December 2020 • Volume 30 • Number 1
2 Preparing Patients for COVID-19
3 Trickle Charge Your Self-Care
During This Ongoing Crisis
4 NNA’s Current and New Members
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 1,000 RNs and LPNs and
delivered electronically via email to 40,000 RNs and LPNs in Nevada
RED ROCK CANYON
CLARK COUNTY, NEVADA
The President’s Message
5 Loneliness and Social Isolation
Cause Emotional Pain in the
7 Taking Time for Self-Care during
11 Healthy Nurses
12 Addressing Sleep Problems During
the COVID-19 Pandemic
13 Nurses in the News
15 The 20/20 Vision: Nevada
Nursing Student Association
16 UMC Annual Research
Empowerment Day 2020 - Virtual
6 Research & EBP Corner
Mary Bondmass, Ph.D., RN, CNE, President,
Nevada Nurses Association
As we move into 2021, many
issues continue to confront
us as nurses individually and
collectively as a profession. The
relentless severe acute respiratory
syndrome coronavirus 2 (SARS-
CoV-2), which causes COVID-19,
has been a continued stressful
presence since March of 2020,
and unfortunately, it is still with
us. However, as we welcome in
the new year, there is hope in
several vaccines, yet there is much to be done before we
even approach getting back to 'normal,' whatever that is.
In a recent NNA Board meeting, my colleagues
and I discussed the pandemic, the current staggering
numbers of infected people in Nevada, subsequent
hospitalizations, and ultimately deaths in some cases. You
may or may not know, but your NNA Board consists of
an eclectic group of nursing faculty, public health and
hospital administrators, retired practitioners, front line
staff nurses, and advanced practice registered nurses
(APRNs). In our recent discussion, all expressed sentiments
of being overwhelmed and somewhat helpless and
sometimes hopeless about what more we could do given
the pandemic's current state; these feelings seemed the
same, no matter which area of nursing we respectively
NNA has implemented several initiatives, including
providing COVID-19 education on our website (from
the CDC and ANA), developed a non-staff nurse
volunteer database, and purchased and distributed
personal protective equipment (PPE) to Nevada nurses.
Still, as the number of COVID-19 cases continued to
grow, we asked ourselves what else we could do.
Despite the good news of vaccines, we know that
the dire situation and the COVID-19 strain on individual
nurses and the entire Nevada healthcare system may
continue well into 2021 and may even get worse
before it gets better. So what else? We came up with a
few other engaging ideas in our Board discussion, and I
want to share them with the entire RNF readership.
As nurses, anyone of us could make sure we stay
informed of the most recent, evidence-based facts of
COVID-19 and correct misinformation whenever and
wherever it occurs (and unfortunately, there is still
a lot of misinformation out there). While the world
learns more about this novel virus and information
rapidly changes, please use the NNA website to
access this free and accurate COVID-19 information.
Once we have the facts, we could disseminate those
The President’s Message continued on page 2
8 NNA Environmental Health
10 Antimicrobial Stewardship -
17 Leadership in Policy and Care
Quality and Safety
18 Nevada Nurses Foundation
Help is needed to distribute the Covid vaccines.
Please consider volunteering.
current resident or
Mark Your Calendars
• 2-day Elko virtual Fundraiser/Symposium
January 21 (5-8pm) & January 22 (8-12)
• Nurses Day at the Legislature - March 2, 2021
Vaccine Volunteers Needed!
Page 2 • Nevada RNformation December 2020, January, February 2021
NNA Mission Statement
The Nevada Nurses Association promotes professional nursing practice through Preparing Patients for COVID-19
continuing education, community service, nursing leadership, and legislative
activities to advocate for improved health and high quality health care for citizens of
NNA State Board of Directors
Mary D. Bondmass, PhD, RN, CNE Mary.firstname.lastname@example.org ..............President
Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC email@example.com .......Vice President
Sherrie Sherk-Olson, BSN .........................................Secretary
Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE firstname.lastname@example.org .........Treasurer
Arvin Operario ...........................................Director at Large
Christa Secord, MSN, FNP-BC email@example.com ................Director at Large
Norman Wright, RN, BSN, MS firstname.lastname@example.org ...................Director at Large
Darlene Bujold, BSN, RN email@example.com ...............President, District 1
Margaret Covelli, DPN, RN Margaret.firstname.lastname@example.org ..........President, District 3
Managing Editor, Linda Bowman, RN, email@example.com
Print Editor, Kathy Ryan, MSN, RN-BC
Mary D. Bondmass, PhD, RN, CNE
Tracey Long PhD, APRN-BC
Lisa Pacheco, MSN, RN
Bernadette Longo, PhD, RN, FAAN
Vicki Walker DNP, BS RN
Are you interested in submitting an article for publication in RNFormation?
Please send it in a Word document to us at firstname.lastname@example.org. Our
Editorial Board will review the article and notify you whether it has been
accepted for publication.
If you wish to contact the author of an article published in RNFormation,
please email us and we will be happy to forward your comments.
Arthur L. Davis
Publishing Agency, Inc.
Susan S. VanBeuge, DNP, APRN, FNP-BC, FAANP
Over the past ten months, the world of practice has
changed for all providers, from hospital service to outpatient
care. One common theme discussed has been the anticipation
of a vaccine for COVID-19. Vaccine distribution is expected
in late 2020 and early 2021 throughout the United States
and the world. Distribution and allocation are planned by
the Centers for Disease Control and Prevention (CDC, 2020).
There are five phase-3 clinical trials for a COVID-19 vaccine in
the United States at the time of this writing.
In my practice, reviewing immunization status is the
norm, but this year my assessment has considered the
upcoming COVID-19 vaccine. Reminders of updating the flu
vaccine are standard during encounters in the season, and then the conversation is
followed by education about the COVID-19 vaccine. Utilizing the CDC's resources, I
have been able to incorporate teaching and preparation for my patients. I've noted
many patients express concern, and more than a few are hesitant to commit to
taking the vaccine once it is available.
The CDC offers providers resources to engage in a compelling conversation about the
COVID-19 vaccine with their patients. There are five techniques and strategies suggested
to start the vaccine's conversation with your patients (table 1). The recommendation is to
start from a place of understanding and empathy, assume they will want a vaccination
but may have limited knowledge, give your strong recommendation as their provider,
listen and respond, and summarize the discussion (CDC, 2020).
1. Start from a place of empathy and understanding.
2. Assume patients will want to be vaccinated but may not know what to expect.
3. Give your strong recommendation.
4. Listen to and respond to patient questions.
5. Wrapping up the conversation.
As we navigate our patients' questions, concerns, and fears, we can equip
ourselves with updated information regarding the vaccine and distribution plans
within the community. One aspect of the COVID-19 pandemic that has become
clear is how vulnerable patients feel about the virus and the unknown future, which
may cause uncertainty with the vaccine. Directing patients to reputable sources to
learn details and information will increase confidence. The CDC suggests strong
recommendations coming from their healthcare provider are critical for vaccine
acceptance. Sharing vaccines' importance to protect health and those in their
community may be important points to emphasize during the conversation.
As practice enters another phase of the COVID-19 pandemic, another aspect
of our roles evolves to incorporate education regarding the vaccine. Being firmly
grounded in understanding the science, efficacy, and distribution planned
to vaccinate the general population will enable practitioners to have these
conversations with individual patients. Presenting evidence-based information and
education within our patient community will provide a foundation for individuals
to make the best decisions for their health and well-being as we all continue to
navigate the COVID-19 pandemic.
Centers for Disease Control and Prevention (2020). Talking to Patients about
COVID-19 Vaccines. Downloaded from https://www.cdc.gov/vaccines/covid-19/
NursingALD.com can point you
right to that perfect NURSING JOB!
Free to Nurses
Easy to Use
E-mailed Job Leads
The President’s Message continued from page 1
facts. Nurses have gained increased credibility during this crisis, and nurses' words
may be meaningful and impactful to the public. This dissemination of facts could
perhaps take the form of writing an editorial for your local newspaper – speaking
to your experience with COVID-19 and the need for people to continue to protect
themselves and others against the virus. We can stop now; even just talking about
the facts of COVID-19 with relatives or friends can be powerful. It is hard to believe,
but still, some people do not know or believe that wearing a mask, washing our
hands, and social distancing are our best preventative weapons until, and maybe
even after, nearly all Nevadans become vaccinated against COVID-19. Sometimes we
may look for grand interventions when simple things like educating our patients and
the public may have a more significant effect.
In addition to our role in educating about the virus, we can model the same behavior
we extol. Just as our parents might have taught us, we need to ‘practice what we
preach.' With the new spotlight that the pandemic has brought to nurses, others will
look to us for advice, and our modeling of COVID-19 preventative behaviors is critical.
I often wonder if we had modeling behaviors from our national leaders back in early
2020, then maybe early 2021 might look different. Nevertheless, today is the situation
we have, and looking forward may be more productive than recounting our past
mistakes. Nurses can lead the way as we move through the new year.
Looking forward to a promising future for all Nevadans, I wish you and yours the
best in the new year.
Mary D. Bondmass, Ph.D., RN, CNE
President, Nevada Nurses Association
December 2020, January, February 2021 Nevada RNformation • Page 3
Trickle Charge Your Self-Care During This Ongoing Crisis
Sherry Stofko, MSN, RN
Sherry practicing self-care in fresh air
A few months ago, I wrote an article about
how nurses were crumbling under the weight and
uncertainty of the COVID outbreak. I asked that you
give yourself “permission to fall apart.” Nurses were
down back then, but we typically don’t stay down
long. Has there been healing and growth since that
time? In the mild “downtime” over the summer, did
we use that time to build resilience and count our
blessings? Did we restore our psychological reserves?
Or did we waste time tallying our complaints against
weak institutional leadership and governmental bodies,
further eroding morale. Did healthcare administrators
use that time to plan and prepare for COVID 2.0, AKA
flu season PLUS an increase in coronavirus patients
fueled by more indoor activities and large-scale political
rallies? Seriously, it’s not like we didn’t know this wave
Collectively, nurses are burning out in
unprecedented numbers. Eight months of tough
circumstances with little improvement will do that.
We are sick of seeing our coworkers kept alive on
ventilators. We can no longer bear to hold the cell
phone while families cry their goodbyes to our intensive
care patients. The smiles that used to soften our bad
days are obscured by tattered, poorly sealing N95's
that have been re-sterilized countless times since April.
Nurses are generally empaths and people-persons who
crave meaningful and unbridled relationships with
friends, family, co-workers, patients, and patients’
loved ones. The barriers of the face masks and
restricted physical contact further the loss of human
connection nurses so yearn for. To top it off, we are
now getting crash courses in crisis standards of care,
team nursing, disaster charting, and managing patients
In the Spring and Summer, nurses felt dejected.
Now, talking to nurses on the front lines, they express
intense anger and frustration. They are “past the
sadness,” as one colleague stated, and understandably
so. Patients are incredibly ill. Units and hallways are
full. Patient-to-nurse ratios are worsening an already
intolerable situation. We're forced to work with
strangers floated to our unit who are not experienced
in our specialty and with whom we have no trusting
relationship. We work in unfamiliar locations with
equipment we’ve never seen before. Despite all this,
we still hold ourselves to the highest standards and
beat ourselves up when patient outcomes are less than
stellar, and the guilt decimates our soul. We dutifully
go back in for an extra shift, even though our crisis pay
bonuses are shrinking as the pandemic lingers on. We
complain about the staffing shortages, and when the
organization brings in travelers, we complain about
that as well.
What I see as the biggest issue is the relentless
feeling of anger fueled by being overwhelmed,
disrespected, devalued, disempowered, silenced. I feel
the same, and I no longer provide direct patient care.
I hear the cries of the bedside nurses who tell similar
stories: reusing single-use protective gear, supervisors
who won’t replace unsafe masks, broken equipment
not repaired. Many nurses who work in institutions
that are not being honored with comparable crisis pay
feel financially undervalued. Of course, hospital bottom
lines have been hit hard by this pandemic, and millions
of unbudgeted dollars have been spent on all sorts of
items and staff. We know that healthcare institutions
code for COVID and receive extra reimbursement
for COVID patients and COVID-related projects. We
ask, “Where is all this governmental funding going?”
because it’s certainly not being funneled to the
frontline staff working in the trenches, risking their lives
and the safety of their families. Healthcare has never
been so much a business as it is right now.
