Ohio Napnap News

May 2003 Newsletter

President’s Report Marilyn Boerio

The conferences from Ohio NAPNAP just keep getting better and better. Congratulations to Cindy Allison and Laurie Freese for all of their hard work and organization, which resulted in a wonderful conference. Topics on primary care emergent issues were thoroughly presented by all of the speakers. The hotel accommodations were excellent, the door prizes celebrated Cincinnati and we all enjoyed networking at lunch. Now it is on to Toledo in the fall. The dates to reserve are September 19th and 20th.

It has been a very busy time in Ohio for Advanced Practice Nurses. In mid-March, I was fortunate to be able to attend “Day at the Statehouse” in Columbus with other APNs. We were all given an opportunity to meet with our local legislators and educate them regarding the role of the Advanced Practice Nurse. Some of the legislators were very familiar with our practice, others needed a bit more education.

The next event to look forward to is attending the National Conference in Orlando. I look forward to meeting other PNPs from around the country and expect to represent Ohio NAPNAP in a very positive light. Because this conference will celebrate the 30th Anniversary of National NAPNAP, which began as local meetings of Ohio PNPs, we were asked to provide our archival albums for display. Thanks to Jan McCleery for keeping 30 years of memories. Also, thanks to all members for encouraging your peers to join Ohio NAPNAP. We have increased our membership from 232 this time last year to 369 members.

Speaking of conferences, you may be aware that we now have a Conference Advisor. Past President, Linda Kerr had graciously accepted this position, which will be a wonderful support to future conference planners, as well as to the President-Elect who serves as the conference program chair.

As a result of the war in Iraq, President of National NAPNAP, Mary Margaret Gottesman has dedicated the website for NAPNAP to our Armed Forces in the spirit of support. The Kyss Campaign Chair, Bernadette Melnyk has revised her former guide assisting children following the September 11 tragedy to a new handout entitled “Helping Children, Teens and Their Families Cope with the War and Terrorism”. This handout can be printed from the web page of NAPNAP.

During this time of war, despite our personal opinions, let us offer comfort and support to the children and families who are touched by the world events. As Americans, let us pray for peace, support our Armed Forces and God bless America.

President Elect Mary Ann Rosecrans

Ohio NAPNAP believes that our members are our strength. It is unfortunate that the Ohio Chapter of the Society of Pediatric Nurses was unable to sustain itself, but it is reassuring to know that Ohio NAPNAP has invited all pediatric nurses to join us. This means past members of SPN, School Nurses, and all other pediatric nurses who want to belong to an organization that advocates for children. Ohio NAPNAP provides opportunities for networking, education, and a legislative list serve, an updated web site, information on clinical practice and ethical issues. One example of the excellent educational opportunities was the Spring Conference. The Cincinnati people did a great job. I say this without any bias even if our President is from Cincinnati! I have no doubt that the Fall conference planned for Toledo will meet the high standards we have become accustomed to. Please mark your calendars for September 20 & 21.

As you will read Angela Enex’s report, one of the recipients of the our child advocacy award is the Texan Migrant Council. In the New Carlisle area, migrant workers are employed by numerous nurseries and work in other agricultural industries such as Dole, picking and processing the lettuce we love to buy in bags. In the mid 90’s the AAP, working in partnership with the Migrant Clinicians Network, released the policy statement “Health Care for Children of Farmworker Families,” to address the health issues particular the children of migrant and seasonal farmworkers. JPHC has published articles regarding this topic. The Head Start Programs operated by the Texas Migrant Council are making an impact on reducing the needs of the young migrant child in a myriad of ways. They value children and value the contribution PNPs can make to the health care of these “earth angels”. The Ohio regional head quarters, located in Toledo is looking for a PNP in the area to provide health care for the children enrolled in a Migrant Head Start Program there. This is a very rewarding opportunity for any PNP who is interested. The role can be what you want it to be. It is essential that each child enrolled in the program receive a physical within 30 days of enrollment. While working with the Head Start Program in New Carlisle I have been able to expand my role to the limit of my capacity. It’s great to network with other health care providers and community services. Fluent Spanish is not a requirement. Please think about the possibilities and call Rachel Batista at the Texas Migrant Council Regional Office in Toledo 1-800-422-2805 or contact me.

Lastly, May is Mental Health month. It is interesting to me that Nurse’s Week falls in this month too! I hope all of you will remember Mental Health Matters and KySS. For more information on children and mental health the April 2003 issue of Patient Care for the Nurse Practitioner has a great article on identifying social-emotional problem in infants and toddlers.

