One Profession. Many Roles.
The Official Publication of the Arizona Foundation for the Future of Nursing
Quarterly Publication distributed to over 58,000 Registered Nurses in Arizona
Vol. 74 • Number 2
We’re Working for You! JOIN US TODAY
Brought to you by the Members of AzNA. For more information on the benefits of membership, please visit www.aznurse.org.
A Year of Milestones
What a year it has
been! Due to the impact
of the pandemic and the
increased visibility of
the ANA Enterprise,
along with the World
has extended the Year
of the Nurse into 2021.
Nurses Week has been
expanded to Nurses
Selina Bliss, RN
Month in May with the theme being “You
Make a Difference”. Weekly themes are
planned for self-care, recognition, professional
development, and community engagement.
The year 2021 also marks milestone
anniversaries including 125 years for the
American Nurses Association (ANA), 30 years
for the American Nurses Credentialing Center,
and 25 years for the OJIN: The Online Journal
of Issues in Nursing (ANA’s scholarly journal).
While we acknowledge and celebrate our rich
history in nursing, other milestones are being
Some of the milestones are grim. Last
February our U.S. flag has flown at half-staff
to remember the 500,000 Americans lost to
COVID-19. On the other hand, as of this writing,
according to the Centers for Disease Control
and Prevention 72 million Americans have been
vaccinated against this deadly disease thereby
reaching 15% of the total U.S. population, with
the U.S. administering over 1.6 million shots a
day. Many of our AzNA members have been
busy volunteering at the vaccination points of
dispensing (PODs) throughout the state thus
contributing to 16.8% of Arizonans receiving at
least one dose. A tipping point has been reached
in the United States in that more Americans
have received at least one dose of the vaccine
than having tested positive for COVID since the
pandemic began. But a shocking milestone has
occurred in that COVID-19 is now the number
one cause of death in the U.S.
On the heartbreaking side, we are seeing a rise
in nurses suffering from burnout, depression,
and anxiety as well as acute stress disorder,
post-traumatic stress disorder, and nurse
suicides. In response to the alarming statistics,
ANA has made promoting the mental health
of nurses a priority by creating the Strength
Through Resilience Committee which focuses
on mental health promotion and prevention,
suicide prevention, and grief.
As we look to milestones here at the Arizona
Nurses Association, in 2019 we recently
celebrated our 100th Birthday as the Arizona
Nurses Association. Our membership continues
to rise quarterly. As we move forward into
a re-entry plan when we get closer to herd
immunity, I am looking forward to the Arizona
Nurses Association Membership Meeting this
upcoming October 1st and 2nd, 2021 when we
can celebrate our professional and personal
achievements from this challenging year.
What a year it has been!
Until then, it is an honor to lead our
professional organization that is considered the
voice of nursing in Arizona,
Selina Bliss, RN, PhD, CNE, RN-BC, ANEF
President - AzNA
current resident or
U.S. Postage Paid
Permit No. 14
CEO’s Message ................... 3
AzNA/AzNF Calendar of Events ....... 3
In Memory of ..................... 3
Congratulations: Magnet Redesignation .... 3
Nurses Who Vaccinate .............4-5
E-Cigarette Quit Attempts
Among College Students ........... 7
Call for Nominations ................ 8
Statement from NAHN-Phx ............ 8
Family Caregiving Context: A Pilot Study ... 9
March of Dimes Nurse of the Year Award ...10
Ask Nurse Melissa .................11
Members on the Move ...............11
Chinese Culture and End of Life Care ......12
Workplace Bullying: A Silent Epidemic .....13
COVID-19 and Mental Health:
Self-Care for Nursing Staff ....... 14-15
Two Year Anniversary Members ........16
AzNA’s Superstars .................16
Welcome New & Returning Members ....17
Virtual Simulation: Impact
on Clinical Judgement .............18
Practice Tips for the Independent
Nurse Practitioner ................19
Page 2 • Arizona Nurse April, May, June 2021
Arizona Nurse Editorial Board
Carol Peyton Bryant, DNP, RN, ACNP, CCRN
Kim Callahan, RN
Rebekah Christopher, RN
Anna Hustin, MSN, RN, NE-BC
Sherry Ray, EdD, MSN, RN, CHSE
Melisa Salmon, MSN, RN, CCRN, MBA
Alicia Shields, MSN, RN, CENP, DNP-student
Melissa Zuber, BSN, RN
The editorial board of the Arizona nurses is comprised of
members of the Arizona Nurses Association, who review all
submissions, provide expert advice on content, attract new authors,
and encourage submissions.
If you are interested in serving on the editorial board, please
contact firstname.lastname@example.org for more information.
Rhonda Anderson, DNSc, RN, FAAN, FACHE
Pat Mews, MHA, RN, CNOR
Chloe Littzen, BSN, RN
Sharon Rayman, MS, RN, CCTC, CPTC
Carol Stevens, PhD, RN
With the abundance of resources available to support healthcare workers, it can be overwhelming
to find a place to start. RNconnect is here to help by providing twice-weekly messages of support
for nurses from nurses, and connect our Arizona nurses to available resources for psychological and
mental health first aid.
Supported in part by generous donations from:
• American Nurses Foundation
• ANM Healthcare Education Solutions on behalf of Dr. Cole Edmonson, DNP
• Anne McNamara
• AzNA Chapters: Greater Phoenix Area, Nurse Educators, Nurse Practitioners, East Valley
• Charles Schwab
• Network for Good
Call for Article Submission
Submit your article or research for publication in AzNA’s quarterly print publication.
The Arizona Nurse is distributed to over 58,000+ RNs in the state.
AzNA welcomes submission of nursing and health related news items and original articles.
We encourage short summaries and brief abstracts for research or scholarly contributions
with an emphasis on application.
To promote inclusion of submitted articles, please review the article guidelines available
on the AzNA website at www.aznurse.org/Guidelines.
An “article for reprint” may be considered if accompanied by written permission from the
author and/or publisher as needed. Authors do not need to be AzNA members.
Submission of articles constitutes agreement to allow changes made by editorial staff and
publishers. See article guidelines for more information.
Submit your article to email@example.com.
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by location and credentials.
Browse our online database of articles and content.
Find events for nursing professionals in your area.
Your always-on resource for nursing jobs, research, and events.
Dawna Cato, PhD, RN, NPD-BC
Board of Directors
Selina Bliss, PhD, RN, CNE, RN-BC
Heidi Sanborn, DNP, RN, CNE
Amanda Foster, BSN, RN
Beth Hale, PhD, RN
Government Affairs Officer:
Denice Gibson, DNP, RN, CRNI, BMTCN, AOCNS
Janice Bovee, MSN, CNM
Robert “Bill” Adams, MSN, RN, CDCES, NHDP-BC
Carol J. Stevens, PhD, RN
Dawna Cato, Phd, RN, NPD-BC, Chief Executive Officer
Wendy Knefelkamp, Director of Operations
Debby Wood, Senior Project Coordinator
The Arizona Nurse (ISSN 0004-1599) is the official
publication of the Arizona Foundation for the Future of Nursing
(AzFFN), peer reviewed and indexed in Cumulative Index for
Nursing and Allied Health Literature. Arizona Nurse Author
Guidelines are available at www.aznurse.org. Call 480.831.0404
or firstname.lastname@example.org for more information.
No material in the newsletter may be reproduced
without written permission from the Executive Director.
Subscription price: included in AzNA membership or
$30 per year. The purpose of the Arizona Nurse is to
communicate with AzNA members and non-members in
order to 1) advance and promote professional nursing in
Arizona, 2) disseminate information and encourage input
and feedback on relevant nursing issues, 3) stimulate
interest and participation in AzNA and 4) share information
about AzNA activities.
For advertising rates and information, please contact
Arthur L. Davis Publishing Agency, Inc., PO Box 216, Cedar
Falls, Iowa 50613, (800) 626-4081, email@example.com.
Responsibility for errors in advertising is limited to corrections
in the next issue or refund of price of advertisement.
Advertisements do not imply endorsement nor approval
by the Arizona Foundation for the Future of Nursing (AzFFN)
of the product advertised, the advertisers or the claims
made. AzFFN shall not be held liable for any consequences
resulting from the purchase or use of advertised projects.
AzFFN, AzNA and Arthur L. Davis Publishing Agency, Inc.
reserve the right to reject advertisements. Rejection of an
advertisement does not imply that the offering or product
for advertisement is without merit, lacks integrity, or that
this association disapproves of the offering or product.
The Arizona Nurses Association is a constituent
member of the American Nurses Association.
April, May, June 2021 Arizona Nurse • Page 3
The Importance of Professional
Calendar of Events
In 2019 the World Health
deemed 2020 the year of
the Nurse and Midwife.
However, little did we know
this year would launch our
profession onto the national
and global stage as nurses
step up and step out to
combat one of the most
significant health risks the
world has seen in recent
history. According to the
John’s Hopkins Coronavirus
Resource Center, 1 confirmed cases of COVID-19
have now passed 113 million globally with 2.5 million
confirmed deaths, and we are not done. Nurses
worldwide have worked tirelessly in both paid and
voluntary positions to serve their patients, families,
and communities. Now, more than ever, nurses
are called upon to meet the needs of vulnerable
individuals and populations. As the nation’s most
trusted profession, the nurse’s critical role amidst
the pandemic has not gone unnoticed. Television,
radio, newsprint, social media, blogs, and more have
highlighted nurses’ selfless and heroic commitment.
The pandemic and subsequent global recognition of
nurses prompted the American Nurses Association
(ANA), WHO, and international colleagues to extend
the Year of the Nurse and Midwife into 2021.
Due to the global elevation of the value of
professional nursing, nurses in Arizona and
across the nation are recognizing the importance
of professional nursing associations. As nurses
expand their professional growth and sphere
of influence, they are embracing the benefits of
membership in both the ANA and Constituent State
Nurses Associations (C/SNA’s). The Arizona Nurses
Association (AzNA) has provided a critical link to
establishing, growing, and maintaining professional
growth. AzNA’s current member count is the highest
in recorded history, with over 3700 members to date.
In addition, nurses are keeping membership year
over year, with a retention rate this year of 76%.
