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
9 Support the Next Generation of
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
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
4 NNA’s Current and New
8 Research & EBP Corner
10 NNA Environmental Health
12 Antimicrobial Stewardship -
14 Nurses in the News
22 Nevada Nurses Foundation
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 1,000 RNs and LPNs and
delivered electronically via email to 40,000 RNs and LPNs in Nevada
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
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
current resident or
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 Mary.email@example.com ..............President
Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC firstname.lastname@example.org .......Vice President
Sherrie Sherk-Olson, BSN .........................................Secretary
Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE email@example.com .........Treasurer
Arvin Operario ...........................................Director at Large
Christa Secord, MSN, FNP-BC firstname.lastname@example.org ................Director at Large
Norman Wright, RN, BSN, MS email@example.com ...................Director at Large
Darlene Bujold, BSN, RN firstname.lastname@example.org ...............President, District 1
Margaret Covelli, DPN, RN Margaret.email@example.com ..........President, District 3
Managing Editor, Linda Bowman, RN, firstname.lastname@example.org
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!
NNA has been the voice for nursing in Nevada for over 100 years. The purposes
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
Are you interested in submitting an article for publication in RNFormation?
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Goals of NNA:
• Promote and uphold excellence and integrity for the profession of nursing
• Educate and advocate for accessible, affordable quality healthcare for clients/
• Monitor the evolving role of the professional nurse
The following positions are open for the 2021 year.
• State Level: a candidate for a Director (three-yr term)
• Northern Nevada - District One: seeking candidates for the positions of
President-elect (one-year. Then moves into President position for two-year
term) Vice President, and multiple Directors-at Large (all two-yr terms)
• Southern Nevada - District Three: Treasurer (two-yr term) and two
Directors at Large
• ANA Membership Assembly (June) in Washington DC: seeking
candidates for one Representative & one alternate (one-yr terms). To
fully represent the goals and mission of NNA, candidates should actively
participate in at least one Committee. This position only serves in the summer
for the Assembly, expenses are covered.
• Nominations Committee: seeking three candidates (one-yr terms)
What are the responsibilities of board members?
The Boards meet monthly for ~90 minutes over the internet for reports and
Board members are instrumental in carrying out the goals and objectives of NNA.
All of which benefit Nevada nurses. Officers may be asked to volunteer to assist in
How do I become a candidate? Self-nominate~!
Click on link below to submit your candidacy form.
Thank you for considering serving the nurses of Nevada - you are
If you'd like more information, please contact NNA Director of Operations Linda
Bowman at firstname.lastname@example.org.
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
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
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 (email@example.com), and let
us know if we can publish your comment,
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
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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Page 4 • Nevada RNformation March, April, May 2021
NNA'S CURRENT AND NEW MEMBERS!!
Anna Marie Zamora
Anne Margaret Bexon
Arkay Marie Lising
Becky Czarnik Rn Ms
Breanna Di Pinto
Charina Mae Picornell
Cherry Grace Daelto
Cheryl Dela Cruz
Clem Victor Manrique
Crista Mae Therese
Dinah Lynn Sinang
Dr. Jon Vrban
Dr. Remeliza Tukay
Edna Dela Cruz
Elena Ellen Maborang
Ellen M. Lewis
Eva Maria Rivera
Greela Joy Yadao
H Rebecca Fuller Gray
Haydee Jeanette Nuno
Jan Michael Arceo
Janet Purcell Gray
Jasmin San Luis
Jayson Paulo Agaton
Jessamine Gale Pantig
Jesus V Cornelio Catre
Joanna Patrice Johnson
John Reynolds Ii
John Paul Mercado
Joseph Taylor Jr
Julius Caezar Henzon
Karen Anne Wolfe
Karen Marie Beardsley
Katelyne May Atijera
Katrina Perkins Davis
Kelly Jane Villaroman
Lee Anna Bristol
Leslee Bridget Magnus
Lisa Marie Pacheco
Lloyzel Faye Yung
Lorraine Jill De Borja-
Lynn Von Schlieder
Ma Renzel Therezna
March, April, May 2021 Nevada RNformation • Page 5
Maria Angela Nina Vela
Maria Gina Agnir
Maria Mernina April
Maria Monica Aragon
Maria Rizel Sturgell
Maria Rosario Wood
Marisa Leah Dela Rosa
Mary Denisse Toribio
Michele (Shelly) Alfaro
Nelly De Dios
Perla Labastida Espejel
R Danessa Rebello
Rachell Anne Agas
Renate Jeddahlyn Flores
Rica Santa Maria
Rich Janel Suanes
Rizza Marie Tawatao
Roscelle Jhoyce Minoza
Samantha Chanel De
Sarah Rose Nelson
Stacey Lea Spahn
Valeria Melendez Estrada
Veronica Niki James
Xandee Shirley Bernabe
Xenia Daffodil Valles
Page 6 • Nevada RNformation March, April, May 2021
Tracey Long PhD, MSN, APRN-BC, CCRN
NNA is recruiting for the position of
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 firstname.lastname@example.org or Director of Operations,
Linda Bowman at Lbowman@nvnurses.org.
