Nevada RN - March 2011


March 2021 • Volume 30 • Number 2





2 NNA’s Call to Serve

6 NNA is recruiting for the position

of Executive Director!

6 Healthy Nurses

7 Get engaged for the 81st Nevada

Legislative Session!

9 Support the Next Generation of

NV Nurses

15 Welcome Board of Nursing

Director of Education

16 The Quest for Warm and Fuzzies

in the Age of Physical Distancing

17 INTERVIEW: Through the Eyes of a

Nevada Nurse

18 Best Practices for Online Meetings

19 UNLV Nursing Program Jumps

into Top 10 Best Online Programs

20 The Effects of COVID-19 on Organ

Donation and Transplantation

21 Focus on Fighting the Pandemic,

Not Each Other

regular features

4 NNA’s Current and New


8 Research & EBP Corner

10 NNA Environmental Health


12 Antimicrobial Stewardship -

Infection Prevention

14 Nurses in the News

22 Nevada Nurses Foundation


The Nevada Nurses Association is a constituent member of the American Nurses Association

Quarterly publication direct mailed to approximately 1,000 RNs and LPNs and

delivered electronically via email to 40,000 RNs and LPNs in Nevada

The President’s Message

Looking for Some ‘Good Trouble’

Mary Bondmass, Ph.D., RN, CNE, President,

Nevada Nurses Association

The American Nurses Association (ANA) Enterprise

joins the World Health Organization (WHO) and

global colleagues in extending the Year of the Nurse

into 2021. This recognition builds on the increased

visibility of nurses’ contributions from 2020 and ANA’s

expansion of National Nurses Week to Nurses Month

in May.

Dear Colleagues,

Isn’t it great that NNA’s

parent organization (ANA), and

the WHO are extending the

Year of the Nurse into 2021? It

truly is a cause for celebration,

but with this celebration let

us not forget to reflect on our

roots and those that came

before us in our profession. Of

course, upon reflection, the

first name that may come to

most of us might be Florence Nightingale; however,

was Nightingale the paragon of virtue that the majority

of our nursing textbooks indicate, or did she have

racist views and actions, as some of our colleagues at

home and across the globe opine? What, Florence was

a racist?! Say it isn’t so! Well, here is where the ‘good

trouble’ comes begins.

While it may not be comfortable to do so, let's

start this conversation, and you decide the issue of

Nightingale's actions for yourself. Investigating our

roots honestly and transparently makes us all fully

informed to offer our opinions credibly.

My thoughts (not speaking for NNA, but myself) are

that while many of Nightingale’s writings and behaviors

may not have been outright racist, given the time in

history she lived. Still, she was not anti-racist either,

and some may say that if you are not anti-racist, you

may be what you are not against. A more inclusive

and historically correct approach might include other

nurses, who were contemporaries of Nightingale’s, e.g.,

Mary Seacole, as exemplars of our profession’s heroes.

I challenge anyone surprised or shocked by the

previous paragraphs I have written to check out

the resources provided and join me in some 'good

The President’s Message continued on page 3

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Mark Your Calendars

Nominations for NNA positions Now Open!!

Tea on the Comstock! June 26, 2021

Page 2 • Nevada RNformation March, April, May 2021

NNA Mission Statement

The Nevada Nurses Association promotes professional nursing practice through NNA’s Call to Serve

continuing education, community service, nursing leadership, and legislative

activities to advocate for improved health and high quality health care for citizens of


NNA State Board of Directors

Mary D. Bondmass, PhD, RN, CNE ..............President

Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC .......Vice President

Sherrie Sherk-Olson, BSN .........................................Secretary

Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE .........Treasurer

Arvin Operario ...........................................Director at Large

Christa Secord, MSN, FNP-BC ................Director at Large

Norman Wright, RN, BSN, MS ...................Director at Large

Darlene Bujold, BSN, RN ...............President, District 1

Margaret Covelli, DPN, RN ..........President, District 3

Editorial Board

Managing Editor, Linda Bowman, RN,

Print Editor, Kathy Ryan, MSN, RN-BC

Dear NNA Member,

NNA invites you to share your talents, insight, and experience to help shape the

future of nursing and healthcare. Consider becoming a candidate for a volunteer

position with Nevada Nurses Association!

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of NNA are to advance and uphold excellence, integrity, and autonomy in the

practice of nursing, and to advocate for accessible, quality health care for all. Serving

on an NNA board allows you to actively play a part in activities that impact nursing

practice and health care.

Mary D. Bondmass, PhD, RN, CNE

Tracey Long PhD, APRN-BC

Lisa Pacheco, MSN, RN

Bernadette Longo, PhD, RN, FAAN

Vicki Walker DNP, BS RN

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March, April, May 2021 Nevada RNformation • Page 3

The President’s Message continued from page 1

trouble’ by either submitting an op-ed for the next

RNFormation or making a comment online.

Below is a verbatim article from Nursing Clio, an

open access, peer-reviewed, collaborative blog that

presents the case against Nightingale and a link to

where you can join the conversation. Given that

the ANA and the WHO have continued the Year of

the Nurse into 2021, I believe it is appropriate for us

to carry on the conversation that gained so much

attention with Nightingale’s 200th birthday celebration.

The Racist Lady with the Lamp

By Natalie Stake-Doucet

SOURCE: Nursing Clio 11/5/2020

Nursing historiography is centered on whiteness.

Even worse, nursing history revolves largely around

a single white nurse: Florence Nightingale. This,

unfortunately, doesn’t mean nurses understand who

Nightingale was. There are nurse historians doing

incredible and diverse work, but in general, nursing,

both as a profession and as an academic discipline,

promotes a view of Nightingale based in a culture of

white supremacy rather than historical facts. Here,

I make explicit Nightingale’s role in British colonial

violence by analyzing some of her writings on the

British colonies. This history allows us to better discuss

the consequences of her legacy in nursing.

Indigenous traditions offended the “cleanliness”

ideal of Victorian Britain. Miasma theory conveniently

supported British supremacy and was a pillar of

public health until the end of the 19th century. More

importantly, it was a political weapon to destroy

Indigenous health and wellness traditions, as it labelled

anything non-British or non-Christian as “filthy.” It is

inaccurate to assume that when Nightingale speaks

of “cleanliness” it is somehow detached from its

ideological roots. When she speaks of cleanliness, filth,

or foulness, there is always an implicit Christian bias.

She could never have supported any form Indigenous

health practices because they were not based in

Christian values.

Natalie Stake-Doucet is a registered nurse, activist,

and PhD candidate. She is passionate about nursing

history, and she studies the socio-political structure of

hospitals in relation to nurses and nursing work.

You can add your opinions and start some ‘good

trouble’ for yourself at the link below or

An opposite view and a response from the

Nightingale Society can be found at the link below.


Some other references are below to help you with

your journey into what may be ‘good trouble’ for you


‘A Letter From Florence Nightingale’. (1924, 1 July). Kai Tiaki:

The Journal of the Nurses of New Zealand, Vol 17(3),



Rodgers, J A. (1985). Nursing Education in New Zealand,

1883 to 1930: The Persistence of the Nightingale

Ethos. MA thesis, Massey University, Palmerston North.

McDonald, L. (Ed.). (2004). Florence Nightingale on Public

Health Care – Collected Works of Florence Nightingale,

Volume 6. Waterloo, Canada: Wilfrid Laurier University

Press, pp 183-5.

Nightingale, F., & National Association for the Promotion

of Social Science. (1865). Note on the aboriginal races

of Australia: a paper read at the annual meeting of

the National Association for the Promotion of Social

Science, held at York, September, 1864. Retrieved from

Waitangi Tribunal. (2019). Hauora – Report on Stage One

of the Health Services and Outcomes Kaupapa Inquiry.

Lower Hutt: Legislation Direct. Retrieved from https://


Please send comments to this article to the

RNFormation Editor (, and let

us know if we can publish your comment,

Respectfully yours,

Nightingale and Colonialism

What is rarely discussed in nursing history is

Nightingale’s racism and her political role in the

genocide of Indigenous people under British rule. She

counseled many key political figures and her writings

on the subject show that she was a staunch supporter

of British colonialism, even with the knowledge of the

death and destruction left in its wake. She believed

Indigenous lives were a small price to pay for the

expansion of the British Empire. Although some of her

contemporaries recognized the brutality of the colonial

system, Nightingale believed imposing British culture

to be necessary. Anything else, she believed, “would

be simply preserving their barbarism for the sake of

preserving their lives.” 1

This racist statement by Florence Nightingale is one

of many. Thanks to digitization efforts, her writings

are now accessible, and it’s easy to find sources that

reveal Nightingale’s racism. She was steadfast in her

belief of the supremacy of white Christian culture. By

her own accounts, Nightingale considered Indigenous

peoples to be inferior, and the British state to be a

“civilizing” force. The quote above is from Nightingale’s

Sanitary Statistics of Native Colonial Schools and

Hospitals, published in 1863, a report commissioned

by the Colonial Office of the British government. In it,

she concluded that the high death rates of Indigenous

people in colonial schools and hospitals reflected the

haste of British authorities to assimilate them. She

felt assimilation should be more gradual in order to

minimize the death toll, but she had no issue with the

death toll itself: “Every society which has been formed

has had to sacrifice large proportions of its earlier

generation to the new conditions of life arising out of

the mere fact of change.” 2

In the report, Nightingale defended the deaths

of Indigenous children in the Canadian precursors

to residential schools: “There is nothing in the school

education as described in the returns, sufficient to

account for the special prevalence of tubercular

diseases in these schools. The causes must probably be

looked for in the close foul atmosphere of the native

dwelling.” 3 Her comments on the Canadian situation

were indicative of her larger position: that the deaths

of Indigenous people was due to habits of Indigenous

people themselves, and that British rule catalyzed a

process of “decay” already in motion.

Victorian “Cleanliness” and Miasma Theory as

Ideological Weapons

It is important to understand the meaning of

cleanliness within the Victorian era and for Nightingale.

Cleanliness was a synonym for purity, and the Victorian

rituals attached to it came with a sense of godly

supremacy. 4 It is beyond the scope of this article to

discuss the ideological roots of the term, but it went

hand in hand with the miasma theory of disease,

which Nightingale believed until the end of her life.

Miasma theory held that bad smells and filth generated

disease. Filth was not just physical, it was also moral.

For example, under miasma theory, Nightingale

believed sex workers embodied evil that spontaneously

generated disease. As Nightingale explained: “When

we obey all God’s laws as to cleanliness,…, health is

the result. When we disobey, sickness.” 5

One of the few pictures of Nightingale

contemporary, Mary Seacole, (above photo by an

unknown author in the public domain)

