The North Dakota Nurse – May 2017


The North Dakota Nurse

North Dakota Nurses Association



Sent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter

does not mean that you are a member of NDNA. To join please go to and click on “Join.”

Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota

Vol. 86 • Number 2 May, June, July 2017

Legislative Session 2017

Page 3

2017 NDNA Day at the Legislature

Page 4

President’s Message

Develop Your Legacy

Tessa Johnson, MSN, BSN, RN

As nurses, professionals, and people in general

we are all hopeful we can be remembered. We want

to be remembered by our parents, our families,

our friends, and even people we have never even

met. I recently attended a conference session that

encouraged us to find our legacy. A legacy can be

simply defined by Merriam Webster dictionary as,

“something (as memories or knowledge) that comes

from the past or a person of the past.” If you think

about the definition, we have the potential to be

very powerful in the lives of our patients as nurses

if we chose to formulate our own legacy and live

by it every day. For example, think about Apple

products. They have made the business a success by

the words “Think Different.” All of their customers

know what they can expect from them and that

their products will always be the newest and

constantly changing. That is the legacy they leave

with the people they do business with.

As respected nurses we are all leaders by

default in the medical field. Leadership is all about

connection and each time we relate with patients

we leave a little of us behind. As a nurse, what our

patients remember about their encounter with us

becomes our legacy. Have you thought about the

story that you are leaving behind to your patient?

That is your legacy. In A Leader’s Legacy, the authors

remind us that “legacies are not the result of wishful

thinking. They are the results of determined doing.

The legacy you leave is the life you lead. We live our

lives daily. We leave our legacy daily. The people you

see, the decisions you make, and the actions you take

-- they are what tell your story.” One of the important

parts of defining your legacy is to make it short,

impactful and in 6 words or

less (Dawn Kaiser). Once you

have accomplished that, it

is important to share your

legacy with others. Once you

share it, others can help hold

you accountable to your legacy

and it will be successful for Tessa Johnson

you. I ask you, can you think

of nurses that you worked with or perhaps a nurse

mentor that left a legacy in your heart? I think most

of us know of somebody like that in our lives.

After attending the session I began to think about

my own legacy as a nurse, a mother, a wife and a

person in general. I can tell you that this is not an

easy task to complete. I think we can all come up

with words that we associate with but it’s hard to

bring it down to a succinct message we want people

to know. I am going to take the first step in sharing

mine and share it with all of the nurses in ND that

read the North Dakota Nurse. My legacy is “Believed

she could, so she did.” This is not a new phrase and

I’m sure many of you have heard it before. It directly

speaks to me in my nursing career and in my life

and I want to commit to living by these words.

Today I inspire you to spend some time purposefully

thinking about your 6 word nursing legacy. Once you

come up with it, write it down, share it and then live

it. I invite you all to share your legacy with me at Be well, we need all of you!


Kouzes, J. M., & Posner, B. Z. (2006). A leader’s legacy.

San Francisco: Jossey-Bass

End of Life Care

Page 8

Nurses Thank you for all you do

now is the time to take care of you too!

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


Like us on Facebook for upcoming information

on NDNA’s Healthy Nurse Conference

in Bismarck on October 6th!

“Happy Nurses Week!” from NDNA


Provided by: District 1, North Dakota Nurses Association

Page 2 The North Dakota Nurse May, June, July 2017

How to submit an article for

The North Dakota Nurse!

The North Dakota Nurses Association accepts articles on

topics related to nursing. We also accept student articles

& evidence based practice articles. All articles

are peer reviewed and edited by

NDNA volunteers.

Deadlines for submission for the rest of this year are 6/13/2017,

9/13/2017 & 12/13/2017. Send your submissions to

The North Dakota Nurse



current resident or

Page 13

Page 2

Page 11


Sen to a l North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsle ter

does not mean that you are a member of NDNA. To join please go to and click on “Join.”

Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota

Vol. 86 • Number 1 February, March, April 2017

NDNA Present at

ANA’s Leadership Summit

North Dakota’s 62,100 Family

Caregivers Need Our Support

Healthy Nurse Healthy Nation

Grand Challenge

Presort Standard

US Postage


Permit #14

Princeton, MN

President’s Message

Healthy Nurse, Healthy Nation

Tessa Johnson, MSN, BSN, RN, President NDNA

Greetings nurses of North Dakota; it is my

pleasure to welcome you all to the first 2017 edition

of the North Dakota Nurse. It has been an honor to

serve as the VP for membership services for NDNA

and I’m so excited to be your NDNA president

for the 2017-2018 term! I would like to personally

thank all nurses who attended our Culture of

Safety conference and annual meeting in October; it

was a huge success. With that in mind, stay tuned

for more upcoming conferences and events!

As we begin another new year many of us have

new goals, resolutions and plans for our personal

and professional lives. The question that I am

certain most professional nurses ask themselves is,

“How do I find the balance to keep myself healthy

in order to uphold my nursing code of ethics and

keep my patients and my nation healthy?” Being

a nurse is only one of our primary roles in life

and many of us are parents, friends, siblings and

leaders along with wearing many other hats.

According to Lachman, Swanson and Windland-

Brown (2015), “The nurse owes the same duties

to self as to others, including the responsibility

to promote health and safety, preserve wholeness

of character and integrity, maintain competence,

and continue personal and professional growth”

(p.364). With that being said it is important for us

as professional nurses to prioritize our needs and

have a healthy work-life balance.

Being a mother and a nurse leader, I also

over-commit myself and take on too much. We are

the type of people who have a hard time saying

no and we want to help as much as we can. I

challenge you to think about what it means for

you to be a healthy nurse. I challenge you to think


of ways you can ensure

your mind, body and spirit

remains healthy. This will

ensure that you can give

100% to your patients and

help create a healthy nation.

When I think about being

an all-encompassing healthy

nurse I think about many

things; minimizing burnout, exercise, healthy diets,

spiritual needs, and fostering personal relationships.

In the coming months we are lucky to have

this topic as a primary focus from ANA as well.

One thing I know for sure is that we are all in

this together. As nurses many of us face the

same challenges and care about the same issues.

