The Nursing Voice March 2019 Page 1
The Official Publication of the Illinois Nurses Foundation
Quarterly publication direct mailed to approximately 185,000 RNs in Illinois.
VOLUME 6 | NUMBER 4 | MARCH 2019
INF Holds Successful Holiday Gala & Fundraiser
and Names the 2nd Annual Nurse of the Year
The Illinois Nurses Foundation (INF) held its annual
Holiday Fundraising Gala on December 8th, 2018 at
the Hilton in Lisle. It was a blissful evening for the
Foundation and all those that came to celebrate.
Multiple organizations and supporters of the foundation
purchased entire tables for the event, which provided
a wonderful way to spend time with friends and family
during the holiday season while supporting a great
cause. As always, the Holiday Gala provided its guests
with the opportunity to do some Holiday shopping,
with an abundance of baskets and gifts to choose
from. Thanks to the overwhelming support of all the
attendees, the Fundraising Gala thrived in raising funds
for Illinois Nurses Foundation.
Guests socialized as they browsed through rows of
raffle and silent auction items. Everyone in attendance
also enjoyed a plated dinner and cash bar as holiday
melodies played in the background.
Again this year, the Foundation held its “Honor a
Nurse” campaign. The project was designed to Honor
nurses who have inspired us; who have fought for
the advancement of the profession; and who deserve
recognition for their commitment to their patients and
the work they do every day.
Nominations for the “Honor a Nurse” campaign were
received throughout the year. The outpour of touching
stories received were reviewed and narrowed down to
five finalists, chosen by the Foundation Board members.
The five finalists were Christine Durbin, PhD, JD, RN,
Jane Llewellyn, PhD, RN, NEA-BC, Jennifer M. Grenier,
DNP, RN-BC, Donna Plonczynski, PhD, CNP and Mary
Kelly, MBA, RN, CNRN, FAHA. The 2018 Nurse of the
Year award was then presented to Mary Kelly. The story
submitted to honor her read:
“Mary Kelly, BS, RN is
a Certified Neuroscience
Registered Nurse whose
focus and passion is expert
and timely care of the patient
experiencing a stroke. Her
background in nursing includes
critical care and neuroscience
nursing. Prior to studying
nursing, she began a business
career in accounting. She is
currently a Disease Specific
Care Reviewer for The Joint Commission. In that capacity
she participates in and leads Comprehensive and Primary
Stroke & Traumatic Brain Injury reviews of stroke centers
across the nation. She has helped to develop reviewer
tools and precepts new reviewers in this role.
Past positions have included the Director of Stroke
Network Operations for a major health system in the
Chicago area and Stroke Program Coordinator for a
major suburban acute care hospital and trauma center.
She applied her business and nursing backgrounds as a
Practice Manager to initiate, develop, and manage a
suburban neurosurgical practice of MDs and an APRN
where she was responsible for daily clinical and financial
operations, interfaced with two hospital systems
for clinical services, managed staff at three physical
locations, communicated with law firms for litigation
and expert witness services and achieved fiscal stability
within six months of opening the practice. She has also
been a critical care staff RN at suburban acute care
trauma hospitals. Throughout her career trajectory
she has developed expertise in TJC/CMS Standards,
Organizational Development, Shared Governance,
Quality Improvement, Fiscal Planning, and Critical
Care. She is a member of the American Heart/Stroke
Association and reviews abstracts for, attends and
speaks at the International Stroke Conference. She is a
member of the American Association of Neurological
Nurses and served on the steering committee to develop
INF Holiday Gala continued on page 3
current resident or
U.S. Postage Paid
Permit No. 14
Message from the INF Director........ 2
President’s Message.................. 3
IANA. .............................. 4
Thank You Sponsors and Donors. . . . . . .4
SNAI Update. ....................... 5
CMSA Update. ...................... 5
The IL Nursing Workforce Center RN
Workforce Report.................. 6
IDFPR. ............................. 6
2019: A Promising Year for the Illinois
Organization of Nurse Leaders....... 6
Indian Nurses of Illinois' Trifold Design
Served Many - An Activity Update. .. 7
So what IS Climate Change? .......... 8
ANA-IL Expert Panel Workplace Safety
Survey 5: Staffing. ................. 9
Alpha Eta Chapter of Chi Eta Phi Sorority
Awards Nursing Scholarships........ 9
Self-Advocacy Skills for Nurses....... 10
Page 2 March 2019 The Nursing Voice
MESSAGE FROM INF DIRECTOR
Alma J. Labunski, INF Director
New Year’s greetings to each one of you. On behalf of
the Illinois Nurses Foundation (INF) Board of Directors,
I thank you for your desire to keep apprised of goingson
within our state of Illinois. This newsletter, which is
mailed to all nurses in the state of Illinois, is especially
designed for that purpose!
As you may well know, one of the hallmark’s of being
a professional is continuing our growth and development
for life. Moreover, the Foundation is a significant venue
that assists in promoting our growth, service and the
welfare of others. As one who has been involved since
its inception in 2001, INF’s purpose remains clear: to
collaborate with community partners in promoting
the health of the public by supporting nurses through
charitable research and educational initiatives. Dedicated
to serving colleagues throughout the entire state of
Illinois, the Foundation strives to accomplish this through
philanthropic activities, such as providing scholarship
funding to graduate and undergraduate students, funding
scholarly initiatives that promote the health of people
and develop the nursing profession, informing the
public about health issues and nursing, and assisting in
supporting nurses in need and/or crisis. Some examples
which reflect its philanthropic dedication follow.
During 2018, numerous scholarships were available
for undergraduate and graduate nursing students. The
Foundation awarded a total of $16,968 in scholarships
to deserving students. Also, numerous applications have
been submitted for 2019, which has a return rate of
March 15, 2019.
Additionally, the Foundation has striven to recognize
our young professionals for their exceptional dynamic
practice. Entitled, “40 Under 40” the commemoration was
initiated four years ago. Selected by peers/colleagues,
40 emerging nurse leaders were honored September
13, 2018. The next commemoration is currently being
planned to recognize accomplished nurse professionals.
Leaders will be awarded on September 12, 2019. You
will not want to miss this celebration, hence, mark your
calendars NOW and check the VOICE for further details
regarding the venue.
There’s no place like
$5,000 Sign on Bonus
Director of Nursing - LTC
RN/OB & RN Case Managers
Quality Improvement RN | RNs | LPNs
Contact Rose Marie at firstname.lastname@example.org
or 877-538-3142 for more information
Furthermore, our Annual Holiday Gala and Fundraiser
on December 8, 2018, held at the Hilton in Lisle, IL
continued to promote our spirit of camaraderie, support,
and service. The event was a delightful evening with
dinner, opportunities to network, donate and serve the
profession as well as prepare for holiday shopping via a
silent auction. Although it was a festive celebration to
honor all professionals, the “Nurse of the Year,” a relatively
new initiative in its second year, was honored at the gala.
In preparation, candidates were selected by professional
nurse colleagues with a minimum donation of $25.00. Of
all the nominees, five were most highly recommended,
and of those five, one was selected by the INF Board to be
honored. The forthcoming gala is already scheduled for
December 7, 2019, at the Hilton Hotel in Lisle, IL. Do not
forget to mark the special date on your calendar.