AzNA members consistently report that
membership benefits such as networking,
professional growth through Continuing Nursing
Education (CNE), certification, publications, and
serving in leadership roles have been critical to
their success. As I talk with nurses across our great
state, they always start by saying, “If it weren’t for
AzNA, I would not...” This sentence typically ends
with them describing their professional journey and
succeeding in formal or informal leadership roles. As
the voice of nursing, AzNA advocates for a healthy
work environment, practicing to the full extent of
your education and licensure, adequate funding for
educational programs, and payment structures that
accurately reflect the value of nursing. AzNA works
in full partnership with the Arizona State Board of
Nursing to regulate the practice of nursing.
The mission of AzNA is “Advancing the Nursing
Profession and Promoting a Healthy Arizona.” We
accomplish this mission by providing services to
our members that promote, elevate, and influence
professional growth. Yearly events include RN
Advocacy Day, the Nurse Practitioner Symposium,
Annual Membership Meeting, Annual Renewal
Retreat for Nurses, AzNA Convention, and many more
hosted by individual and collective chapters across
the state, with additional national programs hosted
by ANA. The Arizona Foundation for the Future
of Nursing (AzFFN) provides scholarships, works
with national leaders on workforce sustainability,
and promotes and develops leadership skills. We
have something for everyone. Do you want to get
involved with public policy? Join the Public Policy
Committee or run for the office of Government
Affairs. Do you want to design, implement, and/or
evaluate CNE? Become a Nurse Peer Reviewer or
run for a chapter position that oversees CNE. Want
to get published? Submit an article for publication
in Arizona Nurse. Want to expand your leadership
capability? Run for office at the chapter or state level
of AzNA, then proceed to national levels with ANA.
Need to expand your professional network? Join
your local chapter or specialty chapter, such as the
Nurse Practitioner Council, Emerging Professionals,
or Nurse Educator Special Interest Group. ANA also
has communities for social networking across the
nation. Do you want to obtain a specialty certification
through the American Nurses Credentialing Center
(ANCC)? We can help with the Success Pays and
Sasmor scholarship programs.
The membership base of AzNA provides the
credibility and influence for us to continue the critical
role and responsibility of showcasing and raising
awareness of professional nursing issues. Although
our membership is strong, we can do better. Now
is the time to join your professional association to
remain relevant, elevate your skillset, and let your
voice and passion be heard. Now is the time to
step up and step out to define your professional
trajectory. Please take time to scan our website for
additional membership benefits.
Dawna L. Cato PhD., RN, NPD-BC
Home – Johns Hopkins Coronavirus Resource
Saturday, July 24, 2021
33rd Annual Southwestern Regional
Nurse Practitioner Symposium
Location: Virtual Event
Friday & Saturday, October 1-2, 2021
AzNA Membership Meeting
and Annual Convention
Location: Wild Horse Pass Hotel and
Registration and event information can
be found at www.aznurse.org/events
In Memory of...
Carol Delafontaine, RN, AzNA
member, past president Rio
Colorado AzNA Chapter 7,
passed away on Sunday,
December 20, 2020 as a
consequence of COVID-19.
AzNA extends congratulations to the following
CNO’s and their teams for Magnet Redesignation:
• Tamara Frost, CNO at Banner Estrella
Medical Center, Phoenix
• Kathy Walker, CNO at Banner - University
Medical Center Phoenix, Phoenix
Now hiring for
Clinical Nursing Faculty
Scheduled to start August 2021
Apply online here:
Maricopa County Community College District (MCCCD) will not discriminate,
nor tolerate discrimination in employment or education, against any applicant,
employee, or student because of race, color, religion, sex, sexual orientation,
gender identity, national origin, citizenship status (including document abuse),
age, disability, veteran status or genetic information.
Page 4 • Arizona Nurse April, May, June 2021
Nurses Who Vaccinate
Carol Stevens, PhD, RN, AzNA Past President
Nurses have always been at the forefront during
infectious disease emergencies, so it is no surprise
to find nurses volunteering to vaccinate during
the COVID-19 pandemic. For over a year, nurses
have selflessly cared for and nurtured patients sick
and dying of COVID-19, yet with the acquisition
and distribution of COVID-19 vaccines, hope for
ending the pandemic is on the horizon. “Nurses
who vaccinate” recognizes this subset of clinicians
who are enthusiastic and determined to get shots
into the arms of many.
Covid-19 vaccinations became available to
Arizonans on December 15, 2020. AZ nurses quickly
recognized the appealing opportunity to volunteer
at vaccination sites across the state. “I wanted to
volunteer to give vaccines because it was a way for
me to support our nursing staff at the frontline. I no
longer work at the bedside but by giving vaccines
I knew I was doing something that would directly
slow down the spread of the virus and provide relief
to my fellow nurses,” said Teri Wicker RN. As Points
of Dispensing (PODs) began to literally pop up
across the state, vaccine leaders quickly mobilized
resources and posted requests for medical and
non-medical volunteers. A monumental team effort
was required to successfully and safely vaccinate
over 3,500 people a day, according to Heather
James RN, Director of Nursing & Quality Assurance
at Dignity Health. James had the responsibility of
planning and opening the Chandler/Gilbert POD,
Lesly Kelly & Sarah Gerber
Carol Stevens, Robin Schaeffer & Teri Wicker
Nurse Positions Available!
• RN • LPN • Student Assigned • Substitute Nurses
Must have authorization to work in U.S. as defined by
the Immigration Reform Act of 1986 and current AZ RN
or LPN license. Great Schedule, Excellent Benefits!
To apply or for more information, please visit our
website at: www.dvusd.org
The East Valley Institute of Technology is
currently accepting applications for instructors
in our high school CNA program as well as an
instructor for our Adult Education Practical
Please use the following link for more information
regarding these positions, and to apply.
“A” Rated Pre-K–12 School District
Angela Jones - 480-461-4112
To access electronic copies of the
Arizona Nurse, please visit
Heather James & dog
April, May, June 2021 Arizona Nurse • Page 5
now operated by AzDHS. As the PODs evolved,
volunteer nurses responded. “I attended a live
classroom presentation on vaccine administration,
received a Certificate and have been administering
vaccines at the Az State Fairgrounds and several
care homes since,” said Pat Mews RN. The PODs
gave this writer and other nurses, many of whom
are retired, the opportunity to pay it forward. What
surprised us all was the “lessons learned” and how
understanding the “vaccination process” was so
beneficial to efficiently and effectively volunteer.
The most important information about Arizona’s
Vaccination Program is understanding that there
are two entities organizing and running the
COVID-19 Arizona response (see resources). The
first step in volunteering is to register with either
the state (Az DHS) or the County Public Health
Department Medical Reserve Corps (MRC). Both
have their own requirements such as background
check, immunizations and license verification.
Once verified in either system, one gets email
notices of volunteer opportunities.
What we learned was not all PODs/sites are
alike. Learning how to sign-up for a shift can be a
challenge because each POD/site has different
hours, roles, numbers of volunteer spots available,
etc. Often PODs were staffed by student nurses
as part of their clinical experiences as well as other
paid and nonpaid medical personnel. While each
POD has similar orientation, much like a shift
huddle, available supplies such as hand gel, cotton
pads, alcohol wipes, band aides and the process
for receiving pre-filled vaccine syringes differed.
One had to ‘learn the ropes’ quickly and then
settle into the rapid and consistent flow of willing
vaccine recipients driving through the vaccination
site. Other differences were surprising. We quickly
learned some nurses were getting paid, some sites
allowed “walk-ins,” some POD sites were staffed
with national emergency response groups such
as Disaster Medical Assistance Teams (DMATs)
and Team Rubicon. One thing was certain – all
opportunities allowed for nurses to meet others
committed to making a difference.
The real joy in volunteering to vaccinate is seeing
the gratitude expressed by anxious and eager people
receiving their vaccination. One can see the sparkle
in the eyes and feel the smiles behind the masks,
as old and young express appreciation and relief.
The rewards I felt after a day of vaccinating were
indescribable, despite the soreness and aches my
body felt after standing for hours. Knowing that I
was contributing to the total number of vaccinated
people was very satisfying. Most of us who volunteer
will continue doing so for perhaps many months to
come, as protecting our community and getting the
pandemic under control is our ultimate goal. I believe
we can all count on change, so staying informed and
sharing vaccination knowledge among our colleagues
STATE Az DHS: AZ-ESAR-VHP
Register at: https://mcdph.samaritan.com/custom/501/
Contact: email firstname.lastname@example.org.
COUNTY VACCINATION PARTNERS:
Maricopa County Dept of Public Health Medical
Reserve Corps (MRC)
Register at: https://esar-vhp.health.azdhs.gov/
Contact: 602-506-6767 or email
OTHER COUNTY PARTNERS, COMMUNITY
HEALTH CENTERS, MOBILE VACCINATIONS
(i.e. Pima County, Yuma County, Coconino County,
etc.), please see County Health Dept websites.
April, May, June 2021 Arizona Nurse • Page 7
E-Cigarette and Subsequent Smoking Use and Relationship
to E-Cigarette Quit Attempts Among College Students
Michelle Correa, RN
Electronic cigarette (e-cigarette) use increased three-fold from 2011
to 2013 and continues to gain prevalence among preteens, adolescents,
and young adults (Centers for Disease Control and Prevention [CDC],
2014). E-cigarettes, including vape, JUUL, and wax pens, are defined as a
device that does not contain tobacco but may include nicotine, flavorings,
and other chemicals (National Cancer Institute, n.d.). With multiple
marketing methods, e-cigarettes dominate in sales by targeting young
and old generations (CDC, 2014). Many youth and young adults believe
that e-cigarettes are cheaper, cleaner, safer, and healthier than traditional
smoking (Gorukanti et al., 2017; Kong et al., 2015). Related to these
perceptions, many young users (40.36%) believe that e-cigarettes help
people discontinue cigarette smoking (Gorukanti et al., 2017). Both nonusers,
who have never used e-cigarettes or cigarettes, and e-cigarette users
agree that e-cigarettes do not contain tar, are not addictive nor considered
a tobacco product, and solely produce vapor with water (Gorukanti et al.,
Though perceived as a “safer” alternative to cigarettes, e-cigarettes are
still not safe. Research indicates that while e-cigarettes may be a cessation
aid for cigarette smokers, the product may produce the adverse effect of
a nicotine addiction and/or combustible tobacco product use (Kong et al.,
2015; Pattinson et al., 2018). Individuals not aware of the consequences
of e-cigarettes may exacerbate current medical problems (i.e., asthma,
respiratory-related issues, hypertension, cardiovascular diseases), continue
their nicotine addiction through e-cigarette use, or initiate a nicotine
addiction had they not smoked before (CDC, 2014). The U.S. Department
of Health and Human Services (2016) reported consequences related to
e-cigarette use, like addiction, brain development and subsequent mental
health issues, chronic disease development, and death.
