Battling COVID19

Stay Safe, Stay Supported

Written by: Adrianna Munoz, MSN, RN, CNL

Note from Colorado ENA Government Affairs Chair, Chelsea Collins, BSN, RN, CEN, SANE-A: Adrianna wrote this piece a few weeks ago, and there was a delay in getting this posted due to other obligations. While the information is still pertinent, and excellently written, please note that there has been additional legislative changes. If you have any desire to help educate Colorado Nurses on legislative happenings, and if you have time, please reach out at government@coloradoena.org. If there is something in particular you would like more information on, please let us know and we can do our best to help educate. Please review the Colorado ENA facebook platform and Colorado Nurses Association webpage and platform for speedier updates. Thank you! And, as always, stay safe.

Hello fellow RNs! This is a crazy time for everyone. We are navigating a new illness, and I want to start off this blog post by saying thank you. Thank you for your continued efforts caring for patients and being a member of a greater healthcare team. And thank you for advocating for nurses and health care professionals. ENA cares about the health and safety of emergency nurses, you can see ENA’s full position statement about COVID-19 here.

This blog entry focuses on the CARES Act, what it means for hospitals, and how Colorado is responding to COVID-19.

Photo taken at Denver Health Medical Center.

What is the CARES Act?

116^th Congress, 2D session, introduced S.3548 in Senate on 03/19/2020.

Objective: “To provide emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic.

More commonly known as the “Coronavirus Aid, Relief, and Economic Security Act” or the        “CARES Act.”

A Few CARES Act Key Points

•  Prices for COVID-19 diagnostic testing must be publicized to the public (Sec.4202.)
• Supplemental awards for health centers (Sec.4211.)
• Rural health services outreach (Sec.4214.)
• “Requiring the strategic national stockpile to include certain types of medical supplies.” This includes personal protective equipment. (Sec.4112.)
• Improve planning considerations for the medical product supply chain (Sec.4111)
• Promote the accessibility of medical supplies and drugs (Sec.4111)

The full bill can be viewed here.

On March 27, 2020 U.S. Congress passed, and President Trump signed into law, the CARES Act, or the Coronavirus Aid, Relief, and Economic Security Act. The CARES Act provided over $2 trillion to stimulate the economy, but it also provided $16 billion for the Strategic National Stockpile. The Strategic National Stockpile, or SNS, provides critical medical supplies, such as PPE and medications, to states and local governments in health emergencies.

While the CARES Act is beneficial, more work needs to be done. Congress confirmed that it will continue to work on additional COVID-19 packages in the near future. Many professional healthcare organizations, including ANA, will be working with them with specific focus on prioritizing the healthcare needs of frontline workers who contract COVID 19, and requiring “Department of Health and Human Services to develop reporting requirements to better track shortages of PPE.” You can track these updates, and additional issues ANA is tackling, here.

Colorado and COVID-19

Since the CARES Act passed March 27^th, Colorado is still short on PPE and is accepting donations (create PPE donation account here). Governor Jared Polis and the state of Colorado have requested several thousand N95 masks, surgical masks, face shields, gowns, gloves, and coveralls; you can see numerical figures here. The state has also ordered $46 million worth of PPE and medical supplies, and this will be distributed to Colorado government agencies and healthcare agencies. Supplies will be allocated based on a specific criteria, including county age and population. While many PPE requests were filled, the state is still short of what it requires. Should your hospital need PPE, please do not hesitate to reach out to your legislator.

Please refer to ENA’s Colorado Emergency Nurses Association page for updates on all things Colorado ENA.

Want More Data?

You can find Colorado’s COVID-19 case data here. This page is updated to reflect the progression of COVID-19 in Colorado.

Photo taken at Children’s Hospital Colorado.

What’s coming down the pipeline in the 2022 Colorado Legislative Session?

Written by Deborah Skeen, MSN, RN, CEN, CPEN 2022 COENA GAC Chairperson February 25th, 2022

A very smart woman once told me that legislation passed at the state level impacts our daily lives even more than the bills passed at our nation’s capital. As I have learned more about government affairs within Colorado these past few years, I have to say I agree! So here’s a quick blog entry to give you a sense of what’s on the agenda early in the 2022 Colorado Legislative Session that might be of interest to emergency nurses. Enjoy!

     In 2020 Colorado passed a bill HB20-1415 protecting workers who raise a concern about health or safety during a public health emergency from employer retaliation. Evidence suggests that the bill is working Democrats want to extend whistleblower protections for Colorado workers beyond public health emergency – The Denver Post. SB22-097 Whistleblower Protection Health & Safety expands the protection for all health and safety concerns regardless of whether there is a declared public health emergency or not C:\097_01.txt (colorado.gov).

