Colorado Nurse - May 2021

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The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

Volume 121 • No. 2 • May 2021

Quarterly publication distributed to approximately 42,200 RNs and LPNs in Colorado


Colorado Nurses

Association President...

Happy National Nurses

Month! The American Nurses

Association has expanded

National Nurses Week to

Nurses Month for the month

of May. This provides additional

opportunities to honor nurses

and acknowledge their

contributions and leadership

in many diverse healthcare

settings and roles.

We enter into this spring Linda Stroup

season with a sense of both

remembrance and hope. Earlier this year, the world marked

the one-year anniversary of the beginning of an historic

global pandemic. None of us realized at that time that the

pandemic would continue well over a year later. As we

reflect upon the past year, we honor the many nurses who

have worked tirelessly for the health of their patients and

communities. We acknowledge our colleagues who have

fallen ill with COVID-19 and extend our best wishes for

their full recoveries. We also remember our colleagues who

have lost their lives to COVID-19. We pause to hold their

memories in our hearts. Their tremendous sacrifices will not

be forgotten.

We continue to have great hope for the health of the

people of Colorado as COVID-19 vaccines are widely

available. Colorado nurses continue to be on the front lines

to support efforts to promote health and well-being for

everyone. We look forward to a time of increased health

for our communities and all of our nursing colleagues and

healthcare partners.

As we look ahead, the Colorado Nurses Association

continues our work to support nurses in three primary

areas of focus: advocacy, education, and engagement.

We encourage you to visit our website and seek

opportunities for involvement with CNA. Nursing

benefits from strong participation and representation.

Thank you to our Colorado nurses for your leadership to

promote the health of Colorado.

From the Desk of

the CNF President

Living in Turbulent Times

More Questions than Answers!

Will all levels of government

work successfully together

to implement new policies

regarding COVID that could

be interpreted as a ‘relief’

from what some may consider

restrictive regulations?

Are lifting some of the

more ‘restrictive’ regulations

a sign that we are returning to

the ‘normal’ we once knew?

Or are we simply moving Sara Jarrett

towards a “new” normal? For

example, should the use of masks become a part of

our understanding of ‘best’ practices for public health.

In addition, should masks be required in places where

public health officials have recognized as high risk?

As more of the population is vaccinated, there still

remains a significant percentage of the population

that chooses not to be vaccinated. A controversial idea

that has been tossed around is making vaccination


Experiencing varying levels of isolation, and

lifestyle changes, the arrival of Spring seems to bring

a renewed sense of hope and purpose. What other

lifestyle changes and community practices should be

considered a part of the ‘new’ normal routine?

Decision makers and influencers in healthcare need

to consider similar questioning. Will there be ‘new’

requirements and regulations as a result of the current

pandemic for employment in the healthcare field?

What might those new requirements include?

Will nursing remain a desirable profession or will

the pandemic have a negative impact on future

recruitment and retention in the profession? How will

the healthcare industry prepare for the future?

Addressing these numerous questions now is the

time to begin to study the future needs for nurses.

What should the education requirements include?

Should licensure requirements follow the education


Lastly, how can nurses participate in the evolution of

a changing healthcare system?

Again, there seems to be more questions than

answers at this time.

Sara Jarrett


current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

Executive Director’s Column ................3

Government Affairs & Public Policy Committee ...4

Peer Assistance ..........................5

District and SIG Reports ...................6-7

In Memory ..............................8

Colorado Center for Nursing Excellence .......9

CNF Appoints New Board Members ..........9


Hispanic Nurses: All of Us .................10

Meet the CNA Board of Directors ........... 11

Pharmacy or Farmacy? .................12-13

State Board of Nursing Seeks New Members ....14

Does Shift Length Matter? .................15

CNA Call for Nominations .................16

Nurse Spotlight: Defending Your License ...17-19

2 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

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Colorado Nurse Publication

Article Submission

• June 15 for August Issue

• September 15 for November Issue

Colorado Nurses Association in partnership

with the Colorado Nurses Foundation seeks

your regular reports and any content you feel

would be informative for Colorado Nurses.

Submit to:



Nominations Sought

for CNA Positions

Colorado Nurses Association is seeking candidates for

several elected positions. As a member of the CNA Board,

you will help to achieve the mission and strategic plan

of the association. In addition, you will ensure financial

sustainability of the association and maximize member

services. The CNA Board meets quarterly.

As an ANA Membership Assembly Representative, you

will represent Colorado at American Nurses Association

Membership Assembly meetings, generally held in June.

CNA currently is allotted three representatives. Candidates

not elected will serve as alternates.

CNA Elections are held annually. Terms begin after

the CNA Membership Assembly in October.

The CNA Nominating Committee develops the slate

of candidates for CNA Elections. Available positions for

2021 are:


Director, Region 1

Director, Region 3

Director, Region 5

Director at Large, Special Interest Groups

Director at Large, Recent Graduate

American Nurses Association Membership

Assembly Representatives – three representatives

to be elected.

CNA Nominating Committee – three members

to be elected.

See the CNA Website for

more information and to submit a nomination.

COLORADO NURSE (ISSN-8750-846X) is published 4 times annually,

February, May, August, and November, by the Arthur L. Davis Publishing

Agency, Inc. for the Colorado Nurses Foundation, 2851 South Parker Rd, Ste

1210, Aurora, CO 80014; Mailing: P.O. Box 3406, Englewood, CO 80155-3406.

For advertising rates and information, please contact Arthur L. Davis

Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, (800) 626-

4081, CNF and the Arthur L. Davis Publishing Agency,

Inc. reserve the right to reject any advertisement. Responsibility for errors

in advertising is limited to corrections in the next issue or refund of price of


Acceptance of advertising does not imply endorsement or approval by the

Colorado Nurses Foundation of products advertised, the advertisers, or

the claims made. Rejection of an advertisement does not imply a product

offered for advertising is without merit, or that the manufacturer lacks

integrity, or that this association disapproves of the product or its use.

CNF and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable

for any consequences resulting from purchase or use of an advertiser’s

product. Articles appearing in this publication express the opinions of

the authors; they do not necessarily reflect views of the staff, board, or

membership of CNF or those of the national or local associations.

Colorado Nurses Foundation wants to hear from you and welcomes

letter to the editors. Correspondence may be sent to Colorado Nurses

Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014;

Mailing: P.O. Box 3406, Englewood, CO 80155-3406; email, info@

To submit an article for publication, consider the following guidelines.

1. Topic is current and relevant to RN practice.

2. 500 word limit

3. Individuals may submit articles for consideration by emailing

Material is copyrighted by the Colorado Nurses Foundation and may not

be reprinted without written permission from CNF.

Co-Editors: M. Colleen Casper, RN, MS, DNP (16)

Eve Hoygaard, MS, RN, WHNP (30)

Carol O’Meara, MS, RN, WHNP (20/30)

CNA Executive Director:

Colleen Casper, RN, MS, DNP



President: Sara Jarrett

Vice President: Margaret Mulhall

Secretary: Carol O’Meara

Treasurer: Eve Hoygaard


Jeanne Burnkrant, Terry Buxton, Colleen Casper,

Lola Fehr, Linda Stroup, Betsy Woolf, Lisa Zenoni



President: Linda Stroup

President Elect: Laura Rosenthal

Vice President: Angela Petkoff

Secretary: Nan Morgan

Treasurer: Carol OMeara

Region 1 Director:

Brenda Tousley

Region 2 Director

(DNA 3, 12, 16, 20, 23):

Amanda Chappell

Region 3 Director (DNA 4):

Mary Satre

Region 4 Director (DNA 6):

Glenda Jackson


Region 5 Director (DNA 7):

Nora Flucke

Region 6 Director (DNA 5):

Deb Bailey

Director At Large (SIGs):

Karen Lyda (SIG 31)

Director At Large (SIGs):

V. Sean Mitchell (SIG 30)

Director at Large (Recent Graduate)

Jeanna Brewer


SIG #2: Colleen Casper (Liaison) DNA #9: Brenda Tousley

DNA #3: Anne Zobec

Colorado Springs

DNA #4: Kathryn Carpenter

Model, CO

DNA #5:

DNA #6: Charlotte LeDonne

Alamosa, CO

DNA #7: Nora Flucke

DNA #12: Amanda Chappell

DNA #16: Rebecca Sposato

DNA #20: Jean Schroeder

DNA #23: Colleen Casper

SIG #30: Ann Pereira

SIG #31: Ruby Martinez,


To contact any person listed above, please use the

CNA/CNF office numbers/address/email address.

CNA Contact Information:

Ph: 720-457-1194 • Fax: 303-200-7099


CNF Contact Information: Ph: 720-457-1004


The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 3

Executive Director's Column

Colleen Casper, DNP, RN, MS

Executive Director

Colorado Nurses Association

“No amount of medical

knowledge will lessen the

accountability for nurses to

do what nurses do, that is,

manage the environment

to promote positive life


– Florence Nightingale,

Notes on Nursing, 1860.

Happy National Nurses

Week in the 2020-2021 Year

of the Nurse and Midwife!

Colleen Casper

Nurse’s Week has never been my favorite celebration.

As a critical care nurse and then a nurse administrator, I

was concerned that one day or one week of celebration

might suggest that both nurses and administrators would

think that a once a year recognition of the work nurses do

would be sufficient. I knew then, and still know today, that

individual nurses and the work of nursing must be top of

mind every day in critical care, the operating room and post

recovery, emergency departments, medical and surgical

inpatient units, pediatric care, obstetrics and newborn care,

long term care, schools, primary and specialty care offices,

chronic care clinics such as kidney dialysis and wound care,

care managers and quality improvement centers, public

health offices, as faculty at schools of nursing, supervisory

and administrative roles, and importantly at the United

States and Colorado Capitol, guiding and influencing health

care policy changes. Nurses work in correctional facilities,

camps, places of worship, patient’s homes, emergency

response systems, publication companies, war zones and

military base, work-places, and so many more provider

settings. With COVID-19, we all now know we can do

most of with the application of technology and telehealth

or in person!

What is it that we do that defines the value of a nurse?

In a word, we provide for trust. For the 18th year in a

row, Gallup surveyors asked U.S. adults to rate the honesty

and ethics of a list of professions, and 85% of Americans

say nurse’s honesty and ethical standards are “very high”

or “high.” For the last five years, nurses rank 20% greater

than the next profession on the list (

High trust in our honesty and ethics is not by accident.

Nurses begin academic preparation by understanding

that a therapeutic relationship is central to patient healing.