Moreover, although not widely known, INF provides
opportunities to donate funds for colleagues who are
in financial crisis, illness or encounter other personal
tragedy. All contributions to the INF are deductible. For
more information, donors may contact INF at 815-468-
8804 or check the website for further information.
Also, a beautiful unprecedented tribute honoring the
life and legacy of Dr. Mary Lebold, who lived to serve
so many of us throughout her professional life was
presented at the gala. Dr. Lebold’s caring, compassionate,
innovative research, as an educator and administrator
were freely shared with all of us who served with her.
Guests affirmed that we will always remember Dr.
Lebold’s life as making an indelible impact and blessing to
us and our profession.
Finally, dear Colleagues, as an active long-term
member of our professional organization for over 62
years, I am thankful to be able to share these news items
and continue serving you and our profession in this new
year of 2019. I trust you will find these pages of NURSING
VOICE enriching, stimulating and rewarding toward your
future involvement in the initiatives of your profession.
Alma J. Labunski, Ph.D., M.S., R.N.; Director, former
Vice-President IL Nurses Foundation; Editor Emeritus
NURSING VOICE; ANA-IL Program Committee; INF Fund
Raising Committee; Consultant, Educational Challenges
Within a Global Culture; Retired Dean and Professor,
North Park University, Chicago, IL
NursingALD.com can point you
right to that perfect NURSING JOB!
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INF Board of Directors
Cheryl Anema PhD, RN ..........................President
Brandon Hauer MSN, RN ....................Vice President
Cathy Neuman MSN, RN .........................Secretary
Karen Egenes EdD, RN ...........................Treasurer
Maria Connolly PhD, RN, CNE, FCCM, ANEF
Maureen Shekleton PhD, RN, DPNAP, FAAN
Alma Labunski PhD, MS, RN
Linda Olson PhD, RN, NEA-BC
Melissa Bogle DNP, APRN, FNP-BC, ACNP-BC
Linda Doling MSN, RN
ANA-Illinois Board Rep
Karen Egenes EdD, RN
Kathryn Serbin DNP, MS, RN
Bonnie Salvetti BSN, RN
ANA-Illinois Board of Directors
Dan Fraczkowski, MSN, RN-BC ....................President
Karen Egenes EdD, MSN, MA, RN. . . . . . . . . . . . . . .Vice President
Pam Brown, PhD, RN, ANEF ......................Treasurer
Kathryn Serbin, DNP, MS, BSN, CCM ...............Secretary
Lauren Martin, RN, CEN
Colleen Morley, MSN, RN, CMCN, ACM
Crystal Vasquez, DNP, MS, MBA, RN, NEA-BC
Kathryn Weigel, MS, RN, GCNS
Stephanie Yohannan, DNP, MBA, RN, NE-BC
Alma Labunski, PhD, MS, RN
Lisa Anderson-Shaw, DrPH, MA, MSN
Karen Mayville, MSN, PhD, RN
Kathy Long-Martin, BSN, MSN, RN
Linda Olson, PhD, RN, NEA-BC
Lisa Hernandez, DNP, RN, CENP
Nancy Brent, RN, MS, JD
Susan Y. Swart, EdD, RN, CAE
ANA-Illinois/Illinois Nurses Foundation
• Subject to editing by the INF Executive Director & Editorial
• Electronic submissions ONLY as an attachment (word
• Email: email@example.com
• Subject Line: Nursing Voice Submission: Name of the article
• Must include the name of the author and a title.
• INF reserves the right to pull or edit any article / news
submission for space and availability and/or deadlines
• If requested, notification will be given to authors once the
final draft of the Nursing Voice has been submitted.
• INF does not accept monetary payment for articles.
Article submissions, deadline information and all other
inquiries regarding the Nursing Voice please email:
Article Submission Dates (submissions by end of the business day)
January 15th, April 15th, July 15th, October 15th
Advertising: for advertising rates and information please contact
Arthur L. Davis Publishing Agency, Inc., 517 Washington Street,
P.O. Box 216, Cedar Falls, Iowa 50613 (800-626-4081), sales@
aldpub.com. ANA-Illinois 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 ANA-Illinois and Illinois Nurses Foundation
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. ANA-Illinois 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
ANA-Illinois or those of the national or local associations.
The Nursing Voice March 2019 Page 3
INF Holiday Gala continued from page 1
new Stroke Nurse Certification. She is a Founding Member of the Midwest Stroke
Action Alliance & past facilitator of Midwest stroke coordinators and supporting
The INF strives to continue evolving and making this event a MUST ATTEND for all
those in the nursing profession and its supporters. A very special thank-you to each
of our major sponsors and our many donors, as well as the volunteers who worked
to make this event a success. Thank you for all that you do to support Illinois Nurses
ANA PRESIDENT'S MESSAGE
The healthcare environment is rapidly changing, as new
care technologies emerge, while state and federal policies and
priorities fluctuate. Amidst never-ending change, public trust
of nurses remains unwavering. At the end of 2018, the Gallup
Organization released its annual ranking of the most trusted
professions in America as determined by the public. For the
17th year in a row, nurses were at the top of the list. However,
trust alone cannot advance the interests of our patients and
the profession. We must transform our collective voices into
This year we have numerous opportunities to act. ANA
partnered with the Health Information Management Systems
Society (HIMSS), a health-IT non-profit association to host
NursePitch at their annual conference in February. This
startup competition was created to increase the voice and visibility of nurse-led and
nurse developed innovation in the digital health ecosystem. Funding was provided to
I hope you can join us this year in Springfield, Illinois for advocacy in action as we
lobby legislators on Tuesday, April 2nd, for Student Nurse Political Action Day, or
Wednesday, April 3rd for Nurse Lobby Day, registration is available online.
It is also essential that we recognize nurses of all types, LPN’s, RN’s and APRN’s who
are doing outstanding work to advance the profession in Illinois. Nominations for the
annual Illinois Nurses Foundation 40 under 40 Emerging Nurse Leader Award will soon
be underway. I encourage you to nominate a colleague who is under the age of 40,
demonstrates exemplary professional practice and also makes an impact outside of the
workplace. Visit www.illinoisnurses.foundation to learn more or nominate a nurse.
With spring fast approaching, our Healthy Nurse Healthy Nation Activities will
resume, and our first event, the Shamrock Shuffle takes place in Downtown Chicago on
Sunday, March 24th. There will a two mile walk, or 8k, and we hope you can participate
with us at the event. Don’t forget to request to join our Healthy Nurse Healthy Nation
Facebook page and watch your email for more upcoming events.
Finally, before you know it, Nurses Week will be here. The theme for 2019 is “4
Million Reasons to Celebrate,” recognizing the milestone numbers of nurses. If your
organization is seeking a speaker, please reach out.
Thank you for all you do on behalf of our patients and the profession.
Dan Fraczkowski MSN, RN-BC
President – ANA-Illinois
Call for Article Submission
Submit your article or research for publication in the Illinois Nurses Foundation
(INF) quarterly print publication. The Nursing Voice is mailed to all 195,000+ RNs
in the state. The INF and ANA-Illinois welcomes submission of nursing and health
related news items and original articles. We encourage short summaries and brief
abstracts for research or scholarly contributions with an emphasis on application.