     HB22-1065 Emergency Mental Health Treatment and Evaluation Standard looks at updating the 72-hour hold law. It does broaden the net for 72-hour holds to be placed on individuals who are of “substantial” risk to harm to themselves or others, rather than of “imminent risk” C:\1065_01.txt (colorado.gov). The bill is still in its early stages and will most likely evolve as it goes through the legislative process Mental health holds: Colorado lawmakers want to improve them (coloradosun.com). Keep an eye out for updates on this bill because it may change as it is debated and discussed by stakeholder groups and lawmakers at the Capitol.

     If you have a passion for injury prevention, you might be interested in hearing about HB22-1064 Prohibit Flavored Tobacco Regulate Synthetic Nicotine. This bill prohibits the advertising, marketing, and sale of flavored tobacco products in the state of Colorado. Electronic cigarette use among youth was declared an “epidemic” in 2018 by the office of the surgeon general in the U.S. Menthol cigarettes and other flavored tobacco products have been shown to be “starter” tobacco products for youth. The nicotine can harm the adolescent brain and affect attention, mood, learning, impulse control, and become habit-forming C:\1064_01.txt (colorado.gov). This bill does not impact products used for smoking cessation.

       Last, but not least, there is a lot of interest at both the state and national level to find ways to address Safe Nurse Staffing. On the state level, Representative Kyle Mullica, an emergency room nurse, is working with legislators and stakeholder groups including the Colorado Nurses Association, physician groups, the hospital association, & the governor’s office, to craft legislation to address this issue. Final details are still in the works. However, we expect them to be made public in the very near future. 

     I can tell you that amendments were approved in October 2021, but have not yet gone into effect, that address nurse staffing regulations through CDPHE as a requirement for obtaining facility licensure in the state. This involves a master nurse staffing plan based on the different types of patients cared for in each hospital unit along with the skill mix, specialized qualifications, and level of competency necessary for nursing staff to ensure that the facility is safely staffed. This master nurse staffing plan must be reviewed with each member of the nursing staff annually and be reviewed periodically (no less than every 3 years). Each hospital must establish a nurse staffing oversight process which shall have at least 50% or greater participation by clinical staff nurses, in addition to auxiliary personnel and nurse management. This is great…nurses will have a seat at the table!

Guidelines must be developed and document the process for how complaints and feedback from hospital staff related to nurse staffing will be received and processed, how decisions are made, and how the staffing plans will be monitored, evaluated, and modified over time. A report of the nurse staffing oversight process findings shall be made available to hospital nursing staff. If the results indicate that the current master nurse staffing plan has not resulted in adequate staffing and met the healthcare needs of the patients, the staffing plan must be modified through the nurse staffing oversight process. Accurate reporting by hospitals to the governing body will also be required including current best practices (considering community standards, benchmarking, or evidence-based metrics), data on patient census, patient acuity or workload, patient outcomes, skill mix, RN education, and workforce metrics and staff feedback. This report must be issued for approval by the governing body following each review of the staffing plan.

     At the national level, two Congressional Democrats in Washington, D.C. have introduced a bill that sets minimum nurse-to-patient staffing requirements Congressional Bill Seeks to Set Federal Nurse-to-Patient Staffing Requirements HealthLeaders Media|. There is also a peaceful protest sponsored by Nurses Against Violence that focuses on safe staffing ratios taking place in Washington, D.C., on May 12^th Nurses’ March on Washington Planned to Address Workplace Violence and Other ‘Serious Issues’ | HealthLeaders Media.  There is a branch of this group, National Nurses March-Colorado, that currently has 1.2k members in its Facebook group, advocating for safe staffing and workplace violence for Colorado’s nurses and healthcare professionals (https://www.facebook.com/groups/608042213592271/) They are planning an 11 am meeting at the Colorado State Capitol on May 12th, followed by a march at 12-noon, and then closing remarks back at the Capitol from 2-2:30 pm. Specifically, National Nurses March – Colorado is demanding safe nurse-to-patient ratios, legislation to end workplace violence and racism, and fair and realistic wages. Currently, neither the Emergency Nurses Association nor the American Nurses Association support mandated nurse-to-patient ratios.

     What are your thoughts on this topic? Do you think hospital-based staffing plans with nurse staffing oversight processes required for facility licensure will work? Do you think the Whistleblower Protection bill will be enough additional support to allow nurses to speak openly about their workplace environments? Other suggestions to help nurses feel safe speaking about their workplace to legislators include allowing nurses to submit their testimony anonymously through a notarized statement, then present the notarized statements in bulk to legislators.

     Please consider telling your member of Congress your story regarding nurse staffing and what your work environment needs @ RN Action:  Tell Your Story: Nurses Need Better, Safer Work Environments (p2a.co)

 Please feel free to post any comments or questions. Thanks for taking a moment to check in on our Colorado Government Affairs Blog!