Individual’s experiencing health challenges need to know

they can rely on competent and compassionate nurses

who are available to monitor and inform them of potential

complications and methods of adapting to them. Nurses

are the largest percentage of the healthcare workforce

and are typically the front line, 24 hours/day and seven

days/week professionally assisting individuals dealing with

physical, emotional, and spiritual distress.

As we enter 2021 Year of the Nurse, thank you to all of

my nurse colleagues who have persevered and provided

nursing care when supplies were limited, staff were limited,

and many times you were all alone in your work. I’d like to

share a powerful video that describes specific examples of

how “Nurses Change Lives.” The examples in the video are

exemplary of how the science and art of nursing affords

nursing professionals the capacity to see beyond the illness

and to address contributing factors to prolonged suffering

and their methods to mitigate and support optimal health,

not only the absence of disease.

The Nurses Change Lives video was originally introduced

by Johnson & Johnson in the fall of 2018 and encompasses

what we know to be true: Nurses have been innovating

and improving healthcare on the frontline throughout

history. In the midst of the COVID-19 pandemic, it remains

a very relevant message. Nurses changes lives, and that

changes everything. Take less than two minutes to view

specific examples of nurses changed lives in a moment

and changes that have been sustained. Examples include

Florence Nightingale who improved mortality rates in the

Crimean war through the use of data to change hospital

environments and the creation of infection control

standards for nursing that exist today, Elizabeth Kenny’s

work during the time of Polio that demonstrated the

importance of movement to assist in healing, and, Jean

Ward’s work discovering that sunlight can cure jaundice

in infants. Nurses changed HIV care and these stories are

timely reminders of the heroic work nurses have provided

over this past year, during the COVID-19 pandemic. We

have yet to hear all of those stories. Nurses Change Lives:

Two Minute Version video can be seen here.

In closing, I would like to quote Jennifer Thew, RN, and

her publication in Healthleaders NOW, 2020:

“I am not going to say, “Happy Nurses Week.” Instead, I

am telling nurses:

• You are strong.

• You are amazing.

• You are indispensable.

• You are role models.

• Thank you!“

4 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

Government Affairs & Public Policy Committee

Legislation Will Impact Nursing and Health Care

The 2021 Legislative Session opened on February

16th, with a predicted high volume of bills set to

impact nursing and health care. GAPP will monitor

these bills as they pass through the legislature. You

can find the complete list of bills the committee is

following on the CNA Bill Tracker located on CNA’s

website. To access the CNA Bill Tracker, select

“Advocacy/Policy” and “Bill Tracking.” You can

obtain detailed information for each bill, including

information on where the bill is in the process, by

selecting the bill on the tracker. At their meetings on

February 28th and March 10th, the GAPP Committee

voted to support:

HB21-1005 - Health Care Services

Reserve Corps Task Force

• Creates a task force to make recommendations

on the creation of a health care services

reserve corps program to provide service in an

emergency or disaster (participants to receive

student loan relief).

• Passed out of the House Health and Insurance

Committee on 2/24/2021 and referred to the

Committee on Appropriations.

HB21-1068 - Insurance Coverage

Mental Health Wellness Exam

• Requires, as part of mandatory health insurance

coverage of preventive health care services,

coverage of an annual mental health wellness

examination of up to 60 minutes that is

performed by a qualified mental health care


• Assigned to the House Health & Insurance


HB21-1097 Establish Behavioral Health


• Bipartisan

• Addresses recommendations from the 2019

behavioral task force.

• Creates a single state agency to lead, promote

& administer the state’s behavioral health



Peer Health Assistance Program

RNs and LPNs

Peer Assistance Services, Inc.

Encourage nurses to SEEK HELP EARLY

HB21-1099 Policies & Procedures to

Identify Domestic Abuse

• Bipartisan

• Recognizes domestic abuse as a form of child

abuse or neglect.

• Implements assessment best practices in

identifying child abuse.

HB21-1106 Safe Storage of Firearms

• Consistent with position adopted by CNA

members at annual meeting.

• Creates the offense of unlawful storage.

HB21-1107 Protections for Public

Health Department Workers

• Bipartisan

• Adds the same protections for public health

workers that currently exist for law enforcement

officials & human services workers.

HB21-1119 Suicide Prevention,

Intervention & Postvention

• Bipartisan

• Broadens the state’s priorities and focus on

suicide, suicide attempts, and after-effects.

Colorado Nurses Association Call for Volunteers

Policy Development Sub-Committee

Angela Petkoff, RN, AGNP

Colleen Casper, DNP, RN, MS

Colorado Nurses Association (CNA) has an active

Government Affairs and Public Policy Committee

(GAPP) that regularly reviews and advises CNA

lobbyists on desired action on pending legislation

in Colorado. We work closely with state lawmakers

and provide them with trusted and reliable input on

health care related legislation. More recently, CNA has

formalized a member volunteer effort, 100 Nurses for

100 Legislators, as a mechanism of assuring that every

SAVE LIVES… both practitioners and patients

Help us to EDUCATE the profession

I am a better nurse because of the program; my

employer has been very supportive; I couldn’t have

stayed clean and sober without the program.

SB21-056 Expand Cannabis-based Medicine at Schools.

• Bipartisan

• School nurse association supports.

• Removes discretion from current law and requires

schools to treat cannabis-based medicine

recommendations like prescriptions.

• Provides disciplinary protection to nurses.

SB21-137 Behavioral Health Recovery Act

• Continues the funding for the medication-assisted

treatment expansion pilot program.

• Expands the CSU AgrAbility project by providing

funding for the project’s rural rehabilitation


• Appropriates money to the CDPHE to address

behavioral health disorders & priorities across the


• Appropriates money to the harm reduction grant


• Requires Medicaid to include screening for

perinatal mood & anxiety disorders for each child

enrolled in Medicaid.

GAPP Co-chairs: Mary Satre (maryskerwin@gmail.

com) and Judith Burke (

Senator and Representative in Colorado knows an RN

in their district.

CNA is now seeking member volunteers to advise

and assist in developing policy on behalf of nurses in

Colorado. We are interested in volunteers to consider

becoming part of our Policy Development Committee

(PDC) that would then inform the CNA GAPP on

priorities for legislative consideration.

The PDC will explore, research, and propose

regulatory or statutory changes that may impact the

nursing profession, nurse work environment, healthcare

access, or patient safety consistent with the priorities of

Colorado Nurses Association. Examples of nurse led

legislation from other states that may be considered

include laws that address safe work environment,

such as establishing a “Safe Harbor” law for Colorado

nurses. Texas and New Mexico have Safe Harbor (SH)

laws that provide nurses with legal protections to

blow the whistle on unsafe patient assignments. SH

establishes a legal process for a nurse to state when

they believe an assignment is unsafe and protects that

nurse from retaliation by their employer or from the

Board of Nursing. The Texas law has been around since

1997 and the New Mexico law was just passed in the

spring of 2019.

This pandemic has highlighted the crucial role of

nurses and the importance of a sustainable nurse

workforce. “Heroic” is the word often used. We know

that nurses have always been heroes, repeatedly

forced to do too much with too little. Now that we’re

finally seeing some reprieve from this pandemic, it’s

time to empower Colorado’s nurses and address work

environment issues for our frontline nurses.

We invite you to consider this important work with

CNA. If you are interested in working with the PDC,

please email



For confidential information:

The Colby Community College Nursing Program offers practical and

associate degree nursing programs in two locations.

We are seeking qualified applicants for the following position:

Director of Nursing and Allied Health - Full Time in Colby



• Kansas RN license and CPR certification required

For a complete job description visit

To apply, submit a letter of application, resume, all postsecondary transcripts and references to:

Human Resources, Colby Community College

1255 S. Range • Colby, KS 67701, materials may be emailed to

Review of applications will begin immediately and continue until the position is filled. EOE

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 5

Peer Assistance

Substance use and abuse associated with the behavioral immune system

during COVID-19: The special case of healthcare workers and essential workers

Dean McKay, Gordon J.G. Asmundson, Department of Psychology, Fordham

University, United States Department of Psychology, University of Regina,


The COVID-19 pandemic has resulted in unprecedented stress on healthcare systems

throughout the world. 1 It has also led to worldwide economic distress. This has resulted in

a splintering of the population, with healthcare workers bearing the burden of caring for

those afflicted with COVID-19, a consequence of which is direct and sustained infection

risk. Essential workers, such as grocery store employees, food delivery service workers, and

postal employees, to name a few, also shoulder significant health risks by ongoing contact

with the public.

As essential workers face these increased infection risks, they also face higher rates

of stress from the pandemic. The recently developed COVID Stress Scales 2 categorizes

stressors from the pandemic into five categories: danger and contamination fear, social

and economic stress, traumatic stress symptoms, checking and reassurance seeking

behavior, and xenophobia. Recent findings suggest that the five factors of the CSS form

a COVID Stress Syndrome. 3 In the general population each of these factors can contribute

to increased substance use and abuse risk. 4 These factors can be compounded in essential

workers and place this group at particularly high risk for substance use and abuse.

Pandemics activate a behavioral immune system. 5 The BIS is an alarm system whereby

individuals show increased monitoring of physical sensations to track possible signs of

infection, which in turn would mobilize action to secure medical care. Recent research

has shown that disgust, an emotion designed to protect from contact with pathogens, is

critically involved in COVID-19 fear for higher levels of interoceptive awareness. 6 According

to the BIS model, activation of this protective system also leads to efforts to identify

tangible infection sources, which in turn promotes xenophobia and stigma.

Essential workers in general, and healthcare workers in particular, who themselves

would have active BIS during the COVID-19 pandemic, face unique pressures from

the general population. While research on disgust suggests that chronic exposure to

pathogens may dampen one’s concern with infection, 7 the other factors of the CSS would

be expected to be highly relevant to healthcare workers and other essential workers in

increasing substance use risk.

Economic stress has been shown to increase the risk of alcohol use in healthcare

workers, particularly for women and lower education workers. 8 Similar findings have been

observed for other drug use, particularly in lower education individuals. 9 Social stress has

long been documented to increase substance use risk in healthcare workers 10 and other

essential workers. 11

Past pandemics have resulted in significant traumatic reactions among healthcare

workers. 12 Trauma symptoms have been found associated with substance use in healthcare

workers, such as following a terror attack. 13 There is emerging evidence that many medical

and non-medical health care workers will develop PTSD stemming from COVID-19-related

experiences. 14

Checking behavior serves as a protective factor during pandemics, such as to inspect

for possible pathogen sources. This in turn can lead to occupational stress, such as

reluctance to work in the face of infection risk, further compounding economic stress.

