Advanced Registered Nurse Practitioner Care
Internet Edition, April, 1996, Volume 7, Number 4
Copyright 1996, Nurse Practitioner Support Services
Official Newsletter of ARNPs United

Table of Contents

The Hanford Health Information Network

by Sandy Rock

A program of the Washington State Department of Health is recruiting health care practitioners to be Radiation Risk Communicators (RRCs). RRCs will constitute a cadre of Washington health care providers who receive training on the health effects of chronic, low-dose radiation exposure, and serve as sources of information for colleagues. Primary care providers are ideally suited for this task. Most information would concern the status of ongoing studies on radiation health effects, and will be continually provided to the RRCs. Those chosen will receive training in ionizing radiation and possible health effects within the important emerging field of environmental risk communication. A Radiation Risk Communication training conference is scheduled to be held in Seattle in the fall of this year.

Over a hundred million curies of radiation were released from the Hanford Nuclear Reservation between 1944 and 1972. Approximately two million people, mostly in Washington State, were exposed to different radionuclides at various dose levels. Although there were other exposures, the most well-defined exposure pathway is that of radioactive iodine (I-131), a suspected cause of thyroid cancer, thyroid nodules and hypothyroidism. Results from the Hanford Environmental Dose Reconstruction (HEDR) project are available now and will be further defined over the next year. The Individual Dose Assessment project is in the formative stages and should be operative by mid-1997. The Hanford Thyroid Disease Study (HTDS) is in full swing, and results are anticipated in 1998.

To date, no link between health effects and Hanford's environmental releases has been established, but various somatic, carcinogenic, and genetic effects are possible. Many people, including scientists, believe that chronic radiation exposure could have caused a number of illnesses and deaths. At the very least, emotional consequences from being exposed to unwanted and potentially hazardous substances have plagued many downwinders. These insidious effects need to be communicated to providers who can empathetically respect the concerns of their patients.

Hanford Health Information Network will be winding down its activities over the coming few years. A corps of health care professionals, Radiation Risk Communicators, willing and able to convey information to their medical colleagues, will continue this important community service. Environmental risk communication has become an important and integral aspect of community medical practice. This is a unique opportunity to learn about this field. The time investment would be minimal; the knowledge gained and service rendered would be great. Any health care provider interested in this project may contact the Hanford Health Information Network project director in Seattle at 800.522.4446, ext 3 or by e-mail at 102521.224@compuserve.com.

1996 Legislative Wrap-Up

by Gail Toraason McGaffick and Tracy Lin, ARNP

Greetings ARNPs United members. For those of you who don't know us, Gail is the lobbyist for ARNPs United, having succeeded Patty Hayes, her former partner. For Gail this is a continuation of her work with ARNPs, having previously lobbied on behalf of advance practice issues during the late 80's. Tracy is the Legislative Chair of ARNPs United. In “real” life she is a pediatric nurse practitioner in Tacoma. We look forward to providing you with updates about what's happening legislatively that impacts ARNP practice.

The 1996 Legislative session ended officially on March 7. The 60 day session, which began on January 8, while brief in terms of days, was actually long and arduous. Many people have reflected that this session was different from previous ones, people weren't very nice. Some of you may be thinking what does “nice” have to do with the Legislature? Every system has its code of behavior, and it's no different with the Legislature. It doesn't mean that people don't get frustrated and angry on occasion, but it does mean that all participants more often than not make an effort to work together to create positive public policy. That didn't happen this session.

Some described the session as “gridlock”. For each interest group or “force” advocating for legislation, there seemed to be an opposite and equal force pushing back. This was particularly true for health care legislation. Over a hundred health care bills were considered during this session, but only 12 made their way to the Governor's desk. Early attempts to move “any willing provider” legislation were met with extremely strong and effective lobbying efforts by the business and insurance communities. In addition, during this session, we were at constant risk of losing the “any category of provider” legislation that was enacted in 1995 to ensure that health carriers include all categories of health care professionals as providers. This issue heated up because of a lawsuit by the carriers against Insurance Commissioner Deborah Senn over implementation. ARNPs United was instrumental in advocating for retention of the any category statute.

In this very challenging environment, we are pleased to announce that ARNPs United was successful. We were able to advocate persuasively for legislation that will positively impact ARNP practice, and we were able to modify or block legislation that was harmful. One of the themes of this session was establishing some guidelines for the operation of managed care. We anticipate this issue will continue to be a focus of provider and consumer groups.