Investing in a Nursing Workforce

     With permission from the author, I would like to share the following article printed in the February 2022 issue of The Colorado Nurse, speaking to the state of nursing today:

Investing in a Nursing Workforce

Colleen Casper, DNP, RN, MS Director of Practice and Government Affairs Colorado Nurses Association

“Never let a good crisis go to waste.” Winston Churchill

Florence Nightingale was a pioneer in public health nursing and dramatically improved the health care planning and delivery of services to the British soldiers in the Crimean war. Nightingale led widespread changes by tracking data specific to incidences and frequency of the horrific conditions that were leading to the death of British soldiers in the military hospitals. Practices that Nightingale studied and implemented continue to be relied upon today, in both hospital care delivery and the education and preparation of public health providers.

 Nightingale’s work highlights the importance of data to drive health care systems improvement. Current data is significantly lacking in terms of hospital specific conditions that are contributing to the “great resignation” of front line nurses and other essential healthcare providers, including pharmacists, respiratory therapists, physicians, certified nurse assistants, environmental health services and food and nutritional services staff. Investing in and assuring an essential health care workforce is going to require significant operational and cultural changes in today’s clinical care environments, from public health, to primary care, acute care, emergency care, and long term care, be it in long term living facilities or at home.

Attempting to describe a path forward, it is our premise that we need to create a more significant and shared awareness of the real factors contributing to workforce resignations. I will focus on the nursing workforce with the understanding that most health care providers share similar characteristics. Those characteristics include:

• Nursing is a relationship and knowledge based profession that requires time to develop competencies and to provide adequate care;

• Nursing practice standards are developed nationally (ANA National Scope & Standards of Care) and are governed at the state level by the Colorado Nurse Practice Act;

 • Inability to provide safe care, whether due to worker safety through things such as personal protective equipment, adequate sick time, and sufficient workforce, puts patients at significantly greater risk of complications;

 • RN and LPN licensees and Certified Nurses Assistants are all subject to disciplinary actions by the Colorado State Board of Nursing based on complaints against licensee related to inability to provide adequate care;

• Moral distress occurs when individual providers are unable to provide the care in accordance with known standards due to factors beyond their control;

• Prolonged moral distress leads to burnout, helplessness, and resignation; and,

• Colorado frontline nurses have repeatedly been silenced by their employers and subject to threats and retaliation.

 This is what “investment” does not look like!

 Moving forward, there are options.

1. The Colorado Department of Public Health and Environment (CDPHE) licenses each and every care facility (employer) in the State of Colorado, including hospitals, a long term care, surgical centers, urgent care centers, home care and hospice care facilities, and probably more. That license is a contract with the State and its people, Coloradans, that assures minimum standards of care are met for all patients, residents, and consumers. CDPHE must more closely monitor the performance of facilities and track essential data points as a means of understanding trends in the incidences and frequency of bad outcomes related to patients and workforce. CDPHE must hold employers accountable and not solely the licensed professionals who are working in sub-optimal work environments.

2. The Colorado Department of Health Care Finance and Policy can take a stronger stance in public reporting of percentages of employer profits that support the nursing workforce. What actual and percentages of costs are afforded “administrative budgets” as compared to direct, front line clinical care? Do these costs reflect the time required for professionals to deliver adequate care?

3. Human resource policies and practices must be adapted to reflect the diverse needs of the front line workers. There is evidence to suggest that twelve-hour shifts are less than safe, let alone greater than three twelve-hour shifts per week. Traveler (temporary contracted) nurses are currently signing contracts for upwards of $330.00 per hour if they agree to work 20 hours of overtime per week, equally more than $15,000.00 per week per nurse. Employers want the federal and state governments to “backfill” this expense. What if we invested $10,000.00 per week to retain experienced staff and assure sane, safe workloads with career pathway development to remain at the bedside?

Without aggressive, responsible, and accountable leadership that includes real investment in workforce and work environments, Colorado nurses will not have a choice but to legislate nurse staffing – on behalf of patients. What’s your choice?

Colleen Casper

Colleen Casper, DNP, RN, MS

Hope you enjoyed this post! Feel free to comment. Thanks for visiting the COENA GAC Blog. Deborah Skeen, MSN, RN, CEN, CPEN. COENA 2022 Government Affairs Chairperson

What is HB21-1256: Delivering Healthcare Through Telemedicine?

Thanks to Susan Lontine, Faith Winter, and Cleave Simpson HB21-1256, Delivering Healthcare Through Telemedicine became law 5/11/2021.

HB21-1256 states that in-person contact between a health care provider (medical or mental health) and the patient is not required. The bill also promotes funding for and lays the groundwork for rules and policies regarding the structure and future of telemedicine (how it is billed, its relationship with insurance, etc.).

What does this mean?

As a patient, you can now officially contact and receive health care services without having an in-person visit for treatment that does not require an in-person visit. This is not new, but it is now formalized. If your provider needs to physically assess you (look in your ears, listen to your lungs, draw blood), you still need to go in person. This bill is a win for mental health services as many times, the provider simply needs to lay ideas on you and have a conversation. 

