Virginia Nurses Today - May 2021

The Official Publication of the Virginia Nurses Foundation 

May 2021 Quarterly publication distributed to approximately 112,000 Registered Nurses 

Volume 29 • No. 2 

We are pleased to provide every registered nurse in Virginia with a copy of Virginia Nurses Today. 

For more information on the benefits of membership in of the Virginia Nurses Association, 

please visit www.virginianurses.com! 

Read about our most successful 

legislative year ever! 

Page 3 

New Virginia Board of Nursing 

President Elected 

Page 4 

CEO Reflections 

Page 5 

VNF’s Nurse Leadership Academy 

to launch in October 2021 

Page 9 

Continuing Education 

Cultural Humility in Nursing Building the 

Bridge to Best Practices 

by Vivienne Pierce 

McDaniel, DNP, MSN, 

RN, Diversity, Equity, and 

Inclusion Council Chair, 

VNA, Diversity, Equity, and 

Inclusion Ambassador, VNF 

Board of Trustees 

Disclosures 

• Nurses can earn 1.5 

nursing contact hours 

for reading this article 

and completing the post-test. Please visit 

https://virginianurses.com/store/ to register 

for and complete the course in our virtual 

learning environment. 

• This continuing education activity is FREE for 

members and $15 for non-members! 

• The Virginia Nurses Association is accredited 

as a provider of nursing continuing 

professional development by the American 

Nurses Credentialing Center’s Commission on 

Accreditation. 

• No individual in a position to control content 

for this activity has any relevant financial 

relationships to declare. 

• Contact hours will be awarded for this activity 

until May 15, 2024. 

Learning Objectives 

• Describe the difference between cultural 

competence and cultural humility. 

• Identify strategies for integrating cultural 

humility in nursing practice. 

• Discuss what is included in diversity, equity, 

and inclusion in the workplace. 

The United States (US)) has become increasingly 

diverse, and some people may find it a challenge to 

keep pace with the transformation. We live among 

various cultures and subcultures. Culture refers 

to a group or community of people who share 

common experiences that shape how those members 

understand or view the world. Generally, culture 

includes groups or a community of people who you 

are born into such as, race, gender, religion, and 

national origin. According to Cross et al. (1989), 

depending on the group you are born into, some 

populations have negative experiences when seeking 

and receiving care and treatment more than other 

populations due to “culturally blind” interactions 

from health care providers. The authors coined 

the term cultural blindness to describe healthcare 

providers’ inability to understand cultural 

differences most specifically in underrepresented 

populations. The lack of understanding is considered 

a low point on their cultural competence continuum 

(Foronda, Porter, & Phitwong, 2020). 

While people may see the world differently, there 

are many commonalities that connect groups. 

Unfortunately, there are decades of historical 

Continuing Education continued on page 12 

Virginia Nurses 

Association & 


Foundation 

Fostering Recovery by 

Creating Moral Community in 

the Wake of a Pandemic 

2021 Fall Conference - 

Thursday, September 23 

According to a recent study by the American 

Nurses Foundation, one in four nurses surveyed 

out of 22,000 individuals sought mental health 

help within the last year and more than half of the 

nurses reported exhaustion. Nurses have been 

severely impacted by the COVID-19 pandemic, as 

well as social injustice, the state of the economy, and 

the many other unprecedented events of the past 

year. 

As we wind down from these events, many are 

beginning to see a light at the end of the tunnel. 

But what about our healthcare professionals? 

Burnout and PTSD are rampant throughout the 

nursing community and members of our nursing 

community are struggling with how to address this 

trauma and look to the future. 

Join the Virginia Nurses Association and the 

Virginia Nurses Foundation for our 2021 Fall 

Conference, Fostering Recovery by Creating Moral 

Community in the Wake of a Pandemic on Thursday, 

September 23 as we delve into the trauma of the 

past year and examine how we as nurses and a 

community move toward recovery and sustainable 

systemic change. 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

VNA Fall Conference and 

VNF Annual Gala Timeline Shift 

Traditionally, our fall conference is held on a September Friday and Saturday night and is 

immediately followed by our annual VNF celebratory gala. This year, however, we have opted to shift 

our two-day conference and gala to spring 2022. At that time, our hope is that the pandemic will be 

well in our rearview mirror and we can safely gather for in-person learning, camaraderie, and a much 

needed celebration of nursing! 

In place of the 2-day conference and gala typically held in September, we are excited to announce 

our day-long virtual conference, Trauma & Recovery in the Nursing Community, jointly presented by the 

Virginia Nurses Association and the Virginia Nurses Foundation, scheduled for September 23, 2021. 

Visit our website virginianurses.com or our Facebook page facebook.com/vanurses for updates!

Page 2 | May, June, July 2021 

2021 National Nurses Week 

Virginia Nurses Today | www.VirginiaNurses.com 

Each year, National Nurses Week begins on May 

6th and ends on May 12th, Florence Nightingale's 

birthday. It’s a week meant to go above and beyond 

in our recognition and celebration of nurses across 

the country and this year, nurses need it more than 

ever. When the World Health Organization (WHO) 

declared 2020 the Year of the Nurse and Midwife, no 

one could have imagined what nurses would face last 

year on both a personal and professional level. Even 

before the COVID-19 pandemic, nurses were the 

backbone of our healthcare system. Now, as nurses 

face new and unprecedented challenges every day, 

we are reminded of just how truly amazing they are. 

2021 Nurses Month Theme - Nurses Make a 

Difference 

Whether it is a national health emergency or 

routine daily care, nurses’ vital contributions impact 

the health and well-being of our communities, which 

is why the American Nurses Association selected 

the theme for May as Nurses Make a Difference. To 

honor nurses and support the nursing profession, 

VNA and ANA will promote weekly themes and 

activities. While continued physical distancing may 

limit face-to-face activities, we encourage everyone to 

think of creative ways to virtually engage. 

The month will be divided into four weekly 

focuses: 

Week 1: Self-care (May 1–9) 

• Use this week to focus on yours’ and your 

colleagues’ mental health and physical wellbeing. 

Week 2: Recognition (May 10–16) 

• Now more than ever, it is important to raise 

the visibility of the critical work nurses do by 

honoring nurse heroes, innovators and leaders. 

Week 3: Professional Development (May 17–23) 

• The free Nurses Month Webinar on May 19 will 

focus on the Nursing: Scope and Standards of 

Practice, 4th Edition. 

Ashby Ponds 

is now hiring nurses 

Open positions include 

- RN Charge Nurse 

- Nurse Manager 

- And More! 

Week 4: Community Engagement (May 24–31) 

• Help promote nurses’ invaluable contributions 

by engaging virtually or in-person with your 

community, educating them on what nurses do, 

and encouraging them to support current and 

future nurses. 

