December Pulse: Call for board nominees & HOD resolutions

Clinical Pearls: Tips to Manage the Stress of the Holidays

The holidays are a stressful time for everyone, but for the healthcare professional, there is no rest for the weary. There are the usual stresses, such as finding time for family and friends, managing finances, holiday decorating, and having to listen to Christmas music before Thanksgiving. As providers, we also have to deal with increased traffic from seasonal illnesses and working the holidays while most are home with their families. Then there are those end of year obligations like managing our CME requirements, licensures, and re-certifications. Feeling stressed yet? You’re not alone!

Here are a few stress busting tips to lower your stress level over the holidays that will positively impact you and your patients.

Be healthy! Stay active. Modify your workout routine if time is an issue.Walking for 20 minutes is better than nothing at all, then get back to your regular schedule after the holidays.Go walk those clinic or hospital hallways during your lunch hour.
Get enough sleep.A lack of sleep can hurt your performance at work especially during long shifts and make you irritable.Replenish your body and mind with a good night sleep.
Eat right.Holiday cookies and cakes are everywhere so be sure to have healthy snacks available and pack a good meal from home for your shift.
Be realistic. It’s okay to say NO. With long shifts and work hours, you feel pulled when asked to make those cookies for school or help with the holiday show. Be honest about what you can do versus what you don’t have time for. Ask for help when you need it.
Make a list and check it twice! The best way to reduce stress is to make a list in advance and plan ahead for decorating your home or office, shopping for gifts, or cooking holiday meals.Hopefully, you will have more time to relax and enjoy the holiday.
Stick to your budget. Finances can be a huge source of stress over the holiday.Make a realistic budget and stick to it.You won’t regret it come January.
Be thankful! Gratitude is strongly associated with greater happiness. Make a list of things you have instead of things you want. Write a thank you note to a coworker or colleague. Give a compliment. Show appreciation. These little acts will lift your holiday spirit and theirs.

Happy Holidays!

CARES Act Updates & How You Can Help Pass This Historic Bill

WAPA continues to work closely with bipartisan sponsors in the Senate and Assembly to advance the Collaboration and Rural Expansion of Services (CARES) Act (SB 515 and AB 575) for consideration by the 2019-2020 Wisconsin Legislature.

Committee hearings and votes are continuing in the Legislature, though at a slower pace as the holidays approach. After November floor sessions earlier this month, indications are each house will only meet three to four times before adjourning in March (if not earlier). Reps. VanderMeer (R-Tomah), Edming (R-Glen Flora) & Considine (D-Baraboo) and Sens. Bernier (R-Chippewa Falls), Sen. Kooyenga (R-Brookfield) & Hansen (D-Green Bay) have authored our CARES bill. The Senate bill has been introduced as Senate Bill 515 and referred to the Senate Committee on Elections, Ethics & Rural Issues. The Assembly bill has been introduced as Assembly Bill 575 and referred to the Assembly Committee on Regulatory Licensing Reform.

We are working with our authors to get committee hearings on our bill scheduled.

We have also continued our outreach to other organizations, soliciting their support.

Here is our current list of supporters (and we continue to actively seek the support of other organizations):

Aurora Health Care
Concordia University
Marshfield Clinic
Quad/Graphics
Rural Wisconsin Health Cooperative
Wisconsin Academy of Physician Assistants
Wisconsin Hospital Association
Wisconsin Primary Health Care Association
WPS Health Insurance

Our opponents remain the Wisconsin Medical Society and the Wisconsin Academy of Family Physicians.

You can help. Please visit WisCARES.org to send a message to your representatives and encourage everyone you know to do so as well.

Here are more tools you may find helpful as you advocate for us:

CARES Act information page
CARES Act toolkit: presentations, handouts, letters
CARES Act action center, WisCARES.org

All eyes are on Wisconsin and we need every PA to join the movement. Please visit WisCARES.org and petition your representative to support us TODAY.

