regarding Oneself In the process of educa ting nu rses, a r eorga nization of the self is brought about by the establishment of a more self-respec ting con cept of what the So often nursing educa tors reflect tha t stud en ts are d ependen t an d unable to establish personal and p ro fessional priorities, and, in their fr ustration, "count the student out. " In order fo r the nurse edu ca tor to m aintain an accepting, loving, and supportive attitud e with the student, it is vital that he be in trospective and examine his own feelin gs about the stud ent's b ehavior and the educator's subsequent b eh avior. If the educator's state of d ep enden ce is not p ersonally acceptable, a t tim es, to himselfj h er self, then a student's d ependence will not likely be accep table either. A s a consequen ce, the studen t m ay be cas t aside as " poor material for the program ." \ '\Those n eed s are being me t, then, th e studen t's or t he educa tor's? It becom es important, then for the nurse educa tor to understand the stu- dent's dependence, accept it as functional for him at that time, and begin with him at that point. It is in the final a pex stage of the maturing process tha t a student' s growing selfunderstanding and self - evalua tion fuses into the planning of new and better solutions and the making of more significant and h ealthy choices - independ ent of the instructor. Gradu all y, the selections tha t are plann ed are acted upon . These action s, b ecau se th ey h ave b een more carefull y tho ugh t o ut and organized, usuall y p rove to be more adequate and success ful than p revious plans. If they still fail som ewhat, the cau ses and the failu res can be examined. At t his p oint the self-evalua tion of action necessary to the planning and evalu a tion of tactics or stra tegies for ad equate living and professional n u rsing contribution takes place. As a st uden t begins to succeed, he gains confiden ce in his own self-yudgments and often takes more ra pid strides in acqui r ing n ew ways of functioning. In all, growth can develop thro ugh the nursing curriculum, accomplished through a human , helping, interd ep endent r elationship b etween the student and the nurse educator. Both members of the rela tionship learn to understand themselves and each oth er, the limitations as well as the cap abi lities of each . The possession and enhancement of self-wor th and value is an outcom e fo r both the student and instructor. Consequently, the ability of both to invest them selves in service to others is the out-growth of such an experien ce resulting in a sen se of pride and accomplishment. "YOU, YOUR PROFESSION AND POLITICS" LEGISLATIVE WORKSHOP DATE : October 5, 1973 TIME: 3:30 to 9:00 p.m. PLACE: Weber State College, Og den , Utah, Union Bu ilding Ballroom REGISTRATION FEE : $2 .00 SEE SEPTEMBER AND OCTOBER CALENDAR OF EVENTS FOR REGISTRATION FORM -- OR C.ALL UNA HEADQUARTERS 322-3439. THIS EVENT FOR UNA MEMBERS ONLY. SUMMER AND FALL, 1973 PAGE 21 Educating Health Professionals For the f uture HELP WANTED ! Dr. Robert H . Kroepsch, Executive Director Western Interstate Commission for Higher Education presented at a banquet honoring Dr. Mildred Quinn, D ea n , Coll ege of Nursing, The University of Utah on the occasion of her retirement The Profession Of Nursing Needs Your Support. I ~ Encourage UNA-ANA Membership TODAY! Hotel Utah, Salt Lake City, Utah June 1, 197 3 I have been asked to share with you tonight some of my p ersonal views about education and health two fields to which Mildred Quinn has dedicated her life. And this I am pleased to do. l must, how ever, at the outset insert a strong disclaimer. Th ese are m y personal views, and they do not in any way purport to reflect th e views of the WICHE Cornmissioners or of the WICHE staff, even though I suspect many of them might agree wi th much of what I shall say_. • • • What will the health system of the future b e like? I should like to begin with a quotation: "No American will b e prevented from obtaining basic medical care by inability to pay." This I b eli eve will eventually come to pass. But b efore it can, there must b e drastic changes in our health system, in its structure and its organization, in the way it is operated and financed, in the p eople who manage and deliver services, and in the ed ucational systems that not only prepare p eople to deliver h ealth services, but also prepare people to receive these services. Let m e repeat the quotation: "No American will be prevented from obtaining basic medical care by an inability to pay." This statement wa s made more than two years ago by Presid ent Nixon. The goal is still somewhere in the future. But each of us must do what he can to aid in the struggle to reach it. Let me describe to you, bri efly, what I b elieve some of the characteristics of our future health system will be. PAGE 22 It will b e comprehensive. A full range of care a nd services will be avail able to everybody: health maintenance, disease di agnosis, acute and intensive care, and restorative and exte nded care. Th e sys tem will embrace m ental illness, as well as alcoholi sm and drug abuse. Health educa tion will reach all of the p eopl e, and increasingly p eople will receive health care, especially a t the maintenance and prevention level, where they live, work, and go to school. There will be a new and increased emphasis on health m aintenance and disease prevention . Peopl e responsible for the sys tem, as well as the publi c, will finally recognize that the prevention of illness is a less expen sive undertaking than the treatment of acute or chronic disease. New scientific developments and preventive medicine will contribute to this trend. The health system will be based on n ational systems of h ealth insurance. There lie ahead blood y and pa inful battles among politicians, insurance companies, labor union s, taxpayers' groups, and organized medicine. But eventuall y there will emerge equitable systems for all . . . includin g the poor, minorities, and the aged . and even the middle-class won' t be forgo tten . The system will have a greater capacity for change than our present one. Computers will give us the ability to test out the implications of various management decisions quickly, as well as the ability to determine the unit cos ts of various procedures accurately. Scientific knowledge will continue to develop rapidly and b e applied more quickly and broadly. Communications networks will provide for the rapid exchange of information among health professionals at all levels, expanding each one's scope of vision. Incentives will b e established to mount the d emonstration and evaluation of new methods and means of providing health care. And consumers and taxpayers will d emand both excellence and efficiency. The roles and tasks of h ealth professionals will be far less rigidly d efined than they are today. H ealth care teams will obscure the existing sharp lines between hea lth professionals. In UTAH NURSE different situations, eli He rent members of the team will be the lead ers 1ew a nd decision-makers. hea lth occ upation s will emerge; o th ers will cha nge; a nd som e ma y di sa pp ear. For exa mple, the cure of cance r will release ma n y highly specialized health professional s to concentrate on other problems. Li ce nsing a nd ce rtifyin g agencies face m an y hea d aches, but they will adju st. Sta te lin es as b a rri ers to prac ti ce will di sa ppea r. Continuing edu ca tion for all members o f th e hea lth systems will be necessa ry to kee p pace with ra pid cha nge . .In creasingly, uni ve rsiti es will recogni ze continuing edu ca tion as one of their major fun ctions, ra ther tha n as a n add-on or overload fun ction. Consume rs o f health se rvices will pl ay a signifi cant role in pl a nning, policy-ma king, a nd evalua ti on of the health sys tem. Their voi ces will b e h eard lo ud a nd clear, not only as indi viduals, but through advi so ry committees a nd councils a t th e community level, as we ll as at the sta te a nd na ti ona! levels. * * * How will thi s health syste m b e sta ffed ? Most health care will be p rovided, not b y indi vidu al practi tioners, but by h ealth team s. T hey will be organized to provide effi cie nt a nd thorough health care by utili zing the talents of each member of the team to the full es t extent - thu s freeing those with unique talents from tasks which ca n be perform ed b y others. And the re will b e a va rie ty of health teams. Le t me d escribe a t least four. • E N VIRO N MENTAL TE A M S. T h ey will identify unhea lthy elements in th e ph ysical a nd social environment a nd work to cor rect them . T h e geopra phical a rea on which they wi II foc us could b e ver y large -an entire river system, fo r exampl e. HEALTH MAINTENANCE AN D DISEASE PREVEN TION TEAMS. They will operate in a more limited community, supporting the work o f the environm ental team s a nd providing health educa tion and compreh