Iowa Nurse Reporter - April 2021





Quarterly publication distributed to approximately 36,000 RNs, LPNs and

ARNPs licensed in Iowa

Volume 4 • Number 3

April, May, June 2021



The COVID-19 Vaccine:

Is it Safe?

Page 4

Greetings, I hope that you

are healthy and have had a great

start to the New Year!

One year ago, we were

beginning to learn about this

new coronavirus and what it

would mean to our personal and

professional lives was quickly

becoming a reality. Throughout

this difficult year, Iowa nurses

have been there to care for and

protect Iowans. I know that it

has not been easy and that you

have all worked long hours in

extremely difficult situations. I,

Lisa Caffery



like the rest of you, want this to be over. However, there

is still much work to be done before we can return to our

lives as they were before the pandemic.

A sign of hope and the beginning of the end of the

pandemic occurred in December when the first vaccines

were approved for use in the United States. While we

all want to return to “normal,” we must stay the course

and continue with masking, social distancing and hand

hygiene. When it is your turn, get vaccinated. If we all do

our part and continue to follow the precautions, we may

be able to enjoy some of the fall and winter activities that

we missed in 2020.

Switching gears... In December Christina Peterson,

Andrea Starmer, Tobi Lyon and I had the privilege of

representing Iowa at the ANA Leadership Summit. The

event was held virtually with over 107 state leaders. The

evening event was packed with information shared by

ANA leadership. Highlights of the meeting included a

presentation outlining ANA’s strategic plan for the next 12

months. ANA strategic goals are as follows:

Goal 1: Elevate the Profession of Nursing Globally

Goal 2: Grow and diversify our credentialing portfolio

Goal 3: Evolve the Practice of Nursing to transform

Health and Health care

Goal 4: Enable Transformational Capabilities through

Operational Excellence

Each has several objectives on how the goal will

be achieved for the next 12 months. The INA Board

of Directors will be reviewing our own strategic plan

and discussing what we can do in Iowa to support

the ANA plan. More detailed information on the

ANA strategic plan can be found when you log into

I want to take this opportunity to congratulate Tobi

Lyon, our executive director on being named 2020

Greater Lansing Entrepreneur of the Year! In addition

to that honor, her company Ngage Management

was named a Best of MichBusiness 2020 winner!

Congratulations also go out to Senior Director of

Education and Membership at Ngage, Andrea Starmer.

Andrea presented at the ANA Executive Enterprise

meeting in January. Thank you both for all you do for INA!

In closing, please remember to be kind to each other.

We are all under an enormous amount of stress as we

continue to navigate through the pandemic and a little

kindness can go a long way! Be sure to take time for

yourself to rest and relax. Thank you for all that you do to

care for Iowans and the profession of nursing.

2021 INA Nurses Day at

the Legislature Recap

page 10

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


In the February edition of the American Nurse, INA Executive Director,

Tobi Lyon, authored the article, “Uplifting Nurses.” In the article, she

shares how INA was able to quickly respond to members’ needs during

the early days by providing virtual support via Networks of Support

sessions and the INA Nurse to Nurse warm line.

Page 2 • Iowa Nurse Reporter April, May, June 2021


Amy Campbell & Craig Patterson

Legislators returned to session on January 11

and laid out an aggressive schedule to complete

the work of the normal 16-week session as quickly

as possible, including a focus on the Governor’s

childcare, housing and broadband priorities. While

the first legislative deadline is still a month away,

both chambers are turning around bills swiftly from

subcommittee to committee to floor debate. Leaders

want to have most policy work done by the time the

state’s Revenue Estimating Conference comes back

to review the condition of the state’s economy and

set new estimates. If things continue to look up,

legislators will wrap up budgets and remaining policy

bills and head home before the April 30th shutdown


Here are a few bills upon which INA has engaged in

the first six weeks of session:

• Spoke in favor of telehealth payment parity for

mental health services (HF 294) and legislation to

instruct professional boards to remove barriers

to the safe use of telehealth and telemedicine

delivery modalities (HF 431). HF 431 passed the

House 92-0; HF 294 is ready for House debate.

• Supported legislation (HF 390) to require the

public and customers be notified when a water

utility stops fluoridation (at least 90 days’ notice).

This bill is also out of committee and ready for

House debate.

If you’re committed to 5 star consumer

experiences, there’s a spot for you!

We are looking for kind, patient-focused individuals

to join the FGH support circle.

Franklin General Hospital could be perfect for you!

Go to under Careers.

Franklin General Hospital offers excellent benefits

including IPERS, health, dental and life insurance,

flexible spending accounts, paid time off, and a free

single membership to the Franklin Wellness Center.

FGH is an equal opportunity employer with

great benefits and a positive work environment.

• Advocated for passage of strong maternal

child health legislation (SF 35), including a bill

to expand Medicaid coverage to 12 months

postpartum (SF 155), to support breastfeeding

(SF 251), and expanded access to up to a

year of contraceptive coverage without a


(HF 434 & SSB 1157). HF 434 is out of

committee and ready for House debate; SSB

1157 will be ready for committee debate this


• Opposed efforts to add exceptions for school

vaccinations (HF 217), prohibit any employer

from requiring vaccinations (HF 217 & SF 193),

and other efforts to undermine the state’s

public health goals.

• Spoke against legislation to place barriers to

access to important health and supportive

services for LGBTQ+ Iowans (HF 193) and low

income individuals (SSB 1125).

• Advocated for a strong sexual assault nurse

examiner and forensic examiner program within

the Attorney General’s Victims Assistance

Division to streamline efforts and expand access

to these services (HSB 179 & SSB 1154). Both

bills are currently in committee but have been

approved by their respective subcommittees

with amendment changes requested by INA.