As a provider, several changes are at play. More rules are coming your way regarding billing and insurance. This is not necessarily a bad thing. The way billing for ICD-10 and CPT codes will expand, allowing you to appropriately charge for your time with your patients; You may be able to work from home and eliminate your commute; your ability to reach a larger network of patients may expand, providing you the ability to increase access to care to the underserved and rural communities. 

What’s the big deal? 

Although the increase in Zoom calls, and remote business meetings have exponentially increased over the last 18 months, telemedicine itself is not a new conversation. The benefits of utilizing remote healthcare services and its impact on reducing health care costs have been well documented. This bill is a big deal because it formalizes the process, thereby laying the groundwork for future innovation. As research continues, many changes in telemedicine will continue to occur, which will ultimately increase access to care, improving public health in the U.S. 

Thanks for reading. 

Cory Peticolas RN BSN CEN. 

For more Colorado ENA updates, follow along @ https://coenagovernmentaffairs.wordpress.com/

HB21-1106: Safe Storage of Firearms

Hello Colorado ENA!

This short blog post discusses HB21-1106, the safe storage of firearms. This post is not partisan, and is purely intended to be an informational and objective narrative. HB21-1106 bill passed and was given to Governor Jared Polis on 04/14/2021. It awaits his signature as of 04/16/2021.

HB21-1106

Safe Storage of Firearms

Prime Sponsors:

Representative Monica Duran

Representative Kyle Mullica

Senator Jeff Bridges

Senator Chris Hansen

Bill Summary:

This bill requires all firearms in Colorado be responsibly and securely stored when not in use. Secure storage is intended to prevent access to firearms by unsupervised juveniles and/or unauthorized users. Should someone store a firearm not in accordance with this bill it is a class 2 misdemeanor.

Licensed gun dealers must provide a locking device capable of securing the firearm. “Transferring a firearm without a locking device is an unclassified misdemeanor punishable by a maximum $500 fine.”

“The bill requires the state court administrator to annually report to the general assembly about the number of charges related to unsafe firearms storage and the disposition of those charges.”

“The bill requires the office of suicide prevention… to include on its website… information about the offense of unlawful storage of a firearm, penalties for providing a handgun to a juvenile or allowing a juvenile to possess a firearm.”

Should Colorado budget have available money, the department (referring to the office of suicide prevention within the department of public health and environment) “is required to develop and implement a safe storage education campaign.”

Please refer to Colorado ENA’s Government Affairs Committee with questions, comments, or topics of concern.

This information for the blog was extracted from http://leg.colorado.gov/bills/hb21-1106.

Article written on 04/16/2021

COVID-19 Vaccine:

An Update and Your Questions Answered

By: Adrianna Munoz, MSN RN CNL and Taryn Ketels, AGAC-NP, MSN

            Hello fellow RNs! Thank you for taking the time to read ENA’s Government Affairs Blog. This post will touch on the COVID-19 vaccine: the federal distribution of vaccines*, Colorado’s distribution of vaccines*, and a special contribution by Taryn Ketels, AGAC-NP, MSN. Hyperlinks are included in the first portion of the blog. Taryn explains common COVID-19 vaccine questions, concerns, and differences between Pfizer and Moderna vaccines. Let’s dive right in.

*Information is time sensitive, article written on 2/15/2021.

Federal COVID-19 Vaccine Response

            As of 2/15/2021, the United States has administered a total of 52,884,356 vaccines. 79,057,800 doses have been delivered to different states, and 14,077,440 people have received two doses of the COVID-19 vaccine. If you would like to look more into this information please visit the CDC’s website. If you are more of a visual person, you may like this map, which displays each state’s percentage of vaccinated population.

            The CDC recommends administering COVID vaccines through these phases. This PDF outlines ethical considerations and supporting data to answer one question: which groups should be offered COVID-19 vaccinations in Phases 1b & 1c? Many healthcare personnel and long term care facility (LTCF) residents have already received vaccines, these individuals are in group 1a. Another important question often arises when people ask when they are eligible for the vaccine: do I have to pay for the COVID-19 vaccine? The federal government is providing the vaccine for free, but the administering provider may charge an individual’s insurance a vaccine administration fee. However, no individual may be denied a vaccine if they are unable to pay the vaccine administration fee.

            Would you like to learn more about COVID-19 vaccine distribution? Visit this HHS website! It details authorization of the Pfizer-BioNTech and Moderna COVID-19 vaccines, prioritizing who receives vaccines first, allocating vaccines, and distributing vaccines. If you would like to contribute to federal data after you’ve received the COVID-19 vaccine, you can participate in V-Safe. V-Safe is a personal phone-based tool that uses text messaging to send vaccinated people a symptom survey after they receive the first and second vaccines.

Colorado COVID-19 Vaccine Response

            At this time, Colorado is in phases 1a and 1b of COVID-19 vaccine distribution. Phases 1a and 1b started in winter. Colorado residents in Phase 1b.2 are eligible for the vaccine beginning February 8, that’s happening now! Look up where you can get vaccinated here.

