The Official Publication of the Oklahoma Nurses Association
Quarterly publication delivered to approximately 64,000 Registered Nurses and LPNs in Oklahoma
Volume 66 • Number 2
The Oklahoma Nurses Association:
2021 ONA Annual Convention
Call for Presentations and Posters
SEPTEMBER 29-30, 2021
HYATT REGENCY TULSA DOWNTOWN, TULSA, OKLAHOMA
The Oklahoma Nurses Association is pleased to
announce the 2021 ONA Annual Convention theme,
The Journey Before Us. Our goal is to focus on
how we move forward on our journey exploring what
lies ahead. How will we find a way to transcend the
storm, not just survive it? How do we incorporate all
that we have learned in the last year that makes us
stronger and tougher and yet, still compassionate?
Because it’s the journey that makes us stronger we
want to learn something new with every step. Share
with us how you and your colleagues embraced
the challenges, found success, were innovative
and any other way you advanced nursing and
patient care. Other professional development areas
include leadership, individual well-being, emergency
response, embracing diversity, patient care and
advancing the discipline.
Call for Proposals
We invite you to submit a presentation or
poster related to the topics listed below. The
strength of the ONA Convention is in its outstanding
array of educational activities, which directly relate
to nurses, nursing and the profession. By reaching
across specialties and practice settings, convention
presentations should strive to enhance the skills of
nurses in all phases of their careers. We want to
continue this tradition through engaging speakers
and presentations. We will have four rounds of
breakout sessions for potentially eight sessions in
Breakout sessions will be held on Thursday,
September 30. These breakout sessions will have
two concurrent 60-minute sessions. The Convention
Committee invites you to submit one or more
proposals for the presentation type most applicable
to you. Convention participants should be able to
clearly identify ideas learned during the presentation
that will directly impact or enhance their professional
Whether this is your first time or you are a
seasoned poster presenter, we encourage you to
submit your work for this year’s Convention. Both
primary and secondary research is acceptable. The
Convention Committee will review posters based on
the following categories.
• Concurrent Session Presentation
(60 minutes) Deadline June 3rd
• Poster Presentation (written format;
30-minute staffed session)
Deadline June 3rd
• Clinical Practice & Research
• Theory, Concept, Teaching Papers &
• Literature Review
Suggested Topics for the Breakout Sessions:
• Advocating for Your Patients
• Altered Standards of Care
• Crisis Response
• Diversity, Implicit Bias and more
• Emergency Preparedness
• End of Life Care – Advance Directives
• Historical Perspectives
• Incivility Issues and Resolutions
• Interprofessional Practice and What That
Means for Nurses
• Just Culture and Beyond
• Nursing Ethics
• Nursing Leadership
• Nurses Voices – Remaining United and
• Nurses on Boards – The Importance of
Nurses Representation in Communities
• Nurse Innovators – Innovation and
• Nursing Research and Evidence-Based
• Political Advocacy in Nursing
• Practice Innovation
• Strength-Based Nursing
• Uncomfortable Conversations: Dealing
with Death, Dying and Organ Donation
• Work-life Balance/Self-care/Mindfulness/
The Call for Proposals form to submit will be
available on our website.
current resident or
CEO Report. ....................... 3
RN2Leader ........................ 4
President’s Message. ................ 5
NURSES MONTH 2021 - You Make a
Difference!. ...................... 6
Educators Corner ................... 7
Call for Nominations! ................ 8
Recognizing Excellence in Nursing. .... 10
Leadership Visited and Revisted. ...... 11
COVID-19 and Mental Health:
Self-Care for Nursing Staff. ......... 12
Emerging Nurses. .................. 14
Kidney Function and Race: Is it Scientific
Medicine or Bias Medicine?. ........ 16
Nurse Resiliency During a Pandemic ... 17
The Oklahoma Nurse May, June, July 2021
Oklahoma Nurses Association Regions and Regional Presidents
President: Lucas Richardson-
President: Donna Fesler
President: Leslie Davis
President: Nakeda Hall
President: Viki Saidleman
Contact information available at www.oklahomanurses.org
Network Television Event to Honor
American Nurse Heroes and the Positive
Impact They Have on the United States
The American Nurses Association (ANA), Al Roker
Entertainment and HealthCom Media, publisher
of American Nurse Journal, have joined forces to
produce a network television and multi-channel
event to celebrate the heroic work of nurses and
the positive impact they have on our nation. The
campaign, titled “American Nurse Heroes,” will
present true stories of nurses on the frontlines of the
COVID-19 crisis and more as they strive to deliver
high quality health care.
The goal of the campaign is to increase the
public’s awareness and appreciation of nurses,
while educating viewers on the magnitude of nurses’
work and their positive impact on society and the
American healthcare system. Numbering more than
four million strong, nurses are the largest group of
health care professionals in this country. Nurses
are with patients and families in all settings where
health care is delivered, from birth to the end of life.
Globally, the nursing profession marked a milestone
in 2020, as the World Health Organization declared
it the International Year of the Nurse and Midwife
in honor of the 200th anniversary of the birth of
Florence Nightingale. Year of the Nurse has been
extended through July 2021.
“The campaign will also inspire viewers to
share stories of nurses who have made a lasting
impression on the lives of their families and friends,”
said ANA Enterprise Acting CEO Debbie Hatmaker,
PhD, RN, FAAN. “We hope to encourage Americans
to support nurses as pillars of society, make the
case to policymakers about the importance of
investing in nursing, as well as inspire young people
to choose nursing as a career.” ANA Enterprise is
the family of organizations that is composed of the
American Nurses Association (ANA), the American
Nurses Credentialing Center (ANCC), and the
American Nurses Foundation.
Additionally, viewers will have an opportunity
to support the American Nurses Foundation’s
non-profit efforts. By supporting the Foundation,
members of the public can demonstrate their
appreciation and support for nurses who are on the
front lines caring for patients during this pandemic,
despite significant risks to their well-being and
safety. Online video vignettes and printed profiles in
American Nurse Journal and at myamericannurse.
com begin this summer, with a network television
event scheduled for later in the year.
Although nurses on the frontlines of the pandemic
have been visible in media and recognized for their
bravery, the general public may not fully understand
the depth and breadth of contemporary nursing
practice and the critical role nurses play in caring
for individuals and communities ranging from illness
care to health promotion and prevention and public
Oklahoma Nurses Association
ONA 2020-2021 BOARD OF DIRECTORS:
President - Shelly Wells, PhD, MBA, APRN-CNS, ANEF
Vice President - Angela Martindale, PhD, RN
Secretary/Treasurer - Amber Garretson, MSN, APRN-CNS, CCRN
President-Elect - Angie Kamermayer, DNP, APRN-CNS, NEA-BC
Education Director - Vanessa Wright, PhD, MSN, RN
Emerging Nurse Director - Tina Edwards, MBA, MSN, RN
Membership Development Director - Amy Hutchens, PhD, RN, CNE
Political Activities Director - Megan Jester, PhD Candidate,
Practice Director - Michele Bradshaw, MSN, RN
Consultant to ONSA - Dean Prentice, Colonel, USAF (Ret),
DHA, MA, BSN, NE-BC
Region 1 President & Rep - Lucas Richardson-Walker, BSN, RN
Region 2 President - Donna Fesler, MS, RN, CNEcl
Region 2 Rep & PE - Emma Kientz, DNP, RN
Region 3 President - Leslie Davis, MSN, RN
Region 3 Representative - Julie Nevins, MS, RN
Region 4 Representative - Leslie Collins, DNP, MS, RN
Region 5 President & Rep - Nakeda Hall, DNP,APRN-CNP
Region 6 President & Rep - Viki Saidleman, MSN, RN
Jane Nelson, CAE — CEO
Amber Feldpausch, CMP— Event Planner
Brendan Dwyer — Communications Specialist
Oklahoma Nurses Association
6608 N Western, #627, Oklahoma City, OK 73116
The subscription rate is $20 per year.
THE OKLAHOMA NURSE (0030-1787), is published
quarterly every February, May, August and November by
the Oklahoma Nurses Association (a constituent member
of the American Nurses Association) and Arthur L. Davis
Publishing Agency, Inc. All rights reserved by copyright.
Views expressed herein are not necessarily those of
Oklahoma Nurses Association.
International Nursing Index and Cumulative Index to Nursing
and Allied Health Literature.
Copies of articles from this publication are available from the UMI
Article Clearinghouse. Mail requests to: University Microfilms
International, 300 N. Zeeb Road, Ann Arbor, MI 48106.
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls,
Iowa 50613, (800) 626-4081, email@example.com. ONA 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 advertisement.
Acceptance of advertising does not imply endorsement or
approval by the Oklahoma 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. ONA 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 ONA or those of the national or
CONTACT THE ONA
Web site: www.oklahomanurses.org
Mail: 6608 N Western, #627, Oklahoma City, OK 73116
Questions about your nursing license?
Contact the Oklahoma Board of Nursing at 405.962.1800.
Want to advertise in The Oklahoma Nurse?
Contact Arthur L. Davis Publishing Agency, Inc.
at 800.626.4081 or email at firstname.lastname@example.org.
ONA CORE VALUES
ONA believes that organizations are value driven
and therefore has adopted the following core values:
• Safe Quality Care
• Ethical Care
• Health Parity
• Integrity and Accountability
• Practice Competence
• Professional Development
• Educational Advancement
ONA MISSION STATEMENT
The Mission of the Oklahoma Nurses Association is to empower
nurses to improve health care in all specialties and practice
settings by working as a community of professional nurses.
Creating opportunities through advocacy, education and
collaboration to become the leading voice for the nursing
profession in the State of Oklahoma.
Engaging Nurses to make a difference!