Looking ahead, the first major legislative deadline

is just a couple weeks away. Bills wanting to continue

the march toward becoming law needed to be out

of their committees of origin by Friday, March 5. Any

non-tax or non-budget bill left in committee after

this time are dead for the remainder of the session.

We know lawmakers will have to come back for

a special session this Fall to do redistricting, since

US Census data has been delayed until September.

This will cause issues in Iowa that are yet to be

resolved, since the Iowa Constitution requires new

maps be approved by September 15. Constitutional

scholars and the Iowa Supreme Court will be looking

at Iowa’s options over the next several months, but

legislators will probably want to get redistricting

done quickly when they return for special session

since the candidate filing deadlines in March 2022

will leave little time for recruiting candidates.

The “Iowa Nurse Reporter” is the official

publication of the Iowa Nurses Foundation

and the Iowa Nurses Association, a constituent

member of the American Nurses Association,

published quarterly every January, April, July

and October.

Executive Director

Tobi Lyon

Phone: 515-225-0495


For advertising rates and information, please

contact Arthur L. Davis Publishing Agency, Inc.,

PO Box 216, Cedar Falls, Iowa 50613, (800) 626-

4081, INF, INA 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 the price of advertisement.

Acceptance of advertising does not imply

endorsement or approval by the Iowa Nurses

Foundation or Iowa 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. INF, INA 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 INF, INA or those of the national or local


1720 Central Ave. E. | Hampton, IA 50441

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April, May, June 2021 Iowa Nurse Reporter • Page 3


Uplifting Nurses

Associations respond to member needs in a pandemic.

Tobi Lyon, MBA, CAE

IN 2020, what kept me up

at night was nurses’ well-being

and how they’ve been dealing

with the impact of COVID-19.

Despite the loss of more than

1,400 frontline workers who

have died of this illness, nurses

continue to work long hours

caring for their patients. They

fear contracting the virus and

bringing it home to their loved

ones. On days off, they adhere

to infection prevention and

control guidelines and limit

Tobi Lyon, MBA,


physical contact, putting the needs of others first. If

you asked anyone in healthcare why they keep going,

their answer would probably be “because I care.”

Facing the new year with an ongoing pandemic,

we as leaders must continue to offer stability,

reliable information, and useful resources to nurses.

The American Nurses Association (ANA) and our

constituent/state nurses associations have played a

critical role in serving an emerging and diverse set of

member needs during the pandemic. This also has

been a time of opportunity to explore new modes of

member engagement.

We knew the only way to make a difference

would be to keep our associations relevant to all that

our members were experiencing in 2020. We had

to act quickly and responsively. At ANA-Michigan,

we restructured our association a few years ago,

which proved critical to our ability to pivot operations

overnight and respond to nurses’ needs during

this time of uncertainty. We set aside routine, daily

operations, and the status quo. Our innovative and

proactive approach has been nationally recognized for

establishing new practices and engaging with frontline

nurses and potential association members.

How did we learn what our members’ needs were

during the crisis? We asked, listened, and prioritized.

We heard firsthand how vulnerable nurses are to the

negative mental health effects related to working

under such extreme conditions and went into motion

to provide a resource. In Iowa, we started a 24/7 Nurse

to Nurse Warm Line to allow nurses to reach out to

other nurses to talk and have someone listen.

We also offered a complimentary storytellers’

workshop to teach nurses how they can effectively

share their countless stories and drive conversations

during the pandemic.

Giving members a platform to have their voices

heard is essential. We held several virtual town halls

with elected officials so they could hear firsthand

the many issues nurses in their districts were facing.

This drove direct care and hero pay to our frontline


We created a virtual platform for connecting nurses

across the state with our Networks of Support series.

We offered webinars addressing stress management

and burnout, which provided self-care tools and

referral information to professionals for expert

assistance. These recorded webinars are part of several

resources for members and their nursing colleagues

offered on our websites. ANA-Michigan responded to

community needs and activated nurse experts to offer

a COVID-19 Training Program for K-12 schools.

To all the nurses putting one foot in front of the

other, know that you’re helping to save lives every day.

However, I’m asking you to please take care of yourself

with these steps:

• Pace yourself as much as possible.

• Acknowledge your frustrations because holding in

your feelings can lead to depression and anxiety.

• Let people help. Some people take joy in helping

frontline workers. Let them help you.

Tobi Lyon is the CEO of Ngage Management,

which manages ANA-Michigan and the Iowa,

Oklahoma, and Wyoming Nurses Associations.


920 N. Cherry Street | Shell Rock, IA 50670 | 319-885-4341

We salute our Nurses and entire

staff for the loving care they

provide our people all year.

For more information, contact

Suzette Eveland, Director of Nursing Services, or Christina Hubka,

Executive Director,

Apply online:


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Page 4 • Iowa Nurse Reporter April, May, June 2021

The COVID-19 Vaccine: Is it Safe?

In December 2020, the

FDA approved the use of the

Pfizer and Moderna COVID-19

vaccines under Emergency

Use Authorization (EUA) in the

United States. The Advisory

Committee on Immunization

Practices (ACIP) gave the

final blessing and provided

the priority lists. Health care

workers have had the privilege

of being the first group of

Americans to receive the

vaccine. For many of us the

vaccine is a sign of hope that

Lisa Caffery



we are at the beginning of the end of the pandemic.

Pictures of health care workers receiving their first

dose have been shared on multiple media platforms.