Mary Bondmass, Ph.D., RN, CNE

President, Nevada Nurses Association

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Lori Eustis

Lori Baumann

Lori Marhanka

Lori Candela

Lorraine Noonan

Lorraine Bonaldi

Lorraine Jill De Borja-


Lorri Lantz

Lowryanne Vick

Luis Vidana

Luis Rodriguez

Luz Aragon

Lya Taylor

Lynn Taylor

Lynn Von Schlieder

Ma Renzel Therezna


Mackenzie Butler

Maddalena Fontein

Madelin Torres

Mae Nekoba

Maelaurece Plaza-Cross

Magdalena Rodriguez

Malcolm Aquino

Manasseh Chibwe

March, April, May 2021 Nevada RNformation • Page 5

Maquette Thompson

Marc Amorelli

Marcie Zajac

Marco Cerda

Margaret Calavan

Margaret Sanger

Margaret Covelli

Margo Baxter

Maria Elario

Maria Sampang

Maria Amezcua-Huerta

Maria Angela Nina Vela

Maria Concepcion


Maria Gina Agnir

Maria Mernina April


Maria Monica Aragon

Maria Rizel Sturgell

Maria Rosario Wood

Mariah Dasilva

Marian Gnandt

Maribel Gomez

Maribeth Fontanilla

Maricel Olan

Marie Luback-Neves

Marie Reyrao

Marie Snook

Marife Aczon-Armstrong

Marilyn Getty

Marisa Wilkinson

Marisa Leah Dela Rosa

Marisela Castorena

Marizel Yukee

Marjeana Lampson

Marjorie Adams

Mark Ferratt

Markeeta Araujo

Markita Griffin

Marlene Kramer

Marphyrose Galang

Marsha Park

Martha Hobby

Martha Drohobyczer

Mary Mackenzie

Mary Courtney

Mary Bondmass

Mary Field

Mary Manoharan

Mary Jingeleski

Mary Whitield

Mary Headley

Mary Huntly

Mary Flint

Mary Mcconville

Mary Earl

Mary Reed

Mary Foster

Mary Denisse Toribio

Maryangelique Sampson

Maryann Tolzien

Maureen Barnes

Maureen Nolen

Mavirginia Espanol

Maya Washington

Maylene Culanag

Meg Hopper

Megan Remien

Megan Gates

Megan Gill

Megan Martinez

Megan Testa

Meia Ford

Meilan Daguman

Melanie Lunghi

Melanie Sharpley

Melanie Lentz

Melany Roque

Melba Schwinghamer

Melisa Smith

Melissa Ridella

Melissa Dorman-Ellis

Melissa Washabaugh

Melissa Cook

Melissa Rosales

Melody Talbott

Melody Tulloss

Mercedes Ocan

Merete Egloff

Merle Williams

Mi’lan Jones

Michael Mcevoy

Michael Bass

Michael Yazinka

Michael Loehr

Michael Basinger

Michael Rice

Michael Cowles

Michele Rath

Michele Arce

Michele Wijangco

Michele (Shelly) Alfaro

Michelle Dunne

Michelle Bland

Michelle Dix

Michelle Albaran

Michelle Sarvela

Michelle Wagner

Michelle Podlesni

Michelle Reynolds

Michelle Dirks

Mika Martin

Mindy Triola

Miriam Volpin

Mojisola Balogun

Mona Beerbower

Moneshia Perkins

Monica Ranada

Monilisa Aquino

Monty Gross

Myra Davis-Alston

Myra Tomas

Nadia Luna

Naitte Jordan

Nanci Quinn

Nancy Bartlett

Nancy Legaspina

Nancy Gubler

Nancy Nurse

Nancy Brewster-Meredith

Nasim Akbari

Natalie Nicholson

Natasha Ross

Natasha Tretheway

Nathan Fowler

Nayeli Melendez

Nelly De Dios

Nemia Chiang

Nethaniah Isip

Ngozi Ajiri

Nicholas Muir

Nichole Fritel

Nicola Aaker

Nicole Caturay

Nicole Gooden

Nicole Courts

Nicole Carr

Nicole Hunt

Nicole Gregorio

Nicole Vaughn

Nicole Miskiewicz-Nelson

Nobuko Wallace

Nonette Chee

Noni Hayman

Norah Lusk

Norman Wright

Nubia Garbutt

Nutchar Ploymee

Odessa Gregorio

Ofelia Esguerra

Ogonnaya Onyema

Okechukwu Olisa

Olga Bienvenue

Oluyemisi Adedotun

Omana Olickal

Ozioma Nwosu

Pamela Johnson

Pamela Adzima

Pamela Guerra

Pamela Burnley

Pamela French

Patrice Gallagher

Patricia Crepps

Patricia Fries

Patricia Strobehn

Patricia Prevosto

Patricia Busch

Patricia Brown

Patricia Alpert

Patricia Correll

Patricia Simmers

Patrick Bucayu

Paula Williams

Peggie Black

Peggy Ince

Peggy Lee

Peggy Kamper

Perla Labastida Espejel

Petal Codrington-Martial

Phoebe Sampang

Precious Achuff

Priscilla Nelson

Priscilla Austin

R Danessa Rebello

Rachel Likes

Rachel Michaels

Rachel Juell

Rachel Moore

Rachel Linnecke-


Rachell Ekroos

Rachell Anne Agas

Ramona Chatman

Rannie Deguzman

Raquel Welsh

Raynette John

Rebecca Black

Rebecca Gansberg

Rebecca Roleff

Rebecca Pierce

Rebecca Graham

Rebecca Cormier

Rebecca Hayslett

Regina Mcferren

Reginald Reyrao

Remedios Jallorina

Renate Jeddahlyn Flores

Rene Wood

Renee Villarruel

Renee Page

Renee Hinojosa

Renee Todd

Renegade Scott-Feagle

Rhea Bautista

Rhigel Tan

Rhonda Strunk

Rica Santa Maria

Rich Janel Suanes

Richard Becker

Rita Siu

Rizza Marie Tawatao

Robert Lopez

Robert Welch

Robert Fox

Robert Erickson

Robert Sullivan-Fisher

Robert Briseno

Robin Hoover

Robin Branham

Roger Patricio

Roland Villareal

Rona Yee

Rona Divinagracia

Ronald Mirano

Ronnie Bordador

Rosalba Renteria

Rosalyne Reynolds

Roscelle Jhoyce Minoza

Rose Hettinga

Roseann Colosimo

Rosemary Witt

Rosemary Gharibian

Rosemary Thuet

Rosetta Longstreet

Roshele Ward

Rowena Mananquil

Rowena Dioquino

Ruth Politi

Sabina Grimes

Sabrina Bratcher

Sally Jost

Sally Adams

Samantha Jones

Samantha Thornton

Samantha Chanel De


Samantha-Rose Threats

Sandra Turner

Sandra Rodriguez

Sandra Talley

Sandra Doolin

Sandra Pierre-Louis

Sara Maul

Sara Mcknight

Sarah Moore

Sarah Johnson

Sarah Linaman

Sarah Webb

Sarah Herbert

Sarah Mccalden

Sarah Maciolek

Sarah Bussmann

Sarah Rose Nelson

Saundra Hart

Savalla Mcleod

Schlene Peet

Sequoyah Tomlinson


Shana Blakely

Shannon Murray

Shannon Grella

Shannon Chartrey

Sharean Oxley

Sharon Freier

Sharon Szeman

Sharon Mann

Sharon Oetting

Sharon Attaway-Hett

Shasta Taylor

Shaun Hasty

Shauna Aranton

Shaunta Brown

Shawn Deal

Shawn Joseph

Shawna Senart

Sheery Villagracia

Sheila Parker

Sheimon Capiendo

Shelby Temple

Shelia Bien

Shelly Nicola

Shelly Soto

Sheri Park

Shermeka Tubbs

Sheron Williams-Nevens

Sherri Yagoubi

Sherri Lindsey

Sherri Howell

Sherrian Miles

Sherrie Olson

Sherry Stofko

Sheryl Bennett

Sheryl Cipollini

Shirin Nazarian

Shirley Caldwell-Butts

Skyler Basanez

Sonia Wyatt-Wright

Sonja Poppenhagen

Sophia Student

Stacey Earley

Stacey Hunt

Stacey Lea Spahn

Staci Thompson

Staci Garner

Stacy Springgate

Stacy Rust

Stacy Thaler

Stacy Wilson

Stacy Demitropoulos

Stephanie Latta

Stephanie Parker-Hyman

Stephanie Prather

Stephanie Crim

Stephanie Dress

Stephanie Curry

Stephanie Herrera

Stephanie Guerrero

Stephanie Hollister

Stephanie Melcher

Stephanie Neder

Stephen Lester

Steven Knott

Susan Hubbard

Susan Becker

Susan Vanbeuge

Susan Growe

Susan Ervin

Susan Englen

Suzann Gordon

Suzanne Duroy

Suzanne Dessaints

Suzanne Elnagar

Sylvia Fernandez

Tabbly Taylor

Tamara Duff

Tamara Mette

Tamasha Benson

Tamera Allred

Tami Beckett

Tammam Whalen

Tammy Bambic

Tanya Lazorwitz

Tanya Liscio

Tara Alcid

Taylor Perry

Tendai Gombe-Lane

Teresa Mercado

Teresa Praus

Terri Vinson

Terry Stanley

Thelma Pacheco

Theresa Gordon

Theresa Brown

Theresa Spina

Theresa Carr

Therese Rohling

Tiffani Lenzi

Tiffany Febre

Tiffany Ramirez

Tiffany Vincent

Tiffiny Cicero

Timothy Hargrove

Tina Procter

Tina Verret

Todd Erickson

Todd D’braunstein

Todd Isbell

Tomas Walker

Toni Orr

Tonya Bryant

Tori Davis

Toya Lewis

Tracey Mccollum

Tracey Silva

Tracey Johnson-Glover

Tracie Gust

Tracy Harig

Trina Hammond

Trinette Broom

Tristen Wydeman

Trixia Mora

Tymeeka Davis

Tysha Jones

Valan Kam

Valeria Melendez Estrada

Valerie Jakubos

Valerie Castaneda

Vanessa Obando

Vanessa Parker

Vanessa Izquierdo

Veda Sargent

Vera Sverdlovsky

Veronica Dunn-Jones

Veronica Brady

Veronica Niki James

Vicki Walker

Vicki Wolms

Vickie Mcpherson

Vicky Lang-Catlin

Victoria Volz

Virginia Enns

Virginia Williamson

Virginia Hayes

Visminda Tagbo

Vivian Smith

Wanda Sheppard

Wanda Macfarlane

Winnie Chua

Xandee Shirley Bernabe

Xenia Daffodil Valles

Yarleny Roa-Dugan

Yashmine Ballesteros

Yvette Medlin

Yvonne Anderson

Yvonne Modarres

Zachary Bunker

Zachary Ashton

Zhuoya Mai

Page 6 • Nevada RNformation March, April, May 2021

Healthy Nurses

Tracey Long PhD, MSN, APRN-BC, CCRN

Feb 2021

NNA is recruiting for the position of

Executive Director!

The board of the Nevada Nurses Association voted to invest in hiring a full-time

Executive Director. (30-39 hours). Below is a link to the job position description.

Nevada Nurses Association has such an opportunity to make a difference to nurses

in Nevada. Hiring an experienced Executive Director will bring NNA to the forefront

in guiding positive and productive changes for nurses in our state.

At a minimum, the right candidate should have excellent communication skills,

strong organizational and project management skills, the ability to develop detailed

plans, familiarity with association management organizations and processes.

Click here for Job Description

If you are interested in the Executive Director's position, please reach out to

President Mary Bondmass at or Director of Operations,

Linda Bowman at

Dismantling Systems of Oppression

Patrice Hester-Harper, M.Ed.

Assistant Dean for Administration, Outreach, and Engagement

School of Nursing University of Nevada, Las Vegas

This February, UNLV School of Nursing successfully concluded its new speaker

series, “Conversations with Leaders on Dismantling Systems of Oppression.”

Open to all, the limited event consisted of four 1-hour virtual lectures, each with a

different special guest and topic to discuss systemic racism and how to neutralize it.

Through historical and modern examples, speakers presented scenarios and possible

solutions to address these issues.

Our list of special guests comprised of experts from both the U.S. and Canada

who are nationally recognized and leaders in their respective fields. Speakers

included PhD candidate Natalie Stake-Doucet (Examining Florence Nightingale’s

complicated history); Drexel University Professor Dr. Roberta Waite (Achieving Health

Equity); Emory University Associate Professor Dr. Kylie Smith (Race and Racism in

U.S. Healthcare), and UNLV Professor Dr. Tyler Parry (Implicit Bias).

The origin of the Speaker Series was born in the aftermath of renewed national

calls for ending oppression in all societal facets in 2020. School of Nursing Dean

Angela Amar proposed a format to address these issues within SON. But the tools

learned to combat racism had additional value for healthcare professionals and

students; nurses frequently encounter racial disparities on the frontlines. While

the scope of the Series was not specifically for nurses and healthcare, audience

members (which were primarily nursing-related) could use the information and

consider applying the proposed solutions in their own careers.

Furthermore, UNLV Nursing’s Speaker Series reinforced its commitment to

diversity, equity and inclusion in addition to continuing its mission of educating

nurses to meet the health care needs of Nevada and beyond. UNLV School

of Nursing offers both undergraduate (traditional and accelerated) tracks and

nationally recognized online graduate programs. In 2021, U.S. News and World

Report ranked the SON Online Master’s program 7th in the nation, up from 11th in

2020. Additionally, UNLV Nursing was named a Center of Excellence in 2019 by the

National League for Nursing.

One lesson we all learned in 2020 was how precious and

fragile our health is. Nurses on the forefront saw firsthand

how delicate life can be as they navigated the challenges

of too many patients and too little personal protective

equipment. We also learned how tender our mental health

can be and many who we never even considered would

have threats to their mental well-being. The silver lining

in a chaotic world threatened by a global pandemic is the

awareness and focus again on our health. Ironically, nurses

who work in the healthcare industry are often not very

healthy individuals. Many of us tend to work too hard, sleep

too little, fail to empty our bladders regularly, eat sugary

comfort foods during difficult shifts to reward ourselves, and justifiably resist aerobic

exercise after a long 12-hour shift. Then its wash, rinse and repeat to do it again

the next day. No wonder nurses often feel exhausted, worn-out and have brain

fog. Even before the pandemic and added emotional trauma and stress on nurses a

study in 2017 revealed up to 63% of hospital nurses claim burnout and are at risk of

compassion fatigue (Crewe, 2017).

The American Nurses Foundation, which is the philanthropic arm of the American

Nurses Association has issued a call to arms to improve the health of our nation’s

nurses. The initiative has given us practical tools to help us succeed. The Wellbeing

initiative was developed for nurses by nurses. The Foundation partnered

with the American Nurses Association (ANA), the Emergency Nurses Association

(ENA), the American Association of Critical Care Nurses (AACN), and the American

Psychiatric Nurses Association (APNA) to address the physical and emotional

stresses our nation’s nurses have experienced due to the worldwide pandemic. The

digital resources include the format to join online groups and express themselves

in narrative journaling. Resources and tools also include online forums such as

peer-to-peer conversations, hotlines, learning cognitive processing techniques and

learning preventive actions such as stress reduction, and mindfulness. The hotlines

and peer conversations are held by volunteer nurses as the healers reach out to heal

each other during the difficult times of the Covid-19 pandemic. The partnership

also developed two apps for easy download on smart phones called the “Happy

App” and “Moodfit” mobile app to support nurses in their individual wellness

goals and habits of health. The apps can be found on your smart phone store or

for download at Additionally, the Well-being Initiative offers a

self-assessment tool and mental health hotlines for nurses.

Information about the full initiative can be accessed at https://www.

In addition to the mental health and wellness nurses face personally, we also face

questions from patients, friends and neighbors about which supplements should

be taken to hopefully prevent Covid-19 infections or strengthen our own immune

system. There is a wide variety of opinions and limited evidence-based studies to

declare definitively which supplements should be taken. Nurses must be well

educated and informed to effectively educate our public.

Reputable resources to learn about such supplements as Vitamin D3, Zinc,

Vitamin C, Biotin, colloidal silver, herbals and botanicals can be found at the

following sites:

o National Center for Complementary and Integrative Medicine: http://nccih.

o Natural Medicines:

o FDA tainted product list:



o Tips for Dietary Supplement Users:


o Tips for Older Dietary Supplement Users:


o HerbList App (free from NIH):

o Merck Manual Online Chapter on Dietary Supplements (for consumers and

health care professionals):


o Dietary Supplements Part 1:

o Dietary Supplements Part 2:


Crewe, C. (2017). The Watson room: Managing compassion fatigue in clinical nurses

on the front line. Virginia Henderson Global Nursing Repository. https://sigma.

West Hills Hospital located in Reno, NV, a leader in

the treatment of behavioral, mental health care and

substance abuse treatment is seeking FT/PT/PRN

Registered Nurses to implement the nursing process

as it relates to our programs.

Visit and click on

CAREERS to apply.

To access electronic copies of the

Nevada RNformation, please visit

March, April, May 2021 Nevada RNformation • Page 7

Get engaged for the 81st Nevada Legislative Session!

powerful and meaningful to your elected official.

A quick search of the Nevada legislature NELIS

system revealed nine current bills with the word

"nursing." Another search of "health care" revealed 35

bills. It is still early in the session, and many bill draft

requests are still in progress, and the expectation

is that more bills will come forward, impacting

health care, patient access to care, and nursing as a

profession. The final budgets will also have an impact

on our patients enrolled in Medicaid and other state


Take time to look at the Nevada Legislature website

to learn about the bills in front of your elected officials.

Attend the committee hearings and general sessions

utilizing the YouTube channel the legislature has set

up this year. You may also offer public comment in

hearings to be part of the process.

There are many ways to be engaged in the legislative

process, and this year is no less important. It may feel

a little different this year because we aren’t there in

person on Nurses Day at the Legislature, but your

voices are no less diminished. I would say the opposite.

This year we need to advocate for our profession, our

patients, and our health in every way possible. See you

at the legislature!


Sebelius, S. (2020). For Nevada lawmakers in 2021, it’s

all about the budget. Las Vegas Review-Journal,

December 28, 2020. Downloaded from https://



APRNs at the Legislature 2019

L-R: Susan VanBeuge, DNP, APRN; Maileen Ulep,

APRN; Sheryl Giordano, DNP, APRN; Teresa

Praus, DNP, APRN

Susan S. VanBeuge,


As you read this article, the 81st (2021) Nevada

Legislature has been in session for nearly two months.

While the session's delivery looks a little different

via online meetings and various means to connect,

the work of the legislative process continues to move


The importance of nurses' engagement in the

legislative process is no different today than in the 1st

session. As a state, we face many challenges in health

care, budgets, and the economy (Las Vegas Review-

Journal, 2020). The pandemic has stretched over the

last year, causing strain on an already overburdened

system and shining a light on the fissures in areas of

access to care.

