Organization Newsletter

Jan 2019

In this issue...

  1. Call to Get Involved!
  2. Getting to Know Your Board Member - Bethany Osgood
  3. WRITE Excellence Award Winners
  4. Specialized Care for Traumatic Brain Injury
  5. Welcome New & Returning Sponsor and Organizations!
  6. 2019 Northwest Rural Health Conference
  7. CME Opportunity: Cultural Humility with LGBTQ+ Patients
  8. Difference in RN Pay and Outlook for Canadian RNs
  9. Concluding... HIPAA Security Risk Analysis


Welcome to the
January 2019 issue of the Washington Rural Health Association e-Newsletter.
Inside this issue you will find news and information from the Executive Director and board of directors, members, and community partners from across the state of Washington. 

If you would like to submit your own story, please click here.

The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.

WRHA Members

WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.


Call to Get Involved!

We’re Seeking Board Members!

On another topic, the Board of Directors currently has three unfilled positions and expects to have one more before our annual meeting in March.  This leaves four opportunities for members to serve as Directors.  A full complement of board members would give the Board more power and flexibility to get the job done.  I invite any member who thinks they might have an interest in serving on the Board to view the structure and duties of Board members by looking at the eligibility requirements on the WRHA website at  Scroll down to Article III. 
Submit a resume through this email address to [email protected] or mail it to Washington Rural Health Association, PO Box 882, Spokane, WA, 99210. 
Please include a statement about why you want to serve and what you could add to the group.  We'd love your help!

Looking for Committee Members

Would you like to have a greater impact on the future of rural health and the direction of the WRHA? If so, consider joining one of WRHA’s committees.  The WRHA is seeking volunteers to join the following committees:

  • Awards Committee – selects WRHA award winners and presents awards at the 2019 NW Rural Health Conference in March
  • Membership Development and Communications Committee – promotes the association to prospective members, increases awareness of WRHA, and develops member benefits. Coordinates WRHA publications including the e-newsletter, In Case You Missed It Updates and funding Opportunities 
  • Legislative Committee – mainly active during the legislative session, this committee reviews the Bill Tracking Report, compiles a list of bills to be tracked, and works for legislative event planning
  • Bylaws Committee – headed by the WRHA president, this committee meets every two years to review Association bylaws
  • Finance Committee – assists executive director and the treasurer in developing an annual budget, review disbursements, makes recommendations to the Board, and manages additional revenue

To request to join any of the committees above, please click here!

For more information about WRHA Committees:

Become an Organizational Sponsor

It has been an especially important year, as we face the daunting challenges of this economic crisis. Your support and financial contribution are a great vote of confidence in our mission.  As a sponsor at the PLATINUM LEVEL, you will receive thanks and recognition on WRHA website, social media outlets and at the Northwest Rural Health Conference program as well as a complimentary exhibit booth and 2 conference registrations.  We look forward to seeing you there.  Thanks for your consideration. 

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Getting to Know your Board Member!

With each publication, we would like to introduce a member of the WRHA Board of Directors.
This publication we would like to introduce a valuable member of the board,
Bethany Osgood, Psychiatric Solutions:


1)   Please tell me your name, where you work, title, your role with WRHA and how long you have been a board member:    
      Bethany Phenix-Osgood, I work at Psychiatric Solutions as the Director of Operations and Business Development. I have been a board member for 1 month.

2)   How did you first become involved with the Washington Rural Health Association?    
      I have attended the yearly conference for several years and have been a plenary speaker. I have worked with members of the board in a professional capacity of advancing rural health initiatives; as well as was  nominated to join the board this past November.

3)   There are several rural health organizations in Washington State. Why did you choose to work with WRHA?    
     I believe in the Mission of the organization and the value of uniting agencies and communities in support of rural health care access throughout the state. By collaboration and interagency strategic alignment, we can together increase the health and wellness of our rural communities.

4)   Why is Rural Health important to you?
      I grew up in a small rural town in SE Washington, and know the value of having access to whole person health care. Often times the rural communities are underserved and can have lack of resources and funding for whole person health care. I am committed to the advancement of patient centered care and increase access for medical, dental, mental health and other health care services for all rural communities in WA State.   

5)   What has surprised you most about working with Washington Rural Health Association?
       Its commitment to collaborating with agencies across the state to discuss, strategize, and collaborate on committing to solving rural health care issues. We are providing a voice and a venue to tackle the tough issues of providing high quality care to the rural communities. 

