Information on bills, legislative actions, testimonies, and CEO video updates can be found on our website at www.mtnurses.org under "Montana Legislature 2025." It is essential to know who your representatives and senators are, how they vote, and whether they truly represent your interests. As constituents, we must hold them accountable for decisions that impact our profession and the well-being of our patients. Stay informed and engaged---your voice matters!

HB 543 "An Act Repealing the Sunset on Reporting and Disclosure of Violence Against Health Care Employees"

• Introduced by Representatives E. BUTTREY, J. ISALY, J. WEBER, D. POWERS, D. BEDEY, M. DUNWELL, L. JONES, T. RUNNING WOLF, S. WEBBER, K. WALSH, J. ETCHART, B. BARKER, D. HAYMAN, B. MERCER, S. MORIGEAU, G. PARRY, C. POPE, P. TUSS.

• Passed out of House Business and Labor committee with a 20 to 0 vote.

• Passed 2nd reading on the House floor with 89 Ayes, 8 Noes, 1 excused, and 3 absent.

• Representatives opposing mandatory reporting of violence against nurses and healthcare employees:

1. REGIER

2. BYRNE

3. DEMING

4. KELLY

5. KMETZ

6. LOVE

7. MILLETT

8. NICOL

• Passed 3rd reading on the House floor 93 Ayes, 6 Noes, 1 absent.

• Representatives opposing mandatory reporting of violence against nurses and healthcare employees:

1. REGIER

2. BYRNE

3. DEMING

4. KELLY

5. KMETZ

6. MILLETT

• On it way to the Senate chamber to be debated after transmittal.

**A special thank you to Representative Buttrey for spearheading this bill and securing many cosponsors. Additionally, a shout out to our Department of Justice putting together the website and posting the first year of data. Please see MNA summary related to that initial data and it can also be viewed on our MNA website.

HB 526 "An Act Adopting the Advance Practice Registered Nurse Compact"

• Introduced by Representative A. Regier.

• Failed in House Business and Labor committee with a vote to table the bill of 12 to 8.

• Representative Regier attempted to "BLAST" the bill off the table onto the House floor during floor session and blast vote failed 44 to 55.

• Bill is dead.

This bill is not ready for prime time in Montana.

• Lack of APRN Input: APRNs were not involved in crafting this compact, yet they are the experts in their practice. They continue to request a seat at the table to ensure their concerns are addressed.

• No Funding for Oversight & Compliance: There is no designated funding to ensure compliance with the compact's requirements.

• Serious Compliance Issues: I have formally filed a complaint with the Department of Labor regarding compliance failures. Montana does not track compact nurses working in our state, even though they are required to obtain a new home state license within 60-90 days.

• Loss of Revenue & Accountability: Many nurses continue working under their compact license for hundreds, even thousands of days without obtaining a Montana license (this is noted in the complaint to the DLI). A review of the NLC (Nurse Licensure Compact) has confirmed this ongoing issue. This results in lost revenue for the state, as these nurses are not purchasing the required Montana license.

• Click here for Joint statement addressing compact concerns for APRNs

• Click here for Key Concerns shared with lawmakers regarding APRN compact

RTW-Right to Work bills

• All so-called "Right to Work" (better described as No Rights at Work) bills were successfully defeated! A huge thank you to our SWAT team members, nurses, and MNA staff who stood strong and attended the hearing on the most harmful of these bills, SB 376. The opposition was overwhelming---over 150 opponents testified against the bill, compared to just two proponents.

• MNA, alongside all of Montana's state unions, united to ensure this legislation failed. Montana has a proud history of collective bargaining, with professional nurses securing their rights since 1967. This legacy was upheld during the 69th legislative session, and we commend our AFL-CIO state federation for their outstanding leadership in coordinating unions across Montana. Together, we showed up, spoke out, and protected the rights of our workers.

• Other RTW bills defeated include SB 277 and SB 94.

