Virginia Nurses Today - August 2020

The Official Publication of the Virginia Nurses Foundation 

August 2020 Quarterly publication distributed to approximately 107,000 Registered Nurses 

Volume 28 • No. 3 

We are pleased to provide every registered nurse in Virginia with a copy of Virginia Nurses Today. 

For more information on the benefits of membership in of the Virginia Nurses Association, 

please visit www.virginianurses.com! 

2020 Fall Conference Legislative Summit 

Year of the Nurse Awards 

Diversity, Equity and Inclusion 

Reflections 

Pages 10 Page 14 

Page 19 

Page 34-35 

Reflections on the Loss of 

a Civil Rights Icon 

Vivienne Pierce McDaniel, DNP, RN 

VNA/VNF Diversity, Equity, & Inclusion 

Council Chair, and VNA/VNF Diversity, Equity & Inclusion Ambassador 

Congressman Lewis during the 

Congressional Black Caucus 

Swearing in Ceremony for the 

116th Congress on 

January 3, 2019 

current resident or 

I was devastated to hear of the 

passing of Congressman John 

Lewis. I will miss seeing and 

talking to him about the civil 

rights movement. I was privileged 

to interview him for the February 

2020 issue of Virginia Nurses Today 

( https://www.nursingald.com/ 

publications/2019), just before his 

cancer diagnosis. We talked about 

the history of the fight for voting 

rights and how we must all get 

into "good trouble" as we work to 

advocate for the patients we serve, 

regardless of where we fall on the 

political spectrum. 

I have met many people 

during my journey as a freelance 

photographer for the New Jersey Nets, 

the Boston Celtics, and as a special 

assistant to many jazz musicians 

and other recording artists. I even 

have a few friends who became very 

successful in Hollywood, but those encounters pale in comparison to 

the first time I met Congressman John Lewis. I had heard stories about 

Bloody Sunday and his near demise on the Edmond Pettus Bridge 

on March 7, 1965 from a relative. My cousin, Reverend Curtis Harris 

(affectionately called Uncle Curtis), shared stories about him, a young 

John Lewis, and Dr. Martin Luther King, Jr. marching to Montgomery 

together two weeks after Bloody Sunday, but to hear Congressman 

Reflections on the Loss of a Civil Rights Icon continued on page 15 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

Virginia Frontline Nurses 

Share their COVID-19 

Experiences 

On May 21, the Virginia Nurses Association hosted a COVID-19 Weekly 

Updates webinar entitled, On the Frontlines of Caring for COVID-19 Patients, during 

which VNA President Linda Shepherd sat down with three RNs from Ballad 

Health and other Virginia health systems to discuss their experiences during the 

pandemic and how it has impacted their work and personal lives. The webinar 

generated a large number of views while shedding light on some of the unsung 

heroes of the global pandemic. 

Jennifer Williams, BSN, RN, CCRN has worked for 

Riverside since 1991, beginning as a CNA and becoming 

an RN in 1993. Williams worked in cardiac surgery ICU, 

cardiac cath lab/interventional radiology, CCU, MICU, as 

an assistant manager for MICU/SICU, and now is in ICU 

at Riverside Doctors Hospital in Williamsburg, VA. She 

currently lives in Gloucester, VA with her husband, dogs, 

chickens, pigs and has two grown children and two 

grandchildren. 

2020 is the “Year of the Nurse,” and has demonstrated 

on a grand scale how important nurses are to the health 

of our communities around the globe. Williams says 

she always knew the nursing profession was a noble and respected one, but to 

be called a hero is not a label she ever considered. Throughout this pandemic, 

nurses have shown time and time again what it means to sacrifice and provide 

care during the worst of times. 

“I have always felt it an honor to be trusted to care for patients,” Williams said. 

“As a critical care nurse, I have been wired to anticipate a crisis, but nothing 

could have prepared me for a global pandemic. To be on the frontline with 

patients who are without the support of their loved ones is an honor in itself, but 

when an entire community reaches out to support you through meals, flyovers, 

lights and sirens, gifts and treats, it is even more humbling. I am, and always 

have been, proud to be a nurse.” 

As an ICU nurse on the frontlines, Williams has had to set the record straight 

on many incorrect notions regarding COVID-19. She laments that there are 

numerous information sources available, and unfortunately, some are unreliable. 

As we enter the reopening phases around the country, Williams stressed that the 

general public needs to pay attention to the facts from reputable sources and the 

scientists studying the virus. 

“My wish is for them to understand that this is uncharted territory and new 

evidence is constantly emerging. The best course of action is to stay at home, 

wash hands frequently, maintain social distancing, and wear masks (nonmedical 

type) when out in public spaces.” 

While wearing masks seem to irritate many, it needs to be understood that 

by doing so properly, the respiratory droplets known to spread the virus through 

talking, coughing and sneezing become limited. Until a solid plan is reached for 

prevention and treatment, Williams cautioned that we must do our part to stop 

the spread and protect not only ourselves, but others. 

During the past months, Williams said she can’t help but to notice the 

division of beliefs regarding COVID-19, not only through media outlets, but in 

general conversation. Whether the topic is about COVID-19 prevention, trends, or 

treatment, many seem to have their own theories. Williams warned that because 

we are in uncharted waters, anything is possible and none of us are immune. 

Virginia Frontline Nurses Share COVID-19 Experiences continued on page 7

Page 2 | August, September, October 2020 

VNF President's Message 

Virginia Nurses Today | www.VirginiaNurses.com 

Exploring Support for Covid-19 

Frontline Nurses and Beyond 

To say these are difficult and trying times for 

everyone is an understatement, especially for those 

in all roles and aspects of healthcare delivery 

environments. Nurses have been on the frontlines of 

the COVID-19 pandemic and have been recognized 

as critical and essential partners in bringing care 

to patients in acute care settings and residents 

in long term care housing. The Virginia Nurses 

Foundation has worked to respond to some of the 

challenges frontline nurses have experienced in 

their work settings, seeking possible programs and 

partnerships in providing peer-to-peer support to 

nurses experiencing mental health challenges. This 

is an arena that would be a focus of the Mental 

Health Roundtable, but a result of the COVID-19 

pandemic has been the suspension of Mental Health 

Roundtable meetings. However, it has not limited 

the work of the foundation in an effort to pursue 

exploration of support programs. 

There are several options being discussed with 

CCA, a national human resources consulting firm 

out of New York that has been ahead of the power 

curve in providing targeted COVID-19 resources 

to healthcare professionals. We are currently 

partnering with CCA to offer five webinars aimed at 

helping nurses diffuse stress and build resilience. 

Each webinar will address topics including 

secondary stress and compassion fatigue, coping 

with health concerns as a healthcare professional, 

and practicing self-care for caregivers. While the 

PowerPoint presentation for each webinar will be the 

same, each session will feature unique conversations 

incorporating what participants share throughout. 

Participants are welcome to attend once or multiple 

times, as desired. These webinars will be held from 

noon - 1:00 p.m. each 

Thursday in August, plus 

September 3. To register for 

these webinars, go to our 

Terris Kennedy, 

PhD, RN 

event calendar at virginianurses.com/events/event_ 

list.asp. 

We are also exploring options with CCA as well 

as the Medical Society of Virginia for developing a 

peer-to-peer program for nurses in crisis who wish to 

reach out for help and guidance. 

This is a work in progress, and we will continue 

to explore the possibility considering cost and 

availability, as well as legislation to remove liability 

exposure for those participating in the program. 

This is a time when we are reaching out to 

other organizations and agencies to explore what 

might already be operational and effective. For 

example, we’re promoting “Nurses Together: Join 

a Conversation,” a program of the Emergency 

Nurses Association supported by ANA. There is 

also a screening program for nurses at risk of 

suicide, along with a a virtual training program 

for nurses who would then work with VNF on the 

implementation of the cognitive-behavioral skills 

building program, “MindBodyStrong.” 

The need for viable, effective programs to 

provide assistance and support to frontline nurses 

experiencing multiple challenges, highly stressful 

environments, and limited time to recover from 

the stress is obvious and needed. The CCA/VNF 

webinars in August are a start, but it is essential 

that frontline staff be encouraged to pursue help and 

assistance during these times of stress without fear 

of stigma or repercussions. 

is the official publication of the Virginia Nurses 

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Phone: 804-282-1808 

The opinions contained herein are those of the 

individual authors and do not necessarily 

reflect the views of the Foundation. 

Virginia Nurses Today reserves the 

right to edit all materials to its style 

and space requirements and to 

clarify presentations. 

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To support the advancement of nursing 

through recognition, research, and 

innovation. 

VNT Staff 

Janet Wall, Editor-in-Chief 

Kristin Jimison, Director of Engagement 

Elle Buck, Managing Editor 

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www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2020 | Page 3 

President's Message 

COVID-19 Response: A Leadership Perspective 

Pandemics have occurred throughout history 

with each bringing their own challenges as a “new” 

disease with unknown nuances that must be 

identified and addressed. COVID-19 is no different. 

From the initial onset of this pandemic, people 

around the globe have watched with anticipation 

and anxiety as the numbers related to COVID-19 

grew worldwide. We faced significant challenges 

relating to how to prepare for the pandemic 

given ongoing changes in CDC guidance and 

best practices. These large scale issues created 

apprehension among medical communities as they 

attempted to prepare for their first PUI (persons 

under investigation) and positive COVID-19 cases. 

Recently, nursing leaders from across Virginia 

shared their challenges and successes in 

preparing for the first phase of the pandemic in the 

commonwealth through VNA’s COVID-19 Weekly 

Updates webinar series. They also provided updates 

on the ongoing operational changes established 

to protect and engage patients, patient families, 

and nursing personnel as well as their plans 

for a second wave. These individuals included 

Deb Zimmermann, DNP, RN, NEA-BC, FAAN, 

Chief Nurse Executive with VCU Health; Melody 

Dickerson, MSN, RN, CPHQ, Chief Nursing Officer 

with Virginia Hospital Center, and Linda Shepherd, 

MBA, BSN, RN, Chief Nursing Officer with Ballad 

Health Johnston Memorial Hospital. 

The overwhelming challenge out of the gate 

for each leader centered around dealing with 

the unknown. As command centers were put 

into operation, no one truly knew what to expect 

relative to: anticipated volumes since other patient 

populations would still require care; how swiftly 

surges would occur once PUIs / positive COVID-19 

patients were identified; what the human resource 

demands would look like; if the required PPE would 

be available and accessible; what community 

support would be required; how the acute care 

facilities could partner with other entities to provide 

a more comprehensive approach to the pandemic; 

and what treatments would prove to be effective for 

this patient population; among other questions. 

Resoundingly, the leaders and their organizations 

turned to their colleagues on the west coast to gain 

insight into their successes and challenges since, 

at the time, these entities were dealing with the 

pandemic first-hand. Many of these conversations 

began in January 2020 and continued as the 

leaders and their teams were challenged to establish 

plans for their respective organizations. 

Learning the lessons shared by medical 

communities in the midst of COVID-19 and utilizing 

the principles of emergency management helped 

the leadership teams to begin preparing for the 

inevitable while basing decisions on worst case 

scenarios and engaging in staff innovation. Each 

leader shared how their organization designated 

and expanded bed capacity, including negative 

pressure room availability, to house anticipated 

PUIs and positive cases. Others pulled from the 

lessons they learned during Ebola and created 

hot and cold zones adjacent to COVID-designated 

rooms. Innovation also took the forefront as 

these organizations worked to establish drivethrough 

testing sites to alleviate emergency room 

overcrowding and conserve some PPE elements 

while trying to actively identify PUIs and positive 

patients. In-house testing was also established at 

several of the organizations to provide expeditious 

identification of PUI / positive cases, a transition 

from receiving results in days to mere hours. 

Nurses also utilized extension tubing which allowed 

IV pumps to be managed outside PUI/ positive 

patient rooms and bunded care to minimize 

exposure of other team members and conserve 

PPE. Spotters were also put into place to monitor 

donning and doffing of PPE to protect staff and 

patients. As PPE usage increased and the ability 

to replenish supplies in some parts of the state 

declined, the reprocessing and sterilization of N95 

masks was investigated and initiated once there was 

an established comfort level among nursing staff 

in utilizing these items. Other initiatives included 

further partnering with the health department and 

community and organizational leaders in prisons, 

public housing, and other peripheral entities as 

a means to create targeted strategies to leverage 

resources to address and possibly minimize 

community spread. 

Sufficient human resources also were, and 

continue to be, an ongoing need to source additional 

bed capacity and allow for creative nursing models, 

which provide safe, high quality care to the patient. 

To expand the need for nurses, most facilities 

engaged in multiple strategies including the use 

of contract labor and redeployment of nursing 

personnel from areas experiencing lower volumes 

or where services were suspended as a result of the 

pandemic. Redeployed nurses were assigned to areas 

of previous competency as appropriate, providing 

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Other strategies included: 

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the establishment of internal float pools made up 

of redeployed nurse resources, use of clinical ladder 

nurses where the ladder aligned with skill set 

designations, and the utilization of multiple forms of 

President’s Message continued on page 6 

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CEO Reflections 

Identifying Common Denominators 

It’s easy to forget to exhale these days. The 

list of problems we as individuals are challenged 

with, as well as those our country faces, can be 

overwhelming: an unrelenting pandemic, civil 

strife, racial disparities and health inequities, 

the approaching elections, the economy, the utter 

emotional and physical exhaustion of nurses waiting 

for the public to throw them a lifeline… to show their 

appreciation for this most trusted profession by 

following the guidance of the scientific community 

with a reverence for the better good. It’s easy to feel 

that everything is out of our control these days. 

Out of chaos comes opportunity, so let’s each 

take stock and consider how we individually and 

as a whole want to emerge from all of this. What do 

you want your personal narrative to be when asked 

years from now, “Tell me what happened in 2020?” 

Perhaps the first step each of us can take is 

to focus on listening to others with different life 

experiences than our own. It’s important that we 

not simply spout what we hear. The onus is on each 

of us to research issues, listen - really listen -- to 

people who have opposing viewpoints or differing 

life experiences, and seek to understand the “why” 

behind those views. Only then can we begin to have 

meaningful discourse, identify common ground, and 

effect positive change. 

I’m reminded of the story of the West-Eastern 

Divan Orchestra. It was formed by conductor Daniel 

Barenboim and the late Palestinian scholar Edward 

Said in 1999 and is composed of Israelis and 

Palestinians. An unlikely pairing, yet with time they 

have been able to coalesce around their common 

denominator, music, and build from there. 

As Barenboim shared in an article in The 

Guardian, describing the aim of this award-winning 

orchestra, “The Divan was conceived as a project 

against ignorance. A project against the fact that 

it is absolutely essential 

for people to get to know 

the other, to understand 

what the other thinks and 

feels, without necessarily Janet Wall 

agreeing with it. I’m not 

trying to convert the Arab members of the Divan 

to the Israeli point of view, and [I’m] not trying to 

convince the Israelis to the Arab point of view. But I 

want to ...create a platform where the two sides can 

disagree and not resort to knives.” 

No matter the issue, I believe the Divan Orchestra 

reminds us of the value of listening… of identifying 

those common denominators. 

At the end of the day, and regardless of all of our 

differences, we all want the same things: health, 

happiness, peace, and love. We cannot achieve any of 

these if we first do not take the time to actively listen 

and learn from the experience of others. 

Come join our caring team of professionals in a Five Star 

rated, CARF accredited community, located in the beautiful 

Shenandoah Valley. We offer a competitive salary and benefits 

package, sign on bonuses and excellent resident to staff ratios, 

and are currently recruiting for CNA, LPN and RN positions. 

For more information and to apply, 

please visit our website at www.svwc.org 

VNA’s Annual Legislative Receptions 

are Going Virtual! 

In order to ensure your health and safety, VNA 

will be holding their free legislative receptions in a 

virtual format this year. Our legislative receptions 

will still occur during their usual time frame in the 

months of October and November. Attendees will 

receive their chapter’s legislative guide, a copy of 

VNA’s public policy platform, and be able to virtually 

meet with legislators in their area. Legislators will 

be segmented by VNA chapters and further broken 

down into smaller groups to allow for adequate Q&A 

time. 

To find a legislative reception with your 

legislators, visit our events calendar at 

virginianurses.com/events/event_list.asp. 

VNA members can expect to receive an email in 

the coming months with the dates and registration 

links for the receptions. This information will also 

be posted to VNA’s Facebook page, www.facebook. 

com/vanurses. For questions about VNA’s legislative 

receptions, please contact VNA Communications 

Coordinator Elle Buck at ebuck@virginianurses.com. 

NURSES MONTH 

SPOTLIGHT


President’s Message continued from page 3 

team nursing. Rapid onboarding processes were also established for education 

and competency demonstrations. 

