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Kentucky Nurse • October, November, December 2013

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October, November, December 2013 Kentucky Nurse •

Accent On ResearchDATABITS

DoesShiftLengthAffectPatientOutcomesandNurseSatisfaction?Nurses work 24/7, including weekends and

holidays . To provide the safest and highest quality of care, nurses need to be alert to changesin patient status, process information quickly,and intervene in a timely fashion. Shift work,overtime, and associated stress can lead to sleepdeprivation or poor sleep quality . Sleep loss not only causes cognitive and behavioral impairments but physiologicalandemotionaldifficulties,aswell.

A recent research study investigated the relationship between shift lengths of pediatric nurses in intensive care unit (ICU) and non-ICUsettings and measured the association of shift length with nursing job outcomes, nurse-reportedpatient outcomes, and nurse-assessed safetyand quality of care in hospitals . This study is the first to link pediatric nurses’ shift length to acomprehensive set of measures reflecting nurse and patient well-being .

The study sample was a subset of pediatric nurse respondents from the Multi-state Nursing Care and Patient Safety Study . This data set provided the analytic sample of 3710 registered nurses (RNs)in 342 hospitals from four states (California, NewJersey, Pennsylvania, and Florida). The hospitalswere among the three types of acute care facilities treatingchildren,ageneralhospital,a freestandingchildren’s hospital, or a children’s hospital in ageneral health system . Nurses in the study provided directpatientcarein1of4typesofpediatricunits,neonatal ICU, pediatric ICU, newborn nursery, andgeneral pediatrics . Nurses were grouped into 3 shift categories: 8, 12, and more than 13 hours. Eighthour shifts included RNs who worked 8 to 9 hours and 12-hour shifts included nurses who worked 12 to 13 hours to account for end-of-shift activities . Fewerthan2%ofnursesworked10to11hours,andthey were grouped in the 8-hour category .

The study measured job satisfaction and burnout among nursing staff, as well as nurses’ intent toleave their employer in the next year. Participantswere also asked to report frequency of central line associated bloodstream infections (CLABI), urinarytract infections (UTI) and complaints from patientsand their family members . Overall quality of nursing care and unit safety status were also measured .

Nurse-reported poor nurse outcomes were fairly common . One in 4 pediatric nurses had high burnout, 1 in 5 was dissatisfied, and 1 in10 intended to leave their employer . These poor outcomes were nearly two times as common among nurses who worked more than 13 hours . The number of nurses reporting intent to leave increased incrementally the longer the shift worked . Adverse eventswerelesscommon,reportedby4%to10%ofnurses overall . Significantly higher percentages of nurses who worked longer shift lengths of 12 or more than 13 hours reported frequent CLABI and frequent UTIs . Between 8% to 30% of nurses reported poor quality and safety outcomes and the number of adverse events increased dramatically for nurses workingmorethan13hours.Halfofthenurseswhoworked more than 13 hours agreed that important patient information was lost during shift change .

The researchers also reported that the most

popular shift length of 12 hours was associated with a 36% increase in the odds of intent to leave compared with the 8-hour shifts . Poorer nurse and patient outcomes with 12-hour shifts should motivate employers to make every effort to guarantee thatshiftsendasscheduled,tolimitovertimeshifts,and to minimize consecutive shifts .

Source: Stimpfel, A. W., Lake, E. T., Barton, S.,Gorman,K.C.,&Aiken,L.H. (2013).Howdifferingshift lengths relate to quality outcome in pediatrics . The Journal of Nursing Administration, 43, 95-100.doi:10.1097/NNA.0b013e31827f2244

Submitted by: Dorothy Biddle, RN, ChristineYoung, RN, R. Maureen Gray, RN, CPHON, andVictoria Spreitler, RN; BSN students at BellarmineUniversity,Louisville,KY

Data Bits is a regular feature of Kentucky Nurse. Sherill Nones Cronin, PhD, RN-BC is the editorof the Accent on Research column and welcomes manuscripts for publication consideration . Manuscripts for this column may be submitted directly to her at: Bellarmine University, 2001NewburgRd.,Louisville,KY40205.

HEALTHMATTERSCOLUMNThe Kentucky Nurse isacceptingarticlesforanewcolumn“HealthMatters.”Articlessubmittedforpublicationconsideration in this columnshouldaddressacurrenthealthmatter(s) thataffects thegeneral population, including such things as health promotion andwellness topics. Articleswouldundergo classic peer review .


Student SpotlightYoungPeoplewith

Depression:ReviewofaNursingResearchReport

Janay Collins, RN-BSN StudentDepartment of Baccalaureate & Graduate

Nursing, College of Health Sciences,Eastern Kentucky University

Richmond, Kentucky

Manyindividualswhoexperiencedepressionhavetrouble with coping and understanding, increasingtheir risk for social withdrawal and self-harm . The experience of depression has been well explored inolder adults; however, much less is known aboutdepression in young adults. Therefore, the purposeof this paperwas to reviewMcCann, Lubman, andClark’s (2011) research report on the experience ofyoung people with depression .

Review of Research Report

McCann et al. (2012) identified that there havebeen few studies of adolescent depression despite its impact on morbidity and mortality and conducted a research study in response to this problem . The research purpose of McCann et al.’s (2012) studywastoexaminethelivedexperienceofyoungpeoplediagnosed with depression . Research questions were not explicitly identified. The literature reviewfocused on prior research studies on depression in adolescents (McCann et al., 2012). Smithand Osborn’s (2008; as cited in McCann et al.)interpretative phenomenological analysis was used as the research framework (p. 336). Writtenconsent was obtained, including written parental/guardian consent for those under 18 years of age,and approval was obtained from a university and a health service research and ethics committee (McCannetal.,2012).Thestudyusedaqualitative,phenomenological research design (McCann etal., 2012). The study participants included a non-probability (convenience) sample of 26 adolescentsbetween the ages of 16-25 years with a primarydiagnosis of depression and no history of psychosis or currently expressing suicidal plans (McCann etal., 2012, p.335). Data saturation was not stated.Data were collected through semi-structured, in-depth, audio-recorded interviews each lastingthirty to sixty minutes (McCann et al., 2012,p.336).Reliabilityandvalidityof thedatacollectionmethods were not explicitly stated and were notapplicable with this being a qualitative research study . Data were analyzed by transcribing and coding the data and grouping themes (McCann etal., 2012). The research findings from McCann etal.’s (2012) study revealed four overlapping themesreflecting young people’s difficulties respondingto depression: (1) struggling to make sense of thesituation, (2) spiraling down, (3) withdrawing, and(4)contemplatingself-harmorsuicide(p.336).