Checking behaviors also contribute to hypervigilance to infection risk, a specific aversive

consequence of activation of the BIS. Further, checking behavior in this context is a proxy

for obsessive–compulsive actions, another potential substance use risk. 15

Finally, among the factors that form the COVID Stress Syndrome, xenophobia is a

unique and specific stressor for healthcare and essential workers, as they are more likely to

be the targets of discrimination from the general population. For instance, some job titles

of the essential workforce are disproportionately from under-represented groups, thus

allowing a conflation of these groups with both their ethnic or racial status and infection

risk by the general population. Beyond the xenophobia faced by under-represented

groups, the COVID-19 pandemic has resulted in stigmatization of essential workers. 16

Broadly, stigma has been shown to increase risk of alcohol and drug use. 17

Collectively, it appears that the COVID Stress Syndrome, through activation of the

BIS and the unique constellation of stressors, places essential workers at high risk for

alcohol and substance use. Lessons from past pandemics have shown that the need for

additional substance use interventions increases. This has already been noted in relation

to COVID-19. 18 This constellation of stressors warrants unique programs of intervention to

manage drug use and abuse. Research to develop such programs is needed, particularly

in consideration of the broad impact of COVID-19. We encourage researchers to

systematically tackle these important issues in preparation for challenges people may face

with substance use and abuse in the face of present pandemic-related circumstances, post-

COVID-19, and for future pandemics.

1. Tanne J.H., Hayasaki E., Zastrow M., Pulla P., Smith P., Rada A.G. COVID-19: How doctors and

healthcare systems are tackling coronavirus worldwide. British Medical Journal. 2020;368

2. Taylor S., Landry C.A., Paluszek M.M., Fergus T.A., McKay D., Asmundson G.J.G. Development

and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders. 2020;72

3. Taylor, S., Landry, C.A., Paluszek, M.M., Fergus, T.A., McKay, D., & Asmundson, G.J.G. (in press).

COVID Stress Syndrome: Concept, structure, and correlates. Manuscript under review.

4. McKay, D., & Asmundson, G.J.G. (2020). COVID-19 and substance use: Current issues and future

preparations. Manuscript under review.

5. Schaller M., Park J.H. The behavioral immune system (and why it matters) Current Directions in

Psychological Science. 2011;20:99–103. doi: 10.1177/0963721411402596.

6. McKay D., Yang H., Elhai J., Asmundson G. Anxiety regarding contracting COVID-19 related to

interoceptive anxiety sensations: The moderating role of disgust propensity and sensitivity.

Journal of Anxiety Disorders. 2020;72

7. Haidt J., McCauley C., Rozin P. Individual differences in sensitivity to disgust: A scale sampling

seven domains of disgust elicitors. Personality & Individual Differences. 1994;16:701–713.

8. Saridi M., Karra A., Kourakos M., Kyriakos S. Assessment of alcohol use in health professionals

during the economic crisis. British Journal of Nursing. 2016;25:396–405.

9. Carpenter C.S., McClellan C.B., Rees D.I. Economic conditions, illicit drug use, and substance use

disorders in the United States. Journal of Health Economics. 2017;52:63–73.

10. Bennett J., O’Donovan D. Substance misuse by doctors, nurses and other healthcare workers.

Current Opinion in Psychiatry. 2001;14:195–199.

11. Lehman W.E., Simpson D.D. Employee substance use and on-the-job behaviors. Journal of

Applied Psychology. 1992;77:309–321.

12. Marunder R.G., Leszcz M., Savage D., Adam M.A., Peladeau N., Romano D. Applying the

lessons of SARS to pandemic influenze: An evidence-based approach to mitigating the stress

experienced by healthcare workers. Canadian Journal of Public Health. 2008;99:486–488.

13. Bogstrand S.T., Skogstad L., Ekeberg Ø. The association between alcohol, medicinal drug use

and post-traumatic stress symptoms among Norwegian rescue workers after the 22 July twin

terror attacks. International Emergency Nursing. 2016;28:29–33.

14. Tan B.Y., Chew N.W., Lee G.K., Jing M., Goh Y., Yeo L.L.L. Psychological Impact of the COVID-19

pandemic on health care workers in Singapore. Annals of Internal Medicine. 2020 doi:


15. Mancebo M.C., Grant J.E., Pinto A., Eisen J.L., Rasmussen S.A. Substance use disorders in an

obsessive compulsive disorder clinical sample. Journal of Anxiety Disorders. 2009;23:429–435.

16. Gold J.A. COVID-19: Adverse mental health outcomes for healthcare workers. British Medical

Journal. 2020;369

17. Room R. Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review.


18. Kar S.K., Arafat S.M.Y., Sharma P., Dixit A., Marthoenis M., Kabir R. COVID-19 pandemic and

addiction: Current problems and future concerns. Asian Journal of Psychiatry. 2020;51

Elsevier hereby grants permission to make all its COVID-19-related research that is

available on the COVID-19 resource centre - including this research content - immediately

available in PubMed Central and other publicly funded repositories, such as the WHO

COVID database with rights for unrestricted research re-use and analyses in any form or by

any means with acknowledgement of the original source. These permissions are granted

for free by Elsevier for as long as the COVID-19 resource centre remains active.

Peer Assistance Services, Inc., provides the statewide Nurse Peer Health Assistance

Program through a contract with the Colorado State Board of Nursing.

Katherine Garcia, MA, LAC, MAC, Clinical Manager,

Bethany Pace-Danley, BSW, MA, CPS II, SBIRT in Colorado Manager, BPace-Danley@

Annie Klein, CPS II, Manager, Communications and Program Outreach, aklein@

Office locations:

2170 South Parker Road, Suite 229 200 Grand Avenue, Suite 270

Denver, CO 80231 Grand Junction, CO 81501

303 369-0039 970 291-3209

Dean McKay, Gordon J.G. Asmundson. Addict Behav. 2020 Nov; 110: 106522.

Published online 2020 Jun 27. doi: 10.1016/j.addbeh.2020.106522

Eden Milestone 2 Community

Come join our team & love where you work.

We are seeking Nurses and Nurse Leaders to promote

the Eden Alternative.

The goal of the Eden Alternative is Elder-directed care. Aging can

be a time of growth rather than decline. This is accomplished

by creating a human habitat through community design, care

partner training, and organizational redesign. We are home!

Excellent benefits including Health & Dental, Vision,

401(k) with match, Education Reimbursement and more.

To apply, submit your resume/application at



BECOME ONE, this is the place for you!

6 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

District and Special Interest Group Reports

DNA 6 – San Luis Valley

DNA 16 – East Metro Denver

CNA District 6 supplies Thank You baskets for SLV Nurses

The Colorado Nurses Association District 6 members of the San Luis Valley,

collected and assembled 70 gratitude baskets and mugs for nurses employed at

San Luis Valley health care agencies for Valentine’s Day. They also advertised their

gratitude on marquees in Alamosa, Conejos and Costilla counties.

DNA 16 Virtual Legislative Event

CJ Cullinan, RN, CNS

May you live in an interesting age.”

English Expression

Colorado Nurses Association (CNA) District Nurses Association of metro-Denver

(DNA-16) has held an annual Legislative dinner for many years. CNA represents

Registered Nurses (RNs), Advanced Practice Registered Nurses (APRN), including Clinical

Nurse Specialists (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse

Midwives (CNM), and Nurse Practitioners. Legislative and regulatory advocacy is done

in collaboration with all of these specialties as well as over 70,000 RNs in the State of


Upon learning that in person lobby days or legislative dinners would not be possible, CJ

Cullinan, RN, CNS, took the lead on behalf of DNA 16 to pivot and innovate an alternative

method of connecting the Faces of Nursing with our legislature. We felt certain that

now, more than ever, connecting both the faces and work of nursing with legislators was

an important reminder of the work done by nurses in all of our Colorado communities,

urban, rural and done twenty-four hours a day, seven days a week.

In collaboration with CNA’s 100 Nurses for 100 Legislators initiative, a call went out

seeking nurses to submit their professional photo with a brief statement about their type

of nursing practice. Over 120 nurses submitted photos that are included in both posters

and booklets. The Faces of Nursing booklets were distributed to every Senator and

Representative and we were assisted in that effort by Representative Kyle Mullica, RN.

Additional planning went in to working with the Capitol staff to plan a safe poster

presentation on the West Side Capitol steps on April 5, 2021 over the lunch hour. We

limited the number of participants and specially designed masks were donated with

“health by example” imprints recognizing the important role we all serve in modeling

public health practices.

This work could not have been accomplished without the dedication and time of

many. That group includes Judy Anderson, Graphic Designer, ABC Imaging providing

significant discount in poster production, and, National Teleprinting significant discounts

and a personal note of thanks to nursing. Collaborative funding came from the Colorado

Center for Nursing Excellence, multiple DNAs, Colorado Advanced Practice Nurses and

Advanced Practice Psychiatric Nurses of CNA and CNA lobbyist Gil Romero of Capitol

Success. I would like to acknowledge the work of friends of nursing Susan Goldstein and

Jane Dodge. We are also grateful to Kayla Koeune, artist, who provided permission to use

her “Modern Hero” print for the cover. Her artwork can be found on

Nurses innovate every day. We have had many “pivots” in this process, and I am proud

of how we have been able to continue our connection with the legislature and reminding

them of the critical role nurses have in providing care, in education, in every facet of

community life.

Left to right- Helen Lester, Sue Foster and

Glenda Jackson. Not pictured- Charlotte Ledonne

Charlotte Ledonne and Sue Foster are volunteering their time to assist with the

COVID mass vaccination clinics in Alamosa County.

Respectfully submitted,

Charlotte Ledonne, RN, BSN, MA, LPC

President DNA 6

Bev RN A Registered Nurse since 1983, my specialty area is Public

Health-HIV/STI Treatment and Prevention working as a Nurse

Field Consultant and Trainer with the Patient Navigation Training

Collaborative. I am a member of the Colorado Council of Black Nurses

and attend Graduate Nursing School. I have a passion for health and

racial equity, along with improving care systems for all patients.

House District 39 Senate District 4


Crystal RN I am an Orthopedic-Surgical Registered Nurse, and

have been a Nurse for 4 years. I love working in the Hospital

because of so many opportunities to have many other experiences as

a Nurse. I’ve been able to Float and Train on other floors and had

the opportunity to work the COVID Vaccine Clinics as well.