Communication to assist in navigating the pandemic on an ongoing basis 

was key to success. Communication was dispersed through multiple platforms. 

Many held town halls to provide information on proposed actions and to obtain 

staff input as leadership wanted to gain insights from their team members and 

make them part of the decision-making process. Other organizations dispersed 

electronic communications daily to provide updates on established changes. 

Team boards were established where staff could post questions and obtain a 

response while purposeful rounding on team members was performed daily by 

the administrative staff to understand the issues and concerns of their teams. 

The number of PUI and positive cases were tracked and communicated daily 

as well as the number of deaths associated with the virus while individuals 

being discharged were celebrated in conversations as well as in person. Many 

nursing groups took it upon themselves to meet and propose ideas to leadership 

regarding changes to nursing practice to improve on efficiencies. Many 

expressed the desire to engage in research related to the pandemic while others 

such as wound care nurses, recognized the need to address skin breakdown 

related to the use of PPE by identifying a product that could be utilized to heal 

as well as prevent skin integrity disruption. Ongoing two-way communication 

was and remains essential. Existing department silos were also removed as 

communication around the pandemic impacted nearly every department, forcing 

teams to work more closely than they ever had before. 

A huge focal area for each of the leaders was the safety of the patient and the 

physical and mental well-being of their teams. Ongoing PPE supply availability 

and conservation of these supplies through specific strategic initiatives was key 

in the current and ongoing protection of nurses and other personnel. Education 

about team-based care models was provided so nurses would understand how 

to most effectively deploy these models for their organizations. Intubation boxes 

were also put into place. The segregation of patient care areas and waiting 

rooms was established within emergency departments and other areas of the 

facilities. Decisions were made to place all PUI and positive cases in negative 

pressure rooms, even though the evidence did not require this. Provisions for 

housing were made for patient families so they could be near their loved ones. 

Correspondingly, housing arrangements were made for nursing personnel 

caring for PUI / positive patients as a means to protect their family members. 

The list goes on as other multiple means were implemented to provide high 

quality care while protecting nursing staff. 

In addition to physical safety, the mental health and well-being of nurses and 

other care providers served to be, and still remains, challenging. The care of 

PUI and positive COVID-19 populations is highly demanding. The care is then 

further complicated by the fact that nurses have, and continue to, stand in for 

visitors and keep families and patients connected. Furthermore, nurses are 

often the individuals who are with patients as they pass, using technology in 

an attempt to provide closure to family members at the time of death. Making 

resources readily available to nurses such as Employee Assistance Programs 

(EAPs), availability of psychological services, counselors, and pastoral services 


through private sector partnerships and associations was identified as a need 

early on by each leader. Other support systems provided programs such as 

“Healing Gardens,” a phone line nurses can call to express their feelings and 

concerns to support teams. All leaders focused on the resilience of nurses as 

well as the stigma associated with seeking help and the need to destigmatize 

such actions as a means to promote sound mental health. 

According to the nursing leaders, other challenges varied among 

organizations, although PPE availability was number one for each facility. In 

the Richmond area, the greatest challenge was identified among the Hispanic 

population, which may defer from seeking care due to immigration status. In 

northern Virginia, turnover in nursing personnel related to refusal to care for 

PUI or positive patients was identified as highly problematic. Specific equipment 

needs were also identified throughout the process with plans to rectify these 

needs in the near future. In southwest Virginia, challenges included lack of 

nursing resources pre-COVID that are now compounded as well as ventilator 

needs. Collectively, the recognition of the publics’ fatigue related to social 

distancing, compliance with face mask use, and hand hygiene diligence 

continues to place the medical community, as well as our local communities, 

at risk. Correspondingly, northern Virginia identified specific success relative 

to their implementation of rapid testing for all admitted patients as multiple 

asymptomatic patients were identified through this process and the appropriate 

care of these patients was then instituted to protect the staff as well as other 

patients. Southwest Virginia recognized successes in partnering with local 

companies to produce facial shields and masks as well as partnering with other 

community groups targeted at minimizing community spread. VCU’s greatest 

success was cited as community collaborations. 

Collectively, all the nurse leaders echoed the outpouring of appreciation 

to their nursing teams for their diligence, hard work, and ongoing pursuit of 

patient care. From the tears shed at the time of death of a patient to the shouts 

of jubilation at the discharge of a COVID positive patient, to the long hours and 

tireless shifts, to the nurses who stepped up to the plate and out of the box, and 

to the other healthcare workers who supported the efforts of the team, a huge, 

humble “thank you” is owed as they transitioned plans into successful actions. 

As we now enter a second wave, the success encountered in phase 1 and 

the lessons learned along the way lend confidence as we move into subsequent 

phases. There is a need to make data based decisions relative to human 

resources, PPE, and other supply resources while also recognizing the ongoing 

need to keep nurses prepared and confident. This is not the first pandemic nor 

will it be our last. Building upon lessons learned and planning for the future are 

key as we all move forward. 

NURSES MONTH 

SPOTLIGHT 

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Virginia Frontline Nurses Share COVID-19 Experiences continued from page 1 

“This virus is indiscriminate and invades without warning,” Williams said. 

“My hope is that this will be taken seriously to avoid further unnecessary deaths. 

Unless you are on the frontline to witness this battle and its path of destruction, 

it is incomprehensible and hopefully only once in a lifetime. Without a doubt, the 

most difficult aspect has to be the vulnerability we all face every day, that we 

show up for our shifts. Could it be the day for exposure, leaving me or a family 

member to become another tally mark or statistic?” 

Williams shared that earlier in the year, she endured a mandatory quarantine 

for 14 days due to in-hospital COVID-19 exposure. Fortunately, she and her 

coworkers were able to return to work and care for the patients in their ICU. On 

her return to work, there were several COVID-19 positive patients. Three of these 

patients became critically ill at the same time, and all were intubated within 

twelve hours of each other. Because Riverside is a smaller facility, two of the 

patients needed to be transferred to a higher level of care, leaving the third in 

Williams’ unit. This patient had endured the typical COVID-19 course: admission 

due to shortness of breath complicated by worsening respiratory failure and 

increased oxygen requirements. He stayed in the ICU for more than three weeks, 

suffering multiple acute episodes, including a few near death incidents. 

“Caring for a patient like that is made more complicated when the family is 

unable to be present due to visitation limitations,” Williams explained. “It is then 

that the nurse not only cares for the patient, but becomes the liaison/lifeline to 

the family, communicating over the phone several times per shift.” 

During those weeks, nearly the entire ICU staff became close to the patient’s 

wife and, in turn, became emotionally invested in his care and recovery. 

Eventually, he was weaned off of the ventilator but remained critically ill. Being 

unaware of his surroundings for many days was frustrating for the family and 

created questions of whether a full recovery would occur. This patient finally 

emerged to a conscious state and was able to communicate his needs, but also 

remained dependent on rigid physical therapy. Staff went the extra mile to make 

connections to his family happen, such as wheeling him to the window so they 

could see him or connecting via FaceTime so they could see and hear each other, 

as well as taking him outside to meet at a social distance. 

“What a grand celebration it was for our ICU team, as well as most of our 

hospital team members, to give loving recognition when this patient was being 

discharged to a rehabilitation facility. This moment of survival will forever remain 

in my memories and in my heart, defining what it means to be a nurse,” Williams 

recalled. 

When asked how she mentally navigates these kinds of experiences, Williams 

explained that moral resilience is a trait that must be learned and is important 

in overcoming challenging times. Many critical care nurses face distress at some 

point in their career, but with the support of administration, coworkers, family 

and community, this resilience is achievable. 

“Having worked with the acutely ill population for more than 20 years, I have 

faced numerous moral and ethical dilemmas, making COVID-19 simply another 

challenge, albeit a tremendous one,” Williams said. 

Williams emphasized that nurses should realize that self-care is of utmost 

importance, as they cannot care for others if they do not care for themselves. 

Whether this is through online or workplace support, families, friends, or 

coworkers, nurses need to reach out to any outlet available. 

“Personally, utilizing these outlets and believing that I have done my best to 

provide care despite the outcome gets me through these tough times, along with 

a little humor! I know that keeping myself educated on this new disease and its 

course as it unfolds and sharing this knowledge and experiences with others can 

only prove useful,” Williams explained. 

She ensures her mind stays healthy through hobbies such as painting, 

gardening and crafting, all of which have played an integral part to her own 

self-care. However, the most important lesson she has learned has been to focus 

on what is truly important: “Being somewhat forced to stay at home when not 

working has helped me to do a “reset” and connect with my immediate family on a 

new level, and for that, I am grateful.” 

The pandemic has certainly underscored how vital nurses are in healthcare 

and is bound to change the nursing profession in multiple ways. 

“To show up and ‘to care for others as we would care for those we love’ 

(Riverside Health System’s mission) during these times takes dedication, 

compassion and courage, prompting the media to portray the nursing profession 

as frontline heroes,” Williams noted. “On the flip side, the same media has 

exposed and exaggerated the ugly truth by focusing on the PPE and staffing 

shortages in the United States.” 

Williams explained that she is uncertain about what to think of nursing in 

the future. Is the nursing shortage going to grow exponentially due the truthful 

tales and stories of nurses who have paid the ultimate sacrifice by unselfishly 

taking a risk to care for others? Or, will prospective nursing students see the 

Virginia Frontline Nurses Share COVID-19 Experiences continued on page 8 

NURSES MONTH 

SPOTLIGHT


COVID-19 Experiences continued from page 7 

career as exciting, stable, full of opportunity and 

rewarding? Williams believes that answer will most 

likely be a “wait and see.” In either situation, she 

thinks that nurses will need heightened support 

from the government in the form of a reevaluation of 

healthcare in its entirety and a focus on increased 

prevention, protection, compensation, retention and 

equality. 

Throughout this difficult time, Williams finds the 

following quote from American Association of Critical 

Care Nurses President Megan Brunson to be a 

shining light for the nursing profession: “Unstoppable 

is knowing if we get knocked down, we get up again. 

We are nurses. We cannot be stopped from doing 

what’s right for our patient.” 

“We are truly an admirable professional group 

of which I am honored to be a part of,” Williams 

concluded. 

Christine Aubry, BSN, RN is 

a Clinical Nurse IIat VCU 

Health where she started in 

June of 2016 as a float care 

partner for supplemental 

staffing. Aubry graduated as 

a double major from VCU in 

May of 2018 with a bachelor’s 

in nursing and psychology. 

She started in June of 2018 

on progressive care medicine 

and has been a nurse for two 

years. Aubry challenged the clinical ladder and 

became a Clinical II nurse this past fall. Since then, 

she has been trained as a charge/resource nurse, has 

been a preceptor to new grad nurses and nursing 

students, and has joined her unit’s Shared 

Governance Committee. Aubry was recently accepted 

to VCU’s Family Nurse Practitioner program and will 

start this fall. 

Aubry explained that as a nurse, many things 

about her practice are always changing and this has 

been true especially during COVID times. As new 

information has come out, nurses have had to adapt 

to changing policies, procedures, and expectations 

while remaining flexible throughout the past months. 

“VCU has been transparent and communicative 

regarding PPE shortages and reuse and I have really 

appreciated their efforts regarding that,” Aubry said. 

“I know other nurses in other hospitals throughout 

the country have not been as lucky.” 

She explained that VCU is reusing airborne masks 

for COVID positive patients but only after they have 

been sanitized using UV light technology. VCU has 

also started extending the use of their droplet masks 

in non COVID positive rooms with the use of a face 

shield, which is then discarded at the end of the 

shift. Aubry mentioned that COVID has completely 

changed the way her unit runs. They have now found 

a new normal, but at first it was very overwhelming 

as they saw huge changes in the way they practice, 

communicate with patients, patient families, and 

other staff members. 

In preparation for patients, her unit’s patient doors 

were changed from solid wood to ones with large 

windows. There were specialty signs that were placed 

on the doors to alert staff on what PPE is required 

to safely enter rooms. They have staff members who 

are door monitors stationed outside rooms to ensure 

all staff are appropriately donning and doffing PPE. 

Aubry also pointed out that staff have been asked to 

cluster care in order to decrease potential exposure 

to COVID positive individuals and conserve PPE. This 

means that patients are alone for long periods of time, 

often unable to communicate with family and have 

limited communication with staff. 

“We have seen more delirium in patients who are 

COVID positive and I suspect this is one contributing 

factor,” Aubry noted. “My unit is a medicine stepdown 

unit and we have accepted a lot of patients 

who were intubated and sedated in the ICU for 

extended periods of time. Many of these patients 

have never been sick or in the hospital, and they now 

find themselves debilitated, unable to walk or feed 

themselves, go to the bathroom independently, alone, 

and without family to support them in the hospital.” 

Aubry recalled having two patients from the same 

family test positive for COVID-19 who were admitted 

to her unit within a week of each other whom she 

both cared for. Three of their other family members 


had been sick with COVID and two had died from it 

a week previously. The first patient remained stable 

throughout her stay, never required oxygen, was 

ambulatory, and not feverish. She was discharged 

home about six days later. Her brother was the other 

patient admitted to the ICU at Aubry’s hospital. He 

was immediately intubated and sedated. Once he was 

extubated, he was transferred to her floor to continue 

his care and rehab while he was medically unstable. 

Unfortunately, he passed away while on Aubry’s floor 

due to complications from pulmonary embolisms that 

were discovered while he was in the ICU. This family 

had been devastated from COVID with so many 

family members dying from the disease in such a 

close timespan. 

“It shocked me how different members of the same 

family had different reactions to this illness,” Aubry 

said. “My heart breaks for the remaining family 

members left to deal with recovering from COVID 

while planning multiple funerals for their deceased 

family.” 

Aubry noted that the Richmond community has 

been incredibly supportive during this time. Her 

hospital has received letters of support from staff 

from other units, families of staff, patients, and other 

community members. Food donations kept staff fed 

during hard shifts and supported local Richmond 

businesses during this hard time. Donated masks 

kept staff safe outside the patients’ rooms, at the 

nurses station, and in the hallways. Headbands to 

secure masks and alleviate sore ears, lotion for dry 

hands, and skincare wipes were also donated. 

“I have also been well supported by my personal 

community,” Aubry said. “Family and friends have 

sent letters of encouragement and thanks as well as 

gift cards to restaurants and businesses to keep my 

spirits up.” 

Aubry hopes that the pandemic will encourage 

nurses to be more empowered to advocate for their 

profession as they have great power as a community to 

make meaningful changes and requests for protection 

equipment. She urges people to continue to follow 

guidelines to stay at home and wear masks in public. 

As a nurse, it is incredibly disheartening for her to see 

large groups of people gathering in public spaces and 

hearing some talk about COVID being fake.


“This is a very real pandemic that has affected communities and families in 

vastly different ways,” Aubry cautioned. “Just because you or your family and 

friends haven’t been personally affected, doesn’t mean this isn’t real.” 

On the bright side, Aubry mentioned how impressed she is with how the 

nursing profession has risen to the occasion to educate and serve the public 

during these unprecedented times. 

“We have advocated for our patients, ourselves and our coworkers on the 

frontlines to ensure that we are caring for our patients and ourselves in the best, 

safest way,” Aubry concluded. 

Carolyn Garcia, RN, works at Hanover Health 

Department as a public health nurse supervisor. She 

has an associate’s degree in registered nursing from 

Germanna Community College and a bachelor’s degree 

in business from Walsh University in North Canton, 

Ohio. Garcia worked 13 years for Geico as a telephone 

claims adjuster before deciding to change her career to 

nursing in 2012. She graduated in December 2013 and 

worked as a registered nurse for Spotsylvania Regional 

Medical Center and Childhelp before getting into the 

public health field. Garcia worked at Fredericksburg 

Health Department for 4 ½ years as the immunization 

coordinator before advancing her career to supervision at Hanover Health 

Department. 

Garcia explained that her interaction with COVID-19 hasn’t left her with 

one particular story to share, but rather an entire collection of experiences 

with people. As a public health nurse, she is notified of any positive COVID-19 

cases. Part of Garcia’s job is to contact the case positive person immediately 

to capture data and information for future analysis by the Center for Disease 

Control (CDC). Garcia noted that she has spoken to so many nice, kind and 

generous people on the phone. There were times when she had people who 

cried knowing they were positive because they were fearful of their family 

members contracting COVID-19. Many people had numerous questions, others 

were kind enough to thank Garcia for what she was doing, and there were 

many people who were just nice to chat with. 

“I even have a few people who continue to contact me with other questions 

or issues that I can help them with,” Garcia explained. “So, in the midst of all 

the fear, I think it was a positive for all to feel a connection with one another.” 

Keeping up with ever changing guidance that the medical field has received 

regarding COVID-19 proved difficult for Garcia at first. At times, information 

seemed to conflict and not make sense to her. It was a challenge for Garcia to 

set aside her opinions about how she would handle a certain situation versus 

what the experts were advising. 

