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An Education Program for Nurses from Referring Hospitals in a Perinatal Regionalization System
principles and practice An Education Program for Nurses from Referring Hospitals in a Perinatal Regionalization System DIANE ELLENBERGER, RN, MSN, AMY HEMME KENNEDY, RN, M S N , and C O L E T T E C H A S E , R N , BSN Administering high-quality perinatal care at a regional center involves more than providing in-center services. An outreach education program was developed for nurses in referring hospitals. The authors believe that through the carefully phased development of un outreach education program, quality perinatal care on all levels can be realized.
Although intensive care for the premature infant has become progressively more sophisticated over the past 25 years, it has been only in the last six years that increased emphasis has been placed on the welfare of the fetal-maternal unit. Thus, health care for improving the outcome of pregnancy is changing its focus from crisis intervention to prevention of neonatal mortality and morbidity. Perinatal regionalization is a relatively recent result of this change of focus. It may be defined as a coordinated, comprehensive program for perinatal health care within a specified geographic area, as determined by population needs. The level of health care delivery each facility in the region is capable of giving should be identified and utilized to the maximum for accomplishing the following objectives’ : I ) make available quality care to all pregnant women and newborns, 2) promote maximum utilization of highly trained perinatal personnel and intensive care facilities, and 3) assure reasonable costeffectiveness.
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To accomplish these objectives, the Illinois Committee for Perinatal Health developed a statewide perinatal health care plan which began implementation in January of 1975. It provides for five perinatal regions with 14 perinatal intensive care centers. Washington University Medical Center (Barnes Hospital, St. Louis Children’s Hospital, and Washington University) was identified as an intensive care center for the Southern Illinois Perinatal Region. The Southern Region involves 30 counties, from the Mississippi River to the Indiana border, with a population of one million (1970 U.S. Census). Half of this population is centered around the St. Louis Metropolitan East area; the other half is in rural farming and mining communities. Approximately 16,000 live births occur here annually.’
Philosophy and Development In assessing the responsibilites of a regional center, it was recognized that administering high-quality perinatal care involves more than providMay/June 1979 JOCN Nursing 0090-0311/79/0514-0000$0100
ing in-center services. The additional responsibility to provide professional continuing education was identified, and it was felt that through the carefully phased development of an outreach education program, quality perinatal care on all levels could be realized. Initially, outreach education at our center was “backed into.” Educational conferences were primarily presented by a physician team, occasionally including a nurse, with focus on normal and crisis-oriented newborn care. Conferences were offered to physicians and nurses; however, attendance was 95-98% nurses. After the initial attempts, the following observations guided the development of the present outreach program : 1. Nurses “listen” differently (more effectively) to another nurse, as opposed to a physician. 2. Nurses have educational needs that are different from those of other professionals. 3. Nurses do not participate actively in discussions to seek clarification when physicians participate in the same conferences. 4. Nurses far outnumber physicians in their participation in this continuing education effort. These observations resulted in the following conclusions: 1. Continuing nursing education is most appropriately implemented by nurses, based on the following principles of learning: a) Learning is motivated when it is planned to meet the needs of the learner. b ) Learning is a process whereby complex concepts are appreciated after fundamental principles are learned. c) Learning is facilitated by reinforcement of knowledge in both the didactic and clinical settings. d ) The learning process is enhanced by a climate which is comfortable for the learner. 2. An educational climate should be introduced through nursing before physician and multidisciplinary team consultation and/or seminars by physician invitation are implemen t ed . Planning and implementing perinatal outreach education requires cooperation, participation, and support May/June 1979 JOCN Nursing
Table 1. Sample of Conference Curriculum 14 minutes 45 minutes 1 hour 1 hour 45 minutes 30 minutes 1 hour 45 minutes
Overview of the Illinois Perinatal Program Identification of the high-risk mother and neonate Nursing care of the toxemic mother prenatally and in labor and delivery Nursing care of the diabetic mother Thermoregulation of the newborn Transport of the mother prior to delivery Stabilization and transport of the high-risk infant Facilitating parent-infant attachment in the highrisk situation