House District 29 Senate District 19

More News from DNA 16

You can make a tangible impact on public health in

Colorado by joining our staff of nurse compliance inspectors.

Critical thinking, clinical experience and health care system assessment

skills are keys to success for ideal candidates.

No weekends or on-call. Great benefits and job satisfaction.

Check the State of Colorado website at

for positions with the department.

Rebecca Sposato MS, RN

This June, members of DNA 16 kept an annual tradition of volunteering at Project

C.U.R.E. The small group sorted several boxes of donated medical supplies. This charitable

organization is the world’s largest non-profit distributor of medical supplies to clinics in

developing nations.

Due to Covid-19 restrictions, DNA 16 modified its annual Healthcare Appreciation Night

at the Rockies. Traditionally, the event occurred in May during Nurse Appreciation Week.

The event was rescheduled for Thursday, August, 20; Colorado Rockies versus Arizona

Diamondbacks. DNA 16 distributed nurse CNA themed facemasks.

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 7

District and Special Interest Group Reports

DNA 20 – West Metro Denver

SIG 31 – CO Advanced Practice

Psychiatric Nurses

Norma Tubman RN, MScN

Fifteen members and guests attended our February

Virtual Meeting. Annette Cannon, DNA 20 member

and Jefferson County Coroner gave an overview

of the Coroner’s Office. She discussed the coroner,

investigator and forensic pathologist roles; the causes

and manners of death in the county; and how the

staff works with families. The presentation included a

virtual tour of the office including the autopsy suite.

Dr. Cannon and her department was recognized by the

Jefferson County Treasurer, Jerry DiTullio, in his March

Update for the work they have performed supporting

Jefferson County families during life-loss tragedies,

especially during the COVID pandemic. He noted

that Dr. Cannon has demonstrated professionalism,

resiliency and empathy to the families.

March’s virtual meeting speaker was Joanne

Clavelle, DNP, RN, NEA-BC, FACHE, FAAN, who spoke

on Professional Governance: Evolution of Structural

Empowerment. Dr. Clavelle is the Chief Executive

Officer of Clavelle Consulting based in Denver and is an

Adjunct Professor for the University of Colorado College

of Nursing. She described the evolution of shared to

professional governance. She distinguished the attributes

and characteristics of professional governance; identified

how the structural framework for governance supports

nursing professional practice and behaviors that improve

outcomes; and outlined how nurse leaders can measure

professional governance and intentionally cultivate a

work environment that supports a positive professional


DNA 20 was a $200 sponsor of DNA 16 and SIGs

30 and 31 100 Nurses for 100 Legislators Project

Colorado Nurses Association Faces of Nursing: A Day

of Remembrance held April 5 at the Capitol. The

project recognized over 100 nurses with a booklet of

the faces of nurses, posters, and custom face masks

saying Colorado Nurse. DNA 20 was proud to be part

of the event which showed incredible appreciation

and support for the efforts of our frontline colleagues

in every health care setting during COVID. Thank

you to DNA 20 members Olivia Martinez, Allison

Windes and Irene Drabek who have worked COVID

Vaccination Clinics.

Congratulations to Annette Cannon who was

elected Chair of the Sig Group for Death Investigations

through the Academy of Forensic Nurses for 2021-23.

In support of nursing students, DNA 20 approved

a $1500 scholarship for 2022 to be awarded by the

Colorado Nurses Scholarship Committee in December.

For information on DNA 20 meetings see the

CNA website or contact president Jean Schroeder at

We experience the world around us through a lens

that has been shaped and polished by our families,

teachers and the environment. For better, and

sometimes worse, these influences predisposed us to

hold biases, prejudices and perceptions that are unfair

and harmful. The nurses of SIG 31 recognize that we

must explore our own preconceptions of others and

how they can influence the therapeutic relationships

we have with them. Further, we must use the privilege

and power of our positions as community leaders

to model and advocate for social justice, fairness and


SIG 31 sponsored three virtual seminars related

to racism, oppression and bias in January, March and

April, and we hope to continue as long as the interest


Nurses can change the world and we are starting

with ourselves. Please join us for our no shame, no

blame presentations. If you registered for the first

program, you will be invited to all future programs. If

you wish to get registered for future programs, contact

Ruby Martinez at

Mary Ann Bolkovatz,

Marlene Pino and

Ruby Martinez

8 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

In Memory

Eve Cook Hoygaard, MS,RN, WHNP

If you are a nurse who has read previous issues

of the Colorado Nurse, you have probably read this

column about nurses who have passed away that

you have worked with or otherwise known at some

time in your career. Did you wonder how we knew

about these losses? We depend upon receiving from

families and friends of these departed nurses. We

depend on other people... like you!

Our criteria for information to be included requires

it being about a RN or an LPN who has been educated

in, lived in and/or worked in Colorado plus the date

and, if available, of where they lived at the time they

passed away. We appreciate provision of additional

information as to where and when, they received

their nursing education, degree(s), age, where they

were employed, special awards (as being a Nightingale

Award or nominee) are examples we consider

including. For women, the issue of including their birth

name sometimes is included if known... if it desired we

would not include this information.

We Remember

Braden, Cynthia RN, BSN (73) passed away in

December 2020 in Metro, Denver. She received her

Bachelors Degree from the University of Michigan.

Her nursing career included Ft. Logan Mental

Health, Jefferson County Mental Health, National

Jewish Hospital, University Physicians prior to 10

years at the University of Colorado Hospital where

she worked in Oncology.

Davison, Richard Keith, RN (39) passed away in

Aurora Colorado in March 2021. He was a graduate of

Concord Career College in 2014.

Henning, Mary Boland, RN (69) passed away in

January 2021. She was a nurse for many years at Knapp

Elementary School, Denver.

Judd, Janis B., RN, BS (77) passed away in December

2020 in Grand Junction. She was a 1966 Graduate of

Presbyterian Hospital School of Nursing (1966) and

worked as a surgical nurse. Later, she completed a BS-

Technical Management/Business from Regis College in

1985. She had lived in Boulder, CO and in Dallas, TX

Light, Nedra, RN (90) passed away in Denver in

March 2021. She had received her nursing license in

1946 and was an active nurse for 46 years. Her career

included the Operating Room and Recovery Room

areas and also as a Float Nurse. She had worked at

Rose Medical Center.

Mendozza, Carol Parchinski, RN (70) She was

a nurse and lactation consultant. She passed away in

February 2021.

Morgan, Alice L, RN, (91) passed away In

Colorado Springs in December 2020. While she was in

High School, she worked as a nursing assistant during

a polio epidemic. Next, she applied to Beth El School

of Nursing, Colorado Springs where she was the first

black student to be accepted. Next, she became the

first black graduate of the school. Later, she became

the first black head nurse hired at Memorial Hospital

in Colorado Springs. She retired after a 21 year

career with the El Paso County Health Department.

Payne, Kathryn Lynette, RN, (63) BSN – Rush

University, Chicago, IL and a BS-Biological Sciences

from Colorado State University, Ft. Collins, CO.

She later earned a law degree from Pepperdine

Law School, Malibu, California. She passed away

in January in Nashville, TN where she was a nurse

educator and ethicist for 38 years at Vanderbilt

University. At Vanderbilt University, she was an

Associate Professor of Nursing in the Center for

Biomedical Ethics.

Ridge, Helen, RN, MSN SN, BS (88), passed

away in Littleton CO in January 2021. She completed

her BSN (1950) from Stanford University in California

and later received an MSN from the University of

Colorado. She worked as a School Nurse in Denver

from 1959 to 1987 when, as supervisor of the school

nurse program, she retired.

Thompson, Mary Agnes Black, RN (80) A Nurse

passed away in Aurora Colorado in January 2021.

We reserve the right to edit material submitted

and endeavor to verify all information included in

this column. If you notice an error, please advise

us and a correction will be published in the next

available We appreciate your providing informations

for this column. To submit information, please

contact Eve Hoygaard at

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 9


Nurses - How Are We Doing?

Ingrid Johnson DNP, MPP, RN

President and CEO –

Colorado Center for Nursing Excellence

There is more and more evidence that nurses

have struggled through COVID in ways that we are

only now beginning to understand. It is likely that

the information around our profession’s response

to the pandemic will evolve significantly over the

coming year or two. It is about time for the Center,

as the state’s nursing workforce center, to complete

a supply/demand survey so we can more fully

understand who is planning to leave the workforce

in the coming years, allowing us to strategize on

how to ensure we have the needed pipeline.

A recent article in Medpage Today is titled:

Nurses Are Not Alright” (https://www. The

article received survey responses from 22,000

nurses from around the country and found that

24% of nurses over the age of 34 and 36% of

nurses under the age of 34 have sought mental

health support since the pandemic hit last March.

Additionally, 70% of nurses are in the process of

getting vaccinated with another 14% planning to

get vaccinated. However, the remaining 16% of

survey respondents stated they either may not or

will not get vaccinated at all. There seems to be a

continued trend of distrust among the population

regarding the vaccinations, even among nurses. This

is concerning when you consider the severity of this


Recently I heard someone scoffing at the

general response that this pandemic has created.

He suggested that because the mortality rate

of the illness is generally low, a vaccine will not

make much of a difference. He showed a statistic

that “only” 1.8% of people die from this illness

and with the vaccine the death rate will decrease

to an estimate of about 1%. What he missed is

that 30,000,000 people in the United States have

been diagnosed with COVID since the pandemic

began. Over 545,000 people in the US have died.

Lowering the mortality rate to 1% from the current

stats would save 245,000 lives. That is significant.

Additionally, worldwide over 126,000,000 people

have been infected and 2,760,000 people have

died. That is a higher mortality rate (2.2%) than

we are experiencing in the US, and I suspect our

lower morality rate is related to the high quality of

nursing care provided in this country.

Nurses understand that the reason public

health officials have taken such a strong stance

in approaching this virus is that it is highly

contagious. The more people that are infected, the

more people will die, even with a generally low

mortality rate. High infection rates have created

high levels of stress on our healthcare system

and on our profession. The health systems across

Colorado are stretching themselves to try and find

opportunities to support their staffs. One chief

CNF Appoints New

Board Members

Colorado Nurses Foundation is pleased to

announce the appointment of three new members to

the CNF Board of Directors. The new directors joined

the board in January and are already hard at work

on foundation activities. They are:

Jeanne Burnkrant, RN, DNP, an Adult and Geriatric

Nurse Practitioner and Senior Instructor at University

of Colorado College of Nursing. She has more than 23

years of experience in health care and post-secondary


Betsy Woolf, RN, MSN, owner of Paincare RN,

provides individualized chronic pain care for persons

with limited access to non-pharmaceutical modalities.

