NANNCentral Summer 2010 • Vol. 26, No. 2 from NANN’s President Professional Growth: What Is Your Plan? Lori Armstrong, MSN RN I hope that everyone’s plan for the summer includes some time for rest and relaxation. Neonatal nurses work extraordinarily hard, giving of themselves throughout what are most often 12-hour shifts. It is essential to take time for yourself—to breathe, to think, to regroup. Stepping back and assessing where you are both personally and professionally is vital to ongoing health and well-being. During these times of relaxation you can see things more clearly. (Often I do my best thinking on airplanes—possibly because that is the only place where I cannot be reached by others.) As professional nurses we don’t just have jobs. We are not shift workers. We are part of a profession. In fact, we are members of the most respected profession in the United States. For the eighth consecutive year, nurses have been voted the most trusted professionals in our country, according to Gallup’s annual survey on perceptions of honesty and ethical standards in professions. Eighty-three percent of Americans believe nurses’ honesty and ethical standards to be either “high” or “very high” (Jones, 2009). With that ranking comes great responsibility. During a time of healthcare reform and challenging political developments, Americans are telling us that they trust us. They trust us during very vulnerable times in their lives—when they or one of their family members is sick. Medical literature documents the discovery and rediscovery of an inseparable link between lifelong learning, ongoing competence, and the delivery of high-quality patient care. We as neonatal nurses must embrace this concept and nurture it (Crocker, 2009). The American Nurses Association (2004, p. 20) asserts in Nursing: Scope and Standards of Practice that “registered nurses as lifelong learners must have available the appropriate and adequate professional development and continuing education opportunities to maintain and advance skills and enhance competencies.” So as you take time to rest and regroup this summer, please take time to think about where you are professionally, what opportunities for learning and advancing are open to you, and, most important, where you want to go. Abraham Lincoln is quoted as saying, “I don’t think much of a man who is not wiser today than he was yesterday.” With these things in mind, let’s embrace the challenge to be lifelong learners. One year from now, we want to be in a different place. I submit to all NANN members and neonatal nurses that we have a responsibility to plan professionally for our future. Nurses make up the largest number of healthcare providers in most organizations, and we deliver that care in the most complex of environments. So take action. Plan for your continuing education. Hone your skills. Plan to have a broader impact on the patients and families that you serve. Rebecca Patten, MSN RN CNOR, president of the American Nurses Association (who met with President Obama last year to address healthcare reform and attended the signing of the historic healthcare reform bill) has revealed the disappointing statistic that 80% of all registered nurses are not members of a professional nursing organization. NANN’s core purpose is to support the professional needs of neonatal nurses throughout their careers. As the only nonprofit professional association exclusively dedicated to neonatal nurses, NANN aims to be the advocate and leading change agent for the neonatal nursing profession in order to optimize care for neonates and their families. We do this for our members—and for neonatal nurses at large—by providing educational offerings, developing essential position statements, and setting practice standards. So what will it be? Will you become certified? Will you learn more about pharmacology? What steps will you take to advance as a neonatal expert during the next 12 months? NANN’s 26th Annual Educational Conference, to be held September 19–22 at Las Vegas’s Paris Hotel, is a great place for you to add to your skill set, meet your 2010 learning needs, and set your plan in motion. This year’s conference is titled “Embracing the Power of Change: Advancing, Leading, and Learning.” Our keynote speaker, John Vance, will set the stage by teaching us about patient safety. He will discuss teamwork and collaboration, the key ingredients of a culture of safety that leads to the delivery of highquality, cost-effective care. Attend the certification review course or learn about perinatal palliative care, the S.T.A.B.L.E. Cardiac Module, neonatal pharmacology, procedural skills, or the challenges of the late-preterm infant in one of the other preconference workshops. The variety of topics and speakers offered this year are outstanding. We value every NANN member and have sought to develop a conference that offers something for everyone. Whether you are a practicing bedside nurse or a seasoned neonatal nurse practitioner, you’ll