Summary

McCann’s et al. (2012) research study revealedseveral adverse effects that depression can have on young adults . The findings showed that depression in young adults can be life-threatening if not treated (McCann et al., 2012). One implication forevidenced-based nursing practice would be to educate family and friends on the signs of depression and how to respond to them . A suggestion for future research would be to conduct a study showing the effectiveness of different treatment methods (e.g.,therapy,medications)onadolescentdepression.

ReferenceMcCann,T.V.,Lubman,D.I.,&Clark,E.E.(2012).

The experience of youngpeoplewith depression:A qualitative study . Journal of Psychiatric & Mental Health Nursing, 19(4), 334-340.doi:10.1111/j.1365-2850.2011.01783.x

DepressioninAdolescents:ReviewofaNursingResearchReportJennifer G. Bauman, RN-BSN Student

Department of Baccalaureate & Graduate Nursing, College of Health Sciences,

Eastern Kentucky University

Depression has been widely recognized and studied in the adult population; however, when itcomes to adolescents, documentation and researchstudies are lacking . It is imperative for healthcare professionals to be familiar with and recognize the differing manifestations of depression in adolescents so they can be more equipped to handle their transition, along with their illness, into adulthood.The purpose of this paper was to review McCann,Lubman,&Clark’s (2012) researchreportonyoungpeopleexperiencingdepression.

Review of Research Report

McCann et al. (2012) brought to light that therewas a lack of information regarding depression in adolescents and, therefore, conducted a researchstudy in response to this problem . The purpose of this research study was “…to examine thelived experience of young people diagnosed withdepression” (McCann et al. 2012, p. 335). Theresearch question(s) was not explicitly stated. Theliterature review focused on prior research studies that pointed out the high incidence of depression in young people and the significant impact it had on theyoungpeoples’lives.

TheresearchframeworkforMcCannetal.’s(2012)study was interpretative phenomenology . Informed consent was obtained, including written/parental/guardian consent for those under 18 years of age (McCannetal.,2012,p.336).Ethicalapprovalwasobtained through an ethics committee and health service research from a university (McCann et al.,2012,p.336).

The study used a qualitative, interpretativephenomenological design (McCann et al., 2012,p. 335). The study participants included a non-probability (criterion or purposive) sample of 26young people . The young people ranged in age from16-25 years andhaddepression as a primarydiagnosis (McCann et al., 2012, p. 335). Of the 26study participants, the median age was 18 yearsof age. Sixteen of the participants were female,mostly single, and 15 of them resided in the samehousehold as one or both parents . Their median durationof treatmentwas4.5months,and inmostinstances, their primary diagnosis was depressionandanxiety, followedbydepressionandacomorbidsubstance use (McCann et al., 2012, p. 336). Data

saturation was not reported . Data were collected through semi-structured, in-depth, audio-recordedinterviews (McCann et al., 2012, p. 336). Eachinterview lasted approximately 30-60 minutes,allowing the person conducting the interview time toaskanin-depthrangeofquestions,sothepeoplecould describe their personal experiences withmental health problems (McCann et al., 2012, p.336).

Data were analyzed using Smith & Osborn’s(2008) interpretative phenomenological method ofanalysis . The research findings revealed “…four overlapping themes, reflecting the young people’sdifficultiesincomingtotermswith,andrespondingin self-protective, harmful and at times lifethreateningways to their depression: (1) strugglingtomakesenseoftheirsituation; (2)spiralingdown;(3)withdrawing;and (4) contemplatingself-harmorsuicide(McCannetal.,2012,p.334).

Summary

The research findings from the McCann et al.’s(2012) study are important to evidence-basednursing practice (EBNP) as they highlight the needto improve mental health literacy for health care professionals, including nurses, so that nurses aremoreawareofthesignsofdepression,youngpeople’sexperiences of depression, and how to respondappropriately to their needs (McCann et al., 2012,p. 339). The findings that government funding,alongwithknowledgeablehealthcareprofessionals,improved community awareness, and support ofyoungpeoplewithdepression,playedavital role instrengthening young people’s ability to counteractthe stigma while promoting self-empowerment,indicate the need for the identification and implementation of EBNP interventions incorporating their finding. (McCann et al., 2012, p. 339).One suggestion for future research would be to develop EBNP interventions designed to promote a smooth transition from youth to adulthood in those with depression and to conduct a research study evaluating the effectiveness of interventions implemented .

Reference

McCann, T.V., Lubman, D.I., & Clark, E. (2012).The experience of youngpeoplewith depression:A qualitative study . Journal of Psychiatric and Mental Health Nursing, 19, 334-340. doi:10.1111/j.1365-2850.2011.01783.x

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YouthSmokingPrevention:PromotionOfEvidence-BasedPracticeIdeasForPrimaryCareProvidersInKentucky

Tiffany Boston, MSN, APRN, FNP-C;Rebecca Eicher, MSN, FNP-C;

Elizabeth Ellison-Brown, MSN, APRN, FNP-C;Diana Spring, BSN, MSN(c), RN;

Marcelo Venegas, MSN, APRN, FNP-C;Nancy Kern, MSN, EdD, APRN, FNP-C;

Ann Lyons, MSN, PhD, RN, CNE

Spalding University School of NursingLouisville, Kentucky

In Kentucky, yearly, 14.1 million packs ofcigarettes are bought or smoked by children . In the nation, the high school smoking rate was 18.1% in2011withKentucky’sratebeing24.1%.Inthisstate,6,100 youth under the age of 18 become new dailysmokerseachyear(CampaignforTobacco-FreeKids,2013).

The national average of adult smokers was 19 .0% compared to the Kentucky average of 29 .0% (Campaign for Tobacco-Free Kids, 2013). It isextremely important to understand that, “nearly90% of adult smokers smoked their first cigarette and71%weredailysmokersbefore18yearsofage;60%startedbefore14yearsofage”(Pbert,Fletcher,Flint, Young, Druker, DiFranza, 2006, pe811). Thissuggests that smoking prevention in youth at the earliest possible age is the most effective strategy to prevent, cigarette smoking, “the chief, single,avoidable cause of death in our society and the most important public health issue of our time” (U.S.DepartmentofHealthandHumanService,1984,p.xiii).