If you or your facility had or has planned an 

exciting Nurses Week event, please share your 

celebrations with us! 

We’d love to know more about your: 

• Florence Nightingale's birthday anniversary 

celebrations 

• Nurses Month celebrations 

• Nurses in action 

• Donations and gifts from the community for 

nurses 

You can share the photos on Facebook, and tag us 

@Virginia Nurses Association, or on our Instagram, 

@virignianurses. You can also send photos of your 

celebrations and events to VNA Communications 

Coordinator Elle Buck, at ebuck@virginianurses. 

com. 

Make sure to frequently check our website, www. 

virginianurses.com, for updates, resources, and 

nurse specific discounts! 

If there is a nurse (or nurses!) you’d like to 

publicly honor during Nurses Week, you can fill out 

the Virginia Nurses Foundation’s Honor a Nurse form 

at https://tinyurl.com/u76zro6. This is the perfect 

opportunity to celebrate a nurse friend, colleague, or 

family member or to say thank you to a nurse that 

has made a difference. We will publish the names 

of honored nurses on our website on the Honor a 

Nurse Tribute Wall and in our quarterly publication, 

Virginia Nurses Today. Additionally, all honorees 

will receive an email letting them know you wanted 

to say thank you. Your donation of $10 or more 

will support the launch of the Nurse Leadership 

Academy. For check donations, go to https://tinyurl. 

com/y9bvcuy2 to download the form to be mailed 

with your check. 

To learn more about the history behind National 

Nurses Week, visit ANA’s webpage at https://www. 

nursingworld.org/education-events/national-nursesweek/history/. 

is the official publication of the Virginia Nurses 

Foundation: 2819 N. Parham Road, Suite 230, 

Richmond, Virginia 23294, VNF’s affiliate, the 

Virginia Nurses Association, is a constituent of 

the American Nurses Association. 

www.VirginiaNurses.com 

admin@virginianurses.com 

Phone: 804-282-1808 

The opinions contained herein are those of the 

individual authors and do not necessarily 

reflect the views of the Foundation. 

Virginia Nurses Today reserves the 

right to edit all materials to its style 

and space requirements and to 

clarify presentations. 

VNF Mission Statement 

VNF is committed to improving the health 

of Virginia’s communities by developing an 

educated and diverse nursing workforce 

through leadership development, research, 

and innovation. 

VNT Staff 

Janet Wall, CEO 

Kristin Jimison, Editor-in-Chief 

Elle Buck, Managing Editor 

Virginia Nurses Today is published quarterly 

every February, May, August and November by 

the Arthur L. Davis Publishing Agency, Inc. 

Copyright © 2020, ISSN #1084-4740 

Subscriber rates are available, 804-282-1808. 

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. 

VNF 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 Virginia 

Nurses Foundation of the products advertised, 

the advertisers or the claims made. Rejection 

of an advertisement does not imply that 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. VNF and the Arthur 

L. Davis Publishing Agency, Inc. shall not be 

held liable for any consequences resulting 

from purchase or use of advertisers’ products. 

Articles appearing in this publication express 

the opinions of the authors; they do not 

necessarily reflect views of the staff, board, or 

membership of VNF, or those of the national 

or local chapters. 

Scan the QR code below 

or call 571-291-6087 

for more information

www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 3 

VNA President's Message 

VNA 2021 Legislative Session Highlights 

The 2021 General Assembly was VNA’s most successful legislative 

session in recent history - possibly of all time! We are incredibly proud of 

all the victories achieved for nursing, especially in the midst of the chaos 

of the pandemic. Nurses across Virginia raised their voices by sending 

thousands of emails, submitting written comments, engaging directly (and 

virtually) with legislators, and testifying at committee hearings. Thank 

you for lending your voice to our efforts! 

The big news - we protected our frontline COVID-19 healthcare heroes! 

HB1985 sponsored by Delegate Chris Hurst passed the General Assembly, 

providing a retroactive workers’ compensation presumption to healthcare 

workers involved in the diagnosis and treatment of COVID patients, meaning if 

they caught COVID-19 on the job, they receive workers compensation benefits 

without having to prove a specific exposure. We are one of only seven states 

to pass this type of legislation, and it is a HUGE win for nursing: 

• The legislation applies to all cases looking back to the start of the pandemic 

on March 12, 2020. 

• A diagnosis from a physician, nurse practitioner, or PA and a positive COVID 

test are required, except that prior to July 1, 2020 when testing availability 

was limited, a positive test or a diagnosis is sufficient to receive workers’ 

compensation benefits. The patient must also present or have presented with 

signs and symptoms of COVID-19 that require medical treatment. 

• A healthcare worker must avail themselves of an employer offered vaccine 

once available in order to maintain the benefit of a presumption, unless 

their physician determines in writing that it would pose a significant risk to 

their health. 

• This legislation goes into effect on July 1, 2022. More information will be 

forthcoming - check our website virginianurses.com for more information 

later this spring. 

We had many other victories and are thrilled with the progress made 

in removing barriers for preceptors of APRN students, reducing practice 

restrictions, expanding CNS prescriptive authority, focusing on the 

importance of school nurses, and more. We also are extremely proud of the 

passage of legislation focusing on a new peer to peer wellness and career 

fatigue program for nurses! 

Funding the Virginia APRN Preceptor Incentive Program 

Last year, we successfully passed budget amendments providing grant funds 

of $500,000 over two years at VDH for practitioners who serve as otherwise 

uncompensated preceptors for APRN students. Due to the fiscal impact of the 

COVID-19 pandemic, this funding was removed from the state budget last 

year. The great news is this year’s final budget agreement included $500,000 

to incentivize preceptors to offer clinical education opportunities for APRN 

students. The Virginia Health Workforce Development Authority is tasked with 

designing the details of the program and grants with input from stakeholders, 

including VNA leadership. 

This program will help increase the number of APRN graduates and thus 

increase access to care, address the primary care shortage, handle mental 

health crises, and manage chronic diseases. 

Reducing Unnecessary Practice Restrictions 

HB1737 passed the General Assembly, reducing the amount of time that 

a nurse practitioner must practice under a collaborative agreement before 

transitioning to autonomous practice from five years to two years. 

HB1817 also passed the General Assembly, allowing 

certified nurse midwives to practice autonomously 

without a collaborative agreement after 1,000 hours of 

practice. 

Linda Shepherd, 

MBA, BSN, RN 

Prescriptive Authority for Clinical Nurse 

Specialists 

Another success was HB1747 which provides that clinical nurses specialists 

(CNS) will be licensed to practice jointly under the Boards of Medicine 

and Nursing and allows the CNS prescriptive authority upon meeting the 

requirements of the boards. 

