Arizona Nurse - April 2021

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 www.aznurse.org. 

PRESIDENT’S MESSAGE 

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 

acknowledged. 

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 

INSIDE 

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 info@aznurse.org for more information. 

Chair: 

Rhonda Anderson, DNSc, RN, FAAN, FACHE 

Vice Chair: 

Pat Mews, MHA, RN, CNOR 

Secretary: 

Chloe Littzen, BSN, RN 

Scholarship Chair: 

Sharon Rayman, MS, RN, CCTC, CPTC 

Elected Trustee: 

Carol Stevens, PhD, RN 


Kimberly Behrens-Grieser 


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 

• AzCHER 

• AzNA Chapters: Greater Phoenix Area, Nurse Educators, Nurse Practitioners, East Valley 

• Charles Schwab 

• Network for Good 

Call for Article Submission 

Submit your article or research for publication in AzNA’s quarterly print publication. 

The Arizona Nurse is distributed to over 58,000+ RNs in the state. 

AzNA welcomes submission of nursing and health related news items and original articles. 

We encourage short summaries and brief abstracts for research or scholarly contributions 

with an emphasis on application. 

To promote inclusion of submitted articles, please review the article guidelines available 

on the AzNA website at www.aznurse.org/Guidelines. 

An “article for reprint” may be considered if accompanied by written permission from the 

author and/or publisher as needed. Authors do not need to be AzNA members. 

Submission of articles constitutes agreement to allow changes made by editorial staff and 

publishers. See article guidelines for more information. 

Submit your article to info@aznurse.org. 

Visit nursingALD.com today! 

Search job listings 

in all 50 states, and filter by location and credentials. 

Browse our online database of articles and content. 

Find events for nursing professionals in your area. 

Your always-on resource for nursing jobs, research, and events. 

Executive Director: 

Dawna Cato, PhD, RN, NPD-BC 

Board of Directors 

President: 

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

Vice President: 

Heidi Sanborn, DNP, RN, CNE 

Secretary: 

Amanda Foster, BSN, RN 

Treasurer: 

Beth Hale, PhD, RN 

Government Affairs Officer: 

Denice Gibson, DNP, RN, CRNI, BMTCN, AOCNS 

Director-At-Large: 

Janice Bovee, MSN, CNM 

Director-At-Large: 

Robert “Bill” Adams, MSN, RN, CDCES, NHDP-BC 

Past President: 

Carol J. Stevens, PhD, RN 

Staff 

Dawna Cato, Phd, RN, NPD-BC, Chief Executive Officer 

Wendy Knefelkamp, Director of Operations 

Debby Wood, Senior Project Coordinator 

The Arizona Nurse (ISSN 0004-1599) is the official 

publication of the Arizona Foundation for the Future of Nursing 

(AzFFN), peer reviewed and indexed in Cumulative Index for 

Nursing and Allied Health Literature. Arizona Nurse Author 

Guidelines are available at www.aznurse.org. Call 480.831.0404 

or info@aznurse.org for more information. 

No material in the newsletter may be reproduced 

without written permission from the Executive Director. 

Subscription price: included in AzNA membership or 

$30 per year. The purpose of the Arizona Nurse is to 

communicate with AzNA members and non-members in 

order to 1) advance and promote professional nursing in 

Arizona, 2) disseminate information and encourage input 

and feedback on relevant nursing issues, 3) stimulate 

interest and participation in AzNA and 4) share information 

about AzNA activities. 

For advertising rates and information, please contact 

Arthur L. Davis Publishing Agency, Inc., PO Box 216, Cedar 

Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. 

Responsibility for errors in advertising is limited to corrections 

in the next issue or refund of price of advertisement. 

Advertisements do not imply endorsement nor approval 

by the Arizona Foundation for the Future of Nursing (AzFFN) 

of the product advertised, the advertisers or the claims 

made. AzFFN shall not be held liable for any consequences 

resulting from the purchase or use of advertised projects. 

AzFFN, AzNA and Arthur L. Davis Publishing Agency, Inc. 

reserve the right to reject advertisements. Rejection of an 

advertisement does not imply that the offering or product 

for advertisement is without merit, lacks integrity, or that 

this association disapproves of the offering or product. 

The Arizona Nurses Association is a constituent 

member of the American Nurses Association.

