Oklahoma Nurse - February 2021





The Official Publication of the Oklahoma Nurses Association

Quarterly publication delivered to approximately 64,000 Registered Nurses and LPNs in Oklahoma

Volume 66 • Number 1

February 2021


Shelly Wells, PhD, MBA, APRN-CNS, ANEF

ONA President

As we look back at

2020, we cannot help but

reflect on the reality of the

International Year of the

Nurse and Midwife. The year

was designated to honor the

200th birthday of Florence

Nightingale and to bring focus

on the need to increase the

global professional nursing

workforce. In reality, our Year

of the Nurse more accurately Shelly Wells

reflected a 4H year – a year of

History, Heartbreak, Heroes and Hope. The year 2020

started with the knowledge that Nurses once again

topped the Gallup list of the most honest and trusted

profession in America. This was the 18th consecutive

year to be awarded the honor! Our patients, families

and public knew that they could trust nurses to

advocate for them. They knew nurses stood up for our

patients to advocate for the conditions that support

justice, health and dignity for everyone. This feeling of

reinvigorated pride in our profession was firmly tested

less than 90 days into the year.

In March 2020, the eyes of the public were on our

profession in a way we never could have dreamed.

We were thrust into the spotlight as the COVID-19

pandemic took hold, and the irreplaceable work of

nurses was highly visible for everyone to see. We

persevered in light of not having full understanding of

the invisible assault on our patients, their families, our

profession and ourselves. Nursing did what nursing

does best – we fought to provide the best care and

treatment we could for everyone – even at great cost

to ourselves. We witnessed an increasing physical

and emotional toll on our nurses as the COVID-19

pandemic unfolded, but we never quit. Fighting

through a shortage of personal protective equipment,

supporting patient care staff and proven therapies for

treating the infection, we understood our obligation to

the public. At great personal risk, nurses continued to

advocate for all in spite of the heartbreak we witnessed

as we cared for, and comforted, critically ill patients

and their families, all while dressed in plastic gowns,

vinyl gloves, eye goggles and a face mask that we may

have been wearing much longer than we thought it

was effective.

Members of our communities recognized the work

we were doing as irreplaceable. Soon, across social

media and newspapers throughout the state, nurses

were being hailed as heroes. Nurses, acutely aware

of the risks to themselves, continued to volunteer to

work with infected patients in acute care and longterm

care facilities. Many isolated themselves from

their own children and other family members to care

for COVID-19 patients. Everyone knew nurses were

at the bedside caring for their loved ones 24 hours a

day. Nurses who usually served in other roles stepped

up to meet the ongoing need to comfort, educate and

advocate for the public who were under the continuing

assault of the COVID-19 virus. Nurse executives

and nurse educators came together to develop

strategies to support our colleagues at the bedside.

Nurses advocated for common-sense public health

measures in their communities to help control the

viral spread. Many found their voices when attending

both in-person and virtual city council meetings and

presenting the science, often being jeered by others.

Nurses appeared in television news and social media

President’s Message continued on page 2

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN



President’s Message. ................ 1

RN2Leader ........................ 3

CEO Report. ....................... 4

Educators Corner ................... 6

ONA Statement on COVID-19 Vaccination. 6

Three Lessons Learned During the

COVID Crisis. ...................... 7

Professional Clarity 2020: Motivational

Andragogy through Shared Student

Experiences. ....................... 9

The Value of Grit and Resilience. ...... 10

Emerging Nurses. .................. 11

Nurse Refresher Course ............. 13

Nursing Policy. .................... 14


The Oklahoma Nurse February, March, April 2021

Oklahoma Nurses Association Regions and Regional Presidents

Oklahoma Nurses Association

Region 1:

President: Lucas Richardson-


Region 2:

President: Donna Fesler

Region 3:

President: Leslie Davis

Region 4:

Representative: Leslie Collins

Region 5:

President: Nakeda Hall

Region 6:

President: Viki Saidleman

Contact information available at www.oklahomanurses.org

Editor: ona@oklahomanurses.org


President – Shelly Wells, PhD, MBA, APRN-CNS, ANEF

President-Elect - Angie Kamermayer, DNP, APRN-CNS, NEA-BC

Vice President – Angela Martindale, PhD, RN

Secretary/Treasurer – Amber Garretson MSN, APRN-CNS, CCRN

Membership Development Director – Amy Hutchens, PhD, RN

Education Director – Vanessa Wright, PhD, MSN, RN

Practice Director – Michele Bradshaw, BSN, RN

Political Activities Director – Megan Jester, MS, RN

Emerging Nurse Director – Tina Edwards, MBA, MSN, RN

Region 1 President – Lucas Richardson-Walker, BSN, RN

Region 2 President – Donna Fesler

Region 3 President – Leslie Davis, MSN, RN

Region 4 Representative - Leslie Collins, DNP, MSN, RN

Region 5 President – Nakeda Hall, DNP, APRN-CNP

Region 6 President – Viki Saidleman, RN

ONSA Consultant – Dr. Dean Prentice, Colonel (Retired),



Jane Nelson, CAE — CEO

Andrea Starmer — Director of Events and Education

Amber Feldpausch — Event Planner

Taylor Dempsey - Director of Communications

President’s Message continued from page 1

coverage describing the current situations in the area’s

hospitals and expressing concerns about the need to

not overwhelm the health care system. Some served

on expert panels with other health care providers

to offer consultation to leaders in government.

Most served as role models in their communities –

masking up when in public and teaching our friends

and families about the need to stay safe and vigilant

against the virus spread.

As the door hit the year 2020 in the tail-end, we

felt hopeful, even with the increasing numbers of

infected in our care facilities. With the approval and

distribution of the COVID-19 vaccines, we are hopeful

that our communities will begin to see a downturn in

the number of active infections, the number of those

requiring virus-related hospitalization, the occurrence

of terrible long-term effects and a decrease in the

number of our friends, families, colleagues and

community members who ultimately die related to

the virus. Pictures of nurses receiving the vaccine and

their experiences with the vaccine are noted through

social media and television coverage in an effort to

promote its acceptance. Nursing is now celebrating

its 19th year at the top of the Gallup list as the most

honest and trusted profession in America. With this

spark of hope is the need for nurses to continue

to be strong advocates for illness prevention and

educate others regarding the rapidly unfolding science

surrounding the spread, treatment and prevention of

the infection. We must continue to stand up for those

without a voice in the middle of this pandemic. We

must continue to combat the untruths that continue

to interfere with effective control, mitigation and

prevention. We must continue to use our voices and

skills to promote health for all in a time of uncertainty.

I look forward to a healthier 2021 and thank each

of you for your dedication to your patients and their

families, your communities, and the profession of


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Oklahoma Nurses Association

6608 N Western, #627, Oklahoma City, OK 73116



The subscription rate is $20 per year.

THE OKLAHOMA NURSE (0030-1787), is published

quarterly every February, May, August and November by

the Oklahoma Nurses Association (a constituent member

of the American Nurses Association) and Arthur L. Davis

Publishing Agency, Inc. All rights reserved by copyright.

Views expressed herein are not necessarily those of

Oklahoma Nurses Association.


International Nursing Index and Cumulative Index to Nursing

and Allied Health Literature.

Copies of articles from this publication are available from the UMI

Article Clearinghouse. Mail requests to: University Microfilms

International, 300 N. Zeeb Road, Ann Arbor, MI 48106.


For advertising rates and information, please contact Arthur

L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls,

Iowa 50613, (800) 626-4081, sales@aldpub.com. ONA and

the Arthur L. Davis Publishing Agency, Inc. reserve the right

to reject any advertisement. Responsibility for errors in

advertising is limited to corrections in the next issue or refund

of price of advertisement.