In 2020, I conducted a cross-sectional study that included an
anonymous screening survey and a survey that assessed e-cigarette use
and non-electronic smoking, e-cigarette withdrawal and cessation, and
non-electronic smoking quit attempts. I recruited 65 eligible* participants
via flyer advertisements, social media advertisements, ASU online
advertisements, and email notices. The study revealed that participants
who used non-electronic smoking also frequently used cigarettes or
marijuana. Participants who used both electronic and non-electronic
smoking preferred using e-cigarettes to non-electronic forms. Participants
who attempted to quit e-cigarettes believed that they would successfully
withdraw from e-cigarettes by switching to marijuana or avoiding nonelectronic
Using these findings and previous research, youth and young adults
seeking e-cigarette cessation need nursing education and intervention. We
can help this population quit by applying principles of the nursing process.
Ask patients about their e-cigarette habits, such as e-cigarette frequency,
perceived e-cigarette harm to self, e-cigarette device, primary flavor
use, nicotine presence, and reason for e-cigarette use. A more objective
scale to assess for e-cigarette use and potential withdrawal severity is the
Fagerström Test for Nicotine Dependence (Carpenter et al., 2010). Find
the most appropriate nursing diagnosis for the patient, such as risk-prone
health behavior. Use motivational interview techniques to promote the
patient to self-assess their willingness and readiness to quit e-cigarettes
(Hettema et al., 2005). Therapeutically communicate with the patient. Hold
your judgment or personal beliefs about the situation because you are
their biggest advocate and ally right now. Offer them interventions to help
them successfully quit e-cigarettes. Start with less invasive options: avoid
triggers such as people or situations; distract yourself with a hobby or task;
talk to someone who has experienced what you’re currently experiencing;
or call the substance abuse helpline (Mayo Clinic Staff, 2016; Malucky,
2010; Substance Abuse and Mental Health Services Administration, 2019).
We can also talk to the provider and ask for medication to help with the
We’re Looking for the Best!
Now Hiring Full-Time, Per Diem
& Seasonal Experienced RNs
Sign-On Bonuses May Be
Available for Core Positions!
An Equal Opportunity Employer/VEVRAA
withdrawal process. Medication may help manage symptoms like anxiety
or depression. All these options give patients the freedom to choose
how they want to quit. They feel in control after a time where they felt
e-cigarettes controlled their life.
We spend the most time with these patients. We are the first line of
defense for identifying and intervening in an e-cigarette user’s habits. We
must uphold that nurse-patient trust and advocate for our patients’ health.
The more we educate ourselves about e-cigarettes and inform our patients,
the more promising outcomes for e-cigarette cessation in the future, like
decreasing e-cigarette popularity and increasing health awareness and
*Eligibility criteria included that participant must have been: an ASU student,
at least 18 years old, and “current” e-cigarette user.
Michelle Corerra, BSN, RN, is a nurse with HonorHealth’s COVID-19/Stroke
Carpenter, M. J., Baker, N. L., Gray, K. M., & Upadhyaya, H. P. (2010). Assessment
of nicotine dependence among adolescent and young adult smokers: A
comparison of measures. Addictive Behaviors, 35(11), 977-982. https://doi-org.
Centers for Disease Control and Prevention. (2014). More than a quarter-million
youth who had never smoked a cigarette used e-cigarettes in 2013. Retrieved
Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R. & Halpern-Felsher, B. (2017).
Adolescents’ attitudes towards e-cigarette ingredients, safety, addictive
properties, social norms, and regulation. Preventive Medicine, 94, 65-71.
Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual
Review of Clinical Psychology, 1, 91-111. https://doi.org/10.1146/annurev.
Kong, G., Morean, M. E., Cavallo, D. A., Camenga, D. R., & Krishnan-Sarin, S.
(2015). Reasons for electronic cigarette experimentation and discontinuation
among adolescent and young adults. Nicotine and Tobacco Research, 17(7),
Mayo Clinic Staff. (2016). Quitting smoking: 10 ways to resist tobacco cravings.
Retrieved from https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/indepth/nicotine-craving/art-20045454
Malucky, A. (2010). Brief evidence-based interventions for nurse practitioners to
aid patients in smoking cessation. The Journal for Nurse Practitioners, 6(2),
National Cancer Institute. (n.d.). NCI dictionary of cancer terms. Retrieved
Pattinson, J., Lewis, S., Bains, M., Britton, J., & Langley, T. (2018). Vape shops: Who
uses them and what do they do? BMC Public Health, 18, 541. https://doi.
Substance Abuse and Mental Health Services Administration. (2019). National
helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline
U.S. Department of Health and Human Services. (2016). E-cigarette use among
youth and young adults: A report of the surgeon general [PDF file]. Retrieved
RNs - Looking for a change?
Sign-on bonuses offered
WARMC has immediate needs for Registered Nurses
• Competitive wages
• Sign-on bonuses (up to $15,000)
• Relocation bonuses
• Tuition reimbursement, Loan forgiveness
• Health benefits (medical, dental & vision)
• PTO/sick time and 401K
APPLY AT WARMC.com
Or, visit us in person on any Wednesday
with your resume in-hand.
If selected to be hired, you will be made an offer on the spot.
For information, contact the HR Dept. at 928-763-0267.
Page 8 • Arizona Nurse April, May, June 2021
Open Positions Available
Call for Nominations
AzNA’s Board members oversee
the direction of the association, take
responsibility for specific projects and teams,
recruit new members, ensure a balanced
budget, and represent AzNA members at
the American Nurses Association. AzNA’s
Board of Directors is an active board that
makes a difference in our profession.
Board members are elected annually for
two-year terms. A recent bylaws change
requires that board positions are elected
in a staggered fashion. Job descriptions
and additional information are posted at
If you wish to run for the AzNA Board
of Directors, please submit a bio consent
to serve form available at www.aznurse.
org/2021Election. Deadline for submission
is August 2, 2021.
The committee is seeking nominations
for the following:
Officer Positions Two Year Term:
DIRECTOR OF GOVERNMENTAL AFFAIRS
AzNA leadership positions provide
opportunities for career advancement
as well as being professionally and
personally rewarding. Volunteer to take a
seat at the table.
Nominations Committee: Roni Collazo,
John Risi, Kathy Wruk, & Board liaison,
Statement from the National Association of
Hispanic Nurses-Phoenix Chapter Regarding
COVID-19 and Hispanic/Latino Communities
The National Association of Hispanic Nurses-
Phoenix Chapter (NAHN-Phx) is dedicated to
educating the community about the health
needs of the Hispanic community. During the
COVID crisis, social media and other public
announcements stress the importance to mask,
wash your hands, and maintain social distancing
at least six feet. All this is important but this does
not address the culture of “familismo” or other
cultures that place importance on family. As we
know when families come together for family
events, these events become super spreaders.
It is important to inform members of families
outside the household to wear a mask when
getting together. The Hispanic Community is very
passionate and loving. This affection for each
other can lead to the spread of COVID if masks
are not worn. Take this opportunity to provide
education about the transmission of COVID and
the reason for wearing a mask.
Strategies to prevent further spread of COVID and
still be with family
Meet outside, social distance, and wear your
mask in close vicinity to others not in your
household. Remember to think of those most at
risk in your lives that would not be ok if infected
What we know:
• Hispanics/Latinos are three times more likely
to be hospitalized with COVID-19.
• Hispanics/Latinos are two times more likely
to die from COVID-19
• Hispanics/Latinos hold essential jobs that are
not able to be performed at home
• Hispanics/Latino have a reduction in life
expectancy due to COVID 19. Our community
has lost two years life expectancy in 2020
• More than half of those infected with COVID-19
have become infected by an asymptomatic
Another important point is to educate about the
significance of getting the vaccine. Identify barriers
to getting vaccinated and dispel myths. We can
only achieve normalcy if everyone is implementing
precautions and receiving their vaccine/vacuna.
We are proud to acknowledge our members,
Paulette Rangel – President of the Phoenix
Chapter, Lyda Velez – President-elect, Karen
Garcia – Membership Committee Chair and Felipe
Santoyo-Cuellar – Education Committee Chair and
Raymundo Marin – Outreach Committee Chair, for
their contribution to providing COVID education
locally and nationally along with our partners,
AARP, Univision, NPR and news outlets.
• Reductions in 2020 US life expectancy due to
COVID-19 and the disproportionate impact
on the Black and Latino populations | PNAS
• Risk for COVID-19 Infection, Hospitalization,
and Death By Race/Ethnicity | CDC
• SARS-CoV-2 Transmission From People
Without COVID-19 Symptoms | Global Health
| JAMA Network Open | JAMA Network
• Table 1. Workers who could work at home,
did work at home, and were paid for work at
home, by selected characteristics, averages
for the period 2017-2018 (bls.gov)
NAHN Phoenix 2021 –
Save the Date
We look forward to seeing you at our virtual conference.
When: Friday, August 27, 2021
More information to come... Visit www.nahn-phx.org
Have you always wanted to live
in the White Mountains?
Arizona Nurse Attorney
Kimberly Kent, RN, JD has
over 28 years of experience with
the Nursing Board, Hearings
and Trials. Our attorneys are
unwavering in their defense of
nurses in Arizona. Appearance
in any legal matter without legal representation is
dangerous. KNOW YOUR RIGHTS. WE CAN
341 E. Camelback • Phoenix, AZ 85012 • 602-264-5600
Enjoy the natural beauty of the White Mountains
and experience "The Accord Difference"
Accord Hospice is seeking
qualified & compassionate nurses.