In 2020, nurses were ranked as the most trusted

profession for the 19th year in a row. This year,

nurses' position rose by 4% since the 2019 poll. Not

surprising, as this year, nurses rolled up their sleeves in

every corner of practice and did their work. From the

bedside, to leadership, advanced practice, and mass

volunteering, nurses performed above and beyond


As a group, we have a powerful voice and stories

to share. We are an evidence-based profession and

discipline with our underpinnings in science and

communication. The experiences from bedside to

boardroom make our voices powerful to the legislature

members as subject matter experts. If you have not

looked up your representatives, take time to know who

your State Senator and State Assembly representatives

are. Once identified, send them an email, and introduce

yourself as their constituent. Let them know you are

a nursing professional and what you do and offer

to be their subject matter expert on nursing. Get to

know your elected representative so that when you

have a question, comment, or opinion on how they

should vote on a bill you’re interested in, then you

have established the relationship to have a meaningful

conversation pertinent to the issue on the table. After

you’ve taken time to meet your state elected officials,

next write to your national representatives. They have

your voice in Washington D.C. at our Nations Capitol,

impacting laws and governance over practice, parity in

pay, and many access to care issues affecting advanced

practice nurses.

Our elected officials want to hear your experiences,

stories, and opinions. Your advocacy for the profession

is where the strength lies as an individual citizen. Our

professional groups are out there advocating for us

as nursing professionals, but your individual voice is

Legal Representation for

Medical Professionals

If the board calls, we have the answer!

Our attorneys have been protecting the livelihood of

doctors and nurses in Nevada for over 40 years.

Clark Hill is a multidisciplinary, national law firm that

draws on our attorneys’ industry and policy knowledge,

our deeply held shared values, and a global network of

premier firms and advisors to provide innovative legal

solutions and client-service excellence worldwide.

Contact John A. Hunt, Esq.


Page 8 • Nevada RNformation March, April, May 2021

Research & EBP Corner

Nursing Application of Light Sedation for Mechanically

Ventilated Patients

Mary Bondmass, Ph.D., RN, CNE

This RNF feature presents abstracts of research and evidence-based practice (EBP)

projects completed or spear-headed by nurses or student nurses in Nevada. The

focus is on new evidence (i.e., research) or the translation of evidence (i.e., EBP) in

Practice, Education, or Research. Submissions are welcome and will be reviewed by

the RNF editorial board for publication; send your abstract submission in a similar

format used below to

Kelsey Swanson, DNP(c) University of Nevada, Reno

Featured EBP in this edition is Kelsey Swanson’s DNP

project. Kelsey has been a cardiac ICU nurse for five years.

She is currently completing her DNP at Orvis School of

Nursing at the University of Nevada Reno. Kelsey is in the

Adult Gerontology Acute Care Nurse Practitioner Track and

will be graduating in May. An abstract of her final project is


Kelsey intends to pursue a career as a hospitalist NP.

Background: Patients with acute respiratory failure are

routinely cared for in intensive care units (ICUs). Decompensation in respiratory

status can be related to a primary pulmonary etiology or secondary to another

acute illness. Many of these patients require the use of a ventilator to maintain

adequate oxygenation. Historically, the use of pharmacologic sedatives in intubated

patients has been common practice. Growing evidence suggests that these

medications extend intubation duration, hospital lengths of stay, delirium, and

long-term cognitive and mood disorders (Peitz et al., 2013). Literature supports

the use of analgosedation, which focuses on pain management before sedation in

mechanically ventilated patients (Devlin et al., 2018).

New research and literature are available that condones the use of lighter sedation

of mechanically ventilated patients. Traditional sedation practices have been shown to

be harmful to patients as they are linked to poor short-term and long-term patient





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outcomes. Intubation times and ICU length of stay are prolonged with heavy sedation

(Treggiari et al., 2009). Heavy sedation puts patients at risk for further complications.

Cognitive function and mood disorders can also be negatively impacted by deep

sedation in mechanically ventilated patients (Treggiari et al., 2009).

Purpose/Methods: This project aimed to advocate and collaborate on behalf of

the nursing discipline in a quality improvement initiative. "Sedation Light" refers to

medication changes to achieve the desired Richmond Agitation and Sedation Score

(RASS) of -1 to +1, as well as the clinical challenges associated with this change.

“Sedation Light” utilizes fentanyl, propofol, and dexmedetomidine. This project

worked to improve nursing care and moral related to “Sedation Light." Specifically,

his project aimed to work with an interdisciplinary team and implement evidencebased

changes to improve nursing care related to "Sedation Light." This project

provided support, education, and advocacy for nursing throughout this transition in

sedation practices to change nursing culture.

Adult learning theory (Knowles, 1973) and Kolcaba’s theory of comfort (Krinsky

et al., 2014) guided this project's implementation.

A special interest group of “Sedation Light Implementation Champions” (SLIC)

was assembled under the DNP student's leadership. This group served as a resource

for nursing staff and was available on most shifts. SLIC supported nursing staff

during shift work and advocated for appropriate application of sedation light

flow sheets compiled by pharmacy. SLIC was closely involved with education and

supportive efforts for staff nurses.

Education for nursing staff was a primary component of this DNP project.

Education was key to nurse endorsement of reducing sedation in mechanically

ventilated patients. Numerous forms of education were offered to allow nurses to

choose which format is most beneficial to them. Presentations of analgosedation,

pain and sedation assessment, and long-term effects of heavy sedation were

presented in unit staff meetings. Pamphlets and tip sheets were created, and SLIC

completed in-services. These individual or small group learning sessions allow for

an intimate discussion of challenges specific to individual patients. Troubleshooting

has been available through these in-services and can help make bedside nurses feel

supported in their challenges.

A unit reference binder for “Sedation Light” was also created. It contains

several original studies for nurses curious about the efficacy of reduced sedation.

This literature can often be difficult and lengthy to read. For that reason, there are

condensed articles explaining the benefits of light sedation, easy-to-read PADIS

guidelines, and copies of "Sedation Light" flowsheets. These quick references allow

for prompt location of applicable information and return to regular nursing duties.

Offering extensive studies and condensed tip sheets allow nurses to seek the level of

knowledge they desire without overwhelming.

Results: This project resulted in an order set that decreased variability in

sedation drugs used. Implementing a facility-wide policy to support the efforts of

"Sedation Light" was a primary objective of this DNP project, and this objective was

accomplished. Qualitative data related to “Sedation Light” was collected during

daily ventilator rounds. These data include Richmond Agitation and Sedation Score

(RASS), standardized sedation awakening trials (SAT), spontaneous breathing trials

(SBT), and mobility as it relates to sedation strategies. Early on in this project, in

April 2019, all patients that qualified for a SAT had one done. In February 2020,

79% of patients qualified for a SAT, and 74% completed them. In July 2020, 86%

of patients were eligible for SAT, but only 74% had an SAT. From this data set, even

fewer patients are having these SATs paired with an SBT. The best month of paired

SAT and SBT performance is April of 2019, where 57% of eligible patients received

an SAT and SBT.

Conclusion/Implication for Practice: This project aimed to directly change

nursing culture and implement scholarly literature and research into practice.

Creating a culture change related to sedation levels in mechanically ventilated

patients is invaluable for patient outcomes. The nursing discipline must realize its

responsibility to evolve practice in the clinical setting. The nursing discipline has

valuable input for quality improvement initiatives. Nurses should seek involvement

in large practice changes, even when initiated by other disciplines. Interdisciplinary

collaboration is key to organizational success and improved patient outcomes.

Abbreviated References

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande,

P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C.,

Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X.,

Fraser, G. L., Harris, J. E., …, Alhazzani, W. (2018). Clinical practice guidelines for the

prevention and management of pain, Agitation/Sedation, delirium, immobility, and

sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873.


Knowles, M. S. 1. (1973). The adult learner: A neglected species. Houston [Tex.]: Gulf Pub.


Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba's

comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150.


Peitz, G. J., Balas, M. C., Olsen, K. M., Pun, B. T., & Ely, E. W. (2013). Top 10 myths

regarding sedation and delirium in the ICU. Critical Care Medicine, 41(9 Suppl 1),

S46-S56. doi:10.1097/CCM.0b013e3182a168f5

Treggiari, M. M., Romand, J., Yanez, N. D., Deem, S. A., Goldberg, J., Hudson, L.,

Heidegger, C., & Weiss, N. S. (2009). Randomized trial of light versus deep sedation

on mental health after critical illness. Critical Care Medicine, 37(9), 2527-2534.


March, April, May 2021 Nevada RNformation • Page 9

Support the Next Generation of NV Nurses

Iris Isabel Martinez

Karen Nava

The Nevada Nursing Student Association (NVNSA)

is holding their 3rd Annual Virtual Conference on

Saturday, May 29th, from 8 a.m. to 2 p.m., and you are

absolutely welcome to join the next generation of NV

nurses! This year's convention motto is "No limits to

success," and we hope students leave the conference

empowered and eager to start their nursing careers!

We will offer the first NVNSA Conference scholarship

to a nursing student, and the funds raised from

registration fees will help supplement this scholarship.

For the first time, we will be inviting high school

students to learn more about the life of a nursing

student and the beauty of the nursing profession. The

conference will include a resilience key-note speaker,

an NCLEX review, a guest panel of hospital recruiters,

resume and interview advice, nursing vendors, raffle

prizes, and much more!

How to Support NVNSA:

1. Join us on May 29th: Your presence will

inspire students because we look up to you. At

a certain point in our lives, we have interacted

with a nurse or nurse(s) who have changed

our lives. NVNSA and its members would be

honored to include you in our conference. The

registration fee for RN’s is $25. Register Here!

2. Donate to NVNSA: We kindly welcome all

donations. If you would like to donate, please

email that way, we

can adequately thank you at the conference and

spotlight you in our virtual convention booklet.

3. Please write an article for our 2021

Virtual Convention Booklet: The beauty of

nursing includes a lifetime of learning and the

opportunity to engage with different specialties

and providers. With that being said, if you

would like to write an article regarding the

nursing profession or even an article to support

students, we would love for you to please reach

out. We will be happy to include your article in

the convention booklet and our website! Please

email for more


4. Follow us on Social Media: Stay up to date

with all things NVNSA via our social media

platforms: @nevadansa on Instagram & @

NVStudentNurses on Facebook.

Sponsorship Plans: Professional nursing

organizations, hospital recruiters, nursing schools

(undergraduate and graduate), companies, and vendors

are encouraged to engage with the future generation

of Nevada nurses. A highlight of our conference is

allowing exhibitors to advertise their services and

network with students. If your organization/company

is interested in participating in the conference, please

register at the following link: http://events.r20.


Kobe Bryant once said, “The most important thing

is to try and inspire people so that they can be great

in whatever they want to do,” the NVNSA team strives

to uplift one another and provide as much guidance,

wisdom, and opportunities as possible because we

all are a team. Nursing is not an individual profession.

Nursing requires teamwork, trust, and the ability to

know that you are not alone and that you can ask

for help. This conference serves as a "New Grad RN

Bootcamp," a "Get to know the nursing profession,"

but most importantly, this conference is meant to serve

as a reminder that there is NO LIMIT TO SUCCESS!

Page 10 • Nevada RNformation March, April, May 2021

NNA Environmental Health Committee

Sustainable Fashion: moving from disposable fashion consumption to

ecological conservation and ethical labor practices

The fashion industry has one of the highest

environmental impacts of a commercial business on

the planet. The production of clothing results in the

use of agricultural fertilizers, pesticides, and fresh water

sources to grow the crops for fibers, along with toxic

chemicals used in dyeing and fabric preparation.

Did you know that Americans toss ~14 million tons

of clothing each year, or an astounding 80 pounds per

person (Miller, 2016; Council for Textile Recycling)? This

fabric waste and the eventual disposal of clothing through

incineration or landfill deposits are hazardous to the

environment. Incineration of clothing releases airborne

pollution from the chemical dyes or fibers, and degrading

cloth in a landfill releases methane gas and chemicals into

the water shed. Therefore, efforts are needed to reduce

environmental contamination from the fashion industry.

Keys to reducing these adverse impacts include (a) limiting

the amount of clothing produced to what is actually

needed by the population, (b) reusing or recycling existing

clothing and fabrics, (c) sustaining the life of a garment,

and (d) manufacturing garments from eco-friendly fiber

sources. All these actions can lower the carbon footprint

from the industry. To bring these actions to fruition, it is

first important to understand the barriers faced to making

a change to a more sustainable clothing industry.

Temporal Aspects of Fashion

Historically, seasonal changes in fashion were

driven by top designers and released to the industry

through the infamous “runway’ fashion shows. These

new “high end” style releases were made far ahead

of time and the subsequent copycats needed months

to manufacture cheaper replicas and get them on

the racks in retail stores. “Slow fashion” reflected the

significant time lag that occurred. Fashion was seasonal

and challenged the consumer with spending more each

year to stay in style.

Nowadays, the speed of changes in fashion has

accelerated across the whole industry – from highend

to inexpensive in-style clothing. “Fast fashion” is

manufacturing replicas of high-end style clothes that

are cheaply produced and cheaply priced. These clothes

are sourced through global production chains then

sold through store chains to consumers. The result is

excessive fabric waste that causes global toxic pollution.

Ethics of Labor Practices in Fashion Manufacturing

Every piece of clothing requires someone to sew

it, even putting in a zipper. There are no automated

machines that make garments. So, basically all

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garments are handmade or sewn on machines by

factory workers. Despite the value of the skilled

seamstress for the industry, they are often poorly

compensated. For example, a $4 t-shirt is offered at a

retail store. How much is the worker being paid that

sewed it together? Consider the pay out to the chain

of manufacturing from the farmer who grows the

crop, the production of the fiber into cloth, the fashion

designer, the seamstress who makes the garment, the

transportation crew, and finally the salesperson. Do the

math, it’s not much profit to go around.

Developing countries aim to become a part of the

world's “fast fashion” apparel market despite poor

working conditions and low pay to their workers.

Countries such as China, Honduras, Bangladesh, Sri

Lanka, and Indonesia export large amounts of clothing

into the United States every year. Look at the tags on

your garments for their origin. The incentive to the

American consumer is to buy more due to the low

price. In honest, more clothing is bought by Americans

than what is really needed.

Despite the publicity decades ago, many popular

fashion brands are still using sweatshops to

manufacture and sew their clothing (see Resources

for a list). In 2021, child labor and modern slavery

still occurs in clothing factories. Sweatshops are

known to have poor working conditions, unfair

wages, unreasonable hours, child labor, and a lack of

benefits for the workers. To protect these workers,

clothing companies can become Fair Trade USA

Apparel and Home Goods Factory certified. This

nonprofit organization offers the trusted Fair Trade

Certified seal on a product, which signifies that it was

made according to rigorous standards that promote

sustainable livelihoods and safe working conditions,

protection of the environment, and strong, transparent

supply chains. Nonetheless, until the consumption

of “fast fashion” declines, there is no incentive for

change. Consumers drive fashion production; therefore,

consumers can influence the transformation to

sustainable fashion trends.

The Principals of Sustainable Fashion

A transformation of the fashion industry is now

underway because of increased ecological awareness

and stewardship of the environment by the public.

Consumers and companies alike want industries that

respect human living conditions, protect biological life

and the environment, support cultural diversity, and

appropriately use scarce global resources. The principles

of 'green' or 'eco fashion’ consider what garments

are made of and how long the garment is used. This

fashion shift strives for garments that are seasonless

and aesthetic in style and can last a long time.

Therefore, more ”slow fashion” is making a comeback

in a new way.

The foundational concepts for sustainable fashion

are to reuse, reform or reprocess fibers from existing

garments or leftover fabrics.