She is certified in both Pain Management Nursing

and Medical-Surgical Nursing. Betsy is also a Clinical

Instructor at PIMA Medical Institute.

Lisa Zenoni, RN, PhD, an Associate Professor at

Loretto Heights School of Nursing at Regis University.

She is the Director of Undergraduate Nursing

Programs and is a Certified Rehabilitation Registered


CNF is pleased to have these talented nurses on

their Board of Directors.

nursing executive told me that they are adding a

self-care component to some of the performance

evaluations on some of the units to test and see if

self-care is considered part of a nurses job, will we

begin to care for ourselves as well as we care for

our patients. The Center offers a self-care support

program to all health professionals across the state.

Please, if you are struggling, reach out to us and

participate in the “Ripple Effect” program designed

to support Colorado’s nurses. We are so grateful to

the wonderful nurses across Colorado and proud

of how nurses have stepped up during this crisis. If

you need support, we are here. Thank you for all

you do!

Nurse Family Partnership

Nurse Home Visitor

We are seeking a nurse to join our Nurse Family

Partnership team. Responsibilities include case

management and care coordination through home

visitation for low-income, first time pregnant women and

their families from early pregnancy up to the child's second

birthday. This is a 20 hour a week regular position.

This position requires travel within Grand County as

well as some travel to Summit County.

Please see program website:


• BSN required

• Current RN license (in good standing) required in the state

of Colorado or an active RN license with a compact state.

• Current CPR required

• Two years recent experience in maternal/child health,

public health, home visiting or mental/behavioral

nursing preferred.

• Home visiting experience preferred

• Excellent written and verbal communication skills.

• Basic computer skills.

• Valid driver’s license and insured automobile required.

• Fluent bilingual (English/Spanish) preferred

Please submit resume, cover letter & Summit

County Job application online at

For more information call (970) 668-9711

Equal Opportunity Employer

10 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

Hispanic Nurses Embrace Precision Medicine and Ensures

Hispanics Are Represented in Medical Research Through All of Us

Amanda D. Quintana DNP, RN, FNP; Immediate Past President,

National Association of Hispanic Nurses – Denver Chapter

Nate Glass, Junior Associate; Clyde Group

In 2019, nurses from the National Association of Hispanic Nurses – Denver Chapter

(NAHN) began educating Latinx communities, health care workers, and other community

members about the importance of precision medicine. Precision medicine is a method

used to specifically focus disease prevention and treatment measures to all populations.

To tailor treatments to individual needs, precision medicine considers the unique factors

that make individuals who they are - such as lifestyle, socioeconomics, environment, and

biology. Until now, little research of this kind has been completed on minority and underserved


Funding from the All of Us Research Program, part of the nationwide Precision

Medicine Initiative from the National Institutes of Health (NIH), provided NAHN with an

opportunity to launch an educational campaign to spread the word about this important

Weld County Public Health

(Greeley, CO)

invite applicants to apply:

Public Health Nurse I or II

• Generalist

• TB & Communicable Disease


To view the complete job

announcements and apply online:


research. Most would agree that the traditional “one size fits all” model of health care

does not adequately address the health care needs of our diverse population. Through

the work of the All of Us Research Program, Hispanic nurses in Denver, along with other

Colorado professional organizations, are working hard to impact change.

Together, NAHN nurses, Promotoras from Vuela for Health, YMCA of Metro Denver

staff, Colorado Council of Black Nurses, Central Colorado Area Health Education Center

and members of the Colorado Rural Health Center have educated and encouraged

hundreds of diverse community members and health care professionals to participate in

this research initiative.

All of Us is a historic effort to gather data from one million or more people living in

the United States to ensure medical researchers have a data source that represents us all.

By considering individual life differences, researchers may uncover paths toward delivering

personalized preventative care and treatment for all populations.

So far, over 370,000 people from all walks of life, nationally, have joined the program.

NIH’s goal of reaching one million people from diverse backgrounds is impressive and

achievable with help from nurses who work with patients every day who can benefit from

this type of research. For them, for our families, for our communities, and for our future,

please help us spread the word about All of Us.

To learn more about the All of Us Research Program please go to: https://allofus. or contact NAHN-Denver Chapter nurses at

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 11

Meet the Colorado Nurses Association Board of Directors:

Linda Stroup,

2019-2021, 1st term


Laura Rosenthal,

2020-2021, 1st term

President - Elect

Angela Petkoff,

2020-2022, 1st term

Vice President

Nan Morgan,

2019-2021, 1st term


Carol O’Meara,

2020-2022, 2nd term


Brenda Tousley, 2019-

2021, 1st term

Region 1 Director

(DNA 8 & 9)

Amanda Chappelle

2020-2022, 1st term

Region 2 Director

(DNA 3, 12, 16, 20, 23)

Mary Satre,

Appointed 2020-2021

Region 3 Director

(DNA 4)

Glenda Jackson,

2020-2022, 1st term

Region 4 Director

(DNA 6)

Nora Flucke, 2019-

2021, 1st term

Region 5

Director (DNA 7)

Deb Bailey, 2020-

2022, 1st term

Region 6

Director (DNA 5)

Karen Lyda, 2019-

2021, 1st term

Director at Large (SIG)

V. Sean Mitchell,

2020-2022, 2nd term

Director at Large (SIG)

Jeanna Brewer,


2021, 1st Term Director

Recent Graduate

Mary M. Ciambelli

ANA Membership


Jennifer Gabel-Adney

ANA Membership


Carol O’Meara

ANA Membership



Colleen Casper

Executive Director

12 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

Will Your Next Prescription Be For the Pharmacy or the Farmacy?

Joanne Evans MEd, RN, PMHCNS

Almost 2500 years ago Hippocrates said “Let food

be your medicine and medicine be your food.” These

words are still relevant today. Some diseases are acute

while others are chronic. Those that are chronic may

include heart disease, hypertension, diabetes, asthma,

arthritis, COPD, kidney disease and some cancers.

The leading causes of death in the US from disease

are heart disease, followed by cancer, chronic lung

disease, stroke, Alzheimer’s, diabetes and chronic

kidney disease. Diabetes is actually the fastest growing

chronic disease in the US. In 2017, Indiana was ranked

6th in the country with diabetes being the leading

cause of death and 13th in the country with heart

disease as the leading cause of death.

In 2014, they counted over 6600 medication

prescriptions plus over the counter medications.

We can only imagine what the number is today.

According to the data from the National Health

and Nutrition Examination Survey in 2015–2016,

45.8% of the U.S. population used prescription

drugs. Nearly 40% of older adults take five or more

prescription drugs. All these medications have side

effects including nausea, fever, chills, headaches,

itching, wheezing, tightness in chest, vomiting,

red and irritated eyes and the list goes on and on.

Pharmaceuticals are actually the ones that benefit the

most from people being sick.

Is it possible that some of these chronic diseases

could be prevented or reversed by nutrition? There has

been extensive research for well over 40 years showing

how food can be used to treat and sometimes reverse

many chronic diseases. There is continual research

showing that plant-based nutrition :

• Prevents and reverses heart disease, diabetes and

some cancers

• Decreases cholesterol and reduce blood sugar levels

• Decreases obesity and complications from being


• Improves mood, sleep, energy, depression, anxiety

• Reverses many chronic diseases

• Increases work productivity

In a research study in five corporate locations in

the US, those practicing plant-based nutrition (PBN)

showed improvement in body weight, blood sugar

levels, and emotional state including depression and

anxiety. In another study, diets that were higher in

plant foods and lower in animal foods were associated

with a lower risk of cardiovascular morbidity and

mortality in a general population. The more people

adhered to a healthy plant-based diet, the lower their

risk of cardiovascular disease. In regards to obesity,

research shows that those who followed a plant-based

diet had more weight loss compared to those who

followed a vegetarian and non-vegetarian diet that

included diary, eggs, fish, or meat at two-month and

six-month intervals.

What specifically is plant- based nutrition (PBN)?

What does it include?

• Vegetables – dark greens, dark yellows and

orange, sweet potato etc.

• Whole Grains – pasta, rice, corn, whole grain

bread, tortilla etc

• Fruit – whole fruit which is better than juice due

to fiber

• Legumes – beans, peas, lentils, tofu, soymilk,

chick peas etc.

• Nuts and seeds

• limited processed foods

• avoiding oil, flour and sugar

With over three million nurses, it seems we could

make a dramatic change in health care for people in

the US, including Indiana, if we shared information

about plant-based nutrition. We all work in a wide

variety of settings including hospitals, (state, local and

private), ambulatory clinics, outpatient offices, home

healthcare, regulatory agencies, organizations, schools,

residential care and etc.

I have volunteered to conduct several 21-day plant

-based programs utilizing the Physicians Committee

for Responsible Medicine (PCRM) which is a free online

Kickstart program. The results were published

in the American Journal of Nursing and the Holistic

Nursing Association Journal. I collected lab work on

two occasions which supported the research already

published. Some people dropped up to 59 points in

cholesterol in 21 days while others also lost weight,

improved their energy and were sleeping better.

In talking with nurses around the country, there

seem to be many reasons nurses do not share

information about plant-based nutrition. They reported

the following:

• Feel they do not know enough and were worried

they could not answer patient’s questions

• Think it was too difficult

• Did not know who to refer patients to

• Thought it may be too expensive

• Thought patients may not be interested

When I spoke with nurses around the US, they

shared that this form of nutritional information was

not given to them in nursing schools. All the nurses

interviewed for my book, Cultivating Seeds of Health

With Plant Based Nutrition, Nurses Share Educational

Approaches to Prevent and Reverse Chronic Disease

(available on Amazon) learned about PBN after

graduation from their nursing programs. Some

learned about it after their own illness and others

when a family member became ill. Several nurses saw

their patients taking the recommended medications

and they were still not getting well. Others recognized

that “everything in moderation” was not working.

Another group of nurses read the China Study by Dr

Colin Campbell or saw the movie Forks Over Knives,

both of which convinced them that PBN was the way

to treat many chronic diseases.