Acceptance of advertising does not imply endorsement or

approval by the Oklahoma Nurses Association of products

advertised, the advertisers, or the claims made. Rejection

of an advertisement does not imply a product offered for

advertising is without merit, or that the manufacturer lacks

integrity, or that this association disapproves of the product

or its use. ONA and the Arthur L. Davis Publishing Agency,

Inc. shall not be held liable for any consequences resulting

from purchase or use of an advertiser’s product. Articles

appearing in this publication express the opinions of the

authors; they do not necessarily reflect views of the staff,

board, or membership of ONA or those of the national or

local associations.


Phone: 405.840.3476

E-mail: ona@oklahomanurses.org

Web site: www.oklahomanurses.org

Mail: 6608 N Western, #627, Oklahoma City, OK 73116

Questions about your nursing license?

Contact the Oklahoma Board of Nursing at 405.962.1800.

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Contact Arthur L. Davis Publishing Agency, Inc.

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ONA believes that organizations are value driven

and therefore has adopted the following core values:

• Diversity

• Safe Quality Care

• Ethical Care

• Health Parity

• Integrity and Accountability

• Practice Competence

• Professional Development

• Educational Advancement


The Mission of the Oklahoma Nurses Association is to empower

nurses to improve health care in all specialties and practice

settings by working as a community of professional nurses.


Creating opportunities through advocacy, education and

collaboration to become the leading voice for the nursing

profession in the State of Oklahoma.


Engaging Nurses to make a difference!

February, March, April 2021 The Oklahoma Nurse 3


Does it Matter?

Dr. Dean L. Prentice, Colonel (Ret), USAF, NC,


Welcome to the New Year!

I think we can say we hope

2021 is going to be a better

year. Much has transpired

during 2020. In all that we

have lived through, there is

hope for the upcoming year.

The important question is,

does it matter?

We have seen the

profession of nursing

highlighted over and over

Dr. Dean Prentice

again this past year for the

work nurses have accomplished. The pandemic has

brought to the forefront just how powerful nurses

are when included on the healthcare team. For all

our concerns over being recognized as valuable,

this past year we have truly proven our worth to the

nation and the world.

Through it all, nurses have done really well to lead

the charge. Much like our first responder colleagues,

nurses didn’t exit healthcare when the disaster hit.

They ran into danger and went to work. They jumped

in front of the runaway bus and saved countless lives

with their nursing action and care. Evidence-based

practice, safety and compassion were offered to all.

Exhausted and overwhelmed at times, nurses

continued the fight. For equity in care, for education

and for preventive care. We took to airwaves, print

and social media to get out the message. Valued

and respected for their knowledge and reputation,

nurses were listened to in many communities as

voices of calm, patience and healing. And there is

more to do in the future.

Our battle with this pandemic is not over. And

what will be the next issue we face? From my

many years in nursing and healthcare, it has never

been more important for nurses and nurse leaders

to continue our push to be heard for the benefit of

our patients and communities. We must though, do

it correctly. Nurses should NOT be the pawns of

politics, bias or agendas for others that wish to use

our hard-earned identification as the “most honest

and ethical professions” for the past 19 years. We

need to protect this most precious reputation.

So what does our New Year hold? Is our diversity

going to make us stronger? Can we continue our

legacy of compassionate care? I look forward to

2021 in all its glory and trials! We are nurses and we

can weather any storm sent our way. Oh, we may

get weary and frustrated. We may cry and we may

just celebrate. However, we are nurses. We hold the

hand and celebrate with the new mother and we

hold the hand of the cherished dying father. There is

nothing we cannot face…if we do it together.

Does it matter? You decide for yourself. I

say, we march into 2021 with a renewed spirit of

commitment to our patients, our profession and our

communities. We stand in that gap and our world

needs us. For me…bring it 2021…I got you!

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The Oklahoma Nurse February, March, April 2021


Inhaling…Building Momentum

Jane Nelson, CAE

CEO Oklahoma Nurses


“Make the most of yourself

by fanning the tiny, inner

sparks of possibility into

flames of achievement.”

- Golda Meir

2020 has been a rough

year, and it looks as if 2021 Jane Nelson

is off to a rocky start. There

seems to be some light with the release of the

COVID vaccine, but time will tell. We need to take

these tiny sparks and fan them into achievements for

nursing. I love this quote by Golda Meir as it requires

us to take what is within us and build something in

return of which we can be proud. This also means

that we need to be strong so how we respond to

2021 is up to each of us. Part of this includes our

ability to breath, inhale and exhale.

I recently listened to Brene’ Brown’s Unlocking

Us podcast on Strong Backs, Soft Fronts and Wild

Hearts. While the podcast is focused on having

a strong back and a soft front, what was more

profound to me was the essentialness of inhaling.

We can exhale all day long but at some point, we

need to inhale. If we don’t inhale, we can’t continue

to exhale and if we don’t inhale, we can’t brave

the wilderness! So, as we walk forward into 2021,

we need to inhale! My sense is that we all need to

remember to be inhaling as we have spent most of

2020 exhaling. So let’s practice it right now. Take a

deep breath…Inhale…now slowing release the air to

exhale. Feel how you are rebuilding your body, your

soul and your emotions. Remember that sensation!

Don’t let it go.

Now let’s talk about moving into 2021! ONA is

continuing its work to advocate for nurses with both

the Governor’s office and the Legislature. We know

you need more staff, that patients both COVID and

non-COVID continue to need care in hospitals, long

term care and clinics. ONA has worked to develop

tools for you to use that include COVID Resources

including ones on the vaccine, along with position

statements specifically on the COVID Vaccine

(included in this paper), and Moral Distress in

Times of Crisis. We continue to work on our nursing

shortage and its effects on nurse staffing during

this pandemic. ONA has been convening nurse

leaders from acute care and nursing education

to discuss ways to build Academic and Clinical

partnerships. The result of this partnership work

includes sharing and replication of a model across

the state, utilizing nursing students in clinical sites

to not only work as techs but also work during their

clinical experiences and be paid for that experience.

Other sharing opportunities include job descriptions

and other innovations to extend the arms of the

ICU/CC nurse. The Nurse Refresher Course was

also updated in a timely manner as a result of this

partnership. As we worked to discuss mutual issues,

it became abundantly clear that we need help from

the Governor, so ONA sent a letter addressing our

concerns, work and suggesting solutions. After an

initial conversation and a media event, we have been

in continued conversation with the Governor’s Team

on solutions to our overflowing hospitals and the

need for more nurses.

The State Legislature begins meeting the first

Monday in February. We are working to ensure that

they hear nursing voices as well. We need your help

to ensure that Legislators hear your voice. There are

issues we know that are coming forward that include

Managed Care, Immunizations, funding for Nursing

Education and other issues that may affect patient

care and the nursing profession. ONA’s legislative

priorities for 2021 are listed below and reflect these


Nursing Practice and Workforce

Nursing is vital to the survival of a quality

health care system. Competent nursing

practice improves the health, safety and state

health rankings for all Oklahomans.

Promoting the role of the nurse and the

profession of nursing to ensure the best health

for all Oklahomans.

Consistently ensuring adequate numbers of

nurses to care for patients in hospitals, long

term care and other healthcare settings is of

critical importance in alleviating our longterm

nursing shortage. Nursing education is

a critical component in the development of

Oklahoma’s nursing workforce.

Providing sufficient quality care to

Oklahomans year-round, ensuring enough

nurses to provide testing, immunizations

and quality care needed during a Pandemic

is of vital importance to both the short-term

and long-term health and well-being of all


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February, March, April 2021 The Oklahoma Nurse 5

nurses will remain healthy and able to practice

in caring for all Oklahomans.