For many of us receiving the first dose was a very

emotional moment…. knowing that we had added

another layer of protection and that we are now one

step closer to the return to pre-COVID life.

Even before the vaccine became available there

were many inaccurate news stories circulating on

social media sites. Some of the misinformation

posted was that the vaccine can cause infertility,

pregnancy loss and alter one’s DNA. None of this

is true. A troubling trend noted after healthcare

workers began receiving the COVID-19 vaccine

is showing that many nurses have not taken the

vaccine due to the concerns listed above. While the

decision to take the vaccine is a personal one, that

decision should be made after reviewing vaccine

information from reputable sources and talking

with your healthcare provider about the risks and

benefits of the vaccine.

Both Pfizer and Moderna COVID-19 vaccines are

mRNA vaccines. Many have expressed concerns

that this is new technology, and the vaccine was

developed too quickly. The reality is that while

these are new vaccines, the technology is not new.

Scientists began developing mRNA vaccine several

years ago during another coronavirus outbreak

and because that outbreak ended quickly and had

very little global impact the vaccine was never fully

developed. So mRNA research continued but had

that work not already been underway it would have

taken a lot longer to develop the vaccines available


Common misunderstandings are:

The vaccine will change my DNA.

mRNA does not enter the nucleus of the cell where

DNA material is kept, so the vaccine cannot change

or affect your DNA.

You can get COVID-19 from the vaccine.

The vaccine is not a live virus vaccine. It does not

contain any of the COVID-19 virus.

I have already had COVID-19 so I do not need to

take the vaccine.

The CDC currently recommends that all people receive

that vaccine when it is available. It is unclear at this

time how long a person who has had the disease

is immune. If you have concerns, talk with your

healthcare provider.

The vaccine may cause fertility issues later.

The CDC and several organizations, such as the

Association of Women’s Health, Obstetric and

Neonatal Nurses, and the American College of

Obstetricians and Gynecologists recommend that all

women who are health care workers are vaccinated.

Links to these recommendations are at the end of the


If I take the vaccine, I do not need to wear a mask


Even though you have received both doses of the

vaccine, you will still need to wear a mask, social

distance and practice good hand hygiene. These

recommendations will likely be in place for several

more months. Public health officials will tell us when it

is safe to return to pre-COVID practices, until then we

must continue to follow their advice.

As I stated previously, you do have the right to not take

the vaccine. That decision should be made after a careful

review of the scientific literature and a discussion with

your health care provider. When providing information

to patients, family or friends we are obligated to provide

accurate information on the vaccine. Both the American

Nurses Association and the Iowa Nurses Association have

published position statements on the vaccine, please take

the time to review them.

Finally, if the opportunity presents itself to you,

consider volunteering at an immunization clinic. It will take

several months to distribute the vaccine and will take all of

us working together to end the pandemic.


INA Statement on Immunizations | Iowa Nurses Association |

Nursing Network

Coronavirus Resources| COVID-19 | ANA Enterprise


COVID-19 Vaccines | CDC

COVID-19 Vaccines and Pregnancy | ACOG


Coe College seeks qualified applicants for a full-time non-tenure

track (NTT) appointment in a baccalaureate nursing program

beginning August 2021. Required qualifications include:

MSN degree completed by start date.

A minimum of 1 year of recent teaching experience.

Successful completion of a criminal background check in

accordance with Coe College policy.

To apply, please visit our website at and click on Careers

Pursuit of a

Nursing Career

Caitlin Jensen

INF Scholarship Recipient

The idea of pursuing a

career in nursing has always

been in the back of my

mind. While growing up, I

witnessed my mothers strong

and devoted commitment to

the nursing profession. She

started out as a community

college graduate with an LPN

license. Since then, she has

worked her way up to a BSN

RN, employed at the Iowa

Department of Public Health

Caitlin Jensen

(IDPH), while also managing to raise four kids along

the way. She is the most motivated and determined

person I have ever met. The thought of being able

to follow in her footsteps has inspired me every day

since I was a little girl.

Flash forward to today and I am approaching

my graduation in May of 2021 from Des Moines

Area Community College (DMACC). Following

graduation, I plan to take the NCLEX, and continue

working for UnityPoint Methodist Medical Center

in downtown Des Moines. I have worked in

this hospital for about a year as a patient care

technician (PCT) and have already applied for a

position in the registered nurse residency program.

I am really excited about the future that awaits

me here. I feel I have obtained the education and

experience needed to succeed in this program.

From an assisted living facility to a nursing home

and now to working in the hospital environment,

I have grown leaps and bounds in my patient

care experience. I am proud to soon call myself a

DMACC graduate and continue on as a UnityPoint


In the fall I will attend the University of Iowa’s

online RN-to-BSN program to obtain my bachelor’s

degree, and one day progress to earning my

doctorate degree in nursing to ultimately obtain

a nurse practitioner license. The areas of nursing

I’m excited to explore more include pediatrics and

critical care. My dream position would be in a

pediatric intensive care unit (PICU). This is the area

that has always caught my eye and I long for the

ability to have a hand in returning a healthy child to

the playground, where they belong.