find a session just right for you. In addition, managers and directors will find a variety of topics in the management track designed to help you support your staff and the patients in their care. And, as always, networking opportunities at the conference abound! When I see you in Las Vegas, I will ask what your plan is. Please ask me for mine! References American Nurses Association. (2004). Nursing: Scope and standards of practice. Silver Spring, MD: Author. Crocker, S. V. (2009). Fall into lifelong learning. Wyoming Nurse, 22 (1), 11. Jones, J. M. (2009, December 9). U.S. clergy, bankers see new lows in honesty/ethics ratings. Retrieved June 1, 2010, from www.gallup.com/poll/124628/Clergy-BankersNew-Lows-Honesty-Ethics-Ratings.aspx. Update on NANN’s Educational Activities Members of NANN’s committees and task forces have been busy! Several new projects and learning opportunities are now available for NANN members and the neonatal nursing community, and others will be available soon. Whether you are seeking to hear the latest from your peers and do some networking, looking to catch up on your continuing nursing education (CNE) requirements, building your résumé and portfolio, or simply wanting a mental challenge, NANN has something for you. What’s Hot at the Annual Educational Conference? Have you registered for NANN’s 2010 conference yet? Join NANN September 19–22 for education, networking, and fun in the exciting city of Las Vegas! Now in its 26th year, this gathering is the premier conference in neonatal nursing, offering you many unique opportunities—up to 25 CNE credits for credentialing and certification (including some in the area of pharmacology), updates on health policy and advocacy, a hot topics session on H1N1 flu, a presentation on ventilator management, a how-to session on process improvement, a neonatal procedural skills lab, and much more. Sessions offer information that represents the current and best states of neonatal care, management, and research through the illustration of best practices and evidence-based recommendations. The conference gives you a great opportunity to network with friends and colleagues in the neonatal community and enhance your knowledge of products and innovations displayed by more than 150 companies in the exhibit hall. But don’t wait—register before August 20 to receive an early-bird discount with savings of $100. In addition, you won’t want to miss a chance to win a $50 American Express gift card through the “Hit the Jackpot with NANN” promotion. For more information, visit www.nann.org or call (800) 451-3795 to ask for another brochure. CNE Store Now Open for Business A new function is now available to you on the NANN Web site. Online CNE has been singled out for ease of access as you look for Web-based learning activities. Just one click will get you to the new Understanding Clinical Research learning module, and other offerings are being planned. Check it out. continued on page 2 NANNP Corner ® NANN and NANNP Represented at June LACE Meeting Lyn Vargo, PhD RN NNP-BC, NANNP Council Member In 2008, the APRN Joint Dialogue Group presented the Consensus Model for APRN Regulation (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008), which outlines four essential elements of advanced practice registered nurse (APRN) regulation: licensure, accreditation, certification, and education (LACE). On January 12, 2010, the LACE work group of representatives from the 40-plus organizations (certifying bodies, educational institutions, nursing organizations, and licensing and regulating bodies) that have endorsed the model met in Atlanta to give an update on their planned implementation of the model by the target date of 2015. NANN and NANNP have formally committed to support LACE’s efforts, and a representative of the organizations has been attending the meetings as a stakeholder, providing input from the perspective of neonatal advanced practice nursing and ensuring that the neonatal population remains a focus within the initiative. (Suzanne Staebler’s report on the January 12 LACE meeting appeared in the March 2010 issue of NANN E-News, archived at www.nann.org/pubs/nann_enews.html.) On June 9, the group met again in Chicago at the office of the National Council of State Boards of Nursing (NCSBN), and I attended as NANN and NANNP’s representative. At this meeting a subcommittee reported on the development of the LACE Web site, which is nearing completion. The site will serve as an electronic platform for LACE, assisting communication among members of the core group but also helping to guide organizations and institutions as they develop common definitions regarding the roles of advanced practice registered nurses, debate on appropriate credentials and scope of practice for APRNs, and seek to achieve uniformity in educational and state regulations that have previously limited the ability of patients to access care from APRNs. Work on answers to frequently asked questions about the