To promote inclusion of submitted articles, please review the Article guidelines
available on the INF website at www.ana-illinois.org/news-events/publications. An
“article for reprint” may be considered if accompanied by written permission from
the author and/or publisher as needed. Authors do not need to be ANA-Illinois
members. Submission of articles constitutes agreement to allow changes made by
editorial staff and publishers. See Article Guidelines for more information. Submit
your articles to firstname.lastname@example.org
Page 4 March 2019 The Nursing Voice
On March 22, 2019 the Illinois Organization for
Associate Degree Nursing will be hosting Legal Hot Topics
for Nursing Program Academic Administrators and Faculty
at Heartland Community College.
This program is applicable to any faculty member or
coordinator of a health career program.
Some presentation topics will include:
• An overview of higher education student due
• Student discipline policy considerations and
• Legal considerations governing student use of
• Accommodating students with disabilities.
Presenter Emily P. Bothfeld, Attorney, Robbins Schwartz
Date: March 22, 2019
Location: Heartland Community College, 1500 W Raab
Rd., Normal, IL 61761
Cost: $90 IOADN member
$110 at door
5 CE hours will be awarded.
To register please submit the following information along
with a check payable to IOADN.
Send registration to: Kankakee Community College,
Attention Kellee Hayes, 100 College Drive, Kankakee, IL 60901
Michael Almeida CRNA, President-Elect IANA
2018 was a big year for the Illinois Association of
Nurse Anesthetists and 2019 looks to be no different.
2019 will be the IANA’s 80th anniversary and we look
to celebrate this at our Spring and Fall conferences
which will be held in Champaign on May 18th and in
Chicago at Northwestern Memorial Hospital September
14th-15th. Make sure to visit our website ILcrna.com
for more details! The mission statement of the IANA is
“Promote and support the profession of nurse anesthesia
in Illinois through health policy advocacy, education
and transformational leadership to advance patient
safety and access to quality care.” The IANA’s priority
is to focus on each one of these aspects of our mission
statement. We start by promoting and supporting the
profession through increasing grass roots effort while
improving our social media presence. This year we
began by forming a successfully ran public relations
committee and completely revamping our website to
provide everyone throughout the state easily accessible
information about Nurse Anesthetists. In January we
celebrate National Nurse Anesthetist week and have
done so by placing billboards for the public to see our
message. 2018’s billboard was in Springfield and this
THANK YOU TO OUR GENEROUS
SPONSORS AND DONORS
year it is located near O’hare on interstate 294 for the
months of January and February. The IANA’s annual
lobby day in 2018 saw more than 80 CRNA’s and student
nurse anesthetists attend. We look to continue to grow
this number in 2019 and beyond. We celebrate with all
other APRN specialties on the passing of the changes to
the Nurse Practice Act, however, look to include Nurse
Anesthetists in the list of APRN specialties to achieve full
practice authority in Illinois. Access to care is another
important aspect of our mission and for the people of
Illinois, remains a top priority of ours. CRNA’s are the
primary anesthesia provider in 89% of counties in Illinois
and the only anesthesia provider in 29% of counties in
Illinois. It is imperative that any legislation that looks to
restrict the practice of ICRNAs not gain any traction as
this would only harm the citizens of our state, particularly
in the rural and critical access hospitals. The last part of
our mission is to advance patient safety and focus on
education. We are extremely proud that in Illinois we
have five Nurse Anesthesia Programs throughout the
state that continue to advance the field of anesthesia.
Each one of these are now entry level Doctoral programs.
Please visit our website for more information or contact
us directly with any questions. On behalf of the IANA, I
wish you and your loved ones a healthy and happy 2019!
Nationally Presented By:
St. Xavier University School of Nursing
Ruthann & Lawrence Sanders
Smits Funeral Home
Stepping Stones – Clint Verhagen
Walter Schultz Insurance
Locally Presented By:
to join our team.
EXPERIENCE THE DIFFERENCE
of a Mission-driven culture.
OSF nurses are valued as true Mission Partners, serving
our patients, and each other, with the greatest care and
love. Experience why Forbes ranked OSF HealthCare the
Best Employer in Illinois.
Positions are available throughout Illinois.
Learn more and
apply online at
Maureen & Jerry Shekleton
Rush University Medical Center
St. Xavier University School of Nursing
Olivet Nazarene University
Marcella Niehoff School of Nursing
SYS Consulting Solutions
Silent Auction Donors
PRP Wine International
Paintball & Laser Tag Explosion
Lock Chicago – Escape Room
Hidden Lake Winery
Chicago Skydive Center & Flight Deck
Par A Dice Hotel/Casino – Peoria
Chicago White Sox
Gizmo’s Fun Factory
Art & Company
Enchanted Castle Rest & Entertainment
Fox Bowl – Wheaton
Chick-fil-A – Orland
Bolingbrook Golf Club
Springhill Suites – Peoria Westlake
Perfect North Slopes
Round the Clock Restaurant
The Open Bottle
Lisa Thomas Salon
Tin Fish Restaurant
Aveda Institute – Cosmetology
Lettuce Entertain You
Ark Encounter/Creation Museum
Holiday World – Santa Claus, IN
Windy City Thunderbolts
St. Louis Gateway Arch
Kane County Cougars Baseball
Buffalo Wild Wings
Comedy Sportz Chicago
Outback – Orland Park
Rock Bottom Restaurant
Topgolf – Naperville
Walts Food Center
Cooper’s Hawk Winery
Chicago Wolves Hockey
Glenwood Oaks Restaurant
Light it Up
Mary Jo Shepard
Aurelios South Holland
Damsel in Defence
Lou Malnatis Pizzeria
Oriental Trading Company
City BBQ – Orland
Chili’s – Dyer
The Nursing Voice March 2019 Page 5
This year, the Student Nurses Association of Illinois
(SNAI) is encouraging students to be more involved by
going to high schools and colleges to talk more about
what they are and how they can be involved. They
have also started the ‘Pay It Forward’ movement. This
movement is centered on inspiring positivity in others
and encouraging them to brighten someone else’s day. To
achieve this, individuals are presented a two-sided card
with one side containing a positive message and request
to pass the sentiment along and the other side providing
a description of the movement (see image). SNAI would
like to thank Muroo Hamed of Chamberlain University
Addison for sharing her wonderful idea with her local
Student Nurses Association and with SNAI. To broaden
the impact of this movement, SNAI is planning themed
monthly postings to demonstrate various other ways in
which nursing students can “Pay It Forward.” If you or
your organization would like to join the movement, be on
the lookout for the upcoming SNAI video on how you can
put the “Pay It Forward” movement into action in your
Everything happens for a reason,
sometimes it just takes time to find yours.
Be the reason three people smile today.
An example of a pre-filled SNAI Pay It Forward (PIF) movement card. The cards will have empty spaces
on the back where members can place a motivational phrase and a way people can pay it forward.
The Chicago chapter of the Case Management
Society of America (CMSA Chicago) is excited to
join ANA-IL as part of the consortium of nursing/
healthcare organizations working collaboratively to
support our profession. CMSA is the leading, oldest,
and largest membership association providing
professional collaboration and education across the
healthcare continuum. CMSA facilitates the growth
and development of professional case managers across
the full health care continuum, promoting high quality,
ethical practice benefitting patients and their families.
We strive for improved health outcomes by providing
evidence-based resources, impacting health care policy
and sustaining the CMSA-developed Standards of Practice
for Case Management.