May, June, July 2021 The Oklahoma Nurse 3
You Make a Difference!
Jane Nelson, CAE
CEO, Oklahoma Nurses
May is a big month
of celebrations including
graduations, Mother’s Day and
most importantly, Florence
Nightingale’s Birthday and
Nurses Month! While we are
all hopeful that this year is
not on a repeat loop from Jane Nelson
2020, the overall theme
for the year is still the Year of the Nurse. But this
year, the American Nurses Association and the
Oklahoma Nurses Association has announced the
theme for this year’s Nurse Month as, “You Make a
Difference.” This theme was selected as a nod to
the great number of nurses that had an unparalleled
impact on patients and health care during this fight
against the pandemic. This theme also provides the
public with an open invitation to #ThankaNurse for
enriching the lives of so many and fighting to make a
difference in our ever-changing world.
There are many ways that employers and nurse
leaders acknowledge the work you do 24/7 including
candy, flowers and other gifts. I think it’s fair to say
that while these thoughtful gifts are appreciated,
there is more that you want and need. You want
more nurses to work with you and provide relief.
You need equipment, supplies and technology to
perform procedures, to protect yourself and to care
for your patients in the best way possible. You need
time for yourself and your family. You want time to
enhance your skills and education.
The news is full of articles and stories about what
nurses need and how you are coping in the light
of this pandemic. Two such articles are American
Nursing is Having a Crisis published in The New
York Times, and Lessons from The COVID-19
Crisis: Overcrowding Hospitals Cost Lives!, from
NPR. Both of these articles do a great job in sharing
the reality of what you have faced over the last year
and what you as a profession truly need. While
much of this isn’t new to you, it is to the general
public - and it’s information they need to know.
Oklahoma has long struggled with a nursing
shortage. While we continue to work on solutions,
we never seem to get over the hump. While we
need more nurses at the bedside, we also need
more master’s prepared faculty to teach nursing
students. Education is just one area nurses with
master’s degrees may practice and unfortunately it
is the lowest paid of all the options. As part of the
budget for Higher Education, the Regents have
requested 12M in funds to be directed to nursing
programs for nursing faculty pay and increasing the
number of nurse faculty. The Oklahoma Academic
Clinical Nurse Partnership is also looking at ways to
expand faculty that might include joint appointments
between clinical and academic partners modeled
after what exists with our physician colleagues and
While we must examine innovative ways to
expand nursing faculty, we must also address other
issues in our state that hinder our ability to attract
and retain nurses. This includes more competitive
salaries, cultural and lifestyle amenities that enhance
the quality of life as well as better schools and
health care access for families. Oklahoma does have
some strong advantages including low cost of living,
especially for housing and energy costs.
So yes, the struggle to fight the nursing shortage
is real. However equally urgent is the challenge
we face to take proper care of the nurses we
have and to truly prioritize Nurse Well-Being. The
American Nurses Foundation has conducted a
number of surveys this year with the most recent
one in February 2021, Pulse on the Nation's Nurses
COVID-19 Survey Series: Year One COVID-19
Impact Assessment https://www.nursingworld.org/
The statistics from this survey reflected the
year nurses had and the toll that COVID-19 is taking
on this dedicated profession. The study reported
that of the nurses surveyed, 51% reported being
exhausted, 43% reported being overwhelmed, 23%
are depressed, 22% are angry and a mere 21% are
optimistic about the future. While these results are
vivid and hard-hitting, even more impactful are the
stats on how nurses are handling the stress and
strain of the pandemic. Only 24% reported having
sought professional mental health support and
of the nurses that haven’t, 52% say they haven’t
needed mental health support, 36% believe they
should be able to manage it themselves and 30%
site a lack of time. Knowing that you are in need
of mental health support should be the only push
you need to get it – but for nurses, it’s sadly not
that easy. Some are concerned that if they did
seek professional mental health support, they
could potentially face license issues, retribution by
the employer and stigma from co-workers. These
roadblocks to mental healthcare for nurses must
be removed and a shift to prioritization of nurse
well-being must occur before a serious problem
becomes far worse.
Apart from the impactful statistics in the survey, a
big take away for me was that some nurses reported
not knowing where to access support or indicating
that they felt Employee Assistance Programs
weren’t available to them. Because nursing support
programs do exist, ONA is working on new ways
to communicate this information immediately. We
have entered into a partnership with ANF and the
Arizona Nurses Association to provide resources to
nurses in our RNConnect Program. This is a texting
service that will provide valuable reminders and
resources to you to help build resilience and find
added strength. On the pages of this publication are
the ways that you can get started in the RNConnect
Everyone knows the hardship the pandemic
has placed on our country’s nurses. What many
don’t know is how deep that hardship has hit. The
American Nurses Foundation survey reported that
40% of nurses indicated they have considered
leaving their employer, citing that work is affecting
health and well-being; staffing issues, stressful
workplace environment and concerns about keeping
their own family safe. Combine the nursing shortage
with the pandemic-weary workforce and you’ve got
a critical industry facing crisis. It is more important
than ever that nurses lean on each other and the
institutions that are here to serve nurses. I feel that
with ANA and ONA programming, faith in each
other, prioritization of self-care and the vaccine – we
will make it through this long dark night together.
Dear Oklahoma Nurses,
The last year has brought unprecedented challenges to our
profession. The Oklahoma Nurses Association is dedicated to
empowering nurses and ensuring they have the support they need.
We are excited to introduce a new free statewide initiative called,
This program allows you to easily integrate well-being into your day
by receiving twice-weekly tips for the next few months on how to destress,
strengthen your mind and body and take care of yourself. The
text messages are aimed at connecting you to resources such as
counseling, easy self-care activities and opportunities to connect with
other nurses facing the same challenges as you.
Sign up today by texting RNconnectOK to 60298
(Msg & data rates may apply. Terms & Privacy: slkt.io/7YfV)
This resource comes from a partnership with the American Nurses
Foundation and Arizona Foundation for the Future of Nursing.
The Oklahoma Nurse May, June, July 2021
Dr. Dean L. Prentice, Colonel (Ret), USAF, NC,
DHA, MA, BSN, NE-BC
It has been such a 2021
so far. We have made it into
spring and we can feel the
breeze of summer coming.
It has been a long winter. If
we measured time based on
our normal lives, we’d still
be stuck in March 2020. But
prayerfully, it looks like life
will regain some “normalcy”
in the next few months.
So what have you been
Dr. Dean Prentice
The Next Great Step
I can say, since the pandemic has upended
most of the aspects of my life, I initially went into
conservation mode. I was doing only things that
had to be done. My trips outside the home were
deliberate, planned and efficient. As time has
continued on, I’ve learned more about my comfort
zone and what I was willing to take a risk on and
what I was not.
This included work and strategically planning my
professional and personal life. However, the time
has come to move forward with plans. It’s almost
like celebrating New Year’s Eve again. A fresh start.
But we have been so long under this spell of simply
surviving, do you care or even have the energy to
start planning again?
I know the answer, whether you answer that
willingly or not…but it is yes. When you take on the
role of nurse and nurse leader, you take on the role
to move things forward. A common saying around
some of my circles these days is to be asked, “How
am I moving the needle?” In other words, what are
you doing today to make a difference tomorrow?
Well fellow nurses, it’s time to start moving the
needle. What is your next great step? What have
you been putting off and what are your plans now
to get back into the game? As a respected voice in
healthcare, we need you to start making a difference
in your work and world. Your work propels health
and healthcare forward. Your impact not only makes
a difference today, but if you make the appropriate
plan, it will positively impact tomorrow. But to get
that done, you need to move.
We know the process. It looks something like this:
assessment, diagnosis, planning, implementation
and evaluation. Sound familiar? Now apply that
process to your work life and the challenges you
are facing. Is the problem staffing? Is the challenge
safety? Is it the orientation of your new hires?
We need to get back into the rhythm of becoming
strategic in our actions. We have lasted long enough
in survival mode during the pandemic. Now, we are
going to move the needle forward for our patients
and our profession. We need you to put the nursing
process in place and begin to resume our role as
leaders in health and healthcare. It just takes making
the first move.
So, what is your next great step?
May, June, July 2021 The Oklahoma Nurse 5
Shelly Wells, PhD, MBA, APRN-CNS, ANEF
I hope your spring is off
to a good start. I am
aware that many of our
colleagues continue to
juggle an abundance of
responsibilities in their
workplaces and at home
with their families. We are
fatigued and pandemicweary.
We all want to get
back to normal - whatever Shelly Wells
that may be. For just a few
minutes, I would like to drift away from the thought
of the current state. I want to challenge everyone to
think about what the past 15 months has been like
– and how it could have been. I am sure we each
have similarities in our pictures. Ponder the thought
– “how can nursing have made a difference?”
For the 19th year in a row, Nursing has been
named the most “trusted” profession by the Gallup
Corporation. The people who respond to those
Gallup surveys – what do they base their trust on?
Do they know what nurses can do? My recent
participation in the AACN Virtual Hill Day to lobby
our elected Oklahoma delegation on nursing’s
contributions to the public infrastructure, drove
home the point that while everyone “admires”
nurses and appreciates what they think we do, they
really do not understand that nursing has no limits!