As you might imagine, much of our work during a session is ensuring that legislators understand the role that ARNPs have in the delivery of quality, cost-effective care to Washington state consumers. While times are changing, many bills are still written as if the only providers are physicians. We both admit that we very much enjoy setting the record straight. We also know that we wouldn't be as effective without the work of many ARNPs United members that made the time to communicate with their legislators this session. Thank you!!

The following is a summary of some of the key issues we worked on for ARNPs United that successfully made it through the process:

Substitute Senate Bill 6392. Disclosure of health insurance policy provisions was a key theme of the 1996 session. Many groups, including ARNPs United, joined together to advocate for a variety of bills that would have increased the amount of information that providers receive from health care insurers. At different times, both of us testified that if you want to empower consumers to make appropriate health care decisions, and one of the most important decisions they will make is what health plan to subscribe to, it logically follows that you want to provide them with information. In the end, only one bill prevailed, SB 6392, prime sponsored by Senator Jeanette Wood. While it didn't contain everything that provider and consumer groups wanted, it is a strong beginning. For example, providers will not be able to talk openly with consumers about health plan provisions without fear of being removed from a provider panel. This is called an anti-gag provision. We anticipate more legislation on this topic in 1997.

Substitute Senate Bill 6150. This legislation, prime sponsored by Senator Pat Thibaudeau, allows 18 different health care professions, including ARNPs, to form a single professional service corporation. Currently the law only allows same “specie” incorporation, meaning that only ARNPs can incorporate with ARNPs, podiatrists with podiatrists, etc. This legislation is seen as an important step in allowing the cost efficient formation of multi-disciplinary groups practices. Unfortunately, the Washington State Medical Association did not see the “light” on this issue, and in order to pass any legislation this session we needed to accept a compromise that excluded both allopathic and osteopathic physicians.

Substitute Senate Bill 6120. This legislation, known as the “drive-by delivery” bill, and prime sponsored by Senator Kevin Quigley, was a topic of intense debate and interest. While there is no specific language guaranteeing women a certain number of inpatient hospital days after giving birth, Substitute Senate Bill 6120 clarifies the ability of the provider and the mother to make decisions concerning her maternity care, including inpatient and postpartum. It's a beginning.

Substitute Senate Bill 6129. This legislation, prime sponsored by Senator Darlene Fairley, eliminates the use of billing prohibition clauses in health carrier contracts with mental health providers. These clauses had precluded consumers from continuing therapy with mental health providers, such as psychiatric nurse practitioners, after their mental health benefits expired, during an appeal, etc.

You may obtain free copies of these bills by calling the Legislative Bill Room at 360.786.7573. If you have any questions or comments, Tracy can be reached at 206.383.5777 Ext 326, and Gail can be reached at 360.754.7266, e-mail: mpwrmnt@aol.com.

AAPPN Prescriptive Authority Fundraiser

by Sally Plumly

The Association of Advanced Practice Psychiatric Nurses will be hosting an Afternoon Delight of wine tasting and delectable desserts on Sunday, April 21st from 3-6 pm in Tacoma. A potpourri of speakers and live music will add to the festivities. We are asking a donation of $20.00 per ticket. For tickets, please contact Sally Plumly at 206.884.4158. All proceeds from this fundraiser will go toward lobbying expenses for legislation to extend ARNP Prescriptive Authority to include schedule drugs. Please consider coming and bringing friends, family and professional acquaintances who might enjoy an elegant afternoon for a very good cause.

Classified Ads

College of Nursing Professor

University of Texas at El Paso, Medical-Surgical Nursing, College of Nursing and Health Sciences: Full time tenure track, positions to begin fall semester 1996. Three

positions are open: Professor, Associate Professor and Assistant Professor in Nurse Midwifery, Family Nurse Practitioner and certification in area of specialty required. Teaching experience preferred. Salary competitive and commensurate with experience. Excellent opportunity in a comprehensive University that services a bicultural community. All programs accredited. Send letter of interest, curriculum vita and listing of three current references (name, address, telephone) to: Helen M. Castillo, PhD, RN, CNA, FAAN, Chair, Department of Nursing, College of Nursing and Health Sciences, 1101 N Campbell, El Paso, TX 79902

Positions open until filled. UTEP does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

ARNP

ARNP needed to join a dynamic team of quality caregivers in a skilled, 190-bed, long term care facility in Kirkland, WA. Call Nancy at 206.823.2323.