CMSA Chicago’s largest event of the year is our local
annul conference, It’s Not Luck, It’s Skill, which we will
host at Drury Lane in Oak Brook on April 11, 2019 from
7:30a.m. – 5:00p.m. Come and earn seven CE’s for RNs
and CCMs, and enjoy a day packed with networking,
learning and fun. For more information visit our website:
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Page 6 March 2019 The Nursing Voice
What are the changes in the nursing workforce in
Illinois? Are there nursing specialties that are more in
demand than others? The Illinois Nursing Workforce
Center (INWC) collected data with RN on-line license
renewal that ended May 31, 2018. The report, executive
summary, and talking points are available on the INWC
website http://nusing.illinois.gov, tab: Data/Reports.
In general, the 2018 survey results are similar to those
collected during the 2016 RN on-line license renewal,
trends and differences are highlighted in the report.
Data on the characteristics, supply and distribution
of RNs in the State of Illinois is essential to maintaining
access to health care and planning for the provision of
essential primary care and other health services. This
report contains data on the demographics of the current
RN workforce, the relative numbers of RNs in each age
group, their cultural diversity, educational preparation,
and specialty practice area. Based on these findings,
issues and concerns around the capacity, distribution and
diversity of the nursing workforce are identified.
Aging workforce: The report presents important
information about the aging of the RN workforce. In
2018, 52% of respondents are 55 years or older, which
although only a 2% increase since 2016 is approximately
10% increase in this cohort of Illinois RNs since 2014. The
The Illinois Nursing Workforce Center
RN Workforce Report
relatively rapid increase in RNs in older age categories
has significant implications for workforce planning.
Similar to 2016, approximately 27% of the respondents
indicated intent to retire within the next five years. This
combination of aging workforce and retirement plans
indicate the potential of an impending nursing shortage
within the next five years.
Diversity: Consistent with the increase in cultural and
racial diversity in Illinois, data indicated a slight increase
in the cultural diversity of the RN workforce in select
groups of the younger cohorts. For those identifying
as Hispanic/Latino, 32% are younger than age 36 years,
while only 6% are over age 55 years. In the multiracial
category, 27% are 35 years of age or younger, while 11%
are over the age of 65 years. The increase in younger age
cohorts did not hold true for all age groups, 9% of Black/
African American respondents reported being younger
than 35 years, compared to the 17% in those over 65
years. White females with initial licensure in the U.S.
constitute a substantial majority, approximately 80% of
Specialty foci: The respondents reported
employment in these top five nursing specialties:
acute care specialties, family focus, medical, surgical
and community-health promotion. The data also
demonstrated the distribution of nurses in specialties
by age cohorts, revealing significantly fewer younger
nurses in specialties such as psychiatric mental-health,
school, home health, gerontology, and community health
nursing. These trends stand in contrast to the Illinois
report, The Workforce Implications of New Health Care
Models (2014), which forecasts a significant increase in
ambulatory services, as well as a concomitant need for
RNs to practice in community-based models of care.
Past reports show that the Illinois nursing workforce
shares many characteristics of our national picture:
approximately 40% of nurses are 55+ years old and
one third intend to retire in the next five to ten years.
Collectively, the 2018 Illinois Registered Nurse (RN)
workforce survey is a useful resource as health care
planners project the human health care capital that will
be needed in Illinois. The information will allow the Illinois
Nursing Workforce Center (INWC) to address questions
around the current RN supply, and if it will be adequate
to meet the health care needs of Illinois citizens. Health
care workforce planners should use these data to help
determine what types of RN (e.g. specialty) will be in
greatest demand, in what locales, as well as the types of
specialties and skills that will be required in future models
Online Resources – Print a copy of your
license, update your address, and more
To print a copy of your license or store a copy on your
smartphone or tablet, go to the Illinois Department of
Financial and Professional Regulation website https://
The icon on the far left, “Get My License,” opens to a
page with three options. Click on “Licensed Professionals”
Register Today...Volunteer Tomorrow
By registering with Illinois
HELPS, the Illinois Emergency
System for Advance
Registration of Volunteer Health
By registering with Illinois Professionals HELPS, the (ESAR-VHP), Illinois
Emergency System for Advance you can be a Registration
part of an alert
system and be the first to
of Volunteer Health Professionals (ESARrespond
to a significant disaster
VHP), you can be a part or of public an alert health system emergency.
and be the first to respond to a significant
disaster or public health Once emergency. you have registered Once
you have registered to become a volunteer,
professional credentials will be
your professional credentials verified and will your be information
verified and your information will become will part become
of the secure
part of the secure statewide database of of volunteer
Register Register Now!
(the middle option), an opportunity to print a free copy
of your license. Licensees only need to provide their
individual license number and either date of birth or last
four digits of social security number.
For licensees interested in storing an electronic license
pocket card on their smartphone or tablet, the link is at
the bottom of this same page, “Electronic Pocket Card
Overview.” Electronic pocket cards may be saved as a PDF
file or by taking a screenshot and storing as a photo.
Please note that all IDFPR correspondence are now
delivered electronically, including renewal reminders
(in lieu of the paper postcard). Licensees are strongly
encouraged to visit IDFPR’s online address change
LicenseReprint/) to provide a current email address and
ensure contact information is up-to-date and accurate.
Change of name CANNOT be completed via this
online process. If your name has changed, you must
submit a written notice to the Department and include
documentation of the name change (marriage license,
court order, or divorce decree). For a copy of the written
notice, please use this link https://www.idfpr.com/Forms/
If you have questions, assistance is available Monday
through Friday by contacting the IDFPR call center at:
1-800-560-6420; or by email at: FPR.PRFGROUP09@
A Promising Year
for the Illinois
The Illinois Organization of Nurse Leaders has developed
a strategic plan through 2020 that will help guide nurses in
advancing leadership and education throughout the year. By
offering programming that teaches specific skillsets crucial
for success in the current world of Illinois healthcare, as
well as providing timely discussions and policy statements
regarding healthcare policy on the national level, IONL is
consistently focused on the future of nursing.
New this year, IONL will be focusing its educational
efforts on exciting tracks that will be held in conjunction
with its Annual Conference, September 19-20 in
Oak Brook, Illinois. These tracks include the Finance
Workshop, Midwest Institute for Healthcare Leadership,
and the Aspiring Nurse Leaders Workshop.
In addition to these in-person workshops, IONL
is dedicated to enhancing education through the
informative NC-3 live webinars that take place each
month, free for IONL members and $40 for nonmembers.
Our February 4 webinar, “Happiness – The
Highest Form of Health” will teach the importance of
personal well-being and its impact on productivity,
engagement and performance. Need more CE credits?
Take advantage of the new IONL Digital Library, a
database of over 30 archived webinars, available as yearly
subscriptions for individuals or organizations, providing
CE from anywhere at any time.
In addition to in-person and remote educational
opportunities, IONL is also committed to providing
opportunities for nurses to build their networks
with fellow healthcare leaders and find mentors and
collaborators to work with. The IONL Fellowship Program
connects nurses from throughout the State of Illinois
with experienced educators to build leadership skills.
Additionally, IONL’s regional events provide the perfect
opportunity to connect with other local nurses in
your area. Many members attribute their success to a
connection they’ve made at one of IONL’s networking
events, and you could be next!