Regardless of our practice setting, advocacy
is at the heart of what nurses do. Advocacy can
be defined as the pleading or arguing in favor of
something – be it a cause, idea or policy. Nurses
instinctively advocate for our patients in care
settings, but our duty to advocate extends beyond
the walls of our workplace. The future of nursing and
health care depend upon leadership and advocacy
to address and meet the needs of our patients and
the communities they serve. Health care is political -
whether we like it or not. Nurses are strong, effective
advocates, and we must expand our skill set and
nursing practice to include political and legislative
The pandemic has brought health to the
forefront of many people’s minds. Many issues
and inequities have been amplified – especially
in public health. The time is right for us to take the
lead in addressing these social justice and inequity
issues that surround health to shape the future of
health care and the nursing profession. It is time
for us to pull up a chair and sit down with decision
makers who are shaping the future. We must think
big, ask many questions, ask for new opportunities,
and understand what needs to be done. We must
leverage our traditional areas of expertise and
expand our knowledge in order to help bring about
the structural and policy changes needed to reduce
health disparities and improve access to quality care
In Oklahoma, we tend to think about policy during
our legislative session every spring. Many engage
in the activities sponsored by the Oklahoma Nurses
Association including Nurses Day at the Capitol and
the Nurse of the Day program during the legislative
session. However, there are eight other months in
the year where the advocacy work of nurses can
make a big impact. Do not let your voice be silent
after the close of the legislative session in May.
The month of May is set aside as National Nurses
Month. The theme is Nurses Make a Difference
and indeed we do! Dr. Camille Burnett at the
University of Kentucky College of Nursing suggests
that as nurses, we need to hit those non-traditional
spaces where our voices should be loud and in turn,
be more effective in determining what the future of
nursing and health care looks like. We need to be
leading the parade, not marching behind it. Every
registered nurse is a leader and strong leadership
in advocacy to meet the needs of our patients,
our communities and our profession is required.
It is time for all nurses to get back to the root of
our practice - and that includes social justice and
advocacy. Florence Nightingale, Harriet Tubman and
Susie Yellowtale have all lit the path for us to follow.
Happy Nurses Month!
The Chickasaw Nation is now accepting applications for all nursing positions
located at the Chickasaw Nation Medical Center in Ada, Oklahoma.
To complete an application and view detailed information, visit
If you would like additional information,
call: (580) 436-7259, or email
APPLICANTS MUST APPLY ONLINE
The Oklahoma Nurse May, June, July 2021
Association can be
Affiliate of ONA
The Oklahoma Nurses Association encourages
nursing and health-related organizations to become
organizational affiliates of ONA but they must first
meet the basic requirements set by the ONA Board
of Directors. These requirements include that the
organization has a governing body comprised
of a majority of registered nurses. In addition,
the organizational affiliate must pay an annual
fee of $500 and be approved by the ONA Board
of Directors. Organizational Affiliates are also
responsible for maintaining a mission and purpose
harmonious with the purpose and functions of ONA.
Benefits to these organizations include: a
voting seat in the ONA House of Delegates and
the opportunity to make informational reports or
presentations to the ONA House of Delegates within
the organizations area of expertise; a column in the
Oklahoma Nurse; a seat on ONA’s Governmental
Activities Committee, which works closely with ONA
lobbyists to support nursing issues in the State
Legislature; a reduced Exhibitor rate at ONA/ONSA
Convention for the organization; and many more.
When a specialty nurse organization joins ONA as
an organization affiliate, the individual members also
have individual benefits that include participation in
the Nurse of the Day program at the Capitol during
Legislative Session and reduced registration for
convention and conferences which is less than the
non-member fee. For more information email Jane
Nelson, ONA CEO at email@example.com
NURSES MONTH 2021
You Make a Difference!
The American Nurses Association (ANA)
continues to celebrate the Year of the Nurse
and Midwife in 2021 because quite frankly, after
everything nurses faced in 2020, one year was
simply not enough recognition for this most
honorable profession. In that same spirit, ANA has
built upon last year’s expansion of the traditional
National Nurses Week to evolve into a monthlong
celebration in May. We recognize many
organizations have already planned programs for
May 6-12, traditionally considered Nurse’s Week.
The expansion to Nurses Month is simply intended
to allow greater engagement, participation and
recognition of nurses and the transition into nurse’s
month will require growth that will occur over several
years to come.
As the largest group of health care professionals
in the United States, nurses’ impact on health
and health care is unparalleled. A month allows
greater opportunities to promote understanding
and awareness of our profession, encourage
young people to consider nursing as a career and
recognize the vast contributions of nurses.
The ANA selected the Nurses Month theme
“You Make A Difference” to encourage
nurses, individuals, employers, other health care
professionals and community leaders to recognize
and promote the vast contributions and positive
impact of America’s nurses. Through sheer numbers
and wide-ranging roles, nurses have an unmatched
perspective on prevention, wellness and delivery of
health care services. Stories of strength, resilience
and determination while navigating an ever-changing
and complex health care landscape reinforce how
nurses make a difference. The goal for having a
different focus each week is to inspire nurses to
engage in activities that make a positive difference
in their own health, well-being, professional
development and community.
Here is the breakdown for each weekly theme in
· Week 1 - Self-care (May 1-9)
· Week 2 – Recognition (May 10-16)
· Week 3 – Professional Development (May 17-
· Week 4 – Community Engagement (May 24-
A new, free webinar for Nurses Month is planned
for May 19th with a focus on the updated Scope and
Standards of Nursing, 4th edition. Register for the
free webinar (https://anayearofthenurse.org/nursesmonth-webinar/),
“Redefining Nursing – Reaffirming
Our Practice: Introducing the Nursing Scope and
Standards of Practice, Fourth Edition” by visiting
the newly updated and improved Year of the Nurse
If you want to share how you made a difference
as a nurse or know a nurse who made a difference,
share your story here (https://anayearofthenurse.
org/nurse-stories/), along with a photo or video.
Your story could be presented in ANA’s new and
improved digital storybook, To Be A Nurse, one
of the newest features on the Year of the Nurse
Follow ANA Enterprise on Facebook, Twitter,
Instagram and LinkedIn to share and retweet inspiring
content during Nurses Month and all year long.
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.
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May, June, July 2021 The Oklahoma Nurse 7
& Workers with
a Reliable Self
Screening Tool for
Employers now have a simple way to minimize the
risk of COVID-19 in the workplace. The new Nurse
Screen App can be used 24-hours-a-day, sevendays-a-week
by employees to help determine if
it is safe for them to go to work or if they need
to isolate/quarantine themselves to prevent
The Coronavirus pandemic has challenged the
way businesses operate and put both employers
and employees under great stress and anxiety. No
one is happy working if there’s a lack of confidence
in the health of the people around them, when
COVID-19 has proven to be so contagious.
Fortunately, a new tool has finally emerged that can
help solve these problems. Just recently launched,
the new Nurse Screen App is the brainchild of
company CEO Jamesha Ross, a registered nurse
for over 20 years. The app delivers a quick and
simple way to protect employees and operations
from outbreaks using CDC guidelines to determine
if it is safe to work or not, providing added safety
and peace of mind to those in health care.
“Nurse Screen App is changing the way we
prevent COVID-19 in the workplace,” said Ross.
“We have heard nothing but praise from our early
users who quickly see how valuable it can be and
how the app can skyrocket peace of mind.”
Nurse Screen App’s self-screening questions
follow the CDC’s recommended guidelines. Some
highlights of the App’s benefits include: Giving
direction on recommended work status; providing
education on preventative measures; delivering
an overview of the work force status for staffing
decisions; generating work status updates to
designated administration staff as questionnaires
are completed; and much more.
The goal of the app is to minimize the risk of an
outbreak in the workplace while also minimizing
the risk of interruption in operations. Because
the Nurse Screen App can be run on nearly any
smartphone, the company looks forward to seeing
businesses large and small start using the app to
help nurses and their communities.
About Nurse Screen App
I've been a registered nurse for over 20 years,
the last 14 years have been providing service in
occupational health. I am passionate about keeping
employees safe and healthy. When COVID-19
hit, we had to figure things out to protect our
employees, operations and revenue. I became
overwhelmed with calls and emails from employees
needing answers after being exposed and facing
the onset of symptoms. With this application,
employees can get answers 24/7 without a
bottleneck and employers can use the aggregated
data to make future staffing decisions.
Jamesha Ross, MBA,
BSN, RN, COHN-S
For more information be
sure to visit https://www.
Marla Peixotto-Smith, MSN, PhD, RN, CNE
Do plants/flowers flourish because we talk to
them or because by talking to them, we become
aligned in the goal of improvement? Therefore, when
planting, we must take better care of the things we
want to flourish. How? One way is to reach out and
tell our stories as nurses. Applicable Occupational
Reflection is a great example.
Dr. Linda Cook has been blogging for a few years
to nurses and nursing students. It is my privilege to
share another one of Dr. Cook’s blogs as a perfect
example of reaching out, reflecting on practice and
telling our stories:
Top Ten Reasons I’m A Nurse (in no particular
I haven’t been unwillingly unemployed for 45
I’ve learned something new every day of my
When I became truly burned out in the OR, I
switched to Critical Care. No seniority lost. Didn’t
even have to change hospitals.
Nothing beats that rush of titrating meds and
fluids to keep the ICP down and the UO up.
Unabashedly having a beer and a burger with my
night shift crew at 8am after a long night.
Watching that ‘Click’ of understanding when
the student nurse assigned to you really gets the
Time to Plant
Running into a former patient at the theater and
getting a huge hug while he tells his friends, “This
woman saved my life!”
Presenting my differential list when going to see
my care provider.
Hearing a joke during report so gross that it
would clear a dinner table and laughing until my
Knowing that I make a
difference in the lives of
patients and peers.
Linda Cook, PhD, RN,
PMHCNS, CNE, is a Full
Professor and Associate
Dean of Kramer School of
Nursing at Oklahoma City
MSN, PhD, RN, CNE, is
an Associate Professor &
Coordinator of the RN2BSN
Program at Rogers State
University. Marla invites
you to contribute to the
Please send your thoughts,
experiences, or strategies to
The Oklahoma Nurse May, June, July 2021
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May, June, July 2021 The Oklahoma Nurse 9
DOES SHIFT LENGTH MATTER?