• Recycled or reclaimed fibers are recovered

from either pre- or post-consumer sources.

Pre-consumer sources are unworn and

unused textile wastes from different stages

of manufacturing. For example, bundles of a

certain fabric are ordered for a dress but cutting

the pattern leaves scrapes of leftover fabric

unused. Instead of throwing it out, it can be

reprocessed. Post-consumer textiles are any

garment that has been worn and then donated

to charities to sell as bulk fabric or returned to

companies for recycling. An example is a jacket

returned to the outdoor clothing company


• “Upcycling” in fashion is the process of reusing

these unwanted and discarded materials that are

made into new materials or products without

compromising the value and the quality of the

used material.

• “Closed-loop technology” is where a product is

recycled back into almost the same product, such

as an outdoor jacket’s fibers reprocessed into a

new outdoor jacket of similar style. Technology

exists to chemically reprocess polyester into its

core components and then spin it back into

polyester thread to make new garments. In

addition, plastic bottles can now be recycled into

synthetic polyester fiber used for clothing.

Extending the lifespan of garments is also

foundational to sustainable fashion. Donations of

clothing to thrift shops allow consumers to re-wear a

garment. Yet, about 70% of what is donated never

makes it to the rack. Instead, it is sold as bulk fabric

or made into rags and cleaning cloths. In addition,

lengthening the lifespan can include re-waxing of

outdoor jackets, replacing a zipper, or repairing

expensive handbags. It’s not waste until it is wasted!

COVID-19’s Impact on the Fashion Industry

The onset of the pandemic literally shut down the

fashion industry. Orders for garments by fashion chains

were abruptly cancelled. Fashion shows were conducted

virtually across the Web. The resulting economic impact

of the pandemic forced consumers to rethink their

purchases and thereby realize they did not need as much

clothing as they use to buy. Designers and manufacturers

together were forced to reevaluate the fashion culture

and manufacturing processes of the industry. Therefore,

the pandemic helped the industry rethink “slow fashion”

with a transformation towards sustainability.

Today, many people want to wear their clothing

over time and have smaller collections that express

their personality. Designers are moving towards

green fashion and are using fibers such as hemp and

bamboo, which are softer than cotton, retain dyes

longer and are more durable for a garment’s lifetime.

Additionally, consumers have the opportunity to

support ethical practices within the fashion industry by

being thoughtful and practical in their spending.

Becoming a Sustainable Clothing Role-Model

There are many ways you can improve the

sustainability rating of your own wardrobe:

1. Rediscover your own personal style. Assess your

wardrobe and keep what you like and need and

donate the rest. Never throw fabrics out in the

trash, instead repurpose, or recycle them.

2. Wear your clothes for a long time. Embrace and

care for them.

3. When you need to, only invest in buying new

“sustainable” clothes and fabrics. Think about

where you buy from and the “Made in …” tag.

4. Research ahead of time and buy from fashion

companies that are more thoughtful on fabric

choices and support fair worker’s conditions.

5. Buy used clothing. Respectable charity thrift

stores support their organization’s mission and

clients in need, but they need your money and


6. Repair your clothing instead of throwing it away.

Yes, you can sew up the holes and tears or take

it to a seamstress. Zippers can be replaced.

7. Use old, non-donatable clothing as rags for

household and car cleaning.

8. Wash clothes on Quick cycles and use cooler

water settings to decrease your carbon footprint.

References & Resources

• Environmental impact of the textile and clothing

industry: What consumers need to know https://



• Fair Trade Certification: https://www.

• 13 fashion brands that still use sweatshops in

2021. Written by Alex Assoune. https://www.

• The Council for Textile Recycling: http://www.

• Top 13 Sustainable Fashion Designers Making

a Change in 2020:

• The World Counts: https://www.

March, April, May 2021 Nevada RNformation • Page 11

NNA Environmental Health Committee

• Love Faustine:

• Patagonia Recycling of Clothing:


Bernadette M. Longo, Ph.D.,


Chair, NNA’s Environmental

Health Committee

President-Elect, NNA District 1

Valerie Werner-Longo

Founder and Creative Director,

Love Faustine

Garment Fibers & their Environmental Impacts

Natural Cellulose Fibers

Cotton: the most common worldwide

fiber used for garments

Bt Cotton: a genetically modified

cotton plant resistant to pest

infestations. Inserted with the Bt

(Bacillus thuringiensis) gene.

Organic Cotton: special farming

is required to meet strict federal


Natural Colored Cotton: grows as

shades of red, mauve, yellow, and


Soy fabrics: derived from the hulls of


Bamboo fabrics: made from heavily

pulped fast-growing bamboo grass

Hemp fabrics: the fibers are more

durable and stronger than cotton

High water usage to grow cotton.

Production of cotton uses large

amounts of insecticides and synthetic

fertilizers. Cotton fibers contain potent

insecticide residues (wash before you

wear). Cotton is usually bleached white

from its natural beige color.

In theory, Bt cotton did not require

insecticide applications. However,

problems in farming have occurred.

Also, there is a high cost for GMO


Grown without the use of genetic

modification to the seeds, without

use of fertilizers, pesticides, or other

synthetic agricultural chemicals.

It is already colored and does

not require synthetic dyes during

processing. Also, it will not fade.

Soy-based fabrics are mostly

biodegradable, so minimal impact on

the environment and landfills.

Pest resistant: does not need pesticides

or agrochemicals. Often bleached


Uses little water to grow and naturally

pest resistant.

Other cellulose fibers: Kombucha: a gel-like film from bacteria/yeast. Pineapple

leaves: an alternative to leather. Piñatex® is a natural, sustainably sourced, cruelty

free material. Coconut parts: leather-like fabrics

Natural Protein Fibers

Wool: known for warmth; consists of

protein and lipids (lanolin); obtained

mainly from sheep. Angora from

rabbits. Alpaca fleece is also soft,

smooth, warm, strong & durable.

Cashmere & Mohair: soft and fine

hairs of a goat's underbelly – rare goats

from Asia.

Silk: strong fiber and considered a

prestigious fabric.

Sheep are treated with injectable or

dermal insecticides. Pesticides are used

in wool cultivation. Toxic chemicals are

often used to preserve wool.

As demand increases, more of these

goats are herded thus affecting land


Mulberry trees are grown to act as

homes for the silkworms. Does not

require pesticides or fertilizers.

MuSkin: 100 % vegetable layer alternative to animal leather. It comes from the

Phellinus ellipsoideus, a big parasitic fungus that grows in the wild on trees in

subtropical forests.

Manufactured Fibers

Polyester fabrics: made from fossil


PET Plastics: also known as

polyethylene terephthalate

Manmade cellulosics (MMCs):

cellulose made from dissolved wood

pulp of trees (e.g. rayon).

Non-biodegradable. Laundry discharges

micro-plastic fibers that release toxins

and can end up in the water system,

oceans and the food chain.

PET plastic clothing comes from recycled

plastics (usually bottles); keeps plastics

out of landfills.


Deadstock (leftover fabric from orders) can be used instead of thrown

away in landfills.

Page 12 • Nevada RNformation March, April, May 2021

Antimicrobial Stewardship – Infection Prevention

It’s time to join forces and defeat Sars-CoV-2

Norman Wright, RN, BSN, MS

It is February 19, 2021

and last year, on this date,

I was attending Nevada’s

Legislative Committee

on Health Care providing

information regarding the

Pan Drug Resistant Organism

(PDRO), Carbapenem Resistant

Enterobacteriaceae (CRE) and

other Multiple Drug Resistant

Organisms (MDRO). I was

promoting legislation to mandate use of the Inter-

Facility Infection Prevention Transfer Form. (1), (2)

During the February 19, 2020 session Nevada’s

State Epidemiologist, Melissa Peek, presented

Nevada’s “Update Concerning the Novel

Coronavirus COVID-19 Outbreak.” Her

comprehensive PowerPoint showed Nevada’s quick

response and preparedness efforts to combat

Coronavirus even though she documented that there

were no confirmed cases in Nevada yet. A more

detailed account of Nevada’s DPBH initial response

can be found in my May, 2020 RNformation article.

The May article, written in February, 2020,

documented the confusion that mixed messaging

was generating. This statement was included:

“COVID-19 stories and predictions are ubiquitous

ranging from a USA Today headline, “Trump

says Coronavirus will be gone by April when the

weather gets warmer”, to a February 11th New

York Post article with this lead, “The coronavirus

epidemic could grip about two-thirds of the world’s

population if the deadly bug is not controlled.” (3)

Unfortunately, the latter is happening. As of

February 19, 2021, worldwide cases total over one

hundred eleven million (111,000,000) and over two

million four hundred thousand (2,4000,000) have

died. Nevada has not been spared. We have over

290,000 confirmed cases and 4,831 deaths to date.

Last year we were “all in this together” until

around mid-April, when unity evaporated and

we began to choose sides. The divide widened

throughout the summer and it continues to date.

Which side you are on, in large part, depends on

the political party that you belong to and what news

sources you obtain your information from.

The red vs. blue divide widened, in large part

due to certain media outlets that promote disputed

science, mis-information, conspiracy theories

disguised as medical research, fake “cures,” and

repeating that the virus will “just disappear.” Basic

public health recommendations to socially distance

and wear a mask were disputed and fights even

erupted when someone was asked to put on a mask.

Please refer to my August, 2020 article: Coronavirus

and PDRO – Fake, Faux and Phony News which

delves into this in greater depth. The main thrusts

of the article were to use the five step “Nursing

Process”, and critical thinking, to sort truth from

fiction and that obtaining accurate, straightforward,

data is essential to accomplish this.

My September 2020 article began with the

Serenity Prayer:

God Grant me the serenity

to accept the things I cannot change,

The courage to change the things I can,

and the wisdom to know the difference.

And I still must say it because I am angry at how

this pandemic, in my opinion, has been mishandled.

By Memorial Day the political lines were drawn

and the divide was exacerbated by the politics of the

November elections, political divides that remain.

Now, a year later, the virus that was supposed

to be gone by last April is still ravaging us. Yes, the

rates have gone down from January 14th when the

7-day moving average of deaths was 46 per day and

the average number of positive cases is also down.


Although this is good news, there is a danger

because each time we thought the pandemic

was over mandates were relaxed and Sars-CoV2

infections roared back. Now there are new viral

strains that are more contagious and possibly more

deadly, and a man with the South Africa strain was

just discovered in Reno.

Some of the deaths that occurred during the past

year could not have been prevented, but if we all

simply agreed to wear a mask and socially distance

for the past year our number of infections and

deaths would have been much lower.

One way to illustrate this is to use a projection

that IHME made last June. The lower green line

represents a flattening of the curve if 95% of

us wore masks and the upper red line shows a

continued upward trend if we didn’t. Reality was

many refused to wear masks or socially distance

and the red trend line never went down. The result,

Nevada will soon experience it’s 5,000th COVID-19


Another way to show that masks work is to

compare Japan’s infection and death rates to

Nevada’s. To date Japan, a nation of over 126 million

people has only had 7,274 deaths from COVID-19,

which averages out to 58 deaths per million.

Compare that to Nevada, with a population of just

over three million, and we have had 4,831 deaths,

equaling 1,568 deaths per million. Space does not

allow me to expand on reasons for the disparity

beyond documenting that in Japan wearing a mask

to avoid getting, or passing on, an infection has

been a common practice for decades and groups like

“No Mask Nevada” do not exist.

On February 23rd I will be giving an hour-long

presentation for Immunize Nevada titled, “How

Politicization and Disinformation Impacted the

Mitigation of COVID-19” which will expand on

the reasons for the disparity in Sars-CoV-2 infections

and deaths comparing the United States with other

nations in the world. By the time you read this article

that webinar will be history, but the presentation

will be archived and found at this link: https://www.

Flash forward to 2021. We now have two

vaccines, Pfizer and Moderna, and more may be

on the way, which brings me back to February 19,

2020, when I was advocating for codification of

the Infection Prevention Transfer Form and laws to

enforce mandates regarding accurate communication

of infectious concerns when a patient is transferred

from one facility to another.

The February 2020 session date was the third time

I appeared before the Legislative Health Committee

and one recurring theme during all three sessions

that I witnessed was promoted by group of women,

and a few men, who repeatedly testified about the

dangers of vaccinations. This group, commonly

known as Anti-Vaxxers told personal stories along

March, April, May 2021 Nevada RNformation • Page 13

with other comments that focused on these main

areas of criticisms to vaccination:

1) Discredited autism/mercury/thimerosal statements

2) Pseudo-science, fake news and alternative


3) That Immunize Nevada is a shill for bigpharma

vaccine companies

4) That people promoting vaccines will “burn

in hell” because vaccines are made from

aborted fetus. Vaccine proponents were even

compared to Nazis.

5) And that the lawmakers should “do more


That last statement about doing research I agree

with, but the research must be from valid sources,

not conspiracy theorists. All of the legislative

committee hearings are taped and if you want to

spend some time you can view their comments by

going to Nevada Legislative archived videos that

is found at this link:

Video/. All you have to do is put in the date of the

session you are interested to view and it will come

up. And the anti-vaxxers are at it again to the point

of disrupting a mass vaccination site at Dodger

Stadium in California.

A few anti-vaxxers brought up “herd immunity”

and that is the danger of their movement. If they

convince a large enough portion of our population

that vaccines are dangerous and discourage enough

of us from becoming vaccinated the pandemic

could slam us again with a fourth wave, possibly

bigger than the one we have just been through. If

that occurs not only will more physical suffering

and death occur, but Nevada’s economy, which is so

dependent on tourism, will not recover either.

A good resource to address the anti-vaccination

movement is a website called, “Shots Heard Round

the World.” It provides resources to combat the disinformation

and intimidation that some members of

this group distribute. (6) https://www.shotsheard.


It is time for our red vs. blue, North against South,

rural vs. urban, us against them – mentality to end.

It is time for us to put aside our political divides, join

forces and work together in unison to fight the war

on Sars-CoV-2. It is time to create common goals and

defeat the virus that has been ravaging us for the

past year.













Page 14 • Nevada RNformation March, April, May 2021

Nurses in the News

Tracey Long PhD, MS, MSN, APRN-BC, CCRN

The daily work of nurses is often unseen but deeply felt by the souls they serve.

We have all recently seen disturbing national and world events that can leave you

feeling paralyzed, hopeless and insignificant. Seeing that one stone thrown into a

pond can send endless ripples to be felt on the other side of the water far away, can

help us remember the power for good of one nurse’s actions.

One example of the positive impact of one person’s actions on many others

is that of a humble nursing student who chose to turn sorrow and grief into

goodness. Jacklyn Lemoine knows the fatal effects of cancer too well. Her mother

died of breast cancer and her father died after battling prostate cancer for years.