We need to do our best to utilize each other,

maintain relationships, fight for being a healthy

nurse and a healthy nation. With many unknown

changes coming with our recent presidential

election, we know that our profession will face

more changes and additional work. My hope for

all the wonderful nurses in our state is to start

out this new year by prioritizing. We need to

prioritize our personal and professional lives and

make sure we know what is important. I ask you

to unite as a strong force and look out for each

other; get involved where you can and take care

of yourself always! North Dakota is lucky to have

great nurses who care about many issues and I

am excited to see what this year brings with new

changes, fresh leadership and a busy legislative

session! Be well, we need all of you!

Tessa Johnson

1. Lachman, V. D., Swanson, E., & Windland-Brown,

J. (2015, September/October). The New ‘Code of

Ethics for Nurses. MedSurg Nursing, 363-368.

15 th Annual Northwest Region North Dakota

Collaborative Educational Conference


April 7, 2017 | Grand Hotel, Minot, ND

The North Dakota Nurse

Official Publication of:

North Dakota Nurses Association

General Contact Information:

701-335-6376 (NDRN)

Carmen Bryhn, MSN, RN

Executive Director

Spirit Lake Tribe Health Center

Fort Totten, North Dakota is

looking for nurses and nurse


Competitive salary and benefits

Health, dental, vision, life insurance, 401 K

and educational assistance.

Sign on bonus • Staff of 75


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Fax: 701-766-1272

HR email:

Are you loyal, driven, and


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Contact Kristin at (701) 584-7247 or to apply.

Welcome New


Rhea Ferry

Alexis Hanson

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Omicron Tau Chapter, STTI Honor Society of Nursing

Contact Hours: to be submitted to ND Board of Nursing

See Page 6

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The State of Montana, DPHHS is an EEO Employer.

For more information and application materials

apply through the Montana Job Service at

Or contact Montana State Hospital,

Human Resources Department | Warm Springs, MT 59756

Phone (406) 693-7031 or 7034 • FAX (406) 693-7059


Tessa Johnson, MSN, RN

Vice President


Kayla Kaizer, BSN, RN

Vice President


Donelle Richmond


Director at Large-

New Graduate

Joe Vetter, BSN, RN


Vice President

Membership Services

Amanda Abrams, BSN, RN

Vice President

Government Relations

Kristin Roers

Vice President

Practice, Education,

Administration, Research

Sherry Burg, MBA, RN

Published quarterly: February, May, August and

November for the North Dakota Nurses Association, a

constituent member of the American Nurses Association,

1515 Burnt Boat Dr. Suite C #325, Bismarck, ND 58503.

Copy due four weeks prior to month of publication.

For advertising rates and information, please

contact Arthur L. Davis Publishing Agency, Inc., 517

Washington Street, PO Box 216, Cedar Falls, Iowa

50613, (800) 626-4081, NDNA and

the Arthur L. Davis Publishing Agency, Inc. reserve

the right to reject any advertisement. Responsibility

for errors in advertising is limited to corrections in the

next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement

or approval by the North Dakota Nurses Association

of products advertised, the advertisers, or the claims

made. Rejection of an advertisement does not imply a

product offered for advertising is without merit, or that

the manufacturer lacks integrity, or that this association

disapproves of the product or its use. NDNA and the

Arthur L. Davis Publishing Agency, Inc. shall not be

held liable for any consequences resulting from purchase

or use of an advertiser’s product. Articles appearing in

this publication express the opinions of the authors; they

do not necessarily reflect views of the staff, board, or

membership of NDNA or those of the national or local


Writing for Publication in

The North Dakota Nurse

The North Dakota Nurse accepts manuscripts for

publication on a variety of topics related to nursing.

Manuscripts should be double spaced and submitted

electronically in MS Word to Please

write North Dakota Nurse article in the address

line. Articles are peer reviewed and edited by the RN

volunteers at NDNA. Deadlines for submission of

material for 2017 North Dakota Nurse are 3/13/17,

6/13/17, 9/13/17 and 12/13/17.

Nurses are strongly encouraged to contribute to the

profession by publishing evidence based articles. If you

have an idea, but don’t know how or where to start,

contact one of the NDNA Board Members.

The North Dakota Nurse is one communication

vehicle for nurses in North Dakota.

Raise your voice.

The Vision and Mission of the

North Dakota Nurses Association

Vision: North Dakota Nurses Association, a

professional organization for Nurses, is the voice of

Nursing in North Dakota.

Mission: The Mission of the North Dakota Nurses

Association is to promote the professional development of

nurses and enhance health care for all through practice,

education, research and development of public policy.

May, June, July 2017 The North Dakota Nurse Page 3

Legislative Session 2017

Kristin Roers, MS, RN, CPPS

By the time you are reading this article, the

2017 Legislative Session is likely over. It has been

a busy session, with NDNA following over 100

separate bills. These bills range from issues of

direct interest to NDNA, like the RN and APRN

Compact Licenses, to issues that are more distant,

like the idea of a Dental Therapist. Some of the

bills we watch help us to determine trends in other

areas of healthcare, while others directly affect

nurses in our state.

Leaders from NDNA were able to speak on

behalf of NDNA on a number of issues:

• CARE Act AARP introduced a version

of their CARE Act, relating to hospital

discharge policies and the identification of a

caregiver after discharge. While the intent

of the bill, that family caregivers should be

competent to care for their loved ones after

discharge, is something that NDNA supports,

the specific wording in this bill would have

placed a huge and unnecessary burden on

bedside nurses. Because of this, NDNA, along

with the ND Hospital Association (NDHA)

testified against this bill.

• Carbon Monoxide NDNA worked with

a father from Colorado who had lost his

daughter to Carbon Monoxide (CO) poisoning

to get a bill introduced to require CO

detectors in all existing apartment complexes

(they are currently required in all new

apartment buildings and houses). NDNA,

along with the Fire Chiefs’ Association and

many private citizens who had lost loved ones

testified in favor of this bill.

• EMS Supervision a bill was introduced that

would have changed the current supervision

requirements of Paramedics or EMT’s

working in a hospital setting. Current law

states that they must be supervised by a

nurse, while the bill proposed to change that

to being supervised by a physician. NDNA

testified to some of the history of how that

original law was created, as well as the fact

that, in many facilities, the only staff that

is present to supervise is a nurse. The bill

was amended, based on our testimony to be

more inclusive of who can supervise, so that

organizations can be flexible to meet their


• Faculty Loan Repayment working with the

ND Center for Nursing, NDNA testified in

favor of adding Nursing Faculty to eligible

groups able to apply for Loan Repayment

through the state. We know that it is

imperative to have more nursing faculty to be

able to meet the workforce needs for nurses in


• Workplace Violence NDNA worked with the

ND Medical Association (NDMA) to draft and

introduce a bill designed to increase penalties

for assaults committed against workers in

a healthcare facility. We know that workers

in the healthcare field are more likely to be

assaulted at work than every industry other

than law enforcement. NDNA wants every

nurse to feel safe at work. NDNA, NDMA and

NDHA all testified in favor of this bill.