Reprinted with permission from
North Dakota Nurse January 2021
Appraised by: Jannelle Stevens, RN, LeAnn
Bingham, RN, & Dylan Gjerde, RN Mayville State
University RN-BSN students
Do nurses who work 12-hour shifts have a higher
rate of burnout than nurses who work 8-hour shifts?
Dallora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L.
H. (2015). Association of 12 h shifts and nurses’
job satisfaction, burnout and intention to leave:
Findings from a cross-sectional study of 12
European countries. BMJ Open, 5(9). doi:10.1136/
Khammar, A., Amjad, R. N., Rohani, M., Yari, A., Noroozi,
M., Poursadeghian, A., Mahsa, H., Poursadeghiyan,
M. (2017). Survey of shift work disorders and
occupational stress among nurses: A cross-sectional
study. Annals of Tropical Medicine & Public Health,
Ruotsalainen, J. H. (2015). Preventing occupational
stress in healthcare workers. Cochrane Database of
Systematic Reviews, (4). John Wiley & Sons, Ltd. doi:
Thompson, B. J. (2019). Does work-induced fatigue
accumulate across three compressed 12 hour shifts
in hospital nurses and aides? PLoS ONE, 14(2), 1–15.
Synthesis of evidence:
This synthesis includes four studies related to
evidence supportive of the proposed research
question. The first study was conducted by
Dallora, Griffiths, Ball, Simon, & Aiken (2015), and
focused on the concern that nurses who work
12-hour shifts have a higher job dissatisfaction
and burnout rate compared to nurses who work
8-hour shifts. A cross-sectional survey was done
on 31,627 RN's in 2,170 general medical/surgical
units within 488 hospitals across 12 European
countries. The study concluded that nurses who
work 12-hours shifts experience an increased rate
of job dissatisfaction when compared to a nurse
working an 8-hour shifts. The same results were
reported for burnout described as, emotional
exhaustion, depersonalization, and low personal
The second study was conducted by Khammar,
Amjad, Rohani, Yari, Noroozi, Poursadeghian,
Mahsa, & Poursadeghiyan (2017). This study
performed a cross-sectional study on 100 randomly
selected shift-working nurses from three hospitals
in Iran. The study focused on the correlation of
shiftwork-related problems and occupational stress,
shiftwork, and job dissatisfaction. The conclusion
of this study showed a high prevalence of
shiftwork-related problems such as, psychological
disorders, digestive problems, sleep disorders, and
musculoskeletal complaints. The study did show
there was a higher rate of job satisfaction when
nurses were able to choose their shiftwork. Stressrelated
issues were more prevalent when there was
a conflict with coworkers.
The third study was conducted by Ruotsalainen
(2015). This study addressed the concern for
healthcare workers suffering from occupational
stress resulting in distress, burnout, psychosomatic
problems, deterioration in quality of life, and lack
of patient care. The purpose of this Cochrane
review was to evaluate the effectiveness of workand
person-directed interventions compared to no
intervention or alternative interventions in preventing
stress at work in healthcare workers. A total of
58 studies (54 RCTs and four CBA studies), with
7,188 participants were reviewed. Organizational
interventions discussed were changing working
conditions, improving support or mentoring,
changing content of care, improving communication
skills, and improving work schedules. The study
concluded that cognitive-behavioral training as well
as mental and physical relaxation reduced stress
moderately. Changing work schedules and having
shorter work schedules also reduced stress. Other
organizational interventions have no clear effects.
The purpose of the final study conducted
by Thompson (2019), was to determine what
performance-based fatigue symptoms presented
after three consecutive 12-hour nursing shifts
compared to a single 12-hour nursing shift.
Participants were mentally tested on their reaction
time and monitored for lapses of attention.
Physical testing consisted of three vertical jumps
and isometric strength assessments on the knee
extensor/flexor, and wrist flexor muscle groups.
The results showed fatigue-based impairments in
several mental and physical performance tasks
which occurred after a single 12-hour shift however,
the impairments were exacerbated following three
consecutive 12-hour shifts.
Evidence suggests that there is a correlation
between the length of shift worked and an increased
rate of burnout. It is necessary for healthcare
institutions and nurses to evaluate the potential
cause for burnout and make the appropriate
changes. Institutions that implemented shorter
shifts with stress intervention and prevention
programs tend to have a lower nurse burnout rate
than those without. Additionally, nurses who can be
proactive with recognizing burnout in themselves
and their coworkers will assure an optimal working
environment and continue to provide our patients
with exceptional care.
Implications for nursing practice:
It has become increasingly apparent that nurses
are suffering from burnout. Healthcare institutions
and nurses need to take the appropriate steps to
recognize, reduce, and prevent burnout. Some steps
aimed at reducing burnout are, developing modified
shift-working programs, avoiding consecutive 12-
hour shifts, provide education on stress reducing
measures, reviewing workload, improving staff
support, mentoring, and improving communication.
Having these proactive interventions in place will be
beneficial for the institution, nurses, and patients.
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 COVID-19.
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 (peerto-peer
conversations, warmlines, hotlines, cognitive
processing techniques) and preventive actions
(stress reduction, mindfulness and educational
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 feedback.
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 activities.
Self-Assessment Tool – an important part of selfcare
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 resources.
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 provider.
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-to-peer
conversations, download the apps or use the tools;
visit the Well-being Initiative at https://bit.ly/35qLV7x.
The Oklahoma Nurse May, June, July 2021
RECOGNIZING EXCELLENCE IN NURSING…
The Oklahoma Nurses Association has many members whose outstanding
contributions should be recognized. The following award categories have been
established to recognize excellence in Oklahoma Nursing:
EXCELLENCE IN NURSING
NURSING RESEARCH AWARD
NURSING IMPACT ON PUBLIC POLICY AWARD
NIGHTINGALE AWARD OF EXCELLENCE
FRIEND OF NURSING AWARD
EXCELLENCE IN THE WORKPLACE ENVIROMENT
Nominees for ONA awards must meet specific criteria. These individuals
must be ONA members, except for the Friend of Nursing Award, which is given
to a non-nurse or for the WPA Excellence in the Workplace, which is presented
to organizations. Members of the ONA Board of Directors may be considered
for ONA awards. However, the members of the Awards Selection Committee
are not eligible for ONA awards.
PROCEDURE AND GENERAL INFORMATION
1. Nominations may be submitted by an individual, association, committees,
regional nurses associations, nursing education programs, organized
nursing services or the Oklahoma Board of Nursing.
2. Nominees Practice area may be in any service setting: administration,
education, direct patient care, legal, consulting, nurse entrepreneur,
public policy or any area in which professional nurses’ practice.
3. Materials required for nominations include the following:
a. completed nomination form (online form)
b. nominator’s narrative statement (described below)
c. brief curriculum vitae and any additional pertinent information (not
required for the Friend of Nursing award nominations)
d. two letters supporting the nomination, such as a supervisor or
5. The narrative statement should detail the accomplishments of the
nominee and be presented concisely. It is this narrative statement,
which is weighed most heavily in the selection process.
6. Nominations and attached materials will be treated in a confidential
7. Awards will be presented at the ONA convention on Thursday.
Recipients will be invited to attend the presentation of the award. If,
because of extenuating circumstances, a recipient cannot be present,
the presentation will be made in absentia.
DEADLINE FOR SUBMISSION
The deadline for submission of nominations is August 1. Submit materials
electronically using the ONA website and any supporting materials via email.
EXCELLENCE IN NURSING
The Excellence in Nursing Award is conferred on a member, who has
developed an innovative, unique and creative approach that utilizes nursing
theory and knowledge/skills in any practice setting: Administration, Education,
and/or Direct Patient Care. The recipient should be recognized by peers as
a role model of consistently high-quality nursing practice and as one who
enhances the image of professional nursing by creating an environment
promoting professional autonomy and control over nursing practice.
NURSING RESEARCH AWARD
The Nursing Research Award recipient is a nurse who has made a significant
impact on nursing research as a basis for innovation as it relates to one of
the following areas: management, clinical practice and/education. Significant
impact means that the nurse has contributed to the creation of new nursing
knowledge through research findings. In addition, the research has improved or
created a plan for improving nursing management, nursing education, clinical
nursing practice and/or patient outcomes in response to the findings.
NURSING IMPACT ON PUBLIC POLICY
Nursing Impact on Public Policy Award honors the nurse, whose activities
are above and beyond those of the general nursing community to further the
political presence of nursing and/or to accomplish positive public policy for the
NIGHTINGALE AWARD OF EXCELLENCE
The Nightingale Award of Excellence is conferred on an ONA member who
during their career:
• Demonstrates innovative strategies to best fulfill job responsibilities and/
or responsibilities in their professional role and within the community in
which they work and live.
• Consistently surpasses expectations of a professional nurse; thus
enhancing the image of nursing as a profession.
• Demonstrates sustained and substantial contribution to the Oklahoma
• Serves as a role model of consistent excellence in his or her area of
Other professional behaviors such as mentoring, advocacy, research
conduction or utilization, publications and presentations should also be
demonstrated throughout his/her career.
FRIEND OF NURSING
The Friend of Nursing Award is conferred on non-nurses who have rendered
valuable assistance to the nursing profession. Their contributions and
assistance are of statewide significance to nursing.
EXCELLENCE IN THE WORKPLACE ENVIRONMENT
The Excellence in the Workplace Environment Award is presented to
organizations that have developed positive work environments. These
organizations must have developed an Innovative and effective program,
approach or overall environment that promotes excellent nursing care, creating
a positive environment for nurses to work and supports nurses in their practice.