Cigarette smoking costs the nation $96 billion annually in public and private health care expenditures.Thefederalandstatetaxpayerburdenfrom smoking related government spending is $70 .7 billion, which is $616 per household. For everypackage of cigarettes sold in the United States for an averagepriceof$5.29,healthcostsandproductivitylosses nationally equal a low estimate of $10 .47 per pack sold (Campaign for Tobacco-Free Kids,2013). Despite the costly personal and financialeffects of tobaccouse, few recommendedpreventiontechniques and prevention programs targeting adolescents are available. Nevertheless, a review ofliterature shows that some important approaches have been found to help primary care providers in their daily practice with adolescents at risk .

A 2006 study of a tobacco prevention program with sixth grade children in Georgia conducted byschool nurses revealed several facts. First, due toincreased negative publicity of smoking, childrentend to underreport tobacco use . Simply asking a child about tobacco use does not ensure an honest answer. Second, tobacco use by parents heavilyaffectschildhoodsmokingbehavior,soparentsneed

to be made aware of the impact of their smoking . Finally, the program uses the LifeSkills® TrainingProgram which combines knowledge, teachingrefusalskills,discussingattitudes,andencouragingassertiveness . Prevention must help the adolescent understand the dangers of smoking and help the child plan ways to refuse tobacco while facing minimalsocialjudgmentfrompeers(Tingen,Waller,Smith,Baker,Reyes,Treiber,2006).

A meta-analysis of smoking prevention programs conducted in 1993 by William Bruvold reviewed 94 studies of prevention programs and ranked them in order of effectiveness . Social reinforcement interventions such as behavior modeling, roleplaying,extendedpractice,andapubliccommitmentto abstain demonstrated the best results . The second most effective programs helped adolescents busy themselves in activities where tobacco use was not practiced, such as community improvementprojects, vocational training, tutoring programs,or recreational activities. These activities, besideskeeping adolescents busy, reduce alienation andincrease self-esteem . The third most effective programs were “developmental,” which focused onlectures, discussions, and group problem solving.Finally, the least effective programs were the“rational”onesthatuselecture,questionandanswersessions, and offer displays of tobacco substances.For providers in clinical settings these studies might help prioritize efforts .

Although school based programs are thought to be the best source for educating children about tobacco use, numerous randomized trials haveshowntheseprogramstobeunsuccessful(Peterson,Kealey,Mann,Marek, Sarason, 2000). The failuresprompted the Hutchinson Smoking PreventionProject (HSPP), a 15 year randomized trial thatbegan in September of 1984 . Interventions used in the HSPP were theory based and aimed at socialinfluences including: skills for identifying andresisting negative social influences, information tocorrect errors inperceptionsof smoking,promotingsmoke-freenorms,motivationtowanttobetobaccofree, help students distinguish between what theywanttodoversuswhattheyareabletodo,promoteself confidence in their ability to refuse pressures and influences to smoke, and enlist positive familyinfluences (Peterson et al., 2000). Although welldesigned,inthetwoyearfollow-upposthighschoolitwasfoundthattheHSPPhadlittletonoimpactonsmoking prevalence .

Very few studies have been done regarding the use of health care settings as a venue to help educate the youth on smoking dangers and prevention . A randomized trial incorporated multiple components aimed at smoking prevention starting with two large health maintenance organizations

in Seattle, Washington and Portland, Oregon(Curry, Hollis, Bush, Polen, Ludman, Grothaus,McAfee, 2003). Participants were chosen fromthese two organizations and randomly assigned to receive smoking prevention or routine care . Interventions were aimed at addressing individual,interpersonal, and environmental (child attitudes,beliefs,knowledgeandbehaviors)factors.Modalitiessuchas a parenthandbook, newsletter and a childpacket that included comic book, pens, stickersand antismoking messages were mailed to families . In addition to written materials, frequent callsby counselors, online access to a Steering Clearwebsite, two videos, and physician messages thatwere motivational and offered encouragement were used . Even though parents and children reported that theyvalued thesemodalities, the interventionswere unsuccessful in lowering youth smoking rates . It was concluded that an emphasis on provider face-to-face education with the child may have improved the outcomes .

In primary care settings, providers are heldresponsible for assessing many health maintenance issues including obesity, substance abuse, andhypertension as well as tobacco use. The 5As:Ask, Assess, Advise, Agree andAssist is a strategybased in behavior change theory and can be used in busy practice settings. This strategy, originallydeveloped to address smoking cessation, is beingused successfully for counseling on other topics . “Assessing readiness establishes where the patient is and helps the physician avoid working harder than the patient” (Vallis, Piccinini-Vallis, Sharma,Freedhoff,2013,p.28).Thisstrategy,ifmorewidelyused could help providers assess all youth and identify those at greater risk .

Another strategy being used in primary care is computer facilitated screening to assess substance use. Harris, Csemy, Sherritt, Starostova, Hook,Johnson, Knight, (2012), developed a five minutecomputer assessment which is completed by adolescents prior to their primary care visit . The information is then used to assign a risk level and presents the provider with 6-10 talking points for use in a 2-3 minute conversation with the patient . With this system the number of adolescents receiving counseling doubled and patients reported increased satisfaction with provider and office visit . Positive effects of delay in initiation or lower rates of substance use were noted at 3 and 12 month follow ups .

Numerous studies have shown that smoking prevention education is not being addressed appropriately . Barriers include inadequate provider education and training, insufficient time and

Youth Smoking Prevention continued on page 7

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UpdatedNeonatalSkinRiskAssessmentScale(NSRAS)Melinda Dolack, BSN, RNC-NIC, CLC

Neonatal Intensive Care Unit,Center for Women & Infants

University of Louisville Hospital/Brown Cancer Center

Louisville, KY

Barbara Huffines, MSN, APRN, FNP-C, CRRNNurse Practitioner, Spinal Cord Injury/

PolytraumaVeterans Administration Medical Center

800 Zorn Avenue, Louisville, KY

Reetta Stikes, MSN, RNC-NIC, CLCAdvanced Practice Educator,Neonatal Intensive Care Unit,Center for Women & Infants


Louisville, KY

Pauline Hayes, BSN, RNC-NICClinical Manager, Neonatal Intensive Care Unit,

Center for Women & InfantsUniversity of Louisville Hospital/

Brown Cancer CenterLouisville, KY

Dr. M. Cynthia Logsdon, PhD, WHNP-BC, FAANAssociate Chief of Nursing for Research


Professor, School of NursingUniversity of Louisville

Louisville, KY

Neonatal Skin

Skin is the largest vital organ and protects the body in numerous ways . An intact integumentary system helps with thermoregulation, tactilesensation, insulation and fat storage, whileproviding a barrier against infection, toxins andfluid and electrolyte losses (Lund, Kuller, Lane,Lott & Raines, 1999; Cislet-Cahill, 2006). Skinintegrity is important for all aspects of nursing across the lifespan, but most especially so inneonates. The Association of Women’s Health,Obstetric and Neonatal Nurses (AWHONN) andNational Association of Neonatal Nurses (NANN)support evidence-based clinical practice guidelines for skin care of neonates (Lund, Osborne, et al.,2001). Impairment of skin integrity in neonatescan be costly on healthcare systems and can have significant effects on morbidity and mortality . Therefore,preventingskinbreakdownisessentialinmaintaining the health of neonatal skin integrity .