I want to express my deepest gratitude to

the Iowa Nurses Foundation for awarding me

this scholarship. It has helped me tremendously

throughout this final year of nursing school,

and overall in achieving my dreams of becoming

a registered nurse. I would also like to extend

a hearty thank you to all the nurses, nursing

assistants and other medical personnel that have

put their lives on the line to care for patients

during the COVID-19 pandemic. I look forward to

continuing the fight against the coronavirus and so

many other diseases that have taken over people’s

lives. I can’t wait to begin my nursing career in

just a few short months. This award from the Iowa

Nurses Foundation was among the final steps to

achieving my dreams. I can’t thank you enough for

believing in me and helping to support my future



RN's and LPN's

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Jalissa Winn, Administrator

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1500 Franklyn Ave, Marengo, IA 52301

Telephone: 319-642-5533

Fax 319-642-3822


The Iowa Department of Human Services’ Cherokee Mental Health

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Registered Nurses and Licensed Practical Nurses with various

schedules available. These positions offer competitive salaries with

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Public Employees Retirement System (IPERS). CMHI’s mission is to

provide patient care through Treatment, Training and Advocacy.

For more details, please visit

or you can contact Human Resources at 712-225-6927.

Page 6 • Iowa Nurse Reporter April, May, June 2021

Do Nurses Make More Nursing Errors Working 12 Hour Shifts

Without Getting a 30-minute Uninterrupted Break?

Courtney Martin, ISU RN-BSN student

On a cold winter day in

December, Nancy Smith

is headed to work on the

oncology unit as a registered

nurse. She has been working

at Luke’s Hospital for the

past ten years. As she drives

to work she thinks about

everything she needs to

get done. However, she

instantly realizes this is her

third twelve hour shift in a

Courtney Martin

row and has one more twelve hour shift to work

this week because her floor is short staffed. As

Nancy arrives to work, she pulls into her favorite

parking spot and gathers all her belongings.

She gets inside the hospital and is screened for

COVID-19 symptoms. Her temperature is taken

and she is asked a series of questions to verify

she does not have any symptoms. After passing

the first check point, she clocks in and goes to

her morning huddle. At the morning huddle

all the patients are assigned, safety issues are

discussed and the unit’s goals are shared. Once

the morning huddle is complete, she gets logged

into her computer and the phone she’ll carry with

her all day then receives reports on her patients

using bed side shift report. The next thing on her

agenda is morning medication pass. She effectively

passes the medications, completes her head-to-toe

assessments and accurately charts her findings.

Nancy finds herself being pulled in several

different directions as she helps answer call lights

and reviews new orders placed by the providers.

With a successful morning behind her, it is now

time for Nancy’s lunch break. As she heads off

the floor to take her 30-minute break, she lets

others know she will be going to get some lunch.

As mentioned before, Nancy carries a phone with

her all day long to keep in touch with her patients,

co-workers, other departments and the providers.

As she puts her lunch in the microwave her phone

rings. It is physical therapy checking in to verify it

would be alright to work with the patient in room

312. She confirms and sits down to eat her lunch.

A few bites into her lunch, she receives another call

from dietary asking if the patient’s blood sugar in

room 322 had been done.

As she finishes up her break the physician calls

to change some orders for the patient in room

308. She scrambles to find something to write on

and digs through her pockets to find a pen. She

wrote everything down and read it back to verify

what she heard. Nancy quickly ate the last few

bites of food and headed back to the floor to put

in the new orders she just received. It has been a

long three days and this lunch break is typical of

the most of her breaks. It is expected she take her

phone to lunch and answer it while eating. She was

exhausted and noticed at this point she was not

thinking as clearly as she was on day one of her

work week. She put the orders in and started the

afternoon medication pass. Except this time was

different. She made a mistake. She forgot to set the

bed alarm on the patient’s bed in room 312. She

started to do her hourly rounding and medication

pass in her next patient’s room when suddenly,

she heard, “HELP!” She went running towards the

voice calling out for help. She arrived to the room

and found her patient on the ground. She assessed

her patient and called for help. The patient was put

back to bed and monitored for any other symptoms

of fall related injuries. The proper paper work for

her patient’s fall was filled out, but she felt terrible

she forgot to set the bed alarm. She knew if she

had been thinking clearly she would not have

forgotten. The rest of the day she carried the guilt

around with her knowing she was not in the best

state of mind to care for her other four patients. At

the end of her shift she knew she needed to get

home and go to bed, so she would be able to be

ready to care for her family the next day.

Like Nancy Smith many nurses across the United

States operate under these conditions. They

work long hours and do not get an uninterrupted

30-minute break. This small amount of time in a 12-

hour period is needed to help nurses relax. If breaks

are not given, it could cost hospitals an extensive

amount of money. Almost all nurses will voice some

level of work-related stress. Consequently there

is increasing attention in the nursing community

and supportive documentation in papers and

articles on the importance of nurse well-being

(Contreras Sallazzo et al., 2020). The welfare of

nurses impacts the nurses themselves, the team,

health organizations and most importantly their

patients (Al Ma’mari et al., 2020). Investing in stress

management techniques, such as breathing, coping

strategies, exercise, mindfulness and social activities

during a break can aid in dealing with stressful

situations (Henson, 2020).

The research or evidence is not well defined in

the literature involving the correlation between

nurses taking breaks and number of nursing errors

made. A few resources provide information about

compassion fatigue and burnout in relation to

errors. Compassion fatigue can lead to high levels

of stress at work, errors in judgment as well as

physical and emotional exhaustion (Henson, 2020).

When individuals are tired, they are more likely to

make nursing errors. Wrong-patient incidents occur

for many reasons, including nurse-related factors

such as tiredness, a lack of skills or negligence and

system-related factors such as rushing or heavy

workloads (Harkanen et al., 2018).

