Nebraska Nurse - May 2021




Sent to all Nebraska Nurses courtesy of the

Nebraska Nurses Foundation in partnership

with the Nebraska Nurses Association

American Nurses

Foundation Launches

National Well-being

Initiative for Nurses

Page 5


Pandemic And

Effects On Nursing


Page 13

In This Issue

current resident or

Awards for NNA

Members &

Scholarships for

Nursing Students

Page 8

Inside the NNA

President’s Column ............................2

NNA State Director ............................3

NNA MIG Reports ............................4

Feature Articles

American Nurses Foundation Launches

National Well-being Initiative for Nurses ............5

Failure to report changes in a patient’s condition .......6

Special Membership Assembly

Actions and Reflections ...........................8

Awards for NNA Members &

Scholarships for Nursing Students ...................8

Nebraska Nurses Foundation

Show Your Pride a Nebraska Nurse! ................9

Happenings at the Nebraska Nurses Foundation .......... 9

NNF Still Seeking Pandemic Nursing Stories! ............ 10

Count the Kicks: Saving Babies’ Lives Can be Simple! ......11

Affiliate Organizations

Nebraska School Nurses Association ..............12

Covid-19 Pandemic And Effects

On Nursing Education ............................ 13-14

Membership Application ........................15

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

Quarterly circulation approximately 36,000 to all

RNs, LPNs, and Student Nurses in Nebraska.

Volume 54 • No. 2

May, June, July 2021

COVID-19 and mental health:

Self-care for nursing staff

Gráinne Ráinne Clancy, BN, MIACP;

D’Arcy D. Gaisser, DNP, MS, RN, ANP-BC; and

Grace Wlasowicz, PhD, RN, PMHNP-BC, ANCC


Along with incalculable loss, the coronavirus

(COVID-19) outbreak has had devastating effects on

the mental health of people with COVID-19, their

families, and the community at large. Healthcare

workers face tremendous stress, both emotionally

and physically, from the grueling work hours and

the threat of contracting the virus at work.

This article addresses the potential mental health

issues for healthcare workers that may emerge from

this pandemic as well as treatment options and selfcare

activities that promote recovery.

COVID-19 and mental health

Nurses working on the front lines of the

COVID-19 pandemic may experience various mental

health problems. Here are a few examples:

• Chronic stress. Nurses are continuously fearful

of contracting COVID-19, infecting others,

encountering prejudice from the public due

to working as a nurse, and dealing with

inadequate supplies of PPE. 1 Stress becomes

chronic when it is overwhelming and cannot

be resolved, resulting in relationship, health,

and sleep problems. 2-5 People with chronic

stress experience intense emotions that can

feel overwhelming and result in thinking

negatively. 6 Nurses on the front lines in

COVID-19 hotspots report feeling like a

graduate nurse again, filled with uncertainty

and worry. 7

• Acute stress disorder. Nurses with acute stress

disorder may have trouble sleeping, worry

constantly, and experience persistent negative

thoughts about their role in the traumatic

event, such as thinking “I should have done

more to help.” 8 When we experience trauma,

we detach from the memory. We ignore

our emotions to protect against the pain,

but these emotions reappear over time and

impact our lives. 9 The nurse may respond

to a minor irritation as if it were a lifethreatening

event. 10 Nurses may feel they

are in a dreamlike state that impacts their

ability to think, process their emotions, and

respond appropriately to situations. 11 If signs

and symptoms of acute stress disorder persist

for more than a month, posttraumatic stress

disorder (PTSD) may be diagnosed. 12

• PTSD. Nurses are not strangers to caring

for critically ill patients who die. 8 However,

the number of patients dying amid a surge

in COVID-19 cases is causing healthcare

workers to feel powerless, which can lead

to PTSD. PTSD can develop after direct or

indirect exposure to a traumatic event, such

as hearing about a traumatic event involving

a family member, friend, or colleagues. Those

with PTSD experience recurrent intense and

disturbing thoughts and feelings stemming

from one or more traumatic events. 10,13,14

Nurses with PTSD may relive an event

through flashbacks or nightmares, and they

may feel sadness, fear, anger, guilt, shame

and detachment or estrangement from

other people. 14 Many traumatized individuals

have a robust and unconscious inclination

to go inward, often to re-experience their

distressing thoughts, painful memories,

and uncomfortable sensations. 15 They may

have an exaggerated, startled response to

certain situations and develop problems with

concentration and sleep. 5

The nursing team’s role

When nurses struggle personally, we tend to

be critical of our colleagues or management and

withdraw from others. Such a change in personality

is often an indicator of struggle. It is often a team

member who will notice that you are not your

usual self and may be struggling with anxiety and

stress. Asking yourself or a colleague three simple

questions can raise awareness about a possible


• Am I ok? Are you ok?

• Do you feel you cannot give anymore?

• Do you feel your work is ineffective? 16

If you are struggling, speak with your colleagues,

acknowledging those feelings and thoughts in the

first instant. If you feel you are not performing

effectively in your workplace, talk with your

manager and state your opinions on being

ineffective. Everyone has limits, and sometimes just

taking a week off might be sufficient.

Nurses who continue to feel this way should

discuss it with their primary healthcare provider and

their employer and review the options available.

A range of supports may be available from your

employer or your professional organization. 17,18

Some nurses may want the support of a counselor.

It is a strength to realize that you are struggling

with your mental health and need help.

Early psychological intervention does make a

difference. 19 Each of us has a limit to stress, and

it is important not to compare your stress levels

to those of another person. There is strength in

being vulnerable and showing our thoughts and

emotions. Brené Brown defines vulnerability as

uncertainty, risk, and emotional exposure. 20

COVID-19 and Mental Health continued on page 7

Page 2 • Nebraska Nurse May, June, July 2021

President’s Column

Kari Wade, RN

Nebraska Nurses Association President

Happy Nurses Week May

6-12th, 2021! This annual

recognition is a time to

celebrate each other, our

profession, and the dedicated

service nurses provide. Nurses

are givers, and over the past

year, nurses have given so

much of themselves to the

effects of the pandemic that

self-care may have been

pushed aside. The final day Kari Wade

of Nurses Week (May 12th)

commemorates Florence Nightingale’s birthday.

Nightingale’s legacy emphasized the importance of

basic needs of people to be healthy, such as air, water,

cleanliness, and light. It’s time we put Nightingale’s

basic needs back into ourselves and ensure we are

prioritizing self-care along with our practice.

As summer approaches, the warmth of the

sunshine brings a feeling of renewal. It’s been a very

long year since this time in 2020, and our mental

health and overall wellness were without question

impacted. This time of renewal is the perfect

opportunity to rebuild those areas to a healthier self.

Get outside and breath the fresh air. Take a walk with

those who bring you happiness. Feel the warmth of

the sunshine on your skin. Not only does sunshine

release serotonin, research shows that just 5-15

minutes of sunlight a day, two to three times a week

on our arms, hands, and face is enough to enjoy the

vitamin-D boosting effects of the sun. Experience

the soothing sound, sight, and touch of water. Visit a

nearby lake for a walk or a picnic. Sit and just listen to

the sounds of a stream or river.

And finally, pull yourself away from screens. Screentime

fatigue has impacted many over the past year with

everything going virtual. Instead, pickup a book and let

your mind visit a creative place or story. Better yet, take

your book to a nearby lake, and enjoy reading while

relaxing on a blanket in the fresh air and sunshine.

Intentionally giving ourselves exposure to the

fresh air, water, light, and time away from screens

is so simple, yet can have powerful impact on our

mental and physical health. So, on this month of our

founder’s birthday, let’s all remember Nightingale’s

basic needs and prioritize our own self-care for a

healthier year. Self-care doesn’t have to mean ‘me

first,’ it simply means ‘me too.’

NNA’s Mission:

The mission of the Nebraska Nurses Association is advancing

our profession to improve health for all. The vision of the

Nebraska Nurses Association is to be a proactive voice for

nurses and an advocate for improved health for all.

