The Nursing Voice - March 2019

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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.


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

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

Message from the INF Director........ 2

President’s Message.................. 3

I-OADN............................. 4

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


Alma J. Labunski, INF Director

Dear Colleagues:

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


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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 can point you

right to that perfect NURSING JOB!

Free to Nurses

Privacy Assured

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E-mailed Job Leads

The Nursing


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

Editorial Committee

Editor Emeritus

Alma Labunski, PhD, MS, RN

Chief Editors

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

Executive Director

Susan Y. Swart, EdD, RN, CAE

ANA-Illinois/Illinois Nurses Foundation

Article Submission

• Subject to editing by the INF Executive Director & Editorial


• Electronic submissions ONLY as an attachment (word

document preferred)

• Email:

• 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@ 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




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

Dan Fraczkowski


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

several projects.

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 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 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

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

process rights

• Student discipline policy considerations and

recommended procedures

• Legal considerations governing student use of

social media

• Accommodating students with disabilities.

Presenter Emily P. Bothfeld, Attorney, Robbins Schwartz

Date: March 22, 2019

Time: 9am-3pm

Location: Heartland Community College, 1500 W Raab

Rd., Normal, IL 61761

Cost: $90 IOADN member

$100 non-member

$110 at door

5 CE hours will be awarded.

To register please submit the following information along

with a check payable to IOADN.



Phone number



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

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



Platinum Sponsor

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!


Register Now

Bronze Sponsors

Nationally Presented By:

St. Xavier University School of Nursing

Ruthann & Lawrence Sanders

Smits Funeral Home

Stepping Stones – Clint Verhagen

Walter Schultz Insurance

Emmanuel Olaifa

Angela Gorazd

Cheryl Anema

Locally Presented By:

Table Sponsors

OSF HealthCare

is seeking


to join our team.


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



Rasmussen College

Maureen & Jerry Shekleton

Maria Connolly

Rush University Medical Center

St. Xavier University School of Nursing

Olivet Nazarene University


Marcella Niehoff School of Nursing

SYS Consulting Solutions

Silent Auction Donors

Texas Roadhouse

PRP Wine International

Cheryl Anema

Katherine Serbin

Paintball & Laser Tag Explosion

Laurie Anema

Lock Chicago – Escape Room

Richard Flansburg

Susan Swart

Hidden Lake Winery


Chicago Skydive Center & Flight Deck

Joanne Buckley

Weber Grill

Par A Dice Hotel/Casino – Peoria

Catherine Neuman

Chicago White Sox

Inspired Edge

Morton’s Steakhouse

Maureen Shekleton

Patricia Janca

Gizmo’s Fun Factory

Linda Roberts

Art & Company

Medieval Times

Enchanted Castle Rest & Entertainment

Fox Bowl – Wheaton


Second City

Space Golf

Chick-fil-A – Orland

Bolingbrook Golf Club

Springhill Suites – Peoria Westlake

Brandon Hauer


Perfect North Slopes

Kristy Dugan

Pam Brown

Chicago Bears

Chicago Cubs

DeYoung Furniture

Round the Clock Restaurant

Ruthann Sanders

Laurel Schaap

Pat Wienski


Witkowski Dental

The Open Bottle

Amanda Buechel

Lisa Thomas Salon

Tin Fish Restaurant



Whiskey Acres

Pinots Pallette

Aveda Institute – Cosmetology

Lettuce Entertain You

Ark Encounter/Creation Museum

Holiday World – Santa Claus, IN

Longhorn Steakhouse

Windy City Thunderbolts

St. Louis Gateway Arch

Accelerate Speedway

Kane County Cougars Baseball

Buffalo Wild Wings

Comedy Sportz Chicago

Outback – Orland Park

Rock Bottom Restaurant

The Patio

Topgolf – Naperville

Walts Food Center

Cooper’s Hawk Winery

Chuy’s Restaurant

Famous Dave’s

Railcats Baseball

Chicago Wolves Hockey

Alma Labunski

Sky Zone

Glenwood Oaks Restaurant

Light it Up

Mary Jo Shepard

Something Special

Aurelios South Holland

Damsel in Defence

Lou Malnatis Pizzeria

Oriental Trading Company

Sheffield’s Restaurant


Emagine Entertainment


City BBQ – Orland

Lumes Restaurant


Beggar’s Pizza

Chili’s – Dyer

Cheesecake Factory



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:


Providing legal and consultation services within

the healthcare field for over 18 years.