April, May, June 2021 Iowa Nurse Reporter • Page 7

Allowing nursing staff to get a 30-minute break

can impact the overall well-being of patients,

decrease instances of nursing errors, increase

patient safety and satisfaction and increase the

job satisfaction levels of nursing staff. Studies have

been conducted in regard to the benefits of selfcare

in acute care settings and the impact it can

have on the patients. Many places of employment

are implementing and evaluating programs that

address the reduction of a nurse’s stress, burnout

and depression (Contreras Sallazzo & Esposito,

2020). According to Owens (2021), one major

theme emerged during a data analysis that showed

positive work environments decrease staff turnover

and increase staff satisfaction. Moreover, in a

regional hospital in Minnesota a restorative space

known as the “serenity room” was installed in a

busy emergency department (Salmela et al., 2020).

They discovered the tranquil room provided a

reduction in stress levels for the nursing staff and in

turn increased patient safety (Salmela et al., 2020).

Furthermore, research confirms it is important to

care for ourselves both physically and mentally by

participating in proper nutrition and rest, limiting

the number of overtime hours worked, taking time

away from work and spending time doing activities

that bring joy to everyday life (Parrish, 2016). Active

participation in self-care activities will contribute

to decreasing stress levels, allowing one to be

more proactive rather than reactive in problematic

situations (Parrish, 2016). Patient outcomes can be

improved when nurses are able to take their full

break without interruptions and implement self-care

techniques (Jameson & Bowen, 2020). The negative

correlation between fatigue and patient safety

culture indicates nurse fatigue has a detrimental

effect on patient safety.


AL Ma’mari, Q., Sharour, L. A., & Al Omari, O. (2020).

Fatigue, burnout, work environment, workload and

perceived patient safety culture among critical care

nurses. British Journal of Nursing, 29(1), 28–34.

Contreras Sollazzo, L., & Esposito, C. L. (2020).

Nurses’ Unions Can Help Reduce Stress, Burnout,

Depression, and Compassion Fatigue Part 1: The

Background. Journal of the New York State Nurses

Association, 47(1), 18–44.

Harkanen, M., Tiainen, M., & Haatainen, K. (2018).

Wrong-patient incidents during medication

administrations. Journal of Clinical Nursing (John

Wiley & Sons, Inc.), 27(3-4), 715-724. https://doi.


Henson, J. S. (2020). Burnout or Compassion Fatigue: A

Comparison of Concepts. MEDSURG Nursing, 29(2),


Jameson, B. E., & Bowen, F. (2020). Use of the

Worklife and Levels of Burnout Surveys to Assess

the School Nurse Work Environment. Journal

of School Nursing, 36(4), 272–282. https://doi.


Owens, R. A., Burwell, P. M., Deese, S., & Petros, T.

(2021). Graduating Nursing Student and Practicing

Nurse Perceptions on Promoting Recruitment,

Work Satisfaction, and Intent to Stay: A Qualitative

Study. Journal of Nursing Regulation, 11(4), 41–50.

Parrish, E. (2016). Civility and Self-Care in Nursing Go

Hand in Hand. Perspectives in Psychiatric Care, 52(2),


Salmela, L., Woehrle, T., Marleau, E., & Kitch, L. (2020).

Implementation of a “Serenity Room” Promoting

resiliency in the ED. Nursing, 50(10), 58–63. https://

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Page 8 • Iowa Nurse Reporter April, May, June 2021


The Voice of Iowa Nurses: Shaping Policy, Advancing Health

Dawn Bowker, PhD, RN, ARNP-BC, SANE

INA Director of Public Policy

The voice of Iowa nurses

and future nurses positively

influence our profession, patients

and policy. It is both powerful

and a privilege to work with

informed nurses to shape the

future of nursing and policy in

Iowa. Each year the Iowa Nurses

Association (INA) identifies

legislative priorities that align

with our mission to “connect,

support, advocate for nurses

and healthcare in Iowa,” and

our vision to “…promote the

growth of the profession, guide

Dawn Bowker,



nursing practice and monitor current issues in nursing.

Our strength is to stay engaged by advocating for and

connecting with Iowa nurses in the diverse, dynamic

health care environment.”

A coordinated effort with the American Nurses

Association, Ngage Management, Advocacy Cooperative

and Iowa nurses will guide INA to identify, define and

direct efforts to broadly address legislative priorities that

are relevant to Iowa and Iowa nurses.

This year the INA Public Policy Committee identified

nine legislative priorities:

1. Support adding nurse residency programs for all

Iowa hospitals that include:

• Fund programs to help new nursing graduates’

transition into practice.

• Recognize that nurse residency programs help to

attract and retain nurses, reduce turnover costs,

provides new nurses the opportunity to improve

and learn skills.

2. Support increased funding for public health,

both state and federal funding that include:

• Increase appropriations to the Essential Public Health

Services line item in the Health and Human Services

budget 2021.

• Support actions that serve to promote health,

reduce health inequities and protect groups

that have been socially and/or economically


• Assure that any major changes to the governmental

public health system are done with the input of

public health professionals and with a vision that

promotes a culture of health in Iowa.

3. Support increased access to mental health

services and support that include:

• Offering a full array of affordable, accessible

treatment options including recovery-oriented

systems for prevention, early intervention and


• Increasing the number of mental health treatment

beds across the state.

• Expanding the psych/mental health nursing

workforce and increasing the number of psych/

mental health nurse practitioners across the state.

• Supporting reimbursement parity for mental health


• Supporting continuation of public health

emergency proclamations that allows for 3rd party

reimbursement for telehealth visits that increases

flexibility, convenience and access as a long-term


4. Support increased funding for nurses related to

protect and recover from COVID-19 that include:

• Fund compensation for nurses who are unable to

work due to a positive or pending COVID-19 test


• Provide support services for nurses who are suffering

with trauma (PTSD) from the COVID-19 pandemic.