• At the time of the writing of this article, the

outcome was not yet clear for any of these


In 2017, NDNA participated in two Nurses Days

in Bismarck we were a sponsor at the ND Center

for Nursing’s Legislative Day on February 6th,

where we had a booth to provide information to

participants on what NDNA does and how to join.

We also hosted a Nurses Day at the Legislature

as a part of the Nursing Student Association of

ND (NSAND) Annual Convention on February

20th. Over 200 students and members attended

committee meetings, an Advocacy 101 discussion,

and sat on the floor with legislators. This

increased visibility of nursing at the legislature

helps keep our issues in front of legislators!

Hiring RNs & LPNs

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Visit our new Facebook page @

Northwood Deaconess Health Center

We would like to extend a Very Special “Thank You”

to all of our dedicated and caring Nurses at

Northwood Deaconess Health Center.

RN Positions Available! Contact: Nancy Carlson, RN/DON

at 701-587-6487 or

A new psychiatric hospital has opened in Grand Forks, ND.

$20,000 Sign-On Bonus for RNs and LPNs!

New Graduates Welcome!

Average starting annual salary for an RN is $56,600.00 and

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To view current Nurse openings and details of what we have to offer,

please visit our website and apply at or contact us at

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Follow us on Facebook, Twitter, and LinkedIn.

A compassionate hand in a time of crisis, Red River

Behavioral Health is dedicated to giving hope and

creating change.

Our nursing department is looking for

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• Competitive wages & benefits

• $5,000 sign on bonus

• Flexible Schedules

• Relocation assistance when needed

Submit resumes to or call Jenny

with any questions at 701-765-7247.

Page 4 The North Dakota Nurse May, June, July 2017


Kayla Kaizer, BSN, RN

Registered Nurse -

Sign on Bonus Included

Dahl Memorial offers competitive wages and benefits for

all full time positions. We offer nurses the opportunity to

hone their leadership and patient care skills to include

Emergency, Med Surg, and Long Term Care.

If you are interested in working in a fun, family style

environment, please call Patricia Rogers or

Melissa Lovec at 406-775-8739 or visit our website to apply:

Dahl Memorial Healthcare

Association, Inc.

PO Box 46 • 215 Sandy Street

Ekalaka, MT 59324

On Monday, February 20th, NDNA and NSAND

joined forces and met at the ND State Capitol

in Bismarck. Two-hundred students from all

over the state were in attendance.

NDNA President Tessa Johnson,

MSN, RN, opened the day with a couple

questions for the group. The first

question was for 3 nursing students

to answer why they went into

nursing school and why they wanted

to be a nurse. One student said, “To

make a bunch of small differences

in many people.” She then went

on to quote Maya Angelou, “At

the end of the day people won’t

remember what you said or did, they

will remember how you made them

feel.” Another student said he wanted to

become a nurse because he wanted to help

people. The last student said she worked on

an Oncology unit and she went into nursing

so that she could “help families and patients

get through their darkest moments.” Tessa then

asked for “seasoned” nurses to answer what they

remembered thinking when they got pinned. A

Find your calling. Essentia Health seeks employees who

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Essentia Health Fargo

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Essentia Health offers competitive salary and benefits.


common answer was “OMG, I finally made it!”

Other answers were “Yes, a real paycheck finally”

and “What is my career going to look like in the

future?” Nursing is so diverse that where those

nurses initially started out at is not where they

are currently and that surprises them looking

back on it.

Finally, Tessa asked what the nursing students

are doing to take care of themselves during

nursing school. One student said she takes a lot

of naps and another student said she is making a

YouTube journey of her life during nursing school.

It is so important to take care of yourself during

nursing school and to maintain those healthy

habits once you get into the nursing profession to

maintain a balanced work and home life.

After the opening, the students broke into two

groups. One group got a tour of the Capitol and got

to sit in on committee meetings that were being

held during the Legislative session. The other

group listened to Vice President of Government

Relations Kristin Roers, MS, RN, CPPS talk about

Advocacy 101 and what actually happens during

the Legislative session. They also heard from Vice

President of Finance Donelle Richmond, BSN, RN,

about the importance of joining your professional

organization such as NDNA.

Lunch was catered and provided by Sanford

Health. At the conclusion of lunch, a few students

were allowed to sit on the floor with select

legislators while the rest of the students headed to

the Ramada Inn for the annual Nursing Student

Association of North Dakota (NSAND) convention.

Everyone at NDNA enjoyed having the students

and instructors with them at the Capitol and we

look forward to having another Legislative Day at

the Capitol again on January 28, 2019!

May, June, July 2017 The North Dakota Nurse Page 5

Nightingale Tribute Names

The Nightingale Tribute was designed

and developed by the Kansas State Nurses

Association in 2003 to honor nurses at the

time of their death. This tribute is performed

by recognizing the names of those who have

passed at the North Dakota Nurses Association

(NDNA) Annual Meeting and also the ANA

Membership Assembly in Washington, DC.

Nursing is a career of teamwork and service;

it is appropriate that we honor our colleagues

not only during their busy careers, but also at

the end of life’s journey. This tribute is for any

registered nurse or

licensed practical nurse

who has worked or lived in

North Dakota.

If you have names of loved ones

or colleagues that have passed away

within the last year please share

via email the loved one’s name,

date of passing & other pertinent

information to to be

recognized at the NDNA Annual Meeting

& the ANA Membership Assembly.

NDNA Nominating Committee

The NDNA Nominating Committee for 2017 is

Jami Falk, Jamie Hammer & Karla Haug. These

elected members will be looking for NDNA members

who wish to serve on the NDNA board for 2018-

2019. Board positions that will receive nominations

are VP of Finance, VP of Communications and VP

of Government Relations. Other positions receiving

nominations are 3 members for the Nominating

Committee and the Membership Assembly

Representative & Alternate. If you are interested in

any positions or have questions about the positions

email us at Make sure your email

address is up to date with ANA/NDNA and watch for

emails to follow this summer regarding nominations!