Please include the following information with your nomination:
Name of Facility
Address of Facility
Description of the positive organizational culture and how it promotes excellent
nursing care, creates a positive environment for nurses to work and supports nurses.
May, June, July 2021 The Oklahoma Nurse 11
Leadership Visited and Revisited
Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN,
FNAP, FAANP (hon)
Director, Marian K. Shaughnessy Nurse
Elizabeth Brooks Ford Profession of Nursing
Frances Payne Bolton School of Nursing
Distinguished University Professor
Case Western Reserve University
“So what is leadership?” This is the simple (yet
complex) question that I am often asked.
Here are the answers I provide:
Leadership is part of your being, the moral
compass that permeates all that you do, say and
Leadership is an attribute that is reflected in your
everyday interactions with everyone in your orbit,
your family and friends, your co-workers, and those
who you barely know, but with whom you have
Leadership is being authentic in the way you
behave with others, the communication that you
share and the feelings and thoughts that you have.
Leadership is also a set of skills, learned
behaviors that encourage others toward a shared
vision, common goals and a greater purpose.
Leadership is finding meaning and purpose in
Leadership is modeling the way in everything that
you do and say.
Leadership is self-awareness, listening to
yourself, reflecting on your own beliefs, your
knowledge and skills.
Leadership is doing what you can to actualize
your unused potential.
Leadership is managing conflict to create true
Leadership is learning from others, the children
in the playground who are spontaneous in their
support of each other, and the board members in
the meeting who are supportive in their own way.
Leadership is humility, knowing that none of us is
Leadership is a belief in the power of our
collective humanity, working together for the good of
Leadership is sharing your deepest convictions
about the way that nursing and healthcare can and
should be, reaching for the stars that promote health
as a right and not a privilege.
Leadership is caring for those most vulnerable,
the neglected, the ill, the down-trodden, the
marginalized…just as nurses do every day in every
Leadership is listening to those whose views
are radically different from yours and trying to find
a common purpose and a common ground for the
good of all.
Leadership is professionalism, understanding
the social contract that we as nurses have with the
public, upholding our ethical obligations to all in our
care and living our professional nursing standards.
Leadership is assuming responsibility for our
own actions, being accountable for our actions and
understanding the consequences.
Leadership is pushing the boundaries when the
boundaries need to change.
Leadership is investing in others’ greatness.
Leadership is identifying needed change and
creating the vision and processes to initiate change.
Leadership is providing guidance, to individuals,
groups and organizations.
Leadership is active and decisive decisionmaking
to achieve shared goals.
Leadership is taking a risk to implement a vision
and achieve goals.
Leadership is understanding yourself, being
aware of your potential and the power of intentional
Leadership is building relationships with those
who can help you and those you can help, building
relationships for the purpose of helping others to
actualize their potential.
Leadership is mentoring others, and allowing
yourself to be mentored.
Leadership is promoting collaboration and
Leadership is knowing when to step back, when
there is an affront to your integrity.
Leadership is being transformational.
Leadership is being an advocate, for patients, for
colleagues and for the public health.
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Leadership is being a trusted professional.
Leadership is motivating others to act.
Leadership is embracing change and effecting
change as needed.
Leadership is acclaiming others’ successes and
assisting them to achieve their highest potential.
Leadership is YOU!
How many of these leadership attributes describe
Which of these leadership attributes do you want
to develop or strengthen?
What is your plan to make it happen?
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The Oklahoma Nurse 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 NP
Along with incalculable loss, the coronavirus
(COVID-19) outbreak has had devastating effects
on the mental health of people with COVID-19, their
families and the community at large. Healthcare
workers face tremendous stress, both emotionally
and physically, from the grueling work hours and the
threat of contracting the virus at work.
This article addresses the potential mental health
issues for healthcare workers that may emerge from
this pandemic as well as treatment options and selfcare
activities that promote recovery.
COVID-19 and Mental Health
Nurses working on the front lines of the COVID-19
pandemic may experience various mental health
problems. Here are a few examples:
• Chronic stress. Nurses are continuously
fearful of contracting COVID-19, infecting
others, encountering prejudice from the
public due to working as a nurse, and dealing
with inadequate supplies of PPE.¹ Stress
becomes chronic when it is overwhelming and
cannot be resolved, resulting in relationship,
health and sleep problems. 2-5 People with
chronic stress experience intense emotions
that can feel overwhelming and result in
thinking negatively. 6 Nurses on the front lines
in COVID-19 hotspots report feeling like a
graduate nurse again, filled with uncertainty
and worry. 7
• Acute stress disorder. Nurses with acute
stress disorder may have trouble sleeping,
worry constantly, and experience persistent
negative thoughts about their role in
the traumatic event, such as thinking “I
should have done more to help.” 8 When
we experience trauma, we detach from the
memory. We ignore our emotions to protect
against the pain, but these emotions reappear
over time and impact our lives. 9 The nurse
may respond to a minor irritation as if it were
a life-threatening event. 10 Nurses may feel
they are in a dreamlike state that impacts their
ability to think, process their emotions, and
respond appropriately to situations. 11 If signs
and symptoms of acute stress disorder persist
for more than a month, posttraumatic stress
disorder (PTSD) may be diagnosed. 12
• PTSD. Nurses are not strangers to caring
for critically ill patients who die. 8 However,
the number of patients dying amid a surge
in COVID-19 cases is causing healthcare
workers to feel powerless, which can lead
to PTSD. PTSD can develop after direct or
indirect exposure to a traumatic event, such
as hearing about a traumatic event involving
a family member, friend, or 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
can point you right to that perfect
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May, June, July 2021 The Oklahoma Nurse 13
Topping off emotional reserves
Nurses on the COVID-19 front lines are plagued by drained emotions,
loneliness and fear. These are normal reactions to an unfamiliar, uncertain
environment. Transitioning away from work at the end of the day is essential for
nurses to top off their emotional reserves.
If you have had a particularly stressful day, acknowledging and discarding
any negative thoughts or feelings can help improve sleep quality. Having a ritual
to signal the end of work is essential. Here are some suggestions:
• Take a shower. Visualize all the worries of the day disappearing down the
• Write down any thoughts or feelings in a notepad.
• Watch a favorite TV program.
• Read a book.
• Listen to your favorite music.
• Contact a friend.
• Write down three things you were grateful for today.
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 selfcare
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.washingtonpost.com/health/2020/07/08/ppeshortage-masks-gloves-gowns.
2. Mariotti A. The effects of chronic stress on health: new insights into the
molecular mechanisms of brain-body communication. Future Sci OA.
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. 2014;20(7):754-758.
5 Kabat-Zinn J. Full Catastrophe Living. 15th anniversary ed. New York, NY:
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.
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/
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 &
10. Van Der Kolk B. The Body Keeps the Score. London: Penguin; 2014:156-157,
11. Bolton EE, Jordan AH, Lubin RE, Litz BT. Prevention of posttraumatic stress
disorder. In: Gold SN, ed. APA Handbooks in Psychology. APA Handbook
of Trauma Psychology: Trauma Practice. Washington, DC: American
Psychological Association; 2017:483-497.
12. Psychology Today. Acute stress disorder. 2019. www.psychologytoday.com/ie/
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?
15. Levine P, Blakeslee A, Sylvae J. Reintegrating fragmentation of the
primitive self: discussion of “somatic experiencing.” Psychoanal
16. Highfield J. Am I OK? Intensive Care Society. 2020. www.ics.ac.uk/ICS/
17. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights,
roles and responsibilities of health workers, including key considerations
for occupational safety and health. 2020. www.who.int/publications/i/item/
18. American Association of Critical-Care Nurses. Well-being Initiative. 2020. www.
19. World Health Organization. WHO guidelines on conditions specifically related
to stress. 2013. www.who.int/mental_health/emergencies/stress_guidelines/en.
20. Brené Brown. Vulnerability. 2020. www.brenebrown.com/definitions.
21. Frank S. As coronavirus slams Houston hospitals, it’s like New York “all
over again.” The New York Times. 2020. www.nytimes.com/2020/07/04/us/
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 email@example.com or call 1-800-247-1500. www.nso.com.
The Oklahoma Nurse May, June, July 2021
Is healthcare a right?
Tina Edwards, MBA, MSN, RN
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This was one of the discussion questions in my
DNP-FNP program that really sparked my interest
the more I researched it. I never realized, until that
point, how many different opinions nurses have
on this subject. I read several arguments saying
healthcare was a privilege, some said it was a
service, and some said it was a right.
When I consider what a right is, I believe this is
something that people cannot be denied. Rights
are our principal standardizing rules for individuals'
entitlement. A right, therefore, cannot be taken away,
nor can it be dismissed.
Did you know that neither the U.S. Constitution
nor the Supreme Court elucidates that healthcare is a
constitutional right for those who cannot afford it? But
prisoners can have full access to medical care under
the Supreme Court ruling. Do we really want granny to
have to commit a crime in order to get a pacemaker?
Do you see a problem with our healthcare system?
Legally speaking, the right to healthcare
incorporates a duty and obligation that includes
everyone who enters a hospital seeking medical
attention requires a health screening. In 1986,
Congress passed "The Emergency Medical
Treatment and Active Labor Act (EMTALA)," an
act guaranteeing non-discriminatory access to
emergency medical care and thus to the health care
system (Zibulewsky J., 2001). Therefore, healthcare
is a right to only those who seek emergency care.
1) Did you know that nurses account for over 20%
of EMTALA violations? (Cohen, 2015)
2) Did you know that nurses can be held
responsible under their state's Nurse Practice Act in
medical malpractice lawsuits for EMTALA violations?