Contact: Ashley Frost
Human Resource/Business Office Manager
Phone (928) 271-8013 or (928) 608-5820
April, May, June 2021 Arizona Nurse • Page 9
Family Caregiving Context: A Pilot Study
Rachel L. Peterson, PhD, MPH, MA
Division of Epidemiology, Public Health Sciences
University of California, Davis
Kim D. Shea, PhD, RN, CHPN, College of Nursing
Jian Liu, PhD, Department of Systems and Industrial Engineering
Kayla Luque, BSN Student, College of Nursing
Jessica Powell, BSN Student, College of Nursing
Yinwei Zhang, PhD Student, Department of Systems and Industrial Engineering
Deborah K. Williams, PhD, MPH, RN, College of Nursing
Lori Martin-Plank, PhD, FNP-BC, NP-C, GNP-BC, FAANP, FNAP, College of Nursing
Beverly J. Heasley, MBA, RN, FNGNA, College of Nursing
Linda R. Phillips, PhD, RN, FGSA, Center on Aging
Janice D. Crist, PhD, RN, FWAN, FAAN, College of Nursing
The University of Arizona
Small changes in older adults’ lives can lead to “tipping points,”
permanently altering health and wellbeing. A “caregiving tipping
point” is a catastrophic event, e.g., a fall with a fracture. Such events
can change older adults’ self-care ability, increase family burden, and
lead to breakdowns of caregiving systems and living arrangements.
Although tipping points appear to be sudden, they are often preceded
by small changes that could have been identified (Crist, Liu et al., 2019).
We seek to predict tipping points with data collected by an affordable
fitness watch, questionnaires, and in-person interviews. In this pilot
study, we investigated if this approach was sufficient to develop tipping
point algorithms and if Mexican American (MA) caregiving families
(older adults and family caregivers) found these activities acceptable.
We focused on MA families because they are less likely than non-Latino
white families to access and utilize long-term support services for many
reasons, including familismo, i.e., “We take care of our own,” and a lack
of trust or culturally tailored information about services (Crist, Ortiz-
Dowling et al., 2019). Also, MA individuals experience more disability at
earlier ages than others (Tarraf et al., 2020).
We recruited MA older adults from local congregate meal sites. We
visited participants in their homes at the beginning and end of one
week. Participants provided demographics and completed a modified
Life Space Questionnaire (LSQ), mapping their regular steps in the home
and the community. Throughout the week, participants completed a
daily diary to record their activities at specific times throughout the day,
noting abnormalities in how they felt, e.g., dizziness, pain. Participants
wore the watch continuously for seven days. Then researchers visited
to download watch and LSQ data, collect diaries, and interview the
older adult. Participants received $30 and kept the watch. The research
was approved by the University of Arizona Institutional Review Board.
Engineers analyzed watch data to detect how much variation
occurred during the week, comparing these findings with participants’
self-reported activities. Engineers used “continuous wavelet transform
analysis” (Nason, 2008) to identify daily step counts, continuous heart
rate, and patterns. The daily dairies aided the interpretation of the watch
data. We used content analysis (Neuendorf, 2002) to identify themes
from the interviews about experiences wearing the watch.
Results from this pilot study of seven MA women ages 58-84 suggest
this method is appropriate for detection of changes in heart rate data
among older adults. However, variations in pedometer data were too
limited to explain the observed variations in participants’ heart rates,
e.g., abrupt changes in heart rate and their extent. The daily diary
information varied widely, limiting the diaries’ usefulness.
Wearing the watch 24 hours/day was acceptable, simple, comfortable,
and familiar. It motivated the women to engage in more physical
activity. Several used the watch to monitor their daily step count to
reach movement goals. Participants noted social benefits and barriers.
One felt “special” by participating in the study and receiving the watch.
Another feared she might become alienated from friends not wearing a
watch. Most participants indicated they relied on younger relatives to
help with technology, although some were interested in learning to use
the technology more effectively.
Findings are a critical step towards predicting tipping points. When
the predictive ability of continuous data becomes more useable,
nurses can better assist community-dwelling older adults to “age in
place.” More sophisticated, but less affordable, watches that collect
additional biometric data may be necessary to develop sensitive and
reliable tipping point algorithms. Early identification of tipping points,
e.g., an older adults’ decreasing mobility, and becoming vulnerable to
falls, could alert nurses and families that it’s time to access services
to prevent catastrophes. This study with MA older adults provides a
template for future research. Contrary to popular assumptions, the
majority of Latino individuals access the Internet through mobile phones
and Latino caregivers access the Internet daily to communicate and find
information (Iribarren et al., 2019). However, the cost of technology will
need to be balanced with its capacity to ensure use while providing
sufficient data to predict tipping points. New findings may guide nurses,
researchers, and policymakers to offer culturally tailored interventions
for supporting older adults’ aging in place.
Crist, J. D., Liu, J., Shea, K. D., Peterson, R. L., Martin-Plank, L., Lacasse, C. L.,
. . . Phillips, L. R. (2019). “Tipping point” concept analysis in the family
caregiving context. Nursing Forum, 54(4), 582-592.
Crist, J. D., Ortiz-Dowling, E. M., Shea, K. D., & Phillips, L. R. (2019).
Knowledge Gaps About End-of-Life Decision Making Among Mexican
American Older Adults and Their Family Caregivers: An Integrative
Review. In Journal of Transcultural Nursing (Vol. 30, Issue 4, pp. 380-393).
SAGE Publications Inc. https://doi.org/10.1177/1043659618812949
Iribarren, S., Stonbraker, S., Suero-Tejeda, N., Granja, M., Luchsinger,
J. A., Mittelman, M., Bakken, S., & Lucero, R. (2019). Information,
communication, and online tool needs of Hispanic family caregivers of
individuals with Alzheimer’s disease and related dementias. Informatics
for Health and Social Care, 44(2), 115–134. https://doi.org/10.1080/175381
Nason, G. (2008). Wavelet methods in statistics with R. Springer.
Neuendorf, K. A. (2002). Defining Content Analysis. In The Content Analysis
Guidebook (pp. 1–35). https://doi.org/10.4135/9781071802878.n1
Tarraf, W., Jensen, G. A., Dillaway, H. E., Vásquez, P. M., & González, H. M.
(2020). Trajectories of Aging among U.S. Older Adults: Mixed Evidence
for a Hispanic Paradox. Journals of Gerontology - Series B Psychological
Sciences and Social Sciences, 75(3), 601–612. https://doi.org/10.1093/
Rehoboth McKinley Christian
Health Care Services is
recruiting RNs for:
Operating Room • ER • ICU
Labor & Delivery • Med Surg
We offer a great working
environment and competitive
compensation package including
Quality Health Care, Close to Home
View our current openings and/or
submit an application online at:
Contact Brian Lalio
Human Resources Generalist/Recruiter
or email at
1901 Red Rock Drive
Gallup, NM 87301
RMCHCS is an EEOC Employer
Page 10 • Arizona Nurse April, May, June 2021
AzFFN to Sponsor the March of Dimes
Nurse of the Year Award
LeAnne Prenovost, RN
There are 15 categories for nurses and friends of nurses to nominate from or
you could sponsor one of the categories.
LeAnne Prenovost (right) receives the March
of Dimes Women’s Health Award, presented to
her by Sharon Glanville (left), March of Dimes
Arizona Board Member.
The March of Dimes (originally known as
the National Foundation for Infantile Paralysis)
originated on the eve of World War II by founder
Franklin D. Roosevelt. FDR, who suffered from
polio, was passionate about systematic efforts
to reduce this disease. During the war years, it
was a struggle to launch the organization and the
March of Dimes was hosted by radio, Hollywood,
and the appeal of the President himself. As a
grassroots effort operated by volunteers, the
March of Dimes encouraged every individual to
contribute 10 cents; thus, the name was born.
With the advent of the Polio vaccine in the 1950s,
the March of Dimes mission shifted to birth
In addition to FDR, a pivotal figure in the March
of Dimes history was Dr. Virginia Apgar, known
for the Apgar Score. Her passion was improving
outcomes of pregnancy and at her death in 1974,
she paved the way for a new focus for the March
of Dimes - healthy pregnancy. In 2003, the March
of Dimes launched its Prematurity Campaign to
confront this alarming trend, the nation’s most
serious perinatal health problem.
The March of Dimes recognizes nurses as
instrumental in the fight for healthy pregnancies
for moms and babies and established the Nurse of
the Year (NOTY) awards. Nurse of the Year events
recognize and honor distinguished nurses for their
outstanding contributions. The March of Dimes
NOTY in Arizona is in its 18th year of recognizing
and celebrating our state’s outstanding nurses.
As a former recipient of the 2017 March of Dimes
NOTY in the category of “Women’s Health,” I can
attest to what an honor this is. I can remember
calling my son after I won and telling him that it
was the most amazing experience of my nursing
career and if I could have bottled that feeling and
sold it, I would be rich.
As nurses, we work hard, we care deeply, we
are the backbone of the healthcare system and
the patient’s last line of defense. We are awesome
and we know that. COVID-19 has validated our
contributions throughout the world. What we
can improve at is recognizing the contributions
we bring to healthcare delivery. We are a
humble group but now more than ever we need
to step up and flood the 2021 March of Dimes
NOTY awards with nominations. We need to
use our written collective voices to recognize
our extraordinary peers, colleagues, and coworkers.
These awards honor extraordinary
nurses who go above and beyond to deliver
I encourage all nurses to nominate and honor
each other, especially after everything we have
been through in this last year! Now is our time.
If every nurse in AZ could nominate a nurse, we
could show our solidarity as a profession and
show our support of each other. Once you have
nominated someone, make sure they follow up to
complete the nomination process and highlight
Once upon a time, I thought that it was not a
good use of my time to complete my application
for the NOTY award. After all, there was no way
I would win and I was not used to showcasing
my contributions. Once I took the time and
thoughtfully reflected on my contributions to
the profession, I felt a sense of accomplishment
upon completion of my application. When Yetta
Gibson, from channel 3TV, called my name as the
March of Dimes NOTY, it was like a dream—the
best dream and day of my life.
Just as the March of Dimes started with just a
dime - everyone has just a dime - every nurse has
just enough time to nominate one nurse this year.