Quality health care is supported when ALL

licensed Nursing professionals are able to

practice at the full extent of their education

and role.

Improving Oklahomans Health Status

A healthy Oklahoman is a productive


Promote the use of evolving scientific and

evidence-based data driven solutions to

provide access to health care for the wellbeing

of all Oklahomans.

Advocate for the use of vaccines and

social behaviors to mitigate the spread of

communicable diseases.


Adequate funding for vital health care

related services, including direct care, illness

prevention and nursing education is critical to

improving Oklahomans health outcomes.

Oppose privatization of state health related

agencies and health services. Privatization

increases costs, destroys healthcare

infrastructure, safe staffing and competent

care, while reducing overall access to health

care. Shifting public dollars to support private

companies and insurers will endanger the

health and well-being of all Oklahomans, while

increasing costs to taxpayers.

Creating shortfalls in funding for health and

behavioral health services will increase

costs in other areas of the state’s budget,

and will lead to dire negative consequences

for individuals, families and communities,

placing all at risk. When funding falls below

critical levels, every other health priority

for Oklahomans and nurses is negatively

impacted. Nursing is one of the few

professions in Oklahoma providing care to our

citizens from conception to grave.


Preserving the Board of Nursing’s oversight

and regulation of nursing practice. Nursing

is the largest group of healthcare providers

including LPN, RN and APRN, each one

with its own unique scope of practice. The

Oklahoma Board of Nursing is already

a consolidated licensure and regulatory

entity governing nursing practice. Ensuring

professional nursing oversight of this board

provides for the critical health and safety

of the public. This self-sustaining, nonappropriated

Board contributes revenue to the

state general fund while providing for efficient,

focused regulation of the nursing profession.

Working with the Executive and Legislative

branches, along with state agencies, to

address nursing workforce issues.

Legislators need to hear from nurses on the

importance of all these issues. ONA works to keep

members up to date on these issues with talking

points and legislative alerts so that we can all speak

with one voice on these very complicated issues.

So what does this all mean? It means being aware

of current legislation affecting the nursing profession

and your patients.

We have ways for you to get involved, some

of which looks different this year. Typically, ONA

supports the Nurse of the Day program that allows

nurses to go to the Capitol and speak to legislators

one-on-one about issues that are important to you

and nurses throughout Oklahoma. However, we

are still working to ensure that this is run in a safe

manner. So please watch for details on social media,

email and ONA’s website www.oklahomanurses.org.

Another way to get involved is attending Nurses

Day at the Capitol on March 2. This event will be

held virtually (more information is available on the

ONA website), and it means sending emails or

making phone calls to your legislators.

So remember, to inhale before exhaling, and

keep your voice raised as we work to make 2021

better than 2020. Let’s all strive to make the most

of our voices by fanning those tiny inner sparks into



The Oklahoma Nurse February, March, April 2021



Time to Plant

Do plants/flowers flourish because we talk to them or because by talking to

our plants we become aligned in the goal of improvement? As educators, we

plant seeds daily. So just like when planting, we must take better care of the

things we want to flourish when teaching. How? One way is to reach out and

tell our real-life stories as nurses. Applicable Occupational Reflection is a great


Dr. Linda Cook has been blogging for a few years to nurses and nursing

students. It is my privilege to begin sharing some of her blogs as a perfect

example of reaching out, reflecting on practice and telling our stories:

To Nursing Students

Because you chose to be a nurse:

You will spend intense years of preparation.

You will work long shifts short-handed.

You will have neighbors at your door asking if you will, “just take a look at this rash.”

You will be the person in the family whose opinion is sought for everything from

bunions to Alzheimer’s, regardless of your area of specialization.

Your children will be ones who don’t go to the Emergency Room unless a bone is


You will end the occasional shift with an empty stomach and a full bladder.

You will find humor in many things that most people find disgusting.

You will eat breakfast twice a day when working night shift.

You will discover that nursing is sometimes hard, scary, sad and stressful.

But you will also discover that:

Patients may forget your name but always remember the way you made them feel.

Balloons made from latex gloves can stop a toddler’s


A smile from a difficult patient makes a difficult shift


Wearing pajamas (AKA scrubs) to work every day can be


You’ve developed the patience of a saint and a heart so

big that you can see the fear in an angry patient’s eyes.

You really do save lives and, deep in your heart, you know

that you could never do anything else.

Linda Cook, PhD, RN, PMHCNS, CNE, is a Full

Professor and Associate Dean of Kramer School of

Nursing at Oklahoma City University.

Marla Peixotto-Smith, MSN, PhD, RN, CNE, is an

Associate Professor & Coordinator of the RN2BSN

Program at Rogers State University. Marla invites you to

contribute to the “Educators Corner.” Please send your

thoughts, experiences, or strategies to marlasmith@rsu.


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ONA Statement on COVID-19


Nurses have worked selflessly to care for others during

the COVID-19 Pandemic. Now they have the opportunity

to protect themselves and others by getting immunized

against this new virus. Nurses and other healthcare

workers have been selected to be among the first to be

vaccinated because of their contact with patients and

their potential for infection.

To be effective, the COVID-19 vaccine must be

received by a large percentage of the adult population, and

nurses who serve as frontline caregivers and make informed

choices to be vaccinated serve as role models and trusted patient educators.

Indeed, nurses’ decisions to be vaccinated against COVID-19 can help

to shorten the duration of the pandemic while protecting the public from

community spread. Ultimately, widespread effective vaccination will reduce the

burden of this disease on acute and critical care units. If a vaccine allows more

nurses to stay healthy, then there will be more support for patient care and

clinical colleagues.

As of December, 21, 2020, the Oklahoma Nurses Association has joined

with the American Nurses Association (ANA) and other nursing organizations

such as the American Association of Critical-Care Nurses (AACN) to strongly

recommend that nurses be vaccinated against COVID-19.

This decision is ultimately up to each individual. We encourage nurses to use

trusted knowledge, ethical frameworks and current science-based resources as

the foundation for their decisionmaking. ONA and ANA believe that there should

be no retaliation against nurses who choose not to take a COVID-19 vaccine.

Nurses, as trusted health care professionals, have a critical role to play in

administering COVID Vaccines to Oklahomans. COVID-19 vaccines can be

safely administered by nurses and nursing students under the supervision of

faculty or other appropriate licensed practitioners.

Our knowledge about COVID-19 and related vaccines is continuously

evolving. (See attached COVID-19 Vaccine Facts.) ONA and ANA will share

information from reliable sources as we advance our understanding on this

topic. Nurses, the most trusted profession, must scrutinize all sources of

information, decline to accept misinformation and disseminate only accurate

information from credible scientific sources.

Recommended Resources:

Oklahoma Vaccine Plan https://oklahoma.gov/covid19/vaccineinformation.html

• Centers for Disease Control and Prevention: Vaccine Recommendations

and Guidelines of the ACIP

• CDC COVID-19 Vaccination Communication Toolkit for medical centers,

clinics, and clinicians

• CMS COVID-19 Provider Toolkit


• U.S. Food and Drug Administration: COVID-19 Vaccines

• Summary infographic of vaccine types from CHEST

• ANA webpage on COVID-19 Vaccines

• ANA webinar and video on COVID-19 Vaccines

• AACN blog on vaccines: "What's Up With the COVID-19 Vaccine?"

• AACN’s position statement: "Science Must Drive Clinical Practice and

Public Health Policy”

• AACN’s blog on how to sort through online information: "Going Viral:

COVID-19 and the Internet"

COVID-19 Vaccine Facts:

• Current vaccines have been FDA approved for Emergency Use

Authorization following three phases of testing on thousands of people.

• The CDC’s Advisory Committee on Immunization Practices recommends

that healthcare personnel be among those offered the first doses of

COVID-19 vaccines.