SB 211 "An Act Revising the Emergency Use of Epinephrine in a School Setting to include Nasal Spray"

• Introduced by C. NEUMANN, V. RICCI, S. NOVAK, L. MUSZKIEWICZ,

B. EDWARDS, J. ISALY, M. LEE, M. NIKOLAKAKOS, B. CLOSE, G. OVERSTREET, A. GRIFFITH, M. CUNNINGHAM, T. MANZELLA, W. CURDY, M. DUNWELL, E. MATTHEWS, W. MCKAMEY, F. SMITH, D. FERN, D. HARVEY, M. REGIER, L. SMITH, M. YAKAWICH, C. GLIMM, E. BOLDMAN, J. COHENOUR,

P. FLOWERS, T. FRANCE, D. HAWK, D. HAYMAN, J. KARLEN, C. KEOGH,

K. KORTUM, F. MANDEVILLE, T. MCGILLVRAY, G. NIKOLAKAKOS,

S. MORIGEAU, A. OLSEN, C. POPE, M. THANE, P. TUSS, M. MARLER,

K. BOGNER, D. JOY.

• Passed in Senate committee and 2nd and 3rd reading with overwhelming support.

• On its way to the House chamber to be debated after transmittal.

**A special thank you to Senator Neumann who sponsored this bill and secured many cosponsors. Also, the Montana Association of School Nurses (MASN) and MNA submitted joint testimony in support of this bill in the Senate committee.

SB 372 "An Act Establishing Safe Staffing Standards for Nurses; Creating Nurse Staffing Committees in Hospitals to Protect and Enhance the Safety and Quality of Patient Care"

• Introduced and carried by Senator Neumann.

• Amendments were offered but not entertained by the committee.

• Failed in Senate Business and Labor committee. Bill is dead.

• CLICK HERE for bill language.

• CLICK HERE for a flyer with talking points shared with all lawmakers.

Special thanks to the nurses that came to Helena Capitol to observe the committee hearing process and big thank you to those of you who testified. It is important for lawmakers to hear from nurses, especially those on the ground directly affected by these laws. Super proud of you.

MNA also thanks Senator Neumann for sponsoring this important legislation, as it remains a TOP priority for our members. Senator Neumann holds a Doctorate in Public Health and resides in Bozeman and we cannot be more grateful for her leadership in addressing healthcare issues.

SB 497 "An Act Addressing Career Fatigue and Wellness in Certain Health Care Providers"

• Introduced by W. MCKAMEY, M. NIKOLAKAKOS, E. TILLEMAN, G. HUNTER,

J. KASSMIER, G. LAMMERS, S. FITZPATRICK, N. DURAM, J. DARLING,

V. MOORE.

• Passed out of Senate Business and Labor committee 9 to 3.

• Passed 2nd reading on Senate floor 30 to 20.

• Passed 3rd reading on Senate floor 28 to 21.

• On its way to the House chamber to be debated after transmittal.

• This bill addresses many healthcare professions; however, here is summary of testimony shared why this bill would be important and impactful to professional nurses.

Issues:

• Nurses, physicians, and healthcare workers are often perceived as invincible, capable of healing and restoring health without limits.

• This perception extends to healthcare professionals themselves, leading to unrealistic expectations of resilience against stress, burnout, and moral distress.

• While campaigns like the American Nurses Association's (ANA) "What is Your Superpower?" aimed to empower nurses, they may have unintentionally reinforced the idea that seeking help is a sign of weakness.

• Many nurses struggle in silence, feeling they should be able to "fix" themselves, fearing that colleagues are stronger and more resilient.

Proposed Solutions:

• A confidential, non-disciplinary self-referral process that is independent of BON oversight.

• Nurses need support, not stigma.

• A non-punitive, confidential mental health pathway is essential to retain and protect the nursing workforce.

• Legislative and institutional changes are needed to ensure nurses can seek help without fear of professional consequences.

**A special thank you to the Montana Medical Association (MMA), including and coordinating our health professions together and assisting us with information and process. Very special thanks to Jean Branscum, CEO of MMA, for her guidance and advocacy for health care professions.

A union's strength in achieving its goals---whether it's holding a meeting, bargaining a contract, or making significant improvements to nursing practice---depends entirely on how active and engaged its members are. Sounds simple, right? But the real challenge is: how do you encourage activism within your union?

The foundation of any activism, whether small or groundbreaking, begins with one essential element: communication. Effective communication with members is the single most powerful way to inspire engagement and action. Whether you work in a facility with 10 nurses or 600, maintaining strong communication is key to building a productive, effective union.

In today's digital world, communication is easier than ever. Nurses across the state are using email threads, text messaging, and private social media groups to foster discussion and teamwork among their members. While developing and maintaining an organized internal communication system takes time and effort, the payoff is immense---a well-informed, empowered membership that is ready to take action.