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 https://bit.ly/35qLV7x. 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
o National Center for Complementary and Integrative Medicine: http://nccih.
o Natural Medicines: https://naturalmedicines.therapeuticresearch.com/.
o FDA tainted product list: https://www.accessdata.fda.gov/scripts/sda/
o Tips for Dietary Supplement Users: https://www.fda.gov/Food/
o Tips for Older Dietary Supplement Users: https://www.fda.gov/Food/
o HerbList App (free from NIH): https://www.nccih.nih.gov/health/herblist-app.
o Merck Manual Online Chapter on Dietary Supplements (for consumers and
health care professionals): https://www.merckmanuals.com/professional/
o Dietary Supplements Part 1: https://youtu.be/SwFalkgN_1Q.
o Dietary Supplements Part 2: https://youtu.be/4L-cCzMtKx8.
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 www.westhillshospital.net 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,
DNP, APRN, FNP-BC, FAANP
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
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
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
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 email@example.com
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.
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),
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
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 firstname.lastname@example.org 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 email@example.com 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
• “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: https://motif.org/news/topsustainable-fashion-designers/
• The World Counts: https://www.
March, April, May 2021 Nevada RNformation • Page 11
NNA Environmental Health Committee
• Love Faustine: https://lovefaustine.com/
• Patagonia Recycling of Clothing: https://www.patagonia.com/recycling.html
Bernadette M. Longo, Ph.D.,
RN, APHN-BC, CNL, FAAN
Chair, NNA’s Environmental
President-Elect, NNA District 1
Founder and Creative Director,
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
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
Silk: strong fiber and considered a
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
Polyester fabrics: made from fossil
PET Plastics: also known as
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
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
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
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: https://www.leg.state.nv.us/
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
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: https://nvnursesfoundation.org
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 www.justserve.org 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,
CHEP, CNE, CPRW, NEA-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
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 https://doi.org/10.3928/00220124-
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!
NursingALD.com can point you
right to that perfect NURSING JOB!
Free to Nurses
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.”
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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
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. https://www.ncbi.nlm.nih.gov/
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. https://www.powerofpositivity.com/
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. https://www.quickanddirtytips.com/healthfitness/mental-health/oxytocin
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.”
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
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)
“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
“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
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
Greater Inclusion of Nursing Students with Disabilities
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.
GROWING UP RESILIENT
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).
LEARNING TO SUPPORT OTHERS
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.
AMPLIFYING MY FOCUS AND INNER STRENGTH
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
THE FIRST. CHANGE THE STEREOTYPE.
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
• 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
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
• 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
• 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
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 (facebook.com/MenInNursingNevada)
and our website (www.MenInNursingNevada.com).
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
“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 CMS.gov: 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 CMS.gov: Newsroom Fact Sheet: https://www.
Health Resources & Services Administration. (2020,
September). Organ Donation Statistics. Retrieved from
Organdonor.gov: 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: http://www.healthdata.org/
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: https://optn.transplant.hrsa.gov/data/
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
• 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
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
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!
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
University of Nevada Las Vegas
DNP and PhD Graduates
Kelly Ann Garthe
University of Nevada Reno
Diana Kaydee Carrol