            Colorado has administered 666,698 people with one dose of the COVID-19 vaccine, and 302,414 people with two doses of the COVID-19 vaccine. When will Colorado get more vaccines? The federal government determines how many vaccines Colorado receives, this is based on Colorado’s percentage of the US population. Colorado has received approximately 76,000 vaccines per week for the past 6 weeks. If you would like Colorado’s COVID-19 vaccination updates, you can visit this webpage. Here you will find a list of COVID-19 vaccine providers and data trends for each of Colorado’s 64 counties.

COVID Vaccine Q&A

Taryn Ketels, AGAC-NP, MSN

• What is the difference between the two mRNA vaccines with current EUA (emergency use authorization) from the FDA (U.S. Food and Drug Administration)?
  • Pfizer and Moderna are the manufacturers who have received EUA for their vaccines. Both are mRNA vaccines (explained in more detail below), require extremely cold temperatures for storage and transport, and require two doses.
  • Pfizer needs to be kept even colder than Moderna and requires reconstitution prior to administration.
  • Pfizer was approved for 16 years of age and older, Moderna for 18 years of age and older.
  • Pfizer 2^nd dose is 21 days after the 1st, Moderna’s 2^nd dose is 28 days after the 1^st
• Can an mRNA vaccine alter our DNA?
  • The vaccines do not have reverse transcriptase and, therefore, cannot alter DNA. Additionally, mRNA is translated in the cytoplasm (doesn’t get into the nucleus where our DNA is stored).
• Can I get the virus from the mRNA vaccines?
  • No, they are not made from a live virus and, therefore, cannot cause infection
• Why do I need 2 vaccines?
  • The first vaccine primes your cells and the second is a booster. As far as we know, it is necessary to receive the second vaccine to achieve greater than 94% effectiveness rate and to create more lasting immunity.
• Do we know how long the immunity will last?
  • The first round of patients from July are still being followed. Moderna showed 4 months or persistent neutralizing antibodies (U.S. Food and Drug Administration, 2020).
• Do I still need to get it if I have had COVID?
  • Yes. While we don’t know how long the immunity from vaccine will last, it is believed to be longer than natural infection.
• How effective are they?
  • Moderna:  94.1%, Pfizer: 95%
• Is the vaccine effective against the new variants?
  • As far as we know, yes. While the variants have different epitopes, they have the same spike, which is where this vaccine works. Both Pfizer and Moderna have begun work creating boosters, should the need arise in the future.
• Will getting vaccinated prevent transmission to others?
  • We do not have enough data yet, but this is being studied. In the Moderna Trial(U.S. Food and Drug Administration, 2020), the participants were swabbed at visits one and two (day 1 and day 28), they measured how many participants in the placebo group and how many in the vaccinated group had asymptomatic PCR+. There were 14 in the vaccine group and 38 placebo group. While this is small data, it does suggest a 2/3 reduction after the first vaccine. Also, many other vaccines, that are not technically “sterilizing,” prevent transmission (think Rubella, yellow fever, influenza).
  • The CDC’s new guidelines recommend that those who are fully vaccinated (between 2 weeks and 3 months after the second vaccine) and exposed to COVID do not have to quarantine. That would suggest that experts do not think vaccinated people wearing masks can transmit to others.  
• Other vaccines(WHO, 2021):
  • Johnson and Johnson is close, they will probably apply for EUA February 26. So far, this vaccine appears to have 90% effectiveness. This is a single dose vaccine and is not the new mRNA technology. Instead, this is an adenovirus based vaccine, with some genetic material changed out to create COVID-19 response. Like the mRNA vaccines, there are none currently approved, however, there are several in clinical and pre-clinical trials. It requires normal refrigeration.
  • AstraZeneca + University of Oxford: Viral vector (non-replicating) vaccine. This one has been approved for emergency use in the UK but has not been submitted for review in the US. It is about 70% effective. Also 2 doses. Normal refrigeration. 
• What if I am pregnant or want to become pregnant?
  • There is no evidence that would suggest that the vaccines can cause infertility. There were women in both trials who became pregnant (U.S. Food and Drug Administration, 2020).
  • Developmental and Reproductive Toxicology (DART) animal data for both Pfizer and Moderna showed no adverse events on female reproduction(AGOG, 2020).
  • American College of Obstetricians and Gynecologists (ACOG) mentions the increased risk of complications in pregnancy when COVID positive and recommends a discussion regarding levels of risk of exposure and joint decision making with patient and provider. They do not recommend withholding the vaccine on the basis of pregnancy.
  • As mentioned by ACOG, there is evidence that COVID carries increased risks for pregnant women, including spontaneous abortions, preterm labor, increase need for cesarian section, and increased oxygen demand during labor (NIH, 2021)
• Basic mechanisms of action:
  • mRNA (messenger RNA) is a molecule in our body that makes protein. It is just the messenger, so it sends its message (meaning it makes a protein) and then it is recycled by the body. The mRNA does not stick around. The mRNA in the vaccine will make the spike protein of the virus, which will display on some cells. This is enough to create an immune reaction.
• Common side effects:
  • Reactogenicity is an expected reaction after a vaccine, it’s the patient’s immune system working! Expected reactogenicity include: pain, redness, swelling, fever, myalgias, headache, or rash (Haerve, et, al. 2019).
  • Common reactions post vaccination were published by Pfizer(U.S. Food and Drug Administration, 2020) and Moderna(U.S. Food and Drug Administration, 2020) in their briefing. I am sure that there will be more data as people continue to get vaccinated and we have a bigger n. See this infographic.
  • Adverse reactions include anaphylactic reactions and autoimmune events.