LACE initiative is also nearly complete. NANN will post the document on its Web site when it is available. Some discussion at the meeting involved determination of continued participation by advanced practice organizations in formalizing the LACE initiative. It was decided that those organizations that have participated in LACE from the group’s inception would continue to participate as active stakeholders. For NANN and NANNP members, this continued input is critical because the changes in LACE will have a significant impact on NNP practice and education. Reference APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). APRN Joint Dialogue Group Report. Consensus model for APRN regulation: Licensure, accreditation, certification, and education. Chicago, IL: National Council of State Boards of Nursing. Retrieved March 9, 2010, from https:// www.ncsbn.org/7_23_08_Consensue_APRN_Final.pdf. Lyn Vargo is clinical assistant professor in the nurse practitioner programs at Stony Brook University, Stony Brook, NY, and the University of Missouri–Kansas City. Update on NANN’s Educational Activities continued from page 1 Developmental Care CNE Learning Modules Developmental Care of Newborns and Infants, second edition, will be available for purchase in August. This edition builds on the strengths of the first edition but offers revised content, expanded chapters, and a CNE component. The CNE modules are independent from the book but draw on its content. Learners can pay a nominal fee and receive credit (up to 38 contact hours) for single chapters or for all the chapters at a reduced price. Developmental Care Specialist Designation Not only is the new and improved textbook on developmental care now available, but so is a new professional development option for neonatal professionals. Coinciding with the publication of the Developmental Care of Newborns and Infants, second edition, a special designation in developmental care will be available to those interested. A designation as Specialist, in the form of a certificate and card, will be provided to those who have studied developmental care and passed a test demonstrating cognitive expertise in that area. Watch your e-mail and www.nann.org for more information about all of these educational offerings, or simply call NANN’s customer service department at (800) 451-3795. Endocrine Disruptors and Neonates Laura Stokowski, MS RN, cochair of NANN’s Health Policy and Advocacy Committee Health concerns related to endocrine-disrupting chemicals (EDCs) have been in the news in recent months, and they matter to those who work with neonates because of their possible effect on neonatal development. An endocrine disruptor interferes with the communication system of glands, hormones, and cellular receptors that control the body’s internal functions, one of which is development of the reproductive system. A concern in perinatology is that EDCs might be interfering with normal development of reproductive organs, especially in males, because male genital development is dependent on specific hormones being present at critical times during fetal development. Exposure during these critical developmental windows might be a cause of atypical genitalia (e.g., cryptorchidism and hypospadias) in newborn boys, and, later on, of infertility, testicular cancer, and prostate cancer, all conditions that have increased in incidence since these chemicals became ubiquitous in our lives. The evidence for adverse reproductive outcomes from exposure to EDCs is strong, and evidence for their effects on other endocrine systems (including the neuroendocrine system and the thyroid), obesity and metabolism, and insulin and glucose homeostasis is also mounting. A group of highly heterogeneous molecules, EDCs include synthetic chemicals used as industrial solvents or lubricants and their byproducts (polychlorinated biphenyls [PCBs], polybrominated biphenyls [PBBs], dioxins), plastics (bisphenol A [BPA]), plasticizers (phthalates), pesticides (methoxychlor, chlorpyrifos, dichlorodiphenyltrichloroethane [DDT]), fungicides (vinclozolin), and pharmaceutical agents (diethylstilbestrol [DES]). Furthermore, some natural chemicals found in human and animal food (e.g., phytoestrogens) can also act as endocrine disruptors. EDCs are widely consumed and are even found in infant formula. Two EDCs of particular concern for infants and children are BPA and plasticizers (phthalates). BPA is a synthetic chemical used in hard, polycarbonate plastics, such as baby bottles and infant incubators. BPA acts as a weak estrogen in the body. Phthalates are synthetic chemicals used to soften polyvinyl chloride products. Phthalates are found in many flexible plastic products (such as intravenous tubing) and in personal care products (shampoos and lotions). Phthalates are anti-androgenic: they oppose the effect of hormones necessary for male reproductive development. Some exposure to these chemicals comes from inhalation of contaminated dust, but other exposure