NNA’s Core Priorities

C – Collaboration

A – Advocacy

R – Recognition

E – Education

NNA’s Official Publication:

The Nebraska Nurse is the official publication of the

Nebraska Nurses Association (NNA) (a constituent member

of the American Nurses Association), published quarterly

every February, May, August, and November. The NNA

provides education, networking opportunities, publications

and other products and services to its members and

extends its mission to all nurses in Nebraska.

Phone: (888) 885–7025

You can leave a message at any time!


Web site:

Mail: c/o Midwest Multistate Division

3340 American Avenue, Suite F

Jefferson City, MO 65109

Questions about your nursing license?

Contact the Nebraska Board of Nursing at:

(402) 471–4376. The NBON is part of the Nebraska Health

and Human Services System Regulation and Licensure.

Questions about stories in the Nebraska Nurse?

Contact: NNA.

COVID-19 has brought unprecedented challenges to our profession. We understand.

That’s why we are writing to you directly to introduce a new statewide initiative, RNconnect 2 Wellbeing,

a free resource from the Nebraska Nurses Association to easily integrate well-being into your day.

Text RNconnectNE to 60298 to receive twice-weekly tips on how to de-stress, strengthen your mind

and body, and take care of yourself. We’ve simplified finding support like counseling, resources, and

opportunities to connect with other nurses facing the same challenges as you.

Sign up by texting RNconnectNE to 60298 today!

LEARN MORE: American Nurses Foundation Well-Being Initiative

Msg&data rates may apply. Terms & privacy:

Come make a difference and

Join our Family.

We are hiring!


Contact our HR Director

for more information:

Please apply at

This newsletter is a service of the Nebraska Nurses

Association and your receipt of it does not mean

you are automatically a member. Your membership

in support of this work is encouraged; please visit

Writer’s Guidelines:

• Any topic related to nursing will be considered for

publication in the Nebraska Nurse.

• Authors are not required to be members of the NNA;

however, when space is limited, preference will be given

to NNA members.

• Photos are welcome, digital is preferred. NNA does not

assumes responsibility for lost or damaged photos.

• Use current APA formatting for any article requiring


• Provide a brief author biography indicating the author’s

nursing experience and/or expertise with the paper’s


o Limit the author’s biography to 4-sentences.

• Submitted material is due by the 2nd of the month in

January, April, July, and October of each year.

• The peer-review is blinded; submit the title page

separately from the article

• Submit the title page and article as Word documents to

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L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa

50613, (800) 626–4081, NNA 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 Nebraska Nurses Association 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. NNA 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 NNA or

those of the national or local associations.

May, June, July 2021 Nebraska Nurse • Page 3

NNA State Director

Kim Houtwed, MBA, BSN, RN

NNA State Director

Happy Nurses Week, Month and Year!

Nurses, this is your time. Never in history has the

world been so focused on the profession of nursing.

You have proven to be compassionate, innovative,

and resilient in the face of the biggest public health

crisis of this century. ANA Enterprise joins with the

World Health Organization and global colleagues in

extending the Year of the Nurse and Midwife into

2021 because of the impact of the pandemic.

Recognizing the challenges ahead, it is important

to look for opportunities to inspire, infuse leadership,

and foster innovation in the months ahead. Below

are suggestions for how you can continue to excel,

lead, and innovate throughout the coming year as the

nation’s most trusted working professionals.

EXCEL – You did the extraordinary in 2020. Make

2021 the year to reflect on your accomplishments,

build upon lessons learned, and infuse self-care

strategies and practices into your life. Self-care is

essential. The American Nurses Foundation created

the Well-Being Initiative to support your mental health

and resilience because it’s you, nurses who are really

feeling the impact of the COVID-19 pandemic. There’s

a host of online resources and tools dedicated to

helping nurses cope with a variety of issues like lack

of sleep, grief, and finances. You will also find familial

support, webinars, and mood-boosting podcasts.

Connect with a mentor.

LEAD – Success Pays Certification program allows

to you demonstrate your specialized knowledge and

continuing competence. This is a critical time in the

nursing profession, which has seen a dramatic increase

in the need for nurses. In order to combat nursing

shortages, we need more people to pursue nursing

as a career. And we need to ensure we continue

building a diverse nursing workforce, to foster greater

equity and inclusion in health care. Connect with

elementary and middle schools, career fairs, community

centers, and youth clubs to talk about your path to

nursing and inspire future nurses. Exercise leadership

skills. Make this the year you learn more about how

you can become an advocate or serve on a board

of directors. Start by visiting Nurses on Boards for

more resources and updates on nationwide board

opportunities. Impact political change. Visit RNAction

to learn how you can ensure nurses’ voices are heard

by politicians. If you want to engage more in political

advocacy, participate in Nebraska Nurses Association

Legislative Day and ANA’s Hill Day in June. These annual

events provide the opportunity for you to share your

perspective as a nursing professional and gain elected

officials support for crucial legislation.

Raise your voice with the media. Share your

perspective about the value of nursing and nursing

leadership amidst the challenges of this pandemic and

the need to continue to invest in and elevate nursing.

Reach out to a reporter in your city who covers health

issues to recommend they do a story about the “Year

of the Nurse” or submit an editorial to your local

newspaper. Look for opportunities to self-identify

as a nurse. Take every opportunity to educate others

about nursing and show pride in your profession.

LEAD Nurses—as the nation’s largest group of health

care professionals and the most trusted profession—

you serve a critical role within America’s health care

infrastructure. Never has this been truer than during

the COVID-19 pandemic. We encourage you recognize

your inherent leadership skills and to apply them in

your health care role and setting.

INNOVATE – Nurses are natural problem

solvers and innovators. Innovations occur at all

levels of health care and nurses can and should

be at the forefront, just like Florence Nightingale,

the first nurse innovator. Consider participating

in some of ANA’s interactive opportunities to

share your voice and learn how nurses are leading

innovation—you just might become inspired

to create the next big innovation! Get social.

Share a week of posts on your life as a nurse.

Give your social media followers a glimpse into

all you do with highlights about your activities,

colleagues, and nursing moments where you make

a difference. #YON2021. Inspire colleagues. Words

of encouragement and random acts of kindness

can make all the difference in a person’s day,

especially a nurse. Share inspirational messages or

a handwritten “words from a nurse” letter to give

the support, encouragement, and motivation we

all appreciate and occasionally need to brighten

the day. Celebrate the power of great nursing.

Honor a nurse mentor, celebrate a nurse colleague,

or thank a special caregiver, nurse friend, or family

member with a contribution to the Nebraska

Nurses Foundation in their name. Are you a nurse

innovator or aspiring visionary who wants to help

build a culture of innovation? Consider sharing

your ideas, thoughts, and advice in a blog post

or writing an article for a nursing, health care

industry, or nursing school publication. Launch

your idea. Do you have a nursing led innovation

you want to see through from concept to reality?

Consider launching your idea at NursePitch a

live, interactive event for nurses to compete for a

chance to turn their innovation dreams into reality.

There is no time like now to start!!

Page 4 • Nebraska Nurse May, June, July 2021

NNA MIG Reports

Omaha Metro Area MIG Update

Anna Mackevicius, BSN RN PMP

Member, Omaha Metro Area Mutual Interest Group

First, my thanks to all of you for your

selfless dedication to care for Nebraska citizens

hospitalized with COVID-19, for continuing to

care for our communities, and for those who have

traveled to work in other communities hard-struck

by the virus. Thank you.

The roll-out of the vaccines offer much needed

hope to everyone. It will take time to vaccinate

our country; knowing that Nurses will continue

to be at the front lines in our hospitals, clinics,

vaccination sites, schools, and nursing facilities is


A bit of information about events planned by

the Omaha Metro Area Mutual Interest Group

this year. Remember, all area nurses are welcome

at any of our event; you do not need be a NNA

member but, of course, we hope you consider

becoming one.

Nurse issue. Feel free to contact me with any

questions. Email address is at the end of this


Nurses Political Reception

No reception is planned for this year. However, we

have reserved the Thompson Alumni Center on UNO’s

campus for August 23, 2022. More information will

be available in early 2022.