Once nurses become knowledgeable about plantbased

nutrition, they have many options to share this

information including:

• Talking with colleagues about plant-based

nutrition (PBN)

• Having plant-based food at all meetings and


• Hosting monthly pot lucks with colleagues and

community groups (post Covid)

• Show movies on PBN and discuss the information


• Ask more detailed questions about nutrition on

intakes with patients including

◦ How many fruits did you eat in past 24-48


◦ How may vegetables did you eat in past 24-48


◦ How many portions of dairy food did you eat I

past 24-48 hours

◦ How many portions of meat did you eat in past

24-48 hours

Have them complete a nutritional assessment -

• Have care plans include PBN

• Have discharge summaries include PBN

• Request PBN guest speakers in educational

settings for undergraduate and graduate level

nursing programs

• Incorporate PBN into all discussions about chronic


• Join a community PBN group or start one

• Collaborate with other health care providers

interested in PBN

• Encourage hospitals to have plant-based foods at

all meals

• Monthly lunches with discussions on various PBN

topics (post Covid)

• Host a free online 10-day (McDougall) plantbased


health/education/free-mcdougall-program/ or

host a free 21-day (PCRM) online plant-based

program – including menus, recipes, cooking

classes, and additional Information - https://

There are several groups available specifically for

nurses interested in learning more about plant- based

nutrition. PCRM hosts the Nurses Nutrition Network

which provides educational programs for nurses.

The American

College of Lifestyle Medicine has a nurses’ support

group and has presentations open to all nurses. https:// There

is also a new health care professionals group forming

in Indiana focusing on PBN and lifestyle to prevent and

reverse chronic diseases.

There are about 110,00 nurses in Indiana. Our

patients need to have a choice on how they will resolve

their chronic health issues and nurses can educate

patients so they hear for the first time that there is a

nutritional option to prevent and reverse many chronic

diseases. Patients should be given all the options

to make an educated decisions about their health.

Sometimes it starts with medication while they are

making nutrition and lifestyle changes. Eventually it

may be the nutritional changes alone that reverse the

chronic disease process. Nurses have an opportunity to

educate people to be healthier in Indiana. Let 2021 be

the time that it happens!





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The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 13


Some examples of breakfast might be the following:

• Cold cereal – with soymilk or rice milk with

peaches, berries or another fruit

• Whole grain toast with jam and fruit

• Oatmeal with non-dairy milk with cinnamon and


• Blueberry buckwheat pancakes and meat-free


For lunch, you might consider:

• Veggie burger with whole grain bun and salad

• Bean burrito, fruit

• Soy yogurt, fruit, vegetable soup, whole wheat


• Hummus wrap with whole wheat pita, shredded

carrots, cucumber, tomato

Some options for dinner might include:

• Black bean chili with cornbread, salad, greens

• Whole grain pasta marinara with mixed

vegetables, salad

• Fajitas with peppers, onions, tomatoes, beans,


• Beans and rice with salsa, corn, salad

Resources for learning about plant-based

nutrition are the following:

• Becoming Vegan, Express Edition: The Everyday

Guide to Plant-based Nutrition, Brenda Davis RD

and Melina Vesanto MS RD

• The China Study. Startling Implications For Diet,

Weight Loss and Long-Term Health. T. Colin

Campbell, PhD and with Thomas M. Campbell II,


• How Not to Die: Discover the Foods Scientifically

Proven to Prevent and Reverse Disease, Michael

Greger MD. FACLM and Gene Stone

• How Not To Diet, Michael Greger MD

• The Starch Solution, John McDougall MD

• The Vegan Starter Kit: Everything You Need to

Know About Plant-Based Eating, Neal Barnard MD

• Prevent and Reverse Heart Disease , Dr Caldwell


Some good cookbooks are:

• Dr. Neal Barnard’s Cookbook for Reversing

Diabetes: 150 Recipes Scientifically Proven to

Reverse Diabetes Without Drugs, by Neal Barnard

MD and Dreena Burton

• The China Study Cookbook by Leanne Campbell,


• Engine 2 Cookbook by Rip Esselstyn and Jane


• Forks Over Knives – The Cookbook: Over 300

Recipes for Plant-Based Eating All Through the

Year, by Del Sroufe, Isa Chandra Moskowitz,

Julieane Hever MS, RD, CPT, Darshana Thacker,

Judy Micklewright

• The Get Healthy, Go Vegan Cookbook: 125 Easy

and Delicious Recipes to Jump-Start Weight Loss

and Help You Feel Great, Neal Barnard, MD

• How Not to Die Cookbook, Michael Greger MD

• The McDougall Quick and Easy Cookbook: Over

300 Delicious Low-Fat Recipes You Can Prepare in

Fifteen Minutes or Less, John McDougall MD and

Mary McDougall

• Prevent and Reverse Heart Disease Cookbook,

Ann Crile Esselstyn and Jane Esselstyn

Nurses interested in websites might consider:

• Dr. Greger – – updated

research on nutrition and disease – many short


• American College of Lifestyle – https://www.

• Dr. McDougall – – free

newsletters, testimonials, current research, Starch

Based Solution Certificate Program, 10-day

residential programs

• Physicians Committee for Responsible Medicine – – free monthly Kickstart programs,

newsletters, current research, multiple languages,

handouts for offices

• Forks Over Knives – https://www.forksoverknives.

com/ – recipes, plant-based news, meal plans,

success stories, cooking course

• Plantrician Project –

vision – list of plant-based doctors, peer review

journal, conferences, cooking class, research and


Nurses looking for apps may be interested in:

• 21-DayVegan Kickstart – PCRM

• Dr. McDougall Mobile Cookbook

• Forks Over Knives

• Michael Greger - Dr. Gregers’ Daily Dozen

Some good plant-based movies are:

Forks Over Knives – especially for diabetes, heart

disease and chronic health issues

Code Blue – focusing on medical training and health

care system

Game Changers- focus on vegan athletes

Cowspiracy – focus on the environment

Food Inc – food supply and industry

Eating You Alive – food connected to chronic disease

Meat the Truth – livestock farming and the


Joanne Evans MEd, RN, PMHCNS is an advanced

practice nurse and has been practicing for almost 50

years. She is certified in plant-based nutrition by 2

national organizations and has been a speaker at many

national, state, and local nursing conferences. She has

published on this topic in several journal in nursing

organizations. She recently published Cultivating Seeds

of Health With Plant Based Nutrition, Nurses Share

Educational Approaches to Prevent and Reverse Chronic

Disease which is available on Amazon. She can be

reached at


American Association of Nurse Practitioners Journal. A wholefood

plant-based experiential education program for

health care providers results in personal and professional

changes. Oct 2019. A. Lessem, S. Gould, J. Evans et al.

American Journal of Nursing, March 2017 – A Plantbased

program – Nurses experience the benefits and

challenges of following a plant-based diet

American Journal of Holistic Nursing, April 2015 - Plant-based

nutrition: Will your next prescription be for the farmers

market OR the pharmacy

Martin CB, Hales CM, Gu Q, Ogden CL. Prescription drug

use in the United States, 2015–2016. NCHS Data Brief,

no 334. Hyattsville, MD: National Center for Health

Statistics. 2019.


Katcher, H.I., Ferdowsian, H.R., Hoover, V.J., et al. (2010)

A worksite vegan nutrition program is well accepted

and improves health-related quality of life and work

productivity. Ann Nutr Metab, 56(4), 245-52

Agarwal, S., Mishra, S., Xu, J., Levin, S., Barnard, N.D., (2015)

A multicenter randomized controlled trial of a nutrition

intervention program in a multiethnic adult population

in the corporate setting reduces depression and anxiety

and improves quality of life: The GEICO Study. Am J

Health Promot 29(4), 245-54.

Trapp, C., Barnard, N., Katcher, H. A Plant-based

diet for type 2 diabetes. (2010, February, 25).

Diabetes Educator.


Roberts, W.C., (2010) It’s the cholesterol, stupid! Am J

Cardiology. 106(9),1364-6.

Esselstyn CB, Jr., et al. A way to reverse CAD? J Fam Pract


Turner-McGrievy, G.M., et al. (2015). Comparative effectiveness

of plant-based diets for weight loss: a randomized

controlled trial of five different diets. Nutrition 31(2), 350-8.

14 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

State Board of Nursing Seeks

New Members

The State Board of Nursing is seeking five new

members to begin four-year terms starting this

summer. Board vacancies include:

• One Licensed Practical Nurse (LPN);

• One Registered Nurse (RN) or LPN working in a

Nursing Home or Intermediate Care Facility.

• One RN or LPN working in a Home Health


• One RN serving as a Nurse Administrator;

• One RN hospital staff nurse.

The time commitment includes one monthly

Board meeting, quarterly full Board meetings, and

occasional emergency meetings to act on nursing

education program applications, complaints,

licensing applications, and rulemaking as authorized

in the Nurse and Nurse Aide Practice Act. Selected

To access electronic copies of

Colorado Nurse, please visit


Board members will be expected to prepare in

advance for these meetings, attend annual ethics

training, and participate in the decision-making

process at meetings. Members are reimbursed for

travel expenses and paid a small stipend for their


Meetings are held remotely or in-person at 1560

Broadway, Denver, CO 80202.

Interested parties may contact Roberta.Hills@ to express an interest in applying or

to ask any questions. The formal application is

processed and accepted by the Governor’s Office of

Boards and Commissions. The Governor’s Office is

continually seeking qualified candidates to serve on

almost 300 boards and commissions that oversee

a large variety of subjects and make a wide range

of decisions affecting the daily lives of Coloradans.

These boards are a tremendous opportunity for you

to help govern and give back to the state.

Applicants should not be concerned if they are

not immediately notified of their status. Selected

members will be contacted.


The State Board of Nursing wants to

inform licensees of recently updated reporting


Colorado statute now requires 30-day reporting

of adverse actions by all Registered Nurses,

Licensed Practical Nurses, Licensed Psychiatric

Technicians, and Certified Nurse Aides.

These categories include:

• Final convictions;

• Malpractice settlements;

• Action taken by a government agency, law

enforcement agency, healthcare institution,

or peer review committee for acts that are

grounds for discipline;

• License discipline in another state, whether

within or outside a compact;

• License revocation, suspension, or surrender

in another state, whether within or outside a


Please submit reports to dora_nursingboard@ Those failing to report these actions are

subject to discipline by the Board. Further details

are available here.