All skin is composed of three layers: theepidermis, dermis and the subcutaneous tissue.The stratum corneum is the outermost layer of the epidermis and is the skin’s main barrier toprotection against toxins, bacteria, fungi andviruses (Lund et al., 1999; Huffines & Logsdon,1997).Thestratumcorneumconsistsof10-20layersin adults and provides control of evaporative heat loss and transepidermal water loss (TEWL). TEWLcancausesignificantmorbiditydue todehydration,thermalinstabilityandelectrolyteimbalance(Afsar,2009). Infant’s skin, unlike mature, adult skin,must transition from the aquatic environment to the aerobic environment . This maturation process isattainedin2-8weeks(Kalia,1998;Lund,1999).Premature infants have an underdeveloped stratum corneum . Infants less than 30 weeks gestation may only have 2-3 layers, while extremely prematureinfants less than 24 weeks may have virtually no stratum corneum (Lund et al., 1999). Because ofthe thinstratumcorneum,water loss inprematureinfants is dramatically increased from adult levels . Afsar (2009)statesthataninfantbornat25weekswill have transepidermal water loss 15 timesgreater than a term neonate . The vulnerable skin of premature infants also has diminished cohesion between theepidermisanddermis,putting themathigher risk for injury from adhesions or friction and their color appears ruddy due to their thin skin,making color a poor assessment of oxygenation(Lund et al., 1999). Adverse outcomes related tothe presence of neonatal wounds/skin breakdowncandevelopwhile in theNICU, including increasedrisk of infection, greater transepidermal waterand heat loss, increased discomfort, lengthenedhospital stay and increased cost (Cisler-Cahill,2006).Ruth(2011)statesthatthecosttohealafullthicknesspressureulcermaybeashighas$40,000.Recognizing infants that are at risk for breakdown allows staff to take preventive measures and prevent these complications . The typical newborn skin assessmentlistsskinas“intact”orsimplymentionsthat skin breakdown is present . There are numerous instruments for more specific pediatric and infant skin assessments, but only a few specificallydesigned for the neonatal period .

The Neonatal Skin Condition Scale (NSCS)was developed by AWHONN in collaboration withNANN to have research-based neonatal skin care guidelines(Lund,Osborne,etal.,2001;Lund,Kuller,et al., 2001). Lund and Osborne (2004) tested thevalidity and reliability of the NSCS . It was assessed using2,820infantsfrom51NeonatalIntensiveCareUnits(NICU)andwellbabynurseriesin27statesinthe United States with site coordinators educated for 1½ days on the NSCS guidelines . It only tested for dryness,erythemaandbreakdown/excoriationonascale from 1 to 9 . It found that infants < 1000 grams commonly have erythema 6 times more frequently than larger babies, since their underdevelopedstratum corneum allows for greater visualization of the vasculature (Lund & Osborne, 2004). Thescaleconcludedthatthehighertheskinscores,theincreased potential exists for a systemic infection,increased breakdown and a longer hospital stay (Lund&Osborne, 2004). TheNSCS is a very basicskin scale but is more applicable to infants greater than 1000 grams .

The Braden Q Scale is a skin scale that was adapted from the adult Braden pressure ulcer scale . It was initially called the “Modified Braden Q Scale” (Quigley & Curley, 1996). The authors ofthe instrument prefer the title, Braden Q Scale forPredictingPressureUlcerRisk,asdiscussedintheirlaterwork (Curley,Razmus,Robert&Wypij, 2003).It is composed of seven subscales . The subscales are rated 1 (least favorable) to 4 (most favorable).Three subscales measure intensity and duration of pressures(mobility,activityandsensoryperception)and four subscales measure tolerance of the skin and supporting structures (moisture, friction/shear,nutritionandtissueperfusion).Patientswithscores of less than 16 are at risk for skin breakdown (Noonan,Quigley&Curley, 2011). TheBradenQ isa thorough skin scale but is more applicable to the acute pediatric population than neonates .

The Neonatal Skin Risk Assessment Scale (NSRAS) was developed by Huffines and Logsdon(1997) specifically for the neonatal population atrisk for skin breakdown and is based on the Braden Scale for Predicting Pressure Sore Risk . The NSRAS hassixsubscales:generalphysicalcondition,mentalstatus, mobility, activity, nutrition and moisture.Each subscale is scored 1 point for a total of 6 thru

24,withahigherscore indicativeof lowerrisk.Thesensitivity and reliability of the NSRAS was piloted on 32 neonates . It was found to be reliable for general physical condition, activity and nutrition.Evidence for predictive validity was present, withsensitivity at 83% and specificity at 81% . Three subscales were deleted (mental status, mobilityand moisture) for psychometric evaluation but areconsidered essential in determining skin breakdown . Therefore, the use of the total instrument isrecommended .

The NSRAS has been widely used internationally . ResearchersandcliniciansinHongKong,8neonatalhospitalsinSpain,TheElsevierResourceCenter,aswellashospitalsinNewJersey,Nebraska,Californiaand Virginia have requested permission for its use .

The NSRAS was developed and tested in 1997,over 15 years ago. The field of neonatology haschanged,necessitating a revision of the instrumentto reflect evidence-based practice . The first author recently updated the instrument for current use . The updated-NSRAS measures the activity of the neonate “completely bed-bound in a humidified giraffe”,which is a specialized incubator for micro-preemies . The humidification of the incubator decreases the insensible water losses experienced by micro-preemies . The previous NSRAS measured activity as “completely bed-bound on a radiant warmer coveredwith saran-wrap”. The revision of the scalemakes it more applicable to current assessments in the NICU while being simple to use and thorough . A pilot study of the revised NSRAS at University of Louisville Medical Center NICU is planned .

Inconclusion,of the threeneonatal specificskinassessment instruments, the NSRAS is preferentialfor ease of use and its specific application to neonates . Accurate prediction of skin breakdown prevents injury to the precious neonates while saving healthcare dollars .