What to do about all this? Even with vaccines on the
way, we have a very long way to go in this pandemic.
We use our cherished thirty-minute break to complain
to and commiserate with staff about the horrible
situation we’re in. We pick up extra shifts when our
supervisors send the guilt texts about how the patients
or our co-workers need us. We are banging our heads
against the walls. We have virtually no control over
corporate America, government, and big pharma who
run this country’s healthcare system, so we need to
take charge when and where we can.
We do have control over our own thoughts,
actions, and reactions. Many nurses are leaving the
profession all together, tossing away their incredible
skill set to start a craft business on Etsy. Uncountable
healthcare workers are jumping ship and swimming
over to the hospital across town or on the other side
of the country. That other hospital is likely suffering the
same woes because American healthcare is broken,
not just your institution. The other facility may manage
differently with seemingly better administrators and
higher pay, but if we don’t have a handle on our own
way of managing uncertainty, anger, and our feelings
of being undervalued, we will find ourselves with the
same complaints in a new setting six months from
now. I wonder if all the people jumping on the travel
nurse band wagon understand what they’re getting
into. Having been a traveler from 1997 – 2006, I know
very well the isolation, insecurity, incessant floating,
bullying, and lack of support that comes with those fat
paychecks. It’s not all rainbows and unicorns.
What are the alternatives? How do we survive
through this horrible pandemic and poor leadership?
Building your resilience and prioritizing your self-care
are paramount. Explore and practice ways to defuse
your anger or respectfully direct it at the appropriate
target. Start using your vacation time before mandatory
overtime is instituted. Don’t answer the calls or read
the texts on your off days. Exercise, stretch, meditate.
Eat decent foods and treat yourself to the cupcakes
now and then. Express gratitude. Tell your co-workers
how valuable they are to you, and why. Try finding
the silver lining; make a game of it. There must be
something good about being floated from NICU to
surgical-telemetry for 12.5 hours. Maybe it’s time
to explore nursing positions in new specialties away
from the bedside, far from the clutches of the Joint
Commission, corporate, unsafe staffing matrices, and
inadequate PPE. Most of the jobs outside direct patient
care require higher levels of education, especially the
ones that allow work from home. Academic degrees
seem to be a huge divider in this, now more than
ever. Maybe it’s time to seriously consider professional
development and growth through programs such
as Duke University’s Nurse Leadership Certificate or
Grand Canyon University’s RN-to-BSN program. Is your
head full of legitimate complaints about how poorly
healthcare is run? Get involved politically or with your
union, or you could write well-crafted letters to the
Nevada Hospital Association.
No matter how you choose to continue in your
career, there’s no question it will be stressful, and the
pandemic will be clouding our sunny skies for a while
longer. Self-care with a focus on learning to handle
recurrent adversities in a healthful way is vital. We
bash administration for not properly planning for 2.0,
but how well have you prepared? We don’t need a
jump start on self-care; it’s too late for that. We need
a trickle charge. What are you doing to trickle charge
your health and wellness?
Page 4 • Nevada RNformation December 2020, January, February 2021
NNA'S CURRENT AND NEW MEMBERS!!
Anna Marie Zamora
Anne Margaret Bexon
Arkay Marie Lising
Breanna Di Pinto
Charina Mae Picornell
Cherry Grace Daelto
Cheryl Dela Cruz
Clem Victor Manrique
Crista Mae Therese
Dinah Lynn Sinang
Dr. Remeliza Tukay
Edna Dela Cruz
Elena Ellen Maborang
Ellen M. Lewis
Eva Maria Rivera
Ginger Faye Flores
Greela Joy Yadao
Haydee Jeanette Nuno
Hea Won Lee
Jan Michael Arceo
Janet Purcell Gray
Jasmin San Luis
Jayson Paulo Agaton
Jessamine Gale Pantig
Jesus V Cornelio Catre
Joanna Patrice Johnson
Joseph Taylor Jr
Julius Caezar Henzon
Karen Anne Wolfe
Karen Marie Beardsley
Katelyne May Atijera
Katrina Perkins Davis
Kelly Jane Villaroman
Lee Anna Bristol
Leslee Bridget Magnus
Lisa Marie Pacheco
Lloyzel Faye Yung
Lynn Von Schlieder
Ma Renzel Therezna
December 2020, January, February 2021 Nevada RNformation • Page 5
Maria Angela Nina Vela
Maria Gina Agnir
Maria Mernina April
Maria Monica Aragon
Maria Nica Diez
Maria Rizel Sturgell
Maria Rosario Wood
Marisa Leah Dela Rosa
Marjorie Von Nordeck
Mary Denisse Toribio
Mary Grace Del Rosario
Michele (Shelly) Alfaro
Naomi Lazore Edwards
Nelly De Dios
Perla Labastida Espejel
R Danessa Rebello
Rachell Anne Agas
Renate Jeddahlyn Flores
Rica Santa Maria
Rich Janel Suanes
Rizza Marie Tawatao
Roscelle Jhoyce Minoza
Samantha Chanel De
Sarah Rose Nelson
Loneliness and Social Isolation
Cause Emotional Pain in the Elderly
Stacey Lea Spahn
Valeria Melendez Estrada
Veronica Niki James
Xandee Shirley Bernabe
Xenia Daffodil Valles
Karra Harrington and Martin J. Sliwinski
** This article was published in The Conversation, a
free on-line newsletter. “We believe in the free flow of
information. Republish our articles for free, online or
in print, under a Creative Commons license.” Read the
newsletter at www.theconversation.com
Maintaining high quality relationships may be a key
for protecting brain health from the negative impacts
of loneliness. The loneliness of social isolation can
affect your brain.
Physical pain is unpleasant, yet it’s vital for survival
because it’s a warning that your body is in danger. Pain
tells you to take your hand off a hot burner or to see a
doctor about discomfort in your chest. Pain reminds us
all that we need to take care of ourselves.
Feeling lonely is the social equivalent to feeling
physical pain. It even triggers the same pathways in
the brain that are involved in processing emotional
responses to physical pain.
Just like feeling physical pain, feeling lonely and
disconnected from others is also a signal that we
need to take care of ourselves by seeking the safety
and comfort of companionship. But what happens
when we are unable to find companionship and the
As scholars at the Center for Healthy Aging at Penn
State, we study the impact of stress on the aging
body and brain, including how it can worsen cognitive
decline and risk for dementia. The social isolation older
adults are experiencing now amid the coronavirus
pandemic is raising new mental health risks, but there
are things people can do to protect themselves.
The health consequences of loneliness
The COVID-19 pandemic has put many older
adults’ social lives on hold, leaving them at greater risk
for loneliness. They know they face a higher risk of
developing severe symptoms from COVID-19, so many
are staying home. Restaurant closures and limits on
visitors to assisted living centers have made it harder to
see family and friends.
But even prior to the pandemic, public health
experts were concerned about the prevalence and
health impacts of loneliness in the U.S. Loneliness
affects between 19% and 43% of adults ages 60 and
older, and many adults ages 50 and over are at risk of
poor health from prolonged loneliness.
Research has shown that prolonged loneliness is
associated with increased risk for premature death,
similar to smoking, alcohol consumption and obesity.
Other health consequences are also associated with
loneliness, including elevated risk for heart disease and
stroke, and it is associated with increased physician
visits and emergency room visits.
Loneliness can affect brain health and mental
Older adults who are socially isolated or feel
lonely also tend to perform worse on tests of
thinking abilities, especially when required to process
Moreover, those who feel lonely show more rapid
decline in performance on these same tests over several
years of follow-up testing.
It is thought that loneliness may contribute to
cognitive decline through multiple pathways, including
physical inactivity, symptoms of depression, poor sleep
and increased blood pressure and inflammation.
Loneliness has also been found to increase the risk
of developing dementia by as much as 20%. In fact,
loneliness has an influence similar to other more wellestablished
dementia risk factors such as diabetes,
hypertension, physical inactivity and hearing loss.
Although the underlying neural mechanisms are
not fully understood, loneliness has been linked with
the two key brain changes that occur in Alzheimer’s
disease: the buildup of beta-amyloid and tau proteins
in the brain. Other indicators of psychological distress,
such as repetitive negative thinking, have also be
linked with the buildup of beta-amyloid and tau in
the brain. Theories suggest that loneliness and other
psychological stressors act to chronically trigger the
biological stress response, which in turn appears to
increase beta-amyloid and tau accumulation in the
How loneliness can contribute to disease
The evidence suggests that prolonged feelings of
loneliness are detrimental to health. So, how do those
feelings get converted into disease?
Loneliness and Social Isolation...continued on page 12
Page 6 • Nevada RNformation December 2020, January, February 2021
Research & EBP Corner
Tranquility Rooms and Stress Reduction
Mary Bondmass, Ph.D., RN, CNE
This RNF feature presents abstracts of research and
evidence-based practice (EBP) projects completed or
spearheaded by nurses or student nurses in Nevada.
The focus is on new evidence (i.e., research) or on the
translation of evidence (i.e., EBP) in Practice, Education,
or Research. Submissions are welcome and will be
reviewed by the RNF editorial board for publication;
send your abstract submission in a similar format used
below to email@example.com
Michelle McGrorey, BSN, RN, OCN, HTCP, NCCA,
HNB-BC, HMIP and Deborah McKinney, BSN, RN, HMIP
took first place honors at the recent 3rd Annual UMC
Research Empowerment Day in the Completed Clinical
Project Category. Michelle and Debbie’s research
focused on the use of Tranquility Rooms to reduce staff
stress at University Medical Center of Southern Nevada.
Their picture, abstract and poster are below.
Michelle McGrorey, BSN, RN, OCN, HTCP, NCCA,
HNB-BC, HMIP and
Deborah McKinney, BSN, RN, HMIP
Jobs in the healthcare industry are among the most
stressful in the U.S. Work hours, burn-out, compassion
fatigue, overtime, and conflict make self-care difficult.
Lack of self-care can render any health care worker
ineffective on the job. In a hospital setting, quiet rooms
are playing a critical role in mitigating severe and/or
overwhelming stress often experienced by staff during
shifts that exhaust emotional and mental reserves.
Quiet rooms have been shown to promote well-being
and resiliency. UMC has created Tranquility Rooms for
staff as safe spaces where they can relax, calm, and
de-stress for a time. It is hoped that staff will regain
necessary emotional, mental, and physical resiliency,
thereby restoring work effectiveness.
To explore the feasibility of maintaining the
Tranquility Rooms permanently, and possibly creating
more rooms, UMC’s Tranquility Rooms were evaluated
for their effectiveness in reducing stress experienced by
Each Tranquility Room is decorated as a home-like
room, offering the C.A.R.E. Channel, an essential oil
diffuser, ambient lighting, a comfortable recliner, and
several modalities known for their calming effects. The
sample included 132 staff, from December 2019 to
September 2020, who voluntarily completed 10-point
Likert scales to measure perceived stress before versus
after using the Tranquility Rooms.
Results and Conclusion:
The Tranquility Rooms demonstrated significant
reduction in employee stress while on-the-job. The
rooms were used throughout all work shifts. Staff
stated the rooms reduced stress and helped them
perform more effectively. Pre-tranquility room use
stress scores were 6.83 compared to 2.43 after
use of the tranquility room (p = < 0.05). Staff have
commented they do not want it known how often
they are using the rooms. Staff are asking for more
Tranquility Rooms and because of the positive
response, UMC is looking for ways to create more
Tranquility Rooms throughout the hospital. Additional
Tranquility Rooms would reduce travel time required
for busy staff. Some staff have even taken it upon
themselves to create Tranquility Rooms within their
Implication for Practice:
According to JAMA, hospitals with better nursing
work environments for nurses provided better quality
December 2020, January, February 2021 Nevada RNformation • Page 7
Taking Time for Self-Care during COVID
By Michelle McGrorey BSN, RN, HTCP, HBN-BC, OCN, HMIP, NCCA and
Vicki Walker DNP, BS, RN
During this time of pandemic practicing nurses are faced with extreme stress
both at home and work. Now more than ever is the time to pause and appraise
your routine for self-care. Practices like mindfulness, aromatherapy, meditation, etc.
may be familiar to you or you may be a novice just exploring what is out there. To
advance your learning here are a few tips for aromatherapy practices.