• Vaccine safety: 
  • Pfizer and Moderna have been studying RNA vaccines for a long time. They had already created a platform (with the intent to treat Zika, HIV, or other viruses) for these vaccines. Genome technology has advanced so much recently that we had the RNA sequence of the virus that causes COVID-19 in January 2020. By May, Pfizer and Moderna were starting Phase I/II trials (Mulligan, et al., 2020). Phase I and II are purely safety trials(Jackson, et al., 2020) (Walsh, et al., 2020). There are people who have had the vaccines since May and they are still being monitored. For the Pfizer vaccine, 40,000 people received the vaccine, for the Moderna, 30,000+ (Pardi, et al., 2018).
• Why did it get through so fast?
  • Billions of dollars and thousands of man hours have been invested. All of the brilliant scientists who have been working on a Zika vaccine, a universal flu vaccine, an Ebola vaccine, an HIV vaccine, and every other vaccine you can think of, were told to focus on THIS disease.
  • They have gone through the expected phases; they just did them simultaneously.
  • Genome technology allowed us to sequence the virus super-fast, so we knew the vaccine target very quickly (Krammer, 2020). 
  • The phase III trial required a certain number of people to become sick to be able to unveil the results. Because this is a highly contagious disease and is continuing to experience surges, those numbers were reached very quickly. When that happened, Pfizer and Moderna put tremendous effort into crunching the data. For example, if 5 people would normally be assigned from the company to work for 3 months to analyze data, instead, the companies assigned 30 people to do it in 2 weeks. The same number of person hours, just less time to finish. 30 people doing the work of 5. The assessments can be completed quicker without cutting any corners.
• How can I check that the vaccine worked?
  • Unfortunately, the recommendation is to trust the process. At this time, the CDC does not recommend antibody testing post vaccination to assess for immunity to COVID-19 (CDC, 2021).
  • There are two main types of antibodies (IgG) that are tested: nucleocapsid and spike. Vaccination effects the spike protein and most IgG antibody tests on the market evaluate nucleacapsid. So, before you run out to get an antibody test at your hospital, check the type of test that they are running.
    • The Abbott test at UCH tests for nucleacapsid (won’t be effective to check post vaccination IgG). I don’t know which tests are being utilized at other hospitals.
    • According to their website, LabCorp has a SARS-CoV-2 Antibody, IgG test number 164055 that checks for spike. https://files.labcorp.com/labcorp-d8/2020-12/L23586-1220-2_nex.pdf

Stay safe, wash your hands, wear masks, there is a light at the end of the tunnel!

Thanks for reading.

American College of Obstetricians and Gynecologists (ACOG). COVID-19 Vaccines and pregnancy: conversation guide for clinicians. Retrieved from: https://www.acog.org/covid-19/covid-19-vaccines-and-pregnancy-conversation-guide-for-clinicians

Centers for Disease Control and Prevention (CDC). (2021). Interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States. U.S. Department of Health and Human Services. https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Haerve, C., Laupeze, B., Giudice, G., Didierlaurent, A., & Tavares Da Silva, F. (2019). The how’s and what’s of vaccine reactogenicity. NPJ Vaccines, 4(39). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760227/

Jackson, L., Anderson, N., Rouphael, P., Roberts, M., Makhene, R., Coler, M., … Beigel, J. (2020). An mRNA Vaccine against SARS-CoV-2 – preliminary report. New England Journal of Medicine, 383, 1920-31. retrieved from: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2022483

Krammer, F. (2020). SARS-CoV-2 vaccines in development. Nature, 586, 516-527. Retrieved from: https://www.nature.com/articles/s41586-020-2798-3#Fig1

Mulligan, M., Lyke, K., Kitchin, N., Absalon, J., Gurtman, A., Lockhart, S., …Jansen, K. (2020). Phase I/II study of COVID-19 RNA vaccine BNT162b1 in adults. Nature, 586, 589-593. Retrieved from: https://www.nature.com/articles/s41586-020-2639-4

National Institutes of Health (NIH). (2021). Severe COVID-19 in pregnancy associated with preterm birth, other complications. Retrieved from: https://www.nih.gov/news-events/news-releases/severe-covid-19-pregnancy-associated-preterm-birth-other-complications#:~:text=Compared%20to%20COVID%2D19%20patients,%2C%20and%20Rebecca%20Clifton%2C%20Ph.