Let’s celebrate moms and babies together with
this remarkable organization and our profession
LeAnne Prenovost DNP, RN, CNE, CHES
April, May, June 2021 Arizona Nurse • Page 11
Ask Nurse Melissa –
A Look at 2021
Hello, my fellow nurses! I don’t know about you,
but on New Year’s Eve, I blew my horn and yelled
good riddance to 2020. I almost immediately realized
that 2021’s arrival was not going to fix all the problems
2020 brought. Most of us are pretty drained by ‘bad
news overload.’ Let’s plan how we are going to come
out of this stronger.
Cynthia Occelli said, “For a seed to achieve its
greatest expression, it must come completely undone.
The shell cracks, its insides come out, and everything
changes. To someone who doesn’t understand
growth, it would look like complete destruction.”
Maybe we have been looking at 2020 the wrong way.
Perhaps all of 2020 traumas were growing pains. It
helped us understand our emotional limits.
Many of us have eight inches of roots showing
in our hair that we cover with a surgical cap. That
thought alone should have given us a clue that our
shells were cracking. We have been tested mentally,
spiritually, and physically. We are social creatures,
and to be in isolation has not been good for us. We
have faced fears of the unknown. We have stretched
ourselves to give all we could to our patients and
Take a moment and look back on what you went
through in 2020. What were your feelings throughout
this pandemic experience? Think about the people
that were by your side. Those people are your tribe.
The moments we have experienced together have
Let’s take that bond, that unity, and put our effort
into strengthening our teams. 2020 exposed our
weaknesses in various ways. We know what those
are now. We should come together to offer solutions
and make positive changes for nursing and patient
care. Now in 2021, unified, we will be able to rebuild
brighter and better.
Have a question for Nurse Melissa?
Email email@example.com with
“Nurse Melissa” in the subject line.
ON THE MOVE
The Friends of the National
Institute of Nursing Research
(FNINR) are pleased to
announce the selection of
Karen L. Johnson PhD, RN,
FAAN into their Ambassador
program. Dr. Johnson is
Director of Nursing Research,
Banner Health. Ambassadors
are selected from a national
pool of applicants based on
their abilities to advance public, health professional,
and policy-maker awareness of the critical research
agenda advanced by the National Institute for
Nursing Research (NINR).
Are you an AzNA Member with an
accomplishment to highlight?
Send to firstname.lastname@example.org.
Established in 1926, and like the tenacious Western spirit that built
Wickenburg, at our rural Community Hospital and Clinics, taking
care of our patients, families, and community comes first. Our team is
committed to providing quality, health, and wellness services to our residents
and surrounding communities within approximately 3,300 square miles.
Being a smaller organization, Wickenburg Community Hospital offers the
opportunity for more personal care to our patients while being close
enough to a major city to enjoy all that Phoenix has to offer.
If you have the passion for caring for patients
“Out Wickenburg Way,” explore the possibilities!
Or contact Dina Steinberg at 928-668-1822.
Page 12 • Arizona Nurse April, May, June 2021
Chinese Culture and End of Life Care
Michelle Hebard, MSN, MBA
Imagine having to make the ultimate decision
for a loved one who has a terminal diagnosis. No
one likes to face a difficult ethical decision when
it comes to a family member. The unexpected
awaits and not knowing what is at the other end
can be traumatizing for anyone. Nurses every
day face the challenge of dealing with ethical
issues. When it comes to end-of-life care, this
can be a difficult decision for all those involved.
The nurse must face the difficult decision of
providing ever-loving care to their patients while
respecting their cultural beliefs. The Chinese
culture can be especially challenging so nurses
must be educated on their beliefs in order to care
for these patients. They need to understand the
role that they play when it comes to caring for
the dying patient. Having education and being
able to communicate properly is critical for endof-life
Mr. Ting Lee is an 88-year-old male that is
terminally ill. His family is there at the bedside
with the patient. The family decides that the
patient should not be made aware of his terminal
condition. The oldest son is at the bedside along
with several other family members. Before the
nurse begins caring for this patient it is important
that they understand their own beliefs and culture.
This will help build a therapeutic relationship with
the patient. By having the nurse identify their own
cultural competency, it can help them from not
judging the patient. In the case of Mr. Lee, it may
be difficult for the nurse to understand why the
family does not want the patient to know about his
The Chinese culture is one of many different
things that make it unique. “People’s beliefs and
attitudes about health and disease are influenced
by their traditional culture” (Tung, 2011, para. 1).
Chinese philosophies and religion play a major role
in how they view healthcare and accept treatment
when needed. Dealing with the illness and end of
life of a loved one can be difficult for this group of
people to deal with. Typically, talking about endof-life
issues is avoided because it is bad luck and
it could hasten the pace of the dying process. This
is also true for cancer and other terminal diseases
that they may deal with. “Chinese believe that a
cancer diagnosis is regarded as a metaphor for
death because of the high mortality rate” (Dong
et al., 2015, p. 191). It is up to the family members
to determine if they are going to tell their loved
one about the diagnosis or keep it to themselves.
The family’s focus is to protect the patient at all
costs. Even at the end of life, they may choose
not to tell their loved one about the terminal
diagnosis. This puts the health professionals in a
dilemma as to whether or not to tell the patient
about their terminal diagnosis in order to facilitate
a good and dignified death for the patient (Tung,
2011). Cultural practices can inhibit Chinese from
seeking medical care when they need it (Denisco
& Barker, 2016).
As primary caregivers for patients when they
are at end of life, it is important to understand
the thoughts of physicians and nurses. Qualitative
research design was used in the article to identify
physician’s and nurse’s perceptions of caring
for dying Chinese cancer patients (Dong et al.,
2015). The data was collected by those who had
a terminal diagnosis. Participants in the study
were of all ages and different parts of the hospital.
There were face-to-face interviews with the
patients. The family gave permission to be a part
of the study. The participants were asked a range
of questions regarding the care they expected
to receive. From the research, it was concluded
that five main themes arose. They involved the
physicians and nurses having a strong sense of
obligation to both the patients and the situation
of culture. The patients want hope and spirit
maintenance as they transition to the end of life.
The Chinese hope and pray for an improvement
in their quality of life. The physicians and nurses
expressed the importance of their presence
and being available at the patient’s bedside. The
nurses and physicians expressed the importance
of maintaining hope for life to the dying patient
(Dong et al., 2015).
The Chinese culture does not like to tell their
family members about their diagnosis. They have
very specific views when it comes to death and
dying. As previously stated, it is bad luck to talk
about a negative outcome, so it is avoided at all
costs. They try to use different methods to help
prolong a patient’s life. It is common to withhold
any bad information from a family member.
Hospice care is typically avoided because the
family feels that they are dumping their loved
one. They are expected to take care of their loved
ones in their time of need and not rely on staff
from the hospital or home care to do it. Due to
this, hospice is not utilized as often as it could be
in the Chinese culture. Ultimately it is up to the
oldest adult male to make any decisions for health
care issues and uses the family for big decisions
regarding the patient. It is normal for the family to
not involve the patient in their care and the nurse
speaks with the family for any decisions regarding
In order to provide culturally sensitive care
to the Chinese people, nurses must be aware of
changing demographics (Denisco & Barker, 2016).
It is important for nurses to realize that people
in the Chinese culture have different demands
and needs when it comes to health and illness
(Denisco & Barker, 2016). It is important for nurses
to understand that cultural competencies involve
understanding and demonstration of knowledge
of the patient’s culture (Denisco & Barker, 2016).
This also involves being adaptive to the care that
the patient requires.
It is not the nurse’s job to judge but to respect
the decision of the family and still advocate for
the patient. Acceptance of the nurse also helps
with cultural sensitivity. “How can patients love
and accept themselves in ways that promote
healing if we, as nurses, are not willing to offer
them acceptance in their myriad of problems
and complexities” (Ferwerd, 2016, para. 4)?
“Through the simple act of acceptance, nurses
can become an agent of healing, whether or
not they are aware of it” (Ferwerd, 2016, para.
4). The nurse should care for the patient as they
would for any other patient. Any procedures or
tests should be communicated with the patient.
Even if the patient is nonverbal, the nurse should
always communicate and let them know what
they are doing. The nurse can help to educate the
family on hospice. For example, since the family
typically wants to care for the patient, the nurse
may talk to the family about the other options
that are offered. These include social workers,
bereavement coordinators, and even volunteers.
This gives the family the option to learn what can
be offered to them if they so choose it. When
the nurse does their assessment of the patient,
they should make sure to tell the patient and
family what they are going to be doing and even
ask permission before doing it. Always keep the
patient and family informed on what is going
on. Communication is key to building a trusting
relationship with the patient and family. Nurses
must remember to speak in terms that the patient
and family can understand.
The Chinese culture is truly unique in many ways.
As a nurse, it is important to be aware of the cultural
aspects of the patient. If the nurse is unsure, it is
alright to ask the family. No matter what, the nurse
is responsible for advocating for the patient and
doing what is best for them. Cultural competency
is more than just understanding racial and ethical
values. It also involves respecting each patient for
their beliefs by not judging and providing safe care.
A nurse must truly understand who their patient is
instead of focusing solely on their health issues.
We are seeking highly motivated nurses
Exciting nursing opportunities and breathtaking allure of Navajoland await
committed and highly motivated nurses.
Come join us in Winslow! We are located just seven miles from the southern edge of the Navajo
Nation, 45 minutes east of Flagstaff and a few hours north of Phoenix. You can go from Standing on
the Corner of Winslow, Arizona to hiking scenic and majestic landscapes.
• Clinical Nurse
• PRN Registered Nurse
• Clinical Care Coordinator
• Public Health Nurse
• RN Case Manager
• Infusion Clinical Nurse
Chen, Y. (2002). Chinese values, health and nursing.
Retrieved from https://onlinelibrary.wiley.com/
Denisco, S. M., & Barker, A. M. (2016). Advanced
Practice Nursing (3rd ed.). Burlington, Ma: Jones
& Bartlett Learning.
Dong, F., Zheng, R., Chen, X., Wang, Y., Zhou, H.,
& Sun, R. (2015, October 9). Caring for dying
cancer patients in the Chinese cultural context:
A qualitative study from the perspective of
physicians and nurses. European Journal of
Oncology Nursing, 21, 189-195. http://dx.doi.
Ferwerd, J. (2016). How to care for patients from
different cultures. Retrieved from https://nurse.
Tung, W. (2011). Hospice Care in Chinese Culture:
A challenge to home care professionals. Home
Health Care Management & Practice, 23, 67-68.