Something Garcia noticed early on while COVID cases were being 

investigated was that people who were symptomatic and tested positive were 

complaining of a loss of taste and smell. The message that was out in the 

media and online was focusing on cough, shortness of breath and fever as the 

primary symptoms, and while they may have been for a lot of people, those 

who were managing their illness at home complained they were not able to 

provide details about other symptoms that they were suffering from. Garcia 

explained that a lot of people thought they were suffering from seasonal 

allergies and learned later that those symptoms were actually caused by 

COVID-19. 

During this stressful time of working overtime and weekends, it is 

important and helpful for Garcia to take the time to decompress and clear her 

head in order to start the next day fresh. Meditation and exercise became her 

stress relievers and regenerators and helped her in tremendous ways. 

“For me, I had to step back and learn self-awareness to do my job to the 

best ability and to be sure that I was advising people of what was appropriate,” 

Garica said. 

Due to the media’s great job supporting and offering appreciation to 

first responders and healthcare professionals who were taking care of the 

sick, Garcia thinks a future with an increase of people starting careers in 

healthcare is something positive that will come from the pandemic. She 

also has hopes that COVID-19 will open the doors for using telemedicine 

more frequently. While some patients may find telemedicine impersonal, it is 

extremely convenient to the patient when dealing with minor issues. Going 

forward with COVID-19, Garcia believes nurses will continue to handle 

patients in the office differently. 

“I can see the health profession focusing on protecting their staff,” Garcia 

said. “There were so many instances where offices and clinics had to shut 

down because of a staff member testing positive and exposing their co-workers 

who had to quarantine for 14 days.” 

Like most places, Garcia’s office was forced to reduce face-to-face interaction 

when COVID-19 struck and was forced to invent creative ways to care for 

patients while protecting the health of their staff at the same time. While most 

facilities have changed their interactions with patients, the use of telemedicine 

and other innovations has allowed for Garcia to continue to care for her 

patients in the same manner she would have if she had been face to face with 

them. 

“It will be interesting to see the lessons that we learn regarding this virus,” 

Garcia said. ”Hopefully we won’t have to experience another pandemic like this 

for a very long time, but I just think about how the medical profession will look 

back on this time to glean insights on how to better prepare for the future.” 

It goes without saying that each and every nurse deserves a huge and 

humble thank you. The world certainly wouldn’t make it through this 

pandemic without them. VNA will continue to feature different COVID-19 

narratives in Virginia Nurses Today. If you or someone you know has a 

unique story that can be shared, please reach out to VNA Communications 

Coordinator Elle Buck at ebuck@virginianurses.com. We also encourage you 

to submit a friend, colleague, or family member to our COVID-19 specific 

Healthcare Heroes campaign. Submissions can be made at: https://tinyurl. 

com/VNAHealthcareHeroes. 

To watch the VNA COVID-19 Weekly Updates webinar On the Frontlines 

of Caring for COVID-19 Patients, go to https://virginianurses.com/page/On- 

DemandContinuingEducation. COVID-19 and mental health specific resources 

for nurses are also available on our website, www.virginianurses.com. 

It takes the best people to 

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A pivotal moment approaching on November 3, and whichever side of the 

political aisle we each fall on, it’s crucial that we educate ourselves on the issues 

and vote. And whatever the outcome of the election, we each need to give great 

thought to how we will put our best foot forward and work to heal the divides of 

this country. For information on the candidates, nursing priorities, and how to 

get involved with the candidates’ campaigns, visit NursesVote.org.

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A Look Back at Nurses Month 

Riverside: 

UVA Health: 

This year the American Nurses Association (ANA) 

extended the traditional National Nurses Week to 

an entire month of recognition in May. Every year, 

VNA creates a webpage with a variety of resources 

for nurses. This years’ webpage featured a 17-page 

discount guide, National Nurses Week history, 

Florence Nightingale birthday resources, shareable 

social media graphics and more! 

VNA also created a Nurses Month Spotlight to 

highlight some of the amazing nurses who make a 

difference in the Virginia community. You can read 

all of the Nurses Month Spotlight articles that we 

posted on our social media at https://tinyurl.com/20 

20VNANursesMonthSpotlights. 

Enjoy these photos of Nurses Month celebrations 

throughout the commonwealth and be sure to check 

out the profiles of featured nurses!


Virginia Hospital Center: 

NURSES MONTH 

SPOTLIGHT 

NURSES MONTH 

SPOTLIGHT


LIVE INTERACTIVE WEBINARS 

Emotional First Aid: Managing 

Stress and Emotional Distress 

during (and after) COVID-19 


2 0 2 0 

T U E S D A Y , N O V E M B E R 1 0 

The Virginia Nurses Foundation, in 

collaboration with CCA, a human resources 

consulting firm, is offering five free webinars 

to help nurses diffuse stress and build 

resilience. 

LEGISLATIVE SUMMIT 

Topics covered during each webinar will 

include: 

• Stress management and resilience 

• Secondary stress and compassion fatigue 

• Coping with health concerns as a 

healthcare professional 

• Practicing self-care for caregivers 

While the PowerPoint is the same in each 

of the five sessions offered, each interactive 

webinar will feature unique conversations 

incorporating what participants share 

throughout. Participants are welcome to attend 

once or multiple times, as desired. 

Mark your calendars! These webinars will be 

held from noon - 1:00 p.m. on August 6, 13, 20, 

27, and September 3. 

Register at 

https://virginianurses.com/ 

events/event_list.asp. 

NursingALD.com 

can point you right to that perfect 

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NursingALD.com 

Free to Nurses 

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E-mailed Job Leads 

NURSES MONTH 

SPOTLIGHT


Reflections on the Loss of a Civil Rights Icon continued 

from page 1 

PRROGGRRAAAM AAAGGENDAAA 

John Lewis recount that day personally, was 

my greatest and most memorable experience. 

I have had the pleasure of being in his 

company and listening to him share stories 

about his imprisonments (40 at last count), his 

sit-ins including one on the floor of Congress 

for gun control, and his Boy from Troy (a name 

bestowed on him by Dr. Martin Luther King) 

adventures. The man who was often late to 

his appointments, because he would stop to 

give a hug, take a picture, or to acknowledge 

an ordinary person, will be missed, but he will 

always be remembered for his extraordinary 

and selfless acts to ensure diversity, equity, 

and inclusivity. 

As nurses and as citizens, we can all honor 

the work and legacy of Congressman Lewis by 

exercising our right to vote in each and every 

election. Please take a moment to read our 

interview and after you're finished, check to 

make sure you're registered to vote at https:// 

www.vote.org/am-i-registered-to-vote/ before 

the upcoming November election. 

Remember, 1 in 80 Virginians is a registered 

nurse, and we have a powerful voice as nurses 

in the voting booth! 

Dr. McDaniel, and cousin, Paulette Rush after 

the 116th Swearing in Ceremony chatting 

with Congressman Lewis about his connection 

to our family 

Why We Need Nurses in 

Elected Office 

As a nurse, you have an incredible opportunity 

to influence the future of your profession in Virginia 

through legislative advocacy. In a recent survey 

of members, legislative advocacy was identified 

as one of the top benefits of membership, and yet 

there are only two nurses currently serving in the 

Virginia General Assembly!! Nurses are the largest 

healthcare profession in the world and for 18 years 

in a row, they have also been voted the most trusted 

profession. There are more than 110,000 nurses in 

the Commonwealth of Virginia, making about 1 in 

80 Virginians a registered nurse! 

Nurses need to lean on years of the public’s trust 

and become involved in health and healthcare policy 

making decisions on the local, state, and national 

level. There is no one better than a nurse to ensure 

the best interests of patients and that our profession 

is represented in policy development. Nurses have 

already mastered the valuable skill of connecting 

with people from every walk of life during difficult 

times, and running for office is the next logical step. 

Any frustrations nurses feel with the profession 

and the healthcare industry can be channeled into 

advocating for positive change. 

The lack of knowledge that policymakers and 

politicians have directly affects patients, nurses, 

the healthcare environment, and legislation that is 

passed. If nurses are not part of the conversation 

and continue to have others speak for them, they 

are ultimately going to be left behind in a field where 

they should be front and center. 1 

There are 110,000 reasons to become involved 

with Virginia legislative advocacy and we’re here to 

help. If you are interested in running for office, visit 

https://www.elections.virginia.gov/candidatepacinfo/. 

To start your advocacy journey, or if you have 

advocacy related questions, visit our website, www. 

virginianurses.com. If you are unable to run for 

office but would still like to be an advocate for the 

nursing profession, make sure you are registered to 

vote. You can check your voter registration status at 

https://vote.elections.virginia.gov/VoterInformation. 

You can also join VNA at the General Assembly 

session every year to help us represent nurses and 

the nursing profession! Learn more about our VNA 

Lobby Days at https://virginianurses.com/page/ 

LobbyDays. You can also sign up for VNA Action 

Alerts by texting TAKEACTION 84483 to receive text 

and email alerts on Virginia politics and legislation 

related to nursing. 

Let your voice be heard! 

References 

¹ How Can We Be Prepared for the Next Healthcare 

Crisis?. Sharon Pearce, MSN, CRNA. 2020. 

John Lewis (far left front row kneeling) and 

Rev. Curtis Harris (far right standing) in 1965 two 

weeks after Bloody Sunday 

Photo Courtesy of Rev. Curtis Harris


Continuing Education 


How Can We Ethically Care for Our Patients with Pain? 

Disclosures 

• Nurses can earn one nursing contact 

hour for reading How Can We Ethically 

Care for Our Patients with Pain. 

Participants must also complete the 

continuing education post-test found at: 

https://virginianurses.com/page/On- 

DemandContinuingEducation 

• This continuing education activity 

is FREE for members and $15 for 

nonmembers! 

• The Virginia Nurses Association is 

accredited as a provider of nursing 

continuing professional development 

by the American Nurses Credentialing 

Center’s Commission on Accreditation. 

• No individual in a position to control 

content for this activity has any relevant 

financial relationships to declare. 

• Contact hours will be awarded for this 

activity until August 15, 2023. 

Phyllis Whitehead, PhD, APRN/CNS, 

ACHPN, RN-BC, FNAP 

Bio: 

Dr. Phyllis Whitehead 

is a clinical ethicist and 

clinical nurse specialist 

with the Carilion Roanoke 

Memorial 

Hospital 

Palliative Care Service 

and associate professor at 

the Virginia Tech Carilion 

School of Medicine. 

She initiated the Moral 

Distress Consult Service 

at CRMH. She is certified 

in pain management and is an advanced practice 

hospice and palliative care nurse. Dr. Whitehead 

has done numerous presentations on pain and 

symptom management, opioid induced sedation, 

moral distress, and patients’ end of life preferences 

locally, regionally, nationally and internationally. 

Her research interests include moral distress 

and improving communication with seriously ill 

patients. She is a board member of the National 

Association of Clinical Nurse Specialists, co-lead of 

the Virginia Nurses Foundation’s Action Coalition, 

and member of the VNF Board of Trustees. She 

was also a member of the ANA Moral Resilience 

Advisory Committee, and is a founding member 

and board member of the Virginia Association of 

Clinical Nurse Specialists. Dr. Whitehead was 

selected for Governor Ralph Northam’s Policy 

Council on Opioid and Substance Abuse this 

year. In 2020 she was elected as a distinguished 

practitioner fellow in the National Academy of 

Practice in Nursing. She is a graduate of Radford 

University where she earned her BSN and MSN and 

earned her doctorate degree at Virginia Tech. 

I am often asked, how can I safely and 

effectively care for my patients with acute and/ 

or chronic pain? There is a fear that we may 

unintentionally cause harm to our patients if we 

administer opioids that result in addiction and 

contribute to the opioid crisis. Both the American 

Nurses Association’s (ANA) Code of Ethics for 

Nurses with Interpretive Statements and American 

Society for Pain Management Nursing’s (ASPMN) 

2019 Pain Position Statements 1 have documents 

that should guide our nursing pain management 

practice. Nurses in all settings and specialties 

care for patients who are in pain. An important 

question is, do we know and apply best practice 

principles in caring for patients with pain? 

Historical Perspective: How Did We Get Here? 

Improvements in recognizing, assessing and 

treating pain significantly increased during the 

last decade of the 20th century. Although some of 

these efforts from that time have been perceived 

negatively, when introduced they were considered 

pioneering and crucial. In 1998, the Veterans 

Health Administration adopted “Pain as the 5th 

Vital Sign” as the slogan for their initiative to 

improve the management of pain for all veterans. 2 

We must remember the intention of these efforts 

was to increase the awareness, diagnosis and 

treatment of pain, not to increase opioid use. As 

the increased focus on recognizing and assessing 

pain was gaining attention, pharmaceutical 

companies were working to improve analgesic 

preparations and little attention was dedicated 

to the ethical principles of beneficence and 

maleficence with increased reliance upon 

pharmacological interventions. Although we “can” 

prescribe an opioid, we must consider whether we 

should if there are other appropriate modalities 

available. Please keep in mind that how payers 

reimburse for therapies and interventions 

determines how physicians and other providers 

prescribe. For example, payers cover opioids but 

not non-pharmacological interventions such as 

massage, guided imagery, and physical therapy 

(limited coverage at best). 

During the last five years, the pain 

management specialty has faced multiple 

challenges and changes related to the opioid 

crisis. In many instances the pendulum swung 

too far in the direction with renewed opioid 

phobia. An unintentional consequence is a 

dying patient being unable to receive necessary 

opioid medications. It has been appalling to see 

handwritten signs on primary and urgent care 

offices stating, “We do NOT prescribe opioids.” 

Opioids are a necessary class of medications that 

should be accessible to appropriate patients using 

evidence-based principles. 

Many of the negative consequences may be 

the result of using the term opioid crisis rather 

than the more accurate term opioid misuse/ 

abuse crisis. Opioids did not create the crisis, 

but rather, it is the misuse and abuse of them 

which led to this point. Although mis-prescribing 

of opioids has played a role in the opioid crisis, 

an evolving illicit drug market is causing an 

increasing number of deaths as a result of 

overdoses. Most recently, opioid-related deaths 

from synthetic opioids have risen from 3,100 

deaths in 2013 to more than 19,400 in 2016. The 

rapid rise of heroin and illicit fentanyl overdose in 

the United States is related to prescription opioid 

abuse; 45% of individuals who use heroin report 

their first opioid exposure to be a prescription 

opioid analgesic, and more importantly, not 

necessarily prescribed to them. 1 It is imperative 

for nurses at all practice levels and settings to 

possess the fundamental historical knowledge 

and skills to effectively identify and intervene with 

individuals who are at risk for Opioid Use Disorder 

(OUD) and to properly advocate for our patients. 

The Hospital Consumer Assessment of 

Healthcare Providers and Systems (HCAHPS) 

questions historically asked patients how satisfied 

they were with their pain management. These 

questions pressured hospitals and prescribers to 

increase the use of opioids as opposed to evidencebased 

interventions that include both opioids, 

nonopioids and nonpharmacological interventions. 

Today these HCAHPS questions have been replaced 

with the more appropriate pain management 

questions such as “During this hospital stay, how 

often did hospital staff talk with you about how 

much pain you had?” and “During this hospital 

stay, how often did hospital staff talk with you 

about how to treat your pain?“ 3 

Additionally, during the last several years 

nurses have increasingly been performing quality 

improvement projects to enhance how we assess 

and manage pain. Although self-report remains 

an important aspect of nursing pain assessment, 

it is not nor should it be the only basis upon 

which pain medications are administered. Instead, 

instruments are needed to focus on patients’ 

functionality, not solely on how patients selfreport 

pain intensity scores. Nurses have begun to 

evaluate the reliability, validity and effectiveness 

of using the Clinically Aligned Pain Assessment 

(CAPA) tool to holistically assess pain as more 

than just an intensity score. 4 This is a promising 

instrument. Please check it out if you are 

unfamiliar with it. 

Nurses must remain dedicated to pursuing safe 

and effective pain management care, education 

and advocacy for our patients who suffer with 

pain management acutely and chronically. 

Multimodal analgesia must be integrated into 

effective pain management interventions. Ongoing 

nursing research is needed as well to explore the 

role of various cognitive behavioral interventions, 

relaxation therapies, meditation, spirituality, 

movement, and energy work among other options. 

Additional research is needed to more fully 

understand how patients living with substance 

use disorders (SUD) and acute and/or chronic 

pain can have their pain best managed and 

quality of life improved. 4 

As nurses, we must never forget that pain is a 

subjective and distressing experience associated 

with actual or potential tissue damage, with 

sensory, emotional, cognitive, and social 

components. 2 Presently, we do not have tools 

that can determine when patients are or are not 

experiencing pain. Although researchers continue 

to seek physiological measures to evaluate pain, 

no valid and reliable objective test currently 

exists to measure pain. 