Please contact with any



Colorado Nurses Association

Annual Conference and

Membership Assembly

October 1 & 2, 2021

2021 Year of the Nurse

Nurses Make a Difference

Call for Speakers

2021 has demonstrated the power and value

of nursing. Colorado Nurses Association is issuing

an invitation to individuals who would like to

contribute to our annual conference as a speaker to

share content with nurses, student clinical nurses,

nurse leaders, and advance practice nurses.

The annual conference will be held at the Hilton

Inverness Hotel in Englewood, Colorado, just south

of Denver.

Conference attendees are looking for leading

edge practice, research, self-care, and career

development content.

Please submit your content for

consideration by June 15, 2021 at:

2021 Call for Presenters


The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 15

Reprinted from The North Dakota Nurse

January, February, March 2021

Appraised by: Jannelle Stevens, RN, LeAnn Bingham,

RN, & Dylan Gjerde, RN Mayville State University RN-

BSN students

Clinical Question:

Do nurses who work 12-hour shifts have a higher

rate of burnout than nurses who work 8-hour shifts?


Dallora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H.

(2015). Association of 12 h shifts and nurses’ job

satisfaction, burnout and intention to leave. Findings

from a cross-sectional study of 12 European countries.

BMJ Open, 5(9). doi:10.1136/ bmjopen-2015-008331

Khammar, A., Amjad, R. N., Rohani, M., Yari, A., Noroozi, M.,

Poursadeghian, A., Mahsa, H., Poursadeghiyan, M. (2017).

Survey of shift work disorders and occupational stress

among nurses: A cross-sectional study. Annals of Tropical

Medicine & Public Health, 10(4), 978–984.

Ruotsalainen, J. H. (2015). Preventing occupational stress

in healthcare workers. Cochrane Database of

Systematic Reviews, (4). John Wiley & Sons, Ltd. doi:

10.1002/14651858.CD002892. pub5

Thompson, B. J. (2019). Does work-induced fatigue

accumulate across three compressed 12 hour shifts in

hospital nurses and aides? PLoS ONE, 14(2), 1–15.

Synthesis of evidence:

This synthesis includes four studies related to

evidence supportive of the proposed research question.

The first study was conducted by Dallora, Griffiths, Ball,

Simon, & Aiken (2015), and focused on the concern

that nurses who work 12-hour shifts have a higher job

dissatisfaction and burnout rate compared to nurses

who work 8-hour shifts. A cross-sectional survey

was done on 31,627 RN’s in 2,170 general medical/

surgical units within 488 hospitals across 12 European

countries. The study concluded that nurses who work

12-hours shifts experience an increased rate of job

dissatisfaction when compared to a nurse working

an 8-hour shift. The same results were reported

for burnout described as, emotional exhaustion,

depersonalization, and low personal accomplishment.

The second study was conducted by Khammar,

Amjad, Rohani, Yari, Noroozi, Poursadeghian, Mahsa,

& Poursadeghiyan (2017). This study performed a crosssectional

study on 100 randomly selected shift-working

nurses from three hospitals in Iran. The study focused

on the correlation of shiftwork-related problems and

occupational stress, shiftwork, and job dissatisfaction.

The conclusion of this study showed a high prevalence

of shift work related problems such as, psychological

disorders, digestive problems, sleep disorders, and


musculoskeletal complaints. The study did show there

was a higher rate of job satisfaction when nurses were

able to choose their shiftwork. Stress-related issues

were more prevalent when there was a conflict with


The third study was conducted by Ruotsalainen

(2015). This study addressed the concern for healthcare

workers suffering from occupational stress resulting

in distress, burnout, psychosomatic problems,

deterioration in quality of life, and lack of patient

care. The purpose of this Cochrane review was to

evaluate the effectiveness of work- and persondirected

interventions compared to no intervention or

alternative interventions in preventing stress at work

in healthcare workers. A total of 58 studies (54 RCTs

and four CBA studies), with 7,188 participants were

reviewed. Organizational interventions discussed were

changing working conditions, improving support

or mentoring, changing content of care, improving

communication skills, and improving work schedules.

The study concluded that cognitive-behavioral training

as well as mental and physical relaxation reduced stress

moderately. Changing work schedules and having

shorter work schedules also reduced stress. Other

organizational interventions have no clear effects.

The purpose of the final study conducted

by Thompson (2019), was to determine what

performance-based fatigue symptoms presented after

three consecutive 12-hour nursing shifts compared to a

single 12-hour nursing shift. Participants were mentally

tested on their reaction time and monitored for lapses

of attention. Physical testing consisted of three vertical

jumps and isometric strength assessments on the knee

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extensor/flexor, and wrist flexor muscle groups. The

results showed fatigue-based impairments in several

mental and physical performance tasks which occurred

after a single 12-hour shift however, the impairments

were exacerbated following three consecutive 12-hour


Bottom Line:

Evidence suggests that there is a correlation

between the length of shift worked and an increased

rate of burnout. It is necessary for healthcare

institutions and nurses to evaluate the potential cause

for burnout and make the appropriate changes.

Institutions that implemented shorter shifts with

stress intervention and prevention programs tend to

have a lower nurse burnout rate than those without.

Additionally, nurses who can be proactive with

recognizing burnout in themselves and their coworkers

will assure an optimal working environment and

continue to provide our patients with exceptional care.

Implications for nursing practice:

It has become increasingly apparent that nurses

are suffering from burnout. Healthcare institutions

and nurses need to take the appropriate steps to

recognize, reduce, and prevent burnout. Some steps

aimed at reducing burnout are, developing modified

shift-working programs, avoiding consecutive 12-hour

shifts, provide education on stress reducing measures,

reviewing workload, improving staff support,

mentoring, and improving communication. Having

these proactive interventions in place will be beneficial

for the institution, nurses, and patients.

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16 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

CNA Call for Nominations

for Annual Awards

Carol O’Meara, Chair, CNA Awards Committee

The CNA Awards Committee is seeking nominations

for the 2021 CNA Awards. The Awards will be presented

during the 2021 Membership Assembly Meeting. The

awards are:

• Margie Ball Cook Award for a CNA member who

has advanced equal opportunities in nursing for

members of minority groups.

• Sara Jarrett Award for a CNA member who has

contributed to nursing practice and health policy

through political and legislative activity.

• CNA Leadership Award for a CNA member who

has served as a leader in CNA through service on

the Board of Directors or on a committee or task


• CNA Emerging Leader Award for a CNA member

who has been a nurse for no more than ten

years and who is emerging as a leader in CNA or

a DNA.

• Carol O’Meara Award for a CNA member who

has made sustained contributions to CNA.

Nominations will also be accepted for the CNA Hall

of Fame. The CNA Hall of Fame was established in

2004 to honor CNA Members whose dedication and

achievements have significantly affected the Colorado

nursing profession. Nominees for the Hall of Fame

may be living or deceased. Criteria for the Hall of

Fame are:

1. The nominee must have demonstrated

leadership that affected the health and/or

social history of Colorado through sustained,

lifelong contributions in or to nursing practice,

education, administration, research, economics,

or literature.

2. The achievements of the nominee must have

enduring value to nursing beyond the nominee’s


3. The nominee must have been prepared in a

formal nursing program.

4. The nominee must have worked in or

represented Colorado.

5. The nominee must be or have been a CNA


To nominate an individual for any of these awards,

send a statement to the CNA Awards Committee,

which describes why your nominee should receive

the award. Include the name of your nominee as well

as your name and contact information. Please limit

your statement to two double-spaced pages. Email

your statement to Deadline

for receipt of nominations is August 15, 2021. The

Awards Committee may seek additional information

regarding the nomination.

In addition to these state level awards; each DNA/

SIG is invited to designate a DNA/SIG Nurse of the

Year. The DNA/SIG determines selection of the DNA

Nurse of the year. DNA/SIG Nurses of the Year will

be honored at the Membership Assembly meeting in

October. DNA/SIGs should submit the name of their

Nurse of the Year, along with a statement about why

the nurse was selected, to the Awards Committee

by August 15, 2021. Email this information to

Did You Know...

Colorado Nurses Association (CNA) worked

with the Colorado Hospital Association

(CHA), the Colorado Organization of

Nurse Leaders (CONL), as well as members

of the public and the staff at the Colorado

Department of Public Health & Environment

(CDPHE) to revise and modernize the nurse staffing

regulations for hospital licensure in Colorado. The

work occurred over a six to eight month timeframe,

with weekly meetings negotiating regulations to

advance assurances that clinical staff will have

a safer working environment. A key change is

described here.

CDPHE Hospital Licensing

Regulations for Nurse Staffing

Master Nurse Staffing Plans now state that

each open patient care unit will be staffed by a

minimum one RN and one auxiliary personnel,

including Emergency Departments.

Unit-based Master Nurse Staffing Plans must be

reviewed annually with, minimally, every RN.

Master Nurse Staffing Plans Effectiveness

Measures must be shared annually with the

facility governing board.

Master Nurse Staffing Plans and Effectiveness

monitoring must be available to CDHPE

surveyors upon request.

In the event that any employee or provider

(RN, MD, RT, PT) feels that their current work

environment is Unsafe or impacting Quality

of Care, you are encouraged to report the

incidence to the CDPHE Complaint Line.

These complaints can be made anonymously

and the information is not shared upon any

follow up surveys.

The CDPHE Complaint Line is found

at the Colorado Department of

Public Health & Environment Health

Facilities Division Web Site.

Colorado Nurses Association

Calls for Reference Proposals

and Bylaws Amendments

Carol OMeara, Chair, CNA Bylaws

and Reference Committee

Reference Proposals on Professional Issues are

requested for discussion and action at the CNA

Membership Assembly Business Meeting in October.

These proposals can be on any topic of concern

to nurses. Proposals for amendments to the CNA

Bylaws are also being requested. Proposals should be

submitted by August 15, 2021.

Contact Carol O’Meara, Bylaws and Reference

Committee Chair, at with any

questions or to submit proposals.


for the 2021-22 school year and beyond.

QUALIFICATIONS: Bachelor’s degree or higher in Nursing

or a closely-related field. (RN or above, BSN preferred)

LICENSURE: Ability to be licensed through the Colorado

Department of Education as a School Nurse.

The RFSD HR Department

may be reached at:

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 17

Nurse Spotlight: Defending Your License

Nurses Service Organization (NSO), in collaboration

with CNA, has published our Nurse Liability Claim Report:

4th Edition. It includes statistical data and case scenarios

from CNA claim files, as well as risk management

recommendations designed to help nurses reduce their

malpractice exposures and improve patient safety.