Career Fatigue and Wellness Program for Nursing 

SB1205 and HB1913 passed the General Assembly and allow certain 

protections for nurses and nursing students to confidentially participate in a peer 

to peer based career fatigue and wellness program. 

Registered Nurses in Schools 

While legislation requiring registered nurses in public schools was not 

adopted, Senate Finance Chairwoman Janet Howell included language in the 

budget directing a workgroup to make recommendations on how to achieve this 

goal. Additionally, the budget includes $50 million in state funding to support 

increasing the number of specialized student support positions per 1,000 

students, including nurses! 

Item 145 #2c 

This amendment funds the commonwealth's share of three specialized student 

support positions per 1,000 students. Specialized student support positions, 

consistent with SB1257, include school social workers, school psychologists, school 

nurses, licensed behavior analysts, licensed assistant behavior analysts, and other 

licensed health and behavioral positions. 

Study of APRN Oversight 

The 2021 Virginia state budget includes language directing the Department 

of Health Professions to study oversight of APRN and recommend any changes 

based on what other states do and recommendations of the National Council of 

State Boards of Nursing: 

Item 309 #3c: “The Department of Health Professions shall study and make 

recommendations regarding the oversight and regulation of advanced practice 

registered nurses (APRNs.) The department shall review recommendations of the 

National Council of State Boards of Nursing, analyze the oversight and regulations 

governing the practice of APRNs in other states, and review research on the impact 

of statutes and regulations on practice and patient outcomes. The department shall 

report its findings to the Governor and General Assembly by November 1, 2021.” 

If you’re interested in learning more about how to engage in the political 

process, be sure to read our CEO’s message on page 7 and check the September 

issue of VNT for information on our Legislative Advocacy hours to be held this fall! 

Our retroactive COVID-19 workers’ compensation legislation 

goes into effect on July 1, 2021. We will provide more 

information as we receive it about how the process will work 

in the August VNT and on www.virginianurses.com. 

NOW HIRING!! 

• Certified Nursing Assistant 

(Evening or Night Shift) Full 

Time with $1,000 Sign-On 

Bonus 

• Certified Nursing Assistant 

Part-Time/PRN 

• Licensed Practical Nurse Full Time 

and Part Time positions available 

For more information, call 804-524-7300. 

To learn more and apply, please visit 

https://virginiajobs.peopleadmin.com/ 

HIRAM W. DAVIS MEDICAL CENTER 

26317 WEST WASHINGTON STREET 

PETERSBURG, VA 23803


The Village at Orchard Ridge is creating an amazing, genuine and caring culture 

join our We CARE team! 

Now hiring for: 

RNs - FT day or night shift & PRN • LPNs - FT night shift & PRN 

• CNAs - FT day shift & PRN • CMA - PRN 

Now offering a Sign-On Bonus for all positions listed!!! 

New Graduates Welcome 

Our full time team members enjoy: 

Generous PTO plan • Medical, Dental, Vision insurance • 403(b) retirement plan 

• Competitive compensation • Tuition reimbursement • Incentive pay 

If you are interested in applying for a position, go to 

careers-nationallutheran.icims.com 

EEO employer 

Marie Gerardo, RN, 

MS, AMP-BC was elected 

by her Board of Nursing 

colleagues to begin her term 

as president of the board 

this past January. Following 

gubernatorial appointment 

in 2012, Ms. Gerardo began 

service, along with board 

staff, to license and regulate 

the commonwealth’s more 

than 250,000 practitioners 

across a range of nursing 

professions. 

Western State Hospital 

“It is a privilege and an honor to work both with 

the members and staff of the Board of Nursing 


New Virginia Board of Nursing 

President Elected 

Marie Gerardo 

(BON) during these unprecedented times,” says 

Ms. Gerardo. She adds, “The practice of nursing is 

expanding to meet the evolving public health needs 

of the people of Virginia and indeed the nation. 

BON is well situated to fulfill its mission to meet the 

regulatory and licensure requirements of a changing 

landscape. During my term, I will seek to further 

this legacy.” 

An accomplished presenter, author and 

researcher, Ms. Gerardo has appeared at numerous 

major conferences. Examples of her respective 

accomplishments include: a major address on Non- 

Drug Strategies to Improve Social Function in 

Dementia; writings on “Managed Care in the PACU'' 

in Perianesthesia Nursing; and, collaboration on a 

randomized study to compare the combined use of 

interferon beta 1a and glatiramer acetate for multiple 

sclerosis. Ms. Gerardo is a graduate of Boston 

College and holds an adult nurse certificate. 

The Board of Nursing is the largest of Virginia’s 

13 health regulatory boards. It’s mission is to ensure 

safe and competent patient care by licensing health 

professionals, enforcing standards of practice, and 

providing information to health care practitioners 

and the public. 

We’re Hiring! 

Opportunities available for RNs, 

LPNs, & Psychiatric Nursing Assistants 

• Psychiatric acute admissions units 

• Psychiatric longer term units 

• Med/Psych unit 

Conveniently located in the Shenandoah 

Valley, WSH affiliates with 9 Schools of 

Nursing and major universities. 

Nursing at Western State Hospital 

Offers Excellent Benefits Including: 

• Up to $7500 RN Sign On Bonus for New Hires 

• $3500 LPN sign on bonus 

• $2000 CNA sign on bonus 

• Eligibility for Federal Loan 

Repayment Programs 

• Moving/Relocation Expenses 

Reimbursement will be considered 

• Unique Clinical Care Opportunities 

• Ongoing Training Opportunities 

• Educational Assistance 

• Comprehensive Healthcare Benefits 

• Group & Optional Life Insurance 

• VRS Retirement Benefits 

• Flexible Spending Account 

• Paid Holidays, Vacation, Sick Leave 

• Short & Long Term Disability Benefits 

• State Employee Discounts 

To submit your credentials for a career enhancing position, simply... 

Visit https://virginiajobs.peopleadmin.com/ 

Connecting Innovation, 

Education and 

Collaboration. 

Duke MMCi has a blended 

format over 12 months. 

https://mmci.duke.edu/ | 919.613.0310 

Eastern State Hospital in 

Williamsburg, Virginia is hiring for full time 

Registered Nurses and 

Psychiatric Nurse Practitioners 

with a $7,500 Sign-On Bonus! 

Eastern State Hospital’s state of the art campus 

consists of two patient care buildings with 

300 patients, and a highly skilled staff. Eastern 

State Hospital offers a competitive benefit 

package to include various health care plans, 

paid life insurance, Virginia Retirement System 

retirement plan, 12 paid holidays, annual, family 

personal and sick leave. 