• Increase funds, access and support for telehealth

access and reimbursement.

• Ensure an adequate amount of appropriate PPE

for all facilities providing care to patients at risk for


• Ensure COVID-19 priorities include Long Term Care


5. Support programs that address violence against

health care workers that include:

• Support detain and restrain orders (therapeutic hold)

for any patient who poses imminent threat to self or


• Given the imminent threat and need for immediate

action, endorse nurse clinical judgment and

authority to implement a therapeutic hold without

first requiring a physician order. Situations posing

threats to patients, nurses and/or others put these

individuals at imminent risk for injury from a patient

or guest.

• Support programs that address lateral violence,

incivility and bullying among and between nurses.

6. Support and fund Midwifery in Iowa that


• Support and fund programs that improve maternal/

newborn care.

• Support and fund one-year Medicaid eligibility postpartum

(most people lose access after 30 days).

• Recognize that in Iowa, women of color are six times

more likely to die from childbirth (national average

three to four times).

• Support mandates of hospital privileges for nurse


Of note: Nurse Midwife on Governor’s COVID task


7. Support increased funding for healthcare access

and coverage LGBTQ+ individuals that includes:

• Increased Access to LGBTQ-centered care and clinics.

• Improve/Increase education of LGBTQ health

disparities to health care workers.

• Ban conversion therapy for minors.

8. Support, protect and fund having a school nurse

in each district in Iowa that include:

• Physical, social and emotional needs of Iowa

youth are different than previous generations.

• Physical, social and emotional needs must be met

for youth to reach their fullest potential.

• School nurses are trained to evaluate youth for

somatic complaints/symptoms. The somatic

complaints/symptoms are often secondary to

the underlying primary mental, physical and

psychosocial health need.

• Youth physical health complaints or behavioral

challenges are often related to exposure

to Adverse Childhood Experiences, (ACEs),

traumatic experiences, including and not

limited to, abuse and neglect. Exposure to

ACEs is associated with school failure as well

as leading causes of morbidity and mortality in


April, May, June 2021 Iowa Nurse Reporter • Page 9

• Youth are the future of Iowa and their health

needs can be addressed with one school nurse

in every building, every day, all day.

• One school nurse in every building, every day, all

day allows youth access to healthcare 180 days

of the year.

• School nurses are knowledgeable, skilled and

qualified to provide comprehensive evidencebased

health care (including health promotion

and disease prevention) to youth.

• School nurses should not be viewed as only for

emergencies and chronic health concerns.

• School nurses are the “connectors” between

youth/families, health care and academics.

• Youth have the value of health reinforced by a

school nurse.

• Research shows attendance is better when a

school nurse is present to evaluate health related

complaints. When youth stay in school, parents

remain productive at work.

• Healthy youth make better learners.

• Per Iowa Department of Education School Nurse

Consultant, there are 702 school nurses in Iowa

and there are approximately 1,415 public school

buildings in Iowa (personal communication

February 21, 2020).

9. Support funding and program development

for Adverse Childhood Events (ACE) screening

and interventions that include:

• Support routine screening of all children at

annual exam visits.

• Support referrals for appropriate interventions

for children who score four or higher on routine

assessment for ACEs.

• Recognize ACEs directly correlate to a higher risk

of depression, diabetes, heart disease, stroke,

cancer, suicide, alcoholism, illegal drug abuse,

poorer health outcomes and decreased life

expectancy as an adult.

Thank you to the nursing leaders who lead the

charge by researching and defining the INA legislative

priorities Anita Leveke, RN, MSN; Pam Diechmann,

MPH, BSN, RN; Lisa Caffrey, MS, BSN, RN, MEDSURG-

BC, CIC, FAPI; Sue Whitty, MA, ARNP, Child/

Adolescent Psychiatric-Mental Health CNS, PMHNP-

BC; Rebecca Devine, DNP, ARNP, PMHNP-BC; Virginia

Wangerin, PhD, MSN, RN, CNE; Lynne Himmelreich,

CNM; Kate Pace, RN, BSN; Luke Stalzer, RN, BSN;

Sharon Guthrie, PhD, ARNP, CPNP, NCSN, RN-BC; Teri

Schloss, MSN, RN, NCSN; Esther Huston, RN, SANE,

RN-BSN Student.

Nurses are a powerful force in the policy-making

process. Our voices and experiences are vital

components in advancing INA’s legislative priorities,

realizing our mission and vision and positively

impacting the future of nursing.

Support adding nurse residency programs for all Iowa hospitals.

Support increase funding for public health, both state and

federal funding.

Support access of affordable mental health services.

Support increased funding for nurses related to protect and

recover from COVID-19.

Support programs that address violence against health care workers.

Support increased funding for healthcare access and coverage for

LTGBQ+ individuals.

Support access to Nurse-Midwifery Care as a partial solution to the

maternity care crisis in Iowa.

Support funding and program development for Adverse Childhood

Events (ACE) screening and intervention.

Support, protect, and fund having a school nurse in every building,

every day, all day.

Page 10 • Iowa Nurse Reporter April, May, June 2021

Andrea Starmer, CMP

Director of Education & Membership

While we couldn’t be together in person at the capitol this year for the INA Nurses

Day at the Legislature, attendees enjoyed a rich, interactive virtual experience! The

day kicked off with our opening Keynote speaker Ann Meyer with her informative

presentation, The Power of Your Nursing Voice. Next up was Dr. Dawn Bowker, INA

Director of Public Policy with an informative introduction into INA’s legislative priorities

for the coming year.