Meet your nominating committee!

Karla Haug, MS, RN is a

member of the Nominating

Committee and is an

Assistant Professor of

Practice and Director of

the LPN-BSN program

at North Dakota State

University. She served as the

faculty advisor to the NDSU

Student Nurses Association

for 10 years. “Being a role

model to students through

Karla Haug

active involvement in NDNA

is very important to me. I

believe that is it through that role modeling that

we can shape the nurses of tomorrow as well as the

profession of nursing.”

Jami Falk, RN, MSSL,

CNML is a member of

the NDNA Nominating

Committee and is

the Veteran Health

Administration’s West

Region Community Based

Outpatient Clinic Nurse

Manager. She works out

of the VA Clinic located in

Bismarck, ND and oversees

the Primary Care clinical

Jami Falk and administrative functions

within four rural clinics in

North Dakota. Over the past 15 years Ms. Falk

has served as a front line Labor and Delivery RN,

ICU nurse, ICU and Dialysis Nurse Manager,

Inpatient Mental Health Nurse Manager, served

as Acting Associate Chief Nurse of Primary

Care in 2011, served in 2015/2016 as the Acting

VISN 23 PCMH Coordinator for ND, SD, IA, NE

and MN. Through these positions she has been

involved in ensuring that front line staff has the

education, training and knowledge they need

to successfully serve patients while ensuring

quality nursing care is provided. Her focus has

been on shifting from reactive care to proactive

care utilizing population health management

principles that focus on health promotion and

disease prevention strategies. She is a graduate

of the University of Jamestown, certified as a

Contracting Officer Representative, and also holds

a Certification in Nurse Manager Leadership

through AONE Association of Nurse Executives.

She graduated in August 2015 with a Master’s

of Science in Strategic Leadership through the

University of Mary in Bismarck, ND.

Jamie Hammer

Jamie Hammer, MSN,

RN is on the nominating

committee. She is the

Director of Nursing at

Trinity Homes in Minot

and is currently enrolled in

the Doctorate of Nursing

Practice: Educational

Leadership Program. “I want

NDNA to be Leaders who

help others achieve their

highest potential in their

nursing career.”



Full-time or part-time positions. Variety of shifts. Recently

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For More Information Contact

Jenny Westphal RN, DON


St. Gerard’s Community of Care

Hankinson, ND


You are invited!


October 6th, 2017

Ramada Inn, Bismarck

Healthy Nurse Conference

Take time for YOU!

Presented by

Like us on Facebook for future

registration information!

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located on the North Dakota and Manitoba border at the International Peace Garden

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For more info, contact us at 701.838.8472


Christine Baumann and Tim Baumann,

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Work while your child attends IMC!

Ask about our tuition exchange program

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New Town, North Dakota Open Position

RN or BSN for Dialysis Clinic


• Is a registered nurse (BSN or ADN) with a North Dakota

License as defined in the North Dakota Health Guidelines and

has at least one year nursing experience.

Contact Callie Baker BSN, MSN, KDU Administrator

TAT-Kidney Dialysis Center 1-701-627-4840

Page 6 The North Dakota Nurse May, June, July 2017

In Touch with Silence

Sherry Burg MBA, BSN, RN

2017 National Nurse Week: The Balance of Mind, Body,

and Spirit reminds us to take time to pause and reflect on

our own self-care, which will allow us to care for others.

So what is getting in our way to give time to ourselves?

Perhaps revisiting our priorities could help our focus. As

Elisabeth Kubler-Ross advised, “Learn to get in touch with

silence within yourself and know that everything in this

life has a purpose.”

Often when starting the day, many of us already have

this “list,” maybe it’s unwritten and etched in the mind or

perhaps in a planner or on a “post-it-note.” There is likely

a little anxiety associated with this list. We might find

ourselves rearranging in the mind how this can all fit

Sherry Burg

together like a puzzle, imagining how multitasking might

allow victory in completing the entire list before our head hits the pillow tonight.

For some, the only conscious priority is: making it through the day! After

years, decades, of being fragmented in thousands of different directions, this idea

of merely surviving the day has become the experience of many.

We may say to a friend, “If it isn’t on fire, it does not get my attention this

week!” This type of statement is meant to be a light-hearted attempt to let our

friend know we aren’t available for anything that is not considered urgent.

But is this really true?

Are we leaving ourselves in a “wing it” mode, if we find our priorities need to


It takes peace of mind and clarity to recognize and reorder meaningful,

personal priorities. This may be slowing down, rather than trying to figure

out how to go faster. Coming back to our center and connecting with stillness,

allowing us to see what is truly important. It allows realization of how we might

improve our awareness and identify when this balance has shifted to a place of

feeling overwhelmed a little sooner next time. Can we learn to grow from these

times of chaos?

To help us grow in our understanding of self-care and to lead the charge for

health and wellness across our communities Save the Date to attend:

The NDNA Conference on October 6, 2017: Healthy Nurse, Healthy


Hope to see you there!

Mindfulness in Nursing

Amanda Abrams BSN, RN

Nursing is a demanding discipline riddled with a

growing amount of professional stressors including difficult

work schedules and long shifts; caring for severely ill

and complex patients; formation of relationships with

patients, families and co-workers; and the demands of

documentation and technological use. The face of health

care is a continuum of change with financial constraints

that cause staffing shortages, shorter patient stays

and limited resources. Our productivity-based society

continues to push for more work in less time. Nursing is

also an emotionally charged profession as nurses are

regularly exposed to trauma, stress, and sadness. This

bombardment of demands and human suffering can lead Amanda Abrams

to emotional contagion further compromising a nurse’s

welfare and effectiveness. These stressors contribute to attrition, callousness,

and burnout in nursing. Nurses often struggle with maintaining their own wellbeing

and are known for caring for others before caring for themselves. Being

able to multi-task and juggle several issues at once is viewed as a necessary

skill, however mindfulness is contrary to this norm. White (2014) suggests that

mindfulness can be a solution to these problems and that health-care providers

that practice mindfulness “demonstrate an improved sense of well-being and

ability to employ self-care strategies.”

Derived from Buddhist teachings, mindfulness is an awareness of being in

the moment and thinking non-judgmentally. Originally used in conjunction

with other techniques such as mantra and deep breathing, mindfulness can be

utilized as a way to achieve deeper meditation. Psychology has taken the concept

of mindfulness and developed it as a treatment modality for stress, depression,

borderline personality disorder, anxiety, substance abuse, and pain among others.