6)   What is the best part of working with WRHA?
      The commitment of the board, the people and the agencies that support the work we do.

7)   What do you see as some of the most challenging issues facing WRHA and Rural Health in our state?
Funding can be a huge pain point and issue when providing patient centered care in rural communities because of the lack of resources, staffing, equipment and geographical hurdles. With the state moving toward integration of health care services, the challenges will be providing all of the services needed in the smaller communities as well as recruiting talent to fill the need.

8)   What do you wish other people knew about Washington Rural Health Association?
     That we are growing and recruiting new members.

9)   If you could change one thing about Washington Rural Health Association what would it be?
Better infrastructure, we are in a reboot phase and will need to work on building up our board and memberships to continue to work on our mission and goals for 2019-2020.

10) Do you volunteer for any other organizations? Why do you feel it is important to volunteer?    
     Over my career I have volunteered for many organizations. SNAP, Catholic Charities, The Salvation Army, Volunteer Fire and EMS, Calvary Kids Camp. Volunteering is at the center of who I am, and drives me every day to ask my self- whom did I help today? In serving I find the greatest joy.

11) How do you like to spend your time outside of work and volunteering?
     My family and my friends are amazing. I am constantly amazed at the wonderful people in my life who give me a lot of joy. We are avid hockey and college football fans and I take in as many games as possible. Our family loves to travel, hike and 4-wheel.

12) What might (someone) be surprised to know about you?
      I was a paid and volunteer fire fighter for both wild land and structural, and I am the 4th generation to be a fire fighter in my family.

13) What do you think will change about Washington Rural Health Association over the next five years?
I hope to inspire, I plan to collaborate, and I will work tirelessly to advance health care access with a focus of patient centered care for the rural communities of WA State.

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2018 WRITE Excellence in Teaching Award Winners

Submitted by: Danielle Bienz, M.Ed.
[email protected]

On September 14, 2018, the WWAMI Rural Integrated Training Experience (WRITE) program held the first annual WRITE Faculty Development Conference in Seattle, Washington. This conference, in collaboration with the Department of Family Medicine’s Advances in Family Medicine & Primary Care Continuing Medical Education (CME) course, provided a full day of interactive sessions focused on curricular advancement, feedback and evaluation, and improved teaching skills lead by teams of UW faculty and current WRITE preceptors. As a part of this event, two WRITE preceptors from Washington state were recognized and presented with the first-ever WRITE Excellence in Teaching Award.  Nominations were collected from current and former WRITE students totaling more than 20 submissions.

The WRITE Excellence in Teaching Award aims to honor preceptors with a track record of excellence in teaching medical students, across any specialty, as well as those that serve as leaders in their rural communities. Award recipients also each demonstrate a commitment to student success and continuous improvement as teachers.

Congratulations to our 2018 Washington WRITE Excellence in Teaching Award Winners!



Specialized Care for Traumatic Brain Injury


Submitted by: Sandra Anderton
Inland Northwest Health Services
[email protected]

About 30 miles outside of Missoula, Montana, Shaela Mamuzich, 17 years old, was driving with her brother, Dakota, when the worst happened.  They were in a car accident with an ambulance.  Dakota, a paramedic with a local volunteer fire department, was able to keep Shaela's airway open despite his own fractured skull and other injuries.  "The responders on the ambulance didn't realize he was also in the wreck until they saw blood running down his face," says Julie, mother of Shaela and Dakota.  "He kept her alive."

Shaela's injuries were extensive, Julie says, and largely affecting her brain.  She was taken to nearby Providence St. Patrick Hospital where her outlook was grim.  "They said she could die," Julie says.  "Each day we just waited and watched how she responded. They kept saying she had positive movements."  "St. Pat's is just awesome," Julie says.  "I've expressed to them how great they were with Shaela and how fabulous they were--everything they did to keep her alive.  They explained everything to us so we felt comfortable."

After two weeks in St. Patrick's intensive care and brain injury unit, Shaela was transferred to St. Luke's Rehabilitation Institute for specialized pediatric care for Shaela's traumatic brain injury (TBI).  "When she was moved to St. Luke's, she wasn't walking, talking or doing much of anything at all," Julie says.  That soon changed as Shaela began therapy sessions spanning the care continuum: physical, occupational, recreational and speech-language therapies.  "Walking was really quick for Shaela," Julie says of how Shaela's outlook changed once in therapy.  "Therapists had her take her own shower right away.  The next day, she started walking.  From thereon, she started walking but wasn't talking.  It took her a while to talk."  Julie was able to room-in with Shaela during her month-long inpatient stay at St. Luke's. 