Her brother chose to deal with the stress and trauma of those losses in maladaptive

ways by covering the sorrow with drugs and alcohol. Jacklyn decided to transform

her sorrow into tangible gifts that would be given to other women also experiencing

cancer and created “Debbie’s Glam Baskets” in honor of her mother Debbie. With

donations from family and friends and generosity of others who responded to her

GoFundMe project, she purchased and put together helpful care kits designed

with natural products that a woman going through breast cancer would use and

appreciate. Each bag is worth $150 and includes natural products without pesticides

or colorings such as deodorant, nail polish, bath treatments, dietary supplements,

a hand crocheted hat, socks, hair pins, nail and lip care, wipes and more that are

gentle on a fragile body fighting cancer. She recently donated seven bags to the

oncology unit at Summerlin Hospital in Las Vegas where the bags will be gifted

to women actively receiving chemotherapy. To watch videos about her mission,

to donate or help assemble these glam bags, please contact her at https://www.

Another organization that sends out ripples of impact for good is the Nevada

Nurses Foundation, which is the charitable and philanthropic arm of the Nevada

Nurses Association (NNA). Their mission is to increase access to quality health care

for Nevada citizens by promoting professional development of nurses through

recognition, grants, and scholarships. Each one volunteer ripples positive blessing

to our own Nevada Nurses. To learn more about this organization and become

involved go to:

The art and science of nursing heroes begins in nursing school and an

organization that helps grow these young nurses, who will quickly become our

nursing colleagues is the Student Nurse Association. Most Nevada nursing schools

have a chapter where students learn organizational skills and leadership and are the

boots on the ground for dozens of community service projects each year including

blood, food and clothing drives. If you have an organization that is looking for

young volunteer health care workers, you can reach out to any of our Colleges of

Nursing and speak to the faculty advisor to create connections. If you are looking for

a worthwhile organization to share your expertise and volunteer hours, you can also

go online to to identify an organization you share an interest

with and be a movement for good. More than ever, a world-wide pandemic has

taught us all that we are all connected with each other and the positive actions of

one can truly make an impact for good on countless others around us.

Jacklyn Jemoine with her Glam Baskets Feb. 2021

March, April, May 2021 Nevada RNformation • Page 15

Welcome Board of Nursing Director of Education

Vicki Walker DNP, RN, BS

You are on the job less than

a month, and pandemic hits.

This was the situation for the

Board of Nursing's (BON) new

Director of Nursing Education,

Dr. Michelle Johnson, EdD,

RN, CPNP-PC. Shortly after

starting in a new role with

the Nevada BON, Dr. Johnson

had to transition to a remote

work structure within the

evolving parameters to prevent the spread of COVID.

This transition left Dr. Johnson in a frustrating situation

because a large portion of her job is to physically assess

programs around the state.

Many nurses in Nevada may not even recognize that

the BON even has a Director of Education position. The

BON itself is appointed by the Governor of Nevada and

has executive, legislative (i.e., advising on and enforcing

legislation), and judicial responsibilities for the oversight

of the nursing profession in Nevada. The BON staff

work for the Board to carry out the daily functions like

issuing licenses. They also serve to advise the Board on

the health of nursing in Nevada.

The Director of Education position functions mainly

to monitor the health of nursing education in our state.

There are several layers of nursing education in Nevada

which include CNA, LPN, ADN, and BSN programs.

While the state doesn't accredit programs, it does

approve new programs and reviews existing programs

on a regular basis. Dr. Johnson serves as the lead for

this approval and review process.

Dr. Johnson has nearly 30 years of experience

in nursing, administration, and academia. Before

coming to the BON, she served as the Chief Nurse

Administrator for Hawaii Pacific University. She

is thrilled to bring her experience to Nevada in

safeguarding that educational programs uphold the

Nurse Mentorships: Growing Our Own, Versus

Eating Our Young

Dr. Susan Rux, PhD, MSN, RN, PHN, ACNS-BC,


Gretta Williams, AS, RN

Reprinted with permission from

New Jersey Nurse October 2020

Nursing is an incredibly inspirational and rewarding

profession unlike any other. However, for all the

momentous experiences, our profession has its

share of challenges, stemming from personal and

interprofessional conflict. Consider the climate of

today’s acute care environment, heavy workloads,

increased patient acuity, and limited resources – the

perfect storm to add to feelings overwhelmingness of

nurses trying to find and maintain balance – who can

the nurse rely on for support and guidance? This is a

quintessential occasion where mentors can offer the

necessary collegial support by modelling a genuine

interest of the success of their fellow nurse. Nurses are

devoted to delivering high quality and compassionate

care to their patients.

Effective mentorship require commitment to

developing the mentoring relationship between the

mentee and mentor (Andrews & Wallis, 1999; Bally,

2007; McDonald, Mohan, Jackson, Vickers, & Wilkes,

2010). Many forms of nurse mentorships exist, with

experienced nurses taking a new nurse under their

wings as a prominent example. The transition from

nursing school to becoming a novice professional

nurse can be an intimidating experience – the new

responsibilities, requisite knowledge, and ethical

principles to uphold. Nursing school provides a

foundational education to prepare students for the

career of professional nurse, but when faced with the

reality of integrating that knowledge into practice,

new nurses may feel unprepared. Incivility, and

related terms such as horizonal violence, underscore

the importance of mentoring in the context of the

overall organizational performance and stability (Bally,

2007). All too often nurses begin their first position

with minimal guidance, leaving that feeling of being

unsupported. A qualitative study by Simons and Mawn

(2010) found that newly licensed registered nurses felt

as though they experienced hostility and were working

with a pack of barracudas that ate their young.

When we consider how to grow our next generation

of nurses, incorporating mentoring into the ongoing

responsibilities of nurses is critical for the development

of elf and social awareness as well as relationship

management acumen. Tomajan (2012) noted that

nurses in staff development roles contribute to role

transition by serving as mentors to nurses in practice.

Mentoring contributes to job satisfaction and a healthy

work environment (Lee, Dennis, & Campbell, 2007).

Nursing mentorship programs are ways to socialize

and prepare nurses for the transition into the nursing

profession. Chan, Glass & Phang (2020) identified,

through a systematic review, three characteristics for

nurse mentorship success: higher level of experience

in nursing, provision of personalized support in

accordance to the mentees’ requirements, and

establishment of a relationship marked by a sense

of mutual gain, engagement, and commitment (p.

47). When considering the phrase, “nurses eating

their young” (Bartholomew, 2006; Rowe & Sherlock,

2005; Simons & Mawn, 2010), one may think of an

experienced nurse being too critical of a new nurse as

a strategy to help them learn or gain competence more

expeditiously, however, this tactic leaves new nurses

feeling discouraged. As nurses, why eat our young

when we can grow our own? With confidence in the

mentoring relationship, the new nurse will be more

confident in asking questions to enrich their nursing

practice, seek advancement in their career goals,

inclusive of serving as a future nurse mentor.

Confucius, a Chinese philosopher and politician

who emphasized personal and governmental morality,

correctness of social relationships, justice, kindness,

and sincerity — “Acquire new knowledge whilst

thinking over the old, and you may become a teacher

of others.”


Andrews, M., & Wallis, M. (1999). Mentorship in nursing:

A literature review. Journal of Advanced Nursing, 29,


Bally, J. M. G. (2007). The role of nursing leadership

in creating a mentoring culture in acute care

environments. Nursing Economic$, 25, 143-148.

Bartholomew, K. (2006). Ending nurse-to-nurse hostility:

Why nurses eat their young and each other.

Marblehead, MA: HCPro, Inc.

Chan, E.-Y., Glass, G. F., & Phang, K. N. (2020). Evaluation of

a hospital-based nursing research and evidence-based

practice mentorship program on improving nurses’

knowledge, attitudes, and evidence-based practice.

Journal of Continuing Education in Nursing, 51(1), 46–

52. Retrieved from


Lee, A., Dennis, C., & Campbell, P. (2007). Nature's guide

for mentors: Having a good mentor early in your career

can mean the difference between success and failure

in any field. Nature, 44, 791-797. doi: 10.1038/447791a

McDonald, G., Mohan, S., Jackson, D., Vickers, M. H.,

& Wilkes, L. (2010). Continuing connections: The

experiences of retired and senior working nurse

mentors. Journal of Clinical Nursing, 19, 3547-3554.

Rowe, M. M., & Sherlock, H. (2005). Stress and verbal abuse

in nursing: Do burned out nurses eat their young?

Journal of Nursing Management, 13, 242-248.doi:


Simons, S. R., & Mawn, B. (2010). Bullying in the workplace:

A qualitative study of newly licensed Registered

Nurses. American Association of Occupational Health

Nurses Journal, 58, 305-311. doi: 10.3928/08910162-


Tomajan, K. (2012). Advocating for nurses and nursing.

Online Journal of Issues in Nursing, 17(1), doi: 10.3912/


state's regulatory standards to ensure the public's

health and safety.

In the midst of a pandemic, Dr. Johnson has found a

positive perspective for the future of Nursing Education

in Nevada. "I am hoping that COVID will not have

a negative impact, but instead, schools will see the

value of online and virtual education environments,"

said Dr. Johnson. "Because every student isn't equal,

we may see more adoption of a variety of education

environments in the future. COVID has forced us to

embrace the value of online."

For those considering entering the nursing

profession, Dr. Johnson advises, “Do your homework,

understand what is involved in a program and what

the profession of nursing entails. You have to be

committed to the educational process and treat it like

it’s a job.” She also draws attention to Nevada school’s

2020 NCLEX pass rates for nursing, which are among

the highest in the nation.

Report on District 1


Darlene Bujold, President, District 1

NNA’s District 1,

incorporating Northern Nevada

and its Rural Areas, is anxious

to move into 2021 as a dynamic

presence. This past year has

driven change and innovation

for all, the NNA included.

Interaction became more

virtual, but we were undeterred

in the continued advancement

of member support via

webinars and zoom meetings. Of course, we continue

to provide this popular publication quarterly to keep all

licensed Nevada nurses informed.

This Northern Nevada District is always proud to

promote and host our biannual Nurses Day at the

Legislature during session held here in Carson City.

Again, this event has been reimagined thanks to the

pandemic. Rather than a one-day live event, we will

promote understanding of processes and encourage

nurse involvement throughout the session by

recognizing and explaining bills and drafts as they arise

that are of special interest to the nursing population.

Several presentations will be offered free of charge

during the legislative session.

This year will mark a transition in leadership as

nominations open to "new blood." My tenure as

President comes to an end in the fall. Dr. Bernadette

Longo has been elected President-Elect and is poised

to take on this leadership role seamlessly. "Bernie" has

a long and illustrious history of volunteerism with both

local and State appointments. She holds a doctorate

in Nursing Education and is a professor emeritus who

continues to teach at the Orvis School of Nursing.

I encourage all who wish to contribute to our

proud profession to consider running for office. My

experience has been one of making lifelong friendships

with amazingly learned colleagues who have never

failed to provide encouragement, support, and

opportunities for personal and professional growth.

2021 offers hope and a light at the end of this Covid

tunnel. Let’s move forward united and take advantage

of what we have learned to make our profession

stronger and more resilient! can point you

right to that perfect NURSING JOB!

Free to Nurses

Privacy Assured

Easy to Use

E-mailed Job Leads

Page 16 • Nevada RNformation March, April, May 2021

The Quest for Warm and Fuzzies in the Age of Physical Distancing

20 ways to release oxytocin, many of which do not require you to be in close proximity to another human.

Sherry Stofko, MSN, RN

I’m a hugger. A long hugger.

Sometimes, an uncomfortably

lingering hugger. I like to get

close to people and really

look into their eyes when

they talk. I’m not afraid of the

“personal bubble.” I prefer to

touch another person’s hand

while I listen empathetically

to their struggles. I share

smiles, laughter, and tears.

These needs and preferences

made 2020 that much

tougher to bear. Aside from

the unrelenting feeling of

uncertainty, the lack of hugging

and close physical contact is, for me, the toughest

aspect of this pandemic.

Close physical connection such as hugs is the core

language of compassion and caring (Psychology Today,

2020). Why do embraces, hand holding, and caresses

- both platonic and romantic - feel so yummy? Likely

it’s the natural release of the neurochemical oxytocin

associated with these activities. Let’s look closer at

oxytocin, which you undoubtedly learned about in your

neuro, endocrine, or OB studies.

Oxytocin is a hormone and neuropeptide

produced in the hypothalamus and secreted into the

bloodstream through the posterior pituitary gland. This

neurochemical works in a positive feedback loop and

has immediate effects on the brain. It may be most

well-known for its role in female reproduction, causing

uterine contractions during childbirth and increasing

milk supply during lactation. Oxytocin is also known

for eliciting feelings of trust, emotional openness,

generosity, relaxation, and pain suppression (Wu,

2020). Studies show promise for oxytocin in treating

depression and anxiety (Han et al., 2018). Recent

research shows that oxytocin has anti-inflammatory

and immunosupportive properties and may even be

helpful in treating the cytokine storm associated with

COVID-19 infections (Imami, 2020).

In addition to being generated naturally in the body

during childbirth and breast feeding, oxytocin is also

released during sexual orgasm, during close physical

contact with loved ones, during activities that stimulate

skin, while crying, and when feeling empathy for

another (Wu, 2020). The warm and fuzzy feeling we

get when cuddling an infant or hugging a friend can be

attributed to this amazing hormone. Because of these

pleasing effects, oxytocin is often grouped with other

feel-good chemicals like dopamine and serotonin and

has assumed nicknames such as “the love molecule,”

“cuddle chemical,” or the “life hormone.”




Sherry generating

oxytocin holding

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So here we are, in this dreadful pandemic that

forces us to limit our physical contact with others,

isolate in our homes, and certainly not hug or kiss

anyone outside our very small quarantine bubble.

During daunting times of fear, uncertainly, grief, and

sadness, humans rely on connection, hugging, and

human contact to sooth the heartbreak (Levoy, 2020).

Over the past twelve months, the lack of platonic

physical touch has been taking its toll on us in the

way of deteriorating mental health and self-esteem;

worsening loneliness, depression, and anxiety; and

increasing suicide rates (Jha, 2020). “In the 1950s,

the University of Wisconsin psychologist Harry Harlow

showed that baby rhesus monkeys raised by surrogate

mothers preferred one that was made of soft terrycloth

but offered no food to one that had food but was

made of wire. Touch was more important than food!”

(Levoy, 2020). Jha (2020) reports on a Carnegie Mellon

University study that demonstrates hugging and

interpersonal touch can boost the immune system. In

a recent study, mice demonstrated signs of depression

and anxiety after only three-to-five weeks of social

separation (Han et al., 2018). Need I remind you how

long we have been socially isolating?

What can we do about the lack of oxytocin on our

systems if we still cannot cuddle or even visit extended

family or friends? How can we boost our body’s natural

secretion of this delightful and pleasing neurochemical,

save for giving birth or renting a breast pump? It’s

actually a lot easier than you may think to self-generate

oxytocin, even when you’re all alone.

Oxytocin release is easily triggered during

interpersonal physical touch: embracing, holding

hands, sex intimacy - orgasms in particular. But we

can also have the same effects while receiving a

professional massage or pedicure, snuggling a body

pillow, massaging your own scalp, or rubbing your

own feet (Levoy, 2020). Stroking and cuddling a pet

can stimulate the same effects; in fact, research shows

that dogs also receive a bump in oxytocin while being

petted (Raypoole, 2020).