Omaha Metro Area Nurses MIG Fun Run/Walk

A virtual Omaha Metro Area Nurses MIG Fun Run/

Walk is on for September 2021. The date will be selected

soon. Walk or run with your family or by yourself.

Choose your own route, run or walk any track, trail or

street... your options are endless! Plan to send pictures

so we can share the day! Look for more details in July/

August on the NNA website or the Nebraska Nurse.

Annual Dinner

The MIG is still considering options for a dinner.

We would love to hear your ideas for a fun and safe

gathering. More to come on this event.

Finally, Happy Nurses Week to everyone! I am

honored to be a member of our respected and trusted

profession. Feel free to contact me at annamackevicius@ if you have any questions about the Omaha

Metro MIG events or membership to NNA.

Omaha Metro Area Mutual Interest Group

Recognizes Local Student Nurse Leaders

Student Leaders Recognition

This virtual event, organized by Omaha MIG

members Beth Flott and Margo Minnich, was held

on March 20; the event was attended by many of

local schools and colleges of Nursing in Region

4. The purpose of the event is to recognize local

student nurses who are leaders of their campus’

Student Nurses Association. Congratulations to all

37 future nursing leaders who were recognized!

See the article in this edition with more details of

this event.

Celebrate Nursing! and the Positive Image of

Nursing Awards

Recognition of the Positive Image of Nursing

continues. No in-person event again this year.

We are accepting nominations until April 19. The

portal can be found at https://nebraskanurses.



b407ebcd6c51. We’d love to have a photo of your

nominee, too! The presentation will be posted

to the NNA website by May 1. As you catch your

breath at work, nominate a peer! Certificates for

each honoree will be sent to their facility or to the

honoree and nominator (if nominated individually).

Look for the list of honorees in the next Nebraska


Region 1 MIG has not met since last March. No

students are currently requesting funds to attend

the National Students Nurses’ Virtual Convention.

As COVID-19 restrictions ease we will consider

reconvening quarterly in September.

Members of the NNA Omaha Metro Area Mutual

Interest Group and current faculty recognized

37 student nurse leaders via a virtual event on

March 20. Creighton University College of Nursing,

University of Nebraska College of Nursing, Clarkson

College, Midland College, Nebraska Methodist

College, College of Saint Mary, and Metropolitan

Community College recognized their local student

nurses who are leaders of their campus’ Student

Nurses Association.

Elisabeth Collins, a Metropolitan Community College

alum, spoke to the group on Nursing Leadership. Ms.

Collins, originally from Nebraska, is a Nurse Practitioner

and the Stroke Coordinator for Guam Regional

Medical Center. Virtual breakout rooms were utilized

to facilitate networking and idea-sharing by students

from the different schools including discussing ideas

for future group events, as well what was learned at

the annual Nebraska State Student Nurses Association

convention held in February.

Congratulations to the following Student Nurse

Leaders of today and our future Nursing Leaders!

Clarkson College

President - Lauren Gilbert

Vice President - Gracie Kliegl

Treasurer - Jeff Shank

Secretary - Molly Coghill

Public Relations - Jessica Heineman & Cristina Franco

College of Saint Mary

President - Kelsey Crum

Vice President - Hannah Johnson

Secretary - Brooklyn Wilke

Publicist/Community Outreach - Anna Hough

Round Table Rep - Atalia Kemp

Fundraising Coordinator - Serena Moore

Level 1 Rep - Kelly Friend

Level 2 Rep - Nicole Knight

Level 3 Rep - Madaline Angel

Creighton University College of Nursing

President - Jillian Lenczewski

Treasurer - Emily Maginot

Metropolitan Community College

Tara Dorsey - Vice President

Alexandra Guzman - Publicity Manager

Midland University

Co-Presidents - Abby Schweers & Rylie Albers

Vice-President - DeMarquez Frazier

Secretary - Brea Lovitt

Treasurer - Erin Kahnk

Social Media Chairperson - Cheyenne Mahnke

Fundraising/Community Service Chairs -

Jenna Cazin & McKenna Gehner

Nebraska Methodist College

President - Katie Kruger

Vice President - Abby Mason

Secretary - Caitlyn Stuthman

Treasurer - Kaylyn Ibsgaard

Fundraising - Jessica Dang

Community Service - Jaclyn Schnakenberg

UNMC College of Nursing

President - Amy Li

Vice President - Paige Blankman

Secretary - Carey Kyes

Treasurer - Ashley Jennings

Image Chair - Chelsie Wojtas

The Omaha Public School District is hiring

school nurses for the 2021-2022 school year.

The full time positions are district wide and

reflect the school year schedule.

A valid nursing license with the Nebraska’s

Department of Health & Human Services,

Certification in Basic Life Support or ability to obtain

within 90 days of hire, and a Bachelor’s degree from

an accredited school of nursing is required.

For more information and to apply, please visit: or reach out to our

Human Resources office at 531-299-0240

Every student. Every day. Prepared for success!







May, June, July 2021 Nebraska Nurse • Page 5


American Nurses Foundation Launches National

Well-being Initiative for Nurses

In response to the growing burden of stress and moral

distress on the nation’s nurses as they valiantly care for

patients on the frontlines of the pandemic, the American

Nurses Foundation (the Foundation), the philanthropic arm

of the American Nurses Association (ANA), announced

the launch of the national Well-being Initiative designed

specifically for nurses across the U.S. These new resources

will help nurses build resilience and take necessary steps

to manage the stress and overcome the trauma caused by


The Well-being Initiative gives nurses access to digital

mental health and wellness-related sources, tools and

more to support their emotional well-being while taking

care of those affected by the virus. Developed ‘for nurses

by nurses,’ the Foundation partnered with the American

Nurses Association (ANA), the Emergency Nurses

Association (ENA), the American Association of Critical-

Care Nurses (AACN), and the American Psychiatric Nurses

Association (APNA).

Nurses are putting their physical and mental health on

the line to protect us all during this pandemic. Every day

they confront traumatic situations while they face their own

worries about the risks to themselves and their families,”

said Kate Judge, executive director, American Nurses

Foundation. “Nurses are always there for us and we owe it

to them to support their well-being during this crisis and in

the future.”

Recognizing individuals process stress, trauma and

anxiety differently, nurses will have the option to join virtual

groups, express thoughts through writing workshops or

talk one-on-one. The comprehensive offering includes

both responsive measures (peer-to-peer conversations,

warmlines, hotlines, cognitive processing techniques)

and preventive actions (stress reduction, mindfulness and

educational materials):

Nurses Together: Connecting through Conversations

– there is significant value in peer support during times

of crisis and these virtual voice and/or video calls provide

nurses a safe space to openly talk about self-care and

wellness, recovery and resilience, care dilemmas and

bereavement. Led by the ENA these are one-hour,

volunteer-led calls for nurses.

Narrative Expressive Writing – writing is a proven

and effective tool for building resilience, improving

mindfulness, and reducing psychological distress. In this

five-week program, nurses respond anonymously to

COVID-19-related writing prompts. A certified responder

reads individual’s submissions and provides confidential


Happy App – emotional support is critical, especially for

nurses tackling anxiety, stress, daily life and death decisions,

fear, and isolation during the COVID-19 pandemic. This

easy-to-use smart phone app connects nurses one-on-one

to a Support Giver team member 24/7.

Moodfit Mobile App – self-care is critical for nurses,

even more as work and life stresses mount during the

COVID-19 pandemic. This mobile app, customized

for nurses, will support them with wellness goals and

activities. Nurses can set and track their own goals

for sleep, nutrition, exercise, mindfulness and other


Self-Assessment Tool – an important part of self-care for

nurses is understanding and connecting with their mental

health needs. This evidence-based tool recommended

by APNA will help nurses identify symptoms, understand

if they need to seek help, and direct them to relevant


Hotlines and Provider Resources – evaluated and

recommended by the Foundation and its partners, these

resources include instructions for finding mental health

providers, how to get a referral, and what to look for in a


A 2017 study found 63% of hospital nurses reported

burnout. During the COVID-19 pandemic the rate of

burnout is expected to increase even more as the mental

and physical strain and moral distress take its toll on nurses.