comes from foods or fluids that are in direct contact with BPA-containing or phthalatecontaining products. Attention to this latter area of exposure is critical to preventing harm from potential EDCs. To err on the side of caution, we must learn more about EDCs and their potential effects on humans. To do otherwise would be to fail in our role as advocates for the health of newborns. On December 3, 2009, Representative Jim Moran (D-VA) and Senator John Kerry (D-MA) introduced the Endocrine Disruption Prevention Act of 2009 (HR 4190, S 2828) to authorize an ambitious research program in endocrine disruption at the National Institute of Environmental Health Sciences. The goal is to develop reliable and reproducible methods to identify chemicals that can disrupt the human endocrine system and to address the full range of health outcomes from exposure to these chemicals. This information will eventually be used to develop a course of action for dealing with environmental exposure to endocrine disruptors. Because this issue affects our neonatal patients, NANN’s Health Policy and Advocacy Committee has been monitoring developments and seeking to educate members about the proposed legislation. A call for action has been posted on NANN’s Web site, and members are encouraged to contact their elected officials in Washington and express their views about the Endocrine Disruption Prevention Act. At the Endocrine Disruption Exchange Web site (www.endocrinedisruption.com), interested individuals can learn more and find help in contacting their congressional representatives. Bibliography Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., et al. (2009). Endocrine-disrupting chemicals: An Endocrine Society scientific statement. Endocrine Reviews, 30 (4), 293–342. Retrieved June 1, 2010, from www.endo-society.org/ journals/ScientificStatements/upload/EDC_Scientific_ Statement.pdf. The Endocrine Disruption Exchange. (n.d.). The Endocrine Disruption Prevention Act of 2009. Retrieved June 1, 2010, from www.endocrinedisruption.com/endocrine.edlaw.php. U.S. Congress. House. Endocrine Disruption Prevention Act of 2009. HR 4190. 111th Cong., 1st sess. Retrieved June 1, 2010, from www.opencongress.org/bill/111-h4190/text. Laura Stokowski is a staff nurse at Inova Fairfax Hospital in Falls Church, VA. NANN’s Partnership with the National Student Nurses’ Association Donna Ryan, MSN RN, NANN Director-at-Large In 2009 the NANN Board of Directors and NANN administrative staff spent much time developing a strategic work plan. One area of focus is membership engagement, particularly efforts to increase recruitment of new members and retention of current members. NANN is also committed to two initiatives to reach out to nursing students who plan to pursue a neonatal nursing career. On June 1, 2010, NANN reduced the membership fee for student nurses to $50 per year. NANN is also developing a partnership with the National Student Nurses’ Association (NSNA), which will provide an opportunity for NANN members to mentor and engage student nurses. With approximately 50,000 members nationwide, NSNA is a preprofessional association that guides the professional development of future registered nurses and facilitates their entrance into the nursing profession by providing educational resources, leadership opportunities, and career guidance. I was asked to represent NANN at NSNA’s 58th annual convention in Orlando, FL, in April 2010. More than 3,000 nursing students and faculty advisors attended the convention. I had the opportunity to talk with many students about neonatal nursing, NANN, and NANN’s member benefits. I was impressed with the caliber of involvement and commitment possessed by the delegates to the convention, and I am optimistic that nursing will be in good hands with these future nurse leaders. After attending the opening ceremony and keynote address by Jennie Chin Hansen, MS RN FANN, president of AARP and senior fellow at the Center for the Health Professions at the University of California–San Francisco, I attended a reception where I met Diane Mancino, NSNA’s executive director, and several NSNA board members. I attended a plenary session, “Quality Transformation in Nursing Education and Practice,” moderated by Rebecca Patten, MSN RN CNOR, president of the American Nurses Association. Beverly Malone, CEO of the National League for Nursing, and Mary Beth Farquhar, vice president for performance measures for the National Quality Forum, were the speakers. They shared their vision and insights concerning the importance of quality indicators for the future of health care and the need to advance society’s understanding of the value of nursing education and practice. Emerging roles and responsibilities are placing new demands and greater expectations on nurses, and nursing education and practice delivery settings are changing. Nurses must therefore prepare—and stay prepared—to provide high-quality nursing services. NANN supports NSNA’s mission to