3) Do you feel that EMTALA should expand to
Urgent care so that people do not seek emergency
care for nonmedical emergencies? Because they 1)
cannot afford it or 2) do not have insurance coverage.
In closing, I believe we as nurses need to raise
our voices and advocate that healthcare is a right!
Not just for prisoners, not just for ER seekers, but
for everyone. If we see that healthcare as a service
or a privilege and not as a right, I believe we are
undervaluing our profession in so many ways.
Cohen, S. (2005). ED nurses are responsible for 20% of
EMTALA violations: Don't be next. https://www.
EMTALA – Healthcare. https://healthcare.uslegal.com/
Health Care: Constitutional Rights and Legislative Powers.
Zibulewsky, J (2001) The Emergency Medical Treatment
and Active Labor Act (Emtala): What It Is and
What It Means for Physicians, Baylor University
Medical Center Proceedings, 14:4, 339-346, DOI:
Benefits include Health,
Dental, Vision, and Retirement.
Good Samaritan Society Liberal
Questions? Call: 405-271-4171
May, June, July 2021 The Oklahoma Nurse 15
An Ethic of Justice Viewed through the Lens of an Ethic of Care:
How Nurse Leaders May Combat Workplace Bullying
Gloria Matthews, DNP, RN, CNL, CDE
University of Oklahoma Medical Center
Valerie Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A
University of Oklahoma Health Sciences Center
Fran & Earl Ziegler College of Nursing,
The purpose of this paper is to present
integration of two ethical approaches to combat
workplace bullying within a clinical setting from an
advance nursing practice leadership perspective.
A description of ethic of care and ethic of justice is
presented and critically appraised as it relates to
managing workplace bullying. The importance of the
application of the ethic of justice through the lens of
the ethic of care will be elucidated.
Description and Application to Workplace Bullying
A failure of nursing leadership to address
workplace bullying demonstrates a lack of
compassion and organizational injustice. Bullying is
the repeated and persistent, abusive mistreatment
by one or more perpetrators towards one or more
victims that is marked by threatening, humiliating
or intimidating conduct, work interference, or
verbal abuse (Fink-Samnick, 2018). Bullying is a
systemic problem and reflects behavior patterns
and surreptitious characteristics of a culture of
violence that contributes to various expressions and
manifestations of violence within an organization
(Smit & Scherman, 2016). The Joint Commission
(2008) notes that intimidating and disruptive
behaviors contribute to medical errors, poor patient
and staff satisfaction, staff turnover and poor
collaborative work environments.
Ethic of Care
The ethic of care is a moral approach
characterized by contextual, holistic empathy and
is based on caring, strengthening and maintaining
interpersonal relationships. It emphasizes the
importance of insight gained from being open
and receptive to the realities and needs of others
(Simola, 2003). The ethic of care aligns with the
authentic, servant and transformational leaders
who put followers’ interests above their own and
influence followers through building relationships,
developing a collective vision, and attending to
the needs and growth of their followers (Groves &
Most occurrences of bullying are learned
behaviors directed by reactions to stress and
organizational norms and, therefore, can be
unlearned (Berry et al, 2016). Leaders guided by
an ethic of care model take decisive action when
confronted with behaviors that do not adhere to
expected conduct. In combating workplace bullying,
effective leaders are proficient in communication
and competent in coaching, staff development,
maintaining high standards of conduct, and
fostering an environment of trust and mutual respect
(Parker, Harrington, Smith, Sellers, and Millenbach,
Bullying is an attempt to intimidate and gain
power over someone else. Structural empowerment
is an effective technique to mitigate the effects and
incidents of bullying (Lachman, 2014). Effective nurse
empowerment can be obtained through shared
governance to minimize power imbalances and
enhance shared responsibility and transparency in
decision making (Berry et al, 2016; Parker et al, 2016).
Skill development is an important weapon in the
battle against bullying. Strategies such as cognitive
rehearsal, skills-based training, and role-playing
have been successful in raising staff awareness and
combating bullying (Balevre, Balevre, & Chesire,
2018; Parker et al., 2016).
Normative leadership models such as
transformational, servant and authentic leadership
constructively address the bullying by modeling an
ethic of care perspective and seeking to facilitate
followers’ self-actualization. The assumption is that
ethical leadership styles promote social cohesion,
professionalism, and empowerment (Webster, 2016).
Ethic of Justice
The ethic of justice is a moral approach that
is characterized by justice, fairness, reciprocity
and the protection of individual rights. Individuals
demonstrate impartiality and the ability to reason
abstractly through the application of formal,
logical and impartial rules (Simola, 2003). The
ethic of justice aligns with the transactional leader
who influences followers by control, reward and
corrective transactions (Groves & LaRocca, 2011).
Structural empowerment is gained through
establishment of an ethical infrastructure that
reinforces ethical principles and behavioral
expectations of members of the organization
(Einarsen, Mykletun, Einarsen, Skogstad, & Salin,
2017). Aligned with the ethic of justice, organizations
establish standardized policies, procedures and
documents such as codes of ethics, procedures
for handling complaints and zero tolerance policies
(Einarsen et al., 2017).
Hutchinson (2009) posits that rather than focusing
on the individual, leaders should direct corrective
measures towards the act of bullying itself and
gain insight into work group and organizational
factors that enable the behavior. The focus is on
reintegration and restoration of social relationships
within the context of a supportive group, such as a
restorative circle, where the attention is placed on
repairing harm rather than blame and punishment.
Reflection on Integration of Ethical Approaches
It is important for leaders to integrate the two
ethical perspectives by distributing justice within a
caring framework (Sorbello, 2008). Organizations
and leaders must clarify and communicate that
bullying is unacceptable. If corrective actions
fail, termination is an acceptable consequence
to continued behavior (Lee et al., 2014). At times,
leaders must implement corrective actions
and uphold values and policies set forth by the
organization, but it is in the delivery and intent that
determines a caring leader.
Combating bullying requires a multidimensional
approach. By establishing a relationship-based
ethics of care perspective, along with visible
organizational-based regulatory sanctions in
communication and ethic of justice, organizations
can create and sustain a respectful working
environment for the prevention of workplace
bullying. The integration of the divergent ethical
perspectives of an ethic of care and an ethic of
justice provides an environment of collegiality,
transparency and support for improved patientrelated
and nurse-related outcomes.
Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018).
Nursing professional development anti-bullying
project. Journal for Nurses in Professional
Development, 34(5), 277-282. https://doi.
Berry, P. A., Gillespie, G. L., Fisher, B. S., & Gormley, D. K.
(2016). Recognizing, confronting, and eliminating
workplace bullying. Workplace Health & Safety,
64(7), 337-341. https://doi.org/10.18291/njwls.
Einarsen, K., Mykletun, R. J., Einarsen, S. V., Skogstad,
A., & Salin, D. (2017). Ethical infrastructure and
successful handling of workplace bullying.
Nordic Journal of Working Life Studies,
7(1), 37–54. https://doi.org/10.18291/njwls.
Fink-Samnick, E. (2018). The new age of bullying and
violence in health care: part 4: managing
organizational cultures and beyond. Professional
Case Management, 23(6), 294–306. https://doi.
Groves, K., & LaRocca, M. (2011). An empirical study
of leader ethical values, transformational and
transactional leadership, and follower attitudes
toward corporate social responsibility. Journal
of Business Ethics, 103(4), 511–528. https://doi.
Hutchinson, M. (2009). Restorative approaches to
workplace bullying: Educating nurses towards
shared responsibility. Contemporary Nurse,
32(1–2), 147–155. https://doi.org/10.5172/
Lachman, V. D. (2014). Ethical issues in the disruptive
behaviors of incivility, bullying, and horizontal/
lateral violence. Medsurg Nursing, 23(1), 56-60.
Parker, K. M., Harrington, A., Smith, C. M., Sellers, K.
F., & Millenbach, L. (2016). Creating a nurseled
culture to minimize horizontal violence in
the acute care setting: A multi-interventional
approach. Journal for Nurses in Professional
Development, 32(2), 56-63. https://doi.
Simola, S. (2003). Ethics of justice and care in
corporate crisis management. Journal of
Business Ethics, 46(4), 351-361. https://doi.
Smit, B., & Scherman, V. (2016). A case for relational
leadership and an ethics of care for
counteracting bullying at schools. South African
Journal of Education, 36(4), 1-9. http://www.
Sorbello, B. (2008). The nurse administrator as caring
person: A synoptic analysis applying caring
philosophy, Ray’s ethical theory of existential
authenticity, the ethic of justice, and the ethic
of care. International Journal of Human Caring,
12(1), 44-49. 10.20467/1091-5710.12.1.44
The Joint Commission. (2008). Behaviors that undermine
a culture of safety. (Sentinel Event Alert, Issue
Webster, M. (2016). Challenging workplace bullying: the
role of social work leadership integrity. Ethics &
Social Welfare, 10(4), 316–332. https://doi.org/10
The Oklahoma Nurse May, June, July 2021
Kidney Function and Race:
Is it Scientific Medicine or Bias Medicine?
Nikeyia Davis, MBA-HCM, BSN, RN, CNN
Reprinted with permission from The Future of
Nursing in Michigan, March 2021
The eGFR, or estimated
rate, is a test used to
determine how well your
kidneys are functioning.
Historically, four factors
are considered when
calculating the eGFR: Age,
gender, creatinine (muscle
waste), and race. Race
is only divided into two
categories, black and non-black.