As Shaela continued to make progress with her TBI, shared celebrations happened between the family and staff.  "Shaela said her first word while I was combing her hair," Julie says of the word she can barely repeat.  "I remember running down the hallway--her nurse asked 'what was it?'  I said it was the f word!"  During Shaela's rehabilitation at St. Luke's, the recreational therapy team learned of her passion for horses.  "She barrel raced before this happened," Julie says.  "Her therapists arranged for her to visit with Free Rein Therapeutic Riding.  She was so excited to be around the horses!"  "I can't even express my feeling about just how wonderful St. Luke's staff is," Julie says.  "I tell anyone who has a teenager or child, St. Luke's is where to take them."

Shaela's mom says she's improving every day, working part-time at her outpatient physical therapy office, playing basketball and enjoying her senior year of high school.  "Before the accident she was a bit more shy and quiet, Julie says.  "Shaela's happy and now talks all the time.  We're determined to help her do all she wants to do from here."

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Welcome and Thank you to New & Returning Members!

Submitted by: WRHA
[email protected]


Washington Rural Health Association would not be able to carry out its advocacy activities and would not be a success without the generous support you have provided us throughout. We deeply appreciate the willingness with which you have and continue to sponsor the efforts that enable us to continue our mission to help improve health for the people living in rural communities. Which will ultimately make our communities a healthier, happier place to live in. We sincerely hope that this association will be maintained and that you will continue to support us in our future endeavors.
Thank you!

Dynamic Collectors, Inc.

Pacific Northwest University of Health Sciences



Jill Thompson - Waterville    


Health Facilities Planning & Development - Seattle
Jefferson Healthcare - Port Townsend
Cascade Medical - Leavenworth



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2019 WRHA Awards



Each year the Washington Rural Health Association honors outstanding individuals and organizations in the field of rural health who have dedicated their time and talents to improving the health and well-being of others.  Previous recipients have stretched the boundaries of possibility by forging innovative programs and services, thereby making rural life healthier and more compassionate.

Consider nominating your favorite rural health individual, program, or organization to regionally honor them for contributions to rural health.  Selections will be made on the basis of a 300-500-word narrative which is part of the nomination form.

The nominator of the chosen winner in each category will be notified prior to the luncheon; so that significant individuals (family members/colleagues) can be invited to the awards ceremony.  The award's recipient in each category can have up to four guests free of charge.  The luncheon tickets are $45 per person after the fourth guest.

The awards ceremony will take place on Tuesday, March 26th, from Noon to 1:00 PM. WRHA will accept online submissions only.  Click nominate and upload supporting materials: NOMINATIONS

Nomination Deadline: February 1, 2019

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 CME Opportunity: Cultural Humility with LGBTQ+ Patients


Submitted by:  Krista Loney
[email protected]

The Eastern Washington Area Health Education Center is hosting a continuing medical education opportunity titled "Cultural Humility with LGBTQ+ Patients".  This CME is approved for AAFP Prescribed credits.  This course will teach learners to define common terms and concepts related to serving LGBTQ+ populations, applying basic counseling techniques, and identifying opportunities for continued learning and growth related to gender identity and sexual orientation. The course is offered online or in-person on Friday, January 25 at 12 p.m.
Register at

See FLYER here.

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 Difference in Pay and Outlook for Canadian RNs in America


Submitted by: Phil Slaton
[email protected]

The U.S. Bureau of Labor Statistics reports a total of over 2.7 million registered nurses, making them the largest health care profession in the country.  The Canadian government reports 273,051 Registered Nurses serving that country's much smaller population.  In both countries, registered nurses are well-paid and highly respected professionals.  

U.S. hospitals are experiencing a high demand for skilled registered nurses and Icon is poised to offer Canadian RNs to U.S. hospitals.  As our U.S. hospital client, you become part of our foreign RN placement program that has placed over 1,500 foreign citizen nurses since 2002.  We exclusively place priority on the EB-3 immigration or TN visa programs.  Icon's foreign RN placement program includes by way of reciprocity or new licensure, that all nurses delivered achieve U.S. RN licensure.  Typically, our U.S. hospitals provide top wages, generous benefits and incentive programs to the nurses.  The Icon Group provides consistent support from start to finish of placement, and we’re with you every step of the way.
Canadian RN Salary:
Canada's health-care system operates on a single-payer model.  Each province runs its own system. Nursing unions negotiate contracts directly with the province, laying out standardized pay grades at varying degrees of training and experience.  A 2011 summary chart compiled by the Canadian Federation of Nurses' Unions showed registered nurse wages averaging $30.30 per hour at minimum, and $38.73 per hour at the maximum rate.