develop and prepare nursing students to lead the nursing profession in the future and unites with NSNA in the goal to support student nurses through excellence in practice, education, research, and professional development. NANN plans to send a representative to speak about neonatal nursing in a panel discussion at NSNA’s conference in Cincinnati, OH, November 4–7, 2010. Donna Ryan is clinical research coordinator and clinical instructor at Duke University School of Nursing, Durham, NC. Chapter News NANN is pleased to have added two chapters to its network of local chapters. The Southern Wisconsin Association of Neonatal Nurses attracts nurses from the Milwaukee and Madison areas. The chapter begins its journey with a list of ambitious goals and great excitement among its members. The Central Florida Association of Neonatal Nurses is our most recent The Delaware Valley chapter sponsored a checkpoint station addition, covering a 50-mile radius around Orlando. The chapter started with 26 members—an impressive number at the March of Dimes Walk for Babies. for a new chapter. It offers continuing education at quarterly meetings and has even held one meeting using video conferencing. Chapter members have also raised money for Transition House, a local charity. To find a chapter near you or to get information about starting a chapter, go to www.nann.org and click on Chapters under the Membership tab. The Delaware Valley Association of Neonatal Nurses sponsored a checkpoint station at Rowan University in Gloucester County, NJ, for the March of Dimes Walk for Babies in April. The checkpoint station was decorated to honor mothers (for upcoming Mother’s Day). The chapter collected 8 cell phones and 112 books for its campaign and distributed information on infant/child cardiopulmonary resuscitation to walkers. New NANN Board and NANNP Council Members Elected The NANN and NANNP Nominations Committees worked hard in 2009 and 2010 to identify a slate of excellent nominees for each organization. Thanks are due to the committee and also to all who voted in this important election. The election has now concluded, and the results have been tallied. We are pleased to announce the new board and council members who will begin their terms after the annual conference in Las Vegas, September 19–22, 2010. NANN Board of Directors Secretary-Treasurer: Gladys Mabey, MN RN Director-at-Large: Carol Wallman, MSN RN NNP-BC Special Interest Group Director-at-Large: Elizabeth Damato, PhD RNC CPNP Staff Nurse Director-at-Large: Julianne Dahl, MSN RNC-NIC NANNP Council District 1: Terri Cavaliere, DNP RN NNP-BC District 2: Lee Shirland, MS APRN NNP-BC District 4: Bridget Cross, MSN RN NNP-BC To all those who were candidates in the election: your willingness to lend your time and expertise to NANN is truly valued. Thank you! This is an exciting time to be involved in NANN, with many important initiatives under way. We look forward to the leadership of this excellent team of volunteers who will guide our organization into the future as strong advocate and leading change agent for the neonatal nursing profession. Silent Auction to Benefit March of Dimes A silent auction to benefit the March of Dimes will take place in the exhibit hall at NANN’s 26th Annual Educational Conference, September 19–22, 2010, in Las Vegas, NV. We ask you, as a friend of the March of Dimes, to help raise money for research and programs that bring comfort and care to babies born prematurely or sick. The following items are examples of appropriate entries for the silent auction: •gift baskets •autographed sports memorabilia •funding for a travel grant to NANN ‘s conference •housewares •garden accessories •gift certificates for national chain restaurants or stores •medical equipment. The ground rules are as follows: 1. The item must be able to be easily displayed on a table. 2. Any gift basket with loose items or valuables must be wrapped in clear plastic wrapping. (Please note: The silent auction site will not be supervised.) 3. All entries must be able to be boxed and shipped to the recipient’s home. 4. All entries must include a card with the name of the donating organization. 5. Gift baskets, or any other wrapped items, should include a list of the contents. Use your imagination to come up with a silent auction item that will invite everyone to place a bid. For more information about the silent auction, please visit the Meetings page at www.nann.org. NANN and the March of Dimes thank you for your support of premature babies. 