This underscores the essential need for these tools and

resources. If you are a nurse and want to join the peer-topeer

conversations, download the apps or use the tools;

visit the Well-being Initiative at

Webster County Community Hospital in Red Cloud

is looking for Full or Part Time, Day

or Night Shift, RN’s or LPN’s.

Competitive wage & benefits with shift differential.

Please call Heidi Kauk at 402-746-5600

or apply online at

“Taking Pride in the Health of our Community”

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Page 6 • Nebraska Nurse May, June, July 2021


Failure to report changes in a patient’s condition

Omobola Awosika Oyeleye, EdD, JD, MSN, MEd, RN-BC, CNE, CHSE

A nurse’s ability to recognize and respond to changes in a patient’s condition is a

crucial element of professional nursing practice. Failure to respond appropriately to clinical

changes can lead to complications and even death. 1 In a study that investigated the impact

of communication in malpractice lawsuits, communication failure was a factor in 32% of

cases involving nurses, with most involving poor communication with other healthcare

professionals about the patient’s status. These cases often result in huge financial

consequences in cost of care and legal damages. 2


Communication of a patient’s status has been the focus of much attention and

research, and various communication frameworks have been generated to facilitate

clinical communication among healthcare professionals about patient status. 3,4 Widely

used examples include SBAR (situation, background, assessment, and recommendation)

and ISBARR (introduction, situation, background, assessment, recommendation, and read


In some cases, however, it is not about the nurses’ ability to communicate with primary

care providers. Rather, they are about the competence and decision-making skills needed

that enables a nurse to assess a patient’s condition and determine the appropriate

intervention, including when to escalate care and seek the expertise of appropriate


Barriers to Communication

Many factors can play into why nurses may not communicate a patient’s status

promptly or at all. These include a busy schedule, a reluctance to “bother” the primary

care provider, or a failure to recognize the circumstances under which a primary care

provider should be notified due to a lack of clinical competence. 2 Nurses need to recognize

the severity and emergent nature of a patient’s condition.

A nurse’s failure to recognize an emergency indicates a lack of competence in nursing

fundamentals and a lack of knowledge about the possible physiologic consequences. This

gap in knowledge can contribute to a catastrophic deterioration in the patient’s condition.

Critical thinking extends beyond mere information, attentiveness, and assessment.

How do nurses acquire the decision-making and critical-thinking skills necessary for their

practice? The clinical competence needed to make decisions, especially in acute situations,

develops over time as the nurse advances from novice to expert. 5

Implications for practice

To determine appropriate interventions and recognize when it is necessary to escalate

care, nurses must:

• accept only patients that they are capable of caring for. 6

• develop the education and skills necessary to recognize when the interventions they

initiate are not effective. 1

• escalate the patient’s care to a more experienced nurse or the healthcare provider

when they find that a patient’s status change is beyond their capability. 7

• follow the facility’s chain of command. A nurse’s vigilance, recognition of an

urgent situation, evaluation of changes in the patient’s condition, and steps taken

to escalate appropriately should be evident in the medical record. 8 Documentation

should include the persons consulted and the actions that resulted from the

consultation. 9

• be aware that nurses can be held legally liable for actions they omit as well as

actions they fail to take in a timely manner. 7

Guidelines for practice

Keep these general guidelines in mind:

• When documenting adverse events, follow your facility’s policies and procedures.

The record should be objective, including only clinical facts without any guesses,

assumptions, speculations about the cause of the event, or personal opinions. 10

• Listen to family members’ concerns. They are often at the bedside much longer than

the clinical staff. They know the patient and are likely already engaging in the care

of the patient at home. They are a valuable source of information and their concerns

should be taken seriously. 11

Nurses should consider carrying their own liability insurance, both for the purposes

of legal liability and for any disciplinary actions taken by the board of nursing. 12

The failure to report changes in a patient’s condition can have serious health

consequences for the patient as well as legal and financial implications for all involved in

the care of the patient. But by meeting the standards of professional nursing care, nurses

can and should avoid these costly consequences.


1. Massey D, Chaboyer W, Anderson V. What factors influence ward nurses’ recognition of and

response to patient deterioration? An integrative review of the literature. Nurs Open. 2016;4(1):6-


2. Crico Strategies. Malpractice risks in communication failures. 2015 Annual benchmarking report.


3. Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-


4. Cudjoe KG. Add identity to SBAR. Nurs Made Incredibly Easy. 2016;14(1):6-7.

5. Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-407.

6. Buppert C. A “safe harbor” for unsafe nursing assignments. Medscape. April 26, 2019. 7. Nurses

Service Organization. Failure to report changes in the patient’s medical condition to practitioner.


8. Thielen J. Failure to rescue as the conceptual basis for nursing clinical peer review. J Nurs Care

Qual. 2014;29(2):155-163.

9. American Nurses Association. ANA’s Principles for Nursing Documentation: Guidance for

Registered Nurses. Silver Spring, MD: American Nurses Association; 2010.

10. Austin S. Stay out of court with proper documentation. Nursing. 2011;41(4):24-29.

11. Sherman DW. A review of the complex role of family caregivers as health team members and

second-order patients. Healthcare (Basel). 2019;7(2):63.

12. Brous E. Reciprocal enforcement and other collateral issues with licensure discipline. J Nurse

Pract. 2017;13(2):118-122.

This article has been adapted for space and originally appeared in the November 2019 issue of

Nursing © 2019 Wolters Kluwer Health, Inc.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s

largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since

1976. The individual professional liability insurance policy administered through NSO is underwritten

by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without

permission of the publisher is prohibited. For questions, send an e-mail to or call

1-800-247-1500. can point you

right to that perfect NURSING JOB!

Free to Nurses

Privacy Assured

Easy to Use

E-mailed Job Leads

May, June, July 2021 Nebraska Nurse • Page 7

COVID-19 and Mental Health continued from page 1

Topping off emotional reserves

Nurses on the COVID-19 front lines are plagued

by drained emotions loneliness, and fear. These

are normal reactions to an unfamiliar, uncertain

environment. Transitioning away from work at the

end of the day is essential for nurses to top off their

emotional reserves.

If you have had a particularly stressful day,

acknowledging and discarding any negative thoughts

or feelings can help improve sleep quality. Having a

ritual to signal the end of work is essential. Here are

some suggestions:

• Take a shower. Visualize all the worries of the

day disappearing down the drain.

• Write down any thoughts or feelings in a


• Watch a favorite TV program.

• Read a book.

• Listen to your favorite music.

• Contact a friend.

• Write down three things you were grateful for


Final thoughts

The COVID-19 pandemic is an unprecedented

event in our lifetimes that will have untold mental

health implications for nurses and other healthcare

professionals on the front lines, both in the short

and long term. Although scientists and healthcare

professionals know more about the disease and how

to treat it now, nurses in current COVID-19 hotspots

will still be treating patients with a serious and

rapidly spreading disease while possibly contending

with shortages of PPE, equipment, and treatments. 21

Nurses will need to receive support from their

team, practice optimal self-care strategies, take

measures to replenish their emotional reserves, and

learn how to transition mentally from work to home

after their shift. Recognizing stress and learning how

to cope will help nurses protect their mental health

as we move forward during this pandemic.


1. Wann W. America is running short on masks, gowns

and gloves. Again. The Washington Post. 2020. www.

2. Mariotti A. The effects of chronic stress on health: new

insights into the molecular mechanisms of brain-body

communication. Future Sci OA. 2015;1(3):FSO23.

3. American Psychological Association. How stress affects

your health. 2019.

4. Heidt T, Sager HB, Courties G, et al. Chronic variable

stress activates hematopoietic stem cells. Nat Med.


5. Kabat-Zinn J. Full Catastrophe Living. 15th anniversary

ed. New York, NY: Piatkus; 2004:249.

6. Newman MG, Llera SJ, Erickson TM, Przeworski

A, Castonguay LG. Worry and generalized anxiety

disorder: a review and theoretical synthesis of evidence

on nature, etiology, mechanisms, and treatment. Annu

Rev Clin Psychol. 2013;9:275-297.