ReferencesAfsar, F.S. (2009). Physiological skin conditions

of preterm and term neonates . Clinical & Experimental Dermatology. 35(4), 346-350. doi:10.1111/j.1365-2230.2009.03562.x

Cisler-Cahill, L. (2006). A protocol for the use ofamorphous hydrogel to support wound healing inneonatalpatients:Anadjunct tonursingskincare . Neonatal Network, 25(4),267-273.

Curley, M.A.Q., Razmus, I.S., Roberts, K.E. andWypij,D.(2003).Predictingpressureulcerriskinpediatric patients: The Braden Q Scale. Nursing Research, 52(1),22-33.

Huffines, B. & Logsdon, M.C. (1997). The NeonatalSkin Risk Assessment Scale for predicting skin breakdown in neonates . Issues in Comprehensive Pediatric Nursing, 20, 103-114 .

Kalia, Y.N., Nonato, L.B., Lund, C.H., & Guy, R.H.(1998). Development of skin barrier function inpremature infants . The Journal of Investigative Dermatology, 111, 320-326 .

Lund, C., Kuller, J., Lane, A., Lott, J.W., & Raines,D.A. (1999). Neonatal skin care: The scientificbasis for practice . Neonatal Network, 18(4),15-27.

Lund,C.H.,Kuller,J.,Lane,A.T.,Lott,J.W.,Raines,D.A.&Thomas,K.K. (2001).Neonatal skincare:Evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices . Journal of Obstetric, Gynecologic & Neonatal Nursing, (30), 30-40 .

Lund, C.H., Osborne, J.W., Kuller, J., Lane, A.T.,Lott, J.W. & Raines, D.A. (2001). Neonatal skincare: Clinical outcomes of the AWHONN/NANNevidence-based clinical practice guideline . Journal of Obstetric, Gynecologic & Neonatal Nursing, (30),41-51.

Lund, C.H. & Osborne, J.W. (2004). Validityand reliability of the neonatal skin condition score . Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(3), 320-327. doi:10.1177/0884217504265174.

Noonan, C., Quigley, S. & Curley, M.A.Q. (2011).Using the Braden Q Scale to predict pressure ulcer risk in pediatric patients . Journal of Pediatric Nursing, 26, 566-575. doi:10:1016/j.pedn .2010 .07 .006

Quigley, S., & Curley,M.A.Q. (1996). Skin integrityin the pediatric population: Preventing andmanaging pressure ulcers . Journal of the Society of Pediatric Nurses, 1(1),7-18.

Ruth, B., (2011). Prevention and treatment of neonatal hospital acquired pressure injuries. [PowerPoint slides] . Retrieved from http://www.nationwidechildrens.org/Document/Get/91772

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resources to provide the prevention education,and negative attitudes on the importance of this education. In primary care offices, the biggestbarrier to education is the lack of time and also the decrease in regular primary care office visits . Particularly in Kentucky, providers face a largeadditional barrier due to the importance of tobacco growth to agriculture and the economy . Tobacco is one of the largest cash crops and it provides many familieswiththeirincometoaffordshelter,clothing,and food . It is difficult for a primary care provider to deliver smoking prevention education to youth/families that are actively involved in producing tobacco(Noland&Kroll,1996).

Bandura’s Social Cognitive Theory offers anexplanation for human behaviors. It is focused onpeople’s belief in their owncapacity to carry out orchange behavior . When interventions are based on this theory, providers can participate in theenhancement of adolescents making decisions about their health behaviors such as smoking prevention . The self-efficacy portion of this theory helps to point out strengths, use persuasion and encouragementand provide a small step approach to behavior change . The following recommendations can be made for primary care providers based in self-efficacy:

• assessingsmokingstatusateachencounterusingtechniquessuchasthe5As

• determiningparentalsmokingstatusasthisplaces the child at high risk

• continually be aware of programs that aresuccessful and how to implement in practice

• establish relationships with youth to helpthem navigate pressures they will encounter

• educate adolescents that he or shewill likelybe introduced to tobacco by a friend or peer

• provider can be delegated as the mainadvocate to educate office staff and other providers

• maintain websites, as a way to track andadvertise smoking education in offices

• seek ways to creatively promote betterprevention techniques

• providecompensationforproviderssotheycangiveextratimetoyouthandtheirparents

In order to incorporate smoking prevention in primary care, new ideas need to be pursued andmore research needs to be conducted . As nurse practitionersmove to the forefront, it is a necessitythat the new generation of practitioners be proactive in preventing this health disparity . This will save future generations from many preventable diseases and save the nation healthcare dollars .

ReferencesBruvold,W.H.(1993).AMeta-AnalysisofAdolescent

Smoking Prevention Programs [Journal] . American Journal of Public Health, 83(6),872-880.Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=9a234bed-fd0f-4a80-bb07-1c8995b08196%40sessionmgr112&h

Youth Smoking Prevention continued from page 5

id=117CampaignforTobacco-FreeKids.(2013).http://www.

tobaccofreekids.org/research/factsheetCurry,S.J.,Hollis,J.,Bush,T.,Polen,M.,Ludman,

E. J., Grothaus, L., & McAfee, T. (2003). Arandomized trial of a family-based smoking prevention intervention in managed care [Journal] . Preventative Medicine, 37,617-626.doi:10.1016/j.ypmed.2003.09.015

Harris,S.K.,Csemy,L.,Sherritt,L.,Starostova,O.,Hook, S. V., Johnson, J.,...Knight, J. R. (2012,May 7). Compute-Facilitated Substance UseScreening and Brief Advice for Teens in Primary Care: An International Trial [Article]. Pediatrics, 129(6),1072-1082.doi:10.1542/peds.2011-1624

Noland, M. P., & Kroll, L. S. (1996). TobaccoUse Among Youth Living and Working in aTobacco-Producing Region [Journal] . Journal of Health Education, 27(6), 341-349. Retrievedfrom http://web.ebscohost.com/ehost/detail?vid=3&sid=ecdf917b-76a5-4933-b733-b20832426e01%40sessionmgr4&hid=20&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=1997021249

Pbert, L.,Fletcher,K.E.,Flint,A.J.,Young,M.H.,Druker, S., & DiFranza, J. (2006). SmokingPrevention and Cessation Intervention Delivery byPediatric Providers, asAssessedWith PatientExit Interviews [Journal]. Pediatrics, 118, e809-e824.doi:101542/peds2005-2869