It is important to understand that the 

hierarchy of pain assessment has changed. The 

first step is now to be aware of potential causes 

of pain. The most common painful experiences 

in healthcare settings are iatrogenic. Preventing 

iatrogenic pain from needle procedures, wound 

care, diagnostic tests, and even repositioning, 

requires clinician awareness and interventions 

before these painful events. It is important to be 

proactive in anticipating pain in known painful 

conditions and experiences before soliciting 

a patient’s self-report of pain or identifying 

behavioral responses to the pain. Improving 

functionality is key to effective pain management. 

Nurses need to understand these strategies and 

work towards integration of non-pharmacological 

interventions into their practice in order to 

minimize the use of opioids and other controlled 

substances. 

Another positive effect is the acknowledgement 

of the necessity to proactively assess and 

identify patients who are at risk for OUD 1 and 

work towards minimizing risk of misuse and 

abuse. This is another opportunity for improved 

understanding and implementation of evidence 

based instruments and how we care and view our 

patients living with pain. 

Ethical Considerations in Caring for Patients 

in Pain 

The ethical principles of beneficence (the duty 

to benefit another) and nonmaleficence (the 

duty to do no harm) oblige nurses to provide 

pain management and comfort to all patients, 

including vulnerable individuals such as those 

who are unable to speak for themselves and living 

with SUD and OUD. 5 Providing comparable and 

high quality care to patients who are vulnerable 

is required by the principle of justice (the equal 

or comparative treatment of individuals). Respect 

for human dignity, the first principle in the Code 

of Ethics for Nurses (American Nurses Association, 

2015), directs nurses to provide and advocate 

for humane and appropriate care. Based on 

the principle of justice, patient care is given 

with compassion, unrestricted by consideration 

of personal attributes, economic status, or 

the nature of the health problem. This can be 

challenging at times, especially when caring for 

demanding patients. 

In alignment with these ethical tenets, the 

International Association for the Study of Pain 

(IASP) initiated the Declaration of Montreal at 

the International Pain Summit, a statement 

acknowledging access to pain management as a 

fundamental human right endorsed by 64 IASP 

Chapters, the World Health Organization and 

many other organizations and individuals. 6 

The declaration acknowledges the importance 

for individuals who are experiencing pain to 

receive evidence-based, appropriate pain-relieving 

treatment. 7 Concerns about the opioid crisis 

have created hesitancy that may affect treatment 

decisions despite the status of pain assessment 

as fundamental to effective and evidence-based 

treatment.


In 2018, the American Nurses Association 

affirmed the ethical responsibility to provide 

clinically excellent care to address patients’ pain 

with assessment and reassessment being key 

to informing treatment decisions (ANA, 2018). 

Pain should be routinely assessed, reassessed, 

and documented to facilitate treatment and 

communication among all healthcare clinicians. 

The requirement to provide effective and 

appropriate pain and symptom management 

is paramount. While vital signs (e.g., changes 

in heart rate, blood pressure, respiratory 

rate) may be important for identifying adverse 

effects of severe pain, 8 vital signs are not valid 

for discriminating pain from other sources of 

distress. 1 Correlation of vital sign changes with 

behaviors and self-reports of pain has been weak 

or absent. 8 

Each patient should be evaluated regularly 

using methods of pain assessment that have been 

identified as significant and appropriate for the 

population to which they belong. Nurses have 

a moral, ethical, and professional obligation to 

advocate for all patients in their care, particularly 

those who are vulnerable to undertreatment. 

Be sure to read the upcoming ethics article in 

our November publication! 

The next article in our ethics series will 

examine the challenges and opportunities of 

caring for patients with chronic pain. Can you 

imagine having persistent pain every moment 

of your day and night? How can you sleep, work, 

or function if you can’t get comfortable? Patients 

with persistent pain are challenging and to be 

honest, I always take a deep breath when I learn 

that one of my patients suffers from it. In the 

upcoming article we will take a look at which 

ethical principles provide guidance in caring for 

these patients. 

References 

1. Herr K, Coyne PJ, Ely E, Gélinas C, Manworren RCB. 

ASPMN 2019 Position Statement: Pain Assessment in 

the Patient Unable to Self-Report. Pain Manag Nurs. 

2019;20:402-403. doi:10.1016/j.pmn.2019.07.007 

2. Wilson M. Revisiting Pain Assessments amid the 

Opioid Crisis. Pain Manag Nurs. 2019;20(5):399-401. 

doi:10.1016/j.pmn.2019.10.002 

3. American Hospital Association. 

4. Quinlan-Colwell A. The Times They are a Changing! 

Pain Manag Nurs. 2019;20(6):517-518. doi:10.1016/j. 

pmn.2019.10.003 

5. Ashkenazy S, DeKeyser Ganz F. The Differentiation 

Between Pain and Discomfort: A Concept Analysis of 

Discomfort. Pain Manag Nurs. 2019;20(6):556-562. 

doi:10.1016/j.pmn.2019.05.003 

6. Madaus SM, Lim LS. Teaching Pain Management 

in Interprofessional Medical Education: A Review of 

Three Portal of Geriatric Online Education Modules. 

J Am Geriatr Soc. 2016;64(10):2122-2125. doi:10.1111/ 

jgs.14309 

7. Wolters Kluwer (Firm), International Association for 

the Study of Pain. Pain Reports. http://journals.lww. 

com/painrpts/Pages/default.aspx. Accessed July 29, 

2017. 

8. Herr K, Coyne PJ, Ely E, Gélinas C, Manworren 

RCB. Pain Assessment in the Patient Unable to 

Self-Report: Clinical Practice Recommendations 

in Support of the ASPMN 2019 Position Statement. 

Pain Manag Nurs. 2019;20(5):404-417. doi:10.1016/j. 

pmn.2019.07.005



CVS MinuteClinic Nurse Practitioners Talk COVID-19 and Nursing 

Marie Kaufmann 

MSN, FNP, AMSN 

Many COVID-19 narratives focus solely on hospital settings, and nurses 

know that the pandemic has impacted all practice settings. VNA recently 

reached out to two CVS MinuteClinic nurse practitioners to hear about how the 

pandemic has affected their personal and professional lives. MinuteClinic is a 

division of CVS Health that provides retail clinic services with more than 1,100 

locations in 33 states. Read on to hear what these nurses had to say. 

Marie Kaufmann, MSN, FNP, AMSN has been in healthcare for 10 years, 

practicing as a registered nurse for six years, and as a nurse practitioner for the 

past year. In her nursing career she has worked in various settings including 

dialysis, rehab and an observation unit. Kaufmann has worn various hats as a 

staff nurse, admissions nurse, and a nursing supervisor. She is excited to now 

be a nurse practitioner and to continue to learn and grow in her nursing career. 

“I have always been very proud to be a nurse,” notes Kauffmann. “Nothing 

makes me happier than seeing the dedication, love, and empathy shown by 

my colleagues throughout the world. COVID-19 has opened the doors for 

us to no longer be constrained by state or even country borders, but to be a 

profession that makes itself known around the world as the face of strength and 

compassion in remarkable times.” 

Most of Kauffmann’s experiences with COVID-19 have been with patients who 

are scared and are having difficulty finding healthcare. She is incredibly happy 

that the doors at MinuteClinic have been open during this time to be able to 

continue serving the community. As doctors offices begin to reopen, she notes 

that she is excited to be able to shift her focus to overseeing several COVID 

testing sites. In the early days of the pandemic, it was extremely frustrating for 

NURSES MONTH 

SPOTLIGHT 

Britton Balzhiser 

MSN, FNP-C 

her to not be able to get the testing she wanted for her patients. Now she’s proud 

to be part of bringing quick and easy testing to the community! 

While most nurses who enter the profession see it more as a calling than a 

career, that doesn’t mean it can’t be incredibly difficult to manage sometimes. 

Nurse burnout was a front and center issue before the pandemic and now 

more than ever, there’s a serious push to make sure nurses are taking care of 

themselves and maintaining a work/life balance. 

“I maintain my moral resilience by remembering that the best way to take 

care of others is to take care of myself first,” Kauffmann said. “I take time 

everyday to have a quiet moment to calm my mind and breathe. Sometimes this 

is 15 minutes of yoga, sometimes it’s a 15-minute walk outside, and sometimes 

it’s just standing in a hot shower at the end of a long day, taking deep breaths 

and letting it go. I also make a point to face my fears and anxieties. A lot of 

times as nurses we like to suppress our emotions so that we can keep going. 

This is very unhealthy and those emotions tend to leak out in other parts of our 

lives when we least expect them. If you find yourself bottling up your emotions, 

it’s time to find someone to talk to. Many companies offer access to free therapy 

sessions and it is 100% worth it.” 

COVID-19 brought to the forefront the very real mental trauma that nurses 

and health professionals can experience as a result of their work. The day in, 

day out stress of being so close to danger and risking one’s own health and 

those that are closest to them takes a heavy toll. The lack of control nurses have 

over their own environment was clear as they witnessed colleagues being put 

into unsafe situations with a lack of personal protective equipment. 

“I think the events of the past few months will help nurses push to have a 

stronger voice in healthcare, workplaces, and within communities,” Kauffmann 

said. “Nurses’ services are invaluable, they are proud of the work they do, and 

should have a leading part in shaping healthcare.” 

Accurate information regarding COVID-19 has been difficult for some to 

discern with so many states taking different approaches to quarantines and the 

24 hour news cycle constantly spitting out information. 

“Things will start being less restrictive, but we should not throw away the 

lessons learned. As flu season approaches and colds start popping up in the 

fall, the importance of staying home if you’re feeling sick can not be emphasized 

enough,” Kauffman stressed. “Continued good hand washing is going to be a top 

priority in keeping our communities safe. We may even start seeing masks out 

more regularly in the public setting, especially during flu and cold season. We 

will not go back to the pre- COVID-19 normal, but we will see a new normal that 

will help keep our society healthier.” 

Kauffmann finished by stating, “despite COVID-19 bringing the world to its 

knees, nurses are going to be there to carry the world forward to a healthier 

tomorrow with a smile on their faces.” 

Britton Balzhiser, MSN, FNP-C has worked as a nurse practitioner with CVS 

MinuteClinic for four years. She currently treats walk-in patients with a variety 

of illnesses and oversees several drive-thru COVID-19 testing sites. 

“I have always loved being a nurse, but witnessing the strength and resilience 

of my colleagues during this pandemic has reinforced my immense pride for my 

chosen profession,” Balzhiser said. “Whether in the ICU or in a small walk-in 

clinic, we have all done our part to keep our patients healthy and I am honored 

to work alongside my fellow nurses.” 

Nurses are a close-knit group and Balzhiser says working through COVID-19 

has further strengthened the bond she has with her colleagues. They support 

each other, whether through providing assistance with a heavy workload, or 

just lending an ear to listen. “I don’t know what I would do without my nursing 

family,” Balzhiser admitted. 

One of her key roles as a nurse practitioner is to be a reassuring presence for 

her patients in times of uncertainty and distress. After an unexpected exposure 

to COVID-19, she found herself in the reverse position as a patient, anxious for 

what her own test results would show. Balzhiser said this experience gave her a 

new viewpoint and a renewed empathy for the fear and worry that her patients 

encounter. 

COVID-19 has brought a new type of public awareness and appreciation for 

the vital role that nurses and nurse practitioners play in the healthcare system. 

Many state governments have created emergency action plans which expand 

the NP scope of practice and highlight the essential services provided by the 

profession. Balzhiser says the pandemic has also led to innovative strategies 

aimed at reducing infection risks while continuing to provide essential patient 

care, something that is particularly seen with the expansion of telemedicine like 

MinuteClinic’s e-visits. 

“States are beginning to reduce restrictions but this does not mean that 

COVID-19 has been defeated,” Balzhiser cautioned. “COVID-19 doesn’t care 

about your political views or that you are tired of being in quarantine. It is 

not going to go away just because the pandemic is old news. We must all unite 

together if we are to ever see an end to the virus. The only way we can truly 

contain this virus is to remain vigilant in our precautions, continue to wear 

masks in public, wash hands frequently, stay home when ill and maintain 

recommended social distancing.” 

Balzhiser believes that all nurses followed a calling to help people when they 

entered the profession. “Even though our training technically prepared us for 

a pandemic, living and working through the reality of COVID-19 is frightening 

and quite different from a theoretical concept. I am so impressed with how we 

as nurses and NPs have all risen to the challenge presented by this virus. We 

continue to choose to go into work each day despite the very real risks we now 

face.” 

Every nurse deserves a huge and humble thank you. VNA will continue 

to feature different COVID-19 narratives in Virginia Nurses Today. If you or 

someone you know has a unique story that can be shared, please reach out to 

VNA Communications Coordinator Elle Buck at ebuck@virginianurses.com. 

We also encourage you to submit a friend, colleague, or family member to our 

COVID-19 specific Healthcare Heroes campaign. Submissions can be made at: 

https://tinyurl.com/VNAHealthcareHeroes.


Mental Health Help for Nurses 

Webpage is Live 

No amount of experience could have fully prepared healthcare providers 

for practicing during this pandemic. During this unprecedented time, 

we know that nurses may have increased needs related to ensuring their 

mental health and wellness. VNA and ANA have gathered resources to offer 

suggestions on self-care, because it’s essential that nurses pause and take a 

moment for their well-being. 

The American Nurses Association recently created a committee to explore 

mental health in nursing. The Healthy Nurse Healthy Nation Strength 

Through Resiliency Committee 2020 examines, develops, and collects 

mental health resources for nurses, including those for suicide prevention. 

The Strength Through Resiliency Committee is comprised of a Work Group 

and Review Committee. The committee was convened in late 2019 and began 

meeting in January, 2020. It is composed of mental health subject matter 

experts, invested nurses, and ANA support staff. 

Available Mental Health Resources: 

• National Suicide Prevention Lifeline 

• How to Survive the Pandemic with An Unbroken Spirit - Actions to Take 

Right Now to Stay Strong and Focused 

• A Comprehensive Approach to Preventing Suicide: The Role of Law, 

Policy, and Social Determinants of Health 

• Healthy Nurse Healthy Nation mental health tips and strategies 

• ANA COVID-19 Resource Center - Mental Health and Well-being 

• 5 Action Steps for Helping Someone in Emotional Pain - Handout 

• And more! 

Visit the Mental Health Help for Nurses webpage at https://virginianurses. 

com/page/MentalHealthHelpforNurses. If you would like to suggest resources 

for this webpage, please contact VNA Communications Coordinator Elle Buck 

at ebuck@virginianurses.com. 

2020 Year of the Nurse Awards 

With your health and safety in mind, the Virginia Nurses Foundation will be 

shifting their Annual Gala to an hour-long virtual celebration this December. All 

VNA members will receive an email once a date has been selected. Nonmembers 

can check our event calendar at https://virginianurses.com/events/event_list. 

asp for Gala updates. 

This year’s Gala awards will be an extension of our annual VNF Leadership 

Excellence awards, which were created to honor outstanding nurses throughout 

the commonwealth who have made exceptional contributions to the nursing 

profession. During 2020 - the Year of the Nurse, nurses have been essential 

to fighting the COVID-19 pandemic in so many ways. They have been on the 

frontlines of providing care to the sick, working to keep their communities safe, 

and providing support with innovative ideas and compassion. 

Our 2020 Year of the Nurse Awards will focus on recognizing the 

contributions of 20 registered nurses from throughout Virginia during the 

COVID-19 pandemic. All nurses are eligible for nomination. 

Nurses who have made a difference during the pandemic can be nominated 

by their peers or a community for a variety of different reasons. We are looking 

for morale boosters, well-being ambassadors, nursing innovators, community 

contributors, and frontline heroes, just to name a few! 

Award Criteria 

Year of the Nurse Awards are based on the premise that during the COVID-19 

pandemic, the nominee enhanced the image of professional nursing and rose 

to the unprecedented challenges facing the nursing profession with compassion 

and respect. 

To be eligible, in addition to any criteria listed in the category descriptions, 

the nominee must: 

• Be licensed as an RN in the Commonwealth of Virginia 

• Be employed in the Commonwealth of Virginia 

Nominees do not have to be frontline care providers. We welcome nominations 

of exceptional nurses who have provided care and compassion across all areas 

of practice and specialities. 

Nomination Instructions 

Nominations are invited from nurses and friends of nursing across the 

commonwealth. All nominations MUST BE submitted via our online portal and 

should include the following: 

• Completed online form 

• Supporting narrative that addresses criteria (500 word maximum) 

• One letter of support (Should be written by someone other than person 

submitting narrative) 

• Nominee’s curriculum vitae or resume 

To nominate a nurse, go to https://tinyurl.com/2020VNFAwards. 

Nominations Deadline 

The nomination period closes on September 30 at 11:59 pm. Finalists will be 

notified by the end of September. 