Pardi, N., Hogan, M., Porter, F., & Weissman, D. (2018). mRNA vaccines- a new era in vaccinology. Nature Reviews Drug Discovery, 17, 261-279. Retrieved from: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2022483

U.S. Food and Drug Administration (FDA). (2020). FDA Briefing Document, Moderna COVID-19 Vaccine. Retrieved from: https://www.fda.gov/media/144434/download

U.S. Food and Drug Administration (FDA). (2020). FDA Briefing Document, Pfizer COVID-19 Vaccine. Retrieved from: https://www.fda.gov/media/144246/download

Walsh, E., French, R., Falsey, A., Kitchin, N., Absalon, J., Gurtman, A., … Li, P. (2020). Safety and imunogenicitiy of two RNA-based COVID-19 vaccine candidates. New England Journal of Medicine 383, 2439-2450. Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMoa2027906

World Health Organization (WHO). COVID-19 Landscape of novel coronavirus candidate vaccine development worldwide. Retrieved from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

2020 Overview & Announcements

Greetings everyone, and welcome to the 2020 legislative session!

I have a few things that I wanted to go over with you. Let’s start with housekeeping items, and then move to the legislative session.

Announcements:

Email updates:
Do you want to receive email updates on legislative issues, and potentially urgent updates? Please fill out this form! Your information will not be shared with anyone outside of the CO ENA Government Affairs committee. Things you may be contacted about include announcements of new blog postings (since all legislative information will be posted here for everyone to access), chances to testify, and calls for writing your legislators. You will be added to a group in outlook that can participate in discussion amongst yourselves, and bring issues forward.

Colorado Nurses Day on the Hill:
For the first time ever, Colorado Emergency Nurses Association is co-hosting Nurses Day on the Hill with Colorado Nurses Association. For a certain amount of ENA members, this means you get to attend FREE! If you would like information regarding attending for free, please email government@coloradoena.org. Information below.

Colorado ENA members, Audrey Snyder and Debbie Skeen, with Rep. Mullica, an ER nurse at CNA Nurses Day at the Capitol in 2019.

February 18, 2020

Scottish Rite Temple
1370 Grant Street
Denver, CO 80203

For more information, and to register, please visit the CNA Website here.

Legislative Dinner:
To follow Nurses Day at the Capitol. Please register here.

If you are attending Nurses Day at the Capitol, please email government@coloradoena.org to be added to the discussion group and for updates on legislation.

A zoom meeting will be held on Sunday, February 16th @4pm & Monday, February 17th @ 7pm MST the night before to discuss the event and answer any questions you may have. Please RSVP to government@coloradoena.org.

Topic: Colorado ENA Government Affairs Meeting

Join Zoom Meeting
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Meeting ID: 912 367 339
Password: 563764

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Do you want to attend ENA Day on the Hill??
Submit your interest to attend by February 5th, 2020 to attend ENA DOTH April 28th and 29th in Washington D.C. Email government@coloradoena.org to express your interest.

Updates:

The Colorado Legislative Session began on January 8th, and is already full speed ahead! With 2.5 weeks into the session, many bills have been introduced that affect healthcare of individuals in Colorado. You will notice some blog posts upcoming regarding the legislative action, but we may not be able to update you on everything coming through. If you have time to write up any summaries of bills or meetings at the Capitol, please reach out to our Government Affairs Committee.

Upcoming updates that you should see in the next week include:

• Nurse Sunset Review
• Summary of the Joint Budget Committee Hearing on the Public Option

You can research which legislation is coming through, here. You can also find your legislator, and listen to committee hearings at that website. Please refer to the Introduction Blog Post to also review different sources.

Timelines for Consideration:

Super Tuesday is coming up, and that is a date that will be important for Coloradans. It is Tuesday, March 3rd. This is the primary election, and you need to be registered to vote. If you choose to change party affiliation, you need to do so by February 3rd, 2020. Primary election takes place on March 3, 2020.

Here is an excellent article for summary of timelines, elections coming up, and things to consider for Coloradans. As always, we will do our best to help you navigate this process, but please reach out to the Colorado Secretary of State for more guidance and information.

Best of luck with everything for this upcoming year, and we look forward to helping shape legislative issues that affect ER nurses and their patients!

Chelsea M. Collins, BSN, RN, CEN, SANE-A
Colorado ENA Government Affairs Committee Chair

ENA DAY ON THE HILL 2019

May 21 -22, 2019

Washington D.C.

This week, six members of the Colorado ENA traveled to Washington D.C. along with nearly 175 ENA members from across the nation to advocate for two federal bills.

Violence, and threats of violence occur every day in our profession.