Peterson, A. V., Kealey, K. A., Mann, S. L., Marek,P. M., & Sarason, I. G. (2000, December 20).Hutchinson Smoking Prevention Project:Long-term Randomized Trial in School-based Tobacco Use Prevention - Results on Smoking [Journal] . Journal of the National Cancer Institute, 92(24), 1979-1991. Retrieved from http://jnci.oxfordjournals.org

Tingen,M.S.,Waller, J. L.,Smith,T.M.,Baker,R.R., Reyes, J., & Treiber, F. A. (2006). TobaccoPrevention in Children and Cessation in Family Members [Journal] . Journal of the American Academy of Nurse Practitioners, 18, 169-179. doi:10.1111/j.1745-7599.2006.00116.x

U.S. Department of Health and Human Services,Office ofSmokingandHealth (1984).The Health Consequences of Smoking: Chronic Obstructive Lung Disease. Retrieved from http://profiles.nln.nih.gov/ps/access/NNBCCS.pdf

Vallis, M., Piccinini-Vallis, H., Sharma, A. M., &Freedhoff, Y. (2013). Modified 5 As Minimalintervention for obesity counseling in primary care [Journal] . Canadian Family Physician, 59, 27-31 . Retrieved from http://web.ebscohost.com/ehost/detail?vid=3&sid=0bb6d6c0-67e9-42fe-ab29-50d87e35ce07%40sessionmgr114&hid=103&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2011910190

District4News

KNA District 4 provided a donation to 2 local organizations, The Healing Place of Campbellsville, and Warm Blessings in Elizabethtown. Pictured are Rhonda Vale, District 4 Director; Brenda Allen, past Executive Director of The Healing Place Campbellsville, Kathleen Ferriell, District 4 President, and Jay Davidson, Executive Director of The Healing Place statewide. Also pictured are two residents of the program.

The Healing Place, Campbellsville is one ofseveral sites of that organization . Their purpose is tosupportmeninmaintainingsobriety.TheHealingPlace provides a residential program using the AA 12 steps to help clients develop skills to stay clean andsober for life.TheHealingPlaceacceptsclientsfrom the community as well as from the Corrections Department .

www.murraystate.edu/nursing

School of Nursing

Advance Your Career!RN - BSN - OnlineContact Linda Thomas, [email protected]

BSNContact the School of Nursing, 270-809-2193

Advance Practice DNP Options:• FamilyNursePractitioner• NurseAnesthesia• Post-Master’sDNPProgram

Contact:DinaByers,PhD,APRN,ACNS-BC

[email protected]

More than 15 years experience in educating advanced practice nurses to meet the complex

health care needs of society.Strong faculty committed to excellence in

education and practice.

RN First Assistant ProgramA Partnership between NKU and

St. Elizabeth Healthcare (Edgewood)Provides didactic and hands-on preparation needed to

assume the role of the first assistant in operative and invasive procedures.

Fall Course Dates: November 4-8, 2013For information email: [email protected]


KNAMembersOnTheMove

Pamela C. Hagan, MSN, RN, has accepted a new position as APRN Practice Consultant with the Kentucky Board of Nursing .

Ruth R. Staten, PhD, PMH-CS-NP BC, is the new associate dean of undergraduate programs at the University of Louisville School of Nursing . “Ruth brings great vision as we seek to expandour undergraduate programs,” said Marcia Hern,EdD, CNS, RN, dean and professor, UofL Schoolof Nursing. “Her leadership and experience willbe essential to guiding our faculty and students to prepare the best graduates for the nursing workforce.”

TheHumanTouch

Copyright 1980Limited Edition Prints

byMarjorie Glaser Bindner

RN Artist

Limited Edition Full Color PrintOverall size 14 x 18

Signed and numbered (750)—SOLD OUTSigned Only (1,250)—$20.00

Note Cards—5 per package for $6.50

tHE PaiNtiNg

“The Human Touch” is an original oil painting 12” x 16” on canvas which was the titledpainting of Marge’s first art exhibit honoringcolleagues in nursing . Prompted by many requestsfromnursesandothers,shepublisheda limited edition of full color prints . These may be obtained from the Kentucky Nurses Association .

The Human Touch

HerstepisheavyHerspiritishighHergaitisslowHerbreathisquickHerstatureissmallHerheartisbig.She is an old womanAt the end of her lifeShe needs support and strengthFrom another .

The other woman offers her handShe supports her armShe walks at her paceShe listens intentlyShe looks at her face .She is a young woman at theBeginningofherlife,Butsheisalreadyanexpertincaring.

RN PoetBeckie Stewart*

*Iwrotethispoemtodescribethepainting,The Human TouchbyMarge.”Edmonds,Washington1994

FORMAILORFAXORDERS

I would like to order an art print of “The Human Touch”©

________ Signed Prints @ $20.00 _________ Total Purchases ________ Package of Note Cards @ 5 for $6.50 _________ Shipping & Handling (See Chart)

_________ Subtotal ________ Framed Signed Print @ $180.00 _________ Kentucky Residents Add 6% Kentucky Sales Tax _____Gold Frame Tax Exempt Organizations Must List Exempt Number _____Cherry Wood Frame _________TOTAL

Make check payable to and send order to: Kentucky Nurses Association, P.O. Box 2616, Louisville, KY 40201-2616 or fax order with credit card payment information to (502) 637-8236.For more information, please call (502) 637-2546.

Name: ________________________________________________________________________ Phone: _____________________

Address: ___________________________________________________________________________________________________

City: ______________________________________________________ State___________ Zip Code: ______________________

Visa/MasterCard/Discover:____________________________ Expiration Date: ________________________________________

Signature (Required): _______________________________________________________________________________________

ShippingandHandling

$ 0.01 to $ 30.00 . . . . . . . . . . . . . . . . . . . . . . . $6.50

$ 30.01 to $ 60.00 . . . . . . . . . . . . . . . . . . . . . $10.95

$ 60.01 to $200.00 . . . . . . . . . . . . . . . . . . . . $35.00

$200.01 and up . . . . . . . . . . . . . . . . . . . . . . . $55.00

*Expressdeliverywillbechargedatcostandwillbechargedtoacreditcardaftertheshipmentissent.

Professional Nursing in Kentucky * Yesterday *today tomorrow

KNA’s limited editionwas publishedin 2006. Graphics by Folio Studio,Louisville and printing by Merrick PrintingCompany,Louisville.

Gratitude is expressed to Donorswhose names will appear in the book’s list of Contributors. Theirgifts have enabled us to offer this limited edition hard-back coffee-table-type book at Below Publication Cost for Advance Purchase Orders .

