The North Dakota Nurse – May 2017

The North Dakota Nurse
North Dakota Nurses Association
Index
THE OFFICIAL PUBLICATION OF THE 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 www.ndna.org 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
president@ndna.org. Be well, we need all of you!
References
https://www.merriam-webster.com/dictionary/legacy
http://www.dawnkaiser.com/
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
PAID
Permit #14
Princeton, MN
55371
Like us on Facebook for upcoming information
on NDNA’s Healthy Nurse Conference
in Bismarck on October 6th!
“Happy Nurses Week!” from NDNA

55371
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 info@ndna.org.
The North Dakota Nurse
NORTH DAKOTA NURSES ASSOCIATION
INDEX
current resident or
Page 13
Page 2
Page 11
THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATION
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 www.ndna.org 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
PAID
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
SAVE THE DATE
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
“NURSING PRACTICE IN CHAOTIC TIMES”
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)
info@ndna.org
Carmen Bryhn, MSN, RN
Executive Director
director@ndna.org
Spirit Lake Tribe Health Center
Fort Totten, North Dakota is
looking for nurses and nurse
practitioners.
Competitive salary and benefits
Health, dental, vision, life insurance, 401 K
and educational assistance.
Sign on bonus • Staff of 75
Contact:
Human Resources
Phone: 701-766-1215
Fax: 701-766-1272
HR email:
slthr@spiritlakenation.com
Are you loyal, driven, and
compassionate?
Join our team of like-minded people.
Licensed Practical Nurse (LPN):
Enrich the lives of patients while choosing your own schedule
and earning extra cash in a full-time/part-time LPN position.
Registered Nurse (RN):
Make a difference and gain valuable experience as a full-time/
part-time charge nurse at JMHCC!
Clinic Nurse RN/LPN – Glen Ullin, Full-time:
Enhance the patient experience through this fast-paced,
supportive clinic role.
All full-time and part-time positions are eligible for our
competitive benefits package along with a $5,000 sign on bonus
and up to $15,000 student loan repayment for nurses.
Contact Kristin at (701) 584-7247 or kheid@jmhcc.org to apply.
spiritlakenation.com
Welcome New
Members
Rhea Ferry
Alexis Hanson
Darleen Bartz
Kendra Roloff
Emily Schafer
Rhonda Hagness
Omicron Tau Chapter, STTI Honor Society of Nursing
Contact Hours: to be submitted to ND Board of Nursing
See Page 6
Elizabeth Perius
Lenae Schneider
Dawn Romfo
Marcia Stubstad
Sheila Heinert
Alyssa Backes
RN to BSN Online Program
MSN Online Program
No Campus Visits — Enroll Part or Full Time
• Liberal Credit
Transfers
• Nationally
Accredited
Montana State Hospital &
The New MSH Galen Forensic
Mental Health Facility
Registered Nurses
• No Thesis
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• No Entrance
Exams
Classes That Fit Your Schedule — Competitive Tuition
BSN-LINC: 1-877-656-1483 or bsn-linc.wisconsin.edu
MSN-LINC: 1-888-674-8942 or uwgb.edu/nursing/msn
If you are innovative and thrive on challenging employment
opportunities, consider joining the dedicated treatment team
at Montana State Hospital & the new MSH Galen Forensic
Mental Health Facility to share in our commitment to provide
quality inpatient psychiatric services for our citizens. We are
presently recruiting for the following positions:
Full-Time, Part-Time, Short Term (Per Diem)
$31.00 possible entry – per experience and
differential for nights and weekends.
***Earn additional differential pay of $2.00 per hour for
evening shifts and $1.50 per hour for weekend shifts.***
The State of Montana, DPHHS is an EEO Employer.
For more information and application materials
apply through the Montana Job Service at
http://statecareers.mt.gov
Or contact Montana State Hospital,
Human Resources Department | Warm Springs, MT 59756
Phone (406) 693-7031 or 7034 • FAX (406) 693-7059
President:
Tessa Johnson, MSN, RN
president@ndna.org
Vice President–
Communications
Kayla Kaizer, BSN, RN
kkaizer@gmail.com
Vice President–
Finance
Donelle Richmond
donelle.richmond@
gmail.com
Director at Large-
New Graduate
Joe Vetter, BSN, RN
joey.vetter@yahoo.com
Officers
Vice President–
Membership Services
Amanda Abrams, BSN, RN
amanda.kuntz@ndsu.edu
Vice President–
Government Relations
Kristin Roers
advocacy@ndna.org
Vice President–
Practice, Education,
Administration, Research
Sherry Burg, MBA, RN
sburg@altru.org
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, sales@aldpub.com. 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
associations.
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 director@ndna.org. 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
needs.
• 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
ND.
• 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
bills.
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
$5,000 SIGN ON
BONUS Possible
We hire new graduates and
offer tuition reimbursement
For more information,
call 701-845-8222 or visit our website at
www.sheyennecarecenter.com.
Applications can also be picked up at
979 Central Ave N, Valley City ND 58072
and faxed back to 701-845-8249.
Visit our new Facebook page @ www.facebook.com/sheyennecarecenter
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 nancy.carlson@ndhc.net
www.ndhc.net
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
LPN is $46,000.00 plus an additional PM and Night differential!
To view current Nurse openings and details of what we have to offer,
please visit our website and apply at www.mslcc.com or contact us at
2425 Hillview Avenue, Bismarck, ND 58501 (701) 223-9407.
Follow us on Facebook, Twitter, and LinkedIn.
www.mslcc.com
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
Registered Nurses
to join our team.
• Competitive wages & benefits
• $5,000 sign on bonus
• Flexible Schedules
• Relocation assistance when needed
Submit resumes to
hr@meridianprograms.com or call Jenny
with any questions at 701-765-7247.