April, May, June 2021 Arizona Nurse • Page 3 

CEO’S MESSAGE 

The Importance of Professional 

Association Membership 

AzNA/AzNF 

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, 

AzNA CEO 

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 

1 

Home – Johns Hopkins Coronavirus Resource 

Center (jhu.edu) 

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 www.aznurse.org/events 

In Memory of... 

Carol Delafontaine, RN, AzNA 

member, past president Rio 

Colorado AzNA Chapter 7, 

passed away on Sunday, 

December 20, 2020 as a 

consequence of COVID-19. 

Congratulations 

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: 

https://www.maricopa.edu/about/careers 

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.


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: www.dvusd.org 

The East Valley Institute of Technology is 

currently accepting applications for instructors 

in our high school CNA program as well as an 

instructor for our Adult Education Practical 

Nursing program. 

Please use the following link for more information 

regarding these positions, and to apply. 

www.applitrack.com/EVIT/onlineapp 

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 

http://www.NursingALD.com/ 

publications 

Heather James & dog


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. 

Resources: 

STATE Az DHS: AZ-ESAR-VHP 

Register at: https://mcdph.samaritan.com/custom/501/ 

Contact: email esarvhp@azdhs.gov. 

COUNTY VACCINATION PARTNERS: 

MARICOPA COUNTY 

Maricopa County Dept of Public Health Medical 

Reserve Corps (MRC) 

Register at: https://esar-vhp.health.azdhs.gov/ 

Contact: 602-506-6767 or email 

Covid19Volunteer@maricopa.gov 

OTHER COUNTY PARTNERS, COMMUNITY 

HEALTH CENTERS, MOBILE VACCINATIONS 

(i.e. Pima County, Yuma County, Coconino County, 

etc.), please see County Health Dept websites.


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., 

2017). 

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 

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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 

promotion. 

*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 

Unit. 

References 

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. 

ezproxy1.lib.asu.edu/10.1016/j.addbeh.2010.06.013 

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 

from https://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html 

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. 

https://doi-org.ezproxy1.lib.asu.edu/10.1016/j.ypmed.2016.10.019 

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual 

Review of Clinical Psychology, 1, 91-111. https://doi.org/10.1146/annurev. 

clinpsy.1.102803.143833 

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), 

847-854. https://doi-org.ezproxy1.lib.asu.edu/10.1093/ntr/ntu257 

Mayo Clinic Staff. (2016). Quitting smoking: 10 ways to resist tobacco cravings. 

Retrieved from https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/indepth/nicotine-craving/art-20045454 

Malucky, A. (2010). Brief evidence-based interventions for nurse practitioners to 

aid patients in smoking cessation. The Journal for Nurse Practitioners, 6(2), 

126-131. https://doi-org.ezproxy1.lib.asu.edu/10.1016/j.nurpra.2009.05.017 

National Cancer Institute. (n.d.). NCI dictionary of cancer terms. Retrieved 

from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ 

electronic-cigarette 

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. 

org/10.1186/s12889-018-5467-9 

Substance Abuse and Mental Health Services Administration. (2019). National 

helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline 

U.S. Department of Health and Human Services. (2016). E-cigarette use among 

youth and young adults: A report of the surgeon general [PDF file]. Retrieved 

from https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_ 

sgr_entire_report_508.pdf 

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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.


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 

www.aznurse.org/2021Election. 

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: 

PRESIDENT 

SECRETARY 

DIRECTOR OF GOVERNMENTAL AFFAIRS 

DIRECTOR-AT-LARGE 

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 

carrier. 

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. 

References: 

• Reductions in 2020 US life expectancy due to 

COVID-19 and the disproportionate impact 

on the Black and Latino populations | PNAS 

• Risk for COVID-19 Infection, Hospitalization, 

and Death By Race/Ethnicity | CDC 

• SARS-CoV-2 Transmission From People 

Without COVID-19 Symptoms | Global Health 

| JAMA Network Open | JAMA Network 

• Table 1. Workers who could work at home, 

did work at home, and were paid for work at 

home, by selected characteristics, averages 

for the period 2017-2018 (bls.gov) 

NAHN Phoenix 2021 – 

Save the Date 

We look forward to seeing you at our virtual conference. 

When: Friday, August 27, 2021 

More information to come... Visit www.nahn-phx.org 

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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. 