It is also crucial to establish open, two-way communication between union leadership and members, ensuring that every nurse has a voice in the union. The concerns and issues raised by members are what drive contract negotiations and union initiatives. When every nurse feels heard, the union becomes stronger, more effective, and better equipped to fight for meaningful change.

That is where your power lies---in the voices of your nurses and the collective actions of your union! Don't hesitate to reach out to your labor representatives to work on a communication plan within your union!!

The development of a short-course, safe, well-tolerated oral treatment for hepatitis C is a remarkable milestone in the field of medicine.  Treatment is recommended for all individuals with hepatitis C infection, including individuals with active substance use, and treatment results in a cure in more than 95% of cases. Yet, despite the availability of an effective cure, many people living with hepatitis C have not been treated.  It is critical that treatment is available where people with hepatitis C receive other services, such as primary care offices.

Led by Montana medical providers, the Montana Hepatitis C and HIV Project ECHO, is designed for Montana medical providers to actively engage in a virtual community with their peers where they can share support, guidance, and feedback.  Each session consists of a didactic presentation led by a subject matter expert as well as an opportunity for providers to discuss de-identified cases and pose specific questions to specialists and clinical peers.

You can register for the Montana Hepatitis C and HIV Project ECHO and access recorded sessions at: https://www.umt.edu/ccfwd/training/projectecho/hepc_echo.php

Leadership in changing times

New scope and standards of practice reflect post-pandemic realities

By Genna Rollins

The U.S. healthcare system has changed profoundly over the past decade, and the skills, competencies, and knowledge nursing leaders need to succeed in this reshaped landscape likewise have evolved. These new realities pervade the American Nurses Association (ANA) Nursing Leadership Scope and Standards of Practice, 3rd Edition (NLSSP), published in April (hubs.ly/Q02B6x_K0).

This comprehensive document reflects more than a dusting off of its 2016 predecessor, with the very name of the specialty changed to nursing leadership from nursing administration.

"We felt that administration was an older term used in hospitals many years ago; one that doesn't reflect the expansive role leaders play in today's healthcare continuum," said Edna Cadmus, PhD, RN, NEA-BC, FAAN, co-chair of the review and revision work group that produced the NLSSP. "The title didn't really reflect the people these standards were serving. We also wanted to make sure that this document didn't get shelved but was available for and used by all leaders within an organization." A New Jersey Nurses Association member, Cadmus is executive director for the New Jersey Collaborating Center for Nursing and a clinical professor at Rutgers University School of Nursing.

"Nursing is evolving constantly, and our scope and standards have to evolve as well," added work group co-chair Christina Dempsey, DNP, MBA, RN, CENP, CNOR, FAAN. "We took the great work that had been done previously and recognized that nursing leadership is about more than nursing administration, which almost has a negative connotation. We wanted this to be all about how nursing leaders lead and function in all the various places where nursing leadership happens, which is way outside just hospitals." Former CNO at Press Ganey, Dempsey, a Missouri Nurses Association member, is CEO of Christina Dempsey Enterprises and president of the Missouri Organization of Nurse Leaders.

Merged standards and competencies

Cadmus and Dempsey, selected as co-chairs of the work group by ANA and the American Organization for Nursing Leadership (AONL), respectively, reflect the two organizations' collaboration in developing the new standards.

The work group utilized standards and competencies from ANA, AONL, the American Association of Colleges of Nursing, and also reports from the Institute of Medicine (2010) and National Academies Future of Nursing reports (2022). Drawing from all these sources, NLSSP outlines six standards of practice (assessment, diagnosis, outcomes identification, planning, implementation, and evaluation) and 13 standards of professional performance such as communication, just and equitable practice, and collaboration. The document also describes 116 accountabilities across 13 domains, including incivility, bullying, and workplace violence; health advocacy; and strategic and financial stewardship.

The standards of practice, professional performance, and accountabilities relate to all nurse leaders, from those in informal and frontline roles to executives, regardless of practice settings, according to Cadmus and Dempsey. For example, leaders in different settings would deal in various ways with their accountabilities involving safety, quality, and risk management. In healthcare provider organizations, frontline nurse leaders would be more concerned with ensuring the provision of safe and quality care while nurse executives would set and implement the organization's quality and safety strategy. In contrast, a nurse leader in a payer organization might be more engaged in evaluating the quality and safety care experience of member beneficiaries.