7. Gonzalez D, Nasseri S. ‘Patients have panic in their

eyes’: voices from a Covid-19 unit. The New York

Times. 2020.


8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of

PTSD’. BBC News. 2020.


9. Muller R. Trauma and the Struggle to Open Up. New

York, NY: WW Norton & Company; 2018:33.

10. Van Der Kolk B. The Body Keeps the Score. London:

Penguin; 2014:156-157, 166.

11. Bolton EE, Jordan AH, Lubin RE, Litz BT. Prevention

of posttraumatic stress disorder. In: Gold SN, ed.

APA Handbooks in Psychology. APA Handbook of

Trauma Psychology: Trauma Practice. Washington, DC:

American Psychological Association; 2017:483-497.

12. Psychology Today. Acute stress disorder. 2019. www.

13. American Psychiatric Association. Diagnostic and

Statistical Manual of Mental Disorders. 5th ed.

Arlington, VA: American Psychiatric Association; 2013.

14. American Psychiatric Association. What is

posttraumatic stress disorder? 2020. www.psychiatry.


15. Levine P, Blakeslee A, Sylvae J. Reintegrating

fragmentation of the primitive self: discussion of

“somatic experiencing.” Psychoanal Dialogues.


16. Highfield J. Am I OK? Intensive Care Society. 2020.


17. World Health Organization. Coronavirus disease

(COVID-19) outbreak: rights, roles and responsibilities

of health workers, including key considerations for

occupational safety and health. 2020.



18. American Association of Critical-Care Nurses.

Well-being Initiative. 2020.


19. World Health Organization. WHO guidelines on

conditions specifically related to stress. 2013. www.


20. Brené Brown. Vulnerability. 2020. www.brenebrown.


21. Frank S. As coronavirus slams Houston hospitals, it’s

like New York “all over again.” The New York Times.


This article has been adapted for space and originally

appeared in the September 2020 issue of Nursing © 2020

Wolters Kluwer Health, Inc.

This risk management information was provided by Nurses

Service Organization (NSO), the nation’s largest provider

of nurses’ professional liability insurance coverage for over

550,000 nurses since 1976. The individual professional

liability insurance policy administered through NSO is

underwritten by American Casualty Company of Reading,

Pennsylvania, a CNA company. Reproduction without

permission of the publisher is prohibited. For questions,

send an e-mail to or call 1-800-247-


Page 8 • Nebraska Nurse May, June, July 2021


Special Membership Assembly

Actions and Reflections

Linda Stones, MS, BSN, RN

Nebraska Delegate

A special meeting of the Membership Assembly

was called by ANA President Ernest Grant. The

business of the special meeting was to make

provisions to allow the ANA Membership Assembly to

be held virtually in 2021. The first item was a provision

that would allow the ANA Board of Directors make

the decision to hold a virtual meeting. An amendment

to the ANA bylaws was submitted to make this a

permanent part of the bylaws. Two other provisos

were presented that would allow membership

The Colby Community College Nursing Program offers practical and

associate degree nursing programs in two locations.

We are seeking qualified applicants for the following positions:

Director of Nursing and Allied Health - Full Time in Colby


• MSN • Kansas RN license and CPR certification required

Practical Nursing Instructor - Full Time in Colby


Kansas RN license and CPR certification required.

BSN or active progress towards a BSN preferred.

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


assembly and elections to be held virtually for 2021

only. As of this writing a final vote was not available.

However, I want to share with you some reflections.

Following this meeting with over 200+ nurses

from across the United States and the US territories,

I was reminded about the number of nurses who

believe in their profession and their professional

organization. They, like I, are engaged in how nurses

are represented and care about their profession.

They are advocating to ensure that we have a strong

and healthy organization to represent nurses. By

participating in these types of events, I am reminded

about the strengths of each individual and how

important it is to hear alternating perspectives.

Nurses spoke in support and opposition of the

amendment. Opposition was concerned with a

small group, such as the Board of Directors, having

too much power. Proponents spoke of trust, and

the need to trust those that we elect to positions of

authority. I think both sides had good points. I tried

to be open, to listen to the intent. I reflected in the

discussion prior to casting my vote for Nebraska.

Through my reflections of the special meeting, I

was once again reminded to listen with the intent to

understand, to gather information prior to making

a final decision. I have faith that the assembly will

make a decision that will serve the organization this

year and know that no matter the outcome, we can

always revisit this issue. Ultimately, my reflection

reminded me once again, how much I am honored

to represent the great nurses in Nebraska. Thank

you for allowing me again to represent you in our

national organization.

Awards for NNA

Members &

Scholarships for

Nursing Students

Awards for NNA Members

Each year NNA sends out a call for nominations

for their nursing awards and student scholarships.

It is now time to peruse the NNA website and

consider nominating your nursing colleagues

for the incredible impact they have had on the

nursing profession, the extraordinary achievements

they have shown, and/or the impact they have

made due to their nursing skills, knowledge, and


The awards include:

Nurse of the Year

• Extraordinary Achievement in Nursing

• NNA Award for Distinguished Service

• Notable New Nurse

• Excellence in Direct Patient Care

• Outstanding Nurse Educator

All nominees must be members of NNA

in good standing. The nominator must have

personal knowledge of the nominee’s abilities

and contributions and reflect the information with

the focus of the specific award in the nomination

letter (self-nominations accepted). Two letters of

support are required with each application – a selfnomination

will have three letters (self-nomination

letter and two more letters of support). Please

include the nominee’s credentials in the letters of

nomination. A curriculum vitae or resume is helpful

but not required.

Scholarships for Nursing Students

Calling all nursing students! NNA also has

several scholarships opportunities available for

students pursuing all levels of nursing education.

Consider applying for the following scholarships:

• NNA Member Scholarship – one $1000

scholarship to an NNA member seeking

higher education

• Arthur L Davis –two $500 scholarships for

pre-licensure nursing students

• Gail Graham Higher Education Scholarship –

one $500 scholarship for nurses furthering

their education


Undetectable = Untransmittable

Educating patients about the value of treatment as prevention can help them manage their HIV. Engaging

patients in routine, brief conversations about treatment as prevention can also help health care providers

become more familiar with each patient, including their adherence and transmission risk.

Tools from CDC can help foster discussions between providers and patients about HIV treatment, care, and


Learn more at:|

Health care providers who treat patients with HIV have an important role in supporting HIV prevention. Because a

patient’s needs may change over time, health care providers should engage patients in brief conversations at every visit

to discuss the prevention steps the patient is taking.

Access NNA’s website to read more about

each award and/or scholarship, and to retrieve

a copy of the awards nomination form (http://

The deadline for submitting scholarship

applications is September 1, 2021. Submit your

application today!

Please contact Stephanie Vodicka, RN, chair of the

NPDC, with questions (

Taking antiretroviral therapy (ART) to achieve and maintain an undetectable viral load enables patients with HIV to stay

healthy. It also helps prevent transmission to others, which is known as treatment as prevention.

Three landmark studies have shown that treatment

prevents sexual transmission of HIV.

Across all three studies, there were no linked HIV transmissions observed between mixed-HIV-status partners when the

partner with HIV was virally suppressed (defined in these studies as having a plasma HIV RNA viral load less than either

200 or 400 copies/mL).

1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. Aug 11 2011;365(6):493-505.

2. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830-9.

3. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIVpositive

partner is using suppressive antiretroviral therapy. JAMA 2016;316(2):171-81.

4. Bavinton B, Grinsztejh B, Phanuphak N, et al. HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and

Brazil. Presented at the 9th IAS Conference on HIV Science (IAS 2017), Paris, France; July 25, 2017.


May, June, July 2021 Nebraska Nurse • Page 9

Show Your Pride a

Nebraska Nurse!

Now is a perfect time to wear or display

your pride as a nurse in Nebraska. The

Nebraska Nurses Foundation seeks to build

camaraderie and pride among nurses in our

state, by continuing to offer “Proud to Be a

Nebraska Nurse” pins to all interested nurses

for a donation of $15 (includes shipping and

handling to send the pin directly to your

door). The gold-toned metal pin, shaped

in the image of the State of Nebraska will

stand out on your lapel, jacket, lanyard,

purse, or hat.

