Oklahoma Nurse - May 2021





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

May 2021

The Oklahoma Nurses Association:

2021 ONA Annual Convention

Call for Presentations and Posters

SEPTEMBER 29-30, 2021


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

• Academic

• 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

Moving Forward

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

and Transplants

• Work-life Balance/Self-care/Mindfulness/

Burnout Prevention

The Call for Proposals form to submit will be

available on our website.

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN



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

Region 1:

President: Lucas Richardson-


Region 2:

President: Donna Fesler

Region 3:

President: Leslie Davis

Region 4:


Region 5:

President: Nakeda Hall

Region 6:

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

Editor: brendan@teamngage.com


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),


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, sales@aldpub.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

local associations.


Phone: 405.840.3476

E-mail: ona@oklahomanurses.org

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 sales@aldpub.com.


ONA believes that organizations are value driven

and therefore has adopted the following core values:

• Diversity

• Safe Quality Care

• Ethical Care

• Health Parity

• Integrity and Accountability

• Practice Competence

• Professional Development

• Educational Advancement


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

medical schools.

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

program today.

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,


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

putting off?

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

ONA President

Greetings everyone!

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

for everyone.

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




The Oklahoma Nurse May, June, July 2021

Specialty Nurses

Association can be

an Organizational

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 jnelson@oklahomanurses.org


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

Nurses Month:

· 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

website (https://anayearofthenurse.org/).

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.

Find events for nursing professionals in your area.

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


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May, June, July 2021 The Oklahoma Nurse 7

Nurse Screen

App Launches

Providing Employers

& 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.

Media Contacts

Jamesha Ross, MBA,


ANA/ONA Member,



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

Pleurovac system.

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

sides hurt.

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


Marla Peixotto-Smith,

MSN, PhD, RN, CNE, is

an Associate Professor &

Coordinator of the RN2BSN

Program at Rogers State

University. Marla invites

you to contribute to the

“Educators Corner.”

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


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

Clinical Question:

Do nurses who work 12-hour shifts have a higher

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


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

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

job satisfaction, burnout and intention to leave:

Findings from a cross-sectional study of 12

European countries. BMJ Open, 5(9). doi:10.1136/


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

M., Poursadeghian, A., Mahsa, H., Poursadeghiyan,

M. (2017). Survey of shift work disorders and

occupational stress among nurses: A cross-sectional

study. Annals of Tropical Medicine & Public Health,

10(4), 978–984.

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

stress in healthcare workers. Cochrane Database of

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


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.

Bottom Line:

Evidence suggests that there is a correlation

between the length of shift worked and an increased

rate of burnout. It is necessary for healthcare

institutions and nurses to evaluate the potential

cause for burnout and make the appropriate

changes. Institutions that implemented shorter

shifts with stress intervention and prevention

programs tend to have a lower nurse burnout rate

than those without. Additionally, nurses who can be

proactive with recognizing burnout in themselves

and their coworkers will assure an optimal working

environment and continue to provide our patients

with exceptional care.

Implications for nursing practice:

It has become increasingly apparent that nurses

are suffering from burnout. Healthcare institutions

and nurses need to take the appropriate steps to

recognize, reduce, and prevent burnout. Some steps

aimed at reducing burnout are, developing modified

shift-working programs, avoiding consecutive 12-

hour shifts, provide education on stress reducing

measures, reviewing workload, improving staff

support, mentoring, and improving communication.

Having these proactive interventions in place will be

beneficial for the institution, nurses, and patients.

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


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:








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.


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.


The deadline for submission of nominations is August 1. Submit materials

electronically using the ONA website and any supporting materials via email.


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.


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 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

nursing profession.


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

Nurses Association.

• 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.


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.


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

Supervising Nurse

Phone Number

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,


Director, Marian K. Shaughnessy Nurse

Leadership Academy

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

your work.

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

win-win situations.

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

building community.

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

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Leadership is acclaiming others’ successes and

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Leadership is YOU!

How many of these leadership attributes describe


Which of these leadership attributes do you want

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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

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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.

Final thoughts

The COVID-19 pandemic is an unprecedented event in our lifetimes that

will have untold mental health implications for nurses and other healthcare

professionals on the front lines, both in the short and long term. Although

scientists and healthcare professionals know more about the disease and how

to treat it now, nurses in current COVID-19 hotspots will still be treating patients

with a serious and rapidly spreading disease while possibly contending with

shortages of PPE, equipment and treatments. 21

Nurses will need to receive support from their team, practice optimal 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:

Piatkus; 2004:249.

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

generalized anxiety disorder: a review and theoretical synthesis of evidence

on nature, etiology, mechanisms, and treatment. Annu Rev Clin Psychol.


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 &

Company; 2018:33.

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?

2020. www.psychiatry.org/patients-families/ptsd/what-is-ptsd.

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

primitive self: discussion of “somatic experiencing.” Psychoanal


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 service@nso.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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Statewide locations g competitive salary and benefits package

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retirement g M-F, 8-5, off nights g weekends and holidays, etc.

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?

(Cohen, 2015)

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,

Lawton Campus

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 &

LaRocca, 2011).

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

40). http://www.jointcommission.org/assets/1


Webster, M. (2016). Challenging workplace bullying: the

role of social work leadership integrity. Ethics &

Social Welfare, 10(4), 316–332. https://doi.org/10



Ada, Oklahoma


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

Kidney Function

The eGFR, or estimated

glomerular filtration

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,

December 2020

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 teresa_towne@bayhealth.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

new “norm.”


American Nurses Association. (2017). Health risk

assessment. www.anahra.org.

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

Nurse. https://www.myamericannurse.com/healthsafety-wellness-10/#

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


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

washing hands.


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.”

2. Overcommunicate.

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

of communication.”

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.

CNS Leadership

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

operational needs.”

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.”

Patient Visitation

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

the caregivers.

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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