Page 4 The North Dakota Nurse May, June, July 2017
2017 NDNA DAY AT THE LEGISLATURE
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:
www.dahlmemorial.com
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
embrace our commitment to patient-and family-centered care
in communities both large and small.
Essentia Health Fargo
is seeking great RN’s
For more information and to apply, visit us at
www.EssentiaHealth.org/findajob
Essentia Health offers competitive salary and benefits.
EOE/Minorities/Females/Vet/Disabled
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 info@ndna.org 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 info@ndna.org. 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.”
HELP WANTED
RN or LPN
Full-time or part-time positions. Variety of shifts. Recently
increased competitive wages, PTO, extended sick leave, etc.
For More Information Contact
Jenny Westphal RN, DON
701-242-7891
St. Gerard’s Community of Care
Hankinson, ND
Website: Stgerards.org
You are invited!
SAVE THE DATE
October 6th, 2017
Ramada Inn, Bismarck
Healthy Nurse Conference
Take time for YOU!
Presented by
Like us on Facebook for future
registration information!
International Music Camp
International Music Camp
located on the North Dakota and Manitoba border at the International Peace Garden
Camp Nurse needed for one-week
sessions in June and July
For more info, contact us at 701.838.8472
or info@internationalmusiccamp.com
Christine Baumann and Tim Baumann,
Camp Directors
Work while your child attends IMC!
Ask about our tuition exchange program
MHA Nation
Mandan, Hidatsa & Arikara Nation
Three Affiliated
Tribes
New Town, North Dakota Open Position
RN or BSN for Dialysis Clinic
Qualifications:
• 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
calliebaker@mhanation.com

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
shift?
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
Nation.
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” (Mindfulnet.org, 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
Mildfulnet.org (2017). Retrieved March 12, 2017 from http://www.mindfulnet.org/page2.
htm
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
health.
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
included:
• 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.
Procedure
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
groups.
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
importance.
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
team.
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.
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Conclusion.
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.
References
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.
nedt.2013.10.005
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/
NJH.0000000000000021
Sanford, P.G. (2010). Simulation in nursing education: A
review of the research. The Qualitative Report, 15(4),
1006-1011.
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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Discussion
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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in the profession, and alleviate effects of the
nursing shortage at local, state, and national levels
(Laschinger, 2012).
Methods
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.
Findings
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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Conclusion
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).
References
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-
2648.2011.05789.x
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/
j.1365-2834.2011.01293.x
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.
nedt.2012.07.003
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
Nursing Education Scholarship, 6(1), 1-17. doi:10.2202/1548-923x.1802
Watt, E., & Pascoe, E. (2013). An exploration of graduate nurses’ perceptions of their
preparedness for practice after undertaking the final year of their bachelor of
nursing degree in a university-based clinical school of nursing. International Journal
of Nursing Practice, 19(1), 23-30. doi:10.1111/ijn.12032
Wolff, A. C., Pesut, B., & Regan, S. (2010). New graduate nurse practice readiness:
Perspectives on the context shaping our understanding and expectations. Nurse
Education Today, 30(2), 187-191. doi:10.1016/j.nedt.2009.07.011
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