In considering nurse leaders to join them on the work group, Cadmus and Dempsey cast a wide net for 26 leaders from diverse backgrounds and practice settings. "We had people who were expert in the LGBTQIA+ community to ensure that we were not only inclusive but also accurate and current," Cadmus recalled. "We had people who were strong in acute care, long-term care, home care, public health, and informatics. We had representation from roles and places where nurse leaders practice---correctional care, the military, academia, hospitals, and ambulatory care."

One of the work group's heavy lifts was to develop a definition of nursing leadership that encompassed its broad vision of the specialty.

Nursing leadership defined

Nursing leadership is the specialty practice devoted to collaboratively and collegially setting the vision, mission, and values for health, human services, and social care. It is the art and science of nursing leadership, influence, empowerment, and governance of and with professional nurses and other team members that advance a culture of clinical and operational excellence, including but not limited to, innovation, transformation, advocacy, quality, safety, equity, diversity,
inclusion, and engagement.

"This new definition is broad enough that it's all encompassing of all roles and inclusive and can be applied by varied leaders in nursing, whether they're leading nursing departments in hospital settings or care settings across the continuum, in academic institutions, or professional societies," said work group member Hussein M. Tahan, PhD, RN, FCM, FAAN, a Maryland Nurses Association member and system vice president for nursing professional development and workforce management and CNO for MedStar Ambulatory Services and MedStar Medical Group in Columbia, MD.

The NLSSP also brings out the emerging concept of professional identity---the set of beliefs, attitudes, and understandings about one's professional role---and calls on nurse leaders to model the way by aligning their actions with shared values.

"Dialogue and science involving professional identity in nursing started to become more common right before the pandemic. We were intentional about bringing in leading researchers in this area to share with us what they're learning," noted Hussein. "If I expect the team I lead or the practice I represent to present a professional stature, demeanor, and existence, it's important for me to demonstrate that in the way I act and model the way."

New emphases

In recognition of the new realities of healthcare, the NLSSP emphasizes diversity, equity, inclusion, and social justice; digital technology; innovation; and emergency mitigation through recovery in ways the prior editions didn't. The pandemic, in particular, brought hard-won knowledge and lessons that required consideration, according to Cadmus.

The document calls on nurses to be leaders of social change, to understand their responsibilities to dismantle racist systems, and to confront dissonate cultural norms. The NLSSP urges nurse leaders to consider these actions as their North Star.

"As nurse leaders, we're obligated to represent everyone, to create opportunities for everybody, to demonstrate equity and diversity in the way we make decisions, and to also accept feedback and recognize when we may not be as inclusive as we ought to be so that we can recalibrate and improve," Tahan elaborated.

In the innovation sphere, the document notes that nurse leaders "need to have the will for disruptive change and a strategic thinking mindset for innovation with a clear understanding of the problem they are trying to solve." This declarative statement and others in the document reflect new demands on nurse leaders forged by the pandemic, according to work group member Joseph Marc A. de Veyra, DNP, MBA, MPH, RN, CNL, PCCN, a Washington State Nurses Association member and CNO of NPHub. During the NLSSP development process he served as associate chief nursing officer for Harborview Medical Center in Seattle.

"Nurse leaders now must have a bias for execution, and we need to pivot and adapt to our strategy on the fly," he observed. "Projects now have to be completed on an accelerated timeline, so instead of implementing after say 3 months of planning, we now have a short window to plan, pilot early on even if it's not perfect, and sharpen our strategy based on a month or so of learning. We can't go into decision paralysis."

The NLSSP also pointedly notes that nurse leaders "dramatically impact nurse well-being by shaping the day-to-day work life of nurses, setting the culture and tone of the workplace, developing and enforcing policies, and serving as exemplars of well-being." The trials and tribulations of the pandemic also focused the work group's thinking on this matter, according to Dempsey. "If there was a word bigger than 'dramatically,' we would have used it," she said. "It's that important, when you think about the data around a positive work environment impacting engagement, patient experience, and outcomes. The positive practice environment is huge and that is absolutely set by the nurse leader."

With the NLSSP redefining nursing leadership, Cadmus, Dempsey, and other members of the work group see good reason for the document to be widely circulated and used extensively wherever nurse leaders practice. "Of course, we'd like nurse leaders to read this and integrate into their practices, but organizations can also use this in the evaluation of their leaders," suggested de Veyra. "This is like the road map to becoming the best nurse leader you can be as your organization emerges from the pandemic."

--- Genna Rollins is a writer/editor at the American Nurses Association.