2010 Brighter Tomorrows Story Contest Winner A Brighter Tomorrow—A Journey That Began in a NICU Kristen Pelshaw, MSN RN CPNP-PC “The sun’ll come out tomorrow, bet your bottom dollar that tomorrow, there’ll be sun” (Strouse & Charnin, 1977). Each birth is a sun rising. Each life is a song sung. More than 12 years ago, I found myself in the midst of a family expectant for the life of their first child. A preterm delivery was not part of their birth plan; they thought they still had time before their child would be born. However, at 28 weeks’ gestation Abigail—or Abby, as she was known by family and friends—was welcomed into the world. It was Thanksgiving 1997. Indeed, this family had much to be thankful for. Abby appeared to be “doing well” in her first few hours of life, but then she tired out. Abby required ventilatory support and an umbilical arterial catheter for several days. She spent many weeks on nasal CPAP [continuous positive airway pressure]. Her parents began to think she would go home with it as if it were her security blanket. Eventually, on February 4, 1998, Abby was discharged with a nasal cannula and supplemental oxygen. As nurses and ministers of health, we often wonder what happens to those who have been entrusted to our care. So often, people come into our lives for a brief period and then move on. “When I’m stuck in a day that’s gray and lonely . . .” (Strouse & Charnin, 1977). Little did I know that our paths would cross again. That gray day would evolve over time, and this little life would grow and become an even more treasured gift. Just a few years ago, I met Abby again, when she was 8 years old; my daughters and Abby attend the same school. This spring, at the age of 12, Abby played the lead in our school musical, Annie. In her red dress, she proclaimed that this “hard knock life” has been transformed into a life where the “sun will come out tomorrow.” I watched this production with a smile in my heart, knowing I have a special connection with Abby that no other attendee that night has had. I cared for Abby as one of her NICU nurses; I nurtured her when her parents were not able to be at her bedside. As nurses, we live our lives for others. In these lives we recognize that we give of ourselves in the midst of difficult situations. As Annie reminds us, “maybe far away or maybe real near by,” we can continue to see the value of life. We should celebrate the symbol of the “little red dress,” which reminds us that what we do is about the value of life lived for others. I have been blessed with the great honor and privilege to have cared for Abigail and heard her song sung. May our special connection continue for years to come. Calendar www.nann.org NANN 6th Annual Research Summit Online abstract submission deadline September 10, 2010 National Neonatal Nurses Day September 15, 2010 NANN 26th Annual Educational Conference Las Vegas, NV September 19–22, 2010 Florida Association of Neonatal Nurse Practitioners Conference October 12–16, 2010 NANN 27th Annual Educational Conference Online abstract submission deadline October 15, 2010 8th International Neonatal Nurses Conference Sponsored by the Neonatal Nursing Association of Southern Africa and the Council of International Neonatal Nurses Durban, South Africa www.nnasa.org.za October 24–27, 2010 NANN 6th Annual Research Summit Scottsdale, AZ April 12–14, 2011 Look for chapter meeting dates at www.nann.org. Reference Strouse, C., & Charnin, M. (1977). Annie (original Broadway cast recording remastered in 2009). Kristen Pelshaw, MSN RN CPNP-PC, is a clinical nurse specialist in the NICU at William Beaumont Hospital in Troy, MI. She submitted this story to NANN’s 2010 Brighter Tomorrows Story Contest. Read all the story submissions on the Meetings page at www.nann.org. NANNCentral 4700 W. Lake Avenue Glenview, IL 60025-1485 NANN CENTRAL (ISSN: 1544-3382) PRSRT STD US Postage PAID Glenview, IL Permit No. 62 2010 March of Dimes Walk for Babies The NANN national office staff, with colleagues and family members, raised $4,397 in the 2010 March of Dimes Walk for Babies on April 24, breaking all previous records. Twenty-three walkers raised $2,397, and $2,000 of that amount was matched by Association Management Center, NANN’s management company, to bring the total to $4,397. Thanks to these and all across the country who walked and supported this worthy cause. NANN 4700 W. Lake Avenue Glenview, IL 60025-1485 (800) 451-3795 • (847) 375-3660 Fax (866) 927-5321 [email protected] • www.nann.org NANN Central Content Reviewer: M. Kathleen Philbin, PhD RN NANN Central™ (ISSN: 1544-3382) is published 3 times per year by the National Association of Neonatal Nurses, 4700 W. Lake Avenue, Glenview, IL 60025, and is distributed to members as a direct benefit of membership. A portion of this membership ($9) goes toward a subscription to this newsletter. Printed in the U.S.A. POSTMASTER: Send change of address orders to NANN Central ™, c/o National Association of Neonatal Nurses, 4700 W. Lake Avenue, Glenview, IL 60025-1485. © 2010 National Association of Neonatal Nurses. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited. The statements and opinions expressed in articles and other materials herein are those of the authors or advertisers. NANN, the editors, and the publisher disclaim any responsibility for these materials. Information for authors is available from the NANN National Office. 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