Since 1999, a multiplier was added to the black
population because it is assumed that blacks have
more muscle mass than whites and therefore, a
higher serum creatinine (Levey et al, 1999). This
assumption that blacks have more muscle mass
was from three small, flawed, and poorly designed
studies published during the 1970s-1990s. This
multiplier makes the eGFR in blacks to appear 15-
18% higher, indicting better kidney function. But is
the function actually better, or are there other factors
impacting the serum creatinine in those studies,
such as socio-demographics, that should have been
considered? Humans are biologically the same. Why
the difference for blacks in the case of eGFR? There
is currently no reliable data that suggests blacks
have more muscle mass than whites.
Who is Considered Black?
Are African Americans or people of African
ancestry, or from Caribbean countries black?
Are people from Sub-Saharan Africa or North
Africa black? Are Somalians or Ethiopians black?
Are we basing being “black” on skin color only or
ancestry? What about a mixed-race person with one
black parent and one non-black parent? Where do
they fall on this scale?
How are other races being accounted for in these
race-based calculations? In India for example, many
people are vegetarians. One study found that the
calculation overestimated the eGFR in the Indian
population by 5% (FitzGerald, 2019). Where does it
begin and where does it end?
Implications of Race Consideration
Implications for considering race as a factor of
eGFR can lead to underdiagnosing chronic kidney
disease (CKD), delayed treatment and referral to
nephrology, delayed referral for transplant, unsafe
medication use and dosing, unsafe use of iodinated
and gadolinium-based contrast agents, and the
decisions on clinical trial inclusion or exclusion.
If the multiplier is removed, many blacks with
CKD will be at more severe stage of kidney disease
and there will be an increase in the prevalence of
kidney disease in blacks from 14.9% to 18.4%.
Removing the multiplier, it may also lead to overdiagnosing
of CKD causing possible unnecessary
anxiety and worry for the patient.
What is being done?
In August 2020, the National Kidney Foundation
and the American Society of Nephrology formed
a task force to reevaluate race in the calculation of
eGFR and the diagnosing of kidney disease. Some
of the charges of the NKF-ASN Task Force on
Reassessing the Inclusion of Race in Diagnosing
Kidney Diseases include:
• Examine the inclusion of race in the estimation
of GFR and its implications for the diagnosis
and subsequent management of patients with,
or at risk for, kidney diseases.
• Recognize that any change in eGFR reporting
must consider the multiple social and clinical
implications, be based on rigorous science,
and be part of a national conversation about
uniform reporting of eGFR across health care
• Attempt to incorporate the concerns
of patients and the public, especially
in marginalized and disadvantaged
communities, while rigorously assessing
the underlying scientific and ethical issues
embedded in current practice.
• Ensure that GFR estimation equations provide
an unbiased assessment of kidney function
so that laboratories, clinicians, patients and
public health officials can make informed
decisions to ensure equity and personalized
care for patients with kidney diseases.
• Keep laboratories, clinicians and other kidney
health professionals apprised of any potential
long-term implications of removing race from
the eGFR formula.
• Issue initial recommendations in 2020.
(National Kidney Foundation, 2020)
Where do we go now?
We must assert ourselves and ask good
questions. Just because we have been doing things
a certain way for so long does not mean we cannot
question the method when it does not make sense.
There is a new light shining on biases, and we must
make sure we are not falling into any of them that
can affect the way we care for our patients.
FitzGerald, T. (2019, August 5). Should race be replaced?
Reconsidering the eGFR equations. — NephJC.
Retrieved from https://www.nephjc.com/news/
Levey, A., Bosch, J., Lewis, J., Greene, T., Rogers, N.,
& Roth, D. (1999, March 16). A more accurate
method to estimate glomerular filtration rate
from serum creatinine: A new prediction
equation | Annals of internal medicine.
Retrieved from https://www.acpjournals.org/doi/
National Kidney Foundation. (2020, August 25). NKF
and ASN form Joint Task Force to focus on
use of race in eGFR. Retrieved from https://
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May, June, July 2021 The Oklahoma Nurse 17
Nurse Resiliency During a Pandemic
Terry Towne, MSN, RN, NPD-BC, NE-BC
Brittany Oakey, MSN, RN, CRRN
Reprinted with permission from DNA Reporter,
Terry Towne began her nursing career as a
graduate of the Robert Packer Hospital School
of Nursing in Sayre, PA then completed her
BSN from Indiana University of Pennsylvania in
Indiana, PA. After joining the USAF Nurse Corps,
she later received her MSN from Arizona State
University. Terry is dually ANCC Board Certified
in Nursing Professional Development and as a
Nurse Executive. She is a member of the Delaware
Nurses Association, American Nurses Association,
Delaware Organization of Nurse Leaders, and the
Association for Nursing Professional Development.
Terry has served as a Clinical Educator in
Bayhealth’s Education Department for several
years. She was nominated as a Delaware Top
Nurse in 2014 and 2015. Terry received the William
H. Spurgeon III Award from National Boy Scouts
of America for outstanding service for Bayhealth’s
Explorers Program in 2015. She was Bayhealth
Nurse Educator of the Year in 2016 and 2019. Terry
currently co-facilitates a new resiliency class for
healthcare professionals at Bayhealth. Terry can be
reached at firstname.lastname@example.org.
Brittany Oakey received her BSN from Wesley
College and her MSN from Wilmington University.
She is an ANCC Board Certified Rehabilitation
Registered Nurse. Brittany is a member of the
Delaware Nurses Association and the Association
for Nursing Professional Development. She received
the Educator of the Year Award and Nurse of the
Year Award in 2018 for Bayhealth Milford Memorial.
Brittany was nominated as a Delaware Top Nurse
in 2020. She currently works as a Clinical Educator
in the Education Department at Bayhealth servicing
both Kent and Sussex Campuses. Brittany
spearheaded the creation of a resiliency program for
healthcare professionals at Bayhealth. Brittany can
be contacted at Brittany_oakey@bayhealth.org.
Resilience is “the capacity to keep functioning
physically and psychologically in the face of stress,
adversity, trauma, or tragedy” (Carpenter, 2014,
p. 2). Resiliency has been studied for more than
40 years and initially was geared by psychologists
toward children (Fleming & Ledogar, 2010). Although
the term resiliency can be applied broadly across
many facets in nursing, it is vital to not only the
survival of, but to the success of nurses. Nurses
work in complex environments facing an array of
challenges while attempting to manage multiple
priorities. Depersonalization, emotional exhaustion,
and moral distress have many nurses experiencing
or struggling with compassion fatigue and burn
out. According to a recent article in Nursing 2020,
approximately 40% of nurses reported burn out
(Rajamohan et al., 2020).
In more recent times, nurses have been
called upon to care for patients plagued by the
Coronavirus Disease 2019 (COVID-19) pandemic
despite little knowledge regarding this disease. With
life’s normal challenges, the safety of nurses on the
front line was in jeopardy without relief, the only
constant being continuously changing standards
and protocols. Never before have nurses been
tested more for resiliency than during the present
most catastrophic healthcare crisis in modern
history. As pointed out by Sherman, “You need
resiliency for a long and productive nursing career….
you need to stop seeing yourself as a victim during
these downturns and become proactive in your
recovery (Sherman, 2018, p. 27).”
Nurses have made it through the tough times
- some believe nurses are now on the other
side, although there is so much uncertainty and
unrest still exist. How does nursing recover as a
profession? The answer is through resiliency.
There are a wealth of resources available to
assist nurses who are struggling with resiliency as
a result of the COVID-19 pandemic. The American
Nurses Foundation (ANF), which is a philanthropic
arm of the American Nurses Association, launched
a national well-being initiative for nurses in May
2020. This foundation partnered with the American
Nurses Association (ANA), the Emergency Nurses
Association, the American Association of Critical-
Care Nurses, and the American Psychiatric Nurses
Association. Through their combined efforts was
the development of resources to assist nurses in
managing stress and overcoming trauma associated
with COVID-19. As a result, a Well-being Initiative
was created by nurses for nurses.
The following ANF resources are available for
nurses who are struggling with resilience:
(1) Nurses Together: Connecting through
Conversations provides a virtual peer
support platform or video to give nurses an
opportunity to speak openly about self-care
and wellness, recovery and resilience, care
dilemmas, and bereavement.
(2) Narrative Expressive Writing is a five-week
program where nurses respond anonymously
to COVID-19 writing prompts and receive
feedback from a certified responder.
(3) Happy App is a smart phone app that
connects nurses one-on-one to a supportive
team member 24/7.
(4) Moodfit Mobile App is intended for nurses
to identify wellness goals and activities. It
gives them the ability to track goals for sleep,
nutrition, exercise, mindfulness and other
(5) The Self-assessment Tool is an evidencebased
tool which helps nurses identify
symptoms, understand if they need help, and
directs them to the appropriate resources.
(6) Hotlines and provider resources are available
that include instructions to find a mental
health provider, to obtain a referral, and to
look for the best provider match.
The ANF also partnered with Nurses House, Inc.
This is a nurse-managed, non-profit organization
designed to help nurses in financial need. Through
this combined effort was the development of a
COVID-19 fund offering a one-time $1,000 grant for
qualified nurses who are ill from COVID-19, care for
a family member with COVID-19, or who are under
employer-mandated quarantine due to the virus
(ANF, May 2020).
The ANA created a Self-Care Webinar as part of
their most recent Covid Webinar series. In addition,
the ANA created a Healthy Nurse Health Risk
Appraisal which surveyed nurses to better focus
on strengthening physical and emotional health
(www.anahra.org). This tool played an integral role
in the formation of ANA’s Healthy Nurse Health
Nation (HNHN) initiative in 2017 to create a healthier
work force among nurses in the USA. Goals of
this initiative were to make self-care a priority for
all nurses to help them serve as role models. The
health areas addressed with the HNHN included
activity, rest, nutrition, quality of life, and safety.