Beyond its clinical intervention uses, mindfulness is a holistic process that has

shown to increase empathy and compassion towards self and others, alleviate

suffering, improve communication techniques, and strengthen inter-personal

relationships in all populations.

Defining mindfulness in exact terms is challenging, as it is a subtle and

abstract process. Jon Kabat-Zinn, the founder of mindfulness-based stress

reduction, defines mindfulness as “paying attention on purpose, in the present

moment, and nonjudgmentally to the unfolding of experience moment by

moment” (, 2017).

To be mindful one does not become or participate in emotions they experience,

they merely observe the emotions. More simply, mindfulness is concentrating

on what is happening in the here and now by letting go of the past while also

not thinking about the future. While simultaneously not exerting expectations

or labeling the moment as good or bad, happy or sad, or positive or negative;

mindfulness is achieved. The process allows the entire experience to come into

consciousness, the cognitions, emotions, and sensations and then creating

openness and curiosity, accepting all information at face value while not

prioritizing or categorizing.

In order to be mindful, one must be present in the moment. This involves

not ruminating about the past or worrying about the future. Presence is

accomplished by gently guiding one’s thoughts back to the present when they

stray from the moment, while maintaining focus in the situation.

Open awareness is another attribute of mindfulness. It can be viewed as

the observation of the cognitions, feelings, and sensations. Openness of the

observation is achieved by not avoiding or giving too much attention on one

aspect of the consciousness. Rather, one must take note of emotions and resist

participating or taking ownership of feelings. For example, in open awareness,

one may find themselves experiencing anger, rather than being angry.

In addition to awareness, a nonjudgmental acceptance of the moment is

necessary to achieve mindfulness. Acceptance is achieved by not labeling what

is observed in consciousness as “good” or “bad.” Being nonjudgmental allows

mindfulness users to “respond rather than react to [their] habitual ways of

thinking, moving and doing” (White, 2014). Labeling a feeling or thought forms

an attachment or significance to it, and mindfulness suggests that doing so

creates suffering and unhappiness. Acknowledgment of and then letting go

once the thought, emotion or sensation passes are crucial to nonjudgmental

acceptance. Mindfulness has the potential to improve the profession of nursing

by giving nurses a skill set to improve holistic approach to patient care, while

maintaining their own well-being. Understanding the concept of mindfulness and

its applications can increase the likelihood of its adoption into nursing practice for

the benefit of the nurse, the patients, and the discipline of nursing.

References (2017). Retrieved March 12, 2017 from


White, L. (2014) Mindfulness in nursing: an evolutionary concept analysis. Journal of

Advanced Nursing, 70(2), 282-294. doi: 10.1111/jan.12182

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May, June, July 2017 The North Dakota Nurse Page 7

Members in Motion

Kendra Roloff, NP & Melanie Schlittenhardt, NP

Pelican Health was founded in 2017 by nurse

practitioners (NP), Melanie Schlittenhardt and

Kendra Roloff. Pelican Health is a comprehensive

pelvic health and continence clinic in Bismarck. We

bring together a unique and dedicated partnership

with 25 years combined experience of delivering

advanced and non-surgical treatments for pelvic


Our journey to an independent practice began

several years ago with a simple urodynamic lab and

an incredible nurse mentor. Evaluating complex

urogynecological disorders with urodynamic

testing was fascinating but we knew we could offer

more. Ultimately, the launch of Pelican Health

was in response to patients’ plea for help. The

need for a specialty pelvic health and continence

clinic was apparent and access to care was limited

by a looming urology shortage. As a result, the

specialty clinic established a variety of services for

comprehensive pelvic and bladder complaints and


• Urinary incontinence

• Urinary retention

• Urinary frequency and urgency

• Recurrent urinary tract infections

• Pelvic pain

• Pelvic organ prolapse

• Painful bladder syndrome

• Postpartum pelvic floor disorders

• Bowel disorders

• Sexual health problems

memberships have contributed to our currency with

the nursing profession and standards of practice.

Perhaps most importantly, our NDNA memberships

have enhanced our networking opportunities. As

we have ventured out into an independent practice,

we’ve gained a greater appreciation for interactions

with supportive and like-minded colleagues. With

every professional interaction and exchange of ideas

with NDNA members, our confidence has grown

positioning us perfectly for our big independent

step. Therefore, we credit our NDNA colleagues

and mentors for our most recent achievement. We

encourage all nurses to become members of this

exceptional association.

Although these conditions are not life

threatening, they have devastating effects on one’s

quality of life. Our team approach to patient care

is guided by concise diagnosis and evidence based

recommendations allowing for the best possible

outcomes. Our assessment and treatments include:

• Evaluation and diagnosis of the pelvic floor

and bladder

• Urodynamic testing

• Timed voiding

• Behavior modifications

• Medications to suppress bladder contractions

and increase bladder capacity

• Bladder supports for pelvic organ prolapse

and/or urinary incontinence

• InterStim therapy management

• Pelvic floor rehabilitation

• Posterior tibial nerve stimulation

• Nursing home consults for pelvic floor and

bladder disorders

Improving patients’ quality of life and confidence

has been extremely rewarding. The relationships

we have forged through dignified and shared

journeys have been the most gratifying aspect of

our career. We thank our patients for their nudge.

We are both members of the North Dakota

Nurses Association (NDNA). There have been many

advantages realized as members of the NDNA. Our

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Page 8 The North Dakota Nurse May, June, July 2017

End of Life Care

Charys Kunkel, MSN, RN,

Wendy Kopp, MSN, RN-BC, and

Melissa Hanson, MSN, RN

Quality end of life (EOL) care requires the utilization of special knowledge

and skills by professional nurses. According to Pesut et al. (2014) “an aging

population requires that nurses in all areas of practice be knowledgeable about

high-quality palliative care” (p.47). Because EOL events are not always readily

available, nursing students often lack the opportunity to learn the knowledge and

skills necessary to provide palliative care. A review of literature has identified the

need for incorporating EOL education into nursing curricula and has prompted

initiatives including the End-of-Life Nursing Education Consortium (ELNEC) to

support and encourage the specialized skills needed to provide EOL care.