ensive screening for di sease. ACU TE A N D I N TENSIVE CAR E T EAMS. They will fun ction prim arily within the walls of m edical facilities, which will include ma ny new types, providing optimum care for seriou sly ill patients. SUMMER AND FALL, 1973 RESTORAT IVE AND EXTENDED CARE T EAMS. They will render care, including thera peutic a nd psychologica l services, to p a tients recovering from va riou s d egrees of illness. To d a te, most of ou r pa st efforts have b een focused prim aril y on the L1un ction s p erfo rmed by the acute a nd intensive ca re tea ms. In the future, more resources, including time, monev, a nd resea rch, will be funn e h~ d into the acti viti es o f the o ther three tea ms. An increasin g number o f interested a nd abl e volun teer workers will assist in th e ac tu al d eli ve ry of h ea lth care, se rving as esse nti al m embers of every t ype of h ealth tea m. As their comp eten cies improve, they will even assume some duties n ow performed by pro fessionals. On e of th e great educa tion al challenges will be to pre pare all those who will m a nage the variou s segmen ts of the hea lth sys tem, those p eople skilled in ma nagement who must also h ave a working knowled ge of the entire system a nd a b asic understanding of th e co ncep ts of h eal th a nd illness. There will be h ealth ombudsma n. They will serve as con sum er ad voca tes, h elping p eople to m ake full use of the hea lth ma intena n ce system , facilita ting their entra n ce into the acute or restorative svs tem s, and assisting them to co pe with those sys tem s su ccessfull y. M an agers of h ealth-rela ted enterprises, who may not be members of traditional hea lth professions, will b e broadly educa ted a nd knowled geable and will administer h ealth progra ms at the nation al, r egion a l, sta te, a nd local levels. A new breed of health facility ad ministra tors will b e n eed ed to m a nage n ew fac ilities for h ealth mainten a nce a nd res tora ti ve ca re as well as ac ute care ce nters. Planning a nd ma n agement specialists will d esign a nd operate the m an agement inform a tion sys tems, which will b e essenti al to suppo rt highly complex health structures. H ea lth data spec iali sts will bridge the gap be tween the da ta managem ent professionals a nd the hea lth professions. They will condu ct research on con sum e r ch a rac teri sti cs, history, a nd need s a nd will disseminate these data quickl y to appropria te persons in the h ea lth system . The primary genera tors of cha nge will b e research er s a nd eva lu a tors: BIOLOGICAL A D ENVIRONMEN TAL RESEARCHERS, who will uncover n ew knowledge to improve the efficiency of all elements of the system. T ECHNI CA L RESEARCHERS, will invent a nd p erfect new m edical machines a nd technologica l d ev ices. C LIN ICA L CARE RESE AR CH ER S, who will d evelop resea rch to d e termin e which a pproac hes, activities, or tec hniqu es used in the direct care o f pa ti ents will result in optimum pa tient response a nd recove ry. H EALTH CARE DELIVE RY R ESEAR C HERS, who will subj ec t the va ri o us systems of d elive ry of h ealth care to inten sive r esea rch and evaluate the results of differen t a pproaches. MANAG E M ENT R~S,EA RC H­ ER S, who will continu e to search fo r new techniqu es for effi cient ma nagement a nd optimum cost effectiveness. EVALUATION SEPECI ALISTS, who will provide feedback loops serving a ll operations. Consumers will also play a n active role in the evalua ti on process. The h ea lth sys tem itself will embrace a n ed uca tion al componen t which will have at leas t two m ajor function s. It will ass ume increasin g responsibilities fo r staff tra ining a nd staff d evelopme nt in close coopera tion with edu ca ti on al insti tution s. T h ere will b e regular procedu res for reexamina tion a nd ce rtifica tion as prerequisites to continuin g practi ce. T h ere will a lso b e educators of consum e rs. ' !\Then p eople a re acutely ill, it usually ta kes bu t a little educa tion to con vince them tha t they sho uld see k medi ca l help. It requi res a far more sophistica ted educa tion al progra m to convince people who a re well that they should ta ke prec ise a nd aggressive continuing steps to m aintain their hea lth. A substa ntia l cadre of personnel, spec iall y trained, will perform this fun ction . * * * So wha t a re the impli ca tions for educating hea lth profession als for the future? Ma rga ret Mead 's classic quote h as special significance for health educa tion. She says, " W e must educa te people in what nobody knew yester(Continu cd on page 24 ) PAGE 23 Health Professionals (Continued from page 23) day, and prepare people in our schools for what no on e knows yet, but what some people mu st know tomorrow." I say thi s quota tion h as specia l signifi ca nce for us b ecause it is estimated that b y 1975 health care will represen t the larges t segment of employment in this country. Already in 1972, the enrollm ents of college juniors in h ea lth profession al programs in creased more than ,- in any other fie ld . . . a whopping 19.5 percent over 1971. In second place were the life sciences with a 12.8 percent in crease and in third place social science m ajors with 8.3 p ercent. All thi s h appened in one year, during whi ch the tota l size of th e college junior class in creased onl y 3.2 p erce nt. It ha s b een pointed out by Alvin Toffler th a t in o rder to avo id future shock, our entire ed uca tion al system mu st shift its focu s from the past a n d present and d evo te more of its attention to th e future. We must produ ce personnel who will coordin ate a nd d eliver h ea lth ca re in n ew ways, p erson n el who are not afra id of innova tion a nd ex perimenta tion, a nd p ersonn el who do not fear sound m e thod s of eva lu ation. Th e mix of people who ed uca te h ealth workers wi ll cha nge. In add ition to th e tradi tiona ! types, there wi ll be sp ecia li sts in ecology an d pollution control. Social a nd beh avioral scientists will orient students t~ hum an perceptions, needs, and prob lems. There wi ll be experts in communi cations, a nd m a n agement ex perts, a nd sys tem s an alysts. Memb ers of minority a nd ethni c groups will sen sitize all h ealth workers to the specia l needs and to the va lue systems of nonwhite, non-middle-class cultures. And increasin gly, we will u se h ea l th practitioners in ta ndem with professional ed ucators. Consum ers a nd volun teers will be train ed as ed ucators to teach the elem ents of health m ainten ance in their home commun ities. Selec ted residents of r ural com munities wi ll serve as h eal th mainten a nce ed ucators. I n flu enti al persons in ethni c communities, where distru st and language barriers now prevail, will provide health educa ti on for their own people. Man y more students wi ll work part-time durin g vaca tion p e riods as h ealth eel uca tors for selected commun ities. PAGE 24 Faculty members will ch an ge, too. They will become p eople-oriented and teach their students about health ca re for p eopl e ra ther than about pati en t care onl y. W ebster's dictionar y d efine s "patient" as "one who suffers or endures; as in a hospital or the like." This con ce pt is too limited. Although there will sti ll be patients the education of all h ealth workers will b e focused on th e broader conce pts of h ea lth ca re for all the peopl e. Faculty members who gain leadership roles wi ll ea rn th em because of their talent, creativity, interes ts in ch a nge, orie n tation to th e future, a nd interest in people. Seniority and form al cred entials wi ll b e less important. D epartm ent chairm en and clea n s who are resistant to ch an ge and who refuse to embrace it, or who represe nt th e a utocrat ic or a uthoritari an pa tte rn s of th e p as t, wi ll n ot be reappointed , but will be r eplaced . ' t\Tavs and m ean s wi ll be d evised to m; ke individual fa culty m embers aware of the importa n ce of keeping the co ntent of what they teach releva nt to the rea l world. Each facult y m emb er regul arl y will h ave practi cal ex p erience as a h ealth worker outsid e th e wa ll s of the i nstituti on in whi ch he teach es, preferably in a situ a tion that is n ovel. This will be a requirement for continu ed emplo yment. White fac ulty will b e sen si tized to the probl em s, n eed s, a nd va lu e system s of th e n on wh ite popu la tion, and efforts to promote ra cia l understandin g will b e m ad e in every edu ca tional settin g. In addition, white fac ulty will h ave pra cti cal ex perien ce in workin g o utsid e the in stituti on in community settin gs, includin g gh ettos, barrios, and reservations. Th ere wi ll also be chan ges in the catego ries of peopl e who a re educa ted . More opportuniti es to b ecom e lea ders in the h ea l th professions wi ll be provided to m embers of minority gro ups. Schools which prepare p eople for p rofession s no w domin a ted b y wom en will actively