April, May, June 2021 Arizona Nurse • Page 13
Workplace Bullying –
A Silent Epidemic
Dr. Palma Iacovitti DNP MBA RN
Reprinted with permission Florida Nurse, November 2020
Dr. Iacovitti has earned her Bachelor’s in Nursing,
MBA and most recently a Doctorate in Nursing Practice
from University of Iowa. Her clinical nursing experience
for nearly 25 years consists of pediatrics, emergency
medicine, gastroenterology, women’s health, and solid
organ transplant. She is currently a Program Manager for
Surgical Oncology Clinics at Baptist MD Anderson.
The stakes for workplace bullying (WPB) are
higher than school bullying because it affects a
person’s livelihood. The Workplace Bullying Institute
(WBI) defines bullying as “repeated, health-harming
mistreatment of a person (the target) by one or
more workers that takes the form of verbal abuse;
Dr. Palma Iacovitti,
DNP, MBA, RN
conduct or behaviors that are threatening, intimidating or humiliating;
sabotage that prevents work from getting done; or some combination
of the three by a cruel perpetrator (the bully)” (Namie & Namie, 2009).
WPB impacts physical and psychological health of nurses, threatens their
working relationships, family, and careers. RN turnover will cost a hospital
from $5.2M – $8.1M (Gooch, 2016). Bullying in the workplace can cost over
$4 billion yearly (2016). A WBI 2017 survey reveals 19% of adult Americans
have experienced abuse; 37% (including witnesses) have been affected by
it; 63% of Americans now are aware that workplace bullying happens; only
9% of the targets are believed that they are being bullied; 77% want a law
against WPB (Namie, 2017).
The rationale to stamp out WPB is to create a healthier, happier, satisfying,
and positive workplace for all employees and patients; decrease the risk
of harm to patients, shield seasoned and newly licensed nurses to practice
under safe conditions avoiding needless distractions of being bullied.
Addressing bullying reduces the risk of losing veteran bedside nurses,
reduces the financial impact on organizations, reduces the risk of increasing
hospital acquired infections and most importantly places perpetrators
accountable for their pathological and unforgivable behavior.
Bleak and dark, torn apart, from nowhere lives were shattered
Suddenly the need to look at everything that mattered
Freedoms that we never knew were even “being free”
Such simple things like family we suddenly can’t see
We thought we were prepared, as planned as we knew how
Just what was coming, we were helpless, when we look back now
We rose as one, standing tall, faced forward from the crowd
Bracing on each other’s strength our purpose we avowed
No one here would stand alone, together - not apart
In unity we stood our ground, our passion from the heart
It is alright to grieve and mourn, to say goodbye, our minds forlorn
Families lost so very much, so grateful for our human touch
We walked with them their final mile, a soft hand and gentle smile
We ask permission in our head to empty hearts and mourn our dead
Brave and stoic at a glance we’ll share our stories given chance
Thankful now the time is passing, the pause, reflection, now amassing
Raw emotion hard to feel, overwhelming, hurt, we keel
Each memory personal, experience too, but we knew we’d make it through
The strength and courage never faltered although our lives forever altered
Miracles too we saw and cheered, lifting spirits, hope appeared
So many families reunited, fear dispersed and future sighted
Celebrate the gift of kindness – of lessons learned always remind us.
Stephanie I M Strickland MS BSN
Bullying is a multi-faceted hidden epidemic. Placing the following
projected solutions in any given order is arduous. Solutions can happen
simultaneously, and each takes effort, patience, dedication, and time.
Leaders in all organizations must first acknowledge bullying is transpiring
then rapidly discover a process to collaboratively examine and manage
nurse bullying in an effort that staff can work in a healthier workplace.
Everyone has a right to come to work in a nonviolent and positive work
C-Suite collaborate with staff and create Leadership/Human Resources
to enforce a “No Tolerance” policy together with an on-going evaluation
of the effectiveness of the “No Tolerance” policy. Perpetrators are
encouraged to be accountable for their behavior and take responsibility
for their actions by making amends to those affected.
Nurses need to be brave by coming forward and exposing their
perpetrator. Otherwise their distorted, despicable, and hateful conduct
Nurse bullying databases must be established. Currently, none are in
existence. Databases are a valuable tool to measure, assess and identify
patterns in health systems. Data can be collected by population subgroups,
regions, or the nation. Should any national nursing organization or nursing
professional desire to contact their legislator or local representative to seek
support for mandating health organizations to introduce a “No Tolerance”
Legislation for either a “No Tolerance” policy or resurrecting the
Healthy Workplace Bill can ultimately help safeguard healthier work
environments, nurses can practice under safe conditions, maintain patient
safety, empower staff to report bullying without retaliation, improve the
quality of care in hospitals. WPB is unacceptable in any occupation.
Most nurses stay silent when they are oppressed and demeaned by
workplace bullies even though organizations have policies in place to
address lateral/horizontal violence. They are encouraged to speak to
someone because they are not alone. Staying silent empowers bullies and
their behaviors. It can also lead the targets to suicide.
Gooch, K. (2016). Becker’s Hospital Review. 5 thoughts and statistics on nurse
bullying. Retrieved from: http://www.beckershospitalreview.com/humancapital-and-risk/5-thoughts-and-statistics-on-nurse-bullying.html
Namie, G. and Namie R. (2009). The Bully at Work. Second Edition Naperville, IL:
Namie, G. (2017). Workplace Bullying Institute. 2017 WBI U.S. Workplace Bullying
Survey. Retrieved from: http://www.workplacebullying.org/wbiresearch/wbi-
Nursing Solutions Inc. (2016). 2016 National Healthcare Retention & RN Staffing
Report.Retrieved from: http://www.nsinursingsolutions.com/Files/assets/library/
Page 14 • Arizona Nurse April, May, June 2021
COVID-19 and Mental Health: Self-Care for Nursing Staff
Gráinne Ráinne Clancy, BN, MIACP;
D’Arcy D. Gaisser, DNP, MS, RN, ANP-BC; and
Grace Wlasowicz, PhD, RN, PMHNP-BC, ANCC NP
Along with incalculable loss, the coronavirus
(COVID-19) outbreak has had devastating effects on
the mental health of people with COVID-19, their
families, and the community at large. Healthcare
workers face tremendous stress, both emotionally
and physically, from the grueling work hours and the
threat of contracting the virus at work.
This article addresses the potential mental health
issues for healthcare workers that may emerge from
this pandemic as well as treatment options and selfcare
activities that promote recovery.
COVID-19 and mental health
Nurses working on the front lines of the COVID-19
pandemic may experience various mental health
problems. Here are a few examples:
• Chronic stress. Nurses are continuously fearful
of contracting COVID-19, infecting others,
encountering prejudice from the public
due to working as a nurse, and dealing with
inadequate supplies of PPE. 1 Stress becomes
chronic when it is overwhelming and cannot be
resolved, resulting in relationship, health, and
sleep problems. 2-5 People with chronic stress
experience intense emotions that can feel
overwhelming and result in thinking negatively. 6
Nurses on the front lines in COVID-19 hotspots
report feeling like a graduate nurse again, filled
with uncertainty and worry. 7
• Acute stress disorder. Nurses with acute stress
disorder may have trouble sleeping, worry
constantly, and experience persistent negative
thoughts about their role in the traumatic event,
such as thinking “I should have done more to
help.” 8 When we experience trauma, we detach
from the memory. We ignore our emotions to
protect against the pain, but these emotions
reappear over time and impact our lives. 9 The
nurse may respond to a minor irritation as if it
were a life-threatening event. 10 Nurses may feel
they are in a dreamlike state that impacts their
ability to think, process their emotions, and
respond appropriately to situations. 11 If signs
and symptoms of acute stress disorder persist
for more than a month, posttraumatic stress
disorder (PTSD) may be diagnosed. 12
• PTSD. Nurses are not strangers to caring for
critically ill patients who die. 8 However, the
number of patients dying amid a surge in
COVID-19 cases is causing healthcare workers
to feel powerless, which can lead to PTSD.
PTSD can develop after direct or indirect
exposure to a traumatic event, such as hearing
about a traumatic event involving a family
member, friend, or colleague. Those with PTSD
experience recurrent intense and disturbing
thoughts and feelings stemming from one
or more traumatic events. 10,13,14 Nurses with
PTSD may relive an event through flashbacks
or nightmares, and they may feel sadness,
fear, anger, guilt, shame and detachment or
estrangement from other people. 14 Many
traumatized individuals have a robust and
unconscious inclination to go inward, often
to re-experience their distressing thoughts,
April, May, June 2021 Arizona Nurse • Page 15
painful memories, and uncomfortable sensations. 15 They may have an
exaggerated, startled response to certain situations and develop problems
with concentration and sleep. 5
The nursing team’s role
When nurses struggle personally, we tend to be critical of our colleagues or
management and withdraw from others. Such a change in personality is often an
indicator of struggle. It is often a team member who will notice that you are not
your usual self and may be struggling with anxiety and stress. Asking yourself or a
colleague three simple questions can raise awareness about a possible problem:
• Am I ok? Are you ok?
• Do you feel you cannot give any more?
• Do you feel your work is ineffective? 16
If you are struggling, speak with your colleagues, acknowledging those
feelings and thoughts in the first instant. If you feel you are not performing
effectively in your workplace, talk with your manager and state your opinions
on being ineffective. Everyone has limits, and sometimes just taking a week off
might be sufficient.
Nurses who continue to feel this way should discuss it with their primary
healthcare provider and their employer and review the options available. A
range of supports may be available from your employer or your professional
organization. 17,18 Some nurses may want the support of a counselor. It is a strength
to realize that you are struggling with your mental health and need help.
Early psychological intervention does make a difference. 19 Each of us has
a limit to stress, and it is important not to compare our stress levels to those
of another person. There is strength in being vulnerable and showing our
thoughts and emotions. Brené Brown defines vulnerability as uncertainty, risk,
and emotional exposure. 20
Topping off emotional reserves
Nurses on the COVID-19 front lines are plagued by drained emotions
loneliness, and fear. These are normal reactions to an unfamiliar, uncertain
environment. Transitioning away from work at the end of the day is essential for
nurses to top off their emotional reserves.