on many levels. The situation at Washington University Medical Center is unique in that the obstetrical and neonatal services, though proximally located, are administrated by two distinctly different institutions. In addition, physician coverage is through association with Washington University School of Medicine as a third administration. Therefore, coordination and communication in planning implementation among the three institutions, includirrg administration, nursing, medicine, and accounting, has been crucial to the success of the outreach education program. The initial program planning originated from the neonatal setting. The impetus was given by an administrative consultant for professional education, consultation, and training, whose position is funded by a National Foundation-March of Dimes grant. The services of this consultant have been invaluable, particularly because they were both objective and directive. Through a series of meetings with the consultant, the general structure of the program took form. A multidisciplinary, multi-institutional Outreach Education Committee facilitated planning of the program and currently assists in administration, financial planning, and coordination of activities. Although implementation began with a focus on crisis-oriented neonatal care, it was soon realized how necessary obstetrical nursing involvement in education is for the success of a true perinatal outreach education program. Our program was deficient because of lack of emphasis on the preventive aspects of perinatal care. Therefore, obstetrical
care is now integrated throughout the entire education program. The Outreach Education Plan evolved into Phase I and Phase II. Phase I was developed as four steps that progressively set the climate for learning. Phase I Step One is designed to introduce the Illinois Perinatal Program to the hospitals in the Southern Illinois Region. This is accomplished via telephone, letter, and personal contact with directors of nursing, inservice directors, or obstetrical nursing supervisors. A follow-up visit is planned to further introduce the perinatal program; to assess facilities, staffing, and physician coverage; and to plan a one-day conference to meet individual hospital needs. The assistance of the Regional Trauma System chief nurse had been very helpful in facilitating initial contacts with the community hospitals in Southern Illinois. Step Two is the actual implementation of continuing education for perinatal and community health nurses. One-day workshops or conferences are held, hosted by one hospital, for four to six hospitals and agencies near to each other. During the educational offerings encouragement is given to participating nurses to share their new knowledge about the Perinatal Program with other nurses, physicians, and consumers. (See Table 1 for a sample curriculum.) The nurses attending t h e workshop/conferences are asked to fill out participation cards for compiling a mailing list. The participants are requested to indicate their additional perinatal education needs and inter-
159
est in visiting the Perinatal Center (see below) in addition to their name, address, hospital, hospital phone, position, and date and location of the conference attended. Staff nurses working in the obstetrical and nursery areas of the Perinatal Center who are able to research, formulate, and deliver lecture material for participation in outreach activities are identified. In addition to increasing job satisfaction through increased responsibility and recognition, participation in outreach education increases the theoretical and clinical expertise of t h e staff nurse. As a reinforcement of learning and to acquaint community nurses with the facilities and services of the Regional Center, a two-day visiting program is also offered, as mentioned above. O n e day of labor and delivery and one day of nursery experience is scheduled, as the majority of nurses care for both mothers and infants in t h e community setting. Key administrative resource persons in the respective institutions encouraged the development of this visiting program, a n d the positive reactions and suggestions of head nurses of LaborDelivery, the Nurseries, and the Obstetric Complications Clinic were vital. Perinatologists, neonatologists, and an anesthesiologist were also informed of the plan, and their responses were equally affirmative and enthusiastic. When nurses indicate their desire to be involved in o n e of these twoday visits, their hospitals or agencies are contacted for possible participation. When a visit has been arranged, participants are asked to indicate their special interest (labor and delivery, nursery, etc.) and their individual learning needs. Following the two-day experience, the nurse who meets t h e objectives can be expected to 1 ) have a greater appreciation for comprehensive obstetric and neonatal care, and 2) share this experience and learning with other nurses in the community to improve the quality of perinatal care. During t h e visit, the participants are assisted and/or guided by either the authors, t h e Perinatal Outreach Education coordinator, or staff nurses so that their experiences will generally include the following: 160
1. Observation of a high-risk mother and fetus during labor, delivery, and recovery. 2 . Exposure to the labor-delivery suite; fetal and maternal monitoring; special diagnostic procedures such as ultrasound, amniocentesis, oxytocin challenge test, L/S ratio, and shake test; and types of anesthesia available. 3. A tour of the maternity inpatient facility and perinatal unit. 4. Attendance at t h e Obstetrical Complications Clinic Conference. 5 . Viewing of care in the observation and premature nurseries, instruction on gestational age assessment, physical examination of the newborn, Dextrostik screening, thermoregulation, and Doppler blood pressure monitoring. 6. A tour of the normal newborn nursery. 7. A tour of the high-risk intensive care nursery, with individualized experience in assessing breath and heart sounds and in suctioning, a n d a demonstration of and instructions in gavage feeding. 