For more information on these opportunities and IONL
membership, visit www.ionl.org.
The Nursing Voice March 2019 Page 7
Indian Nurses Association of Illinois’ Trifold
Design served many - An activity update
The Indian Nurses Association of Illinois (INAI) mission
is to serve as a professional body to identify and meet
the professional, educational, cultural and social needs
unique to nurses of Indian origin and heritage.
INAI professional development, community outreach,
and charity initiatives served many people including
the nurses in Illinois and the local and international
community,” said Association’s President Beena
Vallikalam. Beena and the team crafted a trifold activity
design to effectively provide activities to benefit
nurses and the community. The activities included
professional specialty conferences, free and discounted
rate continuing education sessions, workshops, career
development opportunities, community outreach,
interdisciplinary collaboration, mentoring programs,
professional recognition, participation in medical
missions, response to calamities, charity contributions,
participation in legislative initiatives, encouraged
membership in the Association, organized social events,
encouraged community relations, and empowered
The professional development activities were also
crafted in a trifold design- clinical, community and
APRN tracks. Two APRN Pharmacology conferences, a
Cardiology conference, a Physical Assessment Workshop,
and informational seminars were the highlights of the
professional track. Participants received a total of 25
CEs for these sessions. Nurses were recognized for their
clinical excellence, leadership and advanced practice
registered nurse roles. Their contributions during
Nurses’ Day and APRN Week celebrations were also
INAI maintained its alliance with universities and CE
providers for tuition discounts. Members also presented
topics on regional and national platforms.
The Association’s commitment to the community was
evidenced by outreach programs such as the Friends and
Family CPR Series and health fairs. INAI conducted these
series in four different venues. The series provided an
opportunity to create an awareness of heart diseases
and to teach CPR. The Health Fair served 150 people
and included screening for vision, blood pressure, and
diabetes, mini-presentations on GI disorders, stroke,
diabetes, cardiac arrest, sleep apnea, breast examination,
and advance directives.
During its 2017-2018 term, the INAI was recognized for
its service to the community by the Government of Cook
INAI has reached out to the victims of natural
calamities in United States and India and has participated
in charity missions. As a member association of National
Indian Nurses Association of America (NAINA), INAI
participated in all educational and community outreach
programs. INAI contributed toward the medical missions
in India and Haiti through NAINA. INAI has also been
significantly supportive to the cleft lip and palate repair
and cataract treatment programs.
INAI has been working in close alignment with the
American Nurses Association-Illinois (ANA-IL) and is
a proud active partner of the ICNO (Illinois Coalition
of Nursing Organizations). INAI continues to show
its valuable presence in the community and among
nurses of Indian origin and their professional peers. The
Association welcomes all nurses to join its activities and
urges them to become proud partners in fulfilling its
multifaceted goals and actions.
Executive Board (2017-2018): Beena Vallikalam
(President), Mary Xavier (Executive Vice President), Rani
Kappen (Vice President), Sunina Chacko (Secretary), Lisy
Peters (Treasurer), Dr.Simi Jesto Joseph (APRN track), Dr.
Susan Mathew (clinical track).
Nurses want to provide quality care
for their patients.
The Nurses Political Action Committee (Nurses- PAC) makes sure
Springfield gives them the resources to do that.
Help the Nurses-PAC, help YOU!
So. . . . . . . if you think nurses need more visibility
. . . . . . . . . if you think nurses united can speak more
effectively in the political arena
. . . . . . . . . if you think involvement in the political
process is every citizen’s responsibility.
Become a Nurses-PAC contributor TODAY!
I wish to make my contribution via personal check
(Make check payable to Nurses-PAC).
I wish to make a monthly contribution to Nurses-
PAC via my checking account. By signing this
form, I authorize the charge of the specified
amount payable to Nurses-PAC be withdrawn from
my account on or after the 15th of each month.
(PLEASE INCLUDE A VOIDED CHECK WITH
I wish to make my monthly Nurses-PAC contribution
via credit card. By signing this form, I authorize the
charge of the specified contribution to Nurses-PAC
on or after the 15th of each month.
I wish to make my annual lump sum Nurses-PAC
contribution via a credit or debit card. By signing
this form, I authorize ANA-Illinois to charge the
specified contribution to Nurses-PAC via a ONE
TIME credit/debit card charge.
❑ Mastercard ❑ VISA
________________________ ____________ _________
Credit card number Expires CVV
City, State, Zip Code:_____________________________
Preferred Phone Number:__________________________
Please mail completed form & check to:
PO Box 636
Manteno, Illinois 60950
Page 8 March 2019 The Nursing Voice
At a recent nursing meeting that I attended I asked nurses to pair up and role play
the following: “Your neighbor has just asked you - so what IS climate change?” Each
nurse had to take a turn with a partner and answer that question, as though she/he
were telling her neighbor the answer. After completing the role play, I asked how many
of the nurses were able to answer that question with a high level of confidence and
only about 10% raised their hands. When I ask how many could answer with reasonable
confidence only another 10% raised their hands. How about you, would you feel
confident answering the question? What everyone discovered from this activity was
how unprepared many nurses are to talk about what climate change is. While nurses
are more familiar with what climate change seems to be causing, such as more extreme
weather events, sea level rise, and extensive wildfires, a large portion are unable to
explain what climate change is in simple terms.
So here is a little primer:
The earth’s temperature has historically been modulated by the sun’s rays beating
down, warming the land and water, and then radiating heat back out beyond the earth’s
atmosphere. This process has kept the earth at a livable temperature for humans and
other lifeforms to flourish.
However, we now
have a “blanket”
of gases that are
earth, gases created
substantially by human
activities such as
agriculture. (See the
image below) These
gases are called
because they create the
same warming effect
as a greenhouse and
are slowly warming the
earth – both the land and particularly the oceans. And in the process, they are changing
our climate. Climate is distinguished from weather in that weather is what occurs from
day to day or week to week, but climate is what occurs
over longer periods of time, month to month and year
The process is a bit like what happens to your car
when you leave it outside in the sun with the windows
up. The sun’s rays heat the inside of the car and that
heat cannot adequately escape, so the car heats up.
Just as there is a small range of body temperatures
at which humans can be healthy, the same is true for
all species on earth. When human temperatures rise
from 98.6 to 100.4 degrees it means the difference
from feeling fine to having a fever and not feeling well.
When our temperatures get even higher we begin to
see bodily system distress and damage. What happens
when the earth has a fever?
As the earth warms, we are beginning to see shifts
in climate which are resulting in some areas seeing
much more rain and others much less, some colder
So what IS climate change?
winters, some hotter
As we encounter
more extreme heat
days and extended
heat waves, we are
going to see many
illnesses and even
deaths in humans.
People who work
outside in agriculture,
gas/oil, and many
other fields will be
at higher risk for
of course, extreme
storms and wildfires have been taking an enormous toll on human and ecological
Changes to the earth’s climate can have irreversible effects on plants, including our
agricultural food crops. Rising ocean temperatures is affecting plankton which is the
foundation of the food chain for fish and sea mammals. An estimated billion people
are dependent on fish as their main source of protein. In addition to interrupting the
world’s food supply, there are a great many other health threats that are associated
with the changes we are seeing. For an extensive list of how climate change affects
human health, visit https://bit.ly/2qNLNtW.
