Arizona Nurse - April 2021

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One Profession. Many Roles.

The Official Publication of the Arizona Foundation for the Future of Nursing

Arizona Nurse

Quarterly Publication distributed to over 58,000 Registered Nurses in Arizona

Vol. 74 • Number 2

APRIL 2021

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


A Year of Milestones

What a year it has

been! Due to the impact

of the pandemic and the

increased visibility of

nurses’ contributions,

the ANA Enterprise,

along with the World

Health Organization,

has extended the Year

of the Nurse into 2021.

Additionally, National

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

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

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 for more information.


Rhonda Anderson, DNSc, RN, FAAN, FACHE

Vice Chair:

Pat Mews, MHA, RN, CNOR


Chloe Littzen, BSN, RN

Scholarship Chair:

Sharon Rayman, MS, RN, CCTC, CPTC

Elected Trustee:

Carol Stevens, PhD, RN

Elected Trustee:

Kimberly Behrens-Grieser

Elected Trustee:

Phillip Guarrera

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

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

Visit today!

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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.

Executive Director:

Dawna Cato, PhD, RN, NPD-BC

Board of Directors


Selina Bliss, PhD, RN, CNE, RN-BC

Vice President:

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

Past President:

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 Call 480.831.0404

or 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,

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

Association Membership


Calendar of Events

In 2019 the World Health

Organization (WHO)

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

Dawna Cato,


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

Center (

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

Casino, Chandler

Registration and event information can

be found at

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

Full time

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

Pat Mews

Robin Shaeffer

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:

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

Nursing program.

Please use the following link for more information

regarding these positions, and to apply.

Colleen Hallberg

Carol Stevens

“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

is critical.



Register at:

Contact: email



Maricopa County Dept of Public Health Medical

Reserve Corps (MRC)

Register at:

Contact: 602-506-6767 or email



(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

smoking altogether.

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!

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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.


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

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

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



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Or, visit us in person on any Wednesday

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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

for Leadership

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:





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,

Heidi Sanborn.

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 (

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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.

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.


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).

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.


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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

defects prevention.

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

compassionate care.

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

their accomplishments.

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

this year.

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

loved ones.

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

bonded us.

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 with

Nurse Melissa” in the subject line.



The Friends of the National

Institute of Nursing Research

(FNINR) are pleased to

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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).

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accomplishment to highlight?

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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

the patient.

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.

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Chen, Y. (2002). Chinese values, health and nursing.

Retrieved from


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,


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

Proposed Solutions

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

will continue.

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:

Namie, G. and Namie R. (2009). The Bully at Work. Second Edition Naperville, IL:

Sourcebooks, Inc.

Namie, G. (2017). Workplace Bullying Institute. 2017 WBI U.S. Workplace Bullying

Survey. Retrieved from:


Nursing Solutions Inc. (2016). 2016 National Healthcare Retention & RN Staffing

Report.Retrieved from:


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.

Final thoughts

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.

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.


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 &

Company; 2018:33.

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.


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.


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.


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.

20. Brené Brown. Vulnerability. 2020.

21. Frank S. As coronavirus slams Houston hospitals, it’s like New York “all over again.”

The New York Times. 2020.

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 or call 1-800-247-1500.

Page 16 • Arizona Nurse April, May, June 2021


Elizabeth Smith

Apache Junction

Valerie Macpherson-



Rosine Oriabure


Maria Arndt

Canton, NC

Rachel Dye

Cave Creek

Ashley Medl

Kelly Sharpe


Laura Bennett

Lisa Courchesne

Jayne Koch

Jennifer Mays

Tabitha McKinzie

Tram Nguyen

Tracy Turina Johnson

El Mirage

Eucharia Nwabichie

Fort Collins, CO

Lisa Sikora

Fountain Hills

Robert Kangas


Adam Deshler

Kristin Gurrola

Jennifer Iacovo

Jennifer Oday

Mia Grace Palugod

Donelle Quinn

Tammy Toguchi

Gale Walthall

Two Year Anniversary Members

December 2020 – February 2021


Sharleen Ballance

Jessica Jordan

Jill Lewis

Kevin Lowrey

Gold Canyon

Anna-Marie Gass

Golden Valley

Garret Walker


Stacy Lemoine

Mary Storts

Lackland AFB, TX

Vernon Dickman


Shawna Ziadah


Robert Kalonick

Jodi Lay


Anna Diola


Melanie Isaacs-



Nancy Reed

Jeryl Savage

Derleen Spence-


Kylie Starling

Oro Valley

Pamela Fick

Pensacoloa, FL

Megan Rogel

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located 50 miles east of Flagstaff, Arizona; a compassionate and