There are many interventions to assist with stress
reduction in our daily lives. First and foremost,
nurses must be self-aware of their strengths and
weaknesses. Self-reflection gives nurses the ability
to hone in on past experiences when moving
forward. One strategy to de-stress is by designing
a respite room or Zen Den which is “a space set
aside specifically… to take time away and sit quietly”
(Leverance, 2015, p.29). Another method is to
practice mindfulness where individuals are able to
accept themselves and live in the moment. Keeping
a positive attitude is vital to resilience. The ability
to show gratitude and incorporate humor can also
help individuals to feel better. At a time when there
is social distancing, nurses still need to consider
creative, yet safe ways to network and socialize to
nurture interpersonal connections. Music therapy,
art therapy, and journaling can assist with stress
reduction. Other considerations include fulfilling
spiritual and religious needs in an effort to feel
whole. When practicing these interventions, stress
levels reduce resulting in the ability to cope better
with life’s obstacles.
Nurse resilience is dependent upon many factors.
“A healthy nurse is one who actively focuses on
creating and maintaining a balance and synergy of
physical, intellectual, emotional, social, spiritual,
personal, and professional wellbeing” (ANA
Enterprise, 2020). Despite life’s stressors, nurses
need to take time for themselves to bridge this
gap. Take a break, get the proper amount of sleep,
eat nutritionally, and “acknowledge the emotional
toll of the situation by seeking support” when
needed (Webster & Wocial, 2020). Nurses all make
a difference and are appreciated for their sacrifices
during the COVID-19 pandemic. We are in this
together and can help each other as we return to the
American Nurses Association. (2017). Health risk
American Nurses Foundation, (2020, May 19). American
Nurses Foundation launches national well-being
initiative for nurses. http:/www.nursingworld.org/
ANA Enterprise. (2020). About the healthy nurse
healthy nation grand challenge. https://www.
Carpenter, H. (2014, July 28). Resilience. My American
Centers for Disease Control and Prevention. (2020,
September 28). COVID-19 death and resources.
Fleming, J., & Ledogar, R. J. (2010). Resilience, an
evolving concept: A review of literature relevant to
Aboriginal research. Canadian Institutes of Health
Research. 6(2), 7-23.
Leverance, K. (2015). Become a more resilient nurse
- reduced burnout, prevent compassion fatigue,
and take better care of patients, Oncology Nursing
Society, 30(4) 24-30.
Rajamohan, S., Davis, C. R., & Ader, M. (2020). REST:
Break through to resilience. Nursing 2020, 53-56.
Sherman, R.O. (2018). Building your resiliency. American
Nurse Today. 13(9), 26-28.
Webster, L., & Wocial, L. (2020, September). Ethics in a
pandemic. American Nurse. 15 (9), 18-23.
To access electronic copies of
The Oklahoma Nurse, please visit
May, June, July 2021 The Oklahoma Nurse 19
Eight Lessons Learned From the COVID-19 Pandemic
From My American Nurse
Sean Reed PhD, APN, ACNS-BC, ACHPN
Clinical nurse specialists share experiences on how the pandemic and social
distancing are highlighting the CNS role.
The “new normal” resulting from the COVID-19 pandemic has altered the way
America’s 89,000 clinical nurse specialists (CNSs) do their jobs. For example, how
do CNSs perform all the tasks they have been trained to do while maintaining six
feet of social distance? What information should be communicated to staff?
Four CNSs and National Association of Clinical Nurse Specialists (NACNS)
members recently shared their experiences learned over the past months about
how to maintain social distance while taking on new responsibilities and still be
effective. Their insights go beyond wearing masks, keeping social distance, and
1. Worry only about what you can control.
It’s an ever-changing environment, with new COVID-19 information arriving daily,
frequently resulting in new healthcare policies. Early in the pandemic, the Centers
for Disease Control and Prevention (CDC) changed recommendations regularly,
and CNSs were responsible for disseminated them across many organizations.
“It could get exhausting with the constant changes in policy and protocol.
We had no control over CDC announcements, so we just rolled with it and
worked to keep everyone current,” said Julie DeVaney, CNS at UC San Diego
Health. “We had daily announcements, over-communicated information, and
held what we called a ‘Daily Engagement.’ The Daily Engagement was a formal,
daily conversation with our leadership and the clinical CNSs so we could
disseminate any new information.”
Take the time to critically look at news and other information being
released. Because COVID-19 is constantly evolving and new study results are
being reported regularly, there is a real need to be vigilant about the types of
information being shared. Learning to overcommunicate accurate information
takes time and is essential.
“Initially, we dedicated a lot of time for conversations and supporting staff,
trying to be sure they had accurate information; keeping them updated,” said
Pat Rosier MS, RN, ACNS-BC, a surgical CNS at Berkshire Medical Center
in Pittsfield, Massachusetts. “We answered questions like, ‘What was our
guidance?’ and ‘What was the personal protective equipment [PPE] to use?’
So, you’re always trying to be sure the [nurses] have the accurate information.
And then internally, what were our plans for which units would care for which
types of patients? So, we spent, and continue to spend, time keeping staff upto-date,
calming them down, and sometimes we just listen. Listening is a form
3. Know where and how the staff is getting their information.
Understand where and how nurses obtained new information. According
to Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, CCRN, FCCM, FCNS,
who is CNS, acute medicine service line quality and safety and sepsis leader/
coordinator at ChristianaCare in Newark, Delaware, it’s important to first
locate the news sources used by staff and then check to see if the sources
are credible. If the sources aren’t accurate, speak up and inform the staff, and
provide sources that are credible. This will enable CNSs to prevent the spread
of misinformation before it starts.
4. Persuade with evidence.
As leaders, CNSs need to communicate evidence-based information
thoughtfully to staff without simply reacting to whatever new information is
presented. They need to use their skill and knowledge to persuade—and back
up with evidence—recommended actions. The confidence that evidence brings
to new information can reduce the levels of uncertainty nurses often experience
working on the frontlines of the pandemic.
“The biggest challenge CNSs had to manage was the staff’s fear,” said
Seckel. “Our code words for staff were ‘fluid and flexible’ because what was
common practice for COVID-19 today could change next week due to new
research. We didn’t want to react before we considered the situation with other
experts and leaders, so we put the right information out.”
Messaging becomes exquisitely important in this environment. Rapidly and
constantly changing information makes people more fearful. It’s important for
the CNS to lead and persuade by taking the time with staff and explaining the
5. Insist on a seat at the leadership table.
The pandemic led to healthcare operational leaders and clinical leaders
working together more closely and communicating more as a team. It’s
important to not separate operational and clinical activities from each other and
to make sure everyone is working toward the same objectives. This can only
happen when CNSs play a leadership role.
“Clinical leadership is imperative in a situation like this. CNSs definitely
need to be a voice at the table,” said Matthew Beier MS, RN, CNS-BC, CNOR,
director of advanced practice nursing at Children’s Hospital of Wisconsin
in Milwaukee. “Decisions should not be made strictly from an operational
perspective. Clinical leadership through a CNS, and clinical educator is
absolutely 100% needed in a situation like this. We need to make our voices
heard and advocate for the clinical needs of the organization, not just the
6. Train, train, train.
All training is welcome but, in particular, pandemic surge training had the
unexpected benefit of calming nurses’ nerves and creating an even more
collegial environment. DeVaney helped train more than 300 nurses to manage
a surge that required moving toward a team-nursing model at UC San Diego
Health. DeVaney believes that the pandemic has been enlightening in that it
forced her team to learn new ways of getting the job done better.
“The surge training helped calm nerves because it provided a clear idea of
what may be expected of nurses,” said DeVaney. “They realized it wasn’t going
to be as scary as they thought. Training is helpful in that it sets expectations
and helps staff maintain focus.”
7. Maintain social distance but be socially inclusive.
Social distancing between family and patient—restricting access—is the
hardest part of the job. It’s wonderful when the patients are awake and alert
and want to talk to their family using various media platforms. At the same
time, it’s difficult to watch patients with COVID-19 having to FaceTime family
members. There is no physical contact with the family. The lack of intimacy can
be incredibly sad and heart wrenching.
Nurses can become emotionally drained in this environment. These
situations require a lot of discussion with staff in the form of providing care for
8. Master technology and use it.
“Our infection prevention team has been involved from the very beginning
dictating a lot of our practices when it comes to entering patient rooms,” said
Beier. “We definitely rapidly ramped up our telehealth capabilities doing a lot of
work with the nurses using telehealth right on the patient care unit. Specifically,
with patients who were positive early on in the crisis, we allowed nurses to
stay out of the patient room, only entering for critical needs or necessary
assessments and interventions. Other conversing and interactions are done by
iPad and other similar devices.”
Necessity as the mother of invention has been visible in many adaptive
behaviors, especially when it comes to using technology and bundling care to
facilitate patient visits. During the pandemic, CNSs are helping lead efforts to
improvise communications channels. All the CNSs interviewed highlighted the
importance of technology to help family members communicate with their loved
ones in the hospital. From acting as an intermediary between the patient and family
on a mobile phone to using Facetime and iPads, CNSs have helped institute a
number of communications solutions for their patients. This was especially true in
instances where family members were unfamiliar with technology.
Resurgence of the CNS
Maintaining social distance while performing the role of a CNS during
a pandemic—aptly categorized as a “roller coaster ride”—is challenging,
yet CNSs everywhere have stepped up to lead practice changes needed.
CNSs around the country are successfully modifying and strengthening their
communications, taking on more leadership roles, and adapting existing
systems and procedures for this new normal. Processes like the lessons
learned and shared in this article have helped save lives, comforted patients,
supported nurses and sparked a growing resurgence of the CNS role in
organizations across the country.
Sean Reed is president of the National Association of Clinical Nurse
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