Wisconsin Legislative Updates

PAs in the Armed Services: Senate Hearing Held
Sen. Kooyenga, Rep. Ken Skowronski (R-Franklin), and Rep. Rob Hutton (R-Brookfield) have introduced legislation that would allow physician assistants performing official duties for the armed services to practice without obtaining a physician assistance license from the Medical Examining Board. According to the cosponsorship memo, "[t]his legislation will help streamline the process of bringing additional military nurses and PA’s into Wisconsin to train, and will advance the trauma surgery and resuscitation skills of these licensed providers within the US Army."

WAPA and the Medical College of Wisconsin are registered in support of this legislation.

AB 583 has been introduced and referred to the Assembly Committee on Health.

SB 514 has been introduced and referred to the Senate Committee on Health & Human Services. The Senate committee held a public hearing on the bill on Nov. 20. Eric Elliot, PA-C, DMSc, Chair of the WAPA Legislative & Governmental Affairs Committee, submitted testimony in support of the bill.

PA Power of Attorney & Living Will Determinations: Passed Assembly, Senate Hearing Held
The Assembly passed the bill, with the amendment described, below on Nov. 12. The Senate Committee on Health & Human Services held a public hearing on the bill on Nov. 20. Paula Cynkar testified in support of the bill on behalf of WAPA, along with the Wisconsin Hospital Association. The Wisconsin Medical Society testified in opposition to the bill, though several individuals physicians who testified separately from WMS supported the legislation.

SB 254/AB 287 would make various changes to PAs’ abilities to activate living wills and health care powers of attorney. The bill would:

Allow a physician and a PA or NP to make a finding of incapacity in a patient and activate health care power of attorney. PAs making findings of incapacity may only do so if the overseeing physician affirms the PA is competent to evaluate patients’ capacity to make health care decisions. Under current law, only two physicians findings of incapacity to activate health care power of attorney.
Allow a PA or APRN to issue do-not-resuscitate orders. Under current law, only physicians can issue do-not-resuscitate orders.
Allow PAs or APRNs to certify that a patient has a terminal condition or is in a persistent vegetative state, allowing them to activate a patient’s a living will.

The Assembly Committee adopted an amendment to the bill that would also allow PAs to make determinations that a person is incapacitated for admission to a hospice. WAPA and the Wisconsin Hospital Association are supporting the bill. The Wisconsin Medical Society and the State Bar of Wisconsin are opposed. The bill has bipartisan authors: Rep. Patrick Snyder (R-Schofield), Rep. Steve Doyle (D-Onalaska), Sen. Howard Marklein (R-Spring Green), and Sen. Janis Ringhand (D-Evansville).

Occupational Licensing Reports: Senate Hearing Held
Sen. Chris Kapenga (R-Delafield) is circulating legislation (SB 541/AB 605) that would require the Department of Safety & Professional Services (DSPS) to prepare a report on any bill introduced in the legislature that requires licensing for a particular profession or business. The DSPS report must include:

Potential public harm from unregulated practice
Public benefit from licensing
Evaluation of the least restrictive regulation to effectively protect the public
Analysis of licensure requirements in other states
Estimate of financial burden on licensees

The Senate Committee on Public Benefits, Licensing & State-Federal Relations held a public hearing on the bill on Nov. 20. The Assembly companion has been referred to the Committee on Regulatory Licensing Reform

Vaccine Administration: Signed into Law
Recall, Sens. Patrick Testin (R-Stevens Point) and Janet Bewley (D-Mason) and Reps. Tony Kurtz (R-Wonewoc) and Jimmy Anderson (D-Fitchburg) introduced legislation (SB 110/AB 137) that would expand pharmacists’ ability to administer vaccines.

Gov. Tony Evers signed the bill into law on Nov. 19 as 2019 Act 24.