Awards Selection and Presentation 

The VNF Leadership Awards selection committee will conduct a review of all 

nominations received. Award winners will receive a special “Gala in a Box” to 

celebrate at home, and families, colleagues, and press will be invited to a Virtual 

Gala on December 5 at 7 pm, where we will share short video stories of each 

winner. 

Questions? 

Contact Elle Buck at ebuck@virginianurses.com.



VNF’s Nurse Leadership Academy to Launch in Fall 2021 

The Nurse Leadership Academy is a leadership 

development program for new and emerging 

nurse leaders across all healthcare settings. 

Fellows will learn foundational leadership skills 

and demonstrate these skills through an applied 

leadership project within their organization. As a 

result of the pandemic, the program launch has 

been delayed until October 2021 in Richmond. 

The first six months of this year-long program 

will be dedicated to live didactic sessions and 

webinars focused on five concepts: Fundamentals 

of Effective Leadership, Organizational Culture, 

Facilitating a High Reliability Environment, 

Influencing Change: Driving Outcomes through 

Strategic Action, and No Margin No Mission: 

Examining the Finances of Healthcare. Fellows 

will then have an additional six months to develop 

an applied leadership project with support from 

their individually identified mentor. Checkin 

points with program leadership and peers 

will be convened through a virtual community, 

and the program will culminate at 12 months 

with presentations from fellows on their applied 

leadership projects. The Virginia Nurses 

Foundation is excited to bring this program to 

new and emerging Virginia nurse leaders in 

collaboration with the Virginia Nurses Association. 

Desired Outcome 

Fellows will learn foundational leadership 

skills and demonstrate this through successful 

completion of an applied leadership project within 

their organization. 

Structure 

• Months 1-5: 

- 5 Live didactic sessions and additional 

webinars 

- Fellows will: 

• identify a leadership mentor 

• identify an organization-approved 

applied leadership project that will 

demonstrate a positive impact on 

their organization and showcase their 

leadership acumen 

• complete a leadership assessment 

to gain feedback on their personal 

leadership style 

• Months 6-12: 

- Fellows will complete an applied leadership 

project 

- A virtual community will be provided for 

additional coaching opportunities with 

program leadership and peer-to-peer 

engagement 

• Month 12: 

- Fellows will present a formal presentation 

on their applied leadership project 

Curriculum 

• October 13, 2021: Fundamentals of Effective 

Leadership 

• November 4, 2021: Organizational Culture 

• December 2, 2021: Facilitating a High 

Reliability Environment 

• February 24, 2022: Influencing Change: 

Driving Outcomes through Strategic Action 

• March 24, 2022: No Margin No Mission- 

Examining the Finances of Healthcare 

• Final Program: Applied Leadership Project 

Cost 

Single registration: $1,295 per registrant 

Group registration (If your employer will 

be paying for 3 or more registrants from your 

organization) : $1,195 per registrant 

Sign up to be notified when registration opens 

for the Nurse Leadership Academy https://tinyurl. 

com/VNFNLA. Questions can be sent to VNA/VNF 

CEO Janet Wall at jwall@virginiianurses.com. 

The Nightingale Legacy Fund 

VNF’s Nightingale Legacy Fund, which supports 

the development of the Nurse Leadership Academy, 

also pays tribute to nursing leaders who have 

made a difference. As a contributor, you will have 

the opportunity to recognize those nurses who 

paved the way for you, and whose leadership 

has advanced the profession of nursing; all 

while supporting this very important initiative. 

The nurse leader you recognize will receive an 

email letting them know you wanted to say 

thank you! Please consider contributing to the 

Nightingale Legacy Fund at https://tinyurl.com/ 

VNFNightingaleLegacyFund. 

Lauren Goodloe Nursing Scholarship 

VNF also developed a scholarship for the Nurse 

Leadership Academy to honor the life and legacy 

of Dr. Lauren Goodloe and her commitment 

to nursing and nursing education in Virginia. 

Dr. Goodloe served as president of the Virginia 

Nurses Association while working as a respected 

faculty member and assistant dean for clinical 

operations and associate professor at VCU’s 

School of Nursing, all while fighting a valiant 

battle with cancer. Please take this opportunity 

to put your stamp on the future by making a 

contribution for up-and-coming nurse leaders. 

Contributions can be made at https://tinyurl.com/ 

LaurenGoodloeScholarship. 

NLA Steering Committee Members 

The Virginia Nurses Foundation would like to 

recognize the leadership and members of the NLA 

Steering Committee for their hard work, innovative 

thinking, and dedication toward creating an 

unparalleled leadership program for nurses 

throughout the commonwealth. 

• Terris Kennedy, PhD, RN, President, Virginia 

Nurses Foundation 

• Linda Shepherd, MBA, BSN, RN, President, 

Virginia Nurses Association 

• Lindsey Cardwell, MSN, RN, NPD-BC 

• Jaime Carroll, MHA, BSN, RN 

• Mary Dixon, MSN, RN, NEA-BC 

• Jayne Davey, MSN, RN, NPD-BC, CNN 

• Jay Douglas, MSM, RN, CSAC, FRE 

• Elizabeth Friberg, DNP, RNDonna Hahn, 

DNP, RN, NEA-BC 

• Terri Haller, MSN, MBA, NEA-BC, FAAN 

• Ronnette Langhorne, MS, RN 

• Nellie League, MSN, BSN, RN, NE-BC 

• Nancy Littlefield, DNP, RN, FACHE 

• Trula Minton, MS, RN 

• April Payne, LNHA 

• Meg Scheaffel, BSN, RN, MBS-MHA 

• Jeannine Uzel, RN, MSN 

• Janet Wall, MS 

• Deb Zimmermann, DNP, RN, NEA-BC 

Visit nursingALD.com today! 

Search job listings 

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

Browse our online database 

of articles and content. 

Find events 

for nursing professionals in your area. 

Your always-on resource for nursing jobs, 

research, and events.


Community Health Nursing – A Value to Our Communities 

Kate Clark, DNP, RN, PHNA-BC 

Assistant Professor of Nursing, Eastern 

Mennonite University 

Jessica Knight, BSN, RN 

Nursing Supervisor, Child Health Partnership 

Home visiting has been a foundational skill of 

public health nurses for centuries. In fact, nursing 

as a profession has its roots in primarily home-based 

services. Nurses like Florence Nightingale, Bessie 

Hawes, Lillian Wald and Mary Breckinridge designed 

public health nursing programs to meet families where 

they lived, providing basic nursing care and health 

education. Healthcare has become more centralized 

within clinics and office settings, and the emphasis 

of home-visiting programs has lessened. Over time, 

cuts to public health programs and the pull of higher 

pay for nurses within acute care settings have 

caused many to forget or undervalue the significant 

impact that home visiting nursing programs have 

on the health of communities. However, today with 

the COVID-19 pandemic impacting communities 

throughout Virginia, home visiting has never been 

more important. 

Home visiting nurtures a particular set of nursing 

skills. Home visiting nurses are excellent at developing 

deep trust and partnership with the families they 

work with. In the home setting, the power dynamic 

that can often complicate the nurse-client relationship 

shifts because the nurse is functioning within the 

family’s home. In addition, home visits provide unique 

opportunities for nursing assessment. Nurses often 

engage with children and observe family dynamics. 

The home environment and broader neighborhood/ 

community can also contribute to a fuller understanding 

of the health and health education needs of the family. 

Nurses can be a lifeline for parents who feel isolated at 

home with small children. They provide encouragement, 

support and empowerment to vulnerable families. This 

ability to holistically, deeply understand a family’s 

strengths and needs from multiple perspectives allows 

home visiting nurses to create tailored interventions and 

health teaching for families. 

Home visiting programs are often most impactful 

among vulnerable patient populations. Low-income 

households, single-parent families, minority groups, 

and immigrants or refugees face many barriers 

accessing preventative healthcare services in the U.S. 

Home visiting programs remove barriers to care for 

these families like transportation, inflexible work 

schedules, lack of childcare and the general complexity 

of navigating a disjointed U.S. healthcare system. 

COVID-19 has intensified and exposed these barriers 

and made home visiting, even if it is done virtually, 

vital to providing ongoing nursing care, education and 

support to vulnerable populations. 

The current pandemic has highlighted the 

link between the home, community environment, 

socioeconomic status and the impact those have on 

the health of families and communities. Families, 

particularly low-income and non-English speaking, 

need to have clear, consistent information on how 

best to prevent the spread of COVID-19. While public 

health messaging is important, home visiting nurses 

are well positioned to provide this vital information 

in a way that families can understand and act upon. 

COVID-19 prevention is mostly about understanding 

and mitigating risk for exposure. Nurses can 

partner with families to explore their particular life 

circumstances, including living situation, employment 

status, neighborhood environment, etc. and help 

families make informed choices about how to minimize 

their risk of contracting or spreading COVID-19. 

In addition, home visiting nurses can help families 

navigate additional challenges they may face related 

to sudden unemployment, school closures and lack of 

summer childcare and the increased stress and strain 

on families living through uncertain times. 

Beyond the need for education related to COVID-19, 

there is an ongoing need for general health prevention 

and promotion interventions and education. At a time 

when individuals and families may be hesitant to go 

to their primary care provider’s office or to seek care 

at the local emergency room, home visiting nurses can 

provide important guidance on how to best promote 

the health of the family. The following real life story 

from the CHIP home visiting program, Child Health 

Partnership, illustrates the value of community health 

nursing during the pandemic. 

When all the forms, assessments, screenings, and 

tools are stripped away, the foundation of community 

health nursing is the relationship a nurse builds with 

his/her patient. The COVID-19 pandemic of 2020 

has illuminated this more than ever. Susan was a 

primigravida in her early 20s when she first met her 

community health nurse in January 2020. She was 

due to deliver her first child within a few months. As 

COVID-19 took hold in the United States and began 

to spread across the country, Susan turned to her 

community health nurse for guidance - is it safe to 

attend prenatal appointments? Is it safe to go outside? 

Will I be able to deliver my baby at a hospital? Will 

I be separated from my baby at birth if I’m sick? 

Thanks in part to regular virtual home visits with her 

community health nurse (completed via video chat), 

Susan delivered a healthy baby girl in late March 

2020. Shortly after birth, Susan’s community health 

team identified the need for more support and began 

checking in with her weekly via video chat. This 

increased follow-up helped her nurse identify signs of 

postpartum depression, which the nurse explained 

to Susan and relayed to her medical doctor. Susan 

received a diagnosis of postpartum depression and 

successfully started treatment shortly thereafter. In 

a time when many of the resources that new parents 

rely on to help navigate the early months of newborn 

life were forced to halt services and close their doors 

due to the pandemic, Susan was able to continue to 

reach out to her community health nurse virtually for 

support in everything from infant feeding patterns and 

sleep schedules to finding support for her own mental 

health and wellbeing. Without access to this critical 

support, it is likely that Susan’s baby would have had 

a much more difficult start to life. Susan’s nurse is 

quoted as saying, “We have watched this mom move 

from survival mode into a space where she is now 

making plans for the future.” This was all done during 

a time when most of us found it difficult to think about 

the future. 

This is what community health is all about, 

building relationships to support the well-being of 

children and families. Healthy children in healthy 

homes make for a healthier community. 

NURSES MONTH 

SPOTLIGHT 

NURSES MONTH 

SPOTLIGHT


ULTRASOUND PIVS 


Patrick Hill, DNP 

Stephen Ankiel, RN 

Lisa Milam, DNP 

Virginia Commonwealth University Health System 

Background 

Intravenous (IV) therapy is one of the most frequent 

types of treatment in the inpatient setting (Soifer, 

Borzak, Edlin, & Weinstein, 1998), with up to 90% of 

patients having peripheral intravenous access (PIV) 

(Brown, 2004). Aside from discomfort related to the 

disease process, insertion of PIVs are often considered 

by patients to be the most distressing experience of 

hospital stays (Stephens, O’Brian, Casey, et al, 1982). 

The discomfort associated with PIV insertion may 

lead to increased anxiety and physical responses to 

future attempts to obtain access (Kennedy, Luhmann, 

& Zempsky, 2008). This pain and anxiety can be a 

contributing factor in patient dissatisfaction. 

Although there may be several methods to reduce 

discomfort secondary to PIV insertion (Hosseinabadi, 

Biranvand, Pournia, & Anbari, 2015), minimizing 

attempts is ideal, but this may not be feasible with 

all patient populations. Notwithstanding the fact 

that patients who are difficult to obtain vascular 

access, and thus undergo more PIV attempts, the 

literature reflects that there is no consensus on what 

constitutes the difficult access patient population 

(Partovi-Deilami, Nielson, Moller, Nesheim, & 

Jorgensen, 2016). One study in the United States 

found that patient populations with diabetes, 

intravenous drug abuse, and sickle cell disease were 

predisposed to be difficult for placing PIVs, whereas 

renal failure and increased body mass index were 

not significant factors (Fields, Piela, Au, & Ku, 2014). 

However, Lapostelle, et al. (2007) found body mass 

index to be a significant factor. 

There is a substantial body of evidence supporting 

the use of ultrasound (US) for vascular access. The 

use of US has been shown to reduce complications 

and has been used in practice for more than 30 

years (Lamperti, et al., 2012). The evidence shows 

that the utilization of US to guide PIV insertion 

takes less time than traditional methods of insertion 

(Egan, et al., 2013). Studies also show that US 

guided PIV insertion has increased success rate 

(89%), as opposed to the traditional method (55%) 

(Constantino, Parlkh, Satz, & Fojtik, 2005). This 

decrease of attempts at IV access has been shown 

to lead to improved patient satisfaction (Bauman, 

Evaluation of Methods for Ultrasound Guided 

Peripheral Intravenous Catheter Insertion 

Braude, & Crandall, 2009), and patients actually 

preferred the US methods to traditional methods of 

IV insertion because it was faster and required less 

attempts (Schoenfeld, Shokoohi, & Boniface, 2011). 

Using US can also reduce time by as much as 50% 

to 75% (Partovi-Deilami, Nielson, Moller, Nesheim, 

& Jorgensen, 2016). The success of cannulation on 

the first attempt often averages 77 seconds (Keyes, 

Frazee, Snoey, Simon, & Christy, 1999). The use of US 

guided PIV insertion can also reduce the use of more 

risky central venous catheter insertion (CVC) (Gregg, 

Murthi, Sisley, Stein, & Scalea, 2010), although there 

have been instances of US guided PIV insertion when 

patient situation dictates that CVCs would be more 

appropriate (Egan, et al., 2013), such as with certain 

medications, for example vasopressors or long term 

antibiotic treatments. Although US guidance is most 

useful when veins cannot be visualized or palpated, 

(Liu, Alsaawi, & Bjornsson, 2014), the chance of 

success is eliminated with veins greater than 16 mm 

deep and less than 3 mm in diameter (Panebianco, 

et al., 2009). Panebianco (2009) also found that 

increased vein size was a factor in success of vein 

cannulation. 

The traditional method of vein cannulation may be 

defined as using palpation or visualizing the vessel 

for venipuncture, usually accompanied by a form of 

dilation with either a tourniquet or blood pressure 

cuff inflation. The utilization of US has been shown 

to be beneficial, however there are differing methods 

of insertion, each with their possible advantages. 

The short axis gives a cross sectional view of the 

vessel, see Figure 1. The short axis method has 

the advantage of visualization of the catheter tip 

puncturing the vessel wall, but does not show the 

length of catheter in the vessel. The long axis gives 

a longitudinal view of the vessel, see Figure 2. The 

long axis method of insertion may have the advantage 

of visualizing a length of the vein for valves, 

calcifications, or whether the vessel is tortuous, but 

has the disadvantage of not showing if the tract of 

catheter is lateral to the vessel during insertion. 

Review of Literature 

A review of the available literature to ascertain 

the best methods of enhancing success of PIV 

insertion with US guidance was conducted using 

CINHAL, Pubmed, Google Scholar, and Ovid Medline 

databases. The literature was first searched for 

optimum methods of vein dilation using the search 

terms: vein dilation, tourniquet, blood pressure cuff, 

IV, and intravenous access. Three studies were found, 

but the results were inconclusive. All of the studies 

found that the use of blood pressure cuff inflation 

dilates veins to a greater size (Mahler, et al., 2011), 

inflated the cuff to above diastolic pressure, and did 

not use this in a study of difficult access patients but 

rather studied healthy volunteers. 

Kule, Hang and Bahl (2013), after inflation of 

the blood pressure cuff to 150 mm Hg, found the 

significant increase of peripheral vein size and 

decreased compressibility compared to one or two 

tourniquets, but did not attempt vein cannulation 

and studied healthy volunteers. The only study 

that was conducted on actual patients (Nelson, 

Jeanmonod, and Jeanmonod, 2014), compared the 

use of tourniquet to blood pressure cuff inflated to 

150mm Hg. They concluded that the tourniquet had 

advantage over blood pressure cuff due to patient 

discomfort of cuff inflation to that pressure. They 

also reported that the cuff obstructed the site of PIV 

insertion. 