After a short break to visit exhibitors and the INA discussion forum, attendees

could choose one of four breakout sessions which offered an informative presentation

followed by open discussion on each topic:

1. How a Bill Becomes a Law and Legislative Q&A -Amy Campbell & Craig


2. Increase Public Health Funding – Lisa Caffery, MS, BSN, RN, MEDSURG-BC, CIC,

FAPIC and Pam Deichmann, MPH, BSN, RN

3. Nurse Residency Programs in Iowa Hospitals – Anita Leveke, RN

4. Mental Health Support for All Iowans – Susan Whitty, RN and Rebecca Devine, RN

After a short lunch break, where attendees were able to attend exhibitor zoom

sessions, Amy Campbell and Craig Patterson shared this year’s comprehensive

legislative update. Afterward, the breakout sessions were repeated.

The final segment of the day was a Legislative Townhall with Representative Chris

Hall, Senator Carrie Koelker, and Senator Liz Mathis, moderated by Dr. Dawn Bowker.

Attendees were both educated and energized by the information exchange on

trending topics and legislative policy facing Iowa nurses.

INA thanks all who participated: our 263 attendees, presenters, exhibitors and our

sponsor for this program, Purdue Global. We can’t wait to get together in person next



2021 INA Nurses Day at the Legislature Recap

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Page 12 • Iowa Nurse Reporter April, May, June 2021

Esther Huston, RN, SANE, RN-BSN Student

One of the INA legislative

priorities calls for support

for funding and program

development for Adverse

Childhood Experiences (ACEs)

screening and interventions.

What are ACEs or childhood

trauma, and why is program

development so vitally


Ten years ago I was unaware

of what ACEs were and their

prevalence in our society.

Esther Huston

Since that time, my life has been changed by learning

and understanding what ACEs are, and how they affect

children and children’s future life and health outcomes.

As a nurse and an adoptive mother, I have witnessed firsthand

the effect trauma has on children. I have seen the

direct impression ACEs leave on children and how ACEs

affect how a child learns, grows and develops. ACEs

have profound implications on children’s future physical

health, mental health and life outcomes. ACEs can be

neglect, emotional, physical, or sexual abuse, household

dysfunction such as divorce or parental separation that

leads children to feelings of instability (CDC, 2020). As an

adoptive mother of four children, I have had to dive deeply

into what ACEs are and how they affect my children

because ACE screening is not done in Iowa. As a nurse, I

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INA Legislative Priority Hits Close to Home

started to see how childhood trauma affected my patients

too. The implications of ACEs are staggering.

ACEs have been shown to increase the risk of diabetes,

severe obesity, depression, anxiety, stroke, heart and lung

disease, drug abuse and suicide in adulthood (Felitti et al.,

1998). ACEs can also lead to a decrease in life expectancy

(Brown et al., 2009). For children, knowing how to deal

with stress is a learned response. Cortisol, which is released

as a response to stress, can adversely affect the brain’s

development and structure, leading to learning delays and

behavior issues (Jacob et al., 2019). Children with more

ACEs can have problems paying attention in class, anxiety,

depression and oppositional defiant disorders (Jacob et

al., 2019). Prolonged unrelieved stress can cause immune

suppression and leave a molecular mark on the way genes

are expressed (Jacob et al., 2019). Some adult diseases can

be traced back to trauma experienced as a child (Shonkoff

et al., 2009). High ACE scores have also been correlated to

those within the prison population (Stensrud et al., 2019).

Screening children for ACEs is not a routine practice

in pediatric care. A current practice change to screening

children’s ACE scores would enable providers to initiate

and start interventions for children that could otherwise

lead to developmental delays (McKelvey et al., 2017).

Physiological embedding of childhood adversity makes

adults’ treatment with ACEs a far more difficult challenge

due to decreased ability to change (Shonkoff et al., 2009).

The impact of screening children for ACEs could be one of

the most critical health promotion and disease prevention

avenues that health care has. Providers, however, cannot

treat something they do not know is present. This stresses

the importance that providers should routinely screen

children for ACEs.

In Iowa, ACEs are common. 64% of adults in Iowa

state experiencing one or more ACEs (Iowa ACEs 360,

2020). The percentage of Iowan adults who report living

through four or more ACEs is 17%. (Iowa ACEs 360,

2020). It has been over twenty years since the Adverse

Childhood Experiences Study was published and first

correlated ACEs to decreased long term health outcomes

(Felitti et al., 1998). It is scientifically known that ACEs

affect children’s health and development and long-term

health outcomes. However, if providers do not know that

children in their care have ACEs, they cannot educate

parents and initiate appropriate interventions. In order

to decrease the long-term effects of ACEs, health care

organizations need to regularly screen children in pediatric

settings. Expanding ACE screenings could support direct

intervention by linking families to assistance, home-visiting

services and therapies that support child development

(McKelvey et al., 2017). As health care providers, we must

use what we know about ACEs and apply it to promote

better health outcomes for children.


Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards,

V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood

experiences and the risk of premature mortality. American

Journal of Preventive Medicine, 37(5), 389–396. https://doi.


Centers for Disease Control and Prevention. (2020, April 13).

Violence prevention: About the CDC-Kaiser ace study.



Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F.,

Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998).

Relationship of childhood abuse and household dysfunction

to many of the leading causes of death in adults. The

Adverse Childhood Experiences (ACE) Study. American

Journal of Preventive Medicine, 14(4), 245–258. https://doi.