If you have had a particularly stressful day, acknowledging and discarding any
negative thoughts or feelings can help improve sleep quality. Having a ritual to
signal the end of work is essential. Here are some suggestions:
• Take a shower. Visualize all the worries of the day disappearing down the
• Write down any thoughts or feelings in a notepad.
• Watch a favorite TV program.
• Read a book.
• Listen to your favorite music.
• Contact a friend.
• Write down three things you were grateful for today.
The COVID-19 pandemic is an unprecedented event in our lifetimes that
will have untold mental health implications for nurses and other healthcare
professionals on the front lines, both in the short and long term. Although
scientists and healthcare professionals know more about the disease and how
to treat it now, nurses in current COVID-19 hotspots will still be treating patients
with a serious and rapidly spreading disease while possibly contending with
shortages of PPE, equipment, and treatments. 21
Nurses will need to receive support from their team, practice optimal self-care
strategies, take measures to replenish their emotional reserves, and learn how to
transition mentally from work to home after their shift. Recognizing stress and
learning how to cope will help nurses protect their mental health as we move
forward during this pandemic.
1. Wann W. America is running short on masks, gowns and gloves. Again. The
Washington Post. 2020. www.washingtonpost.com/health/2020/07/08/ppe-shortagemasks-gloves-gowns.
2. Mariotti A. The effects of chronic stress on health: new insights into the molecular
mechanisms of brain-body communication. Future Sci OA. 2015;1(3):FSO23.
3. American Psychological Association. How stress affects your health. 2019. www.apa.
4. Heidt T, Sager HB, Courties G, et al. Chronic variable stress activates hematopoietic
stem cells. Nat Med. 2014;20(7):754-758.
5. Kabat-Zinn J. Full Catastrophe Living. 15th anniversary ed. New York, NY: Piatkus;
6. Newman MG, Llera SJ, Erickson TM, Przeworski A, Castonguay LG. Worry and
generalized anxiety disorder: a review and theoretical synthesis of evidence on
nature, etiology, mechanisms, and treatment. Annu Rev Clin Psychol. 2013;9:275-297.
7. Gonzalez D, Nasseri S. ‘Patients have panic in their eyes’: voices from a Covid-19
unit. The New York Times. 2020. www.nytimes.com/2020/04/29/nyregion/
8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of PTSD’. BBC News. 2020. www.
9. Muller R. Trauma and the Struggle to Open Up. New York, NY: WW Norton &
10. Van Der Kolk B. The Body Keeps the Score. London: Penguin; 2014:156-157, 166.
11. Bolton EE, Jordan AH, Lubin RE, Litz BT. Prevention of posttraumatic stress disorder.
In: Gold SN, ed. APA Handbooks in Psychology. APA Handbook of Trauma
Psychology: Trauma Practice. Washington, DC: American Psychological Association;
12. Psychology Today. Acute stress disorder. 2019. www.psychologytoday.com/ie/
13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
14. American Psychiatric Association. What is posttraumatic stress disorder? 2020. www.
15. Levine P, Blakeslee A, Sylvae J. Reintegrating fragmentation of the primitive self:
discussion of “somatic experiencing.” Psychoanal Dialogues. 2018;28(5):620-628.
16. Highfield J. Am I OK? Intensive Care Society. 2020. www.ics.ac.uk/ICS/Education/
17. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles
and responsibilities of health workers, including key considerations for occupational
safety and health. 2020. www.who.int/publications/i/item/coronavirus-disease-
18. American Association of Critical-Care Nurses. Well-being Initiative. 2020. www.
19. World Health Organization. WHO guidelines on conditions specifically related to
stress. 2013. www.who.int/mental_health/emergencies/stress_guidelines/en.
20. Brené Brown. Vulnerability. 2020. www.brenebrown.com/definitions.
21. Frank S. As coronavirus slams Houston hospitals, it’s like New York “all over again.”
The New York Times. 2020. www.nytimes.com/2020/07/04/us/coronavirus-houstonnewyork.html.
This article has been adapted for space and originally appeared in the September
2020 issue of Nursing © 2020 Wolters Kluwer Health, Inc.
This risk management information was provided by Nurses Service Organization
(NSO), the nation’s largest provider of nurses’ professional liability insurance coverage
for over 550,000 nurses since 1976. The individual professional liability insurance policy
administered through NSO is underwritten by American Casualty Company of Reading,
Pennsylvania, a CNA company. Reproduction without permission of the publisher is
prohibited. For questions, send an e-mail to email@example.com or call 1-800-247-1500.
Page 16 • Arizona Nurse April, May, June 2021
Tracy Turina Johnson
Fort Collins, CO
Mia Grace Palugod
Two Year Anniversary Members
December 2020 – February 2021
Lackland AFB, TX
Little Colorado Medical Center is a 25-bed, critical access hospital,
located 50 miles east of Flagstaff, Arizona; a compassionate and
caring facility in a family oriented community. Enjoy the stress free
pleasures of small town living with benefit of a fast paced stimulating
work environment. LCMC is seeking the following experienced staff:
Current AZ RN license or State Compact
Current BLS/CPR certification
New Grads accepted with 2 year commitment
RN’s with 1 year experience eligible for sign-on bonus
If you are clinically competent, a team player and have excellent
interpersonal leadership and computer skills them come excel and
grow in an outstanding team environment!
Visit our website at
Violeta Brito Toledo
Sioux Falls, SD
Krystal Iglesia Agot
Happy Anniversary to our dedicated
AzNA members celebrating these
special milestones for this past quarter:
December 2020 - February 2021
Amanda Dean Martin
Herendira Valdez Shahnaz
Paula V Williams
Suzanne Van Ort
April, May, June 2021 Arizona Nurse • Page 17
New & Returning AzNA Members
December 2020 - February 2021
Bainbridge Island, WA
Michele M Balducci
Fort Collins, CO
Nicole Angeli Calma
Lake Havasu City
Faith Melody Maglinte
San Tan Valley
Located in Northeastern AZ
Ana Maria Burger
Anu Malla Trzaska
Nursing Opportunities Available
• Emergency Department RN
• Outpatient Clinic RN
• Community Health/Diabetes Program RN Supervisor
• Community Health/ Diabetes Program RN
• Medical/Telemetry Unit RN
• Case Manager RN • Employee Health RN
Contact: Patricia Blosser, MSN, FNP-C, MBA, CNO at
928-755-4559 or firstname.lastname@example.org
Applications available at sagememorial.com/careers/
Send applications to Human Resources
Fax#: 928-755-4659, email@example.com
The Navajo Health Foundation/Sage Memorial Hospital is a drug/alcohol free EOE/AA/Navajo Preference Employer
Page 18 • Arizona Nurse April, May, June 2021
Virtual Simulation: Impact on Clinical Judgment
Amber Kool, MSN, RN
The need for newly licensed nurses to safely
manage multiple complex patients requires strong
clinical judgment skills to appropriately prioritize
and delegate (Bittner & Gravlin, 2009). Direct
patient care experiences in acute care settings
are the typical way nursing students learn clinical
judgment. However, these clinical experiences do
not always provide an opportunity to collaborate,
critical think, or make independent decisions
that will improve patient outcomes (Lippincott
Nursing Education, 2018). The most recent data
from the American Association of Colleges of
Nursing suggests that 80,407 qualified applicants
were not admitted to baccalaureate and graduate
nursing programs with insufficient clinical sites a
contributing factor (2020). The COVID-19 pandemic
has significantly limited direct patient care clinical
experiences for nursing students throughout the
U.S. (Logue et al., 2021). There is an urgent need
to develop teaching-learning practices that will
support the development of clinical judgment as
both an augment and substitution for direct care
clinicals (Thobaity & Alshammari, 2020).
This study investigated the impact of a virtual
simulation (VS) (Sentinel U’s Patient Management
and Delegation and Prioritization of Care) on
clinical judgment in a sample of pre-licensure
BSN students. VS utilizes experiential learning as
identified by Kolb’s Experiential Learning Theory
(1984) to expose the learner to a new experience
and requires the student to reflect, thereby
integrating the learning into their knowledge
bank (McLeod, 2017). As learners reflect on their
decisions and reasoning, they integrate their
previous experiences and the new knowledge
gained through the VS.
Using a one-group, repeated measures design,
a paired-samples t-test was used to measure the
change in perceived clinical judgment pre to post-VS
intervention. The Skalsky Clinical Judgment Scale
measures the construct using a four-point Likert
Scale, with ten questions, which include assessing
perceived abilities in prioritization, delegation, and
There was a statistically significant increase
in perceived clinical judgment scores from preintervention
(VS) (M = 32.17, SD = 4.178) to postintervention
(VS) (M = 34.10, SD = 4.992), t (41) =
2.832, p < .007 (two-tailed). The mean increased
in perceived clinical judgment scores was 1.929
with a 95%.
The positive results suggest that VS may be useful to
support teaching-learning practices related to clinical
judgment development. Perceived increases in
clinical judgment may make students more confident
and encourage them to practice skills further. Further
research is needed to objectively measure clinical
reasoning and resultant patient outcomes that result
from the use of VS as a teaching-learning strategy.
Implications for Nursing the Nursing Profession
Recent evidence suggests that only 10% of
newly licensed nurses score within an acceptable
competency range using a performance-based
(Kavanagh & Sharpnack, 2021). The most recent
practice analyses by the National Council of States
Boards of Nursing suggest that newly licensed RNs
are increasingly required to make more complex
clinical decisions (2015, 2018). COVID-19 exacerbated
existing pre-licensure nursing education challenges
by further limiting already scarce clinical practicum
sites (Dewart et al., 2020). VS may be a useful addition
to direct patient care and high fidelity human patient
simulation to learn clinical reasoning skills. VS may
be helpful as an additional strategy in addressing
the critical nationwide shortage of clinical practicum
sites. Also, VS may bridge the gap in clinical learning
experiences during times when other opportunities
may not exist, such as experienced during the
COVID-19 pandemic and in times of emergencies
and natural disasters.
VS may likewise prove beneficial for skill
development or assessment within clinical agency
orientation and continuing competency efforts.
Similar to its use in the academic environment, VS
within practice and continuing education provides
a safe environment to make decisions without
potential harm to patients (Verkuyl et al., 2019).