You can apply online at jobs.virginia.gov 

and search for Eastern State Hospital 

Western State Hospital : State psychiatric hospital licensed and operated 

by the Virginia Department of Behavioral Health and Developmental Services. 

Eastern State Hospital is an equal employment opportunity 

and affirmative action employer, and prohibits discrimination 

of applicants and employees without regard to race, gender 

(including sexual harassment, sexual orientation, gender 

identity and pregnancy), color, national origin, religion, age, 

veteran’s status, political affiliation, or disability.


CEO Reflections 

Thoughts from the CEO 

Kicking it up a notch, politically speaking 

When it comes to politics, you may be very active 

as an advocate for certain issues that come before 

the General Assembly; signing petitions, meeting 

with your legislators, participating in our virtual 

advocacy hours, and of course putting your voice 

behind your vote. With Virginia’s Gubernatorial and 

House of Delegate primaries just around the corner, 

this may be the time to consider increasing your 

impact through campaign volunteering! 

First, you’ll need to figure out which candidate(s) 

are the best fit given your interests and priorities. 

Which nursing issues speak most loudly to you? 

Is it access to mental healthcare, telehealth and 

broadband, toppling barriers for health inequities, 

ensuring there is a nurse to address the health 

needs of children in every public school, or 

continuing to ensure title and practice protections 

and growth for nurses? Be sure to visit our website, 

www.virginianurses.com to learn more about 

legislative issues relevant to nursing. 

And of course there are a myriad of other issues 

outside of healthcare that may help you identify the 

candidates whose platforms resonate most strongly 

with you. 

A good starting point is the Virginia Dept. of 

Elections website, which includes a list of 2021 

June Statewide and General Assembly Primary 

Candidates. There you can find links to the 

candidates’ websites where you can learn about 

their platforms. Note that there are two tabs in the 

document. One for democrat and one for republican 

candidates, with links to many of their websites. 

Once you’ve identified a candidate you want to 

support, contact the campaign office listed on their 

website and ask them about volunteer opportunities. 

What do they need help with? How much time 

would be required? When could you start? If you’ve 

got a couple hours to spare, there’s an opportunity 

for you. Door-to-door canvassing, for example, is 

a great way to educate voters and has been shown 

to increase turnout by about seven percent. If the 

thought of it makes you nervous, ask a friend or 

neighbor who also supports the candidate to join 

you. Mailing postcards and phone banking (cold 

calling voters) are two more important tools, and all 

three techniques can provide valuable information to 

the campaign about where voters stand in terms of 

their support, and the likelihood of persuading those 

undecided voters. 

I was talking with one of Virginia’s many great 

nursing leaders, Terri Haller, MSN, MBA, RN, NEA- 

BC, FAAN, about this very subject the other day. 

Terri, a past president of both VNA and VNF, who 

recently retired from UVA Medical Center’s nursing 

administration team, reflected that the COVID 

pandemic had impacted her ability to be as involved 

in elections as she normally would have been. 

“Like many others,” Terri shared, “I was 

concerned about the outcomes of congressional 

races across the country, and not just those where 

I am a registered voter. One day, it occurred to me 

that I could write “Get out the Vote” postcards for 

congressional candidate races where I knew the 

races were tight. I contacted those campaigns for 

address lists and devoted several hours over the 

course of a week, handwriting 200 postcards. I was 

thrilled when those candidates won their elections. 

It is extremely gratifying to know that I was able to 

contribute in the elections 

and that my contribution Janet Wall, MS 

made a difference!” 

Whether it’s at the congressional or state level, 

during a pandemic or not, the take-away is the 

same… you can make a difference through your 

volunteer efforts! 

As a volunteer you might also be asked to conduct 

research on voters’ perceptions of your candidate or 

the opposition, and enter it into related databases or 

to volunteer at a campaign booth at a local event. 

You may want to ask if there would be benefit 

to you and other nurses forming a “Nurses for 

[Candidate’s Name].” Who better to help educate 

other nurses about the merits and positions on 

nursing-relevant issues of a particular candidate 

than a group of nurses? 

Rolling up your sleeves and diving in, standing up 

for what and who you believe in, is a very rewarding 

experience that just might prove addictive. And it’s 

one of the best ways for you to have a positive impact 

on state politics. 

The best way? Run for office; a proposition more 

and more nurses throughout the country are taking 

up. We’ll hear some of their stories and talk more 

about that in a future issue of Virginia Nurses Today! 

VNA is a nonpartisan organization. Our goal is 

to ensure you have the resources to be educated on 

the issues and the candidates, to increase nursing’s 

voice in politics, and to ensure nurses are making 

informed decisions at the polls. Who you support 

and how you vote is your choice, and is a choice that 

we will always support.


Virginia Nurses Today | www.VirginiaNurses.com


Virginia is Among the First States to Truly Honor COVID 

Healthcare Heroes 

Virginia Legislators Passed a Frontline Healthcare Workers’ Compensation Bill with 

Retroactivity this General Assembly Session 

“I have been a nurse for 34 years and have dedicated my entire life to 

others. I have not worked since July 27, 2020, when I had three seizures, 

ongoing memory loss, and severe respiratory infection. Now I have heart and 

respiratory changes along with weakness that requires physical therapy,” 

said Holly Zimmerman, RN. 

After contracting COVID-19 in the workplace, Zimmerman suffered severe 

symptoms and was deemed unfit to return to work. She was left with no job 

and no funding to cover her mounting medical and day-to-day expenses. 

“As a single person, I really needed workers’ compensation to pay life's 

expenses. As a result of ineligibility, I have completely depleted my savings 

and 401K. I had to sell my car because I couldn't make the payments. My 

house and student loans have been in forbearance,” said Zimmerman. “My 

doctor reported to me that I had a severe case of COVID and six months later, 

deemed I could not return to work. This is what is hurting our nurses today, 

the length of time to recover.” 

Since the early days of the pandemic, the Virginia Nurses Association has 

received many calls and stories similar to Zimmerman’s. In response to this 

escalating crisis, the organization swiftly proposed HB 1985, a retroactive 

frontline healthcare workers’ compensation bill, to the 2021 Virginia General 

Assembly session. 

Delegate Christ Hurst (D - Montgomery) served as the primary patron of 

the bill while Delegate Jay Jones (D - Norfolk) sponsored a similar version of 

the bill for first responders. 

The bill endured many hurdles early on during the legislative session. 

Most notably, legislators were at an impasse over the compensation dates 

for the bill. The House of Delegates opted for retroactivity coverage starting 

in March of 2020 while the Senate pushed for coverage from July 2021 to 

December 2021. 