8. A review of newborn infant resuscitation with the obstetrical anesthesiologist. Over I00 nurses from Illinois have visited t h e Perinatal Center. Their evaluations have shown enthusiasm a n d a desire to share experience in the home hospitals, which in turn may promote improved supportive measures for families in the home hospital setting. When appropriate, nurses from the Perinatal Center will visit downstate hospitals for exchange of information on an informal basis. Initially, these visits have been in conjunction with Step One. The purpose is to get acquainted with personnel at the community hospitals. These visits have been a time of friendly and productive sharing. It is expected that in time staff nurses from the center will visit the community hospitals to work side by side with the obstetrical nurses for a few days. The eventual goal, therefore, is not only to bring nurses to the Perinatal Center but to bring the center to the community for education. Step Three involves the planning of a two-day Perinatal Nursing Symposium for reinforcement and expansion of previous learning. This edu-
cational offering may include both physician and nurse faculty. Step Four provides nursing and consumer education concerning perinatal regionalization through the March of Dimes field representatives, media coverage, and commu-. nity health nurses. Phase II Following the nursing contact, and subsequent workshop/conferences and exchange visits, Phase 11 of the education outreach program can be implemented. It involves continuing education for the nurse-physician team. Step Urie consists of a n invitation from physicians in southern Illinois to the Medical Staff of the Washington University Perinatal Center for consultation and/or an educational seminar for physicians a n d nurses. Step Two consists of acceptance of the invitation and determination of the nature of the visit and/or content of the seminar. Step Three involves a multidisciplinary team visit to the inviting hospital by Washington University Medical Center physicians a n d nurses for consultation and/or seminar. Step Four is a follow-up visit by the team of physicians and nurses to communicate the evaluation of obstetric and nursery services a n d recommendations for change. Conclusion The experience a t this center has shown that one individual should be identified as responsible for the coordination of planning a n d implementation of perinatal outreach education. This person should have a clinical background in perinatal nursing with a firm theoretical foundation. In addition, experience in education and/or administration is necessary for planning and implementing the outreach activities. Since these qualities are not likely to be found in a single individual, resource persons need to be available with whom the coordinator may collaborate. Before it is realistic to expect to increase awareness of quality perinatal care in the region, it is necessary for the center first to upgrade its May/June 1979 JOGN Nursing
internal educational programs. The respective institutions of the Perinatal Center are in the process of increasing both the quality and quantity of in-service and continuing education for the obstetrical and neonatal nurses. Evaluation of the effectiveness of the Perinatal Outreach Education Program is essential. The overall expectation is an improvement in the quality of the outcome of pregnancy. This improvement is facilitated by positive changes in facilities, procedures, and staffing through the educational process. These changes will be the basis for the evaluation. Acknowledgment The authors acknowledge the assistance, financial and otherwise, of the National Foundation-March of Dimes field representatives from the inception of the program. References 1. Toward Improving the Outcome of Pregnancy: Recommendations for the Regional Development of Maternal and Perinatal Health Services. Com-
A m y Hemme Kennedy is a Clinical S p e cialist at S t . Louis Children's Hospital. She a t tended St. Luke's Hospital Address reprint requests to Diane M. ElSchool of Nurslenberger, RN, 3929 Utah Street, St. ing in St. Louis, Louis, MO 63116. the University of Missouri ( B S N ) , and Saint Louis University (MSN). She is a member of NAACOC, A N A , and the Association for the Care of Children in HosDiane Ellenpitals. berger is a Clinical Specialist and Coordinator of Colette Chase Perinatal Outis a Nurse Spereach Education at Cardinal cialist in ObGlennon M e stetrics at Barnes Hospimorial Hospital tal in St. Louis, for Children, where she was St. Louis, Missouri, and was formerly formerly Nurst'erinatal Outreach Coordinator at St. ing Care A d Louis Children's Hospital. She attended visor in ObBarnes Hospital School of Nursing in St. stetrics. She atLouis, Saint Louis University (BSN),and the University of Colorado (MSN). She is tended the University of Iowa ( B S N ) and is a member of NAACOG. a member of NAACOG and ANA.
mittee on Perinatal Health, The National Foundation-March of Dimes, 1976, p 2 2. A Plan for Perinatal Health in Illinois. Illinois Department of Public Health and the Illinois Committee for Perinatal Health, 1974, p 24
PEDIATRIC NURSES Registration for the October 12, 1979, National Qualifying Examination for Pediatric Nurse Practitioners and Associates will begin June 1 and end August 3. Developed by the National Board of Pediatric Nurse Practitioners and Associates, this certification examlnation evaluates entry-level competency in the pediatric nurse practitioner/associate role. Registration fee: $50; examination fee: $150. For further information contact Mary Kaye Willian, RN, Executive Director, National Board of Pediatric Nurse Practitioners and Associates, 550 North Broadway, Suite 115A, Baltimore, M D 21205.