Under pre-Act 24 law, a pharmacist could not administer a vaccine to a person under the age of 6. Under Act 24, a pharmacist may administer a vaccine to a person under the age of 6 if all of the following apply:

The vaccine is administered pursuant to a prescription order issued within the 29 days immediately preceding the day on which the vaccine is administered.
The pharmacist has successfully completed a course of instruction approved by the Accreditation Council for Pharmacy Education or the board that includes the administration of vaccines to children under the age of 6.

In addition, for a person not under the age of 6, a pharmacist would be allowed to administer without a prescription order any vaccine listed in the current immunization schedules recommended by the federal advisory committee on immunization practices and published by the federal Centers for Disease Control and Prevention.

A pharmacist who administers a vaccine to a person would be required to update, or cause a pharmacy to update, the Wisconsin Immunization Registry within 7 days of administering the vaccine.

In the 2017-18 session, a similar bill failed to pass due to opposition from health care providers, including WAPA, to a provision that allowed patients to opt out of reporting to the Wisconsin Immunization Registry.

The Immunization Registry opt-out provision is not included in the 2019 bill.

WAPA is registered in support of this legislation.

Message from the President

‘Tis the Season!

The holiday time is here and WAPA wants to wish the happiest of holidays to you and your family!

The holidays are one of the busiest times of year and there are many demands on us, both personally and professionally. As providers, we are used to rising to the challenge and giving 100%+. We struggle to say no to family, friends and employers. Add to that the stress of working through the holidays, which not only overlap with the cold and flu season, but also the "I’ve met my deductible so I want to get this done by the end of the year" season.

Let’s all try to take a step back during this time and pay attention to what matters most: our family, our health, our sense of well-being. Clearly our jobs must be a priority because that’s what pays the bills. But the reality is, our jobs are replaceable and we are replaceable to our jobs. We are not replaceable to our family and friends. So, during this time, I urge you to take time for yourself and to spend time with the people you love (or at least like). It’s okay to say no to picking up an extra shift. It’s okay to say no to the party you don’t want to go to. And it’s really okay to say no to hosting the party you don’t want to have.

Instead, take the time to watch a movie with your family, take your kids on a fun outing, go for a run, take a bubble bath, or sit and read a book. Talk to people that you want to talk to. And really listen. It’s those connections that mean the most. It’s those memories that you make with your kids that matter. I like to remember to emphasize presence over presents during the holidays. And that mindfulness matters. When we are fully present in the moment, it’s harder to worry about the future or to regret the past. Enjoy the here and now with those who you care about and who care about you!

Yet despite our best efforts, we will likely experience moments of stress during this holiday season. An easy technique to reduce stress in the moment is the 4-7-8 breath. It’s extremely easy to do. Put the tip of your tongue on the roof of your mouth right behind your teeth. Breath in through your nose to the count of 4, hold your breath to the count of 7, and exhale through your mouth to the count of 8. Do this 4 times in a row. This technique is based on yoga and the purpose is to diminish the fight or flight response of the sympathetic nervous system and let your parasympathetic nervous system get back into control. It easy, free, and actually works.

I wish all of you the best over the next month and beyond! Please read the important updates about the CARES legislation and reach out if you have questions or want to help. Also note that the WAPA elections are coming up next month. Some people are energized by becoming involved and giving back to their profession. If that’s you, we would love to have you join the WAPA leadership or a committee. Talk to you in 2020!

Respectfully submitted,

Julie Doyle, PA-C
WAPA President

Submit your ideas for 2020 HOD resolutions!
The AAPA HOD is the body that decides the national direction of OUR profession. Together, we can usher in a new era of WAPA representation by focusing on educating our members about the issues the HOD will consider and soliciting YOUR input prior to voting. Representation at the HOD is the most impactful way that the average PA can influence changes at the national level. Help represent Wisconsin in this national forum. Contact Tara Streit Chief Delegate, with your suggestions. The 2020 HOD meeting is May 15-17 in Nashville.