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Jessika Casey

Mihaela Coman

Victoria Cruise

Linda Duong

Casey Duprey

Josie Feldman

Krisanne Hudson

Kyle Johnson

Stephanie Knoebel

Candice Larson

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Erin Robinson

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Anthony Shaw

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Sandy, UT

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Sarah Dale

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Rachel Ortiz


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AzNA’s Superstars

Happy Anniversary to our dedicated

AzNA members celebrating these

special milestones for this past quarter:

December 2020 - February 2021

5-Year Members

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Ali Baghai

Janice Bovee

Karen Broderick-Strupp

Darius Candelario

Kimberley Carlin

Jane Carrington

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N. Clark

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Amanda Dean Martin

Alio Deeyor

Dolores Dias

Sandra Dinwiddie

Wilma Ellis

Jolena Epps

James Fowler

Carol Garcia

Amy George

Linda Gerber

Patricia Goldsmith

Heather Grandal

Evangelina Hernandez

Vanessa Hill

Phyllis James

Robert Kiesecker

Margie Kubicki

Elizabeth Lara

Deborah Laverty

Chloe Littzen

Abbie Loeffler

Cynthia Luciano

Maria McNeese

Ashley Mendez

Deborah Milillo

Lisa Miller

Shannon Morgenstern

Melissa Morrison

Christine Moser-Harris

Katherine Naegle

Christine Queval-Chung

Janice Reynolds

Michelle Richardson

Cheryl Robinson

Dina Ruef

Ginny Schoffelman

Carrie Schutte

Diana Septon

William Shuart

Brandi Swanner

Jessica Todd

Jacquelyn Toliver

Julia Trainor

Herendira Valdez Shahnaz

Suzanne Weinrich

Heather Wicks

Paula V Williams

10-Year Members

Noel Arring

Donna Callicutt

Cindy Chambers

Claudia Collins

Sandra Ekimoto

Nicola Friskel

Mark Hansen

Laurene Kordell

Michael Langmead

Christi Lanoue

Robert Lucero

Valerie Pasnau

Robin Sellers

Katie Wall

15-Year Members

Lisa Jaurigue

Leanne Prenovost

Katy Wilkens

25+-Year Members

Jan Atwood

Joyce Benjamin

Selina Bliss

Lisa Brack

Susan Brown

Nancy Cisar

Carla Clark

Sally Doshier

Barbara Durand

Imogene Eide

Teddylen Guffey

M. Harrell

Donna Heitmann

Brenda Hosley

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Anne McNamara

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April, May, June 2021 Arizona Nurse • Page 17

New & Returning AzNA Members

December 2020 - February 2021


Eryn Dunlavey

Amy Ruprecht

Apache Junction

Shannon McGown

Bainbridge Island, WA

Michele M Balducci


Meosha Menyfield


Pedro Gomez

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Casa Grande

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Constance Powers

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Emily Healy

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Steven Woodward


Kayla Davies

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Kellie Edwards

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Quinn Stokes

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Frank Mwinyelle

Golden Valley

Cari MacDonald


Deana D’Andrea

Robin McLinn

Stephanie Nelson

Robinette Reed

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Judith Weimer


Louise Stenberg


Elissa Brooks

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Krystal Pellerito

Lake Havasu City

Mary Widman


Barbara Stone


Renee Kowalsky

Katrina Lovin

Litchfield Park

Sarbjit Singh


Gouni Bouraima

Stephanie Brown

Karissa Ervin

Robin Sterling


Abby Connolly

John Dennis

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Delinda Peterson

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Krystle Smith

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Jeannine Powell


Ryan Clement

Kimberly Cochran

Angeli Daguro

Jennifer Hawkins

Brianna Haynes

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Tera Asseln

Carl Block

Joshua Burgett

Cameron Byrd

Gia Caccavale

Janet Clements

Lindsey Collins

Nathan Dingeldein

Travis Drapeau

Lynn Dugan

Jennifer Ehlert

Teri Gearon

Lisa Gray

Anna Guerra

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Diana Hays

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Jessica Hunsaker

Tiffany Kidd

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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


Major Findings

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),

142-146. doi:10.1097/nna.0b013e31819894b7

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.

DOI: 10.3912/OJIN.Vol26No01Man02

Lippincott Nursing Education. (2018, June 7). Turning

new nurses into critical thinkers. Combining

Domain Expertise With Advanced Technology

| Wolters Kluwer.



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-

280. doi:10.3928/01484834-20170421-04


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• Assistant Director of Nursing

The Caring House is a state of the art facility with excellent nursing patient ratios.

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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


NPI Vice-President

Reprinted with permission RN Idaho,

February 2021

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

(Gustafson, 2020).

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

business decision.

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


nationally accredited

continuing education

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

finally grace.


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

Science Summaries

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

Food Models

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

Education Toolkit

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.

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