May/June 1979 JOCN Nursing
161
Although intensive care for the premature infant has become progressively more sophisticated over the past 25 years, it has been only in the last six years that increased emphasis has been placed on the welfare of the fetal-maternal unit. Thus, health care for improving the outcome of pregnancy is changing its focus from crisis intervention to prevention of neonatal mortality and morbidity. Perinatal regionalization is a relatively recent result of this change of focus. It may be defined as a coordinated, comprehensive program for perinatal health care within a specified geographic area, as determined by population needs. The level of health care delivery each facility in the region is capable of giving should be identified and utilized to the maximum for accomplishing the following objectives’ : I ) make available quality care to all pregnant women and newborns, 2) promote maximum utilization of highly trained perinatal personnel and intensive care facilities, and 3) assure reasonable costeffectiveness.
158
To accomplish these objectives, the Illinois Committee for Perinatal Health developed a statewide perinatal health care plan which began implementation in January of 1975. It provides for five perinatal regions with 14 perinatal intensive care centers. Washington University Medical Center (Barnes Hospital, St. Louis Children’s Hospital, and Washington University) was identified as an intensive care center for the Southern Illinois Perinatal Region. The Southern Region involves 30 counties, from the Mississippi River to the Indiana border, with a population of one million (1970 U.S. Census). Half of this population is centered around the St. Louis Metropolitan East area; the other half is in rural farming and mining communities. Approximately 16,000 live births occur here annually.’
Philosophy and Development In assessing the responsibilites of a regional center, it was recognized that administering high-quality perinatal care involves more than providMay/June 1979 JOCN Nursing 0090-0311/79/0514-0000$0100
ing in-center services. The additional responsibility to provide professional continuing education was identified, and it was felt that through the carefully phased development of an outreach education program, quality perinatal care on all levels could be realized. Initially, outreach education at our center was “backed into.” Educational conferences were primarily presented by a physician team, occasionally including a nurse, with focus on normal and crisis-oriented newborn care. Conferences were offered to physicians and nurses; however, attendance was 95-98% nurses. After the initial attempts, the following observations guided the development of the present outreach program : 1. Nurses “listen” differently (more effectively) to another nurse, as opposed to a physician. 2. Nurses have educational needs that are different from those of other professionals. 3. Nurses do not participate actively in discussions to seek clarification when physicians participate in the same conferences. 4. Nurses far outnumber physicians in their participation in this continuing education effort. These observations resulted in the following conclusions: 1. Continuing nursing education is most appropriately implemented by nurses, based on the following principles of learning: a) Learning is motivated when it is planned to meet the needs of the learner. b ) Learning is a process whereby complex concepts are appreciated after fundamental principles are learned. c) Learning is facilitated by reinforcement of knowledge in both the didactic and clinical settings. d ) The learning process is enhanced by a climate which is comfortable for the learner. 2. An educational climate should be introduced through nursing before physician and multidisciplinary team consultation and/or seminars by physician invitation are implemen t ed . Planning and implementing perinatal outreach education requires cooperation, participation, and support May/June 1979 JOCN Nursing
Table 1. Sample of Conference Curriculum 14 minutes 45 minutes 1 hour 1 hour 45 minutes 30 minutes 1 hour 45 minutes
Overview of the Illinois Perinatal Program Identification of the high-risk mother and neonate Nursing care of the toxemic mother prenatally and in labor and delivery Nursing care of the diabetic mother Thermoregulation of the newborn Transport of the mother prior to delivery Stabilization and transport of the high-risk infant Facilitating parent-infant attachment in the highrisk situation
on many levels. The situation at Washington University Medical Center is unique in that the obstetrical and neonatal services, though proximally located, are administrated by two distinctly different institutions. In addition, physician coverage is through association with Washington University School of Medicine as a third administration. Therefore, coordination and communication in planning implementation among the three institutions, includirrg administration, nursing, medicine, and accounting, has been crucial to the success of the outreach education program. The initial program planning originated from the neonatal setting. The impetus was given by an administrative consultant for professional education, consultation, and training, whose position is funded by a National Foundation-March of Dimes grant. The services of this consultant have been invaluable, particularly because they were both objective and directive. Through a series of meetings with the consultant, the general structure of the program took form. A multidisciplinary, multi-institutional Outreach Education Committee facilitated planning of the program and currently assists in administration, financial planning, and coordination of activities. Although implementation began with a focus on crisis-oriented neonatal care, it was soon realized how necessary obstetrical nursing involvement in education is for the success of a true perinatal outreach education program. Our program was deficient because of lack of emphasis on the preventive aspects of perinatal care. Therefore, obstetrical