Using the same databases, the literature was then 

searched using the keywords: ultrasound approach, 

long axis, long plane, longitudinal axis, short axis, 

short plane, and peripheral intravenous access using 

the separator AND and OR. Four articles were found. 

Fuzier, Rouge, and Pierre (2016) report that the long 

axis gives the advantage of visualizing the needle 

as it courses into the vessel, but may be difficult to 

align, and little difference was found between the 

long and short axis approach. A review by Gao, et al. 

(2016) concluded that there was insufficient evidence 

to determine a difference in success rate between the 

long and short axis approach. Mahler, et al. (2010) 

found that there was no statistical difference between 

long and short axis approach, but that short axis may 

have less insertion time. The operators in this study 

had considerable experience in both approaches, but 

mostly used the short axis method, and the study 

population was healthy volunteers. Panebianco, et al. 

(2009), found no significant difference between long 

and short axis, but left the orientation to the choice of 

the operators rather than randomization. 

Study Question 

From the literature available, there is no evidence 

on how inflation of the blood pressure cuff to above 

diastolic pressure for patients with difficult venous 

access compares to a tourniquet. There is also no 

conclusive evidence on the comparison of long axis to 

short axis orientation of the US for needle approach 

for venipuncture. 

Due to this lack of definitive evidence on methods 

to ensure success with US guided PIV insertion, two 

research questions become relevant. 

1. In difficult access adult patients, is a blood 

pressure cuff inflated to above diastolic 

pressure more effective for vein cannulation 

than tourniquet? 

2. In difficult access patients, does long axis 

approach versus short axis result in more 

successful vein cannulations? 

Methods 

Study Design 

A prospective, randomized, non-blinded study 

comparing long axis to short axis approach for US 

guided PIV insertion. The study also compared 

tourniquet to blood pressure cuff inflated to above 

diastolic pressure. The patients’ method of PIV 

insertion was chosen by a predetermined random 

order by an Excel random number generator in order 

of presentation. All members of the research team 

performing the procedure were intensive care nurses 

of similar levels of ultrasound training, IV insertion 

skill, and experience. 

Figure 1. 

Short axis approach and cannulated vessel. 

Figure 2. 

Long axis approach and cannulated vessel. 

Setting and Sample 

A convenience sample of patients, N=64, with 

difficult access needing US guided PIV insertion 

in an urban academic hospital medical Intensive 

Care Unit. For the purposes of this study, difficult 

access patients were defined as any patient needing 

peripheral access, but not central access, who 

have had two unsuccessful attempts by traditional 

landmark methods of PIV insertion. 

Ultrasound PIVs continued on page 26



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Weston, Janelle 

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Willis, Margaret 

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Winston, Shatema 

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Wood, Amy 

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Zastrow, Tina


Ultrasound PIVs continued from page 22 

Protection of Human Subjects 

Approval was granted by the Institutional Review 

Board (IRB HM20010119) and verbal informed 

consent was obtained as this study does not 

involve collection of any patient information and 

the interventions did not deviate from established 

standards of patient care. 

Data Analysis 

The time and number of attempts or failure 

with the blood pressure cuff versus tourniquet was 

analyzed via Excel software with additional steps 

utilizing the Mann-Whitney U test to compare the 

mean difference for statistical significance. The time 

and number of attempts were also analyzed using 

an independent T test for the long versus short axis 

approach. 

Materials 

The catheter used for vein cannulation was the 

BD Angiocath, 1.1 x 48mm (20 gauge 1.88inch). 

Vein dilation was accomplished by use of Owens 

Minor non-latex nitrile tourniquets, manufacturer 

number TRN184 or Critikon Soft-Cuf blood pressure 

cuffs of appropriate length for the patient’s arm. The 

ultrasound equipment used was the Fujifilm SonoSite 

X-Porte System. 

Procedures 

When patients had two failed attempts at 

traditional peripheral vein cannulation, the research 

team was notified. Peripheral IV insertion was 

attempted by researchers utilizing US guidance via 

the single operator method of holding the US probe in 

one hand and inserting the IV catheter with the other. 

Assigned methods of cuff versus tourniquet and 

long axis versus short axis were pre-randomized by 

the Microsoft Excel random number generator. Cuff 

versus tourniquet and long axis versus short axis 

were written on index cards and sealed in envelopes. 

When the patient agreed to participate in the study by 

giving verbal consent, the sealed envelope was opened 

revealing the methods to be used. 


The blood pressure cuff group used the appropriate 

size blood pressure cuff, with venipuncture mode on 

the ICU monitor. This inflates the cuff to 10 mmHg 

above the diastolic pressure, depending on the last 

blood pressure measurement taken. Due to the short 

period of time, the cuff remains inflated in this mode 

for 60 seconds and a hemostat was used to clamp the 

tubing attaching the cuff to the monitor to ensure 

sufficient time of inflation for IV insertion. 

After the IV insertion, the operator recorded the 

axis used, vein dilation method, number of attempts, 

failed attempts, and time in seconds on the index 

card and returned it to the principal investigator of 

this study for analysis. 

Results 

A total of 64 patients participated in the study 

and were grouped into 4 groups, consisting of 15 in 

the cuff and long axis group, 15 in the tourniquet 

long axis group, 19 in the cuff short axis group, and 

15 in the tourniquet short axis group. They ranged 

in age from 24 to 88 years. The participants were 

47% female with the remainder being male. These 

were all intensive care unit patients with diagnoses 

ranging from septic shock, to exacerbation of COPD, 

status asthmaticus, sickle cell disease, with multiple 

comorbidities. The BMI of each individual patient 

was not recorded as the literature has not supported 

BMI to be of significant contribution to difficult 

intravenous access. 

The total attempts with cuff versus tourniquet, 

n=64, including failure and re-attempt with another 

method and the rate of failure of the patients in the 

cuff group was analyzed. There were 9 failures of the 

cuff group which were subsequently successful with 

the utilization of a tourniquet as a rescue method. 

An independent samples T test was conducted 

to compare the time required to insert by use of 

tourniquet and blood pressure cuff condition. There 

was not any significant difference in the scores of 

time for the tourniquet (M=54.1) and blood pressure 

cuff (M=73.03), conditions t (67),=1.19, p=0.23. A 

Mann-Whitney U test indicated that the success rate 

of the tourniquet (Mdn=45.5) was greater than for the 

cuff (Mdn=34), U=648, p


into the vessel. This may be overcome by sliding the 

probe proximally to the patient, as the needle tip is 

inserted into the lumen, however the investigators 

did point out that it is easy to lose the needle tip in 

this fashion. The weakness identified in the long axis 

insertion was identified as inability to determine if 

the needle tip is in the center of the vessel wall. This 

problem has been identified by the investigators as 

both the vessel and the catheter can be seen on the 

ultrasound screen, making it difficult to ascertain 

if the vein is in front of or behind the IV catheter. 

However, the long axis is superior to actually visualize 

the catheter in the vessel lumen when insertion is 

successful. 

One strength of the study was that the investigators 

were highly experienced ICU nurses who were well 

trained in the use of ultrasound as well as highly 

experienced in PIV insertion. They all had similar 

levels of expertise, therefore the study findings were 

not skewed by unequal levels of skill of the operators. 

Although it was not possible to blind the operators 

for obvious reasons, another strength of the study 

is that it was the only one of its kind that was 

randomized. 

This study did present new evidence on the 

subject, as previous studies were inconclusive. There 

have been previous investigations utilizing phantom 

models or healthy volunteers, however this study 

used actual patient populations. This is the first 

study to examine patient populations in the methods 

of venous dilation for actual IV insertion. 

The results of this study were promising, however 

the main limitation is that it was conducted in an 

inner city academic medical center intensive care 

unit by experienced nurses who had been trained 

in ultrasound techniques, and was therefore limited 

to a single site. Further limitations include that 

all patients received the same type of intravenous 

catheter and the same type of ultrasound machine. 

Further research is needed to determine if similar 

results can be found in other patient populations and 

environments utilizing different types of catheters, as 

well as ultrasound machines. 

Conclusion 

Based on the findings of the study, the investigators 

recommend identifying the vessel with the short axis 

and evaluating the vessel for appropriate length and 

linearity. This is recommended to avoid insertion 

failures related to tortuous vessels. Valves within the 

vein, which make peripheral IV insertion difficult, may 

also be easier to see when the vessel is visualized in 

the long axis method. 

It may be beneficial to proceed with insertion in 

the short axis method until the needle tip begins 

to puncture the vessel wall, then switch to long axis 

to complete the cannulation of the vessel lumen, 

however this has not been studied. This combination 

approach may allow for more definitive identification 

of puncturing the vessel wall in the center, which can 

then be used to visualize the insertion of the catheter 

into the lumen in real time. This offers the advantages 

of both approaches as well as the additional advantage 

of a final confirmation of proper placement. 

Bibliography 

Bauman, M., Braude, D., & Crandall, C. (2009). Ultrasoundguidance 

vs. standard technique in difficult access 

patients by ED technicians. American Journal of 

Emergency Medicine, 27(2). 

Brown, D. (2004). Local anesthesia for vein cannulation. 

Journal of Infusion Nursing, 27(2). 

Constantino, T., Parlkh, A., Satz, W., & Fojtik, J. (2005). 

Ultrasound guided peripheral intravenous access 

versus traditional approaches in patients with difficult 

intravenous access. Annals of Emergency Medicine, 46(5). 

Egan, G., Healy, D., O’Neill, H., Clarke-Moloney, M., Grace, 

P., & Walsh, S. (2013). Ultrasound guidance for difficult 

peripheral venous access: Systematic review and metaanalysis. 

Emergency Medicine Journal, 30. 

Fields, J., Piela, N., Au, A., & Ku, B. (2014). Risk factors 

associated with difficult venous access in adult ED 

patients. American Journal of Emergency Medicine, 32. 

Fuzier, R., Rouge, P., & Pierre, S. (2016). Abords veineux 

peripheriues echoguides. Presse Medicale, 45(2). 

Gao, Y., Yan, J., Ma, J., Liu, X., Dong, J., Sun, F., . . . Li, 

J. (2016). Effects of long axis in plane vs short axis out 

of plane techniques during ultrasound guided vascular 

access. American Journal of Emergency Medicine, 34. 

Gregg, S., Murthi, S., Sisley, A., Stein, D., & Scalea, T. 

(2010). Ultrasound guided peripheral intravenous access 

in the intensive care unit. Journal of Critical Care, 25. 

Hosseinabadi, R., Biranvand, S., Pournia, Y., & Anbari, K. 

(2015). The effect of accupressure on pain and anxiety 

caused by venipuncture. Journal of Infusion Nursing, 

38(6). 

Kennedy, R., Luhmann, J., & Zempsky, W. (2008). Clinical 

implications of unmanaged needle insertion pain and 

distress in children. Pediatrics, 122(S3). 

Keyes, L., Frazee, B., Snoey, E., Simon, B., & Christy, D. 

(1999). Ultrasound guided brachial and basilic vein 

cannulation in emergency department patients with 

difficult access. Annals of Emergency Medicine, 34(6). 

Kule, A., Hang, B., & Bahl, A. (2013). Preventing the collapse 

of a peripheral vein during cannulation: An evaluation of 

various tourniquet techniques on vein compressibility. 

Journal of Emergenct Medicine, 46(5). 

Lamperti, M., Bodenham, A., Pittiruti, M., Blaivas, M., 

Augoustides, J., Elbarbary, M., . . . Verghese, S. (2012). 

International evidence based recommendations on 

ultrasound guided vascular access. Intensive Care 

Medicine, 38. 

Lapostelle, F., Catineau, J., Garrigue, J., & et al. (2007). 

Prospective evaluation of peripheral venous access 

difficulty in emergency care. Intensive Care Medicine, 

33(8). 

Liu, Y., Alsaawi, A., & Bjornsson, H. (2014). Ultrasound 

guided peripheral venous access: A systematic review 

of randomized controlled trials. European Journal of 

Emergency Medicine, 21(1). 

Mahler, S., Massey, G., Meskill, L., Wang, H., & Arnold, T. 

(2011). Can we make the basillic vein larger? Maneuvers 

to facilitate ultrasound guided peripher intravenous 

access: A prospective cross sectional study. International 

Journal of Emergency Medicine, 4(53). 

Nelson, D., Jeanmonod, R., & Jeanmonod, D. (2014). 

Randomized trial of tourniquet vs blood pressure cuff 

for target vein dilation in ultrasound guided peripheral 

intravenous access. American Journal of Emergency 

Medicine, 32. 

Panebianco, N., Fredette, J., Szyld, D., Sagalyn, E., Pines, 

J., & Dean, A. (2009). What you see (sonographically) 

is what you get: Vein and patient characteristics 

associated with successful ultrasound guided peripheral 

intravenous placement in patients with difficult access. 

Academy of Emergency Medicine, 16(12). 

Partovi-Deilami, K., Nielson, J., Moller, A., Nesheim, S., 

& Jorgensen, V. (2016). Effect of ultrasound guided 

placement of difficult to place venous catheters: A 

prospective study of a training program for nurse 

anesthetists. AANA Journal, 84(2). 

Schoenfeld, E., Shokoohi, H., & Boniface, K. (2011). 

Ultrasound-guided peripheral intravenous access in the 

emergency department: Patient-centered servey. Western 

Journal of Emergency Medicine, 12(4). 

Soifer, N., Borzak, S., Edlin, B., & Weinstein, R. (1998). 

Prevention of peripheral venous catheter complications 

with an intravenous therapy team. Arcgives of Internal 

Medicine, 158. 

Stephens, R., O’Brian, M., Casey , S., & et al. (1982). 

Intradermal lidocaine: Does it have a role in setting up a 

drip. Irish Journal of Medical Science, 151.



Advances in Nursing During World War II 

Sarah M. Gilbert, PhD, RN, GCNS-BC 

Samuel D. Lee, BA 

The World Health Organization 

designated 2020 as the Year of the Nurse 

and Midwife as a tribute to the 200th 

anniversary of Florence Nightingale’s 

birth. 2020 also marks 75 years since 

the end of World War II. Military nurses 

were part of a large medical machine 

that not only saved lives but also 

participated in research on new drugs 

and treatments, which would impact 

civilian and military care in the future. 

Specialties were also established or 

became more valued during the conflict. 

Specialty Practice 

Shortages of nurse anesthetists 

during World War II precipitated a 

military training program producing at 

least 2,000 qualified nurse anesthetists 

(Ray & Desai, 2015). The use of newer 

anesthetic medications such as ethyl 

chloride, thiopental sodium, and ethylene 

in addition to ether and nitrous oxide 

enabled nurse anesthetists to utilize 

multiple anesthetics depending on wound type. The use of spinal anesthesia 

and local nerve blocks also saw increased use by nurse anesthetists after 

training by anesthesiologists. Additionally, intravenous administration of 

anesthetic agents became the preferred method of induction. 

The first cadre of flight nurses experienced a shortened and pointed 

introduction to flight nursing that included “first aid, medical and surgical 

care of patients en route by air, loading and unloading patients from the 

planes, and chemical warfare” (Barger, 2013, p. 42). Subsequent groups of 

nurses received more detailed education to include “aeromedical nursing, 

physiology, classification of patients, air evacuation records, operations and 

logistics, tropical and arctic medicine, tactics of air evacuation, special studies, 

sanitation, and hygiene” (Barger, 2013, p. 44). In 1943, Elsie Ott successfully 

completed a six day, multi-stage journey to the U.S. from Pakistan. Ott 

reported multiple problems, solutions, and successes throughout the trip to 

her superiors. These concerns were addressed in a letter sent to Air Transport 

Command officials and subsequently implemented, officially creating flight 

nurse specialization (Barger, 2013). 

Psychiatric nursing was in its infancy as a practice specialty in 1940 and 

nurses were heavily recruited to serve in wards overseas that were overwhelmed 

NURSES MONTH 

SPOTLIGHT 

with “psychiatric casualties” (Silverstein, 

2008, p. 721). Nurses in these hospitals 

assisted with interventional therapies 

and the aftercare required to assure 

recovery. Hildegarde Peplau joined 

the Army Nurse Corps (ANC) after 

completing extensive education on 

neuropsychiatry in the U.S. and Great 

Britain. Her background and education 

on neuropsychiatry and her belief in 

psychoanalytic therapy slowly changed 

the landscape of nursing care and 

treatment of psychiatric illnesses. She 

implemented “walking and talking” 

with the patients singularly or in 

groups (Silverstein, 2008, p. 726) and 

subsequently, developed a theoretical 

framework for psychiatric nursing 

practice (Smith, 2018). 