The Editors have collected pictures,documents, articles, and stories ofnurses, nursing schools, hospitals,and health agencies to tell the story of Professional Nursing in Kentucky from 1906 to the present .

Publication Price - $20.00______ $20 .00 per book______Add$6.50shippingandhandlingperbook______ Total Purchase______ Grand Total

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Address _____________________________________________

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MailOrderto:

Kentucky Nurses AssociationP.O.Box2616Louisville,KY40201-2616FAX:502-637-8236

Assistant Professor of Nursing

McKendree University seeks applications for a full-time, tenure-track Assistant Professor of Nursing for its Kentucky Campuses to begin in Fall 2014. McKendree University offers a RN to BSN program; a MSN program with nurse educator, palliative care, and nurse manager/administrator tracks; and a dual MSN/MBA program. The successful candidate will participate in the undergraduate and graduate programs. Classes are taught in Louisville, Radcliff, and at various locations throughout Kentucky.

The position requires a doctoral degree in nursing or a related field (if doctoral degree is in a related field, master’s degree must be in nursing), at least two years of clinical practice, two years’ experience in nursing education, experience teaching in an online format, and a current, unencumbered Kentucky RN license. Candidates currently enrolled in a doctoral program may be considered for the position.

Send letter of application, curriculum vitae, statement of teaching philosophy, and three current letters of recommendation with contact information referencing position NUR64 to Shirley A. Rentz at [email protected].

Priority will be given to applications received by November 15, 2013. Screening will begin immediately and continue until position is filled. Minorities and members of underrepresented groups are encouraged to apply.

Cumberland River Comprehensive Care Center

Full-Time Certified Psychiatric APRN Positions are now available at the

Cumberland River Comprehensive Care Center in Corbin, KY.

Excellent Fringe Benefits! Must have Kentucky State Licensure.

Contact via email: [email protected]

EOE

St. Elizabeth-ANC Home Care is hiring Registered Nurses for

our Northern KY Office!

•Flexiblefulltimehours•Competitivewagesandvacation•Benefits-401K,health,vision anddental•Pleasantworkingenvironment•Supportiveadministration•Onsiteeducation

Apply today for your confidential interview to www.stelizabethanchomecare.com

7627EwingBlvd,Florence,KY41042


District #1Karyn Michele BentleyRebecca A . BrownMelissa L . BurchettMary Catherine FurmanJoy GriffithDeborah JohnsonBeverly Ann SnawderLaureenTerry-HughesDawn WelchTracy Elizabeth Williams

District #2Robert F . BallAngela Michelle BishopKendra CornishLisa CrabtreeMaricon Banzon DansStephanie K . FieldsDebraSueHallKristyE.HayesSooksai KaewbuaNancyO’Neill

Nancy P . OraftikAlice Marie PottsLaura Lynn SheltonJordan Kyle StokerBettina M . WebbKim Wilder

District #3Lisa ArehartCharlene A . BlevinsTeresa BordersCecilia O . ConnorSondra Sue FeliceJulianne Ossege

District #4HeatherDanetteGriffithsLindsay Shanelle Songer

District #5Andrea Tyson Riley

District #6Lisa F . AbnerAimee Nicole BrockAlicia CookRhondaL.HarveyEleanor LifordLisa Edington TerryKristie Wilson

District #7Jane Ann DeMauroMaria Eve MainKimberly Ann PhillipsKelly Ann PolakVicky Rosa

District #8Shannon CaseyClara S . DorisShana Gaynor-Champion

District #9YvonneM.ChabotJennifer Ashley Phillips

District #10Clara GarrettNicole Isaac

District #11HollyChyannShemwell

WelcomeNewMembersTheKentuckyNursesAssociationwelcomesthefollowingnewand/orreinstatedmemberssincethe

July/August/September2013issueoftheKENTUCKY NURSE


NewProgramToGiveUndergraduateNursingStudentsATasteOfResearch

University of Louisville junior nursing student Shane Watts has lived with type 1 diabetes since he was eight-years-old . Understanding the disease and howtobestmanage it,hesaid, is informationhecanusebothasapatientand as a future health care provider .

Through independent study and UofL’s Summer Research OpportunityGrant (SROP),Watts has had the opportunity to learnmore about diabetesand become knowledgeable about health sciences research in the process .

Working with Diane Chlebowy, PhD, RN, an associate professor whoseresearch focuses on self-management behaviors and glycemic control in adultswithtype2diabetes,Wattshasparticipatedinliteraturereviews;theInstitutional Review Board submission and approval process of a research study;participantrecruitmentforstudies;anddataentryandanalysis.

A newprogramwill givemore nursing students research experience; theUndergraduateResearchScholarProgramstartsinAugustunderChlebowy’sdirection .

Research scholars have weekly interaction with their faculty mentors and will participate in a variety of research and scholarly activities . They’ll help develop grant applications, implement research studies, anddevelop manuscripts or research presentations . These scholars also may present research findings or scholarly work at local, regional, or nationalconferences .

Graduating seniors who have completed two consecutive semesters in the Undergraduate Research Scholar Program and have been recommended by their faculty mentor will be honored during the school’s convocationceremony .

Fall participants are Andrea Timperman, whose mentor is Chlebowy;RachaelChlebowy,KelseyKoopmanandAnnetraTaylor,whowillworkunderthe direction of Barbara Polivka, PhD, RN, the School of Nursing’s ShirleyB. Powers Endowed Professor; and Lindsay Tucker, whose mentor will beassociateprofessorSandySmith,PhD,APRN,NNP-BC.

Taylor, a senior, is involved in research around stress and nursingretention - major problems affecting the profession, quality of patientcare, and the workplace. Her project will focus on compassion fatigue, a

combination of physical, spiritual and emotional depletion when caring forpatients and compassion satisfaction, the pleasure of helping others and ajob well-done .

Taylor said Polivka is a dynamic leader “who honestly cares about the menteeinregardstolife,schoolandtheresearchprojecttheyareassigned.Sheencouragespeopletoexcelinalltheirendeavors.”

Polivka said serving as a mentor has its own rewards .“The students are enthusiastic and interested; it’smyhonor to see them

grow in research knowledge and to become enthusiastic about conducting research,”shesaid.

Theprogrambenefits are two-fold, said LynneHall,DrPH,RN,School ofNursing associate dean of research .

“This opens exciting opportunities for our undergraduate students toobtainhands-onexperiencewiththeresearch. Itwillhelpthemunderstandtheimportanceofevidence-basedpractice,”shesaid.