Visit the link below to access the order

form today.



Happenings at the Nebraska

Nurses Foundation

Following a year of disruption in 2020, the NNF is

finally resuming our work to support the practice of

nursing in Nebraska. We appreciate the sacrifices and

dedication of every nurse, and their family, during this

past year. We are still accepting Covid Stories that share

the work of a nurse, nursing teams, or nurses as part of

interdisciplinary healthcare groups. Check out the Covid

stories in this issue of the Nebraska Nurse. We would

love to share your story, anonymously if you wish. Visit for more


Providing Nursing Project Grants

The NNF Board is happy to announce updated guidelines

and application materials for their Nursing Project Grants.

Applications for the 2022 calendar year grants are being

accepted from now until November 1, 2021.


for more information.


For years, the NNF has depended on the Silent Auction

at the Nebraska Nurses Association Convention as an

important fundraising opportunity. But with the onset

of the pandemic in 2020 and continuing concerns about

the safety of large crowds, the Board is looking at virtual

methods for fundraising. Our goal is to find ways for the

broader community to support our purpose and mission

to support Nebraska nurses. Watch for exciting new

opportunities that you can share with your family, friends,

or the community that might benefit them and contribute

to the foundation.

In addition, the NNF is continuing our Celebrate a

Nurse campaign, please visit the webpage to recognize

and honor a colleague, family member or friend who is

or was a nurse.


Estate Planning Opportunities with the NNF

Several NNA members have already notified us that

they are including the Nebraska Nurses Foundation

in their estate planning. Please consider this option

during your planning to “pay it forward” to the future

generations of nurses in Nebraska.

Happy Nurses



Are you a passionate and driven problem-solver? Join Harlan

County Health System today and be a part of our awesome team!


• Full-time RN - $25,000 sign-on bonus

• Full-time LPN - $17,500 sign-on bonus

(Part-time employees will receive 1/2 of the stated amount above)

*Note: sign-on bonuses are being offered only until June 1st.

They will also require a 3-year contract commitment

with the payout all up front.

Page 10 • Nebraska Nurse May, June, July 2021

Last summer, the NNF announced a project to publish nursing stories related to

the COVID-19 Pandemic to honor the intent of a donation from a group of Raising

Cane’s franchise owners to recognize nurses for their strength, compassion, and caring

during this very difficult time. Two of those stories are featured within this issue of the

Nebraska Nurse. We have received fewer than two dozen stories and many more are

needed to make publication of this historic volume possible. The NNF is not using this

project as a fundraiser and will not benefit financially in any way from the publication

of the stories. This publication will record the essential role of nurses during this event.


Nebraska Nurses Foundation Still Seeking Pandemic Nursing Stories!

Nurses – Please consider sharing your story, which can be published anonymously if

you prefer.

• What inspired you to stay strong?

• How did your team support each other every day?

• Did you share a reflection or a prayer as a team?

• How did you place the needs of your patients and their families beyond your


• Is there a phrase or slogan that has meaning for your team?

• What appreciation or recognition touched you or your team?

Non-Nurses – Did a nurse, group of nurses, or a group of healthcare providers

including nurses have a significant impact on you or your family member? Please tell us

their story.

Please visit the Nebraska Nurses Foundation website https:// submit your reflection, prayer, story or any

other expression of your actions, thoughts, or feelings during this time. You may direct

that your submission be included anonymously if you wish.

Save the Date:

Nebraska PrEP Institute Part Two

May 18, 2021 | 7:45 am - 12:45 pm

You are invited to save the date for the second interactive webinar on

providing PrEP care in Nebraska. Part two of the institute will consist of:

• Navigating clients through costs associated with PrEP

• Experiences of current PrEP providers in rural and urban Nebraska

• Trauma-Informed Approaches to HIV Services

• Updates on Next Generation PrEP products

Register Now!

Continuing education will be provided for: Physicians, Nurses and Pharmacists

Please send any questions to Jesus Villalobos or Daemon Donigan -

May, June, July 2021 Nebraska Nurse • Page 11

Count the Kicks: Saving Babies’ Lives Can be Simple!

Lois Linden, EdD, RN

Lois Linden, EdD, RN is a professor in the Doctor of Education Program at College of

Saint Mary in Omaha, Nebraska. Currently she teaches education, research, and leadership

courses. Her prior experiences were teaching pediatric nursing and management positions

at Children’s Hospital and Medical Center and Immanuel Medical Center in Omaha.


While healthcare technology has moved us forward into 2021, there are still some key

ways to save lives that are simple! One such method, founded by a group of Iowa mothers,

is having near-term mothers daily count the movement of their babies. These mothers

termed the comprehensive program they created Count the Kicks! Based upon the latest

research, they have developed numerous teaching aids to help mothers learn to daily

document the movement of their babies at one point in time. And babies have been saved.

But the story is a tragic one. These mothers came together to support each other after

they each lost a baby due to stillbirth. These unimaginable losses shifted from grief support

to looking forward in wanting this tragedy to be prevented for other mothers and families.

Together, they became researchers, educators, and advocates.

Among the research that they uncovered were studies showing that mothers in their

third trimester of pregnancy could reduce the incidence of stillbirth by daily checking for

fetal movement. As they developed the Count the Kick campaign in Iowa, 14 hospitals in

Norway conducted a multisite study having mothers daily monitor fetal movement and

contacting their health providers if they noticed any decreased fetal movement (DFM)

(Tveit, et al., 2009). The first 10 years of the Count the Kick campaign in Iowa resulted

nearly a 32% decrease in stillbirths while the study in Norway saw a decrease by one-third.

According to the CDC (2016), the incidence of stillbirth in the U.S. is 24,000 babies a

year! Having mothers in their third trimester monitor for DFM could potentially save 7,500

babies annually. This is where you can help. The Nebraska Perinatal Quality Improvement

Collaborative (NPQIC) has funded Count the Kick educational materials for use throughout

the state (see Table 1).

The important step is to teach mothers how to Count the Kicks. The three key steps

for teaching Count the Kicks to mothers at the beginning of the third trimester include

instructing them to:

• Daily count your baby’s kicks with the Count the Kicks app (or chart)

• Select a time when your baby is normally active and time how long it takes to feel 10

kicks (typically 30 minutes to 2 hours)

• Contact your healthcare provider right away if there is any change in your baby’s

normal movement pattern

Using these resources, provide them to organizations and institutions where expectant

mothers can access them, teach third trimester mothers how to monitor for and document

fetal movement on the free kick counting app, and share the information with those within

your own circle–family members, friends and family members of friends, neighbors, and

coworkers. Together with organizations committed to helping reduce stillbirths (see Table

2), we can help save lives through teaching mothers to track fetal movement in the third

trimester, possibly saving the life of a child!

Table 1 Educational Resources for Teaching Count the Kicks

English and Spanish versions

• Sample Lesson Plan for Childbirth Educators

• 3rd Trimester Kick Chart

• Count the Kicks FAQ

• Count the Kicks Videos

• How to Use the FREE Count the Kick app

• Meet Nahla: A Count the Kick Success Story For Providers-Video:

• How to Implement Count the Kicks within Your Practice

• Having the Kick Counting Conversation with Your Patient

• Count the Kicks FAQ video

TABLE 2 Contact Information


Nebraska Perinatal

Quality Improvement

Collaborative (NPQIC)

Contact Information

Organization of Nebraska

professionals who are

funding the Count the

Kick materials for use by

healthcare providers

Count the Kicks Evidence-based stillbirth

prevention campaign to

decrease stillbirth rate

Count the Kicks app

Google Play


App download for

documenting amount of time

to feel 10 kicks/movements


Center for Disease Control and Prevention. (2020, November 16). What is stillbirth? https://

Tveit, J., Saastad, E., Stray-Pedersen, B., Bordahl, P., Flenady, V., Fretts, R., & Froen, J. K.