• The Oklahoma State Department of Health has approved current

COVID-19 vaccines for distribution in Oklahoma with healthcare workers

among the first to be given the opportunity to be vaccinated.

• Both approved COVID-19 vaccines are mRNA vaccines, like the measles

vaccine. These mRNA vaccines protect against infectious diseases

by instructing our cells how to make a protein — or just a piece of a

protein — that triggers an immune response inside our bodies. That

immune response produces antibodies that protect us from acquiring

infection when exposed to the actual virus. COVID-19 mRNA vaccines

give instructions for our cells to make a harmless piece of what is called

the “spike protein.” The spike protein is found on the surface of the virus

that causes COVID-19. Our immune systems recognize that the protein

doesn’t belong there and begin building an immune response and making

antibodies, like what happens in natural infection against COVID-19.

• The vaccine is a two-part vaccine, requiring that you get two doses to

assure immunity. For the Pfizer vaccine the doses are 21 days apart. For

the Moderna vaccine, the doses are 28 days apart.

• The vaccine is 95% effective for all adults, based upon the clinical trials.

• Few side effects were reported, but included fever, headache and fatigue.

• Please continue to follow all transmission-based protocols even after

being fully vaccinated.

February, March, April 2021 The Oklahoma Nurse 7

Three Lessons Learned During the COVID Crisis – As a Family

Member, A Caregiver and the Importance of the 3 C’s

Viki Saidleman, MS, RN

#1: Lessons Learned as a Family Member During

a COVID Crisis

When COVID is in the Room….

Nurse is eyes and ears

For so concerned family,

Providing lifeline

Of true compassion

When family not allowed.


#2: Lessons Learned as a Caregiver

Finally home after a 10-day hospital stay for

COVID-19 complications, my husband announced

his emergency. He could not find his cell phone.

Then, the search began. I immediately lapsed into

nurse mode. I interviewed him regarding the phone’s

last known location. I inspected the immediate

surrounding environment. I listened carefully for

possible sounds emitted by the phone. I palpated

around his body in the recliner to find the phone. I

knelt down to look more closely under his chair.

I looked up from my position on the floor as

he looked down from his seat in his chair. I was

prepared to declare the search a failure and the

phone permanently missing. Then I spotted it.

I used one hand to rest upon my husband’s

arm as I used my other hand to point to the phone

resting in his shirt pocket. I looked at him with

a victorious smile as he gazed at me with an

appreciative, gentle grin and slight nod.

In that moment, we really connected. We found

not only the phone, but much more. In the midst of

the pandemic, we found each other. We effectively

communicated care and compassion for one

another without uttering a word. The search was


In the frantic frenzy of my search for the

phone, I failed to truly take in the whole picture. I

orchestrated a near miss. I lost sight of not only the

phone but I also lost sight of my husband. He and

the phone were inches from me, but I was totally

oblivious and unaware.

While seeking the lessons learned during the

search, I asked myself some pointed questions.

How often do I during a task-focused day cause

near misses? How often am I so busy that I fail to

really see my family, my student, my patient and my

colleague? How often do I teach the importance of

the unique individual and preach patient centered

care, but how often do I actually practice these

concepts? Do I really take time to effectively

communicate care and compassion?

As a result of a successful search, I have begun

my next quest to achieve new future personal goals

for 2021. These goals are particularly appropriate

for a COVID crisis and apply to relationships with

family, students, patients and colleagues. I vow to

be more mindful in my interactions, more committed

to my search for the unique individual, more fixed

upon person-centered care and more attuned to my

mission to truly communicate care and compassion.

#3: Lessons Learned On the Importance of the

3 Cs during a COVID Crisis

As a nurse who has practiced 40 years with 30

years in nursing education, I have committed to lifelong

learning. With the evolving COVID pandemic,

I have discovered new lessons applicable to my

roles as nurse, patient, family member and nurse

educator. My personal experience confirms the

current increased importance of three key nursing

concepts. The 3 Cs are caring, compassion and

effective communication.

Although often difficult to describe, a challenge to

teach and even harder to develop and practice, it is

easy to detect when the 3 Cs are present.

As a nurse, I see the appreciation and relaxation

in a patient’s body language when I show caring,

compassion and effective communication. I

take the time to sit, be mindfully present, listen,

therapeutically communicate and use appropriate

touch all while social distancing, masking and using

appropriate hygiene. I see the difference.

As a patient, I feel the 3 Cs when my oncology

team takes the time in their busy day to return my

calls and answer my many questions, listen to my

story, empathize with my side effects and offer

possible solutions in a respectful manner.

As a family member of a parent in long-term care

during the pandemic, I detect 3 Cs when staff set

up window visits and Face-Time visits and relay

cards and messages for me. I appreciate when the

3 Cs are shown to me when hospice staff offer and

deliver lost glasses to my home after my mother’s

death because it was important to me even when it

was an extra 20 mile trip for them.

As a family member of a spouse hospitalized

during the pandemic when no visitors were allowed,

I sense the 3 Cs during unhurried phone updates

even though they occur without benefit of facial

expressions, body posture, gestures or touch. They

include the conscious effort of positive words of

hope, careful timing, appropriate tone and a perfect

use of silence. I feel care when staff call me and

hold the phone for my husband so we can visit for a

few moments. I experience care when staff ask how

I am doing, too.

As a nurse educator, I can detect students’

frustration and their anxiety learning in a totally

different environment, in preparing to enter practice

during a pandemic and in fearing if they will be

fully prepared with virtual learning and clinical

experiences. When I begin a 3 C conversation

addressing their possible feelings, I can hear

and almost palpate their sigh of relief as they

receive acceptance and acknowledgement of their

experiences and begin to verbalize them.

During this current COVID climate, multiple

barriers may block the 3 Cs. When patient census

is high and acuity heavy, when staffing is often suboptimal,

when competing priorities tax available

resources, when masks, social distancing and

isolation are present, when visitors may not be

allowed and when an even more stressful than usual

health care environment exists, the 3 Cs may take a

back seat.

I choose to identify strategies to maintain,

develop and improve the 3 Cs of caring, compassion

and effective communication during a pandemic.

As a nurse, I will mindfully plan for the 3 Cs

by practicing smiling while sporting my personal

protective equipment, by providing adequate time

to communicate with both patient and family and

by finding opportunities to facilitate communication

virtually if possible.

As a patient and family member, I will thank

health care providers in person, by written notes

and in hospital surveys as I cite specific positive

experienced examples of the 3 Cs. I will verbally

relate what those caring behaviors and acts of

compassion mean to my family member and to me.

As a nurse educator, I will provide adequate time

to address affective learning outcomes that address

key soft skills. I will use personal stories, case

studies, simulations, role-play and critical thinking

in the classroom to develop and practice the 3 Cs.

I will select reflection and discussion activities for

clinical conferences to improve the 3 Cs. I will role

model the 3 Cs in my interactions with students,

Three Lessons Learned During the COVID...continued on page 13


The Oklahoma Nurse February, March, April 2021

Three risk areas nurses face in the time of COVID-19

Georgia Reiner, MS, Senior Risk Specialist,

Nurses Service Organization (NSO)

The spread of the coronavirus (COVID-19)

reinforces the dedication and selflessness of nursing

professionals. This is a scary and uncertain time

for everyone, especially nurses on the frontlines

working tirelessly to help curb the spread of

COVID-19 and balancing an influx of patients.

As nursing professionals work to provide the

best care possible to their patients during a difficult

time, they need to know the steps to take to mitigate

the risks that can impact their license, career and


Three risk areas nurses need to have on their

radar include:

Using social media best practices

Nurses are held to a higher standard than others

because of their role as caretakers and because

they have intimate access to patients’ private

information. Their social media presence should

reflect this heightened responsibility, especially in

this uncertain time. Nurses must carefully consider

a patients right to privacy and act professionally

before posting.