Research shows that healthcare workers are three times more likely to 

contract COVID-19 than the general public, according to a study published in 

Lancet Public Health. Furthermore, nurses treating or diagnosing COVID-19 

positive patients are at an even higher risk of contracting the virus on the 

job than other healthcare workers, per the Centers for Disease Control 

(CDC). Nurses are often working at the bedside, providing one-on-one care 

for extended periods of time to patients with COVID. That extended length 

of time equates to potential exposure to a higher viral load which increases 

likelihood of their becoming infected with COVID. 

VNA knew that a retroactive presumption to March 2020 was essential, 

especially for frontline healthcare workers who were COVID-19 long haulers. 

However, because of the nature of the virus and the massive influx of 

patients continuously straining the system, proving a workplace exposure 

was nearly impossible under existing law. Many healthcare workers 

contracted COVID-19 in the workplace since the start of the pandemic and 

some continue to experience debilitating symptoms for extended periods 

of time, making retroactivity essential to the bill in order to support our 

healthcare heroes. 

VNA Commissioner on Government Relations Mary Kay Goldschmidt noted 

because nurses were prioritized for vaccines, if the workers’ compensation 

hadn’t gone back to March, then “it would have helped almost no one.” 

Another significant concern legislators had was the bill’s fiscal impact on 

the commonwealth. Many state senators were concerned that Virginia would 

not be able to allocate the necessary funds to accommodate all frontline 

healthcare workers if they included a retroactivity clause. However, other 

states had already implemented similar legislation with a high degree of 

success. 

For example, the Minnesota Department of Labor and Industry studied 

the impact of their COVID-19 presumption for several professions, which 

went into effect at the start of the pandemic. Their review concluded that the 

policy change was effective at helping those who contracted the virus on the 

job, and costs associated with the change were less than predicted. 

Furthermore, according to the National Conference of State Legislatures, 

17 states and Puerto Rico have taken action to extend workers compensation 

coverage to include COVID-19 as a work-related illness. All but two states 

that enacted a presumption made it retroactive (those two states enacted 

their COVID-19 presumptions on March 5 and April 8 of 2020). 

“As nurses, we risk our lives every day, even before we knew COVID was 

severely contagious. This is why it needed to have retroactive coverage,” 

Zimmerman wrote in her testimony. 

Thankfully, the legislation passed with full retroactive coverage in early 

March 2021 and while some minor specifics may change, the legislation is set 

to be signed by Governor Ralph Northam (D) sometime in April. 

"We did it!" Del. Chris Hurst, D-Blacksburg, said in a Twitter post. "Health 

care heroes who got COVID on the job will get the retroactive workers’ comp 

presumption they deserve!" 

More specifically, the bill requires a diagnosis from a physician, nurse 

practitioner, or PA and a positive COVID test, except that prior to July 1, 

2020 when testing availability was limited, a positive test or a diagnosis is 

sufficient to receive workers’ compensation benefits. The patient must also 

present or have presented with signs and symptoms of COVID-19 that require 

medical treatment. 

A healthcare worker must avail themselves of an employer offered vaccine 

once available in order to maintain the benefit of a presumption, unless their 

physician determines in writing that it would pose a significant risk to their 

health. 

“I am grateful for this legislation because I would be homeless right now,” 

Zimmerman pointed out. “Passage of HB 1985 will allow us to file and receive 

retroactive workers’ compensation. This will allow me to return to financial 

security.” 

It goes without saying that this is a huge win for nursing and for Virginia. 

For the past year, frontline healthcare workers have been saving lives while 

risking theirs and their loved ones. With the one year anniversary of the 

pandemic passing, this legislation could not come soon enough for some. The 

passage of this bill highlights the desire of all Virginians to finally honor the 

contributions frontline healthcare workers have selflessly made throughout 

the past year. 

"This is how we honor our brave healthcare heroes that put themselves 

in harm's way to treat those infected with this horrible virus," Hurst said 

in a news release. "They sacrifice for us and deserve our utmost praise and 

admiration, but they also deserve our help." 

This legislation goes into effect on July 1, 2021. For more information and 

next steps, please read the August edition of VNT or email Kristin Jimison at 

kjimison@virginianurses.com.


VNF President's Message 


A Welcome Message from VNF’s New President 

Phyllis Whitehead, 

PhD, APRN/CNS, ACHPN, PMGT-BC, FNAP 

Hello, my name is Phyllis Whitehead and I am the 

new President of the Virginia Nurses Foundation. I 

thought it would be nice to get acquainted. 

I knew as a child that I wanted to be a nurse 

partially because of my mother and mostly because 

I wanted to make a difference in my community for 

those who were underserved and vulnerable. I am 

a graduate of Radford University where I earned 

my BSN. I started my career working as a bedside 

Bachelor of Science 

in Nursing (RN to BSN) 

[6 

For practicing RNs who 

wish to obtain their BSN 

Finish in 5 semesters 

part-time 

Financial aid available 

for those who qualify 

Among the state's 

most economically 

priced programs 

nurse in oncology and then in long term care as 

an assistant director of nursing until I returned 

to school to become a clinical nurse specialist and 

earned my MSN. 

After earning my degree, I started a hospice 

service in my rural community and worked there 

for the next 10 years until I was asked to start a 

palliative care service at Carilion Roanoke Memorial 

Hospital. During this time, I earned my doctorate 

degree at Virginia Tech with a concentration in 

end of life care and the impact it has on nurses 

Clinical Nurse 

Leader (MSN) 

For RNs with their BSN who wish 

to become advanced practitioners 

✓ 

Accreditations & Certifications: 

Two starts per year 

(Jan., Aug.) 

Online format with 

two clinical courses 

Part-time curriculum 

for busy RNs 

Certified by SCH EV to operate in Virginia, 

accredited by ABHES & approved by NC-SARA. 

and other healthcare 

professionals. So, if you 

are doing the math, I have 

been a nurse for 32 years! 

Presently, I work as 

a clinical ethicist and 

palliative medicine clinical 

nurse specialist with 

Phyllis Whitehead, 

PhD, APRN/CNS, 

ACHPN, PMGT-BC, 

FNAP 

the Carilion Roanoke Memorial Hospital (CRMH) 

Palliative Care Service. I am also an associate 

professor at the Virginia Tech Carilion School of 

Medicine in Roanoke. 

I initiated several programs including a nursedriven 

pain management service, a palliative care 

service and a moral distress consult service to name 

a few. I am motivated to be innovative and to be of 

service to my fellow nurses. 