(2009). Reduction of late stillbirth with the introduction of fetal movement information

and guidelines—a clinical quality improvement. BMC Pregnancy and Childbirth, 9(32),

1-10, doi: 10:1186/1471-2393-9-32


- Psychiatric/Mental Health

- Advanced Med-Surg

- Pediatric

- Fundamentals/Med-Surg

Warm & Welcoming!

That’s who we are!

We care like family… Join us!

To access electronic copies of the

Nebraska Nurse, please visit

Megan Becklun,


102 W 9th St, Neligh NE 68756

402-887-6397 (Fax)

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for career opportunities

Making a difference in people’s lives

through excellent patient care

Page 12 • Nebraska Nurse May, June, July 2021


Nebraska School

Nurses Association

The Annual Nebraska School Nurses Conference will be held virtually on Monday,

June 7th, and Tuesday, June 8th. The conference is co-sponsored by the Nebraska

School Nurses Association (NSNA) and the Central Nebraska School Nurses

Association (CNSNA). NSNA is the official affiliate of the National Association of

School Nurses (NASN). In addition to co-sponsoring the annual conference, this year

NSNA and CNSNA are also collaborating in providing a limited number of scholarships

available to use towards the conference registration fees. Nurses who are interested in

completing a scholarship application can contact JoDe Kinnaman @ jkinnaman@hshn.

org and Catherine Heck at for application forms.

On another note, the NSNA has open NSNA Board of Directors positions which

will be filled by election at the annual all members NSNA BOD (virtual) meeting to

be held immediately following the conclusion on the first day of the annual school

nurse conference – Monday – June 7th. The open positions include president-elect,

(NASN) state director, secretary, NNA liaison, technology & communication designee,

membership designee and legislative designee. Please contact Catherine Heck at for more information on these open positions.

Visit today!

Search job listings

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

Browse our online database

of articles and content.

Find events

for nursing professionals in your area.

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nursing jobs, research, and events.

May, June, July 2021 Nebraska Nurse • Page 13

Covid-19 Pandemic And Effects On Nursing Education

Nat Rasmussen, PhD, RN and

Eufemia Jacob, PhD, RN

Nat Rasmussen, PhD, RN – Associate Faculty

member at the University of Phoenix since 2013, serving

as a dissertation chair and dissertation committee member

in the PhD program. In addition, Dr. Rasmussen is a

Visiting Professor at the Chamberlain University, teaching

courses related to nursing theory and nursing informatics

in the MSN program since 2013. Correspondence:

Eufemia Jacob, PhD, RN – Associate Professor at

the University of California Los Angeles since 2007. Dr.

Jacob teaches pediatric nursing courses for BSN and

MSN students. In addition, she mentors multidisciplinary

undergraduate research students and DNP and PhD

students in research projects. Correspondence: ejacob@

Declarations of interest: none

COVID-19 Pandemic and Effects

on Nursing Education

The current global pandemic has affected the world

for more than a year. Although vaccines to prevent the

coronavirus disease 2019 (COVID-19) are available and

individuals are being vaccinated, the virus continues

to be transmitted and people continue to become

infected. Nurses on the frontlines of this current

pandemic are caring for patients who are infected

with COVID-19, implementing the practices currently

known to manage this infection. Students in prelicensure

nursing programs are being taught infection

control measures to use in the care of patients with

COVID-19. In addition, alternative clinical experiences,

such as virtual simulation, have been implemented for

nursing students when clinical sites limit the number of

students allowed in their facilities.

Nursing students, in particular, are especially

impacted because they may be dealing with children

who are engaged in remote learning, and attending

school either in-person or online. Nursing education at

all levels has made adaptations, considering the virus,

keeping students safe, and attempting to decrease the

potential stress on students. Faculty also have had to

adapt as they deliver educational content. Despite the

current mitigation efforts and therapeutics available,

the virus remains in the communities, and education,

including nursing students and nursing faculty,

continues to be affected. This paper reviews the effects

of the COVID-19 pandemic on nursing students and

nursing faculty.

COVID-19 Pandemic Effects on Nursing Students

During the COVID-19 pandemic, nursing students

may be dealing with academic work as well as their

families at home. The family members may include

children who are engaged in remote learning and family

members with chronic illness. Maintaining student safety

and minimizing stress present challenges that were not

experienced previously in the schools of nursing. Faculty

face challenges with remote instruction and delivery

of education that traditionally were implemented in

classrooms, skill laboratories, and clinical settings. Despite

the current efforts to reduce or eliminate long-term risks

of COVID-19 infection, nursing education requirements

need to be fulfilled.

Since December of 2019, the COVID-19 pandemic

has spread globally, leading to significant changes in the

social and educational environment for nursing students

and nursing faculty. The pandemic led to significant

effects on learning and nursing experiences, and a sense

of belonging to the nursing and health care community.

Measures preventing the spread were instated, including

“stay at home isolation” and “social distancing.” Courses

and clinical experiences were canceled or postponed, and

school events and travel restrictions were enforced, leading

to the closure of nursing schools.

Nursing education and training continued during the

pandemic, using distance learning technology to deliver

nursing education remotely. Nursing students and faculty

expressed concerns about the ability to return to “normal

life” and adjusting to the “new normal,” being separated

from family, friends, and academic peers. Social life and

interactions, participation in college and university-wide

events, and celebrating important moments, such as

traditional nursing events and graduations, were changed.

Increasing stress and tension were accumulating as the

pandemic continued.

Limitations in knowledge about COVID-19 and the

overwhelming coverage in the media led to anxiety and

fear, with students experiencing distress, frustration,

and irritability (Brooks et al., 2020). The community

quarantine led to loneliness, chronic stress, grief, and

anxiety, potentially leading to psychological effects that are

long-term and negative effects on behavior. For nursing

students, the pandemic’s interruption of their nursing

education was unexpected and the clinical practice of

nursing students in clinical settings was either discontinued

or delayed. Clinical practice is important for nursing

preparation. Inadequate clinical skill development may be

the result of the insufficient application of nursing skills.

In a study of the effects of the COVID-19 pandemic,

Aslan and Pekince (2020) conducted a study of 662

nursing students (20.7 ± 1.6 years), evaluating their

perceived levels of stress. They found that the majority

(68.1%) had worries about being infected and 78.9%

were implementing preventive measures against a

COVID-19 infection. Frequent hand washing (97%),

social distancing (92.9%), and keeping a well-ventilated

environment (91.1%) were considered important

measures to prevent a COVID-19 infection. Some

students (23.6%) knew people who tested COVID-19

positive. The majority (69.5%) expressed that the

community quarantine was the right action. Also, most

of the participants (66.2%) experienced boredom at

home, and some felt safe (44.9%). Female nursing

students had higher stress levels. Nursing students in the

first and fourth years of their program also experienced

higher levels of stress. Variations in experiences were

attributed to watching news media, being concerned

about the likelihood of contracting a COVID-19 infection,

and engaging in a community quarantine (Aslan &

Pekince, 2020).

The COVID-19 pandemic led to nursing students

managing their time differently (Ramos-Morcillo et al.,

2020). There were changes related to a sleep schedule,

shifting to a later time as the usual activities in which

Covid-19 Pandemic And Effects On Nursing Education

continued on page 14

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Page 14 • Nebraska Nurse May, June, July 2021

Covid-19 Pandemic And Effects On Nursing Education

continued from page 13

they engaged were not making them tired when they

were enrolled in online learning. They found it to be

more challenging to wake up early for nursing school

activities that were scheduled early. Nursing students

found challenges in moving from face-to-face learning

activities to synchronous videoconferences, recorded

videos containing course content, and e-learning

platforms for the submission of assignments. Some

nursing students appreciated the interaction with nursing

faculty online and thought it was valuable, allowing

them to ask questions. Recordings of videoconferences

allowed students to review the recorded content as often

as needed. Other students expressed that the duration

of the videoconferences and online instruction was too

long and more cognitively exhausting. Also, the quality

of interactions with nursing faculty was different when

compared to face-to-face learning (Ramos-Morcillo et al.,


COVID-19 Pandemic Effects on Nursing Faculty

The COVID-19 pandemic presented challenges

that were unexpected and not experienced previously

by the nursing faculty. Related to the disruptions in

universities, academic institutions, and schools of

nursing, faculty are experiencing changes in their

role as they provide education to the next generation

of nurses. Nursing faculty are concerned about

student and patient safety as they deliver nursing

care services, provide healthcare information, and

ensure high-quality healthcare (Park et al., 2020).