recruit more m en . Sch ools whi ch prepare p eo pl e for professions now domin a ted by men will actively recru it m ore wo men . More h ea lth edu cation will be gi ve n to such p eople as community plan ni ng ad mini st rators, welfare workers, social security ad mini strators, prov id ers of h ealth in sura n ce, m a nagers of h ealth faci li ties, a nd analys ts of health care system s. Communi ty p eo pl e who want to serve as voluntee rs on various types of hea lth ca re teams will also en roll for in struction. For every p erson who is p a rt of the health care d eliver y system, there will b e a requirement for continuing educa tion programs. In stitu tions wi ll d ecentralize con tinuin g eel uca tion facilities to minimize th e travel required of h ea lth workers. The b u dge ts of schoo ls prep arin g h ealth profession als will reflect this n ew emph asis on continuin g education . Beca use of the rapidity with which n ew knowl edge about all as pects of h ea lth care will b e discove red, curricular revision will be continuou s. Curricula wi II focus on techniqu es of h ealth m ainten ance and di sease prevention , but m ore emph asis will b e given to psychologica l concepts, a n overview of the h ealth system s, techniqu es of scientifi c ma n agement a nd system s an alysis, relation ships b etwee n h ea lth ca re and th e law, and th e developm ent of n ew h ea l th career program s. Team tea chin g will increase a n d wi ll r efl ect a n i nte rd isciplin ary approa ch to ed uca tion. Different typ es of h eal th profession als wi ll b e edu ca ted toge ther. There wi ll d evelop mutu al respec t a mong speciali sts in all h ealth a nd h ealth-related disciplines. The acceptance of the team con cept in the classroom will support teamwork later in th e fi eld . If they a re to work toge ther, they mu st b e ta ught oge ther. Th ere wi ll b e maximum ui lization of com muni ty resources. Th ere will b e m axi mum u tilization of technologica l teaching devices. F lex ibi li ty in th e educat ional tim e spa n wi ll b ~ introd uced so that students ca n more eas il y progress a t their own p ace. Current inte rnsh ip a nd resid en cy progra ms will und ergo cl ra sti c chan ges. After a core progra m of health ed uca ti on, most heal th workers will chose one of two primary careei' pattern s. On e track will emphas ize pra cti ce that is essenti all y cura tive a nd restorative, as in institutional settings . The other will empha size practi ce in community se ttin gs, largely outside h osp ita l wa lls, concentrating on hea lth mainten a nce a nd disease p reventi on. All mean s of promotin g a nd reward ing career d evelopm ent will b e utilized . Credit by exam in at ion wi ll b e universall y accepted. Tested comp eten cies will quali fy students for cred it. T he concep t of the extern al UTA H NURSE degree wi ll be acce pted in theory and practice. High ly motivated and mature students who pass examinations will b e awa rded the appropriate d egree rega rdless of the time they ha ve spent in edu ca tional institution s. The opportunity to exercise options a t variou s points on a ny h ealth ca reer continuum will be provid ed a nd encouraged. New career ladd ers with bui lt-in crossovers will become common p lace. All thi s will req uire b etter and more effective co unseling of students. To provid e every student with the connecting link b e tween hi s or h er educa tion a nd role as a h ealth worker, educational facilities will b e increasingly d ecentralized a nd assoc iated with the n ew facilities for h ea lth delivery care. Ambulatory clinics, outpatient facilities , extended ca re units, half-way hou ses, nursi ng hom es, a nd n eighborhood h ea lth centers will be used as edu ca tional laboratories in the pre para tion of all types of h ealth workers. A m ajor part of each student's edu cation will b e provided in n ew types of education al settings, such as n eighborhood a nd small town h ea lth centers, a nd in more centralized spec ial serv ice faci lities which will b ack up the n etwork of th e small er ce n tcrs. Shifts in attitude on the part of both consum ers a nd h ealth workers will provide a powerful force for chan ge in the hea lth systems and the process of ed ucatin g it. Evalu ation b y students will increase. They will serve in significant numbers on faculty committees that m ake recom mendations abo ut student life a nd about their preparation as h ealth workers. There will b e regul ar evaluation of teaching b y students, p eers, and outside consulta nts to judge each faculty member's effect ive ness. This will b e an importa nt component in m a king deci sions about sa la ry increm ents. Most schools will reta in outsid e a nd pa rtial evalu ators to su rvey the produ cts of the system (t ha t is, their own grad uates) at a reason able time b eyo nd grad ua tion, to ascerta in th e graduates' attitudes toward the quality and releva nce of their ed ucati on. Those who employ the products of the system wi ll also eva luate the quality and sco pe of the hea lth workers' learning. There will b e more em phasis on research in the delivery of health ca re in various types of settin gs, as well as the cost effectiveness of various apSUMMER AND FAll, 1973 proaches. There wi ll be research on teaching techniques and much more ex perimentat ion with innovative a pproach es. More experiments involving control groups will be mounted. Every institution of health education wi ll estab lish a nd m ainta in a Council of the Future in the sense proposed by Alvin Toffler in h is book Future Sh ock. These co uncils consisting of students, faculty, practition ers, a nd consumers - will brainstorm fre ely, eve n wildly, a bout the future, m a king prediction s, drawing up pla n s, a nd init iat ing ch a nge. They will draw on all the sources of research a nd thinking, a nd feed their conclusions back to all components of the system. They will have the a uthority to imp lem ent ex p erimental programs based on their predictions, thu s helping their in stituti ons "to invent the future. " Valuable _service to the communtty A ppeciates your evaluations Listens to the patients Listens to the people i * * * In closing, I quote from Alvin Toffler's Future Shock: "The inability to sp ea k with precision a nd certainty a bout the future, however, is no exc use for silence." To night, I have not b ee n silent, nor h ave I b ee n prec ise. R ather, I have tried to enco urage all of us wh o h ave a n y responsibility for the delive ry of hea lth care or for the edu cat ion of hea lth profess ion a ls to shu ck off th e o ld m yths, a ttitudes, and ste reo types that inha bit us a nd to embrace innovation, ch ange, experimen a tion, and eva luation, so that the h ea lth needs of o u r people will b e more fully met. What I have proposed may seem indigestible to some of you . Others will say that the obstacles are too form idable to overcome. However, almost everythin g I h ave described ton igb t ex ists a nd is workin g well somewhere. ·v vhat we n eed to do now is to find ways to put it all together, knowing full well t hat we ca nn ot design the ultim ate; we can onl y continue to struggle towards it. This is a large dose, granted. But we mu st rememb er the adm oni tio n of Hippocrates: " Extreme remedies are very <1 ppropriate for extreme diseases." Let's make our hea lth system healthier. There are many of you in th is room tonight- and elsew here- wh_o have been d ee ply influ en ced by Mi ldred Quinn, inspired by her devotion and dedication and her faith in the future. You are going to make ma ny of th ese things happen - and soon! I Employs qualified personnel Your concerns are our responsibilites Works towards improved patient servLces Endorses continuing education for personnel Specialized patient care Total h_ealth team commLtment HOSPITAL 4160 West 3400 South Serves: Granger, Hunter, Magna and Kearns PAGE 25 In The Mailbag ... If you desire to write to Elaine, her address is as follows: E laine Murphy Box 58 Nukulofa, Tonatapu Tonga , Friendly Islands FROM ELAINE MURPHY IN TONGA DEAR CORALLENE AND ALL, Just a note to say " Hello" and to remind you all of how fortunate are those nurses who can use known medica l and scientific aids in their practice of nursing. Being in Tonga is like stepping backwards in time twenty-five years as far as types of ~ health problems and methods of pre·· vention and care are concerned. The use of myself in the art and science of nursing is the one thing I can usua lly depend on and I'm grateful to people like Annette Bilger, Hazel Macquin, Mildred Qu inn and Sue Fujiki for their part in developing those skills. The Togan Health Department is striving to use its major funds in the best way possible to use existing knowledge in the delivery of Health Services to its people. WHO and the P eace Corps are being very helpful. The medical and nursing personnel are wonderful to work with - as are most of the Tongans - A Truly Friendly People - which was why Captain Cook named the 250 islands of the Togan Kingdom "The Friend ly Isles". I appreciate receiving the Utah Nurse. I read it from cover to cover hungry for the n ews of people back home. I sometimes wish for a brief statement regarding the background of authors which are unfami liar to me - 1'qe on ly suggestion I have for improvi::Inent. Thank you agai n for keeping in touch. Sincerely, Elaine Murphy NOW! been attending workshops from McKay Hospita l are: Karaleene Miller - "Rehabilitation Continuing Education" workshop in Geriatrics; JoAnn Rowe and Deanne Hales - " I ntermountain Emergency" workshop at the University of Utah and Delpha Allen - "American Academy of Orthopedic-Surgery" workshop. - Joan \ 1\Thite, the new Director of Nursing at St. Benedict's Hospital. Grace Hart of Railroad Clinic will be attending the meeting of the American Association of Medical Assistants in Washington D.C. this Octob er . Joan \1\Thite, Tony Felice and Carol Lamberson attended the "Communications" workshop in Sal t Lake City. Ogden Ci ty School District nurses all successfull y completed their "First Aid Course" which they repeat every three years to be re-certified. Al ice Hirai and Shirley Smith went to Arizona for the "Mental Retardation" workshop. Helen Rogerson and Norene Mecham are wi th the Migrant School in Roy for eight days. Th ey are also p lanning to attend the "\!\Tell Chi ld Assessment" course in August. -The Head Nurses group at St. Benedicts who are actively involved with the pl anning of the new St. Benedict's Hospital. About 100 District 2 UNA members attended the workshop on "Death and Dying" presented by Dr. Kubler-Ross and Dr. G len Vernon. - Ruth Powell and Barbara Tucker who are coordinating the care on the new Stroke Unit at St. Benedict's Hospital. The philosophy of the unit is to start rehabi litation measures as soon as patients arrive on the unit, such as range of motion by the nurse and other measures by the ph ysical therapist and speech therapist. The W eber County Hospital is having an experimental project of ten hour work day in two of its divisions. A lso, "Patient Awareness Week" is observed when an employee goes to one of the un its as one of the patients for one clay. Remotivation and Behavior Modification programs are on going at the hospital. District 2 News CONGRATULATIONS TO: -Jan Higham upon her <~ppo i ntment as Inservice Director of Nursing at McKay Hospital. -Eva Jean Law elected as chairmanelect of the Admin i str<~tive Conference Group. - Verle Lesnan, the new coordinator of the extended program of the University of Utah College of Nursing Baccalaureate Program at \1\Teber Coll ege. Several District 2 nurses have been busy attending various workshops. Doris Maisak and Sally Brush from Intensive Care Unit at McKav Hospital attended the "American Neurological-Surgical" workshop in Beverly Hills, Ca lifornia. Others who have Elsie Knowles of McKay Hospital toured the Scandinavian countries for 23 days. Beth Stallings of Weber County Public Health has retired after 16 years of dedicated nursing service to the community. Elsie Shiramizu Reporter for District 2 for Members of the Utah Nurses Assn.! The following Programs are: Ava!lable through : Officially Sponsored and Endorsed by Your Assn. D Income Protection - provides an emergency paycheck when Illness or injury keeps you from working. D Hospital, Surgical and Medical Expense protection . MutuiJIC\ ~milhil~ 1JN. C11111p.~nq dwt p111JS D Special one - policy Life Insurance for the entire family (and at one low premium that any children in the future) never increases! PAGE 26 l il~ lns u,.nc~ Affil i•t~ : Unit~d o.~ Om•h• M llh.IAl Of 0MAI1A INSUlA ... (( COM,ANY tt0M l OH ICl OM AHA, h lllA~ WM. B. TOOHEY AGENCY Salt Lake . .... . ... 487-0781 2104 E. 33 South Provo ... . .. . . . ... 374-9968 444 No. University Ogden . . .. . . ..... 394-4950 2938 Washington UTAH NURSE Job Satisfaction Among Nursing Service Personnel Welcome To Utah Join ing Holy Cross Hospital's staff as Assista n t D irector of Nursing Service is Miss Annette D inauer. She brings to her position valuable experience and tra in ing in the nursing field. A native of a suburb of Milwaukee, Wisconsin, Annette attended a diploma school of nursing in Milwaukee and then worked as a staff nurse in a psychiatric hospital. A move to Los Angeles and employment once again as a psychiatric staff nurse followed. After attending school on a part-time basis, she ret urned fu ll time and graduated from California State College at Los Angeles wi th a B.S. in Nursing. Graduate school b eckoned and Miss Dinauer received a Masters of Nursing (M.N .) in 1968. Appointment as an instru ctor in the University of New Mex ico College of Nursing (Albuquerque) followed and proved to b e educational and enjoyable. Feel ing that hospital administration offered her more "ac tion, " she assumed the responsibi lities of Assistant Director of Nursing at the University of New Mexico Teaching Ha spi tal. by Edna Lee Neumann A paper presen ted to the Sixth Annual Communicating Nursing R esearch Conference W estern I nlerstate Com mission for Higher Education in Nursing Phoeniz, Arizona April, 1973 INTRODUCTION Annette Dinauer The spaciousness of the Mountain States a ttracted Miss Dinauer in O ctober to Utah and Holy Cross. In her assignment here, much of her time is spent working directly with all Nursing Service coordinators, home health coordinator and admitting order nurse. Spare time away from her work finds Annette reading (everything) and hiking. Free Yourself I• practice nursing at holy cross hospital. Freedom is nothing else but a chance to do better. Camus .. For freedom m nursing practice contact D UAN E D . WALKER, R.N . DIRI!;CTOft 01" l'lURSI N G .ER VICES HOLY CROSS HOSPITAL 1045 East First South Salt Lake City . Utah 84102 Telephone: [phone] AN EOVAL OPPORTUNITY E MPLQVER Concern over manpower needs in nursing has centere~ attention on finding ways to ret~m gTeater numb ers of nurses in active employment. The demand for increased numb ers technoloaical changes, and other ' "'on the nurse&. ~ . d of modifications ' worl work tend to emphasize the importance of examining how she feels about h er job and the con~ext in which it is found. Understandmg the complexities of these at~itudes and r~­ actions assumes great Importance If efforts of employers are to. be ~uc­ cessful in avoiding work ahenatwn, job dissatisfaction, and c<;mtinued increases in the already h1gh rates of nursing personnel turnover. Those concerned with the delivery of hospital nursing services can benefit from efforts to understand more completely factors u~d~rlying nur~es' attitudes towards their JObs. Studymg job satisfaction amon~ ~ursing ~er­ vice personnel can assist m resolvmg the chronic, and ac ute shortage of nursing personnel. In addition to influ en ces on recruiting and retaining nurses, job satisfaction among hospital nurses has been related to su ch aspects of hospital management as high a n~ :ising costs, low rates of productivity, decreased quality of care given . to patients, high rates of absenteeism· and turnover (Woolf, 1970); to professional disill usionment and role conflict (Corwin , Taves & Haas, 1961) ; confusion (Benne & Bennis, J 959) ; role deprivation and loss of professionalism (Kramer, 1968, 1969) ; the inactivity of large numbers of Registered Nurses (Stacey, 1967) ; Bellinger & Cleland, 1969); and the number of nurses who abandon their profession entirely (Lawton, l 970) . Thus given the totality of factors purported to be related to job satis(Con tin ued on page 28) SUMMER AND FALL, 1973 PAGE 27 Job Satisfaction (Continu ed from page 27) faction - or the lack of it - among nursing service personnel, the study o£ this concept is an important one. Yet, in spite of the agreement among practicing nurses, and their employers, as to the importance of job satisfaction, there is wide disagreement as to the meaning of the term itself. Studies of job satisfaction are m arked by a general lack of attention to the exact nature of the concept, per se. This study was undertaken to identify the underlying structure of the concept, job satisfaction, among nursing service personnel employed in gen eral hospitals. Additionally, it was exp ected that sub-samples of nurses would differ in the importance attached to various dimensions of job satisfaction , and that differences b etween hospitals, and b etween Registered Nurses and Licensed Practical N urses wou ld ex ist relat ive to the dimensions. D espite these differen ces, the focal p oi n t of the st udy was the d evelopment of a factor stru cture of job sat isfact ion which wou ld provide a n empiri ca l b asis for a more ad equate definition of job satisfaction among nursing service personnel. In this study, job sa ti sfaction is con ceptu ali zed as a complex, multidimension al set of a ttitudes or feelin gs towards one's job, d etermined p artly b y indi vidu