Today there is an abundance of products for aroma therapy, but consumer
beware, many products on the market are not pure essential oils and you may not
experience the expected biological effects without ensuring product quality. The
essential oil effects that we are suggesting in this article are based on pure plant oil
extracts. We do recommend if you are unfamiliar with product selection that you
seek further guidance from experts.
Here are some simple guidelines:
Oils to Support Relaxation
Oil Primary Effects Uses Techniques for
Oils to Support Immunity
Safety – can be
Oil Primary Effects Uses Techniques for
Great for diffusing
as an air purifier
Great to use for
Use for natural
Use in natural
Safety – heavily
dilute before use;
not for children
Topical: only if
avoid in young
children; may have
dilute before use
Safety – avoid
in babies and
Page 8 • Nevada RNformation December 2020, January, February 2021
NNA Environmental Health Committee
Environmental Health and Homelessness
Shelter is a basic necessity that many of us take for
granted. Since prehistoric times, humans have been
building structures to protect themselves from the
elements. The good fortune to wake up in a warm
bed, turn on the faucet for water, open our refrigerator
for food, and have access to a shower are all modern
conveniences that are commonplace for the majority
of the population. Without a home, it is difficult for
individuals and families to achieve stability, personal
hygiene, obtain employment, receive an education, or
receive necessary health services. People experiencing
homelessness are at an increased risk of premature
death, have higher rates of chronic health conditions,
including mental illness and substance abuse, and use
emergency services more frequently (Maness & Khan,
2014). In the last decade, homeless encampments
have been on the rise, due to the lack of affordable
housing and absence of a living wage (National Law
Center on Homelessness and Poverty, 2017). At the
bedside and in the community, nurses observe in their
patients the importance of shelter and the associated
health impacts of living on the streets on a daily basis.
This article offers a perspective on the challenges of
people experiencing homelessness and the associated
environmental health-related issues.
Environmental Health and Vulnerable populations
It is common knowledge that collective human
actions have negative impacts on our environment
and human health. An estimated 12.6 million people
die every year as a result of avoidable environmental
health risks such as climate change and environmental
degradation (World Health Organization, 2020).
Vulnerable populations such as those experiencing
homelessness are disproportionately affected
by environmental degradation and often lack
representation in environmental regulation and policy.
This same population has a higher risk of disease
processes associated with environmental hazards
(Ramin & Svoboda, 2009).
The COVID-19 Pandemic
History has shown that large-scale outbreaks of
infectious disease present challenges to everyone,
especially the most vulnerable members of the
population. The COVID-19 pandemic has exacerbated
health disparities experienced by the homeless
population and limited their access to available
resources. People experiencing homelessness have
a higher risk of contracting COVID-19 and are
differentially burdened by the impacts of the pandemic
(Karaye & Horney, 2020). Persons experiencing
homelessness who had health risks prior to the
pandemic, now have new barriers to accessing income,
resources, and healthcare.
The pandemic has had a special impact on the
homeless population here in Nevada. Representatives
from various shelters across the state of Nevada have
reported that many shelters had to either reduce
capacity, place a temporary hold on accepting new
clients, or shut down temporary shelters completely as
a result of the pandemic.
Environmental Injuries Related to Homelessness
People who are homeless endure various
environmental injuries as a result of extreme weather
conditions, climate change impacts, and simply living
outside without shelter (Ramin & Svoboda, 2009).
Health becomes a low priority for homeless individuals
who are struggling to meet their basic needs (Koh &
O’Connell, 2016). In interviews with Terry Lindeman,
Director of Family Promise in Las Vegas and Emma
Neville, program manager at Tahoe Coalition for the
Homeless (TCH), it is evident that environmental health
conditions are dependent on the climate of a particular
region, as there is high variability in temperature and
terrain across the state of Nevada.
The homeless population in the Tahoe area suffer
from cold-related illnesses such as hypothermia,
frostbite, and acute exacerbations of chronic respiratory
diseases related to wildfires and high altitude. Whereas,
the homeless population in Las Vegas suffer from heatrelated
injuries such as sunburns, pavement burns,
heat exhaustion, and heat stroke. Both regions see
incidences of dehydration, bug bites, and improper
wound healing due to poor hygiene and unsanitary
living conditions. When caring for a patient who is
experiencing homelessness, it is important for nurses
to include assessments for these conditions and expand
their focus beyond the major presenting complaint.
Hearing a first-hand experience of being homeless
can be a powerful reminder of the many challenges
faced by this population. One of the Tahoe Coalition
for the Homeless clients I spoke with told me her
story, “one time I woke up in the hospital wrapped in
warming blankets and the doctors told me my body
temperature had reached 80 degrees; that was the
night my sister wouldn’t let me into her house and I fell
asleep outside without a sleeping bag” (Anonymous
homeless client, personal communication, October 21,
The Homeless Population in Nevada
According to recent statistics, there are currently
7,169 homeless residents in Nevada which includes
families, young adults, and veterans. Of those
people, 727 on average are unsheltered at night (U.S.
Interagency Council on Homelessness, 2019). As of
2019, there are roughly 567,715 people in the United
States who are experiencing homelessness (National
Alliance to End Homelessness, 2020). It is difficult to
find current statistics on homelessness following the
As it stands, there are not enough resources
in Nevada to fulfill the needs of everyone who
experiences homelessness. Nevada requires more viable
solutions to this growing problem, as there are still
hundreds of Nevadans without shelter on any given
night. The recommendations from the CDC for people
experiencing homelessness is to continue placing
them in temporary stable housing as a priority and
allow those who are living in encampments to remain
where they are (CDC, 2020). Yet, people experiencing
homelessness continue to be displaced from these
encampments without guaranteed housing placement.
Homeless Encampments and Environmental Impacts
All human beings have an impact on the
environment with daily living. Homeless encampments
along the Truckee River in both Reno and Tahoe
have detrimental impacts to this natural habitat and
essential water source. Trash, human waste, and
hypodermic needles litter the river banks and put these
communities at risk. Recently, during the pandemic,
the city of Reno has ramped up efforts to clean up this
area due to environmental threats and fire hazards,
and are displacing homeless people in the process
(Conrad, 2020). However, these types of initiatives
are not getting to the root of the problem, which is
providing a permanent housing solution for people
who are homeless to protect their health, the health
of the public, and the natural environment. Many
people experiencing homelessness simply don’t know
what to do with their waste; anonymous clients of the
Tahoe Coalition for the homeless reported that there
are no public areas to take trash without incurring
illegal dumping fees, bears are frequently encroaching
on their encampments, and there is a lack of public
Housing is the obvious solution to ending
homelessness and the associated negative health
outcomes and environmental impacts. There are
encouraging examples of projects that have been
successful in reducing homelessness. In the United
States, there are 80 communities and three states
that have ended veteran homelessness and four
communities that have ended chronic and veteran
homelessness; this means they have established
systems to ensure that homelessness is rare, brief,
and a one-time occurrence (United States Interagency
Council on Homelessness, 2019). One of the silver
linings of this pandemic is the public health response
from the federal government. The Coronavirus Aid,
Relief, and Economic Security (CARES) Act was passed
by Congress March 27th, 2020 and has distributed
over $2 trillion in economic relief packages to local
communities across the country to protect people from
the public health and economic impacts of COVID-19
(U.S. Department of Treasury, n.d.).
Emma Neville of the Tahoe Coalition for the
Homeless (TCH) received funding from project
Roomkey, a California state program that enables
Encampments of the Homeless
Photos courtesy of the Tahoe Coalition for the Homeless, taken by Ryan Hunt
December 2020, January, February 2021 Nevada RNformation • Page 9
NNA Environmental Health Committee
people experiencing homelessness to shelter in place
through temporary housing. One of the goals with
these new projects is to reduce emergency visits
related to environmental injuries through housing
and preventative care services. “One of the best
things I hear with this job is, thank you for saving my
life” (Personal communication with Emma Neville,
November 10, 2020).
Terry Lindemann of Family Promise of Las Vegas
reports that housing first is the most important answer
to ending homelessness, and reports that collaboration
between nonprofit organizations in Southern Nevada
has been key to helping people in the community who
are homeless, as she says, “it is not going to be one of
us, it is going to be all of us” (Personal Communication,
Terry Lindeman, November 12, 2020).
A Success Story
Terry Lindeman recalls a successful story of one of
the families who was helped through Family Promise
of Las Vegas: “A story I remember well, was a single
mother who was discharged from the hospital with
chronic kidney disease and during her hospitalization
she had lost her job and her apartment. We were
able to place her and her family in housing and pay
her vehicle insurance in order for her to get to her
daily dialysis appointments. From there, we continued
to work with this family in order to achieve their
goals of returning to work, getting back into their
own apartment, and helped them to remain selfsufficient.
This family would have faced insurmountable
challenges without the assistance of our nonprofit
and today they are housed and doing well and they
have been able to overcome all of their challenges”.
(Personal communication with Terry Lindeman,
November 12, 2020).
The Nurse’s Role: Care & Compassion
Nurses have a responsibility at the bedside and
within their communities to help people experiencing
homelessness to improve their health through
education, outreach, and referral to appropriate
resources. These nurse-led interventions increase
participation in public health programs, prevent risky
health behaviors, and improve health outcomes
(Weber, 2019). Nurses also have an obligation to
advocate for policies that aim to reduce homelessness,
climate change, and environmental degradation. The
nurse’s ability to uphold equity and respect when
caring for people experiencing homelessness is crucial
to establishing a trusting relationship with the patient
and helping guide them toward available resources.
In a recent survey conducted by TCH, clients were
asked “what is the hardest thing you face as a result
of being homeless,” and the overwhelming response
was “I don’t feel like I’m treated like a human being
anymore,” one individual stated, “people don’t want
to look me in the eye.” Homelessness is a traumatic
experience and it is imperative that nurses move
beyond judgment and lead with compassion. At the
core of our profession is caring!
Centers for Disease Control and Prevention (2020,
September 16). Retrieved October 22, 2020, from
Conrad, B. (2020, September 24). City to ramp up homeless
camp cleanups, enforce no camping ordinances. This is
Reno. Retrieved from https://thisisreno.com/2020/09/
Karaye, I. M., & Horney, J. A. (2020). The impact of social
vulnerability on COVID-19 in the U.S.: An analysis of
spatially varying relationships. American Journal of
Preventive Medicine, 59(3), 317–325. doi: 10.1016/j.
Koh, H. K., O, C. J. J., & O’Connell, J. J. (2016). Improving
Health Care for Homeless People. JAMA: Journal of
the American Medical Association, 316(24), 2586–
Maness D. L., Khan, M. (2014) Care of the homeless: an
overview. American Family Physician, 89(8), 634-40.
National Alliance to End Homelessness. (2020). State of
Homelessness: 2020 Edition. Retrieved from https://
Shelters and Resources for People Experiencing Homelessness in Nevada
Volunteers of America, Northern Nevada -
phone: (775) 329-4141
address: 335 Record St., Reno, NV 89512
Reno-Sparks Gospel Mission
phone: (775) 323-0386
Friends in Service Helping - Carson City
phone: (775) 882 – 3474
address: 138 E Long St, Carson City, NV 89706
Tahoe Coalition for the Homeless - Tahoe
phone: (530) 600-2822
address: PO Box 13514, South Lake Tahoe, CA,
Friends in Service Helping - Elko
address: 487 South 5th Street, Elko, NV 89801
phone: (775) 738-7800
Las Vegas Rescue Mission
phone: (702) 382-1766
address: 480 West Bonanza Rd, Las Vegas, NV
Family Promise of Las Vegas
phone: (702) 638-8806
address: 1410 S. Maryland Pkwy., Las Vegas, NV
National Law Center on Homelessness and Poverty. (2017).