Ethics Advisor Linda A. Strong

As a section affiliate to the Bioethics Committee of the AAP, I receive a quarterly newsletter from the organization. Instead of the usual ethics
"information" section I thought I would share an interesting piece from
Joseph Zanga, MD, FAAP, and Chairman of the Section of Bioethics.
An ethical dilemma is defined as a common problem that involves two morally
right correct courses of action but you cannot do both. Dr. Zanga's article
entitled, "Would it Be Ethical to Allow Parents to Refuse PKU Testing for
Their Newborns?" poses an ethical dilemma. I found this to be a truly
thought provoking ethical dilemma and have provided an excerpt of it below.
Would it Be Ethical to Allow Parents to Refuse PKU Testing for Their
Newborns?
By: Joseph Zanga, MD, FAAP
"Along with immunizations, one of the great success stories in medicine in
our time has been the availability of newborn testing for a variety of
health and life threatening diseases. Most of us have never seen a child
with untreated PKU and because testing is a routine standard of newborn
care, mandatory in most states, we probably never will".
"Because testing is universal, however, not only do we identify the child
with the condition, but we also identify the parent(s) as carriers. We mark
them as different and perhaps raise issues in their mind as well as in the
mind of their spouses. We think nothing of testing, however, (except in a
positive way) because it is so beneficial to the child that we would
consider it unethical not to do it. Routine/mandatory testing also makes the
disease "mainstream", removing some of its mystery and the affected
individual's shame/guilt".
"Recently the CDC published information making it clear that the closer we
get to routine and even mandatory testing of all pregnant women, and /or
their newborns at the time of delivery for HIV, the closer we get to
eliminating perinatal transmission of this deadly disease (MMWR, November
15,2002/Vol 51/No 45). We now have rapid HIV tests available, which are
highly accurate (very few if any false positives or negatives) and provide
results in no more than an hour. Because more than 90% of pediatric AIDS
cases are the result of perinatal transmission, New York state in 1996
passed a law requiring testing for all newborns. New York's perinatal
transmission rate dropped from 25% to 3.5% with no decline in mothers
seeking prenatal care. More to the point, a similar law passed in
Connecticut in 1999. Before passage fewer than 40% of women were tested for
HIV during their pregnancy. After the law more than 90% of women were
tested, with concomitant declining rates of HIV transmission. The experience
in Texas and in other states with requirements for perinatal testing has
been similar".
Dr. Zanga poses the question: Why then is the AAP not supportive of
mandatory HIV testing? He continues by saying that according to a member of
a committee of the AAP, that might be placed in charge of writing such a
policy, the AAP cannot be supportive of mandatory testing "without
infringing upon the mother's human rights". What rights are they speaking
of? Dr. Zanga comments that the only "rights" might be to continue to carry
and be ill with a treatable but otherwise deadly disease, or to deliver an
infant with a deadly disease that will likely not be treated at the time
when it is most amenable to treatment.
Dr. Zanga ends his commentary with the questions: Is it ethical for the AAP
to take the approach of non- support for mandatory HIV testing? Was it
ethical to support mandatory PKU/newborn metabolic screening? What are your
thoughts on this matter? What about the newborn baby's rights to be
diagnosed and properly treated? Something to think about...

Keeley HardingHealth Policy Committee

House Bill 12 (Carrying of Concealed Weapons (CCW) Legislation)

PASSED the HOUSE

PENDING SENATE (has been assigned to the Criminal Justice Committee)

 Governor threatened to veto any bill that didn't have FULL support of Ohio law enforcement. This bill would allow county sheriffs to issue licenses for carrying a concealed handgun into public places where they shouldn't be: crowded public events, places which have alcohol, places full of curious and rambunctious children, the stressful workplace, nursing homes, and highly charged hospital emergency rooms. Permits would be issued to anyone over 21 with no felony criminal record or history of adjudicated mental illness. Licensees would undergo 12-16 hours of training, and must provide two digits for fingerprinting.

HB 46 (Nurse Income Exemption)

 Proposed legislation

 Exempts from the personal income tax the salaries of registered and licensed practical nurses in the first five years of employment

National Legislation: Children’s Health Insurance Measure

 Proposed legislation

 Sen. Jay Rockefellar (D-W. Va) and Rep. Pete Stark (D-CA) on March 11th unveiled legislation (S 448 and HR 936) that would require parents to ensure that their children have health insurance—if cannot provide proof, then would have to enroll them in MediKids (proposed new federal program similar to Medicaid but could require parents to pay premiums based on income level)

 Budget implications have not been worked out yet

NIWI Conference

In March, I attended the Nurse in Washington Internship Program thanks to a grant from National NAPNAP. It’s an annual conference that is very informative (and motivating) regarding the nurse’s role as it relates to healthy policy. There were nurses from various backgrounds (ranging in credentials from that of student nurse to advanced practice nurse to nurses with doctorate degrees). The program allows time to experience Capitol Hill and make appointments to meet with your U.S. Senator and Representative to talk about health policy issues. Here are a few tidbits that I brought back from the program:

In our present environment of Terror and War, Health Care is taking on a secondary role

( The Nurse Reinvestment Act (introduced by Lois Capps—a nurse and supporter of nurses)—Congress has approved $20 million to fund the Nurse Reinvestment Act (we had asked for $250 million). While significantly less money than originally hoped for, the funds will provide monies for scholarships and loan repayment provisions, for magnet hospital provisions, and career ladders & geriatric nurse training and faculty development.