Another important benefit, Hall said, is that the program encouragesstudents to think about graduate school earlier, as some will consider anacademic career in nursing—a needed step to reduce the nursing faculty shortage. Nationally, there are too few doctorally prepared nurses to teachthenext generation of nurses andUofL aspires to be a leader at improvingthosestatistics,shesaid.

An academic career in nursing which includes research is a possible career goal forWatts, who is considering the School of Nursing’s BSN-PhDprogram .

Watts credits his mentor for inspiring him .“Dr . Chlebowy has imparted to me the spirit of a researcher through her

wisdom,compassion,motivation,andprofessionalism,”hesaid.“Sheismorethanwilling to invest the time, energy, and resources necessary to ensurestudentsuccessandexemplifiestheartandscienceofnursing.”

FrontierNursingUniversityAnnouncesNewMSN+DNPProgram

Newprogramoffersmoreoptionsforgraduatenursingandmidwiferystudents

FrontierNursingUniversity is excited toannounce the introductionofanewcurriculum beginning January 2014 . This new curriculum will allow students to completeaMasterofScienceinNursing(MSN)withafocusinnurse-midwifery,familynursepractitionerorwomen’shealthcarenursepractitionerstudies,andhave the opportunity to seamlessly progress to a companion Doctor of Nursing Practice(DNP)degree.Pleaseseethefullstoryonourwebsitesiteatwww .frontier .edu .

Earn a Credential That’s in Demand Nationwide

• “Top 15” ranked nursing school

• Practice specialties for all interests

• State-of-the-art nursing informatics and facilities

• Community of scholars with broad faculty expertise

• Distance learning opportunities

Learn more. Apply today.www.nursing.vanderbilt.edu

Master of Science in Nursing (MSN)

Doctor of Nursing Practice (DNP)

PhD in Nursing Scienceclinical interventions, health services research

Leading the way to a new model of healthcare in Alaska!Southcentral Foundation (SCF) is an Alaska Native owned, nonprofit healthcare organization located on the Alaska Native Health Campus. SCF is seeking dynamic Registered Nurses to act as Case Managers in Primary Care Clinics.

• 401 K retirement plan • 12 paid holidays • Much Much More!

If you are interested in becoming part of the nationally recognized Anchorage Facility, please visit our website and apply at www.scf.cc or contact Tess Johnson at 907-729-5011/email [email protected]

$10,000 Sign On Bonus &Relocation Assistance!

Online ProgramNursing (RN to BSN) Program

Online Bachelor of Science in Nursing (RN to BSN) Program

The Online Bachelor of Science in Nursing (RN to BSN) program helps prepare students for advancement within their current nursing career. Graduates of this program can go on to work in a variety of areas. For more information on this program and how it can work for you, contact Daymar College Online today!

Call Today! 1-888-338-3538www.Online.DaymarCollege.edu

For more information about graduation rates, median debt of students who completed the program, and other important information, visit our website at http://online.daymarcollege.edu/pdf/disclosures/Nursing.pdf. Daymar cannot guarantee acceptance of its credits by other

institutions. Acceptance of credit is determined by the receiving institution. Students who are planning to transfer credits should contact the receivinginstitutionaboutitstransfercreditpolicy.CareerEducation|AccreditedMember,ACICS


KNACentennialVideoLest We ForgetKentucky’s

POWNursesThis 45-minute video documentary is a KNACentennial Program Planning Committee project and was premiered and applauded at the KNA 2005 Convention. “During the celebration of 100 years of nursing in Kentucky—Not To Remember The Four Army Nurses From Kentucky Who Were Japanese prisoners for 33 months in World War II, would be a tragedy. Their story is inspirational and it is hoped that it will be shown widespread in all districts and in schools throughout Kentucky.

POW NURSESEarleenAllenFrances,BardwellMaryJoOberst,Owensboro

SalliePhillipsDurrett,LouisvilleEdithShacklette,Cedarflat

_____ Video Price: $25.00 Each

_____ DVD Price: $25.00 Each

_____ total Payment

Name _________________________________________

Address _______________________________________

City ___________________________________________

State,ZipCode _______________________________

Phone ________________________________________

Visa * MasterCard * Discover *

Credit Card # _________________________________

Expiration ____________________________________

Signature _____________________________________(Required)

Kentucky Nurses associationP.O. Box 2616

Louisville, KY 40201-2616Phone: (502) 637-2546 Fax: (502) 637-8236

The Clark County Health Department in

Winchester, KY is taking applications for a

Local Health Nurse I - Home Health

to fill an on-going need.

Please refer to our website, http://www.clarkhealthdept.org

for more information.

October 20133 6:00PMKNABoardofDirectors Meeting,CapitalPlazaHotel, 405Wilkinson,Boulevard, Frankfort,KY40601

4 HealthCare Summit 2013 Capital Plaza Hotel, 405 Wilkinson Boulevard, Frankfort, KY

10–11 KANSConvention,Centerfor CourageousKids,Scottsville,KY

21 5:30PMDistrict1,CaféBistro, LowerLevelOlmstead, MasonicHome,Louisville,KY

November 20137 6:30PMDistrict9Meeting,the BeaumontInn,Harrodsburg,KY

11 MaterialsDuefortheJanuary/ February/March2014Issueof Kentucky Nurse

KentuckyNursesAssociationCalendarOfEvents2013-2014

18 5:30PMDistrict1,CaféBistro, LowerLevelOlmstead, MasonicHome,Louisville,KY

28-29 ThanksgivingHoliday– KNA Office Closed

December 201316 5:30PMDistrict1,CaféBistro, LowerLevelOlmstead, MasonicHome,Louisville,KY

20-31 ChristmasHoliday– KNA Office Closed

January 20141 NewYear’sDay-KNAOfficeClosed

20 MartinLutherKing,Jr.Holiday– KNA Office Closed

*All members are invited to attend KNA BoardofDirectorsmeetings(pleasecallKNAfirsttoassureseating,meetinglocation,timeanddate)

LPN – Temporary School HealthLFCHD/School Health

650 Newtown Pike, Lexington, KY 40508

· <23.0 hours per week for 43 weeks per year· Current KY LPN and 2 years LPN experience· Positions report directly to Team Leader Nurse Specialist· $14.3590 per hour

Apply online at www.lexingtonhealthdepartment.org;

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An Award Winning Publication...An Award Winning Publication THE OFFICIAL PUBLICATION OF THE KENTUCKY...

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