Spending time with friends can increase oxytocin

production. Cooking together, listening empathetically,

smiling and laughing all lead to higher levels of

this feel-good hormone (Power of Positivity, n.d.;

Psychology Today, 2013; Wu, 2020). Opening up

emotionally, sharing feelings, encouraging others,

and saying statements of affection or gratitude can

also bump oxytocin levels (Psychology Today, 2013;

Raypoole, 2020). Even if the conversation gets heavy,

know that crying also stimulates oxytocin production

(Power of Positivity, n.d.) and decreases blood levels

of the stress hormone cortisol. Connecting on social

media and “liking” others’ posts can also create a

feeling of connection with others.

Sharing meals with others stimulates bonding as

well. When preparing the menu, remember dark

chocolate and foods containing tryptophan are

known to promote oxytocin (Life Coach Code, 2017).

Tryptophan-laden foods include chicken, turkey,

beef, pork, eggs, fish, tofu, legumes, milk products,

nuts, seeds, and oatmeal (Whitbread, 2021). One

author suggests vitamin B complex and magnesium

supplements may increase oxytocin release (Life Coach

Code, 2017).

Physical exercise is another way to increase oxytocin

release. Swimming, hiking in nature, and dancing to

music were specific activities mentioned as beneficial

(Raypoole, 2020). Relaxing activities such as soaking

in a hot tub, listening to music, spending quiet time

alone, practicing gentle yoga, or engaging in a lovingkindness

meditation have also been encouraged as

ways to generate oxytocin (Life Coach Code, 2017;

Power of Positivity, n.d.; Psychology Today, 2013).

Finally, get creative! Spending time doing a hobby

like knitting, drawing, or playing an instrument has

also been shown to increase oxytocin while releasing

other fell-good endorphins… added bonus when

you give away these created items (Life Coach Code,

2017; Power of Positivity, n.d.). Trying something new,

unique, or scary, especially with someone else, will also

generate a feeling of bondedness (Psychology Today,

2013; Raypoole, 2020).

Putting all this together, I’ve created an itinerary for

a day saturated with the “love molecule.” Don’t have

a puppy or a friend like “Sam”? No problem: use the

power of imagination or practice some self-love.

The ‘Rona has profoundly changed the ways we give

and receive affection. Hugs, which make us feel safe

and loved, are now taboo. Spending time with friends

makes us feel less lonely as we navigate this new world

but is generally discouraged. Love, safety, connection,

trust… these are much needed feelings these days, so

it is crucial we practice alternative methods to generate

oxytocin and improve our mental health. I believe you

can see boosting natural oxytocin levels is much more

accessible than you may have realized. Don’t forget to

pass these tips onto your family and patients.


Han et al. (2018). Long-term isolation elicits depression and

anxiety-related behaviors by reducing oxytocin-induced

GABAergic transmission in central amygdala. Frontiers

on Molecular Science.


Imami, A., et. al (2020). Oxytocin’s anti-inflammatory and

proimmune functions in COVID-19: A transcriptomic

signature-based approach. https://journals.physiology.


Levoy, G. (2020). The pandemic and the pain of losing



Life Coach Code (2017). 29 ways to trick your brain to

create oxytocin naturally [the love chemical]. https://

Power of Positivity (n.d.). 10 ways to increase the oxytocin

in your body.


Psychology Today (2013). The top 10 ways to boost good



Raypoole, C. (2020). 12 ways to boost oxytocin. https://

Whitbread, D. (2021). Top 10 foods highest in tryptophan.

Wu, J. (2020). Why oxytocin is incredible and how to get

more of it.

About the author:

Sherry is a hospital clinical educator and the CEO

of Capricorn Healthcare Consultants. Her passions

are emergency medicine, resiliency development,

and education. She teaches CEU classes on gratitude,

perfectionism, and self-compassion in healthcare and

now offers adventure CEU travel trips to Ecuador.

2375 E. Prater Way,

Sparks, NV 89434

March, April, May 2021 Nevada RNformation • Page 17

INTERVIEW: Through the Eyes of a Nevada Nurse

Submitted and Interviewed by Dr. Bernadette

Longo, RNFormation Editorial Team

“We have to leave our discipline better than the way

we found it.”

Nurse’s Name:

Timothy Martin, BSN, RN

Time in Nursing: 9 yrs

Practice Location: North Las

Vegas VA Medical Center, V.A.

Southern Nevada Health Care


Position/Role: ICU Relief

Charge Nurse

Clients you serve: Veterans

in need of critical care services

(COVID-19 ICU & regular ICU)

What is your typical day like?

“Recently, I have been the lead ICU nurse on the

non-COVID unit. I work 12-hr days and arrive 30-45

mins early to check my assignment. I have two to three

RNs and additional augment staff. The assignments

for nurses have gotten heavier as the epidemic’s surge

has hit us. So, typically the ICU nurses are taking two

ICU patients and two step-down patients, along

with having two augment staff to assist them with

tasks. A team nursing model is used. I make sure the

assignment is balanced and fair. I make sure they’re not


“As the lead ICU nurse, I have to make myself

available for Rapid Responses and Codes that occur

both inpatient, outpatient and on the grounds. This

happens about 1.5 times per shift. Most of them are

either inappropriate activation of the Rapid Response

system or some brief resolving issues. But there

are persons who experience code whites (strokes),

anaphylaxis, heart rhythm disturbances (afib, v-tact)

for example, that occur in different departments at the


What has been the impact of the COVID-19

pandemic on your nursing?

“So, COVID-19 has made me a better nurse in a

number of ways. At the VA we are very fortunate that

typically our patient ratios are very low. COVID has

changed all that. COVID has reinvigorated my time

management and being able to pass on to our younger

nurses – the next generation – just these strategies for

time management and planning out your day. So, that

has made me stronger.”

“We are doing a lot of bedside procedures that

we never did (trachs, pegs). We are doing a lot more

ultrasounds at the bedside looking for DVTs and those

microthrombi. My critical thinking skills have sharpened

because of all the sequalae and symptoms that these

patients experience. One of the earliest practice things

I noticed during COVID-19 was when we were sedating

or anesthetizing a patient. We are now using these

great tools like BIS monitoring (bispectral monitoring

for effects of anesthesia on the brain) and Train of

four (assesses nerve function in patients receiving

neuromuscular blockers). So, we can tell how deep we

have these patients. We need to know this considering

the risks for delirium and because we know deep

sedation increases many risks for these patients. It is

part of the bundle of care and will likely continue for

all patients needing intubation (standard of practice)

going forward.”

“Besides my assessment skills improving, there has

been more of trusting my gut. Like, we all have those

feelings when the patient is going to go south - a bad

feeling we are heading in the wrong direction with the

patient. Yet, all the numbers contradict the way you

feel. Like, it doesn’t look it. But as a bedside nurse,

you can just tell that the patient is going to turn and

that definite sense that death is standing in the room

with you – that you know they are there. I think those

two senses - I have become much more aware of them

during COVID.”

“I had an interesting conversation the other day

with a physician. We got a new patient and he just

didn’t look good yet his stats and ABGs were OK, but

everything was trending flat. He had been improving,

but now flat. I said to myself, ‘I just don’t feel good

about this.’ So, I called the doc at home and asked

that he make his first stop here. I shared my feelings.

In 30 minutes, he was on the floor and the patient had

turned. I said, ‘Oh you’re here so soon.’ He replied, ‘I

was thinking about it and you had never called me at

home before.”

In your opinion, what is the future for nursing?

“The future for nursing is our continuation of the

nursing discipline. As we become novice nurses, we

take this oath of providing care and being nurses and

doing no harm. We need to remember the oath we

took. Part of that oath should be furthering the nursing

discipline. We have to leave our discipline better than

the way we found it. We have to improve it, to grow it

and to nurture it.”

Why are you still choosing to be a nurse today?

“It’s funny, I choose nursing because being a

paramedic didn’t pay enough. Now, nursing has chosen

me! I could no more turn my back on it than it could

turn it’s back to me. Nursing and I are now married

to each other. We are very committed to each other. I

could not imagine being married to another career. The

ability to learn every day, to teach every day, to impact

my patients lives either through direct patient care or

indirectly by helping develop my nurses and through

leadership. I couldn’t imagine choosing another career!

Afterthought: Timothy Martin is an Army veteran

who defended our country for 14 years. He served in

the Bosnia mission as a combat engineer who cleared

land mines and rigged explosives. It inspired him to

become a nurse. He described that the best “coolest”

job in the military was to serve as Team Leader on the

Honor Guard. He was the last voice of the military

thanking the spouse for their loved one’s service.

Today, his coolest memories as a nurse are helping

our veterans heal or transition from this life to the

next, along with seeing a veteran’s family take them

home. He is currently a DNP student at Orvis School of

Nursing (UNR) with the goal of becoming an acute care

nurse practitioner. Thank you, Tim, for your past and

ongoing service!

Greater Inclusion of Nursing Students with Disabilities

Alyssa Macleod

UNLV Level 3 Nursing Student

When life gets hard, you

fight back harder. When I was

born, my parents were told I

would never walk, never talk

and I would be in a wheelchair

for life. Now I am a Level 3

UNLV nursing student trying to

help others in similar roles have

their voices heard. I’ve been

called a hero, a role modelyou

name it, and I am none of

those things. I am someone who just wants to make

the world a little easier for the children of today.


I had a seizure shortly after I was born. I was two

months early weighing just over four pounds. I did

not take my first steps until I was three years old. It is

thanks to a selective dorsal rhizotomy [SDR] (a surgery

that involved opening my spine and burning some of

the nerves leading to my legs) and countless hours of

physiotherapy that I am able to walk today.

I was born with Cerebral Palsy (CP), the most

common motor disability in childhood, according to

the Centers for Disease Control and Prevention. It

affects my ability to move and maintain balance. While

there are different types of CP, the type I have only

affects my legs. With the help of Shriners Hospitals for

Children in Montreal, Canada, and with many surgeries

and Botox treatments in my legs, I defied the odds, and

I am proud to say I now walk unassisted, albeit a little

differently than everyone else.

I have bad days when it’s hard, and my legs don’t

want to work. On my bad days when I’m really stiff

and falling over nothing, these thoughts run through

my head: “Why am I here?,” “What am I supposed to

do?,” “Why is this so hard sometimes”? Then I snap

out of it and realize how far I’ve come (which isn’t easy

for me to do either).


Being a disability advocate started in 2014 when

I was crowned Miss Canada International. I chose

the platform, “Power of Perseverance” (inspiring

people with disabilities to reach their dreams). I

travelled all over Canada and the USA doing speaking

engagements and attending special events as well

as visiting hospitals and nursing homes among many

others for 15 months. After I was crowned Miss

Canada and CP Ambassador, I was asked to talk to

parents and young kids with CP. That’s when I first

thought maybe I’m supposed to be the light at the end

of the tunnel for others. Maybe I’m meant to show

them that CP isn’t the end of the world (although it

really does suck some days). I still haven’t found my

true purpose yet, but I think I’m close.

After spending 20 years as a Shriners patient, I knew

I wanted a career in healthcare when I grew up. The

nurses and doctors at Shriners took such excellent

care of me after all my surgeries and treatments;

they became my second family. I loved going to my

appointments (no one says that, right?). The hospital

staff made such an impact on me, and I knew I wanted

to give back to a community that has given me so

much. But it didn’t come easy.

After my reign as Miss Canada ended, I went to

medical school in the Caribbean. There, I felt like

I didn’t belong. I later found out the school was

changing my passing grades to failing grades and

forcing me out because they didn’t like that I was

disabled. After fighting a losing battle, I returned home

to Canada and decided to apply to nursing. I applied

twice and was not accepted. The director of the

nursing program told me she did not believe I would be

able to perform the required duties because of my CP.

That’s when I turned to UNLV.


I applied to UNLV after reading reviews about how

great their nursing program was. I was very transparent

about my CP, and I got accepted right away, no

questions or discrimination. The SON has been the

most supportive and amazing people I’ve met in my

education journey, and I mean that wholeheartedly. I’ve

been fully accepted here, and it feels amazing to have

so many faculty and classmates in my corner.

For my Community health class, we had to record

a video discussing an issue we would like the Nevada

State Board of Nursing to address. I chose the topic of

greater inclusion of nursing students with disabilities.

Due to my experience of being rejected, I felt like the

myths of disabilities needed to be addressed. One

myth is that since CP affects the brain, many people

also believe that people with the disability are not as

intelligent. That video evolved into a National Student

Nurses Association resolution on the same topic, asking

for greater inclusion. A resolution is a motion that is

adopted by a deliberative body and can potentially

be written into regulation. In my experience, many

people think having CP automatically means you are in

a wheelchair and are then labelled by society as being

less than even if you are not in a wheelchair.

The truth is, I can do what everyone else can do.

I may do it a little differently and some things may

take me a little longer to accomplish but I will do it;

all I need is a chance to show you. In my time doing

clinical rotations, I have not seen another physically

disabled nurse on the floor. I wrote the resolution to

bring attention to how disabilities are perceived and

to make progress towards changing it. Nurses with a

disability have so much to offer, and we can relate to

patients in unique ways due to shared experiences.

We deserve a chance. We should not be scared to go

after our dreams simply because we are afraid of being

rejected or being the first disabled nurse on a unit. BE


UNLV SON has supported and helped me in more

ways I can count. They gave me that chance, and it’s

my pleasure to help them gain recognition for all

they’ve done. It took me a long time to find my place

but I’m so happy I didn’t give up. A disability doesn’t

define you; you define the disability!

Page 18 • Nevada RNformation March, April, May 2021

Best Practices for Online Meetings

Bernadette Longo, Ph.D., RN, CNL, FAAN

Virtual meetings are now commonplace.

These online venues present similar challenges for

professional interactions as in-person meetings often

did. Yet now, you cannot hide in the back of the room.

Virtual meetings accentuate the image of you being

a tile on a screen. Everyone knows that nonverbal

communication is extraordinarily powerful. Therefore,

use these meetings for your career growth! Show up

as the person and professional you want to be! Here

are some tips to assist you with being effective and

professional during online meetings.

Preparing for the Meeting

• Get in the mood: reflect on what you may

learn or contribute to the upcoming meeting.

It’s an opportunity for you to be with others and

show your worth. Smile or laugh because this

energy comes into the meeting and positively

affects others.

• Clean up the area around your computer:

organize key documents for the meeting and

use “bullet point” notes. Use a document stand

that is placed at the side of the computer and

elevates your notes. This allows you to see them

without having to glance down or look far away

from the camera.

• Minimize distractions: choose a location that

is quiet and distraction-free.

• Check the lighting: Have enough light that you

have a natural skin tone and can be clearly seen

(avoid bright lights or facial shadows). Turn off

any overhead lighting. Face a window for natural

light during day meetings (pull down the shade

if too bright). Use light from well above eye level

and a smaller secondary light from behind and

above you (or light reflecting off the ceiling).

This lighting highlights your hair and eliminates


• Turn-off or mute your cell phone. If you have

a weak internet connection, turn off the Wi-Fi to

your cell phone.

• Do a sound-check: rooms with high ceilings

can have an echo. Turn off or avoid noisy

appliances and heater or AC vents. You may

need to use a headset with a microphone.

