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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?

116th 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 27th, 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 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 2nd dose is 21 days after the 1st, Moderna’s 2nd dose is 28 days after the 1st
  • 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.

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
https://zoom.us/j/912367339?pwd=amFqYnJxK29XZ2p3Zlkxa3FFT0RmQT09

Meeting ID: 912 367 339
Password: 563764

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Dial by your location
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Meeting ID: 912 367 339
Find your local number: https://zoom.us/u/alFdhfEFV

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
Image may contain: sky and outdoor

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 14th & 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

All the cards on the table…

Nurses:

Forgive the delay in writing this post, I was busy working nights, and finishing finals. As most of you know by now, Senator Walsh from Washington State completed quite the faux pas: she pissed off nurses.

If you missed what happened, here is a summary: Washington State was discussing a bill (SHB 1155) that limits mandatory overtime and protects nurses’ rights to breaks and lunches. Senator Walsh, from an area with a critical access hospital, attempted to argue that by mandating this critical access hospitals would not be able to survive. However, she did not present her argument correctly. Watch the video here.

Following the statement going viral, memes and outrage all over social media began. Misinformation flew around, and quickly. Health care professionals from all backgrounds, and all different people from walks of life came to the defense of nurses.

Some people did not, however. Colorado Meteorologist Jeff Matthews posted a tweet that was later deleted demeaning the nursing profession.

What was the outcome?

First, there are the phenomenal memes that have come out to not only entertain but bring attention to the issue.

BUT, hilarious memes aside, the reality is that there is a lack of understanding of the health care profession. If we thought the lack of understanding for the health care profession was high, it’s even worse for politics.

Senator Walsh added an amendment to kill the bill, where she further discusses nurses being tired, and if that’s the case, should only work 8-hour shifts. Politically, the tactic makes perfect sense. Not only would nurses dislike and not support this bill with this amendment, others wouldn’t as well, and all legislators would get bombarded with requests to vote no on this bill in return.  

There are numerous articles that one could read on the pros/cons of 12 hour shifts versus 8 hour shifts (see here, here, here, and here, for a small few). While the research can be conflicting, many get into nursing for the ability to work 3 shifts a week and switching to 5-day work week for full time instead, would have significant impacts on personal and family lives of those who work in health care. One could argue that the change could increase burnout, even, as nurses (especially those who work in high stress, critical care environments) have less time to process, recharge, and reset themselves when it comes to personal mental health.

When the bill finally did get passed (without the Walsh amendment), significant misinformation went around social media, and people were vowing to leave the state, or the profession as a whole if it made it all the way to their state that nurses could only work 8-hour shifts. Another consideration is that many nurses work overtime, and count on that extra income. With the Walsh amendment, this reduced the availability for nurses to work overtime, which also stressed many people out.

Courtesy of Washington State Nurses Association Facebook page.

What next?

Ultimately, we need to have a better understanding of how the government works. If you would like a crash course on government, please watch these videos. Educate yourself on how it works, even if that means asking questions on topics you really dislike discussing.

We as nurses absolutely need to begin educating ourselves on the conversation surrounding our profession. Health care is a hot topic, if not the hottest topic in state and federal legislation, and without coming to the table, educated about the topic and the process, we will not be taken seriously. We need to not only advocate for our patients, but we need to advocate for ourselves and our profession. Until we can advocate for ourselves appropriately, are we really doing our patients justice?

This legislative session, I testified on a bill. A very contested bill. The information that was going around was very uneducated, incorrect, and those against the bill appeared to not even have read the content of the bill. I was one of the only health care professionals, and I believe the only, or one of the few nurses who testified.

Chelsea spends another day at the Capitol.

Now, I’m not asking you to dive as deep in as I do when it comes to politics, but here are a few things you can do to better inform yourself, and take action:

  • Join your professional organization and follow their public policy agenda. ENA’s can be found here.
  • Join your local chapter and follow their discussions. Organizations such as ENA, ANA, and others may have government affairs committees that you can join or reach out to for questions and guidance.
  • Find your local and national legislators. This can usually be done by a simple google search.
  • Join the Discussion:
    • Write your state Senator or Representative.
    • Write you national Senator or Representative.
    • Write op-ed’s or letters to the editor.
    • Discuss on social media, or blog posts.
    • And more!
  • Seek out information. Do some individual research. Educate yourself, and then others. Avoid jumping immediately to conclusions, instead, read the bill/statement, do some research, and make an informed decision and further statement of advocacy.
  • Reach out to me, and I’d be happy to help you when I have the time to help you in whatever way I can!

If we are going to change healthcare, we have to change our profession. And in order to change our profession, we have to change ourselves. We have to hold the tough conversations, educate ourselves on current and legislative events, and we have to share. If we don’t, healthcare will never change.

Note: This can apply to ANY profession.

Start the conversation below by posting your favorite meme, current issue concern, or question. Netiquette rules apply, always.

Chelsea M. Collins, BSN, RN, CEN

Colorado Emergency Nurses Association, Government Affairs Committee Chairman

In full disclosure, I am also submitting this for a grade for my Advanced Nursing Health Policy course at Johns Hopkins University (with permission from my professor to post my assignment here).

ENA Day on the Hill 2019

Colorado ENA is proud to announce we are taking applications for attendance to ENA Day on the Hill! Priority preference is given to applications who submit prior to 2/12 at 12 (noon) MST, but applications will be accepted on an ongoing basis.

To be considered, please fill out this form and email government@coloradoena.org your contact information and why you should be chosen for this.

This two-day event features:

  • Keynote address by AB Stoddard, a leading authority on American politics and U.S. elections
  • An interactive training session with a congressional messaging expert on how to most effectively convey ENA’s legislative requests
  • Specific information about ENA’s congressional requests to help you speak knowledgeably about these issues
  • An opportunity to meet with congressional leaders on Capitol Hill to discuss how they can positively influence the future of emergency nursing
  • Networking session and the ENA Update with the Board of Directors

This event is designed for ENA members both new to advocating on Capitol Hill, as well as nurses who have previously attended Day on the Hill.

Please note: Colorado ENA would love to send every person who applies, however, has limited spots, and funding. You can become involved at the state level by joining the committee, or by requesting to be involved as a member if you do not want to join the committee. Email government@coloradoena.org to find out more.