As the media and social media are consumed

by COVID-19 news, nurses may want to join in

and share their thoughts or may be tempted to air

their grievances. Online comments, or comments

to members of the media by a nurse regarding

employers or co-workers, even if posted from home

during nonwork hours, may violate their employer’s

social media or media relations policies. Violations

of employer policies may lead to employment

consequences for the nurse, including termination.

Nurses may want to think twice before posting or

otherwise giving the appearance they are speaking

on behalf of his or her employer unless authorized

to do so and must follow all applicable employer


Preventing medication errors

Nurses must continue to work to catch their own

potential medication errors, as well as the errors

of other healthcare providers in the medication

administration chain. Research has found that the

medication errors result from human factors, including

inadequate communication, biased reasoning,

reduced memory and insufficient training and

inexperience. 1-5 Nurses also identify distractions and

fatigue as contributing to medication errors - which are

factors that the COVID-19 crisis can exacerbate. 2

Since the beginning of April 2020, the Institute

for Safe Medication Practices (ISMP) has received

reports of COVID-19-related medication errors. 6

One error involved a redeployed OR nurse who

administered the wrong type of inhaler after

failing to engage unfamiliar barcode medication

administration technology. 6 Other missed dose

errors have been reported due to communication

failures between nurses and respiratory therapists. 6

To prevent medication errors and other adverse

outcomes, nurses pulled to an unfamiliar unit should

be oriented to the patient population, technologies,

processes and medications typically used on the

newly assigned unit. 6 Nurses should also employ

communication techniques such as a doublecheck/“check

back” to verify they understand all

verbal orders and instructions. 7

Preparing to accept unfamiliar assignments

Nurses are at the forefront of this public health

crisis—treating, educating and preventing the spread

of COVID-19. As the pandemic continues to evolve,

nurses may be given patient assignments outside of

their accustomed practice areas and locations. No

circumstances change nurses’ obligation practice

ethically, but nurses should be aware of their

employers’ protocols for protecting nurses operating

in extreme conditions and scarcities, and to ensure

that the public receives the most adequate treatment

and care possible in the situation.

With so much still unknown about the

coronavirus, it’s also important for nurses to be

aware of the steps they can take if they do not

feel equipped to handle an assignment. When the

assignment is within a nurse’s scope of practice

but not within their realm of experience or training,

saying “no” could lead to dismissal. In these

scenarios, nurses need to share their concerns

with his or her supervisor. Nurses should describe

the task or assignment they don’t feel equipped

to handle, the reason for their feelings, and the

training they would need to be more confident and

better prepared. Speaking up can lead to positive

outcomes for nurses and patients.

These are trying times for healthcare workers.

Being aware of potential risks helps nurses take

steps to protect themselves as they care for others.


1. The Joint Commission. Sentinel event data: root

causes by event type 2004-2012. 2012.

2. Choo J, Hutchinson A, Bucknall T. Nurses’ role in

medication safety. J Nurs Manag. 2010;18(7):853-


3. Brady AM, Malone AM, Fleming S. A literature review

of the individual and systems factors that contribute

to medication errors in nursing practice. J Nurs

Manag. 2009;17(6):679-697.

4. Benner P, Sheets V, Uris P, Malloch K, Schwed K,

Jamison D. Individual, practice, and system causes

of errors in nursing: a taxonomy. J Nurs Adm.


5. Saintsing D, Gibson LM, Pennington AW. The novice

nurse and clinical decision-making: how to avoid

errors. J Nurs Manag. 2011;19(3):354-359.

6. Institute for Safe Medication Practices. COVID-19-

Related Medication Errors. 14 May 2020. Retrieved

from: https://www.ismp.org/resources/covid-19-


7. Agency for Healthcare Research and Quality. Pocket

Guide: TeamSTEPPS. Content last reviewed January

2020. https://www.ahrq.gov/teamstepps/instructor/


Georgia Reiner, MS, Senior Risk Specialist,

Nurses Service Organization, Healthcare Division,

Aon Affinity, Philadelphia. Email: Georgia.Reiner@


This information has been provided as an

informational resource for Aon clients and business

partners. It is intended to provide general guidance

on potential exposures and is not intended to

provide medical advice or address medical

concerns or specific risk circumstances. Due to

the dynamic nature of infectious diseases, Aon

cannot be held liable for the guidance provided. We

strongly encourage visitors to seek additional safety,

medical and epidemiologic information from credible

sources such as the Centers for Disease Control

and Prevention and World Health Organization. As

regards insurance coverage questions, whether

coverage applies, or a policy will respond to any risk

or circumstance is subject to the specific terms and

conditions of the policies and contracts at issue and

underwriter determinations.

This risk management information was provided

by Nurses Service Organization (NSO), the nation's

largest provider of nurses’ professional liability

insurance coverage for over 550,000 nurses since

1976. Oklahoma Nurses Association (ONA) endorses

the individual professional liability insurance policy

administered through NSO and underwritten

by American Casualty Company of Reading,

Pennsylvania, a CNA company. Reproduction

without permission of the publisher is prohibited. For

questions, send an e-mail to service@nso.com or

call 1-800-247-1500. www.nso.com.



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February, March, April 2021 The Oklahoma Nurse 9

Professional Clarity 2020: Motivational Andragogy through

Shared Student Experiences

Samantha Acosta, Ian Fraser, Payton Hill, Amy

Hutchens, Sarah Kellog, Holly Leverett, Rachel

Pacheco, Kaylee Tompkins, The University of

Oklahoma Health Sciences Center

Adult students come with a wide variety of life

experiences and serve as rich resources for learning

(Knowles,1973). Andragogy conveys respect for people

by making use of their experience as a resource for

learning (Knowles, 1973). In the spring of 2020, The

University of Oklahoma Fran and Earl Ziegler College

of Nursing hosted the “OU Inspire” event. This event

engages principles of andragogy by giving nursing

students the opportunity to provide inspiration

and insight to their fellow students via motivational

speaking. The theme was Professional Clarity: 2020.

Junior and senior nursing students emceed the event

and delivered the content.

The first presenter delivered content on

mindfulness. The talk was titled “Mindfulness: Personal

and Professional.” The audience was led through a

guided imagery session and discussed the importance

of mindfulness in one’s daily activities. Mindful

meditation is the process of allowing thoughts to come

and go. Mindfulness and meditation is the ability to

exist in the present moment and not allow things to be

distracting (Kabat-Zinn, 1994). The oxford dictionary

defines meditation as “a mental state achieved by

concentrating while calmly accepting the feelings and

thoughts that come to you, used as a technique to

help you relax” (2020). Mindful meditation can help you

regulate emotions. In nursing, mindfulness has been

associated with a reduction in errors and increased

levels of compassion (Lin, Eckerle, Peng, & Moser,


The second presentation discussed

interprofessional communication. Effective

communication is not only about conveying a message

that you want to say, but it is about conveying the

message so that other people understand and

respond to it. (Communication: Effective vs Ineffective,

n.d). Ineffective communication can occur and lead

to communication breakdown as both parties fail to

deliver or process the received message. Effective

communication stems from listening, not interrupting,

confirming and your understanding (Forbes Coaches

Council, 2017).

The third speech was titled “Transitioning from

Student to Professional: Testimony from New Nurses.”

Testimony was gathered from previous graduates and

a current student reported on the findings. Advice was

shared on transitioning from student to nurse. Coming

to work with an eagerness to learn, being teachable,

asking questions and self-care were recommendations

provided by novice nurses. The three key components

easing the transition from student to professional

included addressing your insecurities now, taking

care of yourself now and cultivating your “why.”