• Check your background: tailor your

background based on the type of meeting and




Set the mood. Avoid visual clutter and

ensure your background does not have any

embarrassing details.

If using Zoom, consider using a virtual

background that is pleasant and nondistracting.

• Position the camera face on. Elevate the

computer as needed to a face level by raising the

laptop (use books or boxes).

• Check your appearance: style your look based

on the type of meeting and audience. Dressing

up helps you get into a professional mood.

o Hair & Makeup: Comb your hair to avoid

flyaway strands. The camera tends to wash

out facial color. Use facial moisturizer to

accent a skin glow. If you choose to wear

makeup - keep it simple with basic mascara,

light blush, and concealer. Light-shaded

lipstick is best. Avoid heavy eye makeup.

o Clothes & Jewelry: If it is an interview, dress

as you would in person. The same goes for

dress in your workplace. Wear long sleeve

tops or blazers that are solid in color. Keep

jewelry simple and classic.

• Set up name/photo: If you have Zoom, set up

your “name” in a professional manner (Name,

RN…). Set up a professional photo of yourself

in the system because it appears when you first

join the meeting.

Joining the Meeting

• Be on time: within 3 to 5 minutes early.

• Smile, unmute and announce or introduce

yourself. Then mute yourself but keep your

camera on.

• If you are the Leader: Join ahead of time.

Verbally greet each person who enters with a

smile (large meetings: welcome as you can).

Quickly review the purpose of the meeting & the

agenda. Be a role model!

During the Meeting

Be Attentive & Participate

• Keep your camera on through the entire

meeting but mute your voice.

• Establish a focal point on the screen near

the camera. Look and speak directly towards this

area. It is natural to want to look at the speaker

or yourself on the screen, but this creates

the appearance of avoiding eye-contact and


• Maintain erect posture. Sit in a straight

chair is best and leaning slightly forward when

speaking helps you project better. Consider

standing for the meeting. This supports your

cardiovascular health!

• Raise your hand to contribute. In small

meetings, you can raise your hand on the screen

at appropriate pauses. In larger meetings,

select Raise your Hand in the meeting controls.

Everyone in the meeting will see that you have

your hand up. Sometimes you may need to use

the chat feature and communicate to the leader

that you have something to add.

• Participate & monitor your Speaking

Style. Speak clearly and not too fast. If you are

nervous, intentionally speak slower until you

relax. Use vocal intonations and a pleasant tone.

• Be kind and considerate: thoughtfully choose

your tone, words, input, and feedback.

• Avoid getting up and leaving. If necessary,

turn off your camera. Be brief.

• Give technology feedback: If malfunctions

with technology occur (e.g., poor connections,

muted but trying to speak), let the person know

and have them repeat their question or assist

them in resolving the issue.

Be Intentional with your Non-verbal Communication

• Smile genuinely: a smile complements the

words spoken and reflects your attitude.

• Nod as you are listening: nodding serves to

reinforce what is being said and is one of the

most universal cultural gestures.

• Use your hands to express when speaking:

when you use your hands, your face lights up

and your voice has energy. Keep your gestures

below your shoulders and away from your face.

• Avoid crossing your arms when listening;

instead, place one arm on the table or both at

your side, or fold your arms on your lap.

• Avoid leaning back or rocking back and forth

in a chair; it communicates that you are bored.

• Avoid multi-tasking; same as in an in-person


• Turning off your camera is unprofessional

and rude to the leader and those who are

contributing. Besides, it communicates that you

may not even still be listening. If your internet

connection is weak and problematic, turn off

your camera and send a chat message to the

leader indicating the problem.

• It’s OK to laugh and enjoy. Virtual meetings

are a time to connect with others and are

important for your mental health.

Ending the Meeting

• Wave your hand to say goodbye! Say thank you.

• If you are the leader: Summarize the key

points, state any follow-up tasks, and especially

thank everyone for attending and contributing.

Learning & Growing

• Reflect by asking: How was I perceived in

the meeting? Could I have done something

differently? Were people interested and

attentive to what I said? Did I listen well to

others? Should I follow-up on anything or with


• Be kind and honest to yourself. Having an

intention to be the person you want to be is the

most important step. Stay on the journey!

March, April, May 2021 Nevada RNformation • Page 19

UNLV Nursing Program

Jumps into Top 10 Best

Online Programs

Joseph Gaccione, Communications & Outreach

Specialist School of Nursing, University of

Nevada, Las Vegas

The UNLV School of Nursing continues to ascend

among the nation's top-rated online graduate and

professional programs. Per its January 2021 survey,

U.S. News and World Report ranks UNLV Nursing's

online master's program as the 7th best in the country,

moving up from 11th in 2020. UNLV has ranked in the

top 30 each year since U.S. News began rating online

nursing programs in 2012.

“We appreciate that U.S. News & World Report

continues to highlight our stellar faculty, staff, and

curricula as among the best in the country," said Dr.

Angela Amar, dean of the School of Nursing. "Our

wonderful online students receive a high-quality

education that prepares them to meet the rapidly

changing health needs of our community. During the

COVID-19 pandemic, the importance of nurses has

been reinforced, and we are meeting the challenge of

preparing our students to enter the frontlines and make

a positive impact.”

Among the most impactful changes to the MSN

program’s recent growth include improved graduation

and board certification pass rates, more faculty and

student resources, and alumni engagement.

All of UNLV Nursing’s graduate school courses are

online. In 2020, UNLV Nursing’s MSN program and

Doctor of Nursing Practice (DNP) Programs catapulted

into the Top 50 of U.S. News and World Report’s Best

Graduate Programs (after ranking in the Top 100 the

year before). Each ranked 40th in the nation.

UNLV’s School of Nursing currently offers two

master's tracks — family nurse practitioner (FNP) and

nurse educator (NE) — that prepare advanced clinicians

and educators in nursing to serve the community's

health needs and educate future nursing care

providers. The school will offer a master’s track for

nurse practitioners in psychiatric mental health in Fall


“We strive to offer a rigorous and engaging online

MSN experience for our students that prepares them to

be culturally responsive and innovative practitioners,”

said Dr. Steven Palazzo, the school’s associate dean for

academic affairs. “Our graduates translate evidence

into practice in ways that promote both healthy

communities and quality improvement at the systems


UNLV Nursing faculty and staff altered their

procedures in 2020 to maintain productive graduate

clinical experiences during the coronavirus pandemic.

Through virtual clinicals and evaluations, FNP students

simulated telehealth scenarios while receiving the

necessary feedback for their performances.

UNLV Nursing’s graduate course catalog also

includes the only Ph.D. in Nursing program in Nevada

and multiple Post-Master’s tracks for Nursing Education

and Psychiatric Mental Health Nurse Practitioner.

U.S. News and World Report ranks online graduate

programs on various criteria, including faculty

engagement; faculty credentials and expertise; services

and technologies that allow for flexible distance

learning; and resulting student excellence.

A Local Chapter Organization Supporting Men in


Andrew Thomas Reyes, Ph.D., MSN, RN

Men in the nursing profession are steadily rising.

In the 1970s, only 2.7% of the nurses were male.

However, in a 2019 report from the U.S. Labor Bureau

of Statistics, about 12% of the registered nurses were

male. As the numbers of men in nursing are also

growing in Nevada, a new chapter of the American

Association for Men in Nursing (AAMN) has been

created in 2018 to support male nurses' professional

development and continue the campaign of increasing

men in the nursing profession. This new AAMN chapter

is the Men in Nursing of Southern Nevada (MNSN).

The MNSN was founded by three faculty members

of the School of Nursing at the University of Nevada,

Las Vegas (UNLV) – Dr. Andrew Thomas Reyes, Dr.

Rhigel A. Tan, and Dr. Reimund Serafica. Together, they

spearheaded providing a framework for nurses, as a

group, to meet, discuss, and influence factors, which

affect men as nurses.

The first election of the MNSN was held last August

22, 2018. The following are the founding officers of

the MNSN: Dr. Andrew Thomas Reyes (President), Dr.

Rhigel A. Tan (President-Elect), Dr. Reimund Serafica

(Vice-President), Stephen Ingerson of the University

Celebrating Men in Nursing!

Medical Center (Treasurer), Anthony Irvey of the

College of Southern Nevada (Secretary), Douglas Foley

of the University Medical Center (Bylaws Committee

Chair), Arvin Operario of Optum (Membership

Committee Chair), and Dr. Marife Aczon-Armstrong of

the Roseman University (Education Committee Chair).

The membership of the MNSN is unrestricted by

consideration of age, color, creed, handicap, sexual

orientation, lifestyle, nationality, race, religion, or

gender. Currently, the MNSN has three female


On September 21, 2019, the MNSN received the

2019 Community Achievement Award as the new

emerging organization promoting diversity given

by Governor Sisolak and the Asian American Group

(AAG). The MNSN, as a local chapter for men in

nursing, continues to support men who are nurses

to grow professionally, to advocate for continued

research, education, and dissemination of information

about men's health issues and men in nursing, and to

facilitate the members' full participation in the nursing

profession and its organization.

More information about the MNSN is found on our

Facebook page (

and our website (

Page 20 • Nevada RNformation March, April, May 2021

The Effects of COVID-19 on Organ Donation and Transplantation

John A. Lilley, MBA, BSN, RN, CPTC

Vice President of Organ Operations

In December 2020, the

Merriam-Webster English

Dictionary announced

“pandemic” as the word of the

year due to its increased use

and investigation of meaning.

At the same time, Dictionary.

com announced the People’s

Choice 2020 Word of the Year

to be “unprecedented.” The

site’s Senior Research Editor, John

Kelly, described the use of unprecedented in the form of

“...the pandemic, the protests, the presidential election,

the extreme climate episodes – 2020 sent us searching for

a word that could do justice to the scale and pace of all

this upheaval” (Minegar, 2020). For those of us in health

care, unprecedented in 2020 meant the added daily stress

in witness of suffering and death from COVID-19, the

emphasis and availability of personal protective equipment

to safeguard the provider, patient, and community, along

with navigating the use of precious resources to maintain

quality for as many patients as possible.

For professionals working in organ donation for

transplantation, unprecedented is also a word that

was commonly used during the tumultuous year of

2020 and over the last several years. As a community

of Organ Procurement Organizations (OPO), transplant

centers, and donor hospitals where a potential donor is

identified, the number of deceased organ donors has

experienced unprecedented growth in the last decade.

Since 2011, there has been a 54.9% (4,463) growth in

the number of recovered donors in the United States.

During the year of the SARS-CoV-2 pandemic, there

was a 6.1% (718) growth of recovered deceased donors

compared to 2019 (U.S. Department of Health & Human

Services, 2021). This increase in deceased donors

equated to more transplants. Since 2011, there has

been an increase in transplants from deceased donors

by 47.8% (10,778) and a growth from 2019 of 3.1%

(987). Considering the pandemic’s effect on donation

and transplantation, one can call these increases

unprecedented in the number of lives impacted and

saved through the incredible gift of organ donation (U.S.

Department of Health & Human Services, 2021).

Nevertheless, there was also a discouraging change

in transplantation in 2020 due to COVID-19. In March

2020, out of the uncertainty of the effects of the virus

and concern for patients, along with centers focusing

their resources on emergent needs, 72% of transplant

centers in the U.S. suspended their living-donor

transplant programs (Boyarski, et al., 2020). Considered

“non-essential” elective medical procedures, kidney

transplants, especially from living donors, were placed

on hold. In a letter to the Department of Health and

Human Services (HHS) in March 2020, the National

Kidney Foundation urged centers and specifically

HHS to stress the importance of defining “nonessential”

procedures that included access to kidney

transplantation. “The National Kidney Foundation

urged the Administration to distinguish which

procedures are truly elective and non-essential from

procedures – like organ recovery and kidney transplant

– that have immediate, significant, and life-long

benefits for patients. These delays and barriers would

effectively preclude most life-saving kidney transplants

for the near term” (National Kidney Foundation,

2020). Overall, for 2020, national living donation

and transplant rates declined by 22.4% (1,655) in

comparison to the previous year (U.S. Department of

Health & Human Services, 2021).

There are currently over 108,000 candidates in

the U.S. waiting for a solid organ transplant (Organ

Procurement & Transplant Network, 2021). The vast

majority (84.5%) of these patients hope for a kidney

from the generous gift of either a living or deceased

donor. Others are looking forward to a new heart,

lungs, liver, pancreas, or intestine to save, heal, and

enhance their life. In Nevada, over 600 patients are

hoping for a transplant.

Nevada has also seen unprecedented growth in

donation and transplantation. Since 2011, the number

of deceased donors from Nevada residents has

increased an extraordinary 206.2% (134), resulting in

thousands of transplants across the country, including

over 500 Nevadans (U.S. Department of Health &

Human Services, 2021). In 2020, twenty additional

deceased organ donors from the previous record year

represented an 11.2% increase (U.S. Department of

Health & Human Services, 2021). These are remarkable


Unfortunately, there are still too many deaths for

those who require a solid organ transplant in the U.S.

and Nevada. On average, 17 people die every day waiting

for a transplant, and another person is added to the

national waitlist every nine minutes (Health Resources &

Services Administration, 2020). Although these numbers

do not compare to our experiences of death during the

COVID-19 pandemic, they have been consistent year over

year, resulting in tens of thousands of deaths.

With the world realizing a death toll from the SARS-

CoV-2 virus projected at close to three million and the

U.S. over 550,000 by May 1, 2021 (Institute of Health

Metrics and Evaluation, 2021), we find ourselves

focused on another phrase. What is our “new normal”

going to be in 2021 and beyond? Many of us have a

current “normal” allowing us to go to restaurants that

are restricted to a lower than standard capacity. We

have access to grocery stores and our favorite big box

store. Moreover, we can enjoy the relative freedom to

move about while following mask-wearing guidelines,

social distancing, and avoiding crowds outlined by the

Centers for Disease Control and our state government.

Our “normal” is very different from those in our nation

and state awaiting a solid organ transplant. The impact

of COVID-19 on donation and transplantation in the

U.S. has yet to be fully realized. The initial examination

has shown a probable loss of life of those on the

waiting list due to the virus’s overall impact. Additional

research is needed. All healthcare entities involved in

providing transplants are focused on improvement.

Also, upcoming governmental changes are pushing for

increasing the recovery and transplant of organs.

In July 2019, the “Advancing American Kidney Health”

presidential executive order was enacted, promoting

several goals in improving kidney health, including

doubling the number of kidneys available for transplant by

2030. This order put in motion an extensive governmental

review of the country’s 58 OPOs. The review included

what measures and how all not-for-profit OPOs are

evaluated and certified. In November 2020, this evaluation

led to the Centers for Medicare and Medicaid Services

(CMS) updating guidelines and conditions for coverage

for OPOs. The new measures are designed to “…improve

the quality of OPO services and hold underperformers

accountable” (CMS, 2020). OPOs will be focused on

meeting overall donation rates and transplantation rates,

with the new proposal estimating the addition of 8000

annual transplants. These measures include a higher

level of transparency using reliable data to evaluate

each procurement agency and place requirements for

quality assurance and performance improvement on

underperforming OPOs. These changes continue to

focus all OPOs on providing as many organs as possible

to reduce the suffering and deaths of those experiencing

end-stage organ failure. However, OPOs cannot do this


OPOs are reliant upon hospital partners to identify

and refer all possible donor candidates. State and

federal statutes outline the need for hospitals to refer

patients promptly to their affiliated OPO. Studies show

that there must be “…a universal understanding that

timely referrals provide both the organ procurement

and the bedside teams with the time they need

to optimally support the family while preserving

their opportunity to donate” (Wojda, et al., 2017).