Specialty Units 

Introduction of field hospitals near 

the front lines expedited the intensive 

interventions needed for soldiers’ 

survival. Due to advanced weaponry, 

severe thoracic and abdominal injuries 

were prevalent (Brown, 2015). Volume 

replacement using whole blood transfusions proved to be the best treatment 

for shock wounds. In 1943, it was recommended by the Surgical Consultant in 

the North African Theater of Operation (NATOUSA) that a system to secure and 

transport whole blood to field hospitals be implemented immediately (Hardaway, 

2004). 

Shock Wards (SW) for intensive treatment of life threatening injuries were 

created and placed near crucial medical and diagnostic services: operating tent, 

surgical wards, and x-ray department. The SW was kept warm (80° F), quiet, 

well ventilated, and smoking was not allowed. Nurses and specially trained 

enlisted men staffed the eight bed ward, worked 12 hour shifts, and were on 

call to respond to incoming casualties. One nurse and one enlisted man cared 

for four critical patients. The ward was prepared by the nurse, who set out 

equipment and placed hot water bottles in the cots. The enlisted man also had 

preparation duties and was trained to give injections, take blood pressures and 

pulses, and recognize changes in the patient’s status. For critically ill patients, 

vital signs were taken every 15 minutes, morphine was given for pain, and 

detailed records were completed. The surgeon was notified by the nurse when 

the patient was stable for surgery (Setzler, 1944, Brown, 2015). 

Most evacuation hospitals also had an Emergency Admitting Ward (EAW) 

which was located near the operating tent and x-ray department. Like the SW, 

casualties arrived by ambulance to the EAW where “each soldier, no matter 

lightly injured, is assigned to a bed” (Setzler, 1944, p. 937). Each patient’s vital 

signs were measured and recorded then the patient was examined by a surgeon. 

The most critically injured were taken to surgery first and then transferred 

to another hospital ward for recovery. The EAW was staffed by six nurses and 

six enlisted men, working 12 hour shifts (or more), caring for 25-30 patients. 

Nurses for these specialty units were trained in the classroom and then 

precepted by a more experienced nurse (Setzler, 1944, Brown, 2015). 

The 300th General Hospital was a research site for penicillin testing and 

administered over five billion units in the first year. This hospital also developed 

the first ‘recovery room’ after post-surgical wards, who admitted up to 120 

patients a day, overwhelmed the nurses, enlisted men and nurse anesthetists, 

who were transporting patients to and from the wards. This post-operative 

unit was staffed by one of the surgical nurses and two corpsmen and could 

accommodate fifteen to twenty patients. There were very few supplies and no 

vital signs or records were kept (Breakiron, 1995). 

Conclusion 

Nurses who volunteered with the armed services were seeking to ‘do their 

part’ but also to see the world. What they did was elevate nursing to a profession 

through their courage, bravery, stamina, and ingenuity. They served around 

the world, laid the foundation for psychiatric nursing, flight nursing, critical 

care/trauma nursing, and emergency nursing. Certified registered nurse 

anesthetists advanced their practice through participation in new methods and 

drugs for induction. Their service showed the value of nursing as an integral 

part of the armed forces hospital system in times of conflict and crises. Their 

sacrifices made it possible for nursing to advance as a profession. They were the 

foundation of modern nursing. 

References 

Barger, J. (2013). Beyond the call of duty : Army flight nursing in world war ii. Retrieved 

from https://ebookcentral.proquest.com ISBN-13: 978-1606351543. 

Breakiron, M. (1995). A Salute to the Nurses of World War II. AORN Journal, 62(5), 710- 

722. doi: 10.1016/s0001-2092(06)63523-0 

Brown, W. (2015). Nursing in the 8th evacuation hospital, 1942-1945. U. S. Army 

Medical Department Journal. https://www.cs.amedd.army.mil/FileDownloadpublic. 

aspx?docid=6cae702a-664e-4cdb- 9897-516b6dc436bf 

Hardaway, R. (2004). Wound shock: a history of its study and treatment by military 

surgeons. Military Medicine. 169. 265-269. 

Ray, W. T. & Desai, S. P. (2016). The history of the nurse anesthesia profession. Journal of 

Clinical Anesthesia. 30. 51-58. doi.org/10.1016/j.jclinane.2015.11.005o 

Setzler, L. (1944). A shock ward in the ETO. American Journal of Nursing. 44(10). 935-937. 

https://wwwjstor.org/stable/2416769. 

Silverstein, C. M. (2008). From the front lines to the home front: A history of the 

development of psychiatric nursing in the U.S. during the World War II era. Issues in 

Mental Health Nursing, 29(7), 719-737. doi:10.1080/01612840802129087. 

Smith, K. (2018). Different places, different ideas: Reimagining practice in American 

psychiatric nursing after World War II. Nursing History Review. 26. 17-47. doi. 

org/10.1891/1062-8061.26.17.


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SPOTLIGHT 

NURSES MONTH 

SPOTLIGHT 

Here’s What You Missed at VNA’s Spring Conference, 

Cultivating a Happy Work Environment 

VNA Commissioner on Nursing Education 

Catherine Cox, PhD, RN, CEN, CNE, Alumnus 

CCRN, George Washington University 

Kudos to VNA for pivoting 

to a virtual 2020 Spring 

Conference given Governor 

Northam’s temporary stay 

at home order due to novel 

coronavirus (COVID-19). 

I believe that those who 

attended the synchronous 

Cultivating a Happy Work 

Environment conference on 

May 27 were skeptical as 

to how it would all work out 

(me included), but soon discovered that it was just 

as engaging as a face-to-face event. We were able to 

interact with all of the speakers by asking questions 

throughout each session as well as answer topical 

survey questions throughout the day. VNA also 

hosted a virtual sponsor and exhibit hall, whereby 

exhibitors and sponsors were able to highlight their 

products. Additionally, all registered attendees 

received links to the live webinar in order to view 

the recording in its entirety - at their own pace 

and on their own time - through VNA’s CE library, 

receiving up to six contact hours for participation 

in the conference after completing the conference 

evaluation. 

Julian Lute kicked off the conference with his 

“Building a Great Workplace with a High-Trust 

Culture Blueprint” presentation, during which he 

underscored that people want to trust who they 

work for, take pride in what they do, and enjoy the 

people they work with. Also, the best leaders should 

be trustworthy, transparent, and collaborative 

whereas employees want to be informed, be free to 

ask questions, and feel supported. Lastly, employees 

will go out of their way to get the job done if they 

look forward to going to work as well as take pride in 

where they work. 

Next, Marian Altman talked with us about 

“Creating and Sustaining a Healthy Work 

Environment” per the American Association of 

Critical-Care Nurses (AACN). AACN shared that 

the healthiest work environments integrate six 

standards: 1) Skilled Communication, 2) True 

Collaboration, 3) Effective Decision Making, 4) 

Appropriate Staffing, 5) Meaningful Recognition, 

and 6) Authentic Leadership. AACN’s Assessment 

Tool is free to use and can be accessed via this link: 

https://www.aacn.org/nursing-excellence/healthywork-environments. 

Dr. Altman concluded with a 

five-item “to-do” list: 1) Start with a self-assessment, 

2) Try some new techniques (e.g., compliment a coworker 

every day, never be a silent witness, be a 

team player, speak your truth, and/or ask someone 

you do not know to share a meal), 3) Assess the 

culture on your unit, 4) Create an action plan, and 

5) Stay the course. 

After the lunch break, we got to experience 

the “Best Practice Short Podium and Idea Pitch 

Sessions” during which we learned what other 

healthcare organizations across the commonwealth 

have implemented within their organizations 

to create a happy work environment. I was so 

impressed with the work my peers are doing to 

make their work environments happy, whether it’s 

taking time to breathe (stop and pause), increasing 

resiliency in nurse managers and team members, 

practicing self-care, and/or saying “thank you” when 

receiving constructive advice. 

The day ended with Eileen O’Grady offering “A 

Master Class on Human Flourishing” where we 

discovered the science of human flourishing and 

what we know about cultivating personal well-being. 

We explored extreme self-care strategies including 

the difference between self-care and selfishness, how 

to deal with difficult others, prevent burnout, and 

build resiliency. Dr. O’Grady is such an inspirational 

speaker and her strategies were such a great way to 

end an amazing day. 

In conclusion, by now our members know that 

the VNA Fall Conference (September 23-24, 2020) 

as well as the VNA Legislative Summit (November 

10, 2020) will be presented virtually. I hope you 

plan to join us for both events, knowing that VNA 

will deliver world-class professional development 

opportunities at a price-point that works within your 

budget. 

To register for VNA’s 2020 Fall Conference, 

Ending Bullying, Incivility, & Workplace 

Violence, go to https://virginianurses.com/page/ 

FallConferenceRegistration. For more information 

on VNA’s Legislative Summit, visit https:// 

virginianurses.com/page/LegislativeSummit. 

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NURSES MONTH 

SPOTLIGHT 


NURSES MONTH 

SPOTLIGHT


Cabin Fever in Older Adults 

Alecia Thomas 

Without a doubt, the COVID-19 pandemic has 

drastically changed our daily lives. Everyone is 

trying to adapt to a new definition of normal by 

adhering to social distancing guidelines and stay 

at home or safer at home orders from government 

officials. The overall goal of these guidelines is 

to protect the health and safety of the public 

by decreasing the spread of COVID-19. While 

eradicating this novel virus is top priority, it is 

also important to note the negative mental and 

physical health effects that home isolation can 

produce in the older population. Many elderly 

patients might say that they have cabin fever or 

simply say they feel lonely due to lack of social 

contact with family and friends. A research 

review conducted by Hawkley and Capitaio (2015) 

revealed that loneliness in adults 50 years of age 

and older is strongly linked to depression, poor 

sleep quality, poor health outcomes, cognitive 

decline, and mortality. The numerous health 

complications associated with loneliness can 

amount to astronomical Medicare treatment costs 

equating to more than six billion dollars yearly 

(Anderson & Thayer, 2018). Alternatively, older 

adults that regularly interact with others and are 

a part of a social network are more likely to live a 

longer and purpose-driven life (National Institutes 

of Health, 2019). 

What is cabin fever? 

Despite the name, cabin fever has nothing to 

do with having an actual fever, instead it is the 

feeling of loneliness caused by staying indoors 

for an extended period. For example, a person 

might experience cabin fever during severe 

weather, illness, or a pandemic. The lack of social 

interaction and outdoor activities can cause 

irritability, stress, and/or heighten the feelings of 

depression and anxiety (Hartwell-Walker, 2020). 

Even though cabin fever is not a recognized 

mental disorder in the Diagnostic and Statistical 

Manual of Mental Disorders, it is still important to 

acknowledge it and offer various coping methods 

to combat cabin fever from spiraling into a state of 

depression. 

How is loneliness measured? 

One of the most well-known and utilized tools 

for measuring loneliness is the University of 

California-Los Angeles (UCLA) Loneliness Scale, 

which effectively measures loneliness in older 

adults (Ausin et al., 2018; Velarde-Mayol et al., 

2015). The scale is comprised of 20 questions 

that measure an individual’s perception of 

lonesomeness by ranking each question from 1 

to 4. Questions are answered by a rating of 1 

for never, 2 for rarely, 3 for sometimes, and 4 for 

often. Examples of questions on the loneliness 

scale are: “how often do you feel unhappy doing 

so many things alone and how often do you feel 

completely alone” (AARP, 2010). The total score of 

the questionnaire can range from 20 through 80; 

a score of 25 or greater indicates loneliness (AARP, 

2010). 

Combating cabin fever 

As everyone adapts to a new sense of normalcy, 

there are many things older adults can do to 

prevent cabin fever from affecting their mental and 

physical well-being. Technology makes it simple to 

click a button to transform the loneliness of home 

quarantine into a live and interactive video call 

with one or multiple individuals. Regular group 

activities, such as church meetings or exercise 

classes can still take place through video meetings 

apps, such as Zoom or Google Meet. Also, social 

media platforms like Facebook make it easy to stay 

engaged and entertained. 

Other options to thwart the feelings of cabin 

fever: 

- Gardening is research-proven to have a 

positive impact on overall health (Soga, 

Gaston, & Yamaura, 2016). 

- Staying active by walking the dog, jogging, or 

running 

- Stimulating your brain cells by reading, 

doing puzzles, or learning something new 

- Being creative and trying do-it-yourself 

projects at home 

References 

AARP. (2010). How Lonely Are You? Retrieved from: 

https://www.aarp.org/personal-growth/transitions/ 

info-09-2010/How-Lonely-are-You.html 

Anderson ,G.O. & Thayer, C. (2018). Loneliness and 

Social Connections: A national survey of adults 45 

and older. Received from: https://www.aarp.org/ 

research/topics/life/info-2018/loneliness-socialconnections.html 

Ausín, B., Muñoz, M., Martín, T., Pérez-Santos, E., 

& Castellanos, M.Á. (2017). Confirmatory factor 

analysis of the Revised UCLA Loneliness Scale 

(UCLA LS-R) in individuals over 65. Aging & Mental 

Health, 23(3), 345_351. doi:10.1080/13607863.2017.1 

423036 

Hartwell-Walker, M. (2020). Coping with cabin fever. 

Retrieved from: https://psychcentral.com/lib/copingwith-cabin-fever/ 

Western State Hospital 

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Hawkley, L.C. & Capitanio, J.P. (2015). Perceived social 

isolation, evolutionary fitness and health outcomes: 

A lifespan approach. Philosophical Transactions of 

the Royal Society B, 370 (1699), 1-12. https://doi. 

org/10.1098/rstb.2014.0114 

National Institute of Health. (2019). Social isolation, 

loneliness in older people pose health risks. Received 

from https://www.nia.nih.gov/news/social-isolationloneliness-older-people-pose-health-risks 

Velarde-Mayol, C., Fragua-Gil., S, & García-de-Cecilia, 

J.M. 2016. Validation of the UCLA loneliness scale 

in an elderly population that live alone. Semergen, 

42(3),177_183. doi:10.1016/j.semerg.2015.05.017 

Soga, M., Gaston, K. J., & Yamaura, Y. (2016). Gardening 

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medicine reports, 5, 92-99. https://doi.org/10.1016/j. 

pmedr.2016.11.007 

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NURSES MONTH 

SPOTLIGHT 


NURSES MONTH 

SPOTLIGHT 

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Practical Tips for Moral Resilience 

Phyllis Whitehead, PhD, APRN/CNS, 

ACHPN, RN-BC, FNAP 

Clinical Ethicist; Clinical Nurse Specialist Palliative Medicine/Pain 

Management 

During these times of COVID-19, nurses and other clinicians throughout 

the world are faced with many ethical dilemmas such as PPE shortages, 

limited COVID-19 testing, and staffing challenges. Such situations can lead 

to moral distress, which is defined as “the experience of being seriously 

compromised as a moral agent in practicing in accordance with accepted 

professional values and standards,” (Varcoe, et al., p. 488). Moral distress 

occurs when we feel that we cannot do the perceived right action resulting 

in our moral integrity being compromised (Hamric, 2007; Hamric, 2012). 

Moral distress results in significant physical and emotional stress, which 

contributes to feelings of loss of integrity and dissatisfaction with the work 

environment (Jameton, 1993). Research demonstrates that moral distress 

may contribute to staff leaving the work setting and profession. It can affect 

relationships with patients and coworkers and the quality, quantity, and 

cost of care. 

Moral resilience is the important ability of nurses to cultivate a sense 

of well-being and growth in response to moral and ethical challenges they 

face in their stressful and rapid-paced work environments (Holtz, Heinze, 

Rushton, 2018; Rushton, 2016). Nurses, organizations, and nurse leaders 

need to foster the moral resilience within themselves and among their 

staffs. One strategy is a Moral Distress Consultation Service. During a 

Moral Distress Consult, trained facilitators provide a 45-60 minute session 

in an open, safe forum to address issues related to any situation causing 

moral distress - end-of-life care, cultural issues, communication, treatment 

choices, etc. - or ways to prevent moral distress by dealing with power or 

personality conflicts based on issues of concern on the unit. The facilitator 

works with the staff to develop action plans for decreasing moral distress 

on the unit or service. 

Many professional nursing organizations provide helpful information 

and tools to support healthy work environments. The following resources 

may provide valuable support to nurses seeking to cultivate a healthier 

workplace for their unit: 

• Healthy Work Environment (American Nurses Association): https:// 

www.nursingworld.org/practice-policy/work-environment/ 

• Healthy Practice Environment Advocacy Guide (Academy of Medical- 

Surgical Nurses): https://www.amsn.org/practice-resources/healthypractice-environment 

Coming Soon! 

We’re thrilled to announce the launch 

of a brand-new VNA website! 