Illinois State Nursing Licensing and Regulatory Boards

Drug Enforcement Administration (DEA)

State Medicaid Agencies

Centers for Medicare and Medicaid Services (CMS)

Federal Drug Administration (FDA)

Drafting Legal Opinion Letters

Expert Witness Services

Licensure and Provider Application Submission



LISLE, IL 60532 630-310-1267


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, 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

of care.

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”

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healthcare professionals.




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


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

Organization of

Nurse Leaders

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

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.



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



Printed Name:___________________________________



City, State, Zip Code:_____________________________

Preferred Phone Number:__________________________

Please mail completed form & check to:


Atten: Nurses-PAC

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

surrounding the

earth, gases created

substantially by human

activities such as

transportation, energy

production, industry,

cooking/heating, and

agriculture. (See the

image below) These

gases are called

greenhouse gases

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

to 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

more heat-related

illnesses and even

deaths in humans.

People who work

outside in agriculture,

utilities, construction,

gas/oil, and many

other fields will be

at higher risk for

hyperthermia. And,

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

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:

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: 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,

and Cara Cook, MS, RN, AHN-BC, Climate Change

Program Coordinator, Alliance of Nurses for Healthy


Visit today!

Search job listings

in all 50 states, and filter by location and credentials.

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of articles and content.

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for nursing professionals in your area.

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nursing jobs, research, and events.

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

Catherine Neuman

Nancy Spector

Alma Labunski

Maureen Shekleton

TIAA Charitable

Linda Olson Stepping Stone

Financial, Inc

Joanne Buckley

Karen Egenes

Cheryl Anema

Margaret Miller

Thank you for our 2018 Donors

P. Joan Larsen

Dan Fraczkowski

Jim Plonczynski

Nicole Wynn

Maureen Murphy

Donna Plonczynski

Trish Hatten

Carol Anaski-Figurski

Maria Connolly

Gayle Peterson

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

developing solutions.

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

this issue.

2. Collaborate with IONL to plan staffing summits

throughout Illinois.

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

and retention.

6. Further explore the ratio of novice nurses to

experienced nurses on units, and how that affects

staffing and retention.

Linda Roberts

Josh Wajtkowski

Dr. Patrick Durbin

Kevin & Mary Kelly

Terri Robinson

Mary Eileen Kloster

Emmanuel Olaifa

Smits Funeral Homes, Ltd

Bonnie Salvetti

Woundcare on Wheels, Inc

Dorothy Stratman Lucey

Alpha Eta

Chapter of Chi

Eta Phi Sorority

Awards Nursing


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

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

Donna Plonczynski

Jennifer M. Grenier

Gloria Simon

Mildred Taylor

Mary Lebold

Lauren Martin

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

verbal violence.

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.

CE Offering

1.0 Contact Hours

This offering expires in 2 years:

February 25, 2021

Learner Outcome:

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.



This course is 1.0 Contact Hours

1. Read the Continuing Education Article

2. Go to 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.


INF website under




February 25, 2021

Complete online payment of processing fee as


ANA-Illinois members- $8.00

Nonmembers- $15.00


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

of interest.


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

or via the INF website

under programs.

Nurses must also advocate for themselves.

How do we improve our work life?

How do we advocate for our self to stop bullying and

workplace violence?

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

(Dean, 2005)

o 65% reported experiencing lateral violence

(Stanley, 2007)

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

management skills;

• 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

quality improvement.

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

nursing practice:

• 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

resolution skills.

• 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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