Allowing time for OPOs to mobilize their resources for

collaborative evaluation, determination of suitability,

and families’ interactions is crucial for increasing the

number of available organs to waiting recipients.

With OPOs and donor hospitals doing everything

they can to ensure organ availability, transplant centers

should be driven to ensure every healthy and safe organ

is implanted. In March 2021, new guidelines outlined

by the U.S. Public Health Service (PHS) for assessing

donors and recipients for HIV, Hepatitis B virus, and

Hepatitis C virus will be implemented. The guidelines

remove the term “increased risk” from donors who have

previously been classified as posing a possible higher

risk of transmitting these viruses through a solid organ

transplant. Since 2013, this label is thought to have led

to the discard of hundreds of organs annually (Volk,

Wilk, Wolfe, & Kaul, 2017). The dramatic improvement

in evaluation and testing in the last several decades for

potential organ donors has led to the PHS changes for

risk assessment in hopes that more organs will help

waiting recipients (Jones et al., 2020).

Patients waiting for a transplant who were already

facing daily challenges of managing chronic and acute

demands of living with organ failure such as dialysis,

ventricular assist devices, oxygen therapy, and frequent

lab and medical assessments did not decrease in 2020

during the COVID-19 pandemic. With over 91,000

patients on the national kidney waiting list, the majority

of whom receive maintenance dialysis, merely managing

the exposure of COVID-19 while trying to provide safe

transplants for these vulnerable patients has been

challenging. COVID-19 has affected potential recipient

patients around the country and here in our local

communities within Nevada. The precious gifts from

deceased and living donors continue to trend upward, but

we, as a collective of donor hospitals, transplant centers,

and OPOs, have an obligation to those waiting recipients

that most of us will never meet. Are you doing your part?


Boyarski, B. J., Werbel, W. A., Durand, C. M., Avery, R.

K., Jackson, K. R., Kernodle, A. B., . .. Massie, A. B.

(2020). Early national and center-level changes to

kidney transplantation in the United States during

the COVID-19 epidemic. American Journal of

Transplantation, 20(11), 3131-3139. doi:10.1111/ajt.16167

Centers for Medicare & Medicaid Services. (2020, November

20). CMS finalizes policy that will increase the number of

available lifesavings organs by holding organ procurement

organizations accountable through transparency and

competition. Retrieved from News Room:



Centers for Medicare & Medicaid Services. (2020,

November 20). Organ Procurement Organization

(OPO) Conditions for Coverage Final Rule: Revisions to

Outcome Measures for OPOs CMS-3380-F. Retrieved

from Newsroom Fact Sheet: https://www.

Health Resources & Services Administration. (2020,

September). Organ Donation Statistics. Retrieved from U.S. Government Information on

Organ Donation and Transplantation: https://www.

Institute of Health Metrics and Evaluation. (2021, January 15).

IHME: COVID-19 Projections. Retrieved from Institute of

Health Metrics and Evaluation:

Jones, J. M., Kracalik, I., Levi, M. E., Bowman, J. S., Berger,

J. J., Bixler, D., . . . Basavaraju, S. V. (2020). Assessing

solid organ donors and monitoring transplant recipients

for human immunodeficiency virus, hepatitis B virus,

and hepatitis C virus infection — U.S. public health

service guideline, 2020. MMWR. Recommendations and

Reports, 69(4), 1-16. doi:10.15585/mmwr.rr6904a1

Minegar, A. (2020, December 16). Merriam-Webster's

2020 Word of the year is 'pandemic,' people choose

'unprecedented'. Retrieved from WWMT News - West


National Kidney Foundation. (2020, March 19). National

kidney foundation urges clarity and flexibility on

elective surgery procedures during COVID-19 outbreak.

Retrieved from National Kidney Foundation: https://

Organ Procurement & Transplant Network. (2021, January

21). Organ Procurement & Transplantation Network:

Data. Retrieved from U.S. Department of Health &

Human Services:

U.S. Department of Health & Human Services. (2021,

January 21). National Data: Donors Recovered in the

U.S. by Donor Type. Retrieved from Organ Procurement

and Transplantation Network: https://optn.transplant.

U.S. Department of Health & Human Services. (2021,

January 21). National Data: Transplants by Donor Type.

Retrieved from Organ Procurement & Transplantation


U.S. Department of Health & Human Services. (2021,

January 21). State Data: Donors Recovered in the U.S.

by Donor Type. Retrieved from Organ Procurement and

Transplantation Network: https://optn.transplant.hrsa.


U.S. Department of Health & Human Services. (2021, January 21).

State Data: Transplants by Donor Type. Retrieved from Organ

Procurement and Transplantation Network: https://optn.

Volk, M. L., Wilk, A. R., Wolfe, C., & Kaul, D. R. (2017).

The “PHS increased risk” label is associated with

non-utilization of hundreds of organs per year.

Transplantation, 101(7), 1666-1669. doi:10.1097/


Wojda, T. R., Stawiski, S. P., Yandle, K. P., Bleil, M.,

Axelband, J., Wilde-Onia, R., . . . Shultz, J. (2017). Keys

to successful organ procurement: An experience-based

review of clinical practices at a high-performing healthcare

organization. International Journal of Critical

Illness & Injury Science, 7(2), 91-100. doi:10.4103/IJCIIS.


March, April, May 2021 Nevada RNformation • Page 21

Focus on Fighting the Pandemic, Not Each Other

Angela Fountain, RN

Reprinted with permission from

Arizona Nurse January 2021

With the stress of fighting the yearlong pandemic

while nurses are being stretched to new lengths in their

work environments, it is a good time to revisit the topic

of incivility. What is it? Does it really matter? How can

I prevent my work environment from having the toxic

effect of incivility?

Incivility – What is it?

Incivility has been referred to as lateral violence,

horizontal violence, and bullying (Blair, 2013). Incivility

has further been defined as “any behavior toward a

coworker that is perceived as or intended to humiliate,

demean, belittle, diminish, and/or isolate and leads

to a power relationship in which the abuser attempts

to control the victim” (Bunk & Magley, 2013, p. 87).

Incivility violates social norms of workplace etiquette

and can involve being condescending, displaying

impatience, refusing to answer questions and general

disrespect toward another co-coworker (Kaiser, 2017).

We, as nurses, should focus on understanding the

impact of uncivil behaviors as incivility affects all

personnel and can diminish communication, which is

vital to promoting the delivery of safe patient care.

Incivility – Who does it? Does it really matter?

Incivility has the potential to occur in all workplaces

in all parts of the world. Healthcare has had especially

high incidences of reported bullying worldwide and the

subject of incivility has been studied in undergraduate

programs, advanced practice specialties, medical school

programs, residencies, and some advanced practice

student roles in all areas of the world (Winston, 2017).

Within the United States, incivility has been studied

specifically within the nursing profession and has

been reported to be as high as 48% (Keller, Budin, &

Allie, 2016). Professional advocacy agencies, like the

American Nurses Association, (ANA) have taken strong

positions against bullying in an attempt to reduce

medical errors and improve the health care and safety

of patients (ANA, 2015).

In order for us to know about whether there is

incivility within our workplace, workplace culture

should be assessed periodically as culture can change

rapidly. As nurses, we recognize that for every action,

there is a reaction. This should prompt us to think

about the collateral damage uncivil work cultures

cause. Not only can errors be made, or patients

harmed, there are physical consequences for persons

exposed to incivility. Sauer et al., (2017), found that

nurses who experience bullying, have decreased

physical functioning, have more complaints of body

pain, and overall felt in poorer general health. Healthy

nurses are better able to care for patients, have fewer

complaints of burnout and display less compassion

fatigue. By assessing and understanding the direct

relationship between perceived bullying and burnout,

we can prevent burnout, keep our patients safe and

our staff healthy.

Feng et al., (2016) found that varying levels of

experience and work areas are key contributors of

workplace bullying. Areas that are highly stressful

such as intensive care units, emergency departments,

and operating theaters yield a higher perceived

level of incivility. Novice nurses also perceived more

incivility than did more experienced nurses. While

this has a variety of factors that can be the cause, it

is important to recognize and support novice nurses

as they begin their practice while providing ongoing

support for more experienced nurses. Through the

study of incivility, it has been identified that colleague

support and promoting professional competence

reduce incivility in the workplace while increasing job

performance and satisfaction.

How can I prevent the ill effects of incivility in my


It takes work but promoting a civil work

environment is not only personally rewarding by having

a work environment where we enjoy, it promotes

better patient care, better outcomes and less attrition.

Reforming flawed processes of tolerating incivility

may help reduce chronically high turnover which

also helps reduce the costs associated with turnover.

Promoting civil work environments supports effective

communication which yields to greater patient safety

and the promotion of an effective team environment.

An effective team environment may result in a decrease

in attrition with the possibility of providing greater

productivity. Creating a positive workplace culture is a

win-win-win. You win, patients win, the hospital wins.

Don’t let your workplace culture become tainted by

incivility. This pandemic is hard enough on us- take care

of each other.

Angela Fountain, DNP, CRNA


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Page 22 • Nevada RNformation March, April, May 2021

Nevada Nurses Foundation EST 2014

Thank you to the wonderful Rural & Frontier Nursing

symposium guest speakers on January 22 -23, 2021.

• Karen Bearer

• Brian Dankowski

• Judy Henderson

• Denyse Ogletree McGuinn

• Kim Simpson

• Eloise Theisen

• Allyson Waldron

The fantastic Nevada Nurses Foundation volunteers

& partners created an interesting and exciting

educational opportunity.

• Dr. Mary Bondmass

• Linda Bowman

• Dr. Vicky Lang Catlin

• Kelly Farley

• Dr. Glenn Hagerstrom

• Kate Hirsch

• Rev Dr. Denyse Ogletree McGuinn

• Dr. Sandy Olguin

• Jessica Rasaminanana

• Kim Simpson

• Veloma Wolfe

• American Cannibus Association

• Great Basin AACN


Nevada Nurses Association

March, April, May 2021 Nevada RNformation • Page 23

Nevada Nurses Foundation EST 2014

Congratulations to Martha Drohobyczer and Laurie

Shultz for being the 2021 Rural & Frontier Symposium

Raffle Prize winners! We appreciate you and your


Speaking of raffle…It is time to buy your 2021 Tea

on the Comstock Big Hat High Tea raffle tickets!! The

wonderful prizes include:

$500 Visa Gift Card

$300 Southwest Airline Voucher

$250 Amazon Gift Card

$250 Target Gift Card

$200 Best Buy Gift Card

hosted a Big Hat High Tea at the Nevada Governor’s

Mansion to raise money for nursing scholarships and

grants. Previous Big Hat High Tea themes include My

Fair Lady (2015), Mary Poppins (2016), Mad Hatter

(2017), Over the Rainbow (2018), Crowns and Tiaras

(2019) and the Wild West Tea on the Comstock (2020).

In 2020, the Tea was held virtually. The most amazing

local entertainers donated their time and talent to

deliver sensational performances. We had a virtual

silent auction and had a wonderful raffle!

The 7th annual BIG HAT HIGH TEA fundraiser will

be in June 2021 and this year’s theme is Tea on the

Comstock. Fingers crossed, prayers and good thoughts

appreciated to actually be in the heart of the Comstock

in June. More information will be announced soon!

It is always the season to be…MERRY! Buy local and

support local NV HEROES! We are grateful to Threads

of eNVy for donating the proceeds to the Nevada

Nurses Foundation.

Thank you Jessica Rasmaninana and Veloma Wolfe

for being our Nevada student nurse models!!


Thank you for supporting the Nevada Nurses

Foundation. We know there are many foundations

and services competing for funds and we appreciate

you recognizing the NNF’s contributions to nursing,

healthcare, and our community.

Thank you and have great days,

Sandy Olguin, DNP, MSN, RN


Nevada Nurses Foundation

“Success has nothing to do with what you gain in life

or accomplish for yourself. It’s what you do for others.”

~ Danny Thomas

Raffle Tickets are 1 for $10, 4 for $20, and 25 for

$100. Call or text us at 775-560-1118.

In 2014, when the NNF was first established,

Margaret Curley, Founding Member & past NNF/NNA

Liaison, suggested we host a High Tea, Betty Razor,

Founding Member & past NNF Treasurer, suggested we

wear big hats, Ian Curley introduced our first Big Hat

High Tea in 2015 and Darlene Bujold sang the first song

in 2015.

It is exciting to see the NNF grow, evolve, and make

a difference in healthcare and the lives of our Nevada

providers. Every year since 2015, the Foundation has

Kudos to Nevada’s Nursing School for conferring doctoral degrees to over 65 nurses during 2020.

Congratulations to all the nurses listed below earning those degrees!

Chamberlain University

DNP graduates

Maisha Moore

Although Chamberlain had only

one DNP graduate from Nevada,

Chamberlain University has nationwide

programs at multiple campus

sites. During 2020, Chamberlain

University granted over 460 DNP


Touro University

DNP Graduates

Margo Wallace

Sussie Akrong

Lea Ramos

Adriene Rivera

Brandon Lowe

Alyssa Sturm

Ibhalukholor Sedenu

Jesus Macanas

Jeoffrey Tinapay

Minjung Hong-Decapio

Tamara Schwing

Margaret Schwimer

Joseph Eslao

Billy Leonardo

Brittani Hicks

Alana Swift

Anna Mark

Rosalyn Phan

Catherine Nitafan-Young

Janell Ocampo

Habtamu Egata

Medard Sison

Bernice Ivoko

Suzette Ryan

Sloane Bowsher

Elizabeth Dania

University of Nevada Las Vegas

DNP and PhD Graduates


Jocelyn Allen

Kaylie Humphreys

Kristen Grunerud

Sarah Deredza

Mary Nara

Teresa Praus

Mailo Branter

Valerie Barboa

Tonya Bryant

Beth Hock

Jud Simons


Susan Belliston

Kelly Ann Garthe

Lynn Senette

Adrian Stamps

Rhiannon Sullivan

Anna Wendel

University of Nevada Reno

DNP Graduates

Adeline Abam

Laura Breu

Kathleen Burns

Susan Cocores

Richard Crisostomo

Anna Froelich

Caren Jaggers

Marjaana Krieger

Rustin Park

Jana Elliott

Jessica Grote

Kelly Lau

Danielle Planas

Jaskaranjeet Bhullar

Diana Kaydee Carrol

Rebecca Edwards

Kathy Goldsworthy

Jennifer Griffo

Cristina Mosqueda

Christine Pebbles

Kristen Seeley

Jamie Young

Alana Rogne

Brandee Shipman

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