In conclusion, given the evolving technology that
underpins VS and its increasing fidelity, the interest
in and application of VS in academic and practice
environments will likely increase. Nurse leaders
will be challenged to implement VS in evidencebased
ways and monitor and measure outcomes to
assure its value.
American Association of Colleges of Nursing. (2019).
Nursing shortage. Retrieved from https://www.
Bittner, N. P., & Gravlin, G. (2009). Critical thinking,
delegation, and missed care in nursing practice.
JONA: The Journal of Nursing Administration, 39(3),
Dewart, G., Corcoran, L., Thirsk, L., & Petrovic,
K. (2020). Nursing education in a pandemic:
Academic challenges in response to COVID-19.
Nurse education today, 92, 104471. https://doi.
Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021)
“Crisis in Competency: A Defining Moment in
Nursing Education” OJIN: The Online Journal of
Issues in Nursing Vol. 26, No. 1, Manuscript 2.
Lippincott Nursing Education. (2018, June 7). Turning
new nurses into critical thinkers. Combining
Domain Expertise With Advanced Technology
| Wolters Kluwer. https://www.wolterskluwer.
Logue, M., Olson, C., Mercado, M., McCormies, C.J.,
(January 31, 2021) “Innovative Solutions for
Clinical Education during a Global Health Crisis”
OJIN: The Online Journal of Issues in Nursing
Vol. 26, No. 1, Manuscript 6. DOI: 10.3912/OJIN.
National Council of States Boards of Nursing. (2015).
2014 RN Practice Analysis: Linking the NCLEX-
RN Examination to Practice - U.S. and Canada. 62.
National Council of States Boards of Nursing. (2018).
2017 RN Practice Analysis: Linking the NCLEX-
RN Examination to Practice - US & Canada 72.
McLeod, S. (2017, February 5). Kolb’s learning styles
and experiential learning cycle. Retrieved from
Sentinel U. (2020, November 30). Nursing
prioritization exercises. https://www.sentinelu.
Skalsky, K. (n.d.). Skalsky Clinical Judgment Scale
validity. American Sentinel University
Thobaity, A., & Alshammari, F. (2020). Nurses on the
Frontline against the COVID-19 Pandemic: An
Integrative Review. Dubai Medical, 1-6. https://
Verkuyl, M., Hughes, M., Tsui, J., Betts, L., St-
Amant, O., & Lapum, J. L. (2017). Virtual gaming
simulation in nursing education: A focus group
study. Journal of Nursing Education, 56(5), 274-
Day and Night Shifts
For the following positions:
• Certified Nursing Assistants
• Registered Nurses
• Licensed Practical Nurses
• Assistant Director of Nursing
The Caring House is a state of the art facility with excellent nursing patient ratios.
12 hour shifts with great benefits and a very generous amount of PTO.
Qualified applicants must have:
• AZ State Certification as a Nursing Assistant & CPR Certification
• AZ State Licensure as an LPN or RN & CPR/BLS certification
• AZ Dept of Public Safety Fingerprint Clearance Card
Please apply at WWW.GRHC.ORG/CAREERS
Email Ylesia Jones at YJONES@GRHC.ORG or Call 520-562-3321 EXT. 1712 or
Email Mark Walter at WWALTER@GRHC.ORG or Call 520-610-8923
(for questions on the Assistant Director of Nursing position)
April, May, June 2021 Arizona Nurse • Page 19
Practice Tips for the Independent Nurse Practitioner
Because of AzNA nurses can say YES
Michelle M. Anderson
DNP, FNP-BC, APRN, FAANP
Reprinted with permission RN Idaho,
Full practice authority has been in place
in Idaho since 1998 (HB662) with removal of
the Board of Medicine governance of nurse
practitioners (NPs). In 2003 legislation passed
removing physician supervision and the rule
amendment was adapted in 2004. With this
opportunity comes the option for independent
NP practice. The Global Signature Authority Bill
(S1240) passed in July removing some further
barriers to independent practice. Owning and
operating your own NP business is not for the
faint of heart. Having the ability to manage all
things with a side order of business acumen is
incredibly important. According to data from
the U.S. Bureau of Labor Statistics, about 20%
of U.S. small businesses fail within the first year
So, given these types of statistics for failure,
why even bother? NPs are not educated in
graduate school on how to run a business, at least
most are not. This is unusual considering how
many other types of programs offer some of these
options. How can you plan for success when you
are never taught the basics? One way to work past
this is to reach out directly to the Small Business
Administration (SBA). They often offer classes,
courses, and counseling to new business owners
or potential business owners. They have an online
learning center dedicated to a lot of the needed
basics to get you on the right path.
there is a strong state-wide
voice for nursing
nurses influence laws, rules
and Scope of Practice
You have made it through graduate school so
utilize the brains you were given and knowledge
that you have. Running a business has a lot of
common-sense aspects to it. You must bring
in more than you put out. You must remember
to offer exceptional customer service. Equally
important is having the team that you work with
be engaged with the practice. A welcoming and
knowledgeable receptionist and an engaging
and skill oriented medical assistant or nurse are
invaluable. Make sure their viewpoint is heard
and acknowledged. Hire the right people into
positions so you are not micromanaging the
practice all the time and able to focus on the
part that is the true joy – patient care!
Enough cannot be said about credentialing
and billing. A good biller and/or billing system
is worth their weight in gold! This is how the
money is collected and how you stay afloat.
Compliance with the insurance companies’
requirements and awareness of the changing
landscape is sometimes more than you can
keep up with. Bringing in people to do the
things you are not sure how to do is a smart
Stay focused on your goals. Important at
the start is the creation of a business plan with
1, 3, and 5-year goals. The SBA offers a free
course and worksheets to get you started. You
should know where you want to go and have
a plan on how to get there. This may involve
the number of patients associated with the
practice, successful attainment and loyalty of
staff or even the ability to simply hire staff. You
might want to look at space and potential for
growth. And above all else, you want to make
sure to manage your overhead. Planning helps
keep you profitable.
promotion of a healthy
Marketing of a new practice is tough for
most of us, largely because we are taught in the
beginning of our nursing career that everything
we do is for someone else. This may be true
to a point, but this is the part where you really
need to shine. In order to shine you have to be
willing to talk about how amazing and skilled
you are and how wonderful your practice is.
This might involve something unique you offer
that another practice does not, or just how
accessible you are to your patients.
As NPs we are renowned for our listening
ability. That is a phenomenal marketing point
as most patients want to be heard. We are
taught early in NP school that 90% of the
time the patient will tell us what is wrong if
we ask the right questions and listen to the
answers. Another strong marketing point is
to be genuine. Market in areas that are of
interest to you. Perhaps you can volunteer as
the healthcare provider at a sporting event, or
belong to a Chamber small business group, but
whatever you chose, be genuine about it. You
do not need to be a guerilla marketer to be a
successful business owner.
Be good to your patients and they will be
good to you. Word of mouth on care is such a
huge way to grow a business. Take time to get
to know your patients and they will recognize
that and refer other like-minded patients your
way. If your passion is young family care then
cultivate that. Also know your limits and set
up a good referral network. Your referral is
an extension of you as the patient is trusting
that you are sending them to another good
Finally, belong to your state and national NP
organizations. They have access to additional
resources you may need or additional expertise.
Most questions that you come across have
already been asked and these organizations
can help save you some leg work. If nothing
else, they can put you in contact with other
independent NPs for support. Although you
are doing this independently, you do not have
to do it alone. Take that first step, do it with
purpose and knowledge, confidence, skill, and
Gustafson, K. (2020, August 7). What Is the Bureau
of Labor Stats Small Business Failure Rate in
2020? LendingTree. https://www.lendingtree.
collaboration on the local
and national level
nurses have access to
mentors and role models
Health Professional Resources
Health Professional Webinars
• Diabetes and Dairy: Research, Recommendations and Real World: Click Here
• A World Well Nourished: Dairy’s Role in Health and Sustainable Food Systems: Click Here
• Dairy DYK: Your Top Questions Answered: Click Here
• Get Cultured on Fermented Dairy Foods: Click Here
• Fat or Fiction: The Science of Whole Milk Dairy Foods Within Healthy Eating Patterns: Click Here
Dairy Nourishes Network
National Dairy Council’s Dairy Nourishes Network brings together food, nutrition and health
professionals to discuss how dairy foods are part of nourishing people and communities, while
also being mindful of the planet. Join here
This is a sample of the Science Summaries published by National Dairy Council ® .
Click here to see more on NDC’s website.
• Dairy in Healthy Eating Plans: Click Here
• Dairy and Type 2 Diabetes: Click Here
• Cardiovascular Disease: Click Here
• Yogurt and Your Health: Click Here
• Cheese and Your Health: Click Here
National Dairy Council’s food models can help make teaching nutrition easy and fun. They are
versatile, printer-friendly and bring the 2015 Dietary Guidelines for Americans (DGA) and MyPlate
recommendations to life. When printed on 8.5-by-11-inch paper, these food models represent
true-to-life serving sizes of the individual foods. Nutrient information is provided on the back of the
images in a format similar to the updated 2018 Nutrition Facts labels.
Nutrition Education Resources
Standards-based Nutrition Curriculum
Dairy Council ® of Arizona has partnered with Dairy Council ® of California to bring AZ teachers
award winning, standards-based curriculum packages for K through Middle School! Both paper and
digital versions available. Check them out here!
Order Free Nutrition Education Materials
The Dairy Council © of Arizona and Nevada provides award winning, age-specific nutrition education
materials throughout the states of Arizona and Nevada at no charge. See the catalog here.
If you are not an Arizona or Nevada resident, and are interested in nutrition education materials, please
visit the National Dairy Council’s website to find the Dairy Council office that serves your area.
Please allow 2-4 weeks to receive the requested materials.
Downloadable Nutrition Resources
Dairy Council ® of Arizona provides nutrition education materials on a variety of topics. Click here
to access downloadable resources that can be reproduced for educational purposes.
Dairy Toolkit - A Moo-velous Resource and
This toolkit for educators and parents is packed with information about many aspects of dairy: nutrition,
kid-friendly recipes, on the farm information, dairy food safety, all about milk, and fun activity sheets to
expand learning. It can be used in school or at home to help kids understand dairy – where it comes from
and why it’s good for them.
Please download this toolkit and feel free to print and share any of the materials you find here.