High Fidelity Simulation (HFS) is an appropriate teaching method for

teaching EOL care to nursing students as it provides students with the

opportunity to respond, react, and increase their levels of self confidence in a

safe and supported environment. As supported by Stoner (2009) “Simulators

provide an effective bridge between the unknown of caring for a dying person and

developing the skills necessary to facilitate a meaningful death experience for

patients and their families” (p. 115). While the use of HFS provides an innovative

opportunity to incorporate EOL education into existing nursing curricula,

researchers have identified lack of current research and the need for further

research to evaluate what effects EOL education and HFS have on students’

cognitive skills and confidence levels (Sanford, 2010; Sperlazza & Cangelosi,

2009; Stoner, 2009).

The purpose of this study was to explore reports of confidence and overall

learning immediately, at one year, and at two years following an EOL HFS.

The population included a convenience sample of nursing students and recent

graduate nurses.


The EOL simulation was designed to introduce first semester junior nursing

students to an EOL experience and allowed them to observe the management

of EOL care. The simulation setting was prepared to resemble an oncology

patient’s room. Two oncology nurses assumed their natural work roles and one

nursing instructor acted in the role of the dying patient’s daughter and sole

family member. A high fidelity simulator manufactured by Medical Education

Technologies, Inc. (METI ®) was dressed to resemble a dying cancer patient. The

simulator was programmed to display physiological changes that would occur in a

dying patient.

Each student sample group received the same preparation materials and

experienced the same EOL simulation script, software program, and structural

environment. Simulation debriefing was a vital component to all of the sample


Description of the Data Collection Procedure

Following IRB approval, written instructions were provided to study

participants by the researcher. Protection of human rights was ensured

and informed consent was obtained with participation being voluntary

and anonymous. Data collection took place at one private single purpose

baccalaureate nursing program located in the Midwest or by mail. Study

participants completed a researcher generated demographic survey and a 13 item

Simulation Effectiveness Tool (SET) that was developed by Medical Educational

Technologies Incorporated (METI®). Overall participant learning and confidence

levels were measured with the SET. The learning subscale consisted of eight

items with a Cronbach’s alpha of .87 and the confidence subscale consisted of five

items with a Cronbach’s alpha of .84. (Elfrink et al., 2012). A 3-point likert type

scale provided participants with a range of responses using the words “strongly

disagree,” “somewhat agree,” “strongly agree,” and “not applicable.”

Junior nursing students were administered the SET in a private room

following their EOL HFS debriefing. Senior nursing students were administered

the SET in a private room and were instructed to evaluate their current

perceptions of the EOL simulation experience that was implemented one year

prior during their junior year. Nurses who had graduated from the program six

months prior were invited by mail to participate in the study and were instructed

to complete the SET to evaluate their current perceptions of the EOL simulation

experience that was implemented two years prior during their junior year.

Analysis of the Data

Descriptive data analyses were conducted using SPSS® 17.0. Overall, 72 of

the 100 eligible participants completed the study. Further analysis indicated 24

(33.33%) of the participants were junior nursing students, 36 (50%) were senior

nursing students, and 12 (16.67%) were recent graduate nurses.

Quantitative Results

Sixty-five (90.3%) of the pooled survey participants either strongly agreed or

somewhat agreed with the confidence subscale survey statements supporting

confidence in their abilities to manage an EOL event. Results indicated 86.1%

(n=62) of the survey participants either strongly agreed or somewhat agreed

with the overall learning statements.

A two-way Chi-Square analyses indicated that there was no significant

difference in the responses among junior, senior or graduate respondents

(p < .05). These results supported the use of simulation as an effective EOL

teaching modality as junior students rated the same level of confidence as

May, June, July 2017 The North Dakota Nurse Page 9

senior students and practicing graduate nurses who

had experienced the same simulation scenario one

and two years prior.

Observational Analysis

and Participant Comments

While the study was designed to gather

quantitative data, observations were noted by

the researcher and comments were shared by

the participants that supported overall study

results. Informal observational analysis by the

researcher identified the EOL simulation to be an

emotional experience as tears were shed by both the

simulation participants and the observing student

participants. One junior participant shared how

their own personal and cultural beliefs made the

EOL simulation difficult to observe because they felt

that it was disrespectful for a family member to say

“goodbye” to a dying person.

A comments section located on the SET provided

study participants with the opportunity to share

unsolicited written feedback. Several junior

participants indicated that the simulation was

an effective learning tool and that it enhanced

their understanding of the nurse’s role throughout

the EOL process. Senior participants who had

experienced the EOL simulation one year prior

shared that the experience “felt very real.”

Another senior participant indicated “simulation

is a wonderful way to learn!” A graduate nurse

participant who had experienced the EOL

simulation two years prior shared how they “vividly

remembered the EOL simulation” and indicated

how using simulation to provide the basics of end-oflife

care helped reduce their own personal anxiety

related to providing care for a dying patient.

The debriefing period provided an opportunity

for students and simulation participants to ask

questions and share personal experiences related

to the EOL event. Several students shared personal

EOL experiences that they had with both family

members and with patients they had cared for in

the clinical setting. The importance of effective

therapeutic communication was a common theme

shared throughout the debriefing session. One

participant shared that the simulation helped

them realize that providing EOL care stretched

far beyond providing care to their patient and that

involving the family of a dying patient was of equal


Different types of EOL experiences such as

unexpected or traumatic death were also discussed

during the debriefing period. This allowed

students to appreciate the uniqueness of each

EOL experience. Further discussions surrounded

the topics of medication administration, comfort

measures, religious practices, organ donation, and

most importantly effective communication between

family members and members of the health care


van der Riet, 2014). Having experienced prior EOL

events coupled with personal, religious, or cultural

beliefs may have influenced student perceptions

during the EOL simulation event. Another

significant limitation is that the study focused on

the care surrounding a simulated terminal oncology

patient, which may not be generalizable to all EOL

situations. This simulation provided students

with the opportunity to observe an expected EOL

event, as EOL events are not always expected. The

simulation experience may have been perceived

differently if the scenario demonstrated EOL by

other means such as trauma or other medical

conditions. Despite this limitation, the review of

literature conducted by Gillan, Jeong, and van der

Riet, found that “the reality of the simulation may

have helped students recognize the inherent stress in

caring for a dying person.”

Recommendations for further study.