Nurse Practitioner Family/Sports Medicine

Job opening with a board certified family practice physician with Certificate of Added Qualification in Sports Medicine. Practice has been established 5 years and consists of 60% family practice and 40% sports medicine. No HMO or Medicaid. 55% Medicare population. Located in Central Florida, the City of Sebring is known for its annual 12 hours of Sebring auto race. The area has many amenities which include affordable housing, good schools, plenty of golf, tennis, boating, and fishing. Sebring is located in the middle of Florida, equal distance from either coast and 70 miles south of Orlando. The office is 2900 square feet with a CLIA certified lab, x-ray facilities, ambulatory cardio-vascular services, and in-office pharmacy. The physician has a hospital practice at Highlands Regional Medical Center. The physician would be willing to train the right nurse practitioner for this position. Resumes can be sent to: John R Caruso, DO, 3218 US 27 South, Sebring, FL 33870, phone: 941.471.3344 or fax: 941.471.1896.

Planned Parenthood ARNP

Planned Parenthood is seeking 2 outstanding p/t clinicians to join our Totem Lake and Bremerton clinic teams. Position requires current WA state RN & ARNP (WHNP, FNP, Adult NP or CNM) licenses. Please mail CV/resume before 4/19/96 to PP/HR, 2211 E Madison, Seattle, WA 98112. EOE.

Continuing Education

Clinical Pharmacology Series 1996

March, 1996. A series of six one-day courses (8 hr sessions) is designed as a pharmacology update for NPs working in a variety of specialties, including Neonatal, Pediatric, Geriatric, Adult, Women's Health and Neuropsychotropic Drug Therapy. Sponsored by the U of W School of Nursing. The first session begins March 2, 1996. For further information, please contact Sheila Keener at 206.543.1047.

Psychopharmacology of Anti-Depressants Seminar

April 20, 1996. This Saturday seminar for psychosocial/mental health clinical specialists and ARNPs will address a variety of topics related to the use of antidepressants. How do abnormal lab values affect prescriptive decisions? What is the role of polypharmacy in treating depression: Where do antidepressants fit in with hormone replacement therapy for perimenopausal and menopausal women? A panel of practitioners will discuss prescribing for the depressed patient using selected case studies. The panel members will facilitate discussion groups at the luncheon. Contact Pacific Lutheran University CCNL, Phone 206.535.7683, Fax 206.535.7590, Internet bennettl@PLU.edu.

Washington State Chapter of the
National Association of Pediatric Nurse Associates and Practitioners

May 2 & 3, 1996. This seminar is titled “Pediatric Update 1996” Keeping our Kids Safe and Healthy”. CEUs: May 2-7.2 advanced practice credits, May 3-7.0 pharmacology credits. Location: Shoreline Conference Center. Contact: Susan Kline, phone/fax 206.781.3287, for further information e-mail skline@u.washington.edu.

Current Concepts in Pediatric Acute Care

May 4, 1996. Saturday at Jackson Hall Auditorium in Tacoma, WA. Presented by Mary Bridge Children's Hospital, MultiCare's Department of CME & Pediatric Critical Care, P.S. For more information please call 206.552.1493.

Pharmacotherapeutics for ARNPs

May 17, 1996 Friday. A variety of pharmacotherapeutic topics of interest to all ARNPs specialties will be presented in general and concurrent sessions. Location: Best Western Executive Inn, Tacoma, WA. Contact Pacific Lutheran University CCNL, Phone 206.535.7683, Fax 206.535.7590, Internet bennettl@PLU.edu.

The INTERNET: New Dimensions for HealthCare

June 1 Saturday. Providence General Medical Center, 14th & Colby Ave - Colby Campus, Everett, WA. Pending Approval 6.8 CEUs for nursing and approved for 6 hours CME (category II). AORN is accredited as an approver of continuing education by the American Nurses Credentialing Center's Commission on Accreditation. PGMC is accredited by the WSMA Continuing Medical Education programs for physicians. As an organization accredited to provide CME, PGMC certifies that this course meets the criteria for 6 hours of Category II CME to satisfy the relicensure requirements of the Washington State Board of Examiners and for the Physicians Recognition Award of the AMA. Through this conference, participants will be able to describe how the Internet works, describe how to connect to the Internet, search for healthcare resources on the Internet, identify the impact of the Internet & the corporate intranet on healthcare professionals. Your speakers: Bob Baxter RN, CNOR & Janet Regan RN, CNOR, are familiar with Mac & PC platforms. Both have vast experience "cruising" the Information SuperHighway. Registration: $55 if postmarked by Friday, May 3rd, $65 for later registration (24 hours notice needed for cancellation) Make check/money order payable to "AORN of Pacific Cascade" Mail to: PLANNING CHAIRMAN, 7324 - 48th Avenue West Mukilteo, WA 98275. Direct questions to (206) 347-0582.