In the last year – 100% of emergency nurses reported verbal assault, and 82% reported physical assault.  Emergency nurses have the highest rate of assaults of all nurses (ENA.org). 

The Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1309/S 851) ensures that health care and social service employers across the country take specific steps to prevent workplace violence and ensure the safety of patients and workers.

The Emergency Medical Services for Children Program Reauthorization Act (HR 776/S 1173) provides continued support for research benefiting children, and the teams who provide emergency care to them, across the country.  This bill was well received by both parties. 

Meetings with Senators, Representatives, and Legislative Aides were highly successful in sharing concerns of emergency nurses and advocating for support of these important issues.

Want to learn more?  Contact Government@coloradoena.org and follow us on twitter @ENAColorado and Facebook.

Jenessa Williams, Chelsea Collins (chair), Alan Favier, Debbie Skeen,
Jeanne Schuppe (CO ENA President), Krystal Paris

Written by Committee Member, Krystal Paris.

Day on the Hill: A members’ perspective

Colorado ENA is en route or on the ground in Washington DC for ENA Day on the Hill this year. Debbie shared her experience from past (local and national) DOTH, and how you can grow and get involved too. Consider joining the committee now, and involvement in future DOTH at the state and national level!

Welcome to this ENA Government Affairs Blog!  I thought perhaps I’d make a post to let nurses know what being involved in government affairs has been like for me. First of all, it has been fun and enlightening! I have been to Day on the Hill (DOTH) in Washington, D.C., advocating for national issues important to us here in Colorado. Last year we met with our legislators to discuss issues such as improving trauma care across the country and seeking training to healthcare providers to help victims of human trafficking. We are seeking ENA members from across the state to become involved so that we can continue building relationships with all of our senators and representatives in D.C. ENA has been amazing in their efforts to educate us on important talking points on each bill, and how best to approach our legislative meetings.

    As my interest in government affairs grew, I was introduced to the Colorado Nurses Association (CNA) and their Government Affairs and Public Policy Committee (GAPP). This committee, composed of nursing professionals, meets twice each month during the legislative session to discuss bills important to the nursing profession here at the state level. We have discussed bills such as freestanding emergency rooms, the scope of practice for healthcare professionals, and Colorado’s “Red Flag bill”. CNA’s GAPP Committee even has a lobbyist to advocate for the issues important to Colorado nurses. Student nurses are often present at the GAPP meetings, and I have found them to be stimulating and very informative.   

Audrey Snyder, Rep. Kyle Mullica (& ER Nurse), Debbie Skeen

 In late February, I attended CNA’s Legislative Day at the Capitol in Denver. We met at the Scottish Rite Temple on 14^th & Grant for breakfast and an overview of the program. Kyle Mullica, (D-Northglenn), who is also an emergency room nurse, spoke to us about his experience as a new legislator here in Colorado. Kyle has introduced legislation such as HB19-1312 which seeks to improve Colorado’s immunization rate. According to the CDC, Colorado is the second-least vaccinated state in the country. This is an important issue, given the U.S. is in the worst measles epidemic in two decades. Next, it was off to the capitol to meet with legislators. I was able to observe the house and senate chambers in action, and then meet with Sen. Robert Rodiguez and a staff member in Rep. Chris Hansen’s office advocating for bills related to hospital transparency and the role of APRNs in workman’s comp. I treated myself to a tour of the capitol, which was time very well spent. Finally, we met back at the Scottish Rite Temple for dinner. It proved to be a great evening to network with other nurses and legislators from across the state.

    So please consider getting involved in government affairs! Healthcare is changing at an incredibly fast pace. As emergency room nurses, it is important that our voices are heard.

Debbie Skeen, MSN, RN, CEN, CPEN

Rep. Titone and Colleen Casper, CNA Executive Director

Hot Topic: Workplace Violence Legislation

Colorado Emergency Nurses Association Government Relations – Hot Topic! The Emergency Nurses Association supports, and urges you to support the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309/ S. 851). ENA members from Colorado, and states across the nation will be meeting with legislators on Capitol Hill, May 22 to discuss important issues affecting emergency nurses, including the  Workplace Violence Prevention for Health Care and Social Service Workers Act (HR1309 / S851). https://www.congress.gov/bill/116th-congress/house-bill/1309 HR1309/ S851 requires the Department of Labor to address workplace violence in the health care and social service sectors. Specifically, Labor must promulgate an occupational safety and health standard that requires certain employers in the health care and social service sectors, as well as employers in sectors that conduct activities similar to the activities in the health care and social service sectors, to develop and implement a comprehensive plan for protecting health care workers, social service workers, and other personnel from workplace violence. (congress.gov) To send an email in support of this important bill to your representatives, please link to ENA’s “Act Now!” online form. http://en411.ena.org/ena/app/write-a-letter?0&engagementId=498755 For up to date information about legislation affecting emergency nursing, ENA public policy positions, email updates, and action items, please see ENA’s Government Relations webpage. https://www.ena.org/government-relations