Continued evaluation of student outcomes

and confidence levels following EOL HFS can

significantly add to the nursing education

knowledge base by providing data to support its

existence. Research should explore the effects of

EOL simulation events on student confidence levels,

particularly in the areas of communication, clinical

reasoning, and prioritization of care. Prior experience

with EOL and the extent of the experience should

be explored as it would provide a solid comparative

baseline. Unsolicited qualitative data from this study

supports the need to explore personal and cultural

beliefs surrounding EOL.

Find your future with the




This study contributes to the body of nursing

knowledge by providing quantitative and unsolicited

participant comments to describe, evaluate, and

support the outcome of confidence and overall

learning among nursing students and new nursing

graduates following an EOL HFS event. The data

obtained from this study validated the use of HFS

as an effective and sustainable educational tool for

teaching entry-level nursing students the special

knowledge and skills necessary to provide EOL care.


Elfrink, V., Leighton, K., Ryan-Wendger, N., Doyle, T.,

& Ravert, P. (2012) History and development of

the simulation effectiveness tool (SET). Clinical

Simulation in Nursing 8(6), 199-210.

Gillan, P.C., Jeong, S., & van der Riet, P.J. (2014). End

of life simulation: A review of literature. Nurse

Education Today, 34(5), 766-774. doi: 10.1016/j.


Pesut, B., Sawatzky, R., Stajduhar, K., McLeod, B.,

Erbacker, L., & Chan, E. (2014). Educating nurses for

palliative care: a scoping review. Journal of Hospice

& Palliative Nursing, 16(1), 47-54. doi: 10.1097/


Sanford, P.G. (2010). Simulation in nursing education: A

review of the research. The Qualitative Report, 15(4),


Sperlazza, E., & Cangelosi, P.R. (2009). The power of

pretend: Using simulation to teach end-of-life care.

Nurse Educator, 34(6), 276-280.

Stoner, M.S. (2009). Using high-fidelity simulation to

educate nursing students about end-of-life care.

Nursing Education Perspectives, 30(2), 115-120.

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This study was limited by the relative small

number of participants and homogeneity of the

sample. A larger sample size would have made the

study more generalizable. In addition, baseline

measurements including students’ perceptions and

experiences related to EOL were not evaluated

prior to the simulation experience. Literature

reviews show that pre-briefing, including informing

students of the nature of the simulation and that

the simulator may or will die, will help promote

psychological safety of the students (Gillan, Jeong, &

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Page 10 The North Dakota Nurse May, June, July 2017

You’re Not Going to Learn It All in Nursing School:

Graduate Nurses’ Perceptions of Preparedness for Clinical Practice

Nicole Hatzenbuhler, MSN, RN and

Julie Klein, PhD, RN

In addition to assuming traditional responsibilities

mandated by the nursing profession, current

health care systems demand that new graduate

nurses quickly develop into efficient, capable

professionals who will provide safe, high quality care

to increasingly complex patients under strenuous

circumstances (Parker, Giles, Lantry, & McMillan,

2014; Watt & Pascoe, 2013). Oftentimes, nurse

graduates are expected to sink or swim in the

complexities of the health care environment; this

pressure can cause stress, anxiety, and challenges in

role adjustment that may lead these new nurses to

question whether their nursing education adequately

prepared them to provide patient care at the bedside

(Hatlevik, 2012). The need to be prepared to enter

clinical practice, also known as ‘practice readiness’

or ‘work readiness,’ has been widely discussed within

nursing literature, and a common theme that has

been identified by stakeholders in the profession has

been a lack of practice readiness among graduate

nurses (Romyn et al., 2009; Watt & Pascoe, 2013;

Wolff, Pesut, & Regan, 2010). Due to the need for safe,

competent registered nurses to provide patient care in

acute settings, ensuring the preparedness of students

to function within their professional roles after

graduation should be a priority focus for nurse leaders.

The purpose of this study was to explore the

lived experiences of nurses who graduated from

baccalaureate degree programs within the last two

years regarding their perceptions of preparedness

to enter clinical practice. The intent of this research

was to achieve a greater understanding of how

educational experiences may influence novice

nurses’ preparedness to assume their professional

roles and responsibilities in clinical settings. The

study was conducted to provide information to

guide the development of socialization strategies

that can promote graduates’ successful transitions

into the nursing workforce, retain novice nurses

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nursing shortage at local, state, and national levels

(Laschinger, 2012).


This qualitative study used an interpretative

phenomenological design to explore 10 graduate

nurses’ perceptions of preparedness for clinical

practice. Maximum variation sampling was used

to obtain research subjects who graduated from six

different nursing programs located in three different

states. All of the subjects were licensed registered

nurses who had BSN degrees and worked in various

acute care settings that included medical, surgical,

oncology, telemetry, adult intensive care, pediatrics,

neonatal intensive care, and the emergency

department. The sample was comprised of six females

and four males whose professional work experience

ranged from 13 months to 27 months. The risks and

benefits of the study were disclosed, and written

informed consent was obtained from each subject.

Confidentiality procedures were implemented to

protect the rights and identities of the participants.

Data were collected through face-to-face, semistructured

interviews. After data saturation was

achieved, thematic analysis was conducted to identify

prevailing themes by coding and categorizing the

narrative data.


Three major categories and themes emerged

during data analysis. These categories were: 1)

“It’s Hard for Nursing School to Prepare You for

Everything”; 2) “Being in the Workforce is Different”;

and 3) Pearls of Wisdom.

Category: “It’s Hard for Nursing School

to Prepare You for Everything”

All of the graduate nurses in this study perceived

that their nursing education provided them with

the basic knowledge and skills necessary to enter

the registered nurse workforce; however, it was not

realistic to prepare them for every patient situation

that may be encountered during their careers.

Participant Eight stated “I mean, nursing school

prepares you, but in a way it doesn’t and I don’t know

that it can” (personal communication, September

26, 2016). Likewise, Participant Four explained

“…there’s just so many different fields in nursing

that it’s hard to prepare you for every single one as

a student” (personal communication, September

12, 2016). The graduate nurses acknowledged that

applying nursing knowledge and skills in professional

practice was an invaluable learning experience

that could not be replicated in nursing school.

Participant Five stated “you learn the basics, but you

don’t always understand how they apply” (personal

communication, September 15, 2016). Similarly,

Participant Six explained “I feel like a good nurse,

or someone who I would trust, is experienced and so

I feel like no amount of school or nothing you can do

in school will change that” (personal communication,

September 21, 2016).