Addressing insecurities includes talking about anxiety,

being authentic with faculty and employers, practicing

coping strategies and knowing that anxiety does not

make you a bad nurse. The components of self-care

included taking care of your physical self so that you

can take care of others and keeping your mind sharp.

Cultivating your “why” was noted as what drives

passion. For many nurses this is the patient. The

presentation concluded with a quote from Abraham

Lincoln. “Next to creating a life, the finest thing a man

can do is save one.”

The last talk delivered was “A Nurses Impact During

Life Changing Events.” The student spoke about the

emotional impact of health care professionals during

end of life and included the story of a very personal

loss. Below is an excerpt of the presentation.

Nurses have the biggest impact in creating a

positive death story. By showing emotion and

assisting the family in the grieving process,

the nurse will impact the family’s experience

forever. It is acceptable for the nurse and

healthcare workers to show emotion during a

tragic experience or death! When healthcare

providers display emotion and sympathy it

shows the family that they care about the patient

and value the patient’s life. Death is inevitably

going to happen to all of us and it is up to the

nurses to help orchestrate a beautiful death by

inviting and empowering the family and allowing

them time to heal. If you find yourself becoming

desensitized to death, take a step back and take

time to reflect on the situation and the patient.

Every patient deserves the upmost respect

during their death. In 2016, my 13-year-old

daughter was involved in a fatal ATV accident.

The healthcare team and law enforcement

officers showed emotion and listened to my

wishes, aiding me and my family in our grieving

process. Their actions helped orchestrate a

positive death experience. Looking back if

the healthcare team was emotionless and

unsympathetic, the hospital experience would

have negatively impacted and haunted us all for

the rest of our lives.

In the words of my daughter, “Your goal in life

shouldn’t be to live forever, but to create something

that will…a legacy is my goal.”

I encourage all of you nurses to think about what

kind of impact you are going to have as a nurse

and what legacy you are going to leave behind.

For further information on how to enhance your

thinking around the end of life experience please

visit the End Well Project at endwellproject.org.

Utilizing principles of Malcolm Knowles andragogy

nurse educators can draw on student experiences to

provide long lasting and impactful learning. Nursing

students come with their own life experiences and can

provide peer directed education that is unforgettable

and enthusiastically received by their classmates.


Communication: Effective vs Ineffective. (n.d.).

Retrieved August 25, 2020 from https://



Forbes Coaches Council. (2017, August 29). Council Post:

16 Effective Ways To Break Bad Communication

Habits. Retrieved August 25, 2020 from https://www.



Kabat-Zinn J. (1994) Wherever You Go, There You Are:

Mindfulness Meditation in Everyday Life. New York, NY:


Knowles, M. (1973) The Adult Learner: A Neglected Species.

Houston Texas: Gulf Publishing Company

Lin, Y., Eckerle, W. D., Peng, L. W., & Moser, J. S. (2019). On

Variation in Mindfulness Training: A Multimodal Study of

Brief Open Monitoring Meditation on Error Monitoring.

Brain sciences, 9(9), 226. https://doi.org/10.3390/



The Oklahoma Nurse February, March, April 2021

The Value of Grit and Resilience During a Global Pandemic

Heather M. Humphreys, DNP, RN, CNE, and

Dana S. Woody, DNP, RN

Reprinted with permission from American Nurse

COVID-19 has

changed the landscape

of the healthcare

industry. In fact, it has

warped an already

intense environment

and made for one that

breeds higher levels of

stress and anxiety than

ever before. Do you know

what is needed to not

only survive, but to thrive,

as a nurse during this time of crisis?

In 2006, the Robert Wood Johnson Project

brought increased awareness of nurse attitudes

and turnover rates with The RN Work Project. Data

indicated that around 18% of new nurses leave

their first nursing job within one year, and 26.2%

leave within two years. Recent (2019) data from NSI

Nursing Solutions indicates an increasing trend,

with approximately 23% of new RNs leaving their

jobs in the first year and one-third leaving within two

years. Overall, bedside RN turnover ranges from

4.5% to 43.9%, and national RN vacancy rates are

of concern at about 9%. Sadly, many nurses also

report feeling burnt out and being disengaged.

Though we have yet to see the full impact of

COVID-19 on nurses in the United States, a recent

study published in JAMA Network Open indicates

that healthcare professionals in China involved

in direct care of COVID-19 patients experienced

symptoms of depression and increased anxiety,

insomnia, and distress. What are we waiting for?

The time is now to address what nurses need to

remain on the frontlines and maintain their passion

for the nursing profession.

Grit and resilience

Angela Duckworth defines grit as passion

and perseverance to achieve long-term goals.

Individuals who are “gritty” are engaged in their

work and able to persevere in spite of negative or

difficult life events. They are motivated and flexible

in using a variety of strategies to reach goals, which

cushions them against the impact of hardships.

Resilience is defined as the ability to bounce back

after adversity or failure. Grit and resilience increase

well-being and decrease burnout.

Globally, the nursing profession is celebrating

“The Year of the Nurse and the Midwife.” Nurses

make up the majority of the worldwide healthcare

workforce and are now recognized as “essential

workers” and “heroes.” Despite positive public

opinion and the rewarding nature of the profession,

we are experiencing a nursing shortage. The

Bureau of Labor Statistics predicts that the United

States will need an additional 200,000 nurses per

year from now until 2026; this is just projected for

one country. Your gifts and talents are needed and

appreciated. The statistics sound daunting, but

consider these characteristics of grit and resilience

as you grow in the profession of nursing.

How to thrive

Do you know what it takes to thrive in the new

healthcare landscape? Literature provides insight

regarding the need for grit and resilience in nursing.

Consider these strategies in your nursing practice:

Realize that mindset does matter. Though

nurses are educated using a generalist approach,

our clinical practice usually focuses on a single

specialty area. After becoming accustomed to one

specialty, it can be intimidating to work in a new

and unfamiliar setting or with a different patient

population—reverting back to the novice nurse. If

we approach recent changes in healthcare with a

growth mindset, realizing we are capable of learning

new things, we are more likely to have a positive


Let learning renew your passion. Florence

Nightingale defined the art and science of the

nursing profession; this includes a life-long

commitment to learning. Nurses working in a time of

crisis can build on their existing skills and learn new

ones to deepen their passion for the profession. Get

your game on, renew your passion, and find your

inner “Flo.”

Remember your purpose. Perhaps you started

your nursing career with the “dream job” mindset;

now you are questioning your purpose. According

to the American Nurses Association, nursing is

the protection, promotion, and optimization of

health and abilities, prevention of illness and injury,

alleviation of suffering, and advocacy in the delivery

of care. This is YOU—remind yourself of your


Maintain “wholeness of character.” As nurses,

we know the importance of providing holistic care

for our patients, but we frequently neglect selfcare.

The ANA Code of Ethics tells us that we owe





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the same duties to ourselves as to others, including

maintaining “wholeness of character.” One essential

aspect of self-care is spiritual self-care, which can

involve a variety of activities such as attending

religious services, prayer, and reflective journaling.

Spiritual care promotes spiritual well-being, which

is associated with resilience among nurses,

supporting a decrease in emotional exhaustion that

is often associated with working in a high-stress


Cultivate a strong support system. The

support of family, friends, and co-workers is integral

to building grit and resilience. Staying connected

and avoiding feelings of isolation are pivotal.

Recent literature suggests that COVID-19 has

greatly impacted the mental health of the nursing

workforce, and steps need to be taken to ensure

mental well-being in this time of uncertainty and


Surround yourself with support, keep up the

social distancing norm, and find ways to take care

of YOU.