References 

Crist, J. D., Liu, J., Shea, K. D., Peterson, R. L., Martin-Plank, L., Lacasse, C. L., 

. . . Phillips, L. R. (2019). “Tipping point” concept analysis in the family 

caregiving context. Nursing Forum, 54(4), 582-592. 

Crist, J. D., Ortiz-Dowling, E. M., Shea, K. D., & Phillips, L. R. (2019). 

Knowledge Gaps About End-of-Life Decision Making Among Mexican 

American Older Adults and Their Family Caregivers: An Integrative 

Review. In Journal of Transcultural Nursing (Vol. 30, Issue 4, pp. 380-393). 

SAGE Publications Inc. https://doi.org/10.1177/1043659618812949 

Iribarren, S., Stonbraker, S., Suero-Tejeda, N., Granja, M., Luchsinger, 

J. A., Mittelman, M., Bakken, S., & Lucero, R. (2019). Information, 

communication, and online tool needs of Hispanic family caregivers of 

individuals with Alzheimer’s disease and related dementias. Informatics 

for Health and Social Care, 44(2), 115–134. https://doi.org/10.1080/175381 

57.2018.1433674 

Nason, G. (2008). Wavelet methods in statistics with R. Springer. 

Neuendorf, K. A. (2002). Defining Content Analysis. In The Content Analysis 

Guidebook (pp. 1–35). https://doi.org/10.4135/9781071802878.n1 

Tarraf, W., Jensen, G. A., Dillaway, H. E., Vásquez, P. M., & González, H. M. 

(2020). Trajectories of Aging among U.S. Older Adults: Mixed Evidence 

for a Hispanic Paradox. Journals of Gerontology - Series B Psychological 

Sciences and Social Sciences, 75(3), 601–612. https://doi.org/10.1093/ 

geronb/gby057 

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RMCHCS is an EEOC Employer


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


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. 

Cheers! 

Melissa 

Have a question for Nurse Melissa? 

Email info@aznurse.org with 

“Nurse Melissa” in the subject line. 

MEMBERS 

ON THE MOVE 

The Friends of the National 

Institute of Nursing Research 

(FNINR) are pleased to 

announce the selection of 

Karen L. Johnson PhD, RN, 

FAAN into their Ambassador 

program. Dr. Johnson is 

Director of Nursing Research, 

Banner Health. Ambassadors 

are selected from a national 

pool of applicants based on 

their abilities to advance public, health professional, 

and policy-maker awareness of the critical research 

agenda advanced by the National Institute for 

Nursing Research (NINR). 

Are you an AzNA Member with an 

accomplishment to highlight? 

Send to info@aznurse.org. 

Established in 1926, and like the tenacious Western spirit that built 

Wickenburg, at our rural Community Hospital and Clinics, taking 

care of our patients, families, and community comes first. Our team is 

committed to providing quality, health, and wellness services to our residents 

and surrounding communities within approximately 3,300 square miles. 

Being a smaller organization, Wickenburg Community Hospital offers the 

opportunity for more personal care to our patients while being close 

enough to a major city to enjoy all that Phoenix has to offer. 

If you have the passion for caring for patients 

“Out Wickenburg Way,” explore the possibilities! 

Or contact Dina Steinberg at 928-668-1822.


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 

care. 

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 

condition. 

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. 

We are seeking highly motivated nurses 

Exciting nursing opportunities and breathtaking allure of Navajoland await 

committed and highly motivated nurses. 

Come join us in Winslow! We are located just seven miles from the southern edge of the Navajo 

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References 

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

Retrieved from https://onlinelibrary.wiley.com/ 

doi/abs/10.1046/j.1365-2648.2001.01968.x 

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. 

org/10.1016/j.ejon.2015.10.003 

Ferwerd, J. (2016). How to care for patients from 

different cultures. Retrieved from https://nurse. 

org/articles/how-to-deal-with-patients-withdifferent-cultures/ 

Tung, W. (2011). Hospice Care in Chinese Culture: 

A challenge to home care professionals. Home 

Health Care Management & Practice, 23, 67-68. 

http://dx.doi.org/10.1177/1084822310383000


Workplace Bullying – 

A Silent Epidemic 

Dr. Palma Iacovitti DNP MBA RN 

Reprinted with permission Florida Nurse, November 2020 

Dr. Iacovitti has earned her Bachelor’s in Nursing, 

MBA and most recently a Doctorate in Nursing Practice 

from University of Iowa. Her clinical nursing experience 

for nearly 25 years consists of pediatrics, emergency 

medicine, gastroenterology, women’s health, and solid 

organ transplant. She is currently a Program Manager for 

Surgical Oncology Clinics at Baptist MD Anderson. 