care is now integrated throughout the entire education program. The Outreach Education Plan evolved into Phase I and Phase II. Phase I was developed as four steps that progressively set the climate for learning. Phase I Step One is designed to introduce the Illinois Perinatal Program to the hospitals in the Southern Illinois Region. This is accomplished via telephone, letter, and personal contact with directors of nursing, inservice directors, or obstetrical nursing supervisors. A follow-up visit is planned to further introduce the perinatal program; to assess facilities, staffing, and physician coverage; and to plan a one-day conference to meet individual hospital needs. The assistance of the Regional Trauma System chief nurse had been very helpful in facilitating initial contacts with the community hospitals in Southern Illinois. Step Two is the actual implementation of continuing education for perinatal and community health nurses. One-day workshops or conferences are held, hosted by one hospital, for four to six hospitals and agencies near to each other. During the educational offerings encouragement is given to participating nurses to share their new knowledge about the Perinatal Program with other nurses, physicians, and consumers. (See Table 1 for a sample curriculum.) The nurses attending t h e workshop/conferences are asked to fill out participation cards for compiling a mailing list. The participants are requested to indicate their additional perinatal education needs and inter-
159
est in visiting the Perinatal Center (see below) in addition to their name, address, hospital, hospital phone, position, and date and location of the conference attended. Staff nurses working in the obstetrical and nursery areas of the Perinatal Center who are able to research, formulate, and deliver lecture material for participation in outreach activities are identified. In addition to increasing job satisfaction through increased responsibility and recognition, participation in outreach education increases the theoretical and clinical expertise of t h e staff nurse. As a reinforcement of learning and to acquaint community nurses with the facilities and services of the Regional Center, a two-day visiting program is also offered, as mentioned above. O n e day of labor and delivery and one day of nursery experience is scheduled, as the majority of nurses care for both mothers and infants in t h e community setting. Key administrative resource persons in the respective institutions encouraged the development of this visiting program, a n d the positive reactions and suggestions of head nurses of LaborDelivery, the Nurseries, and the Obstetric Complications Clinic were vital. Perinatologists, neonatologists, and an anesthesiologist were also informed of the plan, and their responses were equally affirmative and enthusiastic. When nurses indicate their desire to be involved in o n e of these twoday visits, their hospitals or agencies are contacted for possible participation. When a visit has been arranged, participants are asked to indicate their special interest (labor and delivery, nursery, etc.) and their individual learning needs. Following the two-day experience, the nurse who meets t h e objectives can be expected to 1 ) have a greater appreciation for comprehensive obstetric and neonatal care, and 2) share this experience and learning with other nurses in the community to improve the quality of perinatal care. During t h e visit, the participants are assisted and/or guided by either the authors, t h e Perinatal Outreach Education coordinator, or staff nurses so that their experiences will generally include the following: 160
1. Observation of a high-risk mother and fetus during labor, delivery, and recovery. 2 . Exposure to the labor-delivery suite; fetal and maternal monitoring; special diagnostic procedures such as ultrasound, amniocentesis, oxytocin challenge test, L/S ratio, and shake test; and types of anesthesia available. 3. A tour of the maternity inpatient facility and perinatal unit. 4. Attendance at t h e Obstetrical Complications Clinic Conference. 5 . Viewing of care in the observation and premature nurseries, instruction on gestational age assessment, physical examination of the newborn, Dextrostik screening, thermoregulation, and Doppler blood pressure monitoring. 6. A tour of the normal newborn nursery. 7. A tour of the high-risk intensive care nursery, with individualized experience in assessing breath and heart sounds and in suctioning, a n d a demonstration of and instructions in gavage feeding. 8. A review of newborn infant resuscitation with the obstetrical anesthesiologist. Over I00 nurses from Illinois have visited t h e Perinatal Center. Their evaluations have shown enthusiasm a n d a desire to share experience in the home hospitals, which in turn may promote improved supportive measures for families in the home hospital setting. When appropriate, nurses from the Perinatal Center will visit downstate hospitals for exchange of information on an informal basis. Initially, these visits have been in conjunction with Step One. The purpose is to get acquainted with personnel at the community hospitals. These visits have been a time of friendly and productive sharing. It is expected that in time staff nurses from the center will visit the community hospitals to work side by side with the obstetrical nurses for a few days. The eventual goal, therefore, is not only to bring nurses to the Perinatal Center but to bring the center to the community for education. Step Three involves the planning of a two-day Perinatal Nursing Symposium for reinforcement and expansion of previous learning. This edu-