Tent city, USA: the growth of America’s homeless
encampments and how communities are responding
[pdf]. Retrieved from https://nlchp.org/wp-content/
Ramin, B., & Svoboda, T. (2009). Health of the homeless
and climate change. Journal of Urban Health: Bulletin
of the New York Academy of Medicine, 86(4), 654–
United States Department of Treasury (n.d.) The CARES act
works for all Americans. Retrieved November, 14 from
United States Interagency Council on Homelessness (2019).
Nevada Homeless Statistics. Retrieved on October 20,
2020, from https://www.usich.gov/homelessnessstatistics/nv/
United States Interagency Council on Homelessness (2019).
Communities that have ended homelessness. Retrieved
October 20, 2020 from https://www.usich.gov/
Weber, J. J. (2019). A systematic review of nurse led
interventions with populations experiencing
homelessness. Public Health Nursing, 36(1), 96–106.
World Health Organization. Climate change and human
health. Retrieved November 11, from https://www.
Eddy House - Reno
phone: (775) 384-1129
address: 888 Willow St., Reno, NV 89502
Shannon West Homeless Youth Center
phone: (702) 369-4357
address: 1650 E. Flamingo Rd. Las Vegas, NV 89119
Nevada Partnership for Homeless Youth
phone: (702) 383-1332
address: 4981 Shirley St, Las Vegas, NV 89119
HopeLink of Southern Nevada
phone: (702) 566-0576
address: 178 Westminster Way, Henderson, NV
Nevada 211 of the Nevada Department of
Health and Human Services
City of Reno: Homeless Resource Page
Nevada Homeless Alliance
Help Hope Home
Tihisha Vaccaiah, RN
The Orvis School of
University of Nevada
Bernadette M. Longo,
Ph.D., RN, APHN-BC,
Emerita, Orvis School
Get a free radon test kit!
Jan. 1 thru Feb. 28
call the Nevada Radon Hotline
All Nevada homes should be tested for radon!
Page 10 • Nevada RNformation December 2020, January, February 2021
Antimicrobial Stewardship – Infection Prevention
SARS-CoV-2 and Infection Prevention - Stop the Bleed
By Norman Wright, RN, BSN, MS – Infection Preventionist
It is Thanksgiving Day 2020. SARS-CoV-2 (Coronavirus)
infections and Covid-19 hospitalizations are surging for the
third time this year, and the wave is building with no crest
in sight. During the first wave back in April 2020, Nevada’s
highest seven-day running average of SARS-CoV-2 infections
was only 161. The second wave peaked on July 20, 2020,
when the 7-day average of daily infections increased to
We are now experiencing the third wave, and it is hitting
hard. We have blown past last summer’s numbers, and on
November 26, 2020, Nevada’s 7-day average of infections
more than doubled to 2,415.
Before the election, people attended packed campaign rallies, many without
masks, and street demonstrations continue. CDC’s recommendations are ignored,
and people crowd into airports traveling to spend Thanksgiving with family.
Continuing to disregard basic infection prevention guidelines will result in infections,
hospitalizations, and deaths, to increase astronomically.
Graph #1 Nevada’s Daily Infections
Graph #2 Nevada’s Hospitalizations
It is Thanksgiving, and to date, 2,092 Nevadans have died. Yes, treatment options
are improved, and the percentage of deaths vs. the number of infections has
decreased; the only problem, infection rates are skyrocketing.
I pray I am wrong, but I fear deaths will increase at a blistering pace in the
coming months. The Institute of Health Metrics (IHME) latest estimate is that by
February 2021, Nevada’s death toll will be over 3,700. The unfortunate reality,
deaths peak about a month after the number of infections begins to decrease, and
Nevada's daily infection numbers continue to escalate.
At NNA’s 2019 annual convention, a “STOP The BLEED” educational session
was taught. Without going into details, the most important takeaway was, “When
someone is bleeding, do something, anything, to stop the bleeding." Tear off
your sweaty shirt or your belt, use anything at all that can compress, or acts as a
tourniquet, to stop a person from bleeding out.
That said, an infection prevention article telling you to press an unsanitary towel
or to tie your shoelace above an open wound seems to be a non sequitur, but it
is not. First Aid Basics are ABC (Airway, Breathing, Circulation). Bottom line, if
the person dies from bleed out before getting to the hospital, infection prevention
recommendations and antimicrobials are of no concern nor useful.
When someone is bleeding out, immediate action must be taken, or death
quickly occurs. Yesterday's 7-day average of SARS-CoV-2 deaths in the United States
was 1,708, and the CDC estimates that the numbers will increase.
September 11, 2001, when 2996 Americans died after four hijacked airplanes
crashed into the World Trade Center, the Pentagon, and a field in Pennsylvania - is a
date burned into my memory – and now, every two days, more Americans die from
COVID-19 than died on 9/11 - think about that for a minute.
The daily tally of COVID-19 deaths has continued for so long that many have
become numb to the reality and are experiencing “COVID Fatigue." Some of us, too
many, refuse to wear masks, shelter in place, or take other necessary precautions.
Despite the increase in hospitalizations and deaths, mixed messaging has caused
confusion. Some still don’t believe SARS-CoV-2 is real, while others are letting their
Media emphasis has been on a "cure," not prevention. Ineffective remedies such
as hydrochlorothiazide were hyped, and mitigation efforts were minimized, even
discounted. The result, infections are spreading like wildfire.
Vaccine development has been politicized and hyped for months. Vaccines
are now in the process of being approved, and indications are, before the New
Year, there will be at least two different vaccines available, some claiming a 95%
immune response. Hopefully, by February 2021, we will be vaccinating health
care professionals, first responders, vulnerable senior citizens, and others with comorbidities.
But it will take many more months before a large percentage of our
population can be vaccinated.
The term “Herd Immunity” is being discussed in the media as a way out of
our dilemma, but between 70 to 90 percent of our population must be infected
or vaccinated before “Herd Immunity” is achieved, and this probably will not occur
until early summer, if at all.
A problem with “Herd Immunity Theory” is that immunity to Coronavirus may
not last long. Unlike smallpox and polio vaccines, SARS-CoV-2 immunity may last
only a year or less. (1) (2) (3) (4)
The trajectory of how quickly Coronavirus infections spread is frightening,
and this is where the analogy of comparing the "slow-motion pandemic" we are
experiencing is equated with the quick action that must be taken to preserve a life
when witnessing someone bleeding after a car accident, or a mass shooting. — (See
accompanying article Stop the Bleed Training).
SARS-CoV-2 is a novel virus that spreads rapidly. Every day we learn more
about it, and older data that is less accurate gets mixed in. Since last January, we
have been fed a constant barrage of information and misinformation regarding
COVID-19. It is on TV, in newspapers, the Internet, Twitter, and various other media
Masks help to stop spreading infection from the wearer to others, and masks also
protect the wearer from being infected, but wearing a mask has become politicized.
Many media sources continue to spread doubt, causing confusion and noncompliance.
The result, the number of infections is soaring into the stratosphere. (5)
Basic infection prevention practices, wearing a mask, social distancing, hand
hygiene, and doing other preventative measures is how we stop the slow bleed of
hospitalizations and deaths from COVID-19, and this is where the analogy of saving
the life of someone who is bleeding out differs from the unified approach that must
be taken to stop the spread of the infection.
Mitigation requires buy-in from society as a whole, and if we fail, tens of
thousands more will unnecessarily die.
But viewing the pandemic only in terms of the number of hospitalizations
or deaths is shortsighted. Ignoring the societal, economic, and psychological
impacts, many recovering from a SARS-CoV-2 infection, even those who were not
hospitalized, have a different form of "COVID fatigue," which is one of the many
post-infection symptoms that “Long Haulers” have. (6)
Today is Thanksgiving, and 2020 is a year we will all remember. Let’s be thankful
for all we have because looking at what is lost only creates negativity that generates
a downward spiral.
After the October 1 Las Vegas shooting occurred, the term “Vegas Strong”
resounded, and we recovered. It is time for us to work together, and when we do,
Nevada Strong, indeed USA Strong, will echo around the world.
Ultimately the actions we take today determine our future. Not just your future,
but a future that our children and their grandchildren hopefully will enjoy. Ultimately
infection prevention is an individual responsibility that everyone must practice. If we
don't deal with COVID-19 locally, it is impossible to control it anywhere.
Onward to 2021 – and the future!
December 2020, January, February 2021 Nevada RNformation • Page 11
By Tracey Long PhD, APRN-BC, CDE, CNE, CCRN
Nurses educate patients
about the value to get vaccines
all the time, but how many
nurses actually get those same
vaccines for themselves? The
annual influenza vaccination
is often a requirement for
healthcare professionals to
reduce absenteeism and
morbidity and mortality,
however only approximately
78% of health care personnel actually comply with
the recommendations for themselves (CDC, 2018).
Coverage was lowest among nurses working in longterm
care settings. According to a qualitative study,
the reasons why nurses decline influenza vaccination
included mistrust of safety, overuse of vaccinations
and even rebellion over being told what to put in their
own body and wanted decisional autonomy (Pless et al.
2017). And yes, nurses do have a right, just like anyone,
However, nurses hold a responsibility to deliver
complete and objective information when providing
patient education. Research proves a nurse’s opinion
sways the advice they give patients and vaccinated
nurses are more inclined to recommend vaccination
than those who are unvaccinated (Smith et al, 2016).
Interestingly, the more highly educated the nurse is, the
higher the incidence they will be vaccinated.
Just as each nurse has unique values and beliefs,
each healthcare professional is an individual who
may decide their position about personal vaccination.
It is also true that nurses may deliver a healthcare
intervention they do not believe in, yet still administer
the care or medication the Provider orders. Regardless
of which side you take, every nurse has the right
to choose for themselves their habits of health and
balance that with their nursing duties.
We also have seen polar opposite opinions from
nurses during the COVID-19 worldwide pandemic
and face mask use in the past nine months. With the
production of hoped-for vaccines against COVID-19,
nurses will be asked by friends, family and colleagues
what to do. Regardless of a nurse’s personal or
political opinion, current health counsel against
COVID-19 should still be given by nurses and includes
the following based on the CDC guidelines: wash
hands frequently with soap and water or any alcoholbased
sanitizer, dispose of used tissues and masks
into a plastic-lined waste bin instantly, use a tissue
to cover your mouth and nose while coughing or
sneezing, don’t touch your mouth, eyes, or nose,
avoid close contact with any individual having cold or
flu-like symptoms, clean surfaces often, avoid sharing
utensils, food, or drinks, avoid crowded places and
stand six feet apart from others. If you are unwell, seek
medical attention immediately, stay at home and avoid
There is no doubt that despite adherence to the
CDC guidelines, people are still getting sick and nurses
are exhausted. The media reports higher anxiety,
suicide and depression in America in 2020 because
of the long-term consequences of COVID-19 and
social distancing. As people rely on the opinion and
education of nurses, we can make a difference in the
possibly worse virus the world is experiencing- fear and
Beyond the prudent CDC guidelines against
COVID-19, the next level of patient education for
health care guidelines for mental health may include
the following for yourself and those you educate:
If media is creating or worsening your anxiety, stop
consuming it. Distance yourself from the negativity
of media and fear (ADAA, 2020). You can still stay
informed by catching major headlines on an occasional
review of weekly highlights, but you don’t have to
bombard yourself with the plethora of negativity and
focus on racism, hatred, crime and distress most news
cycles focus on.
Take Control of Your Thoughts
The more your mind focuses on worst-case
scenarios, the more anxious you will feel. Rather than
allowing the very normal negative and fearful thoughts
that pass through your brain to stay and destroy your
energy, take action into problem solving. Much of
anxiety and stress comes from fear of the unknown
and lack of control. Rather than allowing your mind to
entertain doomsday thoughts, be proactive and focus
your thoughts on actions you can take that are in your
control. Proactive action towards your own goals is a
great way to crush pessimism.
Focus on Being Productive and New Ways of
Although you cannot control a worldwide
pandemic or political crisis, you do have control
over your response to the crisis. Among the many
humorous posts on social media was the comparison
of two women who each announced, “I’m using
this quarantine time to better myself by developing
a new skill at home,” while the other quipped “I just
ate carrot cake with my bare hands.” Life isn’t what
happens to you, but rather how you choose to respond
to it. A good sense of humor helps a lot. Pass the carrot
cake. Fork is optional.