The stakes for workplace bullying (WPB) are 

higher than school bullying because it affects a 

person’s livelihood. The Workplace Bullying Institute 

(WBI) defines bullying as “repeated, health-harming 

mistreatment of a person (the target) by one or 

more workers that takes the form of verbal abuse; 

Dr. Palma Iacovitti, 

DNP, MBA, RN 

conduct or behaviors that are threatening, intimidating or humiliating; 

sabotage that prevents work from getting done; or some combination 

of the three by a cruel perpetrator (the bully)” (Namie & Namie, 2009). 

WPB impacts physical and psychological health of nurses, threatens their 

working relationships, family, and careers. RN turnover will cost a hospital 

from $5.2M – $8.1M (Gooch, 2016). Bullying in the workplace can cost over 

$4 billion yearly (2016). A WBI 2017 survey reveals 19% of adult Americans 

have experienced abuse; 37% (including witnesses) have been affected by 

it; 63% of Americans now are aware that workplace bullying happens; only 

9% of the targets are believed that they are being bullied; 77% want a law 

against WPB (Namie, 2017). 

The rationale to stamp out WPB is to create a healthier, happier, satisfying, 

and positive workplace for all employees and patients; decrease the risk 

of harm to patients, shield seasoned and newly licensed nurses to practice 

under safe conditions avoiding needless distractions of being bullied. 

Addressing bullying reduces the risk of losing veteran bedside nurses, 

reduces the financial impact on organizations, reduces the risk of increasing 

hospital acquired infections and most importantly places perpetrators 

accountable for their pathological and unforgivable behavior. 

Rising 

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 

environment. 

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” 

policy. 

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. 

References 

Gooch, K. (2016). Becker’s Hospital Review. 5 thoughts and statistics on nurse 

bullying. Retrieved from: http://www.beckershospitalreview.com/humancapital-and-risk/5-thoughts-and-statistics-on-nurse-bullying.html 

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

Sourcebooks, Inc. 

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

Survey. Retrieved from: http://www.workplacebullying.org/wbiresearch/wbi- 

2017-survey/ 

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

Report.Retrieved from: http://www.nsinursingsolutions.com/Files/assets/library/ 

retention-institute/NationalHealthcareRNRetentionReport2016.pdf


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,


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 

drain. 

• 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. 

REFERENCES 

1. Wann W. America is running short on masks, gowns and gloves. Again. The 

Washington Post. 2020. www.washingtonpost.com/health/2020/07/08/ppe-shortagemasks-gloves-gowns. 

2. Mariotti A. The effects of chronic stress on health: new insights into the molecular 

mechanisms of brain-body communication. Future Sci OA. 2015;1(3):FSO23. 

3. American Psychological Association. How stress affects your health. 2019. www.apa. 

org/helpcenter/stress-facts. 

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; 

2004:249. 

6. Newman MG, Llera SJ, Erickson TM, Przeworski A, Castonguay LG. Worry and 

generalized anxiety disorder: a review and theoretical synthesis of evidence on 

nature, etiology, mechanisms, and treatment. Annu Rev Clin Psychol. 2013;9:275-297. 

7. Gonzalez D, Nasseri S. ‘Patients have panic in their eyes’: voices from a Covid-19 

unit. The New York Times. 2020. www.nytimes.com/2020/04/29/nyregion/ 

coronavirus-nyc-hospitals.html?searchResultPosition=1. 

8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of PTSD’. BBC News. 2020. www. 

bbc.com/news/uk-52258217. 

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; 

2017:483-497. 

12. Psychology Today. Acute stress disorder. 2019. www.psychologytoday.com/ie/ 

conditions/acutestress-disorder. 

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. 

psychiatry.org/patients-families/ptsd/what-is-ptsd. 

15. Levine P, Blakeslee A, Sylvae J. Reintegrating fragmentation of the primitive self: 

discussion of “somatic experiencing.” Psychoanal Dialogues. 2018;28(5):620-628. 

16. Highfield J. Am I OK? Intensive Care Society. 2020. www.ics.ac.uk/ICS/Education/ 

Wellbeing/ICS/Wellbeing.aspx. 

17. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles 

and responsibilities of health workers, including key considerations for occupational 

safety and health. 2020. www.who.int/publications/i/item/coronavirus-disease- 

(covid-19)-outbreak-rights-roles-and-responsibilities-ofhealth-workers-includingkey-considerations-foroccupational-safety-and-health. 

18. American Association of Critical-Care Nurses. Well-being Initiative. 2020. www. 

aacn.org/nursingexcellence/well-being-initiative. 

19. World Health Organization. WHO guidelines on conditions specifically related to 

stress. 2013. www.who.int/mental_health/emergencies/stress_guidelines/en. 

20. Brené Brown. Vulnerability. 2020. www.brenebrown.com/definitions. 

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

The New York Times. 2020. www.nytimes.com/2020/07/04/us/coronavirus-houstonnewyork.html. 

This article has been adapted for space and originally appeared in the September 

2020 issue of Nursing © 2020 Wolters Kluwer Health, Inc. 

This risk management information was provided by Nurses Service Organization 

(NSO), the nation’s largest provider of nurses’ professional liability insurance coverage 

for over 550,000 nurses since 1976. The individual professional liability insurance policy 

administered through NSO is underwritten by American Casualty Company of Reading, 

Pennsylvania, a CNA company. Reproduction without permission of the publisher is 

prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. 

www.nso.com.


Anthem 

Elizabeth Smith 

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Collins 

Avondale 

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Buckeye 

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Canton, NC 

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Cave Creek 

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Chandler 

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Tabitha McKinzie 

Tram Nguyen 

Tracy Turina Johnson 

El Mirage 

Eucharia Nwabichie 

Fort Collins, CO 

Lisa Sikora 

Fountain Hills 

Robert Kangas 

Gilbert 

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Two Year Anniversary Members 

December 2020 – February 2021 

Glendale 

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Golden Valley 

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Goodyear 

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Mary Storts 

Lackland AFB, TX 

Vernon Dickman 

Lakeside 

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Laveen 

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Marana 

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Maricopa 

Melanie Isaacs- 

Mendelsohn 

Mesa 

Nancy Reed 

Jeryl Savage 

Derleen Spence- 

Ogilvie 

Kylie Starling 

Oro Valley 

Pamela Fick 

Pensacoloa, FL 

Megan Rogel 

Little Colorado Medical Center is a 25-bed, critical access hospital, 

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

caring facility in a family oriented community. Enjoy the stress free 

pleasures of small town living with benefit of a fast paced stimulating 

work environment. LCMC is seeking the following experienced staff: 

Registered Nurse 

Current AZ RN license or State Compact 

Current BLS/CPR certification 

New Grads accepted with 2 year commitment 

RN’s with 1 year experience eligible for sign-on bonus 

Relocation Package 

If you are clinically competent, a team player and have excellent 

interpersonal leadership and computer skills them come excel and 

grow in an outstanding team environment! 

Visit our website at 

www.lcmcwmh.com/careers 

and/or email: 

careers@lcmcwmh.com 

EOE 

Peoria 

Marsha Grobman 

Fatma Gulser 

Christine Long 

Phoenix 

Breanna Adams 

Stephanie Barendt 

Violeta Brito Toledo 

Martha Carey-Lee 

Valerie Carli 

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Linda Duong 

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Krisanne Hudson 

Kyle Johnson 

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Candice Larson 

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Anthony Shaw 

Lauren Shurson 

Carissa Taube 

Letha Thomas 

Tammy Tyree 

Prescott 

Nancy Rosales 

Queen Creek 

Lori Alvarado 

Rebekah Barraza 

Betty Yurgel 

Rimrock 

Naya Otto 

Sahuarita 

Deana Gil 

Georgina Rotzler 

Sandy, UT 

Stephanie Dickson 

Scottsdale 

Heidi Buller 

Jacque Cushard 

Sarah Dale 

Cathleen Rhodes 

Sedona 

Sue McWilliams 

Sioux Falls, SD 

Janet Boston 

Surprise 

Rhonda Hornstein 

Nicole King 

Leticia Suarez 

Tempe 

Nicole Hill 

Mary Jerde 

Patricia Knutesen 

Rosie Moses 

Lisa Rosch 

Tolleson 

Krystal Iglesia Agot 

Tucson 

Claire Bethel 

Roy Dong 

Tiffany Gonzales 

Jessica Hunter 

Elaine Kay 

Donna McArthur 

Karen Mcbean 

Marie McDermott 

Shannon Pearlman 

Donna Sweeney 

Carla Transue 

Lorraine Varela- 

Herrera 

Waddell 

Wendy Ortiz 

Rachel Ortiz 

Yuma 

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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 