The entire appropriations bill contains the following items for nursing:

Advanced Nursing Education $50.5 million ($9.5 million decrease from 2002)

Nursing Workforce Diversity $10 million ($3.8 million increase from 2002)

Nurse Education & Practice $27 million ($10.7 million increase from 2002)

Nurse Corps $20 million ($9.7 million increase over 2002)

Geriatric Nurse Education $3 million new funding

Nurse facility loan repayment $3 million new funding

Total $113 million or $20 million more than 2002

( There are 2.7 Million nurses nationwide (we are a significantly larger group than doctors)—we could do some major influencing in health policy if we would all become ( Cash buys your visibility

COMMERCIAL INSURANCE
( UNITED HEALTH CARE IS ACCEPTING APNSas of March 1st
(Medical Mutual of Ohio is indicating that they will follow very soon

Medicaid/Under & Uninsured

(Final Resolutions still PENDING (as of this writing)

(Many groups/individuals have rallied together in opposition of proposed budget cuts by Governor Taft.

Rx authority

( Effective February 2, 2003 you MUST have your CtP# (or CtP-E#) on prescriptions

( For more information on prescriptive authority (including required CEUs specifically related to pharmacology) check out the Ohio Board of Nursing Website at

Health Insurance Portability & Accountability Act

( Is it HIPPA or HIPAA?….it’s HIPAA (see above). For more information check out Ohio’s HIPAA website at

( Must be in compliance by April 14, 2003

Email List

Would you like to be added to the OHIO NAPNAP HEALTHY POLICY EMAIL ALERT LIST? I’m finding it hard to include all issues in the Ohio NAPNAP Newsletter and keep updated on ALL issues relating to Health Policy. I’m asking for your help. If you hear of an issue and would like to share it with other members please email me at nd I will share the information with Ohio NAPNAP members. The title of the email will have OHIO NAPNAP in the subject line (so as not to confuse it with junk mail). If you have not already sent me your email address and would like to be included on the email alert list please send your current email address to

Sandy Neville Constitution & Bylaws

The Ohio NAPNAP membership approved an amendment to the bylaws under Health Policy/Chairperson at the spring meeting in Cincinnati on March 22, 2003. The new amendment provides for Ohio NAPNAP to pay OAAPN dues for the chairperson since the chairperson is required to be a member of OAAPN and sits on the OAAPN board. The new change will be added to the bylaws.
Thanks, Sandy Neville

Practice CommitteeBarbara Schaffner

Reminder about the "Calcium Counts" program available
free for presentation. Have all interested contact myself or Linda Kerr and
receive a fully developed power point presentation on computer disc or
overhead transparencies (lecture notes also provided).
Also OtterbeinCollege,Department of Nursing offers:
A 6.1 contact hour totally on-line course related to the Legal, Fiscal, and
Ethical Implications of Prescribing for Advanced Practice Nursing. The
course can be totally completed at home without any trips to campus. Cost
is $100.00. Course does meet the Board of Nursing requirement for
continuing education related to Ohio law and prescribing.
Also, we offer a 45 contact hour course on Advanced Pharmacology that is
totally on-line. Cost $500.00. Meets all pharmacology requirements of the
Ohio Board of Nursing to apply for prescriptive privileges (CTPe) in Ohio.
For more information about both courses or to register, please contact Linda
Brantch at 614.823.1614 or .

Who We Are Brochure

Hope you read the DRAFT of Ohio NAPNAP’s “Who We Are Brochure” enclosed in the summer edition of the newsletter. All that remains is importing Black and White pictures of PNPs in practice. SO if you have a digital camera and can get a picture in black and white of you doing what you do, please send it to . Remember if you take a picture with kids other than your own, we need releases signed by the parent. A child with a helmet would be great too! After this is completed, the form will be offered to all PNPs as a brite white copy so that you can copy your own and choose your own paper OR you can request copies for an small fee (includes coping, paper, and mailing) Please call either Linda Strong or Kerr with questions or comments.

CALCIUM COUNTS CALCIUM COUNTS

PNPs all know the importance of calcium for kids. Sharing those facts with kids and parents has become another special interest topic (TLC) for Ohio NAPNAP. An educational Program-in-a-Packet entitled CALCIUM COUNTS is now available to all PNPs in Ohio. It was developed and created similar to the helmet safety packet. It provides a Power Point presentation done in OVERHEAD TRANSPARENCIES (28) with the PRESENTER’S FOLDER that has the information for each slide and HANDOUTS that can be copied for your presentation.