Category: “Being in the Workforce Is Different”

All of the graduate nurses in this study identified

differences in students’ and registered nurses’

responsibilities in patient care situations. They

discussed various aspects of their professional

roles that they had not been adequately prepared

for during their nursing education. These

responsibilities included delegating, prioritizing,

using time management to care for multiple patients,

and communicating/interacting with other health

care disciplines and patients’ family members.

Additionally, the participants discussed their lack of

preparedness for a variety of high stress situations.

These situations involved caring for high acuity

patients; responding during difficult social situations;

making decisions when ethical dilemmas were

involved; and coping with codes, death, and dying.

Participant Five explained “you feel like you’re so

sheltered in school, and then you get out there and

you see these different situations, and you have to

approach them without looking scared or terrified.”

Many of the participants described recognition

of the reality of their jobs and their level of

professional responsibility after being on their own

after orientation. This realization was explained by

Participant Four:

And also, you think ‘do I actually know enough

to be a nurse? How do I compete with these

nurses that have been nurses for 20 years and

I still take care of the same patients?’ That,

I think was one of the scariest realizations

after I started working on my own. (personal

communication, September 12, 2016)

Category: Pearls of Wisdom

All of the graduate nurses in this study freely

shared recommendations that were based on their

experiences to better prepare novice nurses for

entry into professional nursing practice. To ease

the transition to the role of the registered nurse,

the graduate nurses emphasized the importance

of mentoring from instructors, preceptors, and

experienced staff members; more hands-on

experiences in nursing education; consistency and

progression during new graduate orientation; and

the need for students to develop lifelong learning

skills because learning as a nurse does not end after

graduation or orientation. Participant Eight stated

“you can’t be on orientation forever. And you can’t be

a student forever. I think you just have to learn to ask

questions and learn to grow” (personal communication,

September 26, 2016). All of the graduates agreed that

preparedness for the reality of their professional roles

and responsibilities was an ongoing process, rather

than a finite endpoint in their careers. Participant

Seven explained “everything’s a learning experience”

(personal communication, September 26, 2016).

Final Assertion

The findings from data analysis resulted in

the following final assertion for the study: All of

the graduate nurses in this study perceived that

their nursing education gave them the necessary

background to enter clinical practice as registered

nurses but stated that their education could not

completely prepare them for the reality of their

professional responsibilities. The graduate nurses

emphasized distinct differences between the roles

of student and nurse; they identified knowledge and

skills that could only be gained through experience as

a registered nurse. The graduate nurses in this study

offered advice for students/novice nurses, academic

institutions, and health care employers to better

prepare graduates for a successful transition into

professional nursing practice.

Implications for Nursing Practice

This study’s findings supported the need for a

collaborative approach among nurse leaders to better

May, June, July 2017 The North Dakota Nurse Page 11

prepare graduates to navigate the challenges that are associated with entry into

professional nursing practice. Nurse educators within academic institutions are

responsible for designing curricula that give students opportunities to prioritize,

delegate, practice time management skills, as well as and interact with different

health care disciplines and patients’ family members. In addition, strategies for

coping with emergent situations; death and dying; difficult social situations; and

ethical concerns should be integrated throughout nursing curricula. An increase

in the number of clinical hours, a greater emphasis on high acuity nursing

concepts, and interprofessional education experiences within pre-licensure

nursing programs may be beneficial to enhancing graduates’ preparedness.

Nurse leaders within health care organizations should provide ongoing support

to new graduates throughout their first year of practice through graduate

nurse residency and mentoring programs. Orientation programs for new

graduates should be modified to ensure consistent preceptors for each trainee.

These programs should also be sufficient in length and support progression

in knowledge and skill levels to ensure that novice nurses achieve the required

competencies expected for their unit by the conclusion of the orientation period.

In addition, nurse leaders within health care organizations can create additional

internship opportunities for students and develop academic-practice partnerships

with local nursing programs to ensure an adequate number of clinical placements

sites and hands-on learning experiences for students.

Students and novice nurses can enhance their own preparedness for

professional practice by seeking out practical experience opportunities through

internships or employment as a nurse aide. Graduate nurses should also be

cognizant of limitations in their knowledge and skill levels and actively seek

assistance from preceptors and experienced staff members as necessary.

All stakeholders in nursing are responsible to ensure that graduate nurses

develop lifelong learning skills and are mentored throughout their educational

experiences and their transition into the workforce.

Recommendations for Future Research

The findings of this study reflect the acute care service context in a single

Midwestern city and, therefore, cannot be generalized to other populations or

settings. Future research on preparedness utilizing a quantitative approach is

necessary to produce data that could be extrapolated to other graduate nurse

populations. Quantitative research methods could also be used to measure the

effectiveness of the strategies that were recommended to enhance the practice

readiness of graduate nurses.

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Practice readiness among graduate nurses will continue to present challenges

for nurse leaders due to the complex and dynamic nature of health care. A

collaborative approach among nurses in academic, research, and practice settings

is necessary to implement socializations strategies that will enhance graduate

nurses’ knowledge, skills, and abilities and will provide support to these novices

as they transition into professional practice. Facilitating graduates’ successful

transitions into the workforce is an important strategy to address turnover and

retention among novice nurses, the nursing shortage, patient safety, and other

related issues that pervade current health care systems (Laschinger, 2012;

Walker & Campbell, 2013).


Hatlevik, I. R. (2012). The theory-practice relationship: Reflective skills and theoretical

knowledge as key factors in bridging the gap between theory and practice in initial

nursing education. Journal of Advanced Nursing, 68(4), 868-877. doi:10.1111/j.1365-


Laschinger, H. K. S. (2012). Job and career satisfaction and turnover intentions of newly

graduated nurses. Journal of Nursing Management, 20(4), 472-484. doi:10.1111/


Parker, V., Giles, M., Lantry, G., & McMillan, M. (2014). New graduate nurses’ experiences

in their first year of practice. Nurse Education Today, 34(1), 150-156. doi:10.1016/j.


Romyn, D., Linton, N., Giblin, C., Hendrickson, B., Limacher, L., Murray, C., & ... Zimmel,

C. (2009). Successful transition of the new graduate nurse. International Journal of

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Education Today, 30(2), 187-191. doi:10.1016/j.nedt.2009.07.011

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Page 12 The North Dakota Nurse May, June, July 2017

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