cational offering may include both physician and nurse faculty. Step Four provides nursing and consumer education concerning perinatal regionalization through the March of Dimes field representatives, media coverage, and commu-. nity health nurses. Phase II Following the nursing contact, and subsequent workshop/conferences and exchange visits, Phase 11 of the education outreach program can be implemented. It involves continuing education for the nurse-physician team. Step Urie consists of a n invitation from physicians in southern Illinois to the Medical Staff of the Washington University Perinatal Center for consultation and/or an educational seminar for physicians a n d nurses. Step Two consists of acceptance of the invitation and determination of the nature of the visit and/or content of the seminar. Step Three involves a multidisciplinary team visit to the inviting hospital by Washington University Medical Center physicians a n d nurses for consultation and/or seminar. Step Four is a follow-up visit by the team of physicians and nurses to communicate the evaluation of obstetric and nursery services a n d recommendations for change. Conclusion The experience a t this center has shown that one individual should be identified as responsible for the coordination of planning a n d implementation of perinatal outreach education. This person should have a clinical background in perinatal nursing with a firm theoretical foundation. In addition, experience in education and/or administration is necessary for planning and implementing the outreach activities. Since these qualities are not likely to be found in a single individual, resource persons need to be available with whom the coordinator may collaborate. Before it is realistic to expect to increase awareness of quality perinatal care in the region, it is necessary for the center first to upgrade its May/June 1979 JOGN Nursing
internal educational programs. The respective institutions of the Perinatal Center are in the process of increasing both the quality and quantity of in-service and continuing education for the obstetrical and neonatal nurses. Evaluation of the effectiveness of the Perinatal Outreach Education Program is essential. The overall expectation is an improvement in the quality of the outcome of pregnancy. This improvement is facilitated by positive changes in facilities, procedures, and staffing through the educational process. These changes will be the basis for the evaluation. Acknowledgment The authors acknowledge the assistance, financial and otherwise, of the National Foundation-March of Dimes field representatives from the inception of the program. References 1. Toward Improving the Outcome of Pregnancy: Recommendations for the Regional Development of Maternal and Perinatal Health Services. Com-
A m y Hemme Kennedy is a Clinical S p e cialist at S t . Louis Children's Hospital. She a t tended St. Luke's Hospital Address reprint requests to Diane M. ElSchool of Nurslenberger, RN, 3929 Utah Street, St. ing in St. Louis, Louis, MO 63116. the University of Missouri ( B S N ) , and Saint Louis University (MSN). She is a member of NAACOC, A N A , and the Association for the Care of Children in HosDiane Ellenpitals. berger is a Clinical Specialist and Coordinator of Colette Chase Perinatal Outis a Nurse Spereach Education at Cardinal cialist in ObGlennon M e stetrics at Barnes Hospimorial Hospital tal in St. Louis, for Children, where she was St. Louis, Missouri, and was formerly formerly Nurst'erinatal Outreach Coordinator at St. ing Care A d Louis Children's Hospital. She attended visor in ObBarnes Hospital School of Nursing in St. stetrics. She atLouis, Saint Louis University (BSN),and the University of Colorado (MSN). She is tended the University of Iowa ( B S N ) and is a member of NAACOG. a member of NAACOG and ANA.
mittee on Perinatal Health, The National Foundation-March of Dimes, 1976, p 2 2. A Plan for Perinatal Health in Illinois. Illinois Department of Public Health and the Illinois Committee for Perinatal Health, 1974, p 24
PEDIATRIC NURSES Registration for the October 12, 1979, National Qualifying Examination for Pediatric Nurse Practitioners and Associates will begin June 1 and end August 3. Developed by the National Board of Pediatric Nurse Practitioners and Associates, this certification examlnation evaluates entry-level competency in the pediatric nurse practitioner/associate role. Registration fee: $50; examination fee: $150. For further information contact Mary Kaye Willian, RN, Executive Director, National Board of Pediatric Nurse Practitioners and Associates, 550 North Broadway, Suite 115A, Baltimore, M D 21205.
May/June 1979 JOCN Nursing
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