I hold several certifications: one in pain 

management and another as an advanced practice 

hospice and palliative care nurse. I enjoy sharing 

and learning from others and have presented on 

pain and symptom management, opioid induced 

sedation, moral distress, and patients’ end of life 

preferences locally, regionally, nationally and 

internationally. I have also been honored to have 

presented numerous presentations for Virginia 

Nurses Association and Virginia Nurses Foundation 

conferences and webinars on opioid use disorders, 

moral distress and ethics. 

My curious nature has led me to ask lots of 

questions throughout my career which naturally 

nudged me down the research path. My research 

interests include pain management, moral distress 

and improving communication with seriously ill 

patients. 

I have been an active Virginia Nurses Association 

and Virginia Nurses Foundation member for many 

years. I served as the co-lead of the Access to Care 

Workgroup, was selected as one of the co-leads of the 

Virginia Action Coalition and have actively served 

until transitioning into the role of VNF president. I 

was instrumental in the launch of VNF’s Mental 

Health Roundtable several years ago and have 

been an active participant co-leading the Stigma 

Workgroup. I became intrigued with this project 

because my pain management background piqued 

my interest in how we can better care for patients 

and fellow nurses who have been diagnosed with 

substance use and opioid use disorders. This led 

to my selection for Governor Ralph Northam’s 

Policy Council on Opioid and Substance Abuse 

representing the Virginia Nurses Association 

in order to better manage and address these 

challenging issues. Working with VNA/VNF CEO 

Janet Wall, MS, I was recently selected to lead the 

foundation’s Robert Wood Johnson Foundation 

Innovation Award work to implement several 

initiatives intended to advance mental health of K-12 

students in economically disadvantaged areas of the 

commonwealth. 

In 2020 I was elected as a Distinguished 

Practitioner Fellow in the National Academy of 

Practice in Nursing. 

I am honored to assume the office of Virginia 

Nurses Foundation President. I am passionate about 

nursing and promoting the role of the nurse here 

in Virginia. Everyday, I see the positive impact that 

nurses have on patient care, their organizations 

and communities. Nurses also need support 

and encouragement as we navigate the complex 

healthcare landscape. I am excited to be part of the 

future work, collaboration and innovation of the 

Virginia Nurses Foundation and look forward to 

working with you. 

Henrico County Public Schools now hiring 

RNs for the 2021-2022 school year. 

Generous benefits including Dental, Flexible 

Spending Accounts, Income Protection, Virginia 

Retirement System (VRS) and more! 

To view and apply visit: 

henricoschools.us/ 

careers/


VNF’s Nurse Leadership Academy to 

Launch in Fall 2021 

The Nurse Leadership Academy is a brand 

new year-long leadership development program 

spearheaded by the Virginia Nurses Foundation in 

partnership with the Virginia Nurses Association 

and set to launch virtually this October. Intended 

for new and emerging nurse leaders across all 

healthcare settings, fellows of this robust program 

will learn foundational leadership skills and 

demonstrate these skills through an applied 

leadership project within their organization. 

The first six months of this Academy program will 

be dedicated to live didactic sessions and webinars 

focused on five concepts: Fundamentals of Effective 

Leadership, Organizational Culture, Facilitating a 

High Reliability Environment, Influencing Change: 

Driving Outcomes through Strategic Action, and 

No Margin No Mission: Examining the Finances 

of Healthcare. During the subsequent six months, 

fellows will develop an applied leadership project 

with support from their individually identified 

mentor. Check-in points with program leadership 

and peers will be convened through a virtual 

community, and the program will culminate at 12 

months with fellows’ presentations of their applied 

leadership projects. 

Desired Outcome 

Fellows will learn foundational leadership skills 

and demonstrate this through successful completion 

of an applied leadership project within their 

organization. 

Structure 

• Months 1-5: 

o Five Live didactic sessions and additional 

webinars 

o Fellows will: 

- identify a leadership mentor 

- identify an organization-approved applied 

leadership project that will demonstrate a 

positive impact on their organization and 

showcase their leadership acumen 

- complete a leadership assessment to gain 

feedback on their personal leadership 

style 

• Months 6-12: 

o Fellows will complete an applied leadership 

project 

o A virtual community will be provided for 

additional coaching opportunities with 

program leadership and peer-to-peer 

engagement 

• Month 12: 

o Fellows will present a formal presentation on 

their applied leadership project 

Curriculum 

• October 13, 2021: Fundamentals of Effective 

Leadership 

• November 4, 2021: Fundamentals of Effective 

Leadership Cont’d. 

• December 2, 2021: Organizational Culture 

• January 19, 2022: Facilitating a High 

Reliability Environment 

• February 24, 2022: Influencing Change: 

Driving Outcomes through Strategic Action 

• March 24, 2022: No Margin No Mission- 

Examining the Finances of Healthcare 

• TBD: Final Program Applied Leadership Project 

Presentations 

Cost 

Single registration: $1,295 per registrant 

Group registration (If your employer will be paying 

for three or more registrants from your organization): 

$1,195 per registrant 

Sign up to be notified when registration opens for 

the Nurse Leadership Academy https://tinyurl.com/ 

VNFNLA. Questions can be sent to VNA/VNF CEO 

Janet Wall at jwall@virginiianurses.com. 

NLA Steering Committee Members 

The Virginia Nurses Foundation is infinitely 

grateful to these nursing leaders for their 

hard work, innovative thinking, and 

dedication toward creating an unparalleled 

leadership program for nurses throughout the 

commonwealth. 

• Terris Kennedy, PhD, RN, Immediate Past 

President, Virginia Nurses Foundation 

• Linda Shepherd, MBA, BSN, RN, 

President, Virginia Nurses Association 

• Lindsey Cardwell, MSN, RN, NPD-BC 

• Jaime Carroll, MHA, BSN, RN 

• Mary Dixon, MSN, RN, NEA-BC 

• Jayne Davey, MSN, RN, NPD-BC, CNN 

• Jay Douglas, MSM, RN, CSAC, FRE 

• Elizabeth Friberg, DNP, RN 

• Donna Hahn, DNP, RN, NEA-BC 

• Terri Haller, MSN, MBA, NEA-BC, FAAN 

• Ronnette Langhorne, MS, RN 

• Nellie League, MSN, BSN, RN, NE-BC 

• Nancy Littlefield, DNP, RN, FACHE 

• Trula Minton, MS, RN 

• April Payne, LNHA 

• Meg Scheaffel, BSN, RN, MBS-MHA 

• Jeannine Uzel, RN, MSN 

• Janet Wall, MS 

• Deb Zimmermann, DNP, RN, NEA-BC



VNA rolls out sleek CE learning platform 

Did you know that as a member benefit, VNA 

has more than 30 hours of nursing continuing 

professional development available to you for free?! 

It’s now easier than ever to access! VNA launched a 

new learning environment this month and we want 

our members to be the first to check it out! 