While there are some natural sources of greenhouse gases, the ones that we
have the most capacity to reduce are those that are manmade. As individuals we can
assess our household’s contribution to greenhouse gases by using a “carbon footprint
calculator,” such as this one from the U.S. Environmental Protection Agency: https://bit.
ly/1XIc9pa. As nurses, we can help promote climate healthy purchasing and practices in
our health care facilities, K – 12 schools, faith-based organizations, universities, and any
other settings in which we have influence.
The new International Council of Nurses (which ANA is a member of) announced its new
position statement on climate change in September 2018 and calls on all nurses to help
address climate change (see: https://www.icn.ch/sites/default/files/inline-files/PS_E_
Nurses_climate%20change_health.pdf). It calls for us to heed the scientific evidence
which, in the case of climate change, is abundant.
We must be able to talk about this issue with
a degree of confidence and we must engage both
individually and as a profession to advocate for policies
and practices that will decrease greenhouse gas
production from a wide range of its sources. The truth
is climate change is a health issue and that’s what we
nurses are all about.
For more resources on climate change and health,
including nurse-focused guides and webinars, visit the
Alliance of Nurses for Healthy Environments Climate
and Health Toolkit: climateandhealthtoolkit.org. To join
our free monthly calls on Climate Change and Nursing
please email the authors.
Authors: Barbara Sattler, RN, DrPH, FAAN, Professor,
University of San Francisco, email@example.com
and Cara Cook, MS, RN, AHN-BC, Climate Change
Program Coordinator, Alliance of Nurses for Healthy
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The Nursing Voice March 2019 Page 9
ANA-Illinois Expert Panel Workplace
Safety Survey 5: Staffing
Pamela Brown, Ph.D., RN, ANEF
First, I want to thank all of you who responded to
Survey 5: Staffing. The response was very gratifying
and made the results more powerful. I also invite you
to send your staffing related stories to ANA-Illinois, as
stories deliver a greater impact than numbers. Over 700
nurses responded to Survey 5, with 75% of respondents
indicating they provide direct patient care, and 80%
indicating they have access to continuing education
offerings, specific to patient care, provided by their
employer. This group is predominantly female (91%),
between 26-39 years of age 49%). Most live (54%) and
work (46%) in urban and suburban areas, earn over
$50,000 (83%) annually, and have a BSN or higher degree
(77%). The majority work 12-hour shifts (66%) on days
(55%). Most (56%) work on Medical-Surgical and higher
acuity Medical-Surgical units.
Only 27% of respondents reported working in a facility
that has a Staffing Committee, and only 18% report that
the staffing plan is being used on their unit. Most (73%)
report that they are not sure (37%) or they do not have
(36%) a Staffing Committee, and predominantly (81%)
report that the staffing plan is not used (36%) or they are
not sure (45%) if their unit uses the staffing plan.
Respondents reported being responsible for an
average of 10 patients per shift, with an average of four
additional admissions, transfers, and/or discharges. Other
added responsibilities included: being charge nurse or
team leader (25%), preceptor/teacher (16%), part of the
code or rapid response team (10%) and providing consults
or procedures (5%) for other nurses. Most (75%) work
through their break time and most (63%) work overtime.
The majority (55%) report their workload as higher than
they are comfortable with.
Respondents predominantly (79%) report having
discussions about staffing at least weekly (78%) with 25%
having discussions daily. Over the past month this group
reported experiencing “dangerous” staffing levels 33%
of the time. When asked if it was safe to report staffing
concerns, almost 70% reported feeling safe (69%) to
report concerns and 31% feeling unsafe. The majority
(57%) reports they have enough qualified staff to handle
the number of assigned patients, with 40% indicating they
Linda Olson Stepping Stone
Thank you for our 2018 Donors
P. Joan Larsen
Walter W. Shultz Agency Inc.
do not have enough qualified staff. Over 60% of nurses
feel they rarely (46%) or never (18%) feel unqualified to
care for patients with specialized equipment or certain
conditions. Solutions during short staffing include nurses
taking a heavier load (85%), use of float nurses (55%),
nurses volunteering for overtime (51%), managers/
supervisors fill in (25%), pulling in agency nurses (20%),
and altering routine (19%) care.
1. It is past time to listen carefully to bedside
nurses about staffing issues and include them in
2. Illinois has legislation in place that requires
staffing committees to create staffing plans
based on patient acuity. These committees are
mandated to include bedside nurses. According to
over 70% of bedside nurses, the plans are not in
existence or are not being used.
3. Bedside nurses report working in “dangerous”
staffing levels over 30% of the time.
4. Bedside nurses (63%) consistently work overtime
and work through their break times (75%).
5. Bedside nurses (55%) report that their workload
is consistently higher than they are comfortable
1. Share results of this survey to raise awareness of
2. Collaborate with IONL to plan staffing summits
3. Assess legislation from other states and ANA
policies for ways to increase accountability of
4. Further explore how bedside nurses cope with low
staffing issues, and what are the ramifications of
work-arounds, or short cuts.
5. Further explore the relationship between staffing
6. Further explore the ratio of novice nurses to
experienced nurses on units, and how that affects
staffing and retention.
Dr. Patrick Durbin
Kevin & Mary Kelly
Mary Eileen Kloster
Smits Funeral Homes, Ltd
Woundcare on Wheels, Inc
Dorothy Stratman Lucey
Chapter of Chi
Eta Phi Sorority
Toni L. Oats, BSN, RN, President
Chi Eta Phi Sorority, Incorporated, is an international
sorority of professional nurses and nursing students.
The nursing sorority was established in Washington DC
at Freedman’s Hospital in 1932 and has a membership
of more than 4,000 nurses. There are 90 Graduate
Chapters and 40 Undergraduate Chapters in the
United States including the Virgin Islands. Chi Eta
Phi Sorority is a recognized leader in “Developing
Healthy Communities through Advocacy, Collaboration,
Education, Leadership, Research and Service.”
On March 31, 2018, Alpha Eta Chapter,
Incorporated, of the Chicago Chapter of Chi Eta Phi
Sorority, Incorporated, hosted its 30th Annual Robert
Reid Scholarship Fundraiser Luncheon at the Hilton Oak
Lawn in Oak Lawn, IL. The luncheon is named in honor
of Mr. Robert Reid who was the first black male nurse
to join Alpha Eta Chapter, Incorporated and Chi Eta Phi
Sorority, Incorporated. Charted in May 1980, Alpha
Eta Chapter, Incorporated, has given over $75,000.00
in scholarships in the last 30 years to nursing students
enrolled in AAS, BSN and MSN nursing programs. To
purchase tickets for the March 31, 2019 luncheon and
to learn more about Alpha Eta Chapter, Incorporated,
visit our website at alphaeta-chietaphi.org.
From July 7-13, 2019, Alpha Eta Chapter,
Incorporated along with the chapters from
Waukegan, Illinois, Nu Phi Chapter, Incorporated,
and from Milwaukee, Wisconsin, Theta Chi Chi
Chapter, Incorporated, will be supporting Chi Eta Phi
Sorority, Incorporated’s biennial national educational
conference. The Conference will be held at the
Westin in Lombard, Illinois. For additional information
regarding registration, vendor opportunities and
sponsorship, visit the national website at www.