In response to the COVID-19 pandemic, there was

an expeditious adoption of the online delivery of

educational methods to ensure that nursing students

met academic requirements on time. Nursing students

experienced delays in clinical placements because

of the rapid changes occurring within the clinical

environment (Hayter & Jackson, 2020; Jackson et al.,

2020). A “shock phase” was experienced. There were

disorientation and confusion with the conversion

of courses that they developed and previously

delivered over long periods. Nursing faculty noted

that the disruption in routines decreased students’

cognitive performance, and the ability to concentrate

and focus. Eventually, faculty noticed that students

were assimilating the new routines, and increasingly

becoming attentive during online classes and seminars.

University information technology support helped

to ensure that online tools were functioning, and

provided nursing faculty with instructions on strategies

for continuing quality learning experiences for nursing


In addition to clinical skill performance, nursing

faculty cultivate nursing students in professionalism,

promoting self-reflection and critical thinking. Clinical

assignments foster nursing clinical reasoning, the

formation of cognitive thoughts, and understanding

of the application of nursing skills to nursing practice.

Specialty coaching and supportive mentoring are being

recognized to be particularly important during the

COVID-19 pandemic (Hayter & Jackson, 2020; Jackson

et al., 2020). Implementing these strategies encourages

nursing students to reflect on life and the changing

environment as they accumulate nursing knowledge

during the COVID-19 pandemic.

Cheng et al. (2020) evaluated an experiential learning

program (ELP) for nursing education in 103 first-year

nursing students. They found significant differences

in self-reflection between the pre- and post-tests,

including in behavior, thoughts, feelings, critical and

analytical thinking, open-mindedness, inquisitiveness,

and reflective thinking, during the COVID-19 pandemic.

Participation in the learning process strengthened

their abilities to reflect and critically think. Under the

guidance of clinical nursing faculty during the delivery of

nursing care, students provided feedback and reflection,

indicating an improvement in self-confidence and

the ability to communicate, think critically, and work

collaboratively with the team.

In another study, Ramos-Morcillo et al. (2020) found

that student clinical practice in nursing education was

most emotionally challenging for students depending

on whether or not the COVID-19 imposed significant

effects on their final clinical experience and limitations in

working with registered nurses and patients during the

last term before graduation. Some students selected the

option to graduate later as they did not feel prepared

for practice and were concerned about the potential

challenges in obtaining employment. Nursing faculty

expressed concerns with internet connectivity, especially

when multiple family members were engaged in remote

learning or working online, limiting students’ ability to

attend online classes, causing interference during exams,

and using devices that were not updated for remote

learning technologies. The presence of children in the

home can be disruptive. Some students who previously

preferred studying in the academic and public libraries

that were closed due to the pandemic, have to stay at

home where learning is not optimal.


While antiviral medications, immune-based therapies,

and preventive measures were found to improve patient

outcomes, COVID-19 infections continue with some

individuals requiring hospitalization and increasing

exposure risk to nurses, clinical nursing faculty, and

nursing students. Despite the release of the limited

number of COVID-19 vaccines, stress and fear of acquiring

COVID-19 infection remains as the number of infected

individuals continues to increase. Schools of nursing

are recommended to continue accommodations to

decrease stress, ensuring student safety, and creating

student assistance programs for financial, psychosocial,

and educational needs. Nursing faculty have a significant

role to help students and maintain academic standards

while keeping students informed of changes promptly

as students continue to cope and adapt to completing

academic requirements. A systematic evaluation of

remote learning experiences for students needs to be

conducted to promote quality teaching and changes

need to be considered to facilitate academic success and

timely progression during the COVID-19 pandemic. With

the recent release of the COVID-19 vaccine immunization

process, a post-pandemic future appears promising.


Aslan, H., & Pekince, H. (2020, August 17). Nursing students’

views on the COVID-19 pandemic and their perceived stress

levels. Perspectives in Psychiatric Care.


Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely,

S., Greenberg, N., & Rubin, G. J. (2020). The psychological

impact of quarantine and how to reduce it: Rapid review of

the evidence. The Lancet, 395(10227), 912–920. https://doi.


Cheng, Y.-C., Huang, L.-C., Yang, C.-H., & Chang, H.-C. (2020).

Experiential learning program to strengthen self-reflection

and critical thinking in freshmen nursing students during

COVID-19: A quasi-experimental study. International Journal

of Environmental Research and Public Health, 17(15). https://

Hayter, M., & Jackson, D. (2020). Pre-registration undergraduate

nurses and the COVID-19 pandemic: Students or workers?

Journal of Clinical Nursing, 29(17/18), 3115. https://doi.


Jackson, D., Bradbury-Jones, C., Baptiste, D., Gelling, L., Morin, K.,

Neville, S., & Smith, G. D. (2020). Life in the pandemic: Some

reflections on nursing in the context of COVID-19. Journal of

Clinical Nursing, 29(13-14), 2041-2043.


Park, M., Jeong, M., Lee, M., & Cullen, L. (2020). Web-based

experiential learning strategies to enhance the evidencebased-practice

competence of undergraduate nursing

students. Nurse Education Today, 91.


Ramos-Morcillo, A. J., Leal-Costa, C., Moral-García, J. E., &

Ruzafa-Martínez, M. (2020). Experiences of nursing students

during the abrupt change from face-to-face to e-learning

education during the first month of confinement due to

COVID-19 in Spain. International Journal of Environmental

Research and Public Health, 17(15).


The Nebraska Masonic Home is a

continuing care retirement community

that provides independent living,

assisted living, long-term nursing care,

and Alzheimer’s/dementia care located

in Plattsmouth, NE, just 20 minutes south of Omaha.


Nurse Surveyors play an integral role, through regular

and unscheduled surveys at health care facilities

throughout Nebraska, in assuring safety for

Nebraskans who access health care services.

The State of Nebraska is looking for nurses to join

our survey teams. For more information about

job opportunities, duties, qualifications and

how to apply for a Nursing Services Surveyor

Consultant (RNs) or a Health Facilities Surveyor

Consultant (RNs or LPNs) position, please visit

DHHS.NE.GOV - and click on “Nebraska

DHHS jobs” to find current openings.


We are hiring for full-time and part-time

RNs, LPNs, and CNAs.

We offer an excellent benefits package and a

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(402) 438-2500

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Straight talk and sound advice in

administrative license matters including:

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• License Reinstatement

May, June, July 2021 Nebraska Nurse • Page 15

Join our Team!

RNs and LPNs

We thank our nurses for

their dedicated service!


Glenwood Resource Center (GRC) is seeking

applicants for RNs and LPNs caring for those with

Intellectual Disabilities and Physical Disabilities.



RNs & LPNs

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Multiple positions available with great benefits and a

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Apply online or call 402-933-2561

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Pain Management Guidance

The Nebraska Department of Health and Human Services (DHHS) continues to take action to help

prevent drug overdoses in Nebraska. This document was developed by DHHS in collaboration with an

expert advisory task force, actively practicing providers, and senior state officials. Written for clinicians

who are helping people live better lives.

Although opioids can be a useful option for pain management, inappropriate use can result in significant harms. This guidance

document will assist in making clinical decisions easier and provide effective options to treat pain while ensuring patient safety.

This document was created with the assistance of the Pain Management Guidance Task Force and in partnership with the Nebraska

Medical Association.

“ the Art of the Difficult

Conversation. It is worth its

weight in gold.”

“These are a quick reference

that could benefit providers.”

Art of Difficult


Guidance on having those

challenging discussions

with patients


Acute Pain

Guidance on opioid and

non-opioid options


Overview of tools for

evaluating and managing

your chronic pain patients

Learn more: DHHS.NE.GOV/PDMP

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