United States RN Salary:
The situation for registered nurses in the U.S. is considerably more fluid, with a wide variance in wages between employers and workplaces.  The U.S. Bureau of Labor Statistics offers comprehensive national figures reporting a national average of $35.89 per hour.  The lowest-paid 10 percent of RNs reported wages of up to $24.62 per hour, with the top 10 percent earning $48.96 per hour or more.  

Although the two countries differ in their health-care systems, both show significant regional variations in RN pay.  Several other factors can affect nurses' compensation on either side of the border.  For example, advanced nurse practitioners and clinical nurse specialists can expect to earn significantly higher incomes, often exceeding $120,000 per year.  In Canada, nurse contracts often include percentage or dollar-amount bonuses for seniority, usually beginning at the 10-year milestone.

Employment prospects for registered nurses are very strong in both countries.  In summary, Canadian RNs are not a cheap labor resource; but they can be an excellent available labor source.  U.S. hospitals must be willing to offer a welcoming, nurturing environment with top pay, excellent benefits and incentive programs to recruit and retain these excellent nurses.

Questions?  Please contact:
Phil Slaton, The Icon Group
[email protected] - [email protected]

"Diversity Builds Community"

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 Concluding HIPAA Security Risk Analysis Help

Submitted by: Alan Davis
Proteus Consulting
[email protected]

Let’s finish last newsletter’s article discussing the HIPAA Security Rule’s Risk Analysis citation.  We previously differentiated a risk analysis from a compliance assessment and explained risk analysis frequency strategies.  It is our observation that many small or rural healthcare organizations firmly believe that their HIPAA program flies under the Office of Civil Rights radar.  But the most recent corrective action plan recipient (as of this writing) is a Colorado critical access hospital, so it’s important to get a security risk analysis completed correctly regardless of size or location.

The HIPAA Security program requirement to “…conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability…” of ePHI can result in some head-scratching to provide a reasonable and appropriate risk analysis.  But a risk assessment doesn’t have to be intimidating or result in an unrealistic workload.

Start a risk assessment with the methodology recognized by the federal government using NIST Special Publication 800-30, Guide for Conducting Risk Assessments.  Plan a project that defines your process, risk model and risk measurement.  To summarize the NIST material, include:

  •   a scope that defines the people, places, systems and processes (e.g. policies & procedures)
  •   all ePHI repositories
  •   identifying all threats and vulnerabilities
  •   assessing current security controls
  •   determining the likelihood and the impact of a risk event happening, and
  •   using all of these parameters to calculate risk.

A risk may include theft, unauthorized disclosure, fraud, or a number of other events that threaten ePHI security.  Risk needs to be quantified (e.g. on a point system) or differentiated (e.g. high, medium, low).  The following examples may help improve security and validate a HIPAA Security program, but lack the measures to be considered a bona-fide risk analysis:

  •   a HIPAA Security Rule compliance evaluation using the 2016 OCR Audit Protocol
  •   an assessment of information services or technology security controls, even when mapped from a reputable security controls source (e.g. NIST, SANS, etc.) to the Security Rule.  This type for work does support the Security Rule’s “Evaluation” citation
  •   completing a checklist.  Risk is not “checked”.

The output of a risk analysis is a risk register.  Once risk is identified, the Security Rule requires that “…Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level…”.  In simpler terms, manage that risk!  Identify a person responsible and assign a date to complete the work required.  This person needs to determine whether the risk will be:

  •   avoided (e.g. decommission the risk source)
  •   transferred (e.g. to another company)
  •   mitigated (i.e. remedied), or
  •   accepted.

There are plenty of very thorough information security or auditor-based companies, but we recommend that a Covered Entity or Business Associate organization seek a HIPAA dedicated company to help learn the risk analysis process.

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Join the discussion, connect with us! Share your stories and ideas, get the latest news, and act to help preserve rural health care and access in Washington state!  Please head over to Facebook, Twitter or LinkedIn and look us up at WASHINGTONRURALHEALTH!  

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  Thank You to our Sponsors

Please consider sponsoring the Association today.  Click Here.