al characteristics the worker brings to the job, a nd partly b y environm ental factors h e p erceives on the job. Furthe r, social forces su ch as norms and roles also influence these att1 tudes. Job satisfac tion involves affective, cognitive, a nd probabl y eva lu ative components; and includes a n action tendency. Job satisfaction influen ces one's behavior on th e job, probably through processes of d eveloping preferen ces (Yarrow, 1960). A ttitudes such as satisfaction vary from p erson to p erson, a nd over tim e, alth ough they are ch arac terized as b eing relatively stabl e and consistent (Scott, 1968). The individual's level of job sa ti sfaction, like hi s other · a ttitudes, is inferred . In thi s case, job satisfaction or di ssa ti sfaction is inferred from the subject's response to statements about various aspects of his job. basic factor structure of job satisfaction among nursing service personnel employed in general hospitals, and assessing the importance of these structural components to the subjects. The study involved comparison of hospitals and other sub-samples. A factor analyti c approach was chosen b eca use it results in various relatively independent dimensions of a concept, whi ch can b e compared across sam pies. This mu I tidim ensional approach attempts to go b eyond surfa ce, global, judgments in that it brings to li ght additional dimension s of subjects ' responses. The techniqu e automatica ll y (through the correlation of each item in the m easure with e ver y other i tem ) selects and weigh s each item in term s of its r ela tive contribution to a given factor ial dimension. In the fin al an alysis, one is able to iden tify the stru cture of job satisfaction among nurses, and the importance of each facet. measure relating to unique aspects of the job of the nurse. The subject was asked to indicate her level of agreement with seventy statements about various aspects of her job, and to indicate on a fivepoint scale, how important she thought th a t aspect of the job was to h er work . It was not obviou s how the measure wou ld be scored. The questionnaires were hand ed in without identification, and an effort was made to avoid any connection b etween the research er, and hospital m an agement. The m easure of job sa tisfa ction chosen for the study was on e d eveloped b y William E. Sedlacek (1966) . It seemed to b est represent an integra ti on of theore tical formul ations and pa st empiri ca l research . Item s were add ed to th e Sed lacek THE SAMPLE The sample consisted of 760 registered nurses and li cen sed prac tical nurses employed in four gen eral hospitals in the Sa lt Lake City m etropolitan area. The subj ects were RN 's and LPN 's in staff, supervisory, a nd administrative position s, both full and p art-tim e employees from all clinica l areas, and from all three shifts. The p ercentage of total sample parti cipa tion was R2 % of the nurses employed in the four hospitals, for the hospitals individu ally 90 % , 86% , 82 % and 69 % . This obviously was not a ra ndom sam pl e of hospital nurses, ind eed it was n ot meant to Table 1 Factor Structure of Satisfaction Items To tal Sa mpl e RN LPN I. Intrinsic Finan cial Advancement Supervisor 2. Fin an cia l Advancement Intrin sic Work Clim ate 3. Supervisor Supervisor Intrin sic 4. Work Load V/ ork Stress Work Load 5. Rol e In-Service Work Stress 6. Recognition R ecognition P ay 7. Authority Authority Role 8. Social Service Social Service Indep enden ce 9. Perso nal Problem s Pay Aestheti c Factor Structure of Importance Items l . Social Service Intrinsi c Intrin sic 2. Financial Advancement Financial Advancem ent R ecognition 3. ' Vork Stress Interperson al Relations Fina n cial Advancement METHOD 4. Authority Authority Job Advancement The research design for this investiga tion was a correlation al field study, with a primary aim of id entifying the 5. In-Service Supervisor 6. Work Load PAGE 28 UTAH NURSE be, but rather a heterogeneous sample with respect to the selected variables. It was assumed that such a sample would provide a reasonable empirical test of the basic, underlying structure of t he concept. TH E FACTOR ANALYSIS The survey responses were submitted to principle components factor analysis, with unities as the d iagonal elements of the intercorrelation matrices. Normalized varimex rotations were used in all analyses, with the rotations based on satisfaction (or importance) items, and not on the demographic variables. Both the satisfaction items and the importance items were submitted to separate factor analyses for the total sample of 760; for the 501 Registered Nurses, and the 259 Licensed Practical Nurses. The data were analyzed by Univac 1108 Computer. THE RESULT The factor structure of the Satisfaction Items and the Importance Items are presented in Table I , and show differences in the Total Sample, and the RN and LPN subsamples. Tabels 2, 3, 4, and 5 contain the actua l items, and the correlations for the rna jor, stable factor dimensions appearing in all three analyses. For a somewhat clearer understanding of factor analysis, it should be noted that there is consistency in the actual items, and the content of the items. The clustering of items, rather than the exact order of items is of primary interest. The size of the loadings, or correlations, is generally high throughout. Negative correlations are considered an artifact of the rotation process. The Intrinsic factor may b e defined as including those facets of one's job directly related to the work itself, such as using one's abilities, expressing one's self, feelings of accomplishment, receiving recognition for achievement, and the nature of the work one does. In this case, we see the very core aspects of the nurses' job. That is, helping others, the kinds of patients with which she works, and her nursing experience. The Supervisor factor is seen as representing two aspects of the worker's attitude toward her Supervisor. The Supervisor aspect of job satisfaction is thus defined as all aspects of the job relating to the Supervisor, including her technical competence, and her interpersonal relationships. Table 2 Largest Item Loadings on the Intrinsic Factors LPN RN Total Jtem 70. I am satisfied with the chance I get to help people less fortunate than I am. -.62 -.62 -.60 69. There are p lenty of opportunities to use my education in nursing here. -.59 -.6.5 -.78 50. I like the type of patients I work with. -.51 -.48 32. The experience I get on my unit is not as useful to m y nursing career as that on some other unit would be. -.48 -.48 58 . I do not get enough of a fee ling of accomplishment from my work. -.44 40. I have too little opportunity to use my abilities in this Hospital. -.33 -.53 -.39 \ i 43. The doctors and nurses work as a team on my unit. -.46 63. I have someone over me, tell ing me what to do, too often. -.46 Table 3 Largest Item Loadings on the Supervisor Factors RN LPN 22. I wish my supervisor knew more about her job. .75 .77 -.67 7. My supervisor could use a lot more training as a technician. .72 .74 -.62 36. My supervisor is too interested in her own success to care about the needs of employees. .70 .72 -.59 31. I don't like the way my supervisor keeps putting things off, she just lets things ride. .67 .70 -.75 10. I am content with the freedom I have to speak to my supervisor and ask for help or explanations. .59 .59 -.54 '19. My personal feelings are important to my supervisor. .43 .39 -.53 55. Staff nurses and superv isors do not seem to be work ing toward the same goals. .32 .30 Item Total 14·. Administration keeps us in the dark about things we ought to know. -.40 18. I like the way the In-Service education program is being carried out. -.40 (Continued on page 30) SUMMER AND FALL, 1973 PAGE 29 Table 4 Job Satisfaction Largest Item Loadings on the Financial Advancement and Reward Factor Total Item 47. There are not enough opportunities for advancement here. -.66 -.64 33. There a re plenty of good jobs h ere for those who want to ge t ahead. -.66 -.59 52. There is plenty of room to move ahead fi-.61 n a nciall y in thi s Hospital. -.70 16. I don ' t feel I ha ve a good future with this Hospital. -.50 -.53 5 1. Administration does not give nursing enough support to do a good job. -.34 -.41 There is real evidence for the strength and importance of the Financial Advan cem ent and Reward Factor, in both the top ranking of the factors and the relatively consistent and high loadin gs of items. The Fi n an cial Advan cem ent and Reward aspect of the concept, job sa tisfaction , may be defin ed as on e's current finan cial reward and on e's p erce ived opportunities to move a head in the hospital organization . LPN RN 667 . Where I am h eadin g on the sa lary sca le is satisfactory with m e. -. 30 -.53 (.5 1)* (.4 1) 45. I lik e m y duty a nd time off schedule. -.47 (.4 0) 59. I a m sa ti sfied th a t I ca n provid e m y family with enough to ea t. (.70) -.72 3. 