Through the generous donations of
individuals, we honor the following nurses:
2018 In Honor Donations
Jennifer M. Grenier
Christine R. Durbin
To access electronic copies of the
Illinois Nursing Voice, please visit
2018 Memorial Donations
Mary M. Lebold
Page 10 March 2019 The Nursing Voice
Self-Advocacy Skills for Nurses: Dealing with Incivility,
Bullying and Workplace Violence Part I
Ann O’Sullivan, MSN, RN, CNE, NE-BC, ANEF
Karen Kelly, EdD, RN, NEA-BC
Determine causes and effects of verbal violence and
Demonstrate strategies to respond to verbal violence.
Identify resources to use in the workplace to reduce
This continuing education article is the first in a
two-part series on Dealing with Incivility, Bullying and
Workplace Violence. Part 1 discusses the definition,
causes, prevalence, costs and effects of incivility, bullying
and workplace violence. Part 2 will be published in the
July edition of The Voice and will discuss strategies and
resources to respond and reduce workplace violence.
The American Nurses Association (ANA) declared 2018
The Year of Advocacy. Advocacy is defined as the act or
process of pleading for, supporting, or recommending a
cause or course of action. Advocacy may be for persons
or for an issue. (ANA, 2015). Every day, in countless large
and small ways, nurses make the world a better place.
These moments of everyday advocacy we change the
lives of vulnerable people and improve conditions for
those around us. Nurses inspire, innovate, and influence
at the bedside and beyond.
1.0 Contact Hours
This offering expires in 2 years:
February 25, 2021
80% of those reading the article and completing
the post-test, the nurse will be able to describe
the causes and effects of workplace violence, use
effective strategies to respond to workplace violence
and identify one or more resources to use to reduce
violence in the workplace.
HOW TO EARN
CONTINUING EDUCATION CREDIT
This course is 1.0 Contact Hours
1. Read the Continuing Education Article
2. Go to https://www.surveymonkey.com/r/22192 to
complete the test and evaluation. This link is also
available on the INF website www.illinoisnurses.
foundation under programs.
3. Submit payment online.
4. After the test is graded, the CE certificate will be
emailed to you.
HARD COPY TEST MAY BE DOWNLOADED via the
INF website www.illinoisnurses.foundation under
TEST AND EVALUATION MUST BE COMPLETED BY
February 25, 2021
Complete online payment of processing fee as
ANA-Illinois members- $8.00
To earn 1.0 contact hours of continuing education,
you must achieve a score of 80%
If you do not pass the test, you may take it again at
no additional charge
Certificates indicating successful completion of this
offering will be emailed to you.
The planners and faculty have declared no conflict
This continuing nursing education activity
was approved by the Ohio Nurses Association,
an accredited approver by the American Nurses
Credentialing Center’s Commission on Accreditation.
CE quiz, evaluation, and payment are available
online at https://www.surveymonkey.com/r/22192
or via the INF website www.illinoisnurses.foundation
Nurses must also advocate for themselves.
How do we improve our work life?
How do we advocate for our self to stop bullying and
How do we empower ourselves?
We must start with advocating for ourselves before
we can fully influence the direction of the profession and
Many Names…Same Issue
The issues of bullying and workplace violence have
many names: behaviors undermining a culture of safety;
workplace conflict; lateral/horizontal violence; workplace
abuse; bullying; mobbing; incivility; disruptive behavior;
nurses eat their young; hazing, and more. No matter what
we name this behavior — it creates a work environment
that a reasonable person would find intimidating,
threatening, violent or abusive and it affects a person’s
psychological or physical wellbeing.
Bullying can be defined as intentional, repetitive,
intimidating behavior or repeated unwanted
psychological, physical, or sexual abuse, or harassment.
Incivility comprises a wide range of behavior others
experience as disrespectful, thoughtless, or rude.
Horizontal or lateral violence is described as nurse-tonurse
abuse or aggression. No matter what term is used
the similarity is that another person physically, verbally,
or emotionally abuses another person.
The American Medical Association (2002) defines
bullying as “personal conduct, whether verbal or physical,
that affects or potentially may affect patient care
negatively constitutes disruptive behavior.”
The National Institute for Occupational Safety and
Health (NIOSH) defines workplace violence as “violent
acts, including physical assaults and threats of assaults,
directed at persons at work or on duty.” (OHSA, 2015)
Bullying includes verbal violence—threats, verbal
abuse, hostility and harassment, which can cause
significant psychological trauma and stress, even if no
physical injury takes place. Verbal assaults can also
escalate to physical violence.
Prevalence of Bullying
Numerous studies over the years have reported on
the incidence of bullying among and of nurses in the
o 2013—30% of nurses in hospitals feel bullied (Papa
& Venella, 2013)
2008—80% surveyed experienced violence in the
workplace; 52% from colleagues (Hader, 2008)
o 2004—89% surveyed experienced verbal
aggression, 61% was nurse to nurse violence
o 65% reported experiencing lateral violence
o 2007—86% experienced “mobbing” and its
outcomes (Yildirim, 2007)
More recently, Maxfield (2014) surveyed 2283
corporate employees and found that 96% of people have
experienced workplace physical or emotional bullying/
violence. This author included instances of verbal
violence including — emotional or controlling behavior
(79% reported); sarcastic, cutting, disrespect (74%);
silent treatment, cold shoulder, excluding (68%–very
common in health care); gossip, rumors (64%); sabotage,
undermining (52%); and physical assaults (11%). It is
interesting to note that most bullying reports are in the
form of verbal violence.
An ANA Study in 2015 surveyed 4118 nurses of which
42% were staff nurses, 16% were nurse managers, and
20% were nurse educators. Respondents reported that
patients, families, and patients’ friends were most prone
to committing a violent act. RNs, patients’ families,
doctors, administrators, and managers were most likely
to exhibit incivility. The most prevalent type of violence
was worker on worker (52%) and patient on worker
(45%). When asked if they positively intervene when they
witness bullying/uncivil behaviors, 38% reported always,
59% reported sometimes, and 3% reported never.
The ANA-Illinois Expert Panel on Workplace Safety
surveyed nurses in 2018 to determine what their
experience of incivility and bullying behaviors was. Over
300 surveys were returned with the following results:
The following behaviors occurred one to three times in
the past month:
• Leaders speaking or acting disrespectfully to them;
• Being the brunt of rude treatment from a peer;
• Being the brunt of rude treatment by a leader;
• Being the brunt of sarcastic remarks form a leader;
• Being yelled at by a peer;
• Being the brunt of sarcastic remarks from a
• Being the brunt of sarcastic remarks from a peer;
• Being humiliated by a leader;
• Being humiliated by a peer;
• Being humiliated by a physician;
• Being yelled at by a leader.
In OSHA in 2015 reported that workplace violence
is widespread and vastly underreported in healthcare
professions. Surveys highlight the prevalence of
workplace violence among healthcare occupations.
• 12 percent of emergency department nurses
experienced physical violence—and 59 percent
experienced verbal abuse—during a seven-day
period (2009–2011 Emergency Nurses Association
survey of 7,169 nurses).
• 13 percent of employees in Veterans Health
Administration hospitals reported being assaulted
in a year (2002 survey of 72,349 workers at 142
• The numbers often only include incidents that
led to time away from work. While some data
are available for other violent incidents, surveys
show that many incidents go unreported, even at
facilities with formal incident reporting systems.
