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Nebraska Nurses Foundation in partnership
with the Nebraska Nurses Association
Initiative for Nurses
Effects On Nursing
In This Issue
current resident or
Awards for NNA
Inside the NNA
President’s Column ............................2
NNA State Director ............................3
NNA MIG Reports ............................4
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
Nebraska School Nurses Association ..............12
Covid-19 Pandemic And Effects
On Nursing Education ............................ 13-14
Membership Application ........................15
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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
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.’
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: www.NebraskaNurses.org
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?
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: slkt.io/7YfV
Come make a difference and
Join our Family.
We are hiring!
RNs, LPNs, CNAs
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
• 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
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626–4081, firstname.lastname@example.org. 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
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.
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@
gmail.com 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
Celebrate Nursing! and the Positive Image of
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 UPDATE
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
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!
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
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:
district.ops.org or reach out to our
Human Resources office at 531-299-0240
Every student. Every day. Prepared for success!
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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
“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
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
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 https://bit.ly/35qLV7x.
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 www.websterhospital.org.
“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
• 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
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
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 email@example.com or call
NursingALD.com can point you
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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
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
• 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
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. www.apa.org/helpcenter/stressfacts.
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. www.nytimes.com/2020/04/29/nyregion/
8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of
PTSD’. BBC News. 2020. www.bbc.com/news/uk-
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. www.who.int/
18. American Association of Critical-Care Nurses.
Well-being Initiative. 2020. www.aacn.org/
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 firstname.lastname@example.org or call 1-800-247-
Page 8 • Nebraska Nurse May, June, July 2021
Special Membership Assembly
Actions and Reflections
Linda Stones, MS, BSN, RN
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 www.colbycc.edu/employment
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 email@example.com
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
Awards for NNA
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
• Arthur L Davis –two $500 scholarships for
pre-licensure nursing students
• Gail Graham Higher Education Scholarship –
one $500 scholarship for nurses furthering
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: dhhs.ne.gov/Pages/HIV-Prevention.aspx| cdc.gov/preventioniscare
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
Please contact Stephanie Vodicka, RN, chair of the
NPDC, with questions (firstname.lastname@example.org).
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
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
NEBRASKA NURSES FOUNDATION
Happenings at the Nebraska
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
https://nebraskanursesfoundation.org/book/ 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. https://nebraskanursesfoundation.org/
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.
WE’RE LOOKING FOR NEW FACES!
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
Nebraska Nurses Foundation Still Seeking Pandemic Nursing Stories!
Nurses – Please consider sharing your story, which can be published anonymously if
• 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
Please visit the Nebraska Nurses Foundation website https://
nebraskanursesfoundation.org/book/to 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! https://www.matec.info/event/?ER_ID=37106
Continuing education will be provided for: Physicians, Nurses and Pharmacists
Please send any questions to Jesus Villalobos or Daemon Donigan
email@example.com - Daemon.Donigan@nebraska.gov
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
Organization of Nebraska
professionals who are
funding the Count the
Kick materials for use by
Count the Kicks www.countthekicks.org Evidence-based stillbirth
prevention campaign to
decrease stillbirth rate
Count the Kicks app
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
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Page 12 • Nebraska Nurse May, June, July 2021
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 firstname.lastname@example.org 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
email@example.com for more information on these open positions.
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by location and credentials.
Browse our online database
of articles and content.
for nursing professionals in your area.
Your always-on resource for
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
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
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 &
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. https://doi.org/10.1111/
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. https://doi.org/10.1111/
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. https://doi.org/10.1016/j.
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). https://doi.org/10.3390/
The Nebraska Masonic Home is a
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FACILITY SURVEYOR RN
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
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We offer an excellent benefits package and a
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May, June, July 2021 Nebraska Nurse • Page 15
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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
“...read 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
Guidance on opioid and
Overview of tools for
evaluating and managing
your chronic pain patients
Learn more: DHHS.NE.GOV/PDMP