Engage in Stress Reducing Activities
Train your mind to manage stress by employing a
variety of strategies including focusing on gratitude,
exercising your body, guided meditation, yoga, writing
gratitude notes and more, which can lower stress.
Find something new you’ve been wanting to do
but could never find the time to learn or do. Life will
never be stress-free, but your actions can help make it
manageable and not destructive.
Do Not Go Beyond CDC Guidelines
Nurses can help decrease the anxiety and stress of
our patients by confirming that people do not need to
be compulsive about handwashing, taking off clothes
before entering a house, and washing off groceries
before allowing them into the home. These are anxiety
measures, not the CDC measures.
Preserve a Sense of Normalcy
When social distancing is still recommended, you
can still maintain a routine by making your bed in the
morning, getting dressed for work even if you work
from home, exercise at home instead of a gym, and
have a scheduled dinner as usual but maybe invite
friends over a video chat platform. Social distancing
doesn’t mean social isolation.
Seek Out Professional Help
For many people, distressful times can reveal
underlying medical or mental health conditions that
do require professional help. Nurses can help people
recognize if what the patient is experiencing is normal
or if they need additional resources and help. This
includes being in-tune with the mental health of your
own colleagues and nurses you work with. After the
Twin Towers in New York City fell September 11, 2001,
nurses were there at the side of the firefighters and
rescue crews to assess and strengthen them in their
work. Nursing is a team sport and we need to watch
out for each other.
In the year of the Nurse, nurses really did shine and
continue to earn the title of most trusted profession.
People rely on nurses for good health education and
by being well-informed, presenting information and
resources objectively, we can collectively be a strength
to the well-being of our communities.
For ideas to help yourself, your family and your
patients, feel free to share the Coping Calendar
designed by www.actionforhappiness.org.
Anxiety and Depression Association of America, (ADAA)
(2020). COVID-19 anxiety reduction strategy. Retrieved
Centers for Disease Control and Prevention (2018). Influenza
Vaccination Coverage Among Health Care Personnel-
United States, 2017-2018. https://www.cdc.gov/mmwr/
Pless, A., McLennan, S., Nicca, D., Shaw, D. and Elger,
B., (2017). Reasons why nurses decline influenza
vaccination: a qualitative study. BMC Nurse 2017;
16:20. Retrieved from https://www.ncbi.nlm.nih.gov/
Smith, s., Sim, J., and Halcomb, E., (2016). Nurses’
knowledge, attitudes and practices regarding influenza
vaccination: an integrative review. Journal of Clinical
Nursing Oct;25(19-20). Retrived from https://pubmed.
Page 12 • Nevada RNformation December 2020, January, February 2021
Addressing Sleep Problems During the COVID-19 Pandemic
Denise S. Rowe DNP, APRN, FNP-BC
The Covid-19 Pandemic has produced significant
stressors including mass unemployment, financial
hardships, and an increase in mental and physical
health conditions. Health care workers are on the
frontline providing the first line of care to those
infected and sick due to COVID-19. Stressors from the
pandemic are high. Consequently, surveys of healthcare
workers report high incidences of problems sleeping.
Sleep is vital to the maintenance of the body’s
defense system and for promoting homeostasis. Along
with diet and exercise, healthy sleep—of adequate
quality, duration and timing is one of three pillars of
maintainable health (Goldstein and Walker , 2014),
Sleep disruptions and deficits interfere with
immune system responses by interrupting circadian
rhythms, negatively impact the endocrine system that
manage and maintain internal bodily functions and
some cytokines (IL=-1, IL-6, TNF-a) which are linked
to disease and immunosuppression (Besedovsky,
Lange, and Haack, 2019; Irwin, 2015; Santos, Tufik, &
De Mello, 2007). While sleep deficits have not been
directly linked to an increase in diagnoses of COVID-19,
immunosuppression from sleep deficits can increase
the risk for opportunistic diseases and worsen clinical
outcomes resulting from COVID-19.
When stressors are high the body often triggers an
inflammatory response to eliminate the stressors and
aid the body system in reverting back to a normal state
Since the onset of COVID-19, high insomnia rates
(34-36%) have frequently been reported among
frontline healthcare who care for patients at risk or
diagnosed with COVID-19 (Lai, et al., 2020; Zhang et
al., 2020). Healthcare workers face higher stress from
providing care to COVID-19 patients, fear of getting
infected themselves and constantly facing death
by working on the frontlines. These circumstances
contribute to sleep disturbances at home.
Epidemiological data show that nurses experience
high incidences of sleeping problems. Among nurses,
57% to 83% reported having insomnia, inadequate
sleep, sleep deprivation and poor quality of sleep
(Qiu et al., 2020; Zdanowicz, Turowski, Celej-Szuster,
Lorencowicz, & Przychodzka, 2020) , and up to 50%
of nurse worldwide reported short sleep duration
(Furihata, Saitoh, Suzuki, et al., 2020; Stimpfel, Fatehi,
& Kovner, 2019). A larger study in the United States
found that 68.1% of nurses regularly slept less than
seven hours and 11.4% slept less than five hours
(Stimpfel et al., 2019). It is important to note that the
National Sleep Foundation recommends that adults
should sleep seven to nine hours per night (Hirshkowitz
et al., 2015). Nurses experiencing sleeping problems
were at risk for committing errors at work. Dorian
and others (2006) found sleep deprivation increased
the risk of medication errors, incorrect documentation
and fostered poor communication between nurses,
patients, and other staff.
There are many strategies available to manage
or prevent sleep disturbances during the COVID-19
• Make sleep health a priority—set aside seven to
eight hours per night for sleep.
• If possible, maintain a regular schedule for sleep,
work and recreation which provides cues, helps
to maintain a routine and trains one’s individual
• For day shift workers: self-exposure to daylight
as much as possible is recommended to regulate
circadian rhythms and sleep-wake cycles.
• For night shift workers: avoid direct exposure
to sunlight on the way home from work by
• For night shift workers, setting an alarm to
maintain a regular wake-up schedule. Exposing
yourself to sunlight right after awakening is
• Allow one hour or more to unwind before sleep.
• Go to bed when sleepy.
• Maintain a sleep environment that is
comfortable (e.g. dark, quiet, and at around 20
degrees Celsius/68 degrees Fahrenheit).
• If sleep does not occur within 15-20 minutes,
consider quiet activity such as reading in another
room and return to bed when sleep is imminent.
• Follow the same sleep routine to maintain a
regular sleep-wake schedule. Arise at the same
time every day. Do not sleep in regardless of
• Avoid intense or blue light and use of electronic
items (television, cell phones, tablets) in
bedroom and close to bedtime. These items
inhibit the release of the sleep-inducing
• Use stimulants (e.g. caffeinated beverages) with
caution and avoid them five to six hours before
sleep; they could have negative collateral effects
on the next sleep episode.
• Avoid alcohol before sleep. While alcohol is
initially de-arousing it has a rebound effect of
increasing night-time awakenings and reducing
• Avoid smoking or nicotine 30 minutes before
sleep. Nicotine worsens sleep quality and
increased night-time awakenings.
• Avoid eating too many sugary foods before
sleep. They can significantly activate your
metabolism and worsens sleep.
• For night shift workers, have a light snack before
bedtime to avoid being awakened by hunger.
• Reserve bedroom for sleep and sex only—not
for working or planning the next day activities.
• Following sleep deprivation, a short 15
to 30 minutes be effective in decreasing
the homeostatic burden of the sleep drive
and improving cognitive and psychomotor
• Avoid napping five to six hours before longer
sleep if insomnia is a problem. While insomnia
can be a normal response to stressful events, if
insomnia occurs several times per week, seek
professional help to prevent insomnia from
becoming a chronic problem.
Healthy sleep is critical to coping physically and
mentally with a major life event such as the COVID-19
pandemic. Ongoing education is needed to remind
healthcare workers about the importance of healthy
sleep practices to prevent or minimize adverse health
outcomes as the COVID-19 pandemic surge continues.
Besedovsky, L., Lange, T., & Haack, M. (2019). The sleepimmune
crosstalk in health and disease. Physiological
reviews, 99(3), 1325-1380.
Dorrian, J., Lamond, N., van den Heuvel, C., Pincombe, J.,
Rogers, A. E., & Dawson, D. (2006). A pilot study of
the safety implications of Australian nurses' sleep and
work hours. Chronobiology international, 23(6), 1149-
Furihata, R., Saitoh, K., Suzuki, M., Jike, M., Kaneita, Y.,
Ohida, T., ... & Uchiyama, M. (2020). A composite
measure of sleep health is associated with symptoms
of depression among Japanese female hospital nurses.
Comprehensive Psychiatry, 97, 152151.
Goldstein, A. N., & Walker, M. P. (2014). The role of sleep
in emotional brain function. Annual Review of Clinical
Psychology, 10, 679–708. https://doi.org/10.1146/
annurev-clinpsy-032813-153716 Epub 2014 Jan 31.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni,
O., DonCarlos, L., ... & Kheirandish-Gozal, L. (2015).
National Sleep Foundation’s updated sleep duration
recommendations. Sleep health, 1(4), 233-243.
Irwin, M. R. (2015). Why sleep is important for health: a
psychoneuroimmunology perspective. Annual review
of psychology, 66.
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Tan,
H. (2020). Factors associated with mental health
outcomes among health care workers exposed to
coronavirus disease 2019. JAMA network open, 3(3),
Qiu, D., Yu, Y., Li, R. Q., Li, Y. L., & Xiao, S. Y. (2020).
Prevalence of sleep disturbances in Chinese healthcare
professionals: a systematic review and meta-analysis.
Sleep medicine, 67, 258-266.
Santos, R. V. T., Tufik, S., & De Mello, M. T. (2007). Exercise,
sleep, and cytokines: is there a relation?. Sleep
medicine reviews, 11(3), 231-239.
Stimpfel, A. W., Fatehi, F., & Kovner, C. (2020). Nurses'
sleep, work hours, and patient care quality, and safety.
Sleep health, 6(3), 314-320.
Zdanowicz, T., Turowski, K., Celej-Szuster, J., Lorencowicz,
R., & Przychodzka, E. (2020). Insomnia, sleepiness,
and fatigue among polish nurses. Workplace Health &
Safety, 68(6), 272-278.
Zhang, C., Yang, L., Liu, S., Ma, S., Wang, Y., Cai, Z., ... &
Zhang, J. (2020). Survey of insomnia and related social
psychological factors among medical staff involved in
the 2019 novel coronavirus disease outbreak. Frontiers
in Psychiatry, 11, 306.
Loneliness and Social Isolation...continued from page 5
Feeling lonely and socially isolated can contribute to
unhealthy behaviors such as getting too little exercise,
drinking too much alcohol and smoking.
Loneliness is also an important social stressor
that can activate the body’s stress responses. When
prolonged, that response can lead to increased
inflammation and reduced immunity, particularly in
older adults. Inflammation is the body’s response
to fight off infection or heal an injury, but when it
continues unchecked it can have a harmful impact
on health. Stress hormones play an important role
in making sure that inflammation doesn’t get out of
control. But, under chronic stress, the body becomes
less sensitive to the effects of the stress hormones,
leading to increased inflammation and eventually
In healthy older people, loneliness is related to
a stress hormone pattern similar to that of people
who are under chronic stress. This altered pattern in
the stress response explained why people who were
lonelier had poorer attention, reasoning and memory
Social activity can buffer against the decline
Maintaining high quality relationships may be a key
for protecting brain health from the negative impacts
Older adults who feel more satisfied in their
relationships have a 23% lower risk of dementia, while
those who feel their relationships are supportive have
a 55% lower risk of dementia, compared to those who
feel dissatisfied or unsupported in their relationships.
Maintaining social activity also buffers against
decline in thinking abilities, even for those who live
alone or who have signs of beta-amyloid accumulation
in their brain. One reason for these benefits to brain
health is that maintaining strong social ties and
cultivating satisfying relationships may help people to
cope better with stress; people who feel better able to
cope with difficulties or bounce back after a stressful
event show less buildup of tau protein in their brains.