1 am fairl y p aid compared to other employees. (.44) (.60) 25. I do n ot have enough authority to handle my job responsibilities. * (.5 1) 9. I ca n just barely li ve on m y pay. (.61) *L oadings for the P ay factor. Table 5 Largest Item Loadings on the Work Load- Work Stress Factors I .\ Hem Total RN 65. The d aily work load is so h eavy it prevents me from doing a good job. .70 (-.42) * 28. vVe n ever seem to have enough nursin g staff on m y unit. .69 ( .20) LPN .27 (-.76) 62. There too often is a work problem that takes a lot of fi guring on m y part. .16 (-.40) 48. ' 1\Te h ave adequ ate cl e rica l and non-nursing sta ff on m y unit. (-.56) -.74 17. Nurses on m y unit experience a lot of pressure and stra in. ( .74) 51. Administration does not give enou gh support to do a good job. ( A1 ) nursing * Loadin gs for the Work Stress factors. PAGE 30 Table 5 conta ins th e item s with the highest loadin gs on the fa ctors labeleel Work Load and ·w ork Stress. The combined factor represents a somewha t more ge nera l picture, in tha t elements of ph ysical work load and psychological stress an d tens ion are given different empha sis in the three samples, ye t th e it em content is too simi lar to divid e them into more distin ct factors . The Total Sample factor stresses the physica l work load, the R N sample emphasizes the psychological pressures, whi le th e LPN sample includ es both factors almost together. The Work-Load Stress factor is defin ed as those asp ec ts of the job relating to the ph ysica l work load , and to psychologica l stresses and pressures. In addition to these fo ur stable fac tors, relatively co nsi stent across all analyses, some other factors emerge. Three acldi tiona I factors were stabl e for the total sample in th e RN analyses. These were lab eled R ecognition , Authority and Socia l Service. one of these were represented in t he LPN sample. CONCLUSIONS -.32 (.39) * 30. ' 'Vorking und er press ure brings out the b est in m e. .36 68. 1 do not have to "boss" peop le too much on m y job. (Continu ecl from page 29) From this investi gation of job sa tisfact ion amon g hospital nursing service p ersonnel, a genera l picture of th e mea ning of work emerges. From the viewpont of the nurse 's interaction with others in h er world of work , comes concern s for the servi ce she renders to others (the social service aspects) through the veh icl e of the nature of h er ac tivit ies (th e intrinsic aspects) , and to a som ewhat lesser d egree, concern s regardin g supervi sion. From the viewpont of more p ersonal variables, another side of the work picture emerged as con ce rn for one's opportunities for long-range finan cial ga in , for the physical, and psychological stresses and pressures of one's dail y work assignm ent, for the authority one has and need s, and UTAH NURSE one's opportunity to gain additional work related knowledge and skilL Two of the concerns are primarily interpersonal in nature, the intrinsi cSocial Service, a nd Supervisor factors; the remainder are more personally and individuall y d e termined . Of the aspects ranked important in the nurse's own individual terms, the most important was the potential for obtaining increases in salar y over time. The m ajor importance of financial and p ersonal gain are shared by virtually all nurses in this sample. The pattern of attitudes toward the job combines two closely associated but independent attitudes. Firs t the concern for rendering service, and second, the financial gains resulting to the individuaL Members of the nu rsing occupation have long recognized and taken prid e in the first of these job reia ted attitudes, often using these service a ttitudes as a b as is of the " professional " status of nurses and nursing. Some nurses have con sidered the second set of attitudes, with the attenda n t concerns for wages, advan cement, fringe ben efits, collective bargaining a nd so on, with con sidera bl e embarrassmen t and guilt, while sti ll others have strenuou sly d e ni ed such co ncern s with a n egative and d efen sive sta nce. Evidence su ch as that prese nted here ca nnot aspire to resolve such philosophical confli cts, but it does attest to the widesprea d importa nce such attitudes hold for man y nurses . The Level of Job Satisfaction Among Nursing Service Personnel ., Having establi sh ed a rl efi ni tion of job satisfaction among nursing service personnel participatin g in this study, it is possible to d etermine how sa tisfied or dissatisfied these nurses are with the m ajor as pec ts of the ir work The satisfaction level for th e first ranked Importance fa ctor, Social Service, indicates dissa tisfaction with the chances one gets to help others, with feelings of accomplishment, with the kind of work clone, the experience one gets, and the opportunity to u se one's abilities. There is satisfaction with the other items loading on thi s fac tor. It would seem that this sample of hospital nurses obtain feelings of satisfaction from parts of the Social Service aspects of their jobs. SUMMER AND FALL, 1973 There is dissa tisfaction with the room to move ahead fin an cially, where on e is head ing on the sa lary sca le, opportunities for advancement and the future one has with the HospitaL There is sa ti sfac tion with the amount of pay and the fairne ss with which it is given, with retirem ent benefits and with the number of jobs avai lable for those who want to get a head . Thus, there seems to be general satisfa ction with pay, but ge neral dissatisfaction with adva ncem en t opportuniti es. In the Work Stress fa ctor, the samp le is satisfied with thi s a rea, with a n e utral ranking on adeq ua cy of nursing staff. There is evide nce of a di chotomy in the feelin gs abo ut a uthority. There is satisfaction with the person al use of the authority the nurse h as, but general di ssatisfac tion wih the amo unt of a uthority the nurse perceives she has. There is satisfaction with the final factor ra nked highly important by this sampl e, In-Serv ice. Even though a Supervisor fa ctor did not emerge in the Total Sample, or the RN sampl e in the a nal yses of Importance item s, a nd em erged relatively la te in the LPN Importa n ce a n alysis, it did show up promin entl y in the Satisfaction analyses. T h e nurses in this sample indicate they a re dissa ti sfi ed with their Supervi sor as a techni ca ll y comp ete nt practitioner, but they are satisfi ed with their inte rpersonal relation ships with h er. \ Vhile they see m to like h er as a perso n, feel sh e takes their fe elings into consideration, a nd they feel free to talk with h er, asking for h elp or ex plan ation s, they alw wish she knew more about h er job, were more technically competent, ca red more abo ut the needs of employees (note the differe nce b etwee n n eeds a nd feelings expressed b y the subj ec ts), dislike her putting things off (indicating perhaps that she does not have an swers to problems, so puts them off) , a nd fin ally they do not see staff nurses a nd supervisors working towa rd common goals. lt would seem then, tha t even with a group of similar item s clustering toge ther to form a fairl y unified set of a ttitudes about specific areas of one's job, there are still variances of sa tisfaction and dissatisfaction regarding the intern al elements of those broad fac tors. One sees this dichotomy regarding satisfaction and dissa tisfaction within the Social Service factor, a nd more clearl y within Financial Advancement, where the advancement aspects are a so urce of dissatisfaction, while the pay as pect seems to satisfy the m ajority of nurses in this sample. Authority is a third fa ctor in which there are mixed feelings of satisfaction, while there is genera ll y satisfaction with both Work Stress and In-Servi ce. lt is evide nt then , th a t the co ncept of job satisfaction, at least among nursing service p ersonn el, is a much more complex and in adeq ua tely understood notion than has bee n rea lized to date. References Bellin ger, A. C., & Clela nd , V. S. A com para tive a nalysis of Negro a nd Ca ucas ia n nurses on se lected orga ni smi c a nd jobre la ted varia bl es. Nursing Research, Novembe r-December, 19669, 18 (6) , 534-538. Be nn e, K. D ., & Be nni s, i V. Role confusion a nd conflict withi n nurs i ~g; Part I. Role of th e professio na l nurse. P art ll : i Vhat is t·eal nursi ng. Amer-ican journal of Nursing, 1959, 59, 196- 198, 380·383. Corwin , R. J., Taves, M. ]. , & H aas, J. E. Profess iona l d isillu sionm e n t. Nuning R esem·ch, Summer, 1961 , 10 (3), 141 -144. H e rzbe rg, F. H ., Mau sne r, B., Pe te rson , R . 0., & Capwell , D . F. j ob a ttitudes: revie w of resea rch a nd op ini on . Pittsburgh : Psychologi ca l Services of Pittsburgh, 1957. H e rzbe rg, F. H. , Ma usne r, B., & Sn yde rm a n , B. B. Th e motivat ion to work. Ne w York : Wil ey a nd Sons, 1959. Krame r, Marl e ne, R ole model s, role con cept ion s, a nd rol e dep ri vation . Nursing R esearch, 1968, 17 (2), 11 5-121. Krame r, Ma rl e ne. Th e new g radu a te speaks - again . American .Journal of Nursing, September, 1969, 69 (9), 1903· 1907. Lawton , U. vVh y nurses aband on th e ir profession . Nursing Times, Aug ust G, 1970, 1022- 1023. Locke, E. A . J ob sa tisfac tion a nd job perform a nce: a th eore tica l a nalysis. 