Iowa ACE 360 (2020). Healing Iowa: How Iowans are

reshaping systems and communities for children to thrive

in response to Adverse Childhood Experiences. https://


Jacob, G., van den Heuvel, M., Jama, N., Moore, A. M., Ford-

Jones, L., & Wong, P. D. (2019). Adverse childhood

experiences: Basics for the paediatrician. Paediatrics & Child

Health, 24(1), 30–37.

McKelvey, L. M., Conners Edge, N. A., Fitzgerald, S., Kraleti,

S., & Whiteside-Mansell, L. (2017). Adverse childhood

experiences: Screening and health in children from birth

to age 5. Families, Systems & Health: The Journal of

Collaborative Family Healthcare, 35(4), 420–429. https://doi.


Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009).

Neuroscience, molecular biology, and the childhood roots

of health disparities: building a new framework for health

promotion and disease prevention. JAMA, 301(21), 2252–


Stensrud, R. H., Gilbride, D. D., & Bruinekool, R. M. (2019).

The childhood to prison pipeline: Early childhood trauma

as reported by a prison population. Rehabilitation

Counseling Bulletin 62(4) 195-208. https://doi.



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April, May, June 2021 Iowa Nurse Reporter • Page 13


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Page 14 • Iowa Nurse Reporter April, May, June 2021


The Iowa Nurses Foundation (INF) is the

charitable and philanthropic arm of the Iowa Nurses

Association with a mission to promote and support

the professional and educational development of

registered nurses in Iowa. The year 2020 was difficult

for so many, but the INF was still able to secure just

under $3,000 in new charitable donations. A sincere

thank you to all that donated, either with a cash

gift or through participation in one of our annual


The first fundraiser of 2021 was the T-Shirt

Fundraiser/First Run held in February and March,

which raised $595 for the INF. If you missed out on

getting your custom INF “Iowa Nurses – We Are All

In This Together” t-shirt, don’t worry, as you’ll get

another chance to participate in the second run of

this fundraiser right before the Annual Conference

this Fall. An additional opportunity to donate to INF

awaits in May, for our Move-A-Thon Fundraiser held

in honor of Nurse’s Month.

These important fundraisers are more than just an

opportunity for you to show your loyalty and pride in

this most honorable profession, it is a way for you to

hold the door open behind you for the future nurses

of Iowa through critical scholarships funded by INF.

In 2020 alone, INF awarded $7,000 in scholarships

to hardworking well-deserving students seeking to

add their skills, energy and intelligence to the Iowa

nursing workforce.

Please consider donating this year to INF to help

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April, May, June 2021 Iowa Nurse Reporter • Page 15

Leadership Visited and Revisited

Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, FAANP (hon)

Director, Marian K. Shaughnessy Nurse Leadership Academy

Elizabeth Brooks Ford Profession of Nursing | Frances Payne Bolton School of Nursing

Distinguished University Professor | Case Western Reserve University

“So what is leadership?” This is the simple (yet complex) question that I am

often asked.

Here are the answers I provide:

Leadership is part of your being, the moral compass that permeates all that you

do, say and believe.

Leadership is an attribute that is reflected in your everyday interactions with

everyone in your orbit, your family and friends, your co-workers, and those who

you barely know, but with whom you have contact.

Leadership is being authentic in the way you behave with others, the

communication that you share and the feelings and thoughts that you have.

Leadership is also a set of skills, learned behaviors that encourage others toward a

shared vision, common goals, and a greater purpose.

Leadership is finding meaning and purpose in your work.

Leadership is modeling the way in everything that you do and say.

Leadership is self-awareness, listening to yourself, reflecting on your own beliefs,

your knowledge and skills.

Leadership is doing what you can to actualize your unused potential.

Leadership is managing conflict to create true win-win situations.

Leadership is learning from others, the children in the playground who are

spontaneous in their support of each other, and the board members in the

meeting who are supportive in their own way.

Leadership is humility, knowing that none of us is infallible.

Leadership is a belief in the power of our collective humanity, working together

for the good of all.

Leadership is sharing your deepest convictions about the way that nursing and

health can and should be, reaching for the stars that promote health as a right

and not a privilege.

Leadership is caring for those most vulnerable, the neglected, the ill, the downtrodden,

the marginalized…just as nurses do every day in every organization.

Leadership is listening to those whose views are radically different from yours and

trying to find a common purpose and a common ground for the good of all.

Leadership is professionalism, understanding the social contract that we as nurses

have with the public, upholding our ethical obligations to all in our care, and living

our professional nursing standards.

Leadership is assuming responsibility for our own actions, being accountable for our

actions and understanding the consequences.

Leadership is pushing the boundaries when the boundaries need to change.

Leadership is investing in others’ greatness.

Leadership is identifying needed change and creating the vision and processes to

initiate change.

Leadership is providing guidance, to individuals, groups, and organizations.

Leadership is active and decisive decision-making to achieve shared goals.

Leadership is taking a risk, to implement a vision and achieve goals.

Leadership is understanding yourself, being aware of your potential and the power

of intentional communication.

Leadership is building relationships with those who can help you and those you can

help, building relationships for the purpose of helping others to actualize their potential.

Leadership is mentoring others, and allowing yourself to be mentored.

Leadership is promoting collaboration and building community.

Leadership is knowing when to step back, when there is an affront to your integrity.

Leadership is being transformational.

Leadership is being an advocate, for patients, for colleagues, and for the public health.

Leadership is being a trusted professional.

Leadership is motivating others to act.

Leadership is embracing change and effecting change as needed.

Leadership is acclaiming others’ successes and assisting them to achieve their

highest potential.

Leadership is YOU!

How many of these leadership attributes describe you?

Which of these leadership attributes do you want to develop or strengthen?

What is your plan to make it happen?


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