This is good news because, with the importance
of social distancing for controlling the COVID-19
pandemic, how people manage their feelings and
relationships is likely more important for brain health
than the fact that they are spending time physically
Strategies for coping with loneliness
Loneliness is a common and normal human
experience. An important first step is to recognize this
and accept that what you are feeling is part of being
Rather than focusing on what’s not possible at the
moment, try to refocus your attention on what you can
do to stay connected and make a plan to take action.
This could include planning to reach out to friends
or family, or trying new activities at home that you
normally wouldn’t have time for, such as online classes
or book clubs.
During times of high stress, self-care is essential.
Following recommendations to maintain regular
exercise and sleep routines, healthy eating and
continuing to engage in enjoyable activities will help
to manage stress and maintain mental and physical
Karra Harrington is a Postdoctoral Research Fellow,
Clinical Psychologist, at Pennsylvania State University.
Martin J. Sliwinski is the Professor of Human
Development and Family Studies, Director of the Center
for Healthy Aging, at Pennsylvania State University.
December 2020, January, February 2021 Nevada RNformation • Page 13
Nurses in the News
By Tracey Long PhD, APRN
Some people are born to be a nurse. Some people are
also born with special gifts and when they’re both, the
world is blessed.
One couple, Branden Murphy and Kristine Hafner are
those kinds of people that embody the spirit of nursing.
They are both pediatric nurses in Las Vegas, Nevada who
met while trying to adopt the same child on a pediatric
unit. In the following interview, you’ll feel their passion for
What made you interested in being a foster parent?
As a pediatric nurse who worked with hundreds of
children, I noticed that special needs kids who didn't get to go to a foster home
went to a skilled nursing home. That bothers me because it’s not natural for a child’s
home to be a facility. I believe kids should be at home with a family that loves them
and a dog by their side. I love special needs children. The more complex they are the
more I love them. It's just normal for me to want to give great nursing care to them.
When I turned 30, I still wasn't married, and I always wanted to be a parent.
I decided to become a single foster parent. Leon was my first foster baby. I met
Leon when he was nine days old in 2015, and he was admitted for shaken baby
syndrome. His older brother was also badly abused with multiple burns. A third
sibling was born into this dysfunctional family and Leon was the youngest. All three
children have now been adopted and the parents are currently incarcerated. I was
his foster parent for two years and then was able to adopt him as a single parent
and he was such a blessing to me. He has a G tube, is trach dependent, and has
central deafness and blindness. He has hydrocephaly as his brain couldn't develop
so he is chronologically five years old, but his ability is as a three-month-old. "They
took away 1/2 his brain by being a shaken baby," stated the grandmother. He is so
cute; I just love him!
How did you both meet?
I met my wife when we were both trying to adopt the same child, we cared for
in her PICU unit and through foster care. She had just adopted Steven, who was
beaten up at 11 months old with over 20 fractures, a deflated lung and missing
most of his teeth with a broken jaw. She has a huge heart and always wanted to
take home so many babies with special needs. We met by a mutual nurse friend.
We were both trying to adopt Skyler, a two-year-old who was born with her
intestines outside of her body, known as gastroschisis, due to parental alcoholism
and meth use.
Kristine fell in love with me when I took Leon snow sledding which made her
realize I want a normal life for these children. We both believe these children should
be able to experience life as normal. I’ve taken our special needs children swimming,
sledding and all kinds of activities to allow them a normal life, even with a trach
tube or special equipment.
Additional stories on this impressive couple can be found at:
Branden currently serves on the Nevada State Board of Nursing since 2019. He
has been working as a nursing professor for Arizona College of Nursing and after
hours he volunteers his time to be an advocate for children and providing a home to
children without options. Branden is in the process of opening Silver State Pediatrics,
which is a new skilled nursing facility in Las Vegas. He will be the Assistant Director
Kristine works as a PICU nurse at Sunrise Hospital in Las Vegas, Nevada and must
work hard to not fall in love with every patient!
Image Source: family picture taken by the Murphy family through Make a
Wish Foundation. Branden and Kristine Murphy and their four children
Who are your other children?
In addition to my first son Leon and her first adopted son Steven, we have now
adopted Skyler who is dependent on permanent intravenous feedings, and our
biological daughter London. Our hobbies are really taking care of medically complex
children and becoming advocates for them. We also continue to foster medically
complex children and currently have one foster baby.
What is your advice for foster parents?
If you have the desire or ability to serve as a foster parent, it’s a great
opportunity. There are so many children who need a loving and stable home. Just
be careful because you might fall in love and want to keep the child if you’re lucky!
These kids deserve to be loved by a family.
Who pays for their care?
All the children have Medicaid. We spend a lot of time trying to navigate the
health system. We have great compassion for those who aren’t nurses and are
trying to be an advocate for their own special need’s children because it’s not an
What is your advice for helping pediatric populations?
It is estimated that about 80-90 percent of car seats for children are installed
incorrectly so we as nurses need to educate our parent populations about correct
West Hills Hospital located in Reno, NV, a leader in
the treatment of behavioral, mental health care and
substance abuse treatment is seeking FT/PT/PRN
Registered Nurses to implement the nursing process
as it relates to our programs.
Visit www.westhillshospital.net and click on
CAREERS to apply.
Page 14 • Nevada RNformation December 2020, January, February 2021
SAVE THE DATE!
Nurses Day At The Legislature
Tuesday, March 2, 2021
Nevada State Legislature
401 S. Carson Street
Carson City, NV
Free CEU’s will be provided!
Watch for registration details on NNA’s website
Rural & Frontier
JOIN US! 2-day Virtual Conference - Presented
by the Nevada Nurses Foundation (Rural & Frontier
Visit - nvnurses.org; https://nvnursesfoundation.org/
Networking and Informative Seminars
January 22, 2021 5pm to 8pm
January 23, 2021 8am to 12 pm
Nursing Continuing Education Units Available
• Adolescent Mental Health
• Human Trafficking
• Keeping the Patient with COVID-19 Safe
• Medicinal Marijuana
• Opioid Abuse
Register before January 1st for a discounted fee.
Students who are not members of NSNA
may join NSNA and have their registration
Please contact Sandy Olguin
Scholarships to attend may be available, contact
Sandy at above email or at
December 2020, January, February 2021 Nevada RNformation • Page 15
The 20/20 Vision: Nevada Nursing Student Association Empowerment
Jessica Rasamimanana, NVNSA Southern
Chelsey Honrud, NVNSA Secretary
Iris Isabel Martinez, NVNSA President
The Nevada Nursing Student Association (NVNSA)
has fiercely empowered Nevada nursing students
and exudes resilience. This year has brought many
opportunities, and no one could ever have imagined
it would be possible to thrive amid a pandemic.
However, NVNSA found 20/20 clarity and will only
continue to rise in the coming years. Below are two of
the most significant accomplishments NVNSA has had
the honor to participate in, as recounted by Jessica
Rasamimanana (NVNSA Southern Regional Director)
and Chelsey Honrud (NVNSA Secretary).
clinical skills. We have partnered with many of the
Southern Nevada Region schools and have student
nurse volunteers come out from UNLV, NSC, Roseman,
and CSN the first of every month and as needed. We
are so grateful to bring so many schools and people
together through this volunteering experience. When
we can help others through simple acts of kindness,
we can fully experience an event that allows us to
work cumulatively towards our goals. By supporting
our nursing students, we have allowed for expanded
knowledge of diabetes resources and the creation of
a wide range of opportunities for advancement. It has
been gratifying to be a part of something that helps to
better our community, and we cannot wait to be a part
of our next event.
As 2020 ended and we move into 2021, we cannot
wait for all the future opportunities we have yet to
encounter. Most importantly, we are eager to take on
all the many challenges to enter our path, as we have
all experienced first-hand the gift of growth and strong
leadership it brings. NVNSA would like to thank all the
fierce and resilient nurses who continue to inspire NV
nursing students and continue to show us the power of
a nurse’s heart!
Nevada Nurses Foundation SSON Student
Event & Gala: It was such an honor for several
NVNSA members to be named 'Rising Stars' as nursing
students in Nevada. To be recognized for the work we
are doing for our fellow students was so validating.
NVNSA has been providing many opportunities for
nursing students in Nevada. NVNSA hosted a virtual
event for Nevada nursing students, the Shining Stars of
Nursing (SSON) Gala. The SSON student event provided
students from all over the state with networking and
informational sessions regarding furthering their
education, financial planning, job opportunities, and
a mini NCLEX review, all free of charge. While NVNSA
provided this free to students, this occasion served as
a fundraiser for the NVNSA 2021 convention. At the
SSON Gala, we had an opportunity to meet and learn
from nurses in Nevada and gain more insight into the
profession we are about to enter. Speaking with the
"50 under 50" nurses and hearing about the fantastic
things they are doing for the nursing profession in
Nevada was inspirational; we cannot wait to join the
nursing profession officially.
SAVE THE DATE!!!
Bringing together nursing students throughout
Nevada. We are one big team! #Strongertogether
Shining Stars of Nevada: Behind the scenes
of the annual Shining Stars of Nevada (SSON)
Student virtual event, the NVNSA coordinated
and ran the student event.
• NCLEX Hurst Review
• Pharmacology Kahoot review
• Resume review + Interview tips
• Raffle prizes
• Student scholarship giveaway
• Alumni panel
• NCLEX review giveaways
• and much more!
NVNSA 3rd Annual Convention
via zoom on Saturday, May 29th @ 8am
THEME: New Grad RN Bootcamp:
No limits to success!
Support the next generation of nurses. From new graduate
RN’s, to incoming nursing students, to high school students!
We would love to see you here! #Strongertogether
More details coming soon!
*Contact firstname.lastname@example.org for any questions*
Live in Las Vegas!
We offer outstanding career opportunities for qualified
people who share our commitment to providing expert
healthcare and excellent customer service.
The Nevada Nurses Foundation awarded NVNSA
Board of Directors and NVNSA members the
2020 Rising Star Certificate. A huge honor and
indeed an amazing night!
D.I.V.A. Program: Another significant opportunity
that we have been able to bring to our fellow
nursing students was collaborating with the Diabetes
Intervention for a Victorious and Active Lifestyle
program, otherwise known as the D.I.V.A program.
This event was an amazing opportunity for our fellow
students to be out in the community, educate, practice
our skills, and encompass all NVNSA stands for.
These volunteers can assist with taking manual blood
pressures, blood sugar monitoring, weights, and other
Our employees enjoy opportunities for professional
development and career advancement, as well as
a competitive compensation and benefits package.
* Growth Opportunities * Vacation, Sick, Holiday Pay
* Generous 401k * Medical/Dental/Vision
* Education Reimbursement
We are currently recruiting
full-time and per diem
Registered Nurses and
other Clinical Support
Come Join the Family! Apply online.
Recruiter: (702) 657-5580
Page 16 • Nevada RNformation December 2020, January, February 2021
UMC Annual Research Empowerment Day 2020 – Virtual Edition
Heather Spaulding, MSN, RN, RN-BC, CPN
Cheri Filewood, RN
The Chief Nursing Officer of University Medical
Center of Southern Nevada (UMC), Debra Fox, had a
vision for a day where interprofessional healthcare
workers came together to support UMC’s vision of
being a premier academic medical center. Her vision
became a reality on May 9, 2018, when UMC hosted
their First Annual Research Empowerment Day. This
day's three objectives are to bring evidence-based
practice to the bedside, recognize research excellence
formally, and enhance UMC's partnership in higher
learning (Neue & Walker, 2018).
The First Annual Research Empowerment Day set
the foundation for the future of research at UMC.
The first event was held at UMC and featured 54
posters in the categories of care presentations, clinical
research, completed clinical projects, proposed clinical
projects, and knowledge enhancement. Poster authors
represented medicine, nursing, therapies, pharmacy,
academia, and even engineering. A neutral panel
of judges reviewed the posters using preset criteria.