0Tganiza tiona l B ehavioT and H uman Pe1'fonnance, 1970, 5, 484-500. Scott, vV. A. Att itud e measure me nt. In Lind zey, G .. & A ronso n , E. (Eels.), Th e hand book of social Psycho logy, Vol. 2, TeseaTch methods (2nd Ed.) . R eacli.p g; Massachu setts: Adcl ison-vVesley, 1968. Sedl acek, William E. Em pirical a nd theOI-c ti cal aspects of job sati sfaction. U npu b lished d octora l dissertation . Kansas State U nive rsity, 1966. Stacey, J . R Ns te ll why they took off the ir caps. ModeTn HosPital, J a nu ary, 1967, 108, 76-7 7. vVoolf, Don ald A. Measuring job sat isfaction. HosPitals, November I , 1970, 44, 82-87. Yanow, Marian R ., The m easurem e nt of childre n 's a ttitudes and va lu es. In Mussen , P a ul (Ed.) ., Handbook of reserch methods in child development. New York: Wi ley a nd Sons, 1960. Pp. 646-648. PAGE 31 UI\I/\ - USM/\ Joint Practice Committee A supplementary report to UNA membership b y A THLEEN B. GODFREY Co-chairman of the Joint Practice Committee ln response to the many inquiries sent to m embers of the Joint Practice Committee, the UNA Executive Director and the UNA Board , we wish to take thi s opportunity to provide for th e genera l m embership information abo ut the n a ture of th e Join t Prac ti ce Committee, and also to explain where we are as of .Jul y l , 197 3. As a committee o ur invitation is extended to you to con tact members of the Board ind ividu all y ancl j or collectively to an swer any qu es tion s you might have. One of the prim ary recomm endati on s from The National Com mission for the Study of N ursing a nd N ursing Education was that a coll aborative effort between m ed icine a nd nursing be established at the national, state, and local levels in an attempt to improve health care. Through action of the American Medical Association and the American N urses' Association, The Nationa l Joint Practice Committee, a n interprofession al organi za tion, was established to improve h eal th care. The cha irman of the NJPC is Robert A. Hoekelman, M.D., and the Vice Chairman is Shirley Anne Smoyak, R .N. Commissioners include Gem-ose J. A lfa no, R .N ., P a tricia Anne D evin e, R .N., Thomas F. Dillion, M.D., A. A la n Fischer, M.D ., ¥Filyn J. Howe, R .N., Joseph vV. Marshall, M.D., Nancy Mel vin, R .N. , William H. Muller, Jr., M.D., Robert A. Murray, M. D ., Otto C. Page, M.D. Anna J. Sherlock, R.N., Virginia Stone, R.N ., Barbara B. Taylor, R .N., and J ames W. Walker, M.D. It was recommended that similar interprofessional groups b e formed at the state level through the state m edica l and nurses' associations. In line with this, the former Utah Nurse Profession Liaison Committee was re-organized in the winter of 1971 to b ecom e Utah's .Joint Practice Committee. At that time Athleen B. Godfrey, R .N., who was Chairman of the UNA Council on Prac tice, and Dr. G. Myers were elected as Co-chairm an of this n ewly formed committee. Other committee m embers included nurses who were clini ca lly situ a ted and represented specialty areas of PAGE 32 health practice as well as ph ysician s elected to thi s committee by the Utah State Medical Associatin. Nurse m emb ers included Esther Anderson, R .N., Barbara Kea n e, R.N ., Marjorie Kimes, R.N ., Myrtle P avich, R.N ., Elsie Shiramizu, R.N ., Sister Mary Roger Andert, R.N ., Maxine Thomas, R .N ., Sister J a n e Chantell, R. N., an d Sandre Brooks, R.N. Doctors representing the USMA included Rob ert Lamb, M.D., Anthony Temple, M.D., D elbert Goates, M.D., Michael Romn ey, M.D., Cloyd Hofheins, M.D. , J ames Orme, M.D., Bruce Walters, M.D., George Veasy, M.D. , Howard Sharp, M .D ., a nd Russel Hirst, M.D. Robert P o ulson, M.D., h as served as committee liaison to the USMA Board of Trustees in his role as USMA Cha irm an of the Council on Health R esources R elations. Those physicians who have actively served on the comm ittee have b een tremendously supportive of the joint effort ai m ed a t improvement of health ca re. One nurse-member of the com mittee has b een replaced. Beth Vaughn was selected by the Psychia tri c Co nferen ce Group to represent th at sp ecialty when Sister .J a ne Chantel moved from our state. Dr. Garth Myers resigned hi s position with the committee last fall, (1972) a nd Dr. Robert Lamb h as functioned capably as Co-cha irm an sin ce that tim e. I would refer the UNA m embership to the Convention I ssu es of the Uta h N urse, 1972 a nd 1973, for areview of the efforts a nd accom plishments of this committee. T h e Utah State Medical Association h as n ow expressed relu cta n ce to develop a committee entitled "Joint Practice Committee". The UNA h as indicated that it does not desire semantics to delay the important work of thi s committee, a nd th a t the UNA will continu e to cooperate with the "N u rse Pro fession Liaison Committee" as long as the members function in a joint practice role. Happily, the UNA Boa rd h as endorsed the committee as the "UNA Joint Practi ce Committee". Numerous sugges tion s a nd recomm endations for additional nurse and physician representatives to the committee h ave b een received. The nurse m embers of the current committee are m ee ting in July to formulate guidelin es regarding committee design a nd membership which will b e presented to the UNA Board . Until these guicleli nes are completed , a nd presented to and accepted b y the Joint Prac tice Committee's goals and objectives will b e developed a nd regulated by the committee itself, as is the pra cti ce with the N JPC. As of July, 197 3, a prim ar y goal of the committee is joint spon so rship of a training in-service progra m to up-grad e nursing practice in the admini stra tion of oxytoxics during labor. The committee is collab oratin g in this effort with physician s, the UN A Admini strative Conference Group, a nd the Mate rn al Child Conferen ce Group . Several things have com e to pass since the inception of th e committee that will ultim a tel y co ntribute to joint practice efforts. The UNA and ANA Certification programs will d emon strate the profession's desire to b e accounta ble for nurses' action and the d esire to maintain standards of professional practice. Now there are loca l programs where the effectiven ess of joint effort and the extended role of the nurse have brought about improvement of local health care so mu st nursing accept the added respons ib ility of pl anning a nd guiding the delivery of health care services at the loca l level. It is to this end that the Joint Practice Committee is strivin g. As is noted in the 197 3 Convention Ann ual Joint P ractice Committee rep ort, support of the N JCP guid elines directs o ur committee efforts at effecting communi ca tions and joint planning that will enhan ce h ea lth care for all. The committee is not working to d efine or defend nursing's role in h ealth care - only insofar as the com mittee identifies a nd d efines collaborative efforts in meeting h ealth care needs. Study of the expanded role of the nurse (or physician) is really only a very small p art of the work of joint practice groups. As a profession nursing must be willing to jo intl y shoulder respo nsibility to plan and execute effective h ealth services for all. This same respon sibility lies with the individu al professional nurse. It is time that each profession al nurse critique h er own practice and h er own a ttitudes toward s collabora tive prac tice. The clay when nu rsing collabora ted only to establish or d efend the role of nurses is hopefull y long gone; commitment to the patient and h ealth care n eed s must replace commitment to the nursing profession. UTAH NURSE The members of the Joint Practice Committee have shown a remarkable degree of commitment to nursing goals and nursing's work over the past two years. The Committee looks forward to continued support from the UNA Board and staff, who agree that the Committee must strive to effec t joint effort volunarily between the two professions - medi cine and nursing- in order to improve heal th care for the p eople of Utah. Ella Frandsen Retires After 48 Years The Emergency Nurse Conference Group The Emergency Nurse Conference Group saw one of their dreams come true thi s past year. IRMP started the first ENT (emergency nurse training) program in September, 1972, with eleven nurses in the program. Another class finished in February, and the last class will be completed in June 1973. 