Donna Anderson 

Ali Baghai 

Janice Bovee 

Karen Broderick-Strupp 

Darius Candelario 

Kimberley Carlin 

Jane Carrington 

Sharon Cason 

N. Clark 

Mary Clouse 

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 

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New & Returning AzNA Members 

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Anthem 

Eryn Dunlavey 

Amy Ruprecht 

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Bainbridge Island, WA 

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Fort Collins, CO 

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Gilbert 

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Located in Northeastern AZ 

Show Low 

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Surprise 

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Applications available at sagememorial.com/careers/ 

Send applications to Human Resources 

Fax#: 928-755-4659, hr@sagememorial.com 

The Navajo Health Foundation/Sage Memorial Hospital is a drug/alcohol free EOE/AA/Navajo Preference Employer


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. 

Design 

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 

communication. 

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%. 

Discussion 

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. 

References 

American Association of Colleges of Nursing. (2019). 

Nursing shortage. Retrieved from https://www. 

aacnnursing.org/news-information/fact-sheets/ 

nursing-shortage 

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. 

org/10.1016/j.nedt.2020.104471 

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. https://www.wolterskluwer. 

com/en/expert-insights/turning-new-nurses-into 

critical-thinkers 

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. 

Vol26No01Man06 

National Council of States Boards of Nursing. (2015). 

2014 RN Practice Analysis: Linking the NCLEX- 

RN Examination to Practice - U.S. and Canada. 62. 

https://www.ncsbn.org/15_RN_Practice_Analysis_ 

Vol62_web.pdf 

National Council of States Boards of Nursing. (2018). 

2017 RN Practice Analysis: Linking the NCLEX- 

RN Examination to Practice - US & Canada 72. 

https://www.ncsbn.org/17_RN_US_Canada_ 

Practice_Analysis.pdf 

McLeod, S. (2017, February 5). Kolb’s learning styles 

and experiential learning cycle. Retrieved from 

https://www.simplypsychology.org/learningkolb.html 

Sentinel U. (2020, November 30). Nursing 

prioritization exercises. https://www.sentinelu. 

com/solutions/prioritization-and-delegation/ 

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:// 

doi.org/10.1159/000509361 

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 

NOW HIRING! 

Day and Night Shifts 

For the following positions: 

• Certified Nursing Assistants 

• Registered Nurses 

• Licensed Practical Nurses 

• Assistant Director of Nursing 

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

12 hour shifts with great benefits and a very generous amount of PTO. 

Qualified applicants must have: 

• AZ State Certification as a Nursing Assistant & CPR Certification 

• AZ State Licensure as an LPN or RN & CPR/BLS certification 

• AZ Dept of Public Safety Fingerprint Clearance Card 

Please apply at WWW.GRHC.ORG/CAREERS 

Email Ylesia Jones at YJONES@GRHC.ORG or Call 520-562-3321 EXT. 1712 or 

520-610-0595. 

Email Mark Walter at WWALTER@GRHC.ORG or Call 520-610-8923 

(for questions on the Assistant Director of Nursing position)


Practice Tips for the Independent Nurse Practitioner 

Because of AzNA nurses can say YES 

YES 

YES 

Michelle M. Anderson 

DNP, FNP-BC, APRN, FAANP 

NPI Vice-President 

fnpmma@yahoo.com 

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. 

YES 

YES 

promotion of a healthy 

Arizona 

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 

provider. 

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. 

References 

Gustafson, K. (2020, August 7). What Is the Bureau 

of Labor Stats Small Business Failure Rate in 

2020? LendingTree. https://www.lendingtree. 

com/business/small/failure-rate/ 

YES 

collaboration on the local 

and national level 

www.aznurse.org 

YES 

nurses have access to 

mentors and role models 

aznurse.org/JoinToday

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. 

https://arizonamilk.org/ 

for-schools/virtual-learningresources/#healthprofessionals 

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. 

https://arizonamilk.org/ 

for-schools/virtual-learningresources/#nutritioneducation 

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.

Arizona Nurse - April 2021

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