The time is now

Evidence supports the association of grit

and resilience with feelings of well-being, career

satisfaction, decreased emotional distress, and

decreased attrition rates. The time is now to

consider these characteristics in your professional

mindset and ensure you have the grit and resilience

to thrive in your nursing career.

Heather M. Humphreys is associate professor and

Dana S. Woody is associate professor at the Liberty

University School of Nursing in Lynchburg, Virginia.


American Nurses Association. Code of ethics with

interpretive statements. https://www.nursingworld.org/


American Nurses Association. What is nursing? n.d.


Duckworth A. Grit: The Power of Passion and

Perseverance. Scriber; 2016.

Duckworth A. 2020. Angela Duckworth Q&A: What is grit?


Dweck C. Mindset: The New Psychology of Success: How

We Can Learn to Fulfill our Potential. The Random

House Publishing Group; 2006.

Lai J, Ma S, Wang Y, et al. Factors associated with

mental health outcomes among health care workers

exposed to coronavirus disease. JAMA Netw Open.


Mealer M, Jones J, Meek P. Factors affecting resilience

and development of posttraumatic stress disorder in

critical care nurses. Am J Crit Care. 2017;26(3):184-92.

NSI Nursing Solutions, Inc. 2019 NSI National health

care retention & RN staffing report. 2019.



O’Keefe PA, Dweck CS, Walton, GM. Implicit theories

of interest: Finding your passion or developing it?

Psychol Sci. 2018;29(10):1653-64.

Pines EW, Rauschhuber ML, Norgan GH, et al. Stress

resiliency, psychological empowerment and conflict

management styles among baccalaureate nursing

students. J Adv Nurs. 2012;68(7):1482-93.

PRC. National nursing engagement report. 2019.




Rushton C, Batcheller J, Schroeder K, Donohue P. Burnout

and resilience among nurses practicing in highintensity

settings. Am J Crit Care. 2015;24(5):412-20.

Salles A, Cohen G, Mueller C. The relationship between grit

and resident well-being. Am J Surg. 2014;207(2):251-


Suzuki Y, Tamesue D, Asahi K, Ishikawa Y. Grit and work

engagement: A cross-sectional study. PLoS ONE.


World Health Organization. The international year of the

nurse and the midwife. 2020. https://www.who.int/


February, March, April 2021 The Oklahoma Nurse 11

I Give You Permission

to Fall Apart

By Sherry Stofko, MSN, RN

Reprinted with permission from Nevada RNformation August 2020 issue


Nurses Never Stop Learning

Tina Edwards MBA, MSN RN

ONA Emerging Nurse Director

Dear fellow nurse:

I give you permission to be anxious, fearful, angry, broken-hearted. I free

you of your unwavering sacrifice, loyalty, grit, and determination. I am granting

you liberty to experience your brokenness, exhaustion, overwhelm, and grief.

I encourage you to drop into your shadow emotions and to let them out with

a death wail or Irish funeral cry in the open Nevada landscape. I give you

permission to fall apart.

Our lives took an unprecedented turn in mid-March, one we never

anticipated, but certainly now find as no surprise: a respiratory-spread,

communicable disease passed effortlessly around our globally-connected

world and “suddenly” rocking the human race. How could “we” not have had

forethought and been ready for this? Clearly, we were not prepared in any way;

we were not equipped with PPE, with governance and policy, or with coping

mechanisms. In my 25 years as a hospital-based RN, I have never experienced

such widespread risk, fear, uncertainty, misinformation, rapid change, and

lack of strong leadership, let alone all of this concurrently. For many, the

associated emotional roller coaster involves denial, anger, sadness, isolation,

and boredom. For healthcare workers, we have the privilege of adding in several

heavier emotions:

• Shock: “How is this happening in the United States in 2020?”

• Betrayal: “They want us to wear the same mask for a week?”

• Envy: “Stop complaining that you’re bored at home when I’m getting

pummeled at work.”

• Frustration: “If I get one more 500-word email about another new policy, I

might crack!”

• Fear: “What if I bring it home to my family?”

• Exhaustion: “I can’t bear to drag myself in there again tonight.”

• Terror: “The nightmares and insomnia are killing me.”

• Grief: “What happened to my old life?”

• Guilt: “I wish I could do more.”

All of these reactions are completely normal during a disaster, a global

catastrophe, a pandemic, or any crisis event. The issue here is that this is not

merely an incident; it’s ongoing with no clear end in sight. Our stress levels, and

therefore our cortisol and epinephrine levels, are chronically elevated. We are

living in our sympathetic nervous systems - freeze, fight, or flight. We spend

most of our time trapped in a limbic hijack. As nurses, we have no refuge –

both work and home are incredibly stressful. It’s during times like these when

we discover if our coping mechanisms and resilience are strong enough to

withstand the chaos and uncertainty.

And they are. My dear healthcare brothers and sisters, we are enduring. It

may not be pretty; in fact, it is probably embarrassingly messy. There should be

no shame in it. Times are really tough. Nothing is ideal. But we are enduring. We

are fluctuating through the stages of grief and, ever so slowly, we are moving

towards acceptance and maybe even finding meaning in it all. During this

time, be gentle with yourself. Reach out for help. Finally make that counseling

appointment. Find a support group. Journal. Share. Practice self-compassion.

Scream out loud in the woods. When I feel emotionally flooded, I find calmness

in pausing for a few seconds, then incorporating the acronym “RAIN.” It stands


• Recognize what is happening: thoughts, behaviors, emotions.

• Allow the experience to just be there without trying to change anything.

• Investigate what you are feeling with curiosity and non-judgement.

• Nurture yourself with self-compassion and self-care (Brach, 2013).

Being in a new environment with increased expectations and an atmosphere

of seasoned nurses may give some a feeling of unease. There is a wealth of

knowledge surrounding you, yet you don’t want to be seen as the new nurse

who is unsure of her/himself. If only nursing school provided a survival guide

along with the gazillion other courses and assignments, we may feel more

ready. Despite that feeling of uncertainty, you are not alone. Those seasoned

nurses are still learning too! Education does not stop after graduating nursing

school; with multiple changes in healthcare, new medications, shifts in

paradigms and the pandemic crisis, we are all learning something new every

day and every shift.

With all that being said, you should continue to educate yourself continuously

and create a mindset that there is much to learn.

- Have a patient with an illness or disease you have never heard of? Study


- A new medication is developed for heart failure. Read about it.

- A different theory on nursing practice. Acquire the knowledge.

- A new policy or procedure in your department. Teach and live by it.

Continuing education does not necessarily mean that you have to go on

to graduate school, it simply means that you are empowering yourself to not

become stagnant and obsolete. At times of uncertainty I often look to this

quote for guidance and inspiration to continue learning, “Let us never consider

ourselves finished nurses…. we must be learning all of our lives.” - Florence


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Perhaps all this falling apart can help us come together… together with

our loved ones, with our co-workers, with other nurses nationally. It is time to

prioritize our self-care and strengthen our resilience as nurses and as humans.

Now, we ought to finally demand our employers recognize and mitigate the

effects of work-related trauma on the mental wellbeing of their employees. We

must band together, focusing on what is important in our field: safety, wellness,

and solidarity of nurses, which inevitably and undeniably leads to improved

safety and wellness of the patients in our care and in our communities.

Let us all give each other permission to fall apart during this time. In the

falling, I encourage us to explore ways to cushion the fall. And in our collective

falling apart, let us “fall forward together.”


Brach, T. (2013). The RAIN of self-compassion. https://www.tarabrach.com/wp-content/


Chisholm, C., Personal conversation, 5/6/2020

Moskowitz, M. (2020). Emotional world of healthcare providers. https://www.