Winners were announced during a live event with
certificates and ribbons presented. This first event's
overwhelming response established a platform for
highlighting clinical research (Walker, 2018). Contact
hours for continuing education were awarded for
attending the event and completing the event’s
Building upon the first year's success, the Second
Annual Research empowerment Day showed growth
with an additional twenty posters. On September
11, 2019, 74 posters were featured from different
interprofessional team members from UMC (UMC
Hospital, 2019) and healthcare professionals in
academia. Posters were judged using the same five
categories for the second year, and winners were
announced during a live event with certificates and
With the success of the first two years, UMC's
Research Empowerment Day Committee had set a goal
to feature 100 posters for 2020. There was a plan to
add two additional categories for healthcare profession
students–undergraduate and healthcare professions
students–graduate to allow future healthcare workers
such as medical students, nursing students, therapy
students, and more to highlight their work in a
professional venue. As the planning committee began
to plan the Third Annual Research Empowerment
Day, the world suddenly found itself in the middle
of a pandemic. All healthcare-related conferences
and UMC's Research Empowerment Day came to
a screeching halt while our frontline staff worked
diligently to assist patients affected by this new disease.
The healthcare community began to learn more
about this new virus, and the Centers for Disease
Control and Prevention (CDC) put guidelines in place
to keep everyone safe. The CDC asked everyone to
practice social distancing (CDC, 2020) and limit large
gatherings. With the new social distancing guidelines
in place, those who plan conferences and events
to advance healthcare knowledge began to seek
alternatives to these types of events.
Working with the UMC's Infection Preventionists,
incident command, and senior leadership, the planning
committee was approved to move forward with a
virtual venue. A call for posters went out. Despite
the short notice, the planning committee was able to
obtain participants to partake in the third annual event,
demonstrating that the healthcare community desired
to grow from research even during difficult times.
With the new virtual venue, the committee sought
to ensure that guests outside of UMC could participate
in the event. The planning committee worked diligently
with the marketing team and the web developer to
create this new virtual venue. Twenty-six posters were
accepted from various UMC disciplines and two from
our academic partners to total twenty-eight posters.
These posters were the displayed on UMC’s webpage
within their respective categories.
With the social distancing guidelines, another
challenge the planning committee faced was the
annual award celebration. The planning committee
concluded that the best way to celebrate was to host
a virtual celebration via WebEx, with posters on virtual
display on November 18 and 19, 2020. This event
concluded on November 19, 2020, from 1030 to
1200, with authors present to answer the attendees'
questions. The event started with welcomes from
UMC's CEO and CNO and a brief presentation of
posters by poster authors, followed by the poster
Despite a global pandemic, UMC has seen active
participation in the Annual Research Empowerment
Day initiative. Due to our healthcare workers' busy
schedules, the posters are approved to remain as an
active Continuing Education event for a full year. The
ongoing poster displays will allow additional UMC staff
and all healthcare providers in Nevada and beyond, to
visit the site and obtain FREE 1.5 Contact Hours using
the link below.
UMC thanks all healthcare workers near and far for
their service. We hope you will take the time to visit
our site, review the posters, and complete the survey to
obtain your free contact hours.
CDC. (2020, Nov 17). Social distancing: Keep a safe
distance to slow the spread. Retrieved from Centers
for Disease Control and Prevention: https://www.cdc.
Neue, P. C., & Walker, V. (2018, March). UMC hosts first
annual research empowerment day. Nevada State
Board of Nursing News, p. 23. Retrieved from http://
UMC Hospital. (2019, September). UMC Hospital @UMCSN
Tweet. Retrieved from https://twitter.com/UMCSN/
Walker, V. (2018, September). 2018 UMC Research
Empowerment Day. Nevada State Board of
Nursing News, p. 8. Retrieved from http://epubs.
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boating, fishing or any other sport you like! You can
even ride your bike to work! Save money, less time
commuting and spend more time with your family!
Working conditions, taxes and health are better
here in Douglas County than in any other county in
Northern Nevada. It’s greener on this side of Nevada -
rugged, relaxed, reachable! Come join the family. At
Carson Valley Medical Center Hospital we are seeking
to expand our Nursing staff. Located in Gardnerville
Nevada, 20 miles from beautiful South Lake Tahoe,
CVMC is a full-service critical access hospital.
CVMC supports an ICU unit, med tele unit, outpatient
infusion center, ambulatory surgery center and 24
hour ER. 6 months recent critical care experience
required. Successful applicant will be scheduled
a combination of shifts in the ICU and Med-Surg/
CVMC offers competitive wages and benefits, plus a
retention bonus of $5,000 over 2 years employment.
Interested applicants please apply online at
cvmchospital.org or call 775-782-1514.
December 2020, January, February 2021 Nevada RNformation • Page 17
Leadership in Policy and Care Quality and Safety
Nursing Policy in Times of Uncertainty surviving, thriving on the edge
As we confront new and existing realities and move
into this decade launched by the Year of the Nurse
and Midwife, we critically examine the history and the
future of nursing by inaugurating a new column called,
Leadership in Policy, Care Quality and Safety. The
purpose of the column is to engage nurses in dialogue
and galvanize them to take leadership in the individual
but overlapping aspects of policy, care quality and
safety. Each quarter you will find a short column on
a topic related to one or more of these intersecting
factors. Leadership is the framework that underpins
each column. We believe that no matter where nurses
work or the position held, leadership is a critical skill
for all nurses not only those who hold titles that imply
leadership, e.g. manager, director, dean, but every
nurse regardless of practice setting or role. Our goal is
to raise awareness about the leadership opportunities
in policy, care quality, and safety across settings,
specialties, communities and the globe by focusing on
inspiring exemplars and action steps that that be taken
Rebecca M. Patton, DNP, RN, CNOR, FAAN
Margarete L. Zalon, PhD, RN, ACNS-BC, FAAN
Ruth Ludwick, PhD, RN-BC, APRN-CNS, FAAN
Marian K. Shaughnessy Nurse Leadership
Academy, Case Western Reserve University
Call to Action
As we write this column during the COVID-19
pandemic, we are in the midst of unprecedented
change and risk for our personal lives, our families,
our professional lives, our communities, our country,
and our world. Little did we think when we planned
this column about policy, leadership, quality and
safety that we would be facing one of the greatest
challenges in our lifetimes. This crisis has thrust nurses
into the forefront of the public’s mind. How ironic that
this coincides with the World Health Organization’s
declaration that this is the Year of the Nurse and the
Midwife. While nurses are essential on the frontlines
at the sharp edge of care, it is the lens of nurses that
provide critical insights in evaluating and formulating
policy to achieve quality and safety patient care
Everyday nurses walk the tightrope of uncertainty.
The uncertainty of practice is a constant that
requires the attention of all nurses, vigilance, and
most importantly activism. COVID-19 has magnified
these unknowns to astronomical proportions. The
accelerated pace of uncertainty with COVID-19 has led
to care dilemmas and crises, with variations in practice
standards that negatively impact health outcomes.
We are bombarded with challenges like mass
shootings, climate change, water supply, and emerging
diseases. Now we are in the midst of a pandemic,
which not only impacts the health of our communities
and workforce, but has dire financial consequences
for so many. How many of these challenges have
you faced? What challenges have you faced that are
not even listed here? What will come next? We don’t
always know what will come next. We do know that
nurses will be there on the frontlines. When nurses
are asked to volunteer in a crisis, they show up for
wars, disasters, and pandemics. Nurses are in the
frontlines of policy implementation. Often in times of
crisis, policies are disregarded, ignored, or unofficially
discarded. Nurses often know whether a policy is
workable, flawed or whether it is doomed to fail. We
have seen policy failures like changing instructions
on the use of personal protective equipment (PPE) as
supplies dwindle. On the other hand, times of crisis
can lead to policy gains as illustrated by a willingness
to allow advance practice registered nurses full practice
To counteract policy failures, correct flaws and take
advantage of opportunities for policy advancements,
we need to be knowledgeable, and prepared. This
means participating in policy so that we understand
concerns expressed by broad constituencies and take
action using our nursing expertise. This expertise is
needed so that the policies are realistic, workable and
meet the needs they were designed to address. Policy
is more than enacting a law; it includes formulating
rules, regulations and guidelines. Policies occur at many
levels, often simply referred to as Big “P” and little “p”,
the former often focus on state, federal or international
laws and the latter to local government or local
associations or organizations.
Move to Action
Moving to action requires identifying the preferred
outcome with clarity. This is achieved by examining the
data, sharing information, and capitalize on your skills
to move an issue forward.
Know the data, appraise credibility of sources, and
interpret its meaning
“In God we trust, but everyone else needs to bring
This quote attributed to Edward Fisher when
testifying before Congress (Source) is a fitting start
for policy involvement. Nurses have the knowledge
and are in a unique position to use and leverage data
for patient advocacy. Knowing the data, appraising
sources and interpreting its meaning are critical steps
in the processes for research, quality improvement and
evidence-based practice. Nurses all have intellectual
capital related to these processes regardless of their
practice setting or role. Your intellectual capital can be
enhanced with the following strategies:
• Use the resources available from professional
associations: the American Nurses Association,
state nurses associations, specialty nurses
associations and interdisciplinary professional
• Subscribe to a wide variety of data sources
including journals, news alerts, list servs
• Track and identify progress on issues you are
• Determine the credibility of sources
• Verify the facts
• Identify content experts for policy issues
• Interpret the meaning
• Identify policy implications of research and
quality improvement projects
• Identify the strengths and weaknesses in the
data in support of your
• Sift fact verifying the facts and determining the
credibility of sources
• Interpret the meaning of information
Have the stories, share them widely.
Stories can be more powerful than only presenting
data. Stories provide an emotional tug, create drama,
and provide context. Stories get attention, but data
strengthens the power of stories. Most stories have
multiple audiences. Framing your story in a way that
varying audiences understand transmits important
knowledge and fosters identification with stark
realities. Storying telling is subject to several caveats.
With the advent of social media, sharing stories has
become easier, it also has created a medium for
false stories to grow exponentially (as they are often
salaciously framed). Second, be aware of people
and organizations that try to block stories, especially
when bad news happens. (p 320 book) As the most
trusted profession, nurses have a strategic position
opportunity to frame and share their narratives widely
with a variety of audiences at the little p to the Big P
to level as outlined below varying audiences and frame
stories using the following avenues. These strategies
are not static and can be adapted to the virtual world.
Garnering the support of colleagues, stakeholders and
the public can be accomplished with these strategies:
• Post digital content (social media)
• Disseminate facts and reports in print media
(fact sheets, policy briefs, articles, letters, press
• Disseminate research findings
• Engage key stakeholders
• Contact legislators about key issues on an
ongoing basis and when votes come up
• Speaking up at public meetings
• Presenting in public forums
• Model inspirational behaviors
• Participate in town hall meetings
• Meet with legislators and regulators
• Create elevator speeches
• Be social media savvy
Know your skills, capitalize on them.
Nurses have the skills to move beyond only being
implementers of policy and only on the sharp edge of
policies; we need to be the developers of policies. To
capitalize on the potential of four million nurses, all
nurses in any setting or role need to assess how their
skills can be applied to policy. This positions nurses to
enhance practice and the work environment as well as
advance issues of importance to nurses and the public
we serve. Policy work needs to become ingrained as
part of the culture of nursing. P. 470
Common and overlooked strategies to improve an
individual policy role would include the following which
you can act upon immediately :
• Register and vote
• Be a poll worker
• Join interest-based organizations and become an
• Finding a mentor
• Volunteer to work on a campaign.
• Serve on a workplace committee, task force or
• Attend networking events
• Participate in legislative days
• Contribute to candidates and political action
• Complete your profile for Nurses on Boards
• Seek local community board positions
• Communicate with elected officials
• Capitalize on workplace communication
channels for policy discussions
• Volunteering for an organizational or
The following are generally are longer term actions,
but can be done in the short-term as well depending
your policy trajectory:
• Assume a leadership role for a workplace
committee, task force or practice council
• Be a mentor
• Representing your organization to the external
• Seek an internship or fellowship with a legislator
or other policymaker
• Further your formal policy and content education
• Serve on a political action committee board
• Seek a board position
• Volunteer for appointed office
• Run for office in your organization or community
In times of uncertainty, there are certainties. One
certainty is the mandate for all nurses becoming
involved in policy. The American Nurses Association’s
Code of Ethics for Nurses’ (2015) supports nurses’ roles
in policy with the expectation that nurses advocate
for the health and safety of patients, collaborate in
the promotion of health, work to improve the ethical
environment of practice settings, and advance the
profession through nursing and health policy.