The new learning environment makes it incredibly 

easy for you to access continuing education courses, 

complete them at your own pace, and manage your 

nursing contact hour certificates! Simply logon 

to VNA’s website, visit our Nursing Continuing 

Professional Development store to select your 

course(s), and then complete your education. You 

can come back any time to complete your courses or 

obtain your certificates – no need to remember where 

you were in the process. We’ll save your spot! 

We have an ever growing selection of pre-recorded 

webinars, articles, and conference recordings 

on diverse topics including ethics, legislative 

advocacy, COVID-19, staffing, patient safety, and 

more. Browse our store by category or search for a 

specific word to easily find relevant courses. With 

more than 30 hours of free content for members, 

VNA is your source for professional development 

and the contact hours needed for your license 

renewal. To learn more, visit virginianurses.com/ 

store and watch a brief video to show you how to 

start taking advantage of this awesome new learning 

environment today! Remember to check in monthly 

as we continually add new content! 

W e’re H iring! 

RNs, LPNs, CNAs, and more! 

Various shifts (full time, part-time, per diem) 

www.wcbay.com/careers 

3100 Shore Drive, 

Virginia Beach, VA 23451 

NOW 

HIRING 

NURSES 

www.saintmaryshome.org 

NOW HIRING 

LPNs & RNs for full-time, 

part-time, & PRN opportunities 

Fairfax, Annandale, McLean & Alexandria 

https://discoverymood.com/careers/ 

https://centerfordiscovery.com/about-us/careers/


Congratulations to our new Chapter leaders! 

Piedmont Chapter 

Student outreach chair 

Sally Haines, MSN, FNP-BC, BSN, RN 

Clinician 

University of Virginia Medical Center 

“I hope to deepen and expand my roots by 

becoming a leader in our local VNA chapter. As 

student outreach chair, I hope to give back to the 

nursing community that has helped me start my 

nursing career and get to where I am today.” 

Government relations chair 

Janice McCormick, RN, MSN, CPNP 

University of Virginia Medical Center 

“It is imperative that nurses be at the table with 

those individuals creating health care policy and 

legislation. As a nurse leader, it's absolutely crucial 

to listen to others, to demonstrate empathy and 

to work together to resolve issues. I've heard from 

legislators that they want to hear from nurses, 

they want to know about our patients and families 

experiences, so they can be better informed.” 

Hampton Roads Chapter 

Board of Directors: 

Vanessa Moore, BSN, RN 

Consulate Health Care Norfolk 

“I am a dedicated hard-working nurse looking 

forward to broadening my territory. I am excited to 

be more involved in the local chapter, and thrilled 

to have an opportunity to be of service to the 

organization and help with continued growth.” 

Sandra OIanitori, MS, RN 

Norfolk State University 

I really care about VNA from the chapter level, 

state level and the national level. I do my very best 

to participate and be committed to my nursing 

organization in giving my time, talent and treasures. 

Being involved in professional organizations has 

served me well in my career and in networking 

and collaboration with my fellow colleagues. I look 

forward to sharing my experiences with members of 

the chapter. 

Linda Burnette, BSN, MSA, RN, CENP, CHEP 

ECPI 

“I believe in the importance of belonging to 

professional organizations to network, mentor, 

support great work of those within our profession, 

and facilitate growth for all of those involved. I am 

committed to the work that is done with VNA and 

proud to be part of it, and I look forward to this 

opportunity to expand my experience.” 

Government Relations Chair 

Christine Payne, BSN, MBA 

Immunization RN 

“I believe that as nurses, advocacy and 

community activism are natural extensions of 

patient care. We are a trusted profession and as 

such, our words matter. Our concerns and positions 

on issues of import have validity. To that end, I have 

maintained an active presence in the development 

of state policy, and advocating for many issues, I 

have cultivated many quality relationships with 

members of the state legislature, as well as members 

of the Governor's Cabinet. It will be an honor to help 

elevate the voice of our profession and advocate for 

the VNA's legislative agenda.” 

Student outreach chair 

Catherine Paler, MSN RN PCCN 

Sentara 

“I look forward to utilizing my considerable work 

experience, coupled with my education to promote 

best practices and professionalism in nursing 

practice. As student outreach chair, I hope to gain 

more experience in building relationships with other 

committees, networking, and playing a key role in 

shaping the future for nursing.” 

Central Virginia Chapter 

Board of Directors: 

James Gill, MS, AGACNP-BC, CCRN 

Sound Critical Care 

“I have a true passion for the nursing profession and 

believe that nursing is not just a job, but a lifestyle. I 

want to be an advocate for changes to better serve our 

patients, their families, and our nurses in Virginia. I 

continue to develop my own career and will continue to 

grow in nursing for the rest of my life. It is my calling, 

and I look forward to serving the Central VA chapter.” 

Olayinka Majekounmi, MSc, BSN, RN-BC 

Aetna/CVS Health 

“I am a patient advocate, and I have a passion 

for, and commitment, to education, health care and 

customer service. While I am new to the Richmond 

area, I am not new to leadership. I am looking 

forward to developing new ways to get involved in 

and serve the greater Richmond metro area, and I 

believe that this is a great way to start!” 

Student outreach: 

Tyler Gaedecke, BSN, RN 

“Nurses are uniquely positioned to create systemic 

change in health equity and national wellbeing if 

we can empower each other the way I believe we 

can. A massive part of that is communicating this 

empowerment to young nurses in school as part of their 

professionalization. That is why I would love to create a 

relatable bridge to nursing students in Central Virginia 

during my term as Student Outreach Chair so that we 

can empower nurses from the very start of their career.” 

Treasurer: 

Beverly Ross, PMHCNS, BC, Retired 

“I have experience in the position of treasurer over 

this past year and have learned a great deal. It has 

been an honor and a pleasure to serve the nurses of 

Virginia and Chapter 5 for over 30 years in a variety 

of capacities. I will continue to serve as treasurer 

with enthusiasm and a commitment to the values 

and needs of our members.”


Continuing Education 


Continuing Education continued from page 1 

events which have occurred that continue to cause 

disconnect, misunderstandings, and even violence. 

Racial injustice, oppression, and historical trauma 

is embedded in the daily lives of people from 

marginalized groups. According to the National 

Collaborating Centre for Determinants of Health 

(2020), marginalized populations are groups and 

communities that experience discrimination and 

exclusion because of unequal power relationships 

across economic, political, social and cultural 

dimensions. Becoming culturally aware, 

appreciating cultural diversity, and practicing 

cultural humility will help you overcome and 

prevent racial and ethnic divisions as well as the 

misunderstanding that creates conflict. Cultural 

awareness is one of the concepts of cultural 

competence. 