The Oklahoma Nurse February, March, April 2021

The Importance of Nurses Addressing Implicit Bias

Ahnyel Jones-Burkes, DNP, RN-BC

Director of Leadership and Professional


Reprinted with permission from Louisiana State

Nurses Association Pelican News July 2020 issue

Implicit Bias functions in an unconscious or

unintentional manner, and this type of bias does not

necessitate the perceiver to approve it or dedicate

attention to its expression (Blair, Steiner & Havranek,

2011) Research shows there is a correlation between

implicit bias and healthcare disparities. Issues like

COVID-19 and maternal mortality have highlighted

the impacts of health disparities. The Center for

Disease Control defines Health Disparities as

preventable differences in the burden of disease,

injury, violence or opportunities to achieve

optimal health that are experienced by socially

disadvantaged populations. (Centers for Disease

Control and Prevention, 2018). We are in the perfect

position as the most trusted profession to ensure

we address healthcare disparities while guarding

against implicit and explicit biases because it can

negatively impact patient care.

Health Disparities can be caused by poverty,

environmental threats, inadequate access to

health care, individual and behavioral factors, and

educational inequalities (Centers for Disease Control

and Prevention, 2018) In recent events we have seen

just how important it is to understand the issues

impacting the communities we serve. These events

should strengthen our commitment as a profession

to provide the best possible care for each patient

every time.

We must strive for health equity which is defined

by Healthy People 2020 as the “attainment of the

highest level of health for all people” (Healthy People

2020). To achieve health equity, we as healthcare

providers must take an active role in examining

the patient holistically while striving to eliminate all

barriers and biases.

The Institute for Healthcare Improvement

recommends the below strategies to reduce Implicit


• Stereotype replacement – identifying

responses based on stereotypes and

consciously changing the response.

• Counter-stereotypic imaging – Imaging the

individual as the opposite of the stereotype.

• Individuation – Seeing the person as an

individual rather than a stereotype (e.g.,

learning about their personal history and the

context that brought them to the doctor’s

office or health center).

• Perspective taking – “Putting yourself in the

other person’s shoes.”

• Increasing opportunities for contact with

individuals from different groups – Expanding

one’s network of friends and colleagues or

attending events where people of other racial

and ethnic groups, gender identities, sexual

orientation, and other groups may be present.

• Partnership building – Reframing the

interaction with the patient as one between

collaborating equals, rather than between a

high-status person and a low-status person.

(IHI Multimedia Team, 2017)

The above recommendations also align with

recommendations from the Joint Commission

regarding overcoming implicit bias. If you would

like to gauge your own implicit bias there is an

assessment which is a free tool named the Implicit

Association Test.


Blair, I. V., Steiner, J. F., & Havranek, E. P. (2011).

Unconscious (implicit) bias and health disparities:

where do we go from here?. The Permanente journal,

15(2), 71–78.

Centers for Disease Control and Prevention. “Disparities.”

Centers for Disease Control and Prevention, Centers

for Disease Control and Prevention, 17 Aug. 2018,


“Disparities.” Disparities | Healthy People 2020, www.


IHI Multimedia Team. “How to Reduce Implicit Bias.”

Institute for Healthcare Improvement, 26 Sept. 2017,


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February, March, April 2021 The Oklahoma Nurse 13

Nurse Refresher Course

Three Lessons Learned During the COVID...continued

from page 7

Kim R. Hinds, DNP, RN, CNE

Jaye Lynn Robertson, MS, MA, DNP, RN, CNEP

For more than two decades, there has been a

shortage of licensed practical nurses and registered

nurses in Oklahoma. Today, Oklahoma does not

have enough nurses to meet the needs of critically

ill COVID-19 patients and continue to meet the inpatient

and out-patient needs of medical-surgical,

pediatric, neonatal and all other types of patients.

Health system nurse executives and their academic

partners are collaborating to address this acute


One strategy being used in Oklahoma to increase

the number of available registered nurses (RNs)

and licensed practical nurses (LPNs) is the offering

of a Nurse Refresher Course by the University

of Oklahoma, Fran and Earl Ziegler College of

Nursing in collaboration with Oklahoma Career Tech

System. This course is designed to update nursing

knowledge and skills in order to meet continuing

qualifications for practice as required by the

Oklahoma Board of Nursing.

Recently, based on changes in policy made

by the Oklahoma Board of Nursing, the Nurse

Refresher Course has been revised to use a

competency-based framework where specific

knowledge and skill outcomes are used to evaluate

achievement. This methodology recognizes that

students learn differently and may require a

different amount of time to achieve the competency

requirements of the course.

The updated Nurse Refresher Course allows

students to move through the course at their own

pace, while focusing on his or her specific learning

needs to meet continuing qualifications for practice

as required by the Oklahoma Board of Nursing.

After completing the online didactic portion of the

course, students may now complete the skills and

clinical experience portion of the course in as little

as 40 hours. Using a competency-based framework

and reducing the number of clinical hours decreases

learning and time barriers and potentially increases

the number of available registered RNs and LPNs for


Oklahoma nurses seeking to return to practice

and/or refresh their nursing knowledge and skills

should review the Oklahoma Board of Nursing

Instructions for reinstatement or return to active

status of RN or LP single-state license (https://

nursing.ok.gov/reinstateappl07.pdf) and the

Oklahoma Board of Nursing Refresher Course Policy

(https://nursing.ok.gov/refresher.pdf). Contacting

the Oklahoma Board of Nursing is also encouraged

to ensure enrollment in the Nurse Refresher Course

meets the continuing qualifications for practice

requirements for one’s particular situation.

To register for the Nurse Refresher Program,

contact an approved Career Tech Center and

complete an application. Additional information

about the Oklahoma Board of Nursing Board-

Approved Refresher Courses can be found at


Flyer.October.2020.pdf. The course fee is $2,000

and includes access to the online course or four

months, lab and simulated clinical experience


With the COVID-19 pandemic surge, creating

a way for nurses to update their knowledge, skills

and meet the continuing qualifications for practice

is one strategy nurse leaders have implemented to

increase the number of available registered nurses

(RNs) and licensed practical nurses (LPNs) for


clients and families. I will take time to check-in with

the students regarding their emotional health.

In the current COVID crisis, much has changed.

As nurses, social distancing and isolation

interventions change our practice. As patients

and family members, health care changes as

family members may not be able to be physically

present to provide support. As a nurse educator,

the educational environment changes with social

distancing as we adjust teaching/learning strategies

for class, lab and clinical.

What has not changed is the critical importance

of the nurse equipped with the ability and skills

to provide much needed care, compassion

and effective communication–even in a COVID

pandemic. May we all rise to the challenge, adapt

to the new health care climate and do what we do

best as nurses–provide the 3 Cs and truly make a




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The Oklahoma Nurse February, March, April 2021

Nursing Policy in Times of Uncertainty surviving,

thriving on the edge

Leadership in policy and

care quality and safety

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


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 can

be taken by nurses.

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


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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 authority.

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




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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


• 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

passionate about

• 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 :

February, March, April 2021 The Oklahoma Nurse 15

• Register and vote

• Be a poll worker

• Join interest-based organizations and become an active member

• Finding a mentor

• Volunteer to work on a campaign.

• Serve on a workplace committee, task force or practice council

• Attend networking events

• Participate in legislative days

• Contribute to candidates and political action committees

• Complete your profile for Nurses on Boards (nursesonboard.org)

• Seek local community board positions

• Communicate with elected officials

• Capitalize on workplace communication channels for policy discussions

• Volunteering for an organizational or community-based initiative

The following are generally are longer term actions, but can be done in the shortterm

as well depending your policy trajectory:

• Assume a leadership role for a workplace committee, task force or practice


• Be a mentor

• Representing your organization to the external community

• 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/practice-policy/nursing-excellence/ethics/codeof-ethics-for-nurses/

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