• A survey of 4,738 Minnesota nurses found that
only 69 percent of physical assaults and 71 percent
of non-physical assaults were reported to a
• Another medical center found that half of verbal
and physical assaults by patients against nurses
were never reported in writing.
• Bullying and other forms of verbal abuse are
particularly prone to underreporting. Reasons for
underreporting include lack of a reporting policy,
lack of faith in the reporting system, and fear of
Costs of Disruptive Behavior
The costs of bullying and disruptive behavior have
been widely reported in the literature: decreased
retention/recruitment; increased turnover; decreased
nurse satisfaction/morale; decreased knowledge,
learning, creativity, quality; decreased patient
satisfaction; and nurses leaving the profession. Joint
Commission (2008) reported the effects of disruptive
behavior as stress, a culture of fear, disengagement, lost
productivity, absenteeism, psychological and physical
harm, undermined culture of patient safety which
fosters medical errors and plays a role in preventable
adverse outcomes, increased cost of care, and the loss of
qualified clinicians, administrators and managers to more
professional work environments. All these factors have
widespread effects on patient care and nurses’ morale.
Maxfield (2014) reported that 80% of those surveyed
say that this bullying affects five or more people other
than themselves; 20% report that dealing with the
bullying takes seven plus hours/week with a projected
$8,800 a year lost productivity.
OSHA (2015) states that workplace violence is costly.
• If an employee requires medical treatment or
misses work because of a workplace injury,
workers’ compensation insurance will typically
have to pay the cost.
• One hospital system had 30 nurses who required
treatment for violent injuries in a particular year,
at a total cost of $94,156 ($78,924 for treatment
and $15,232 for lost wages).
• If your organization self-insures, it will bear the
full cost. If your organization does not, its claim
experience can still affect insurance premiums.
• Caregiver fatigue, injury, and stress are tied to
a higher risk of medication errors and patient
• Studies have found higher patient satisfaction
levels in hospitals where fewer nurses are
dissatisfied or burned out.
• Injuries and stress are common factors that drive
some caregivers to leave the profession. The
estimated cost of replacing a nurse is $27,000 to
$103,000. (OSHA, 2015)
Why Disruptive Behavior Still Occurs??
With all this evidence about the prevalence and cost
of disruptive behavior, you may ask yourself—Why does
this disruptive behavior still occur? Reasons cited in the
literature (as noted by Joint Commission, 2008) are:
The Nursing Voice March 2019 Page 11
• Fear of retaliation;
• Stigma of blowing the whistle;
• History of it being ignored or excused as
• Nurses feel helpless/victims;
• “No one really cares;"
• Tolerance contributes to escalating problem;
• Silence is permission—if you observe it & don’t
speak up—that’s permission;
• Inexperienced nurses more likely to report;
• Experienced nurses more likely to perceive
policies and procedures are ineffective;
• Nurses lack interpersonal, coping or conflict
• Stress: poor staffing levels, long hours;
• Pressures of healthcare environment.
Bullying persists because bullies are not being held
accountable, people say nothing, stay away from them,
avoid working with them, and vent to others (Maxfield,
2014). Nurses report they don’t speak up about the
bullying because they don’t know how, fear of retaliation,
and/or it takes too much time and energy with very little
change in the bullying behavior.
Three Forms of Bullying
Maxfield (2014) discusses three forms of bullying:
• A personal attack which includes isolation,
intimidation, and degradation;
• Erosion of professional competence and
reputation, which damages professional identity
and can affect career options; and
• Attacks through work orders or tasks, which
includes obstructing work or denying due process.
Some examples of bullying include:
• Being accused of errors made by someone else;
• Nonverbal intimidation;
• Being belittled;
• Being gossiped about;
• Feeling ignored;
• Excluded from activities or conversations;
• Being humiliated in front of others;
• Being assigned undesirable work;
• Unwarranted or invalid criticism or blame;
• Exclusion or social isolation;
• Unreasonable demands;
• Denied advancement opportunities.
Remember, sometimes the more passive behaviors
can be the most damaging and the most pervasive!
Factors contributing to increased bullying
In the complex, busy, understaffed organizations
of today several factors have been suggested which
contribute to increased bullying:
• Significant organizational change (restructuring,
technology, finances, ACA);
• Worker characteristics (e.g., age, gender, parental
status, new staff);
• Workplace relationships (poor information flow,
lack of employee participation in decision-making);
• Work systems (e.g., lack of policies about behavior,
high rate and intensity of work, staff shortages,
interpersonal conflict, role ambiguity) (Maxfield.
Professional Standards of Behavior
ANA establishes standards for nurses in ethics,
communication, leadership and collaboration which
provide direction about a nurse’s responsibilities in
dealing with workplace bullying and incivility (ANA, 2015).
The registered nurse practices ethically:
• Takes appropriate action regarding instances of
illegal, unethical, or inappropriate behavior that
can endanger or jeopardize the best interests of
the healthcare consumer or situation.
• Speaks up when appropriate to question
healthcare practice when necessary for safety and
The registered nurse communicated effectively in all
areas of practice:
• Assesses own communication skills in encounters
with healthcare consumers, families and
• Seeks continuous improvement of own
communication and conflict resolution skills.
The registered nurse leads within the professional
practice setting and within the profession:
• Treats colleagues with respect, trust and dignity.
• Develops communication and conflict resolution
• Participates in professional organizations.
• Communicates effectively with the healthcare
consumer and colleagues.
The registered nurse collaborates with the healthcare
consumer and other key stakeholders in the conduct of
• Adheres to standards and applicable codes of
conduct that govern behavior among peers
and colleagues to create a work environment
promoting cooperation, respect, and trust.
Nurse leaders have specific responsibilities in
preventing and dealing with workplace bullying and
incivility as outlined in the Nursing Administration Scope
and Standards of Practice (ANA, 2015):
• Develop healthy work environments using
evidence-based management practices.
• Create healthy work environments that are safe,
empowering and satisfying.
• Promote ongoing evaluation and improvement or
personal and team communication and conflict
• Evaluate effectiveness, consistency and fairness in
interpersonal interactions and communication
• Create an environment that stimulates positive
innovation and change.
• Support a work environment that promotes
cooperation, respect and trust.
The ANA Code of Ethics (2015) provides further
direction for nurses regarding bullying:
• Provision 6: The nurse establishes, maintains, and
improves the ethical environment of the work
setting and conditions of employment that are
conducive to safe, quality health care.
o 6.2: Nurses are responsible for contributing
to an environment that demands respectful
interactions among colleagues, mutual peer
support, and open identification of difficult
o 6.2: Nurse executives have a particular
responsibility to assure that employees
are treated fairly and justly. Unsafe or
inappropriate activities or practices must not
be condoned or allowed to persist.
In summary, I quote from the American Nurses Association
position statement on Incivility, Bullying, and Workplace
Violence states that “all registered nurses and employers in
all settings, including practice, academia, and research must
collaborate to create a culture of respect, free of incivility,
bullying, and workplace violence.” In other words, violence
should never be an accepted part of practice. Stay tuned
for Part 2 of this series to learn more about strategies and
resources to deal with and prevent workplace violence.
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