Loaded with tools, resources, and 

education, our new website will launch 

in late summer, so be 

sure to bookmark 

www.virginianurses.com! 

• Healthy Work Environments (American Association of Critical Care 

Nurses): https://www.aacn.org/nursing-excellence/healthy-workenvironments 

• Healthy Perioperative Practice Environment: Patient & Workplace 

Safety (Association of perioperative Registered Nurses): https://www. 

aorn.org/guidelines/clinical-resources/position-statements 

• Healthy Work Environment in the Emergency Care Setting 

(Emergency Nurses Association): https://www.ena.org/docs/defaultsource/resource-library/practice-resources/position-statements/ 

healthyworkenvironment.pdf?sfvrsn=a4170683_14 

For more information about moral distress, moral resilience, and Moral 

Distress Consult Services, contact Phyllis Whitehead at pbwhitehead@ 

carilionclinic.org. 

Strategies to consider when you experience an ethically and/or morally 

challenging situation: 

• Get the whole story. Encourage others to do so as well 

- Speak up. Encourage dialogue 

- If seen as risky, that’s the first problem to tackle 

• Focus on the ethical dimensions of care 

- What we ought to do? 

- Which obligation is primary? 

- What are the goals of care? Have they changed? Do they need to 

change? 

• Debrief Situations with a goal of preventing the recurrence of a similar 

case 

- What could we have done differently? 

- How can we anticipate next time? 

- Include entire interprofessional team 

• Interprofessional education on moral distress 

- Nurture the expectation of collaboration 

• Target unit/service practices that improve communication: 

- Interprofessional rounds 

- Unit/service conferences 

- Family meetings 

• Develop Proactive Systems & Processes 

- Early, frequent, consistent communication with patients and 

families 

- Clear articulation of health team goals 

- Team speaks with one voice 

• Develop institutional resources that are: 

- Available 

- Known 

- Santioned 

• Develop policies/guidelines encouraging team collaboration, ethics 

consultation, provider continuity 

• Identify the moral distress sources operating in your unit/division/ 

service and target interventions there 

- Then, extend to the organization if the problems are systemgenerated 

• Initiate Ethics and/or Moral Distress Consults 

- To reduce moral distress levels among staff 

- To provide an interprofessional avenue for frank discussion and 

problem solving in morally distressing situations 

- To assist staff in developing strategies to address barriers to highquality 

patient care 

- To empower staff to raise concerns 

• Identify your ethical/moral distress 

- Providing inadequate or harmful pain management 

- EOL futile care challenges 

- Poor teamwork and challenging communication issues 

• Work on strategies to improve your teamwork and communication. 

(Holtz, 2018; Rushton, 2016; Varcoe, 2012; Whitehead, 2015) 

References 

Hamric, A.B., Blackhall, L.J. (2007). Nurse-physician perspectives on the care of 

dying patients in intensive care units: collaboration, moral distress, and ethical 

climate. Crit Care Med, 35, 422-429. 

Hamric, A.B., Borchers, C.T. & Epstein, E.G. (2012). Development and testing of an 

instrument to measure moral distress in healthcare professionals. AJOB Primary 

Research, 2, 1-9. 

Holtz H, Heinze K, & Rushton C. (2018). Interprofessionals’ definitions of moral 

resilience. Journal of Clinical Nursing. 27(3-4):488-494. doi: 10.1111/jocn.13989. 

Jameton, A. (1993). Dilemmas of moral distress: moral responsibility and nursing 

practice. AWHONNS Clin Issues Perinat Womens Health Nurs, 4(4), 542-551. 

Rushton, C.H. & Carse, A. (2016). Towards a new narrative of moral distress: 

Realizing the potential of resilience. The Journal of Clinical Ethics, 27(3), 214-218. 

Varcoe C., Pauly B., Webster G., & Storch J. (2012). Moral distress: tensions as 

springboards for action. HEC Forum, 24(1), 51-62.2. 

Whitehead, P.B., Herbertson, R.K., Hamric, A.B., Epstein, E.G., & Fisher, J.M. (2015). 

Moral distress among healthcare professionals: Report of an institution-wide 

survey. Journal of Nursing Scholarship, 47(2), 117-125.


Nurses care for all patients, regardless of their race, 

age, religion, gender, or other status. The Code of Ethics 

for Nurses obligates us to advocate for our patients 

and communities and speak up against racism, 

discrimination and injustice. 

We must expect the same level of care from the 

authorities. We demand justice for George Floyd, 

Ahmaud Arbery, and Breonna Taylor, and an end to the 

deaths of Black people and other racial minorities at the 

hands of those who are meant to protect them. 

As nurses, we see the devastating effects of racism in 

our communities. Systemic racism is a very real public 

health crisis, and the COVID-19 pandemic has only added 

to the stress and health inequity in Black communities 

and other communities of color where higher rates of 

infection and deaths are being experienced. 


VNA and VNF Statement on Systemic 

Racism and Health Inequity 

Included in this issue of VNT are reflections from 

Black nurses on the racism they have faced throughout 

their nursing career and their hopes for ways we can 

move forward toward change. 

We as nurses have a responsibility during this time 

to use our trusted voices to call for change. We also 

encourage all nurses to listen and learn as we work to 

address the issues that lead to so many needless deaths 

in Black communities and communities of color. 

To help further this work, we are removing the 

paywall from our continuing education on health 

inequity, beginning with Social Determinants of Health: 

The Zip Code is the Most Important Number on the 

Patient’s Chart and Advocating for Health Equity. 

We also would like to invite all nurses to join us on 

August 26 at 12 pm for our latest COVID-19 virtual 

webinar, A Focus on Health Equity in the Midst of the 

Pandemic. Our featured speaker will be Dr. Janice 

Underwood, Chief Diversity, Equity, and Inclusion 

Officer, Office of Governor Ralph S. Northam. During 

this program, you will learn how COVID-19 is impacting 

our vulnerable populations across the commonwealth, 

what measures Virginia is taking to support these 

populations, and how Virginia nurses can help make an 

impact and provide equitable care to all. 

Additionally, The Virginia Nurses Foundation is 

offering five free webinars to help nurses in Virginia 

diffuse stress and build resilience during these 

challenging and unprecedented times. Topics covered 

during the webinars will include: stress management 

and resilience, secondary stress and compassion 

fatigue, coping with health concerns as a healthcare 

professional, and practicing self-care for caregivers. 

More information can be found at https://tinyurl.com/ 

vnfstresswebinars. 

We will post other relevant continuing education 

resources, articles, and action steps to our social media 

and website each Thursday, which is our weekly day of 

focus on health inequity and health justice. 

We must also continue to encourage our 

communities to continue to stay vigilant in the fight 

against COVID-19. It is vital that all Virginians continue 

to wear masks in public settings and practice social 

distancing and adequate handwashing to prevent the 

spread of COVID-19, including while exercising their 

first amendment right to assemble. 

If you would like more information on how to get 

involved with VNA’s Diversity, Equity, and Inclusion 

Council, please contact Kristin Jimison at kjimison@ 

virginianurses.com 

My Journey as a 

Black Nurse 

Frances E. Montague, DNP, RN-BC, GNP 

Having been born before 

the era of the Civil Rights Act, 

I know what discrimination 

is. I grew up in rural Virginia 

approximately 45 minutes 

west of Richmond and less 

than 30 minutes east of 

Prince Edward County. Before 

I started elementary school, 

I had some idea of racial 

discrimination. I did not 

totally understand, but I knew 

people affected by the closure of public schools in Prince 

Edward County to avoid integration. The schools in my 

own county, Amelia, did not reach full integration until 

1969, with the first fully integrated graduating class 50 

years ago in 1970. 

Fast forward to the spring of 1970, and I am applying 

to nursing programs. My first desire was to attend 

a hospital-based nursing program. So, I went about 

making applications. I received a letter from Johnston 

Willis Hospital to come for an entrance exam. The 

results of my test, as I was informed by a letter from the 

school, indicated that I should enter a licensed practical 

nurse (LPN) program. They included information on how 

to apply. Yes, it crushed my spirits and all I could think 

was I did not want to be an LPN and did not want to 

go to LPN school. At that time, the Black nurses I knew 

were either LPN’s or nurses’ aides. The Black registered 

nurses I had seen were working at the all Black hospital 

in Richmond. I knew there was more available for us, 

but needed to determine how to obtain the ‘more’. After 

being strongly encouraged by my mother, I rejected 

their offer of the LPN program. Later, I understood that 

each year the white hospital schools of nursing had a 

quorum of one or two Black students per class. Many 

of my nursing friends in my early career had been the 

one student in their class and one of three or four in the 

entire program. I will never know if I did not qualify or if 

the token student(s) had been chosen. 

I then applied to Norfolk State University and 

there obtained an associate degree in nursing. Upon 

graduation, I was able to obtain a job at my firstchoice 

facility. The experience was wonderful as the 

facility had an eight-week nurse internship program. 

In my first year I had little to no opportunity for charge 

nurse responsibility. There was a young white nurse 

working the evening shift by request. She had gained 

employment a few weeks later than I had. On weekends


she worked the day shift as the charge nurse. I was doing well on my job according 

to my evaluations during my probationary period. However, at the end of my first 

year, which determined if I would be promoted, my evaluation shocked me. The 

written portion did not reflect what I had been told and the check off portion was all 

average. It said I excelled at nothing. I reminded my head nurse that she had made 

no indication that my work was only average. I had been told I was doing well. The 

explanation was, I had not been in the charge nurse role and had not been evaluated 

in my leadership abilities. Do I need to say the conversation ended in a conference 

with the supervisor and a rewriting of my evaluation? 

Growing up in rural Virginia, I was introduced to the throws of segregation. I 

know what it means to wait in the colored waiting room in the white doctor’s office, 

which was the only one in our county. I have used the colored toilets with the chipped 

and rust-stained toilet bowls and sinks. I cannot remember drinking from the colored 

water fountain but I do remember them being located in the dark hall near the toilet. 

As I have lived and moved around, I have faced racial discrimination in different 

manners. I lived in a very small town in a southwestern state where the Black 

population was 7%. In reading a book about the town, the story says Blacks were 

driven out of town in fear for their lives when a white deputy sheriff was killed by a 

“half-witted Negro” in a bad crap game. As there was no organized or fair law and 

order, the Negroes were told not to let the sun go down on them in that town. The 

next morning, there was not a single Black person left in town. This story was told 

with relevance and pride by some of the citizens. There were no attempts to hide the 

dislike of people who were not native to that county. That included race, ethnicity, 

and any one further north than the adjoining county. It held very true for the older 

people in town. 

As a nurse, I have faced situations of patients asking for the nurse while I am 

providing care for them with my name tag that clearly included RN. I have had 

patients send for the charge nurse and refused to talk to me when I arrived. I have 

been told by patients that they did not want me to provide their care and there 

was one incident when I was the only licensed nurse on duty and I had to stand 

by the bedside while a white nursing assistant physically handed the patient the 

medications that I had prepared. The patient refused to take them from me. Today, 

I would have to write ‘refused’ and the patient would have been without medications. 

The refusal was because of the color of my skin. 

In my fifty wonderful years of working with patients on many levels, in many 

facilities, and of many races, ethnic backgrounds, creeds, and cultures, I have faced 

racist remarks and behaviors. Not one of these deterred me from being a registered 

nurse, a nurse practitioner, a nurse educator, prepared at the doctoral level. If 

anything, it propelled me forward. 

In the Midst of a Walk 

Sandra Olanitori, MS, RN 

As a member of ANA/VNA, I took part in the opportunity 

that was offered to all members to reserve a room at any 

Hilton Hotel during the COVID-19 pandemic in the United 

States to “get away.” I reserved a room at a Hilton Hotel in 

Washington, D.C. from May 31 to June 4 of this year. The 

incident involving Mr. George Floyd happened some days 

before. During this time in D.C., you could see writings such 

as “Black Lives Matter” on statues, buildings and signs that 

many people were carrying. As my grandson and I were 

walking to get food from the local eating spots, we were 

in the midst of a walk involving many people with signs 

and chanting “Black Lives Matter,” “Justice for All,” “Stop 

Racism,” “Stop Modern Day Lynching,” and “Stop Police Brutality.” All of these signs 

made me reflect back on the discrimination, racial injustices, biases and prejudices 

that I have faced in my life growing up and in my professional career as a registered 

nurse because of the color of my skin. 

During this walk to get food, I stopped and leaned against a building and closed 

my eyes; I could see what I have faced in my lifetime. I said to myself that these acts 

have never left. History and the mindset of this country is just repeating itself. Some 

of the things in my reflection are: 

• I asked a nursing supervisor who was white for the night shift nurse’s aide 

position because I wanted to go to nursing school. She told me she would grant 

the request, but that I will never make it and will come crawling back to her to 

ask for the day shift again. 

• One day I was working at the medication cart in full uniform including the 

nurse’s cap, mixing meds to put in an IV solution. The white doctor came to me 

and said, “where is the nurse, I need some assistance.” 

• Many times at the nurse’s station I could hear white doctors say, “I do not want 

a Negro or colored nurse to take care of my patients; they cannot think.” 

This is the tip of the iceberg. There are many more stories that I can remember. 

But the question is, “How did I survive in my profession?” I thought about the Black 

nurses that came before me and they survived. They survived with integrity, grit, 

perseverance and a love for the profession. They did it and I can do this. It was hard 

and it is still hard. 

The following are other strategies I used for survival: 

• The Black nurses worked together to form organizations such as Chi Eta Phi 

Sorority, Inc. and the Black Nurses Association to provide and improve the 

health of Black Americans nationwide. Black nurses gave their all to their 

patients and careers. Many times this was done without any recognition. The 

first Black woman to become a judge was the Honorable Jane Bolin. During 

her time, she stated, “Those gains we have made were never graciously and 

generously granted. We had to fight every inch of the way.” I followed this 

woman’s work and professional ethics and I have enjoyed my profession to the 

fullest despite the obstacles I have faced. 

• I have to constantly pray and ask my God for help every day to continue my 

journey in being a registered nurse. 

Think about this: the first Black woman to receive an international pilot’s license 

was Bessie Coleman. During her time, she stated, “The air is the only place free from 

prejudices. I, as the nurse of today, want to see the same thing on land. When is it 

coming?” 

Reflections on Diversity, Equity, 

and Inclusion 

Karen Faison, PhD, APRN-BC, CNE 

My perception of diversity, equity and inclusion is based 

upon my experiences as a youth growing up in segregated 

Washington, DC in the 1950s and ‘60s. During that time, 

my neighborhood and public schools were Black. The 

grocery stores and other businesses we frequented were run 

by Caucasians and were located in our segregated Black 

community. All of my healthcare was delivered by Black 

health professionals. I had access to Freedmen’s Hospital, 

where I was born, which is now Howard University Hospital. 

My grandmother completed practical nursing school 

in Washington, DC. Her graduation picture shows a class 

of Black ladies surrounded by white faculty. Again, that 

was the 1950’s. The picture is consistent with what we know as the early challenges 

within nursing education: too few Black faculty to teach Black nurses to deliver 

nursing services to Black patients. 

My desire to become a nurse was developed in high school. I attended a 

historically Black college/university and began my professional journey with my first 

staff nurse position located in Georgia. There, I noted I was one of only a few Black 

RNs in the entire hospital. Later, I would transition to other hospitals in southern 

states where I remember I was one of a few Black RNs. When I advanced to graduate 

school to become a nurse practitioner, I was the only Black RN in my concentration. 

Frequently in the clinical setting, I would be the only Black healthcare provider. 

As time went on, I thought we were getting better and including more Black 

students in nursing. However, today there is definitely a lack of Black nurses. The 

patients will greatly benefit from Black nurses who are more sensitive to the needs 

and cultural influences of the Black patient. There is also a need for Black nurses 

on boards and in educational settings. As a representative of the community, we can 

bring a varied perception on issues facing our community. This has become very 

evident during the pandemic where many people of color have an adverse outcome. 

Nursing education, a social determinant of health, underscores the need for 

diversity in the profession. A pipeline for students to consider nursing as a profession 

should begin in middle school. This should continue into high school in order to 

prepare students for the rigor of nursing school. The percentage of Black nursing 

students are on the decline; while the percentage of Black communities with chronic 

diseases and poor outcomes is on the rise. 

The nursing profession can make a concerted effort to diversify the profession to 

include minorities and people of color. This will assist in addressing a more equitable 

workforce that is sensitive to the needs and cultural differences within communities. 

Being inclusive will strengthen the healthcare workforce. Professional goals related to 

diversity, equity and inclusivity are long overdue. The time is now as we move forward 

in this era of social justice and the “Year of the Nurse and Nurse Midwife.” Nursing 

must be a part of the conversation. 

NURSES MONTH 

SPOTLIGHT

Virginia Nurses Today - August 2020

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