American Nurse Journal. 2024; 19(8). Doi: 10.51256/ANJ082428

Reprinted with permission from ANA on the Frontline in American Nurse Journal.

Innovation in motion

Award recipients advance digital tool, novel device

The American Nurses Association (ANA) Innovation Awards, sponsored by Stryker and offered annually, highlight, recognize, and celebrate nurse-led innovation that improves patient safety outcomes. The 2023 recipients provided updates as they continued developing their innovations.

2023 Individual Award

Robin Austin, PhD, DNP, DC, RN-BC, FAMIA, FNAP, co-developed the "My­Strengths + MyHealth" (MSMH) application, a digital tool that enables patients and consumers to compile comprehensive, whole-person health assessments. MSMH captures individual, family, and community self-identified strengths, challenges, and needs across 42 discrete concepts, including social drivers of health and resilience. Users self-report their health data across these concepts within the following four domains: my living, my mind and network, my body, and my self-care. Austin and her colleagues created MSMH in 2017 and collaborated with community members to ensure the language used in the tool is at an accessible, 5th grade reading literacy level.

Austin is using ANA Innovation Award money to do the following:

• Redesign the MSMH user interface to enhance functionality of the application and make it more efficient and user friendly.

• Integrate MSMH with clinical settings and currently existing electronic health record (EHR) systems.

• Ensure patients' voices are included in EHRs.

"Our work going forward aims to use MSMH data within the clinical environment to facilitate a paradigm shift toward whole-person health and resilience and to include this data as part of a longitudinal care plan," Austin said.

2023 Team Award

Roxanne McMurray, DNP, APRN, CRNA, co-created the McMurray Enhanced Airway (MEA), the first distal pharyngeal airway device that improves airway management and patient safety in sedated patients. Unlike traditional airway devices, MEA extends beyond the tongue, providing a fast, easy, and effective way to open upper obstructed airways. The MEA simplifies positive pressure mask ventilation with intraoral ventilation and can help decrease or avoid hypoxia during intubation.

The ANA Innovation Award has enabled McMurray and her team at McMurray Medical to raise awareness and recognition of the MEA among nursing, emergency medical care, and anesthesia providers.

McMurray Medical also has:

• Applied for European Union patents and obtained another U.S. patent.

• Applied for a National Institutes of Health Small Business Innovation Research Direct-to-Phase II grant in collaboration with Stanford Medical Center to conduct a randomized controlled trial to compare the MEA with existing airway devices.

• Published articles in peer-reviewed journals to provide evidence-based data and case studies that demonstrate MEA's efficacy and safety.

"The ANA Innovation Award has been a catalyst for the MEA's success and growth," McMurray said. "The award has enhanced MEA's reputation and exposure, as well as facilitated its development and dissemination. The award also validated MEA's contribution to advancing airway management practice to improve patient outcomes."

Oriana Beaudet, DNP, RN, PHN, vice president of nursing innovation at ANA, added, "The evidence-based medical device and technology innovations created by our 2023 winners are actively improving the health and outcomes of individuals and communities. To see both groups expand their work across the United States and internationally this year is extraordinary---we can't wait to see where they'll go next!"

The 2024 ANA Innovation Award winners will be announced in March 2024. More information about winners is available at nursingworld.org/innovation. Applications for the next cycle of the awards open on June 1, 2024.

American Nurse Journal. 2024; 19(3). Doi: 10.51256/ANJ032429

Reprinted with permission from American Nurse Journal.

Membership reminders....

Can't Find MNA's Membership Application?

MNA now has an electronic application on our website. Please visit https://www.mtnurses.org/about/join/. 

Please check your membership status.

If you fall into any of the below categories, you could qualify for the 'Professional Reduced Rate' $38.65/month.  Your rate will not automatically change.  You must let us know.

• You are a new graduate.  You must apply within the first six months after receiving your initial RN licensure and this rate is good for one year.

• You are an RN in a full-time study program working towards a higher degree.  You will need to provide proof of enrollment, and you could receive this rate for up to 3 years.

• You are an RN 65+ year of age who is licensed and working.  You could receive this rate for the remainder of your employment.

If you are working in a collective bargaining position and move into a non-collective bargaining position, please contact the Montana Nurses Association to let us know.  Your membership dues will continue to be paid until you authorize them to be discontinued.  Please remember, only you can cancel your membership and membership payments.

To provide MNA with information on your status or to receive additional information on MNA membership please e-mail Brandi Dearing, Brandi@mtnurses.org