Mood Disorders 1996: An Update for the Primary Care Clinician

June 21, 1996. This conference will enable primary care physicians to recognize and initiate treatment of the major mood disorders as they present in the primary care setting. Topics related to DSM IV diagnostics, pharmacological management, psychotherapeutic modalities, differential diagnosis of medical vs. psychiatric disorders, pain management and others. Location: Westin Hotel, Seattle, 8:30 am-5:15 pm. Speakers: John Wynn, MD, David Tauben, MD, Doron Raphaely, MD. CE credits of 8.6 contact hours is pending through WSNA. Of the 8.6 total hours, 3.3 are in the category of pharmacology. For information, contact Orca Healthcare Resources, 1717 16th Ave, #6, Seattle, WA 98122 or phone: 206.328.9416

Association of Reproductive Health Professionals' (ARHP)
33rd Annual Reproductive Health `96

November 14-17, 1996. Location: Nashville, TN at the Stouffer Renaissance Hotel. This meeting will be held in conjunction with Planned Parenthood Federation of America and cosponsored by the National Association of Nurse Practitioners in Reproductive Health. Sessions focus on interaction of AIDS and other STDs, diagnostics and the consequences of STDs, contraception, cancer prevention and detection, pregnancy management and the latest in primary care therapies. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation. Contact ARHP at 202.466.3825 for more information.

3rd Biennial Clinical Women's Health in the Perimenopause `96

November 22-24, 1996. Location: Amelia Island, FL at the Ritz-Carlton. Sessions focus on contraception and cancer, practical guidelines for evaluation, diagnosis and treatment of disorders common to the midlife woman. Nationally respected speakers will discuss the latest research, future trends and public policy. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation. Contact ARHP at 202.466.3825 for more information.

Basic Colposcopy Training, Advanced Colposcopy, Endometrial Biopsy, IUD Insertion Training, Vulvar and Vaginal Lesion ID Course, Gynecology Review and LEEP/Cryo Training Seminar.

CME Solutions, LLC has been approved as a provider by the Washington State Nurses Association. Contact hours are available for every course. Call Karen Taylor at 206.865.9005 for dates and location. Fax number is 206.865.0616.

Editorial Information
ARNP Care Office
212 Railroad Ave N, Kent, WA 98032
206.852.9042 Fax 206.480.0002
care@nurse.net

Editors:
Susan Caverly, MA, ARNP
Robert T. Smithing, MSN, ARNP
Madeline D. Wiley, MSN, ARNP 		Production Staff:
Melanie Finley, Kelly Libby, &
Pete Mullin
Contributing Editors:
Ted Ritter, MN, ARNP 		Publisher:
Nurse Practitioner Support Services

Ad Information

Copy deadline is the second Tuesday of the month prior to publication. Ads may be accepted later then this on a space available basis. Position Available Ads per insertion of less than 66 words are $45, of 66 to 130 words are $75. Continuing Education Announcements per offering for up to three (3) insertions of a BRIEF description are $35, sponsoring organizations of ARNPs United may publish CE announcements at no charge. New Product Announcements per product for one insertion of 130 words or less are $75. Ad Inserts are $480 for one issue. All ads are subject to space limitations and editing. Call for detailed rate information. Mail copy to ARNP Care, 212 Railroad Ave N, Kent, WA 98032. Phone 206.852.9042. Fax 206.480.0002. E-mail care@nurse.net

Please Join Us

You may believe that because this newsletter arrives every month you are a member of ARNPs United. That is wrong. Since 1989 ARNP Care has been sent to every ARNP in Washington regardless of membership status. This is in imminent danger of stopping due to a lack of funds. Remember the number of members is what makes an organization strong and credible with the legislature and others. So join us today. Individual memberships are $150 per year. Lifetime memberships are $1000. Student currently enrolled in a ARNP program may join for $50 per year. Make your check out to ARNPs United and mail it to: ARNPs United, 212 Railroad Ave N, Kent WA 98032.

Member Thank You!

Thank you for being one of the ARNPs in this state who have joined ARNPs United. Without your support it would not have been possible to have hired a lobbyist and had such a successful legislative session in 1995. It is also clear that without your support the organization would not have been capable of moving forward in developing a solid framework to build on the grassroots efforts of the ARNPs in this state. ARNPs who are not members of ARNPs United have received ARNP Care printed on lavender paper to let them know they are not members.

Nurse Practitioner Support Services
212 Railroad Ave N, Kent, WA 98032. Phone: 253.852.9042 Fax: 253.852.7725
npss@nurse.net
Copyright 1998 Nurse Practitioner Support Services