You may access the complete report, and

additional Risk Control Spotlights, at:


This Nurse Spotlight focuses on our analysis and risk

recommendations regarding one of the most significant

topics in the report: Defending Your License.

A nurse’s license is one’s livelihood, so protecting

it is paramount. A nurse’s practice and behavior

is expected to be safe, competent, ethical and in

compliance with applicable laws and rules. The State

Board of Nursing (SBON) serves to protect the public

and promote the progress of the profession, and

thus should be respected for its work in these areas.

However, when a complaint is made against a nurse to

the SBON, nurses must be equipped with the resources

to adequately defend themselves. Being unprepared

may represent the difference between a nurse retaining

or losing their license. This Spotlight provides an

overview of the role of the SBON in the legal/regulatory

system, describes the disciplinary process, and imparts

helpful recommendations on defending yourself if you

were to receive a complaint summons.

The 4th Edition of the NSO/CNA Nurse Liability Claim

Report revealed a total of 1,377 closed license protection

matters with payment in the five-year analysis, with an

average defense expense of $5,330. This data reflects an

increase over the previous data set.

The chart below represents the 2020 distribution of

license protection matters by license type. The average

total payment represents only the legal fees and other

expenses involved in defending the nurse against the

complaint. Any costs or expense associated with fines

or indemnity/settlement payments to a plaintiff are not

included. The percentage of license protection matters

correlates to the proportion of RNs and LPNs/LVNs

within the overall CNA/NSO-insured nurse population.

Understanding the Legal System

There are three types of law, the third of which

comes into play during licensing complaints.

• Civil law protects the rights of citizens and offers

legal remedies. Civil actions typically involve a

plaintiff suing to collect money to compensate

for an injury. One example of a civil action would

be a medical malpractice lawsuit. The outcome of

civil cases is determined by the preponderance of

evidence in favor of one party.

• Criminal law involves the system of legal rules

that define conduct that is classified as a crime.

Examples include driving under the influence,

theft or assault. Criminal cases are determined by

proving guilt beyond a reasonable doubt.

• Administrative law governs the rules and regulations

made and enforced by government agencies—such

as your state Board of Nursing. Administrative cases

are determined by the state providing ‘clear and

convincing’ evidence of the allegations, though this

language may vary by state.

The Nurse Practice Act

Every state has enacted laws and regulations that govern

the conduct of licensed professionals. The law specific to

licensed nursing professionals is the Nurse Practice Act. All

nursing professionals should become conversant with their

relevant state Nurse Practice Act. The Nurse Practice Act

gives your state Board of Nursing and professional license

regulatory agency the authority to:

• Provide nurses with certain rights and responsibilities;

• Develop practice and education standards,

policies, and administrative rules and regulations;

• Educate nurses regarding nursing practice;

• Credential and issue nursing licenses; and

• Enforce the laws pertaining to nursing practice by

investigating reports of professional misconduct

and making decisions regarding discipline.

Licensee Rights During the

Disciplinary Process

If you are named in a licensing complaint, the state will

not provide nor recommend an attorney, but gives you

the right to retain an attorney. The state also permits you

the opportunity to present evidence to defend yourself

during a hearing.

Nurse Spotlight

For risk control strategies related to:

• Documentation

• Medication Administration

• Liability for Nurse Managers

• Depositions

• Communications

• Home Care


The Disciplinary Process

A board complaint can be filed against a nurse by

anyone, for example, a patient, a patient’s family member,

a colleague or an employer. You may or may not know

the identity of your accuser and the complaint can be filed


In addition, many states require self-reporting of

certain violations, such as misdemeanors, felonies, and

plea agreements.

Involvement in a disciplinary action will take time to

resolve, which can make the entire process stressful.

The process is illustrated by the graphic below.

Investigative Stage

While the procedures may vary by state, all

complaint reports are investigated, including those that

are anonymous. Many if not all SBONs are required to

investigate every complaint they receive. However, the

SBON may not be permitted to tell you how it received

the report, or give you any information or documents.

Some SBONs use board-appointed investigators

who may or may not be nursing professionals. The

investigator will use various methods to determine

the facts, such as interviewing parties who were

present, reviewing documentation and records,

performing drug screens (if impairment is alleged), and

compiling any pertinent facts related to the events and

circumstances surrounding the complaint.

You may receive a letter, email or a phone call from the

SBON asking you to submit a written statement explaining

the reported incident. Or, the SBON may require you to

appear at a certain time and date for an interview with

the investigator. Never ignore a request from the SBON.

If you are contacted during the investigative stage,

consult with an attorney before you respond to the

SBON within the deadline set by the Board. You must

be cooperative, but be aware that whatever you

share is evidence the investigator will provide to a

prosecuting attorney or the SBON.

Nurses should not appear at proceedings without

legal counsel present. Look to your legal counsel for

guidance before answering questions from or making

statements to the SBON or the investigator. Your

attorney may be able to speak to the investigator, learn

more about your matter, and help you navigate the

entire process in a positive direction.

Prosecution Phase

Upon completion of the investigation, the

prosecuting attorney or state agency will determine

how to proceed. One option is an informal conference.

Although less formal than an actual hearing, informal

conferences are official proceedings. During the

conference, you will be interviewed by a member of

the SBON and possibly its attorney. Your attorney

should be present with you during all proceedings.

• You will have an opportunity to produce any

evidence that supports your case.

• A resolution may be offered, ending the matter.

If the SBON believes it has significant evidence

against you, the matter may proceed directly to a

Defending Your License continued on page 18

18 • Colorado Nurse | May 2021

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

Defending Your License continued from page 17

formal hearing where a discipline action may be proposed. The hearing is similar

to a civil trial. It may take place in a courtroom-like setting before an administrative

law judge and hearing panel. The hearing panel may include several SBON board

members, or the entire SBON, depending upon the state. A court reporter records

the entire proceeding and a transcript is made. When both sides have presented

their cases, the hearing is concluded.

• Information is exchanged, known as discovery, and you are entitled to the

documents possessed by the prosecutor.

• Witnesses may be called to testify.

• The nurse undergoes cross-examination.

The outcome of the formal hearing is a ruling by the administrative law judge and

the SBON. The process can take months or even years to fully resolve – lengthening

the process – and increasing the cost.


Comprising 32.5 percent of license protection matters, professional conduct

allegations are the most frequent allegations asserted against nurses in license

protection matters. Collectively, professional conduct, scope of practice and

documentation error or omission account for 67.0 percent of all license protection

closed matters, see Figure 24.

State Board of Nursing Actions

SBON disciplinary actions can range from no action against the nurse, up to and

including revocation of the nurse’s license to practice.

The majority of matters in the 2020 analysis, 45.6 percent, resulted in the SBON

deciding to take no action. In 15.5 percent of matters the nurse received a letter of

concern which is considered a ‘warning’ or reprimand. The more serious outcomes

include: Probation 12.0 percent, Surrender 4.8 percent, Suspension 3.2 percent, and

Revocation 1.5 percent, see Figure 28.

In some cases, the SBON may impose multiple disciplinary actions, such as receiving

a reprimand coupled with a fine. Depending upon the state in which you practice,

most outcomes involving discipline against a nurse’s license are permanently a matter

of public record and reported to the National Practitioner Data Bank (NPDB). The SBON

also may report that disciplinary action to other agencies, regulatory authorities, or other

SBONs, which may decide to initiate their own investigation and take action.

Nurses who have had adverse disciplinary actions may appeal those decisions. The

standards for appealing a SBON decision are defined by your state and will outline the

specific requirements, time frames, and processes.

According to the National Practitioner Data Bank, nursing

professionals were on average more than 62 times

more likely to be involved in an adverse licensing

action than a medical malpractice payment in 2019.*

Risk Management Recommendations

Below are some proactive concepts and behaviors to include in your customary

nursing practice, as well as steps to take if you believe you may be involved in a

SBON matter related to your practice of nursing:

Everyday Practice

• Practice within the requirements of your state nurse practice act, in

compliance with organizational policies and procedures, and within the

national standard of care. If regulatory requirements and organizational scope

of practice differ, comply with the most stringent of the applicable regulations or

policy. If in doubt, contact your SBON or specialty professional nursing association

for clarification.

• Document your patient care assessments, observations, communications

and actions in an objective, timely, accurate, complete, and appropriate

manner. Never alter a record for any reason or add anything to a record

after the fact unless it is necessary for the patient’s care. If it is essential to add

information to the record, properly label the delayed entry, but never add any

documentation to a record for any reason after a complaint has been made. If

additional information related to the patient’s care emerges after you become

aware that SBON action is pending, discuss the need for additional documentation

with your manager, the organization’s risk manager and your legal counsel.

• Maintain files that can be helpful with respect to your character. Retain

copies of letters of recommendation, performance evaluations, thank-you letters

from patients, awards, records of volunteer work and continuing education


The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2021 | Colorado Nurse • 19

• Immediately contact your professional

liability insurer if you:

• Become aware of a filed or potential professional

liability matter against you.

• Receive a subpoena to testify in a deposition

or trial.

• Have any reason to believe that there may

be a potential threat to your license to

practice nursing.

• Refrain from discussing the matter with

anyone other than your defense attorney

or the professionals managing your


• Promptly return calls from your defense

attorney and professionals. Contact your

attorney or designated professional before

responding to calls, e-mail messages or

requests for documents from any other party.

• Provide your insurer with as much

information as you can when reporting

such matters, including contact information.

• Never testify in a deposition without first

consulting your insurer or legal counsel.

• Copy and retain all legal documents for

your records, including:

• The summons and complaint

• The subpoena

• Attorney letter(s)

• Any other legal documents pertaining to the


This information is designed to help nurses

evaluate risk control exposures associated with their

current practice. It is not intended to represent

a comprehensive listing of all actions needed to

address the subject matter, but rather is a means of

initiating internal discussion and self-examination.

Your clinical procedures and risks may be different

from those addressed herein, and you may wish to

modify the tool to suit your individual practice and

patient needs. The information contained herein is

not intended to establish any standard of care, serve

as professional advice or address the circumstances

of any specific entity. These statements do not

constitute a risk management directive from CNA.

No organization or individual should act upon this

information without appropriate professional advice,

including advice of legal counsel, given after a

thorough examination of the individual situation,

encompassing a review of relevant facts, laws

and regulations. CNA assumes no responsibility

for the consequences of the use or nonuse of this


This information was excerpted from NSO and

CNA’s full report, Nurse Liability Claim Report: 4th


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