'With deep regrets a nd sadness IRMP folds up in Jul y and thi s a ffects the Emerge ncy Nurse Program. W e would like to encourage all nurses to voice their opinions, concerning the continuation of the Emergen cy Nurse Training P rogram, to Congressmen, State Legisla ture R epresentatives a ndj or hospitals. The recommendations of Standards of Prac tice for the E.R. Nurse were set up by the committee with the assistance of Susan Williams, of the IRMP Program. J , A transfer slip was completed and we hope it will be u sed by all emergency rooms, whenever transferring a patient to enable the patient to receive quality care. With the increasing number of emergencies arriving in all emergency depar tm ents, we would like to encourage all E. R. Nurses to come out and join the group to help with future problems of the Emergency Nurse. R espectfully submitted, Rosemarie Morelli, E. R. C. G. Chairman Promote UNA-ANA Membership SUMMER AND FALL, 1973 District 4 - Elta Frandsen A registered nurse for 48 years, Elta Frandsen, 70, recently retired and was honored on her final day with a special party at Carbon Hospital. Hospital Director of Nurses, Nora Dalpiaz, presented Mrs. Fra ndsen with a corsage and presents for working 46 years a t the Carbon Hospital. Mrs. Frandse n was born, raised and educated in H elen a, Montana. She entered St. John 's School of Nursing, Helena, Montana, in 192 1 and graduated in May of 1924. Upon gradua ting she worked in Helena for qt'2 years doing special duty nursing. "We worked 12 hour shifts and sometimes more", Mrs. Frandsen recalled. Then she came to Salt Lake City and from there moved to Loga n, Utah and worked in the Community Hospital. She then moved to Price, Utah. " I was ca ll ed from the Nurses' R egistry and asked if I would come to Pri ce and work in the hospital on gen era l duty", Mrs. Frandsen said. "The shi fts were 12 hours for $100 a month ". The most surprising incident that Mrs. Fra ndsen said she remembers was picking up the n ewspaper once and read ing the h eadlines " Kindness of nurse remembered in .will". Ap1 / pa rently a young m an fro m South Amer ica, which Mrs. Frandsen once a ttended , died and left her a sum of money. " I was swa mped with telephone calls," Mrs. Frandsen remembers. Mrs. Frand sen ha s three children , two sons and a d aughter and three grand-daughters. care • 1sourgame. put your valuable nursing skills into action with In Idaho: CASSIA MEMORIAL HOSPITAL, Burley: FREMONT GENERAL HOSPITAL. St. Anthony; IDAHO FALLS L.D.S. HOSPITAL. Idaho Falls; In Utah: COTTONWOOD L.D.S. HOSPITAL. Murray; FILLMORE L.D.S. HOSPITAL. Fillmore; LATTER-DAY SAINTS HOSPITAL, Salt Lake City ; LOGAN L.D.S. HOSPITAL, Logan; McKAY -DEE HOSPITAL CENTER. Ogden : PANGUITCH L.D.S. HOSPITAL, Panguitch; PRIMARY CHILDREN'S HOSPITAL. Salt Lak e City; SANPETE L.D.S. HOSPITAL. Mt. Pleasant.; SEVIER VALLEY CHURCH HOSPITAL. Richfield : UTAH VALLEY L.D.S. HOSPITAL. Provo; In Wyoming: STAR VALLEY L.D.S. HOSP ITAL, Aft on . PAGE 33 All About The V.A. Nurses Nurse Clinician Program Underway On e of the curren t trend s in professio nal nursin g is the "e xpa nd ed ro le", w herein nurses utilize the tr ad iti o nal pa ti en t hi sto ry an d p h ys ica l exa min a ti o n to assess and plan p at ien t ca re. The Vetera n s Adm ini stratio n id en tifies nu rses with these skill s as Nurse C lini cia ns. Pictured a bove a re th e nego ti ators, front row, left t o rig ht, Aaron Turne r, Robert D. Sim pso n, Jacki e Ma lee, Ma ry Lee Po tte r; second row, All e n H. Lundg re n, Ja net Ni coll, Donna De ll, Ge rald A. Tischn e r, Ethel Mae Jaco b, Sha rl e ne Platt, Cora lle ne McKea n, Sharon Ca rl son a nd Irene Ault. T he fi rst N nrse Clini cian cla ss at V AH, Sa lt L ake City fini shed a sixweek progra m on Jun e 3, 197 3. Selec ted ph ysician s acted as cl in ica l p receptors for the nu rses. u rses ha ve b eO ur V.A. Staff come lead e rs in th e state, b eing the first to o rga ni ze an d obtain excl usive recogn 1tio n un d er executi ve ord er 1149 1 (as a men ded ) a nd th e righ t to nego ti a te a contract wi th m a n agement. T h is right was exe rcised o n Jun e 10, w hen the nu rses sat d ow n wi th m a n agem ent to n egotiate th eir fi rs t co n tra ct which was the first co ntrac t for nurses i n Utah. Mary L ee P o tter, A N A re p resenta tive fo r fede rall y emplo yed nurses, acted as a co nsul tant fo r the n u rses, as did Corall en e M cKea n , Ex ecu tive D irec tor of UNA. The a tmosp h ere was o ne of con geni ality an d good hu mor, whi ch facilita ted smooth n ego tiations, allowing them to be comple ted in three clays. M an agem ent and the staff nurses ga ined a m u tual u nd ersta nd ing a n d resp ec t for each other 's responsib ilities. Thro ugh the process of nego tiati on s, a r elation sh ip was es tab lish ed tha t will facili ta te imp roved communication s, whi ch will resul t in the improvem en t of del iver y of h eal th ca re to th e V .A . p atien ts. J ackie M alee, Chai rm an PAGE 34 In O ctober 1972, a r egisterecl nu rse co mm ittee proposed to VA H Sa It La ke C ity Admini stra tive, that an "o n site" N urse Clini cian progra m b e d e veloped . A u niqu e fea ture of t he progra m is that th e nurse clini cian s will utilize th eir n ew skill s on inpa ti en t a nd o utpa t ient areas wh ere o th er VA hospi ta ls have limi ted the p rogra m to admi ssio n and o u tp atient areas. \, k Row 1 : Kathy Kontas, Head Nurse, Wa rd 2-A; Jac ki e Ma le e, Ward 1-B; Va lynn Laymon, Ward 3-D. Row 2 : Jane She ldon, Prog ra m Coordinator; Hilda Brown, Wa rd 4-A; Kate Edd ington, Day Hos pita l; Lee Ann Co le ma n, Pre-Admission Assess me nt Area; Berdena Borde r, Wa rd Administrator, Ward 3-C; Marilyn Rawson, Ward 3-B. (Rita Lundgren , Ni g ht Nurse, Bu ildin g 3, and Maril yn Ba rlow, Wa rd 3-A were absent wh e n th e photo was take n.) UTAH NURSE In Appreciation : I feel very grateful for the honor that was given me in the presentation of the lifetime membership, A.N .A. pin, and lovely corsage at the U.N.A. Banquet last week. Please extend my appreciation to the board of directors, President Carolita, and the M.C.H. Council for their consideration of me for this honor. I feel very humble for such a recognition. In my nursing career I've always tried to do my best in whatever position I held during the years that I worked and often felt unequal to the tasks that were required, but at the same time have felt a commitment to nursing, and have endeavored to maintain high standards in relation to what I may have done. I hope I can continue to make some contribution to nursing and health care in our locality. I feel grateful for being able to keep in touch with U .N.A. now through a Lifetime Membership. And to you, Corallene, thanks for all you've done to assist me personally, as well as further nursing in ou r state. Sincerely, Edla Terry My Thanks To You A letter of thanks was received from Mildred Quinn, Dean of the University School of Nursing giving thanks to the Utah Nurses' Association for her lifetime UN.-\ membership and other spec ial recognitions. Convention Time Winners: Two of the exhibitors at convention had a driwing. The Mutual of Omaha offered an AM-FM Clock Radio and the winner was LEONA TERRY, 2808 East 2960 South, Salt Lake City. The Bonneville Sylvan Life Insurance Company had for their prize, a small TV. The winner for it was NELL OLSEN, Ephraim, Utah. CONGRATULATIONS to you both! UNA Headquarters has a New Face Thanks to District No. 1. Congratulations: UNA wishes to extend their congratulations and best wishes to Richard Dean who was elected as the 2nd Vice President of the National Student Nurses' Association. The U. .A. ex tends congratulations to DOROTHY RYAN on her appointment to the H ealth Maintenance Orga nization Advisory Council. We wish yo u well in your appointment. Lettering across the front of the build ing , Donated in MemQ~y of LUCILLE SUMME~HAYS See next issue of Utah Nurse Employment Opportunities At University Hospitol Excellent openi ng if you qualify . REQUIREMENTS : Masters Degree with demon strated co m petency and pract ical experience in m ajo r surgica l procedures . Management and budget and superviso ry abi lities. Must be able to relate w e ll with a ll medical and profe ssional staff. Experience in teaching ho spital staff is necessary . SALARY: Salary is open to commensu rate with education and experience. Excellent benefits . CONTACT: Un iversity Hospital . . . Area cod e 801 - 582 -3711 Ext. 301 Immediate Openings for Baccalaureate Nurses in Psychiatric Nursing Service Offering EXPANDED ROLE IN CRISIS INTERVENTION, inpatie nt the ra py and some consultant to other n ursi ng service areas . POSITIONS ALSO AVAILABLE IN NEWBORN ICU, offeri ng excellent learning e x per iences wi th latest equ ip m ent and treatments provided for babies f rom Intermountain West. OPENINGS AVAILABLE on transport team to pick-up ne w borns in f ive state a rea . SALARY: Excellent sa lary and benefits including reduced Univers ity t uition . CONTACT: Please w rite o r call collect: NURSING ADMIN ISTRATION UNIVERSITY HOSPITAl 50 North Me dical Drive Sa It lake City, Utah 84132 A rea code 801 -532 -371 1 EQUAL OPPORTUN ITY EMPLOYER SUMMER AND FALL, 1973 PAGE 35