We have highlighted strategies that nurses should
use to increase their involvement in making policy
decisions to strengthen our practice and improve the
health of the public we serve. The collective action of
over four million nurses in our country and 21 million
nurses across the globe has the potential to be a
powerful force for policy change.
American Nurses Association. (2015). Code of Ethics
for Nurses with interpretive statements. Silver Spring,
MD: Author. https://www.nursingworld.org/practicepolicy/nursing-excellence/ethics/code-of-ethics-fornurses/
Page 18 • Nevada RNformation December 2020, January, February 2021
Nevada Nurses Foundation EST 2014
Rural & Frontier Nursing Scholarship Fundraiser
Join us on Friday, January 22nd and
Saturday, 23rd, 2021
2-day Virtual Conference Networking &
• Adolescent Mental Health
• Keeping the Patient with COVID-19 Safe
• Caring for the Patient who identifies with LGBTQ
• American Cannabis Nurses Association
• Opioid Abuse
• Holistic Nurses Association
The Rural & Frontier Nursing Scholarship is awarded
to a rural certified nursing assistant, licensed practical
nurse, or a registered nurse pursuing an advanced
nursing degree. For more information, please contact
us at email@example.com or 775-560-
Rural & Frontier Nurse Recipients
Important 2021 Nevada Nurses Foundation Dates:
2021 Rural & Frontier Nursing Symposium
January 22 and 23, 2021
2021 7th Annual Big Hat High Tea
March 27, 2021 (COVID-willing) at the NV Governor’s
2021 Grant Application
October 1, 2020 to February 1, 2021
2021 Scholarship Application
February 1-28, 2021
August 1-28, 2021
2022 Grant Application
October 2, 2021 to February 1, 2022
2021 6th Annual Shining Stars of Nursing Student
October 2, 2021 (student nurse conference)
2021 6th Annual Shining Stars of Nursing in Nevada
October 2, 2021 in Las Vegas, Nevada
2021 Tuesday Giving
November 30, 2021
In 2014, the Nevada Nurses Foundation (NNF)
gained federal recognition as a 501(c)(3), non-profit
organization. The mission is to increase access to
quality healthcare for Nevada citizens by promoting
the professional development of nursing through
scholarships, grants, and recognition.
The NNF started with an idea which lead to many
discussions, a lot of paperwork, collaboration, and a
healthy amount of time, money, and commitment.
Thank you to the initial NNF Board of Directors, Mrs.
Margaret Curley, Barbara Wardwell, and Calmoseptine
for believing in the NNF!
Photographed: The first Nevada Nurses Foundation
Board of Directors from left to right, Elizabeth Fildes
(Director), Denise Ogletree McGuinn (Vice President),
Sandy Olguin President), Betty Razor (Treasurer), and
Susan Growe (Secretary).
Nevada Nurses Foundation Values
• Integrity: the quality of being honest and having
strong moral principles.
• Collaboration: the action of working with others
to produce or create something.
• Quality: a distinctive degree of excellence; high
standard or condition.
• Stewardship: the action of being fiscally
The first scholarships were awarded in 2015 to the
• Doreen Begley; $1,000.00, NNF RN to BSN
• Annie Carlos; $1,000.00, Vroman & Wildes
• Linda Cirillo; $1,000.00, NNF Pre-lic Scholarship
• Amy Edelman; $1,000.00, Arthur L. Davis
• Robin Hollen; $1,000.00, Vroman & Wildes
• Heidi Johnston; $2,500.00, NNF Doctorate
• Maria Poggio D’Errico; $2,500.00. NNF Master’s
in Nursing Scholarship
• Delene Volkert; $1,048.00 Nevada Nurses
Association Legacy Scholarship
• Michael York; $500.00, NNF Pre-lic Scholarship
• Richard Young; $500.00, NNF Pre-lic Scholarship
2020 Nevada Nurses Foundation Board of
President/CEO: Dr. Sandy Olguin
Vice President: Rev. Dr. Denise Ogletree McGuinn
Chief Financial Officer: Nicki Aaker
Treasurer: Dr. Glenn Hagerstrom
Secretary: Karen Bearer
Director & Community Outreach: Dave Tyrell
Director & Community Outreach: Dr. Heidi Johnston
Photographed: Dave Tyrell, Sandy Olguin, Karen
Bearer, Denise Ogletree McGuinn, and Glenn
Hagerstrom. Missing Nicki Aaker and Heidi Johnston
Please join me in welcoming new NNF Advisory
Board members; Dr. Caren Jaggers, Dr. Sherri Lindsey,
and Lauren Parker!
Allyson Waldron, RN
Annette Clark, RN
McGilvrey, RN 2017
Register for Elko Symposium Here!
2020 Scholarship Recipients
• Nicole Cabrera-Heiring, BSN, RN, CLC;
$1,000.00, NNF Scholarship Recipient
• Anna Maria Holder, CCMA, BS, $1,000.00, NNF
• Yolanda Gardner, RN, ASN; $1,000.00, NNF
• Wendy Merchant, MSN-Ed, CNS, RN; $1,000.00,
NNF Doctorate Scholarship
• Casey Pruyt, CNA, AA; $1,000.00, NNF CNA-RN
• Masha Zelenin, RN; $1,000.00, 2020 Jessie J.
December 2020, January, February 2021 Nevada RNformation • Page 19
Nevada Nurses Foundation EST 2014
Page 20 • Nevada RNformation December 2020, January, February 2021
Nevada Nurses Foundation EST 2014
Congratulations Nevada Nurses Foundation scholarship recipients! Thank you
for pursing your education! We are so PROUD of YOU! Thank you to all of our
scholarship donors and Legacy Scholarship sponsors.
Thank you to the Nevada Nurses
Foundation Endowment sponsors for
establishing an endowed scholarship fund
and placing your trust in the Nevada Nurses
The following endowments have raised
• Karen Bearer; Frontline Heroes
• Erick Christopherson Endowed Legacy
• Margaret and Ian Curley Endowed
• Greg Peistrup Endowed Legacy
• Debra & John Scott Endowed Nursing
• Yvette Wintermute Legacy Scholarship
Debra Scott and Dr. John Scott
Margaret and Ian
Karen Bearer, sponsoring
To access electronic copies of the
Nevada RNformation, please visit
Threads of eNVy, a local Las Vegas business, has been very generous to the
Nevada Nurses Foundation. They created these amazing T-shirts as a way to give
back and support nurses in Nevada. The NNF receives proceeds from the sale of the
Support Local Heroes shirt.
Purchase your T-shirt at Threads of eNVy.
Follow, Like and share their Instagram page.
The Big Hat High Tea normally held at the Governor’s Mansion, was interrupted
by the COVID-19 pandemic where we moved our event from March to August 2020
and from in-person to virtual. Recognizing and honoring our scholarship and grant
recipients wasn’t the same this year, however, we celebrated everyone, listened to
amazing entertainers and had a wonderful time!
December 2020, January, February 2021 Nevada RNformation • Page 21
Nevada Nurses Foundation EST 2014
Thank you, Rev. Dr. Denise Ogletree McGuinn for
being the Mistress of Ceremonies from the comfort
of your home in Las Vegas. Thank you Karen Bearer
and Dr. Mary Bondmass for traveling from Las Vegas
to Reno to help with the virtual tea. Thank you for
presenting. Your valuable contributions prior to
and during the event went above and beyond my
expectations. Thank you, Nicki Aaker for presenting
and creating the souvenir program. You’re a hard
worker and a reliable team member. Thank you
Alyx Olguin, for volunteering and coordinating food
and beverages for everyone! Thank you, Dr Glenn.
Hagerstrom, for taking care of all the financial matters,
including raffle ticket sales and silent auction payments
all the way from Florida. Thank you, Lyle Pritchett, for
creating a wonderful online silent auction!
• 2019: Mary Poppins
• 2020: Crowns & Tiaras
2020 Shining Stars of Nursing Student Event
Saturday, October 3, 2020.
Chelsey Honrud (NVNSA secretary), Jessica
Rasamimanana (NVNSA So. Regional Director),
Iris Martinez (NVNSA President), Katie
Rutherford (No. Regional Director), and Karen
Nava (NVNSA Breakthrough to Nursing Director)
Karen Nava & Katie
Thank you to our wonderful Silent Auction Donors
and Winners!! Painting created and donated by Blair
Thank you to the Nevada Nurses Association
District 1 for sponsoring $500 toward the raffle prizes.
Congratulations to our raffle prize winners.
$500 Visa Gift Card: Jolinda Cabras Ramos
$300 Southwest Airline Voucher: Dr. Heidi Johnston
$200 Amazon Gift Card: Mitzi Husbands
Thank you to our NNF Big Hat High Tea Planning
Team and silent auction sponsors.
Iris Martinez & Katie Rutherford leading the 2020
Shining Stars Student Nurse Event.
Erika Manasewitsch, Shelby Pauletto,
Robert Branda, & Sean Lacsamana
Thank you, Darlene Salvo, NNF
Advisory Board member and NNF
Entertainment Director for directing
an amazing entertainment line-up.
Many thanks to Marsh Broeder, The
Fabulous Trio (Robert Branda, Erika
Manasewitsch, Shelby Pauletto),
Robert Miller, Darlene and Martin
Marsh Broeder Thank you, Kelly Farley, for your
wonderful silent auction pictures
and behind the scenes wizardry needed to run the
Zoom event. Your resilience, optimism and cleverness
are valuable attributes!
Every year, we change the theme of the Big Hat
High Tea. Let’s see if you can match the year with the
• 2015: Over the Rainbow
• 2016: My Fair Lady
• 2017: Mad Hatter
• 2018: The Wild West Tea
Mary Bondmass and Lauren Park
CCSD, SOUTHWEST CAREER
& TECH HIGH SCHOOL
seeking full-time CNA Instructor
Must be a licensed nurse.
Contact Donna Levy, Principal
Page 22 • Nevada RNformation December 2020, January, February 2021
Nevada Nurses Foundation EST 2014
2020 People’s Choice Director of Nursing
Congratulations, Tracey McCollum, Carson Tahoe
Health’s Shining Stars of Nursing in Nevada 2020
People’s Choice DON! You’re amazing!
Tracey McCollum, MSN, RN, CENP, NEA-BC has just
been appointed to be a Board Member on the Nevada
State Board of Nursing! Congratulations, Tracey!
Tracey was joined by her Carson Tahoe Health
Family! Cassidy Jost, Danielle Dare, Joanne Miller, Kim
Kammann, Megan Martinez, Janelle Martin, Maria
Freed, Jim Freed, and Dee Tison!
Beth and Darren Melton
Doris Bauer, 2020 Distinguished Nurse Leader
with Lifetime Achievement
Looking for Exceptional Nurses...
Northern Nevada Medical Center offers progressive employee
programs including a culture of Service Excellence that honors
outstanding employee efforts at every level. We provide a generous
benefits/compensation package, 401K and tuition reimbursement.
You’ll enjoy the innovative approaches to personalized health care
in our 124-bed acute care hospital located on a scenic hillside over
looking the Truckee Meadows in Sparks, NV.
For more information, please call Leah Webb at
775-356-4085 or visit www.nnmc.com/careers.
2375 E. Prater Way,
Sparks, NV 89434
December 2020, January, February 2021 Nevada RNformation • Page 23
Nevada Nurses Foundation EST 2014
SAVE THE DATE: Shining Stars of Nursing in Nevada
in LAS VEGAS, NV on Saturday, October 2nd, 2021!
There are many foundations and organizations
competing for your funds and on behalf of the Nevada
Nurses Foundation, we appreciate your past and future
support and charitable donations.
Thank you and have great days,
Previous Big Hat High Tea themes include My Fair
Lady (2015), Mary Poppins (2016), Mad Hatter (2017),
Over the Rainbow (2018), and Crowns and Tiaras
(2019), and The Wild West Tea on the Comstock.
Legal Representation for
If the board calls, we have the answer!
Our attorneys have been protecting the livelihood of
doctors and nurses in Nevada for over 40 years.
Clark Hill is a multidisciplinary, national law firm that
draws on our attorneys’ industry and policy knowledge,
our deeply held shared values, and a global network of
premier firms and advisors to provide innovative legal
solutions and client-service excellence worldwide.
Contact John A. Hunt, Esq.
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