Cultural Competence 

Cultural competence has been the foundation 

for providing care to diverse populations in the 

healthcare environment for decades (Greene- 

Moton and Minkler, 2020). Although the concept of 

cultural competence derived from social workers 

and psychologists in the early 1980s (Nadan, 2017), 

there are many nursing theorists who studied 

cultural competence to garner more knowledge 

with the hopes that nursing professionals would 

provide more culturally appropriate, patient 

centered care. Cultural competence promotes 

acknowledgement and acceptance of differences in 

appearance, behavior and culture (Nadan, 2017). 

Just as there are many cultural theorists, there 

are several definitions for cultural competence. A 

landmark definition of cultural competence from 

the U.S. Department of Health and Human Services 

Health Resources and Services Administration was 

requoted by Greene-Moton and Minkler (2020): 

Cultural competence comprises behaviors, 

attitudes, and policies that will ensure that a 

system, agency, program, or individuals can 

function effectively and appropriately in diverse 

cultural interaction and settings. It ensures 

an understanding, appreciation and respect 

of cultural differences and similarities within, 

among, and between groups (p. 142). 

Madeleine Leininger is the founder and leader of 

the academic field of transcultural nursing. The 

seminal work of Leininger and McFarland (2002) 

underpins the significance of nurses gaining an 

understanding of a patient’s cultural background 

and how it impacts the patient’s health. Nurses can 

use that knowledge to develop the appropriate care 

plan to improve the patient outcomes. Leininger’s 

transcultural nursing theory allows nurses to study 

cultures to understand similarities and differences 

in groups and prepares nurses to interact with 

human beings on a cultural level to assist them 

in attaining and maintaining meaningful and 

therapeutic practices. Many nursing theorists who 

followed Leininger used her transcultural nursing 

theory as a foundation for their work. 

Cultural theorist Campinha-Bacote (1998) first 

developed her cultural competency in the delivery of 

her healthcare services model in the late nineties. 

Campinha-Bacote defined cultural competence 

as “the process in which the nurse continuously 

strives to achieve the ability and availability to 

Join our team of dedicated 

professionals as we brighten the journey of 

those with advanced illness. 

NOW HIRING: 

• RN, On Call 

• RN, Clinical Manager 

• RN, Admissions Manager 

• RN, Case Manager, Loudoun/Clarke/Winchester 

• RN, Inpatient Care Center 

Offering $5,000 Sign-on Bonus to be paid out over the first two years 

Please apply at https://brhospice.org/get-involved/ 

or contact tlambert@blueridgehospice.org 

effectively work within the cultural context of a 

client, individual, family or community” (p. 6). 

Campinha-Bacote (2002) refined her model of 

care in 1998, introducing cultural competence as 

a process with constructs that included cultural 

awareness, cultural knowledge, cultural skill, 

cultural encounters, and cultural desire. There does 

not seem to be an endpoint to cultural competency 

causing a controversy as to whether it is obtainable. 

Best practices for cultural competency seem to point 

toward valuing cultural diversity, self-awareness and 

accepting differences. My position is it cannot be 

done without applying cultural humility. 

Cultural Humility 

Public health physician Melanie Tervalon 

and clinical administrator, Jane Murray-Garcia, 

introduced the concept of cultural humility over 

three decades ago in 1998 on the premise that it 

was more important than trying to achieve cultural 

competence (Greene-Moton and Minkler, 2020). 

Since its induction to the fields of medicine and 

public health, cultural humility has been accepted 

in multiple disciplines as an achievable guidance 

of unbiased, patient-centered care. Masters et al. 

(2019) introduced a tool created by a workgroup 

within the Society of Medicines Hospital Medicine’s 

Practice Management Committee as a framework for 

addressing biases in patient care using the 5-Rs of 

cultural humility. The 5-Rs are reflection, respect, 

regard, relevance, and resiliency. One of the aims 

of the tool is to reduce implicit biases and decrease 

disparities as healthcare providers interact with 

culturally diverse patients (Masters et al. 2019). 

Cultural diversity and cultural awareness lay the 

foundation for cultural humility. The basic premise 

for awareness is to understand first before expecting 

to be understood (Barnes et al., 2020). According 

to the authors, taking a personal inventory of your 

becoming will help you to understand who you 

are, and how you relate to those around you. How 

you view yourself, and your biases allows you to 

challenge any maladaptive and potentially damaging 

beliefs (Barnes, et al., 2020). Inquisitiveness, 

continuous critical self-reflection, and lifelong 

learning are the principles of cultural humility. 

Figure 1. 

Visualizing Health Equity: One Size Does Not Fit All 

Infographic 

Note. The Robert Wood Johnson Foundation does not 

require permission to reuse this image. Download 

and share this image to #PromoteHealthEquity, which 

means a fair and just opportunity for all. 

The National Institutes of Health (NIH) defines 

cultural humility as “a lifelong process of selfreflection 

and self-critique whereby the individual 

not only learns about another's culture, but one 

starts with an examination of her/his own beliefs 

and cultural identities'' (Tervalon, & Murray- 

Garcia, 1998; Yeager & Bauer-Wu, 1998). Nurses 

Foronda, Reinholdt, & Ousmnan (2016) suggest 

that we live in a multicultural world where power 

balances exist, and cultural humility is a process 

of openness, self-awareness, egoless, supportive 

interactions, self-reflection and critique after 

willingly interacting with diverse individuals and 

the results of achieving cultural humility are mutual 

empowerment, partnerships, respect, optimal care, 

and lifelong learning (Figure 1). When you foster an 

environment of humility it allows you to establish 

relationships with people from cultures different 

from your own. Forming relationships with people 

from diverse populations goes beyond learning about 

their cultures. It allows you to act as an ally against 

racism and other forms of discrimination and 

oppression. 

Figure 2 

Inclusivity in the Workplace 

V. McDaniel, 2021 

The controversy of whether you should practice 

cultural competence or cultural humility continues 

to be a debate. While some colleagues in the nursing 

profession and other disciplines have suggested 

abandoning cultural competence for cultural 

humility, in 2018, Campinha-Bacote introduced a 

new paradigm of thought (Figure 2) that suggested 

there is a synergistic relationship between cultural 

competence and cultural humility and that 

synergy is embodied in a term she coined "cultural 

competemility” (Campinha-Bacote & Fitzgerald, 

2019). According to the authors, “competemility 

has the potential to contribute to impacting the 

delivery of culturally conscious healthcare services 

and experiences to all patients, families, and the 

community.” 

Integration of Cultural Humility in Nursing 

Practice and the Workplace 

Intentional engagement in self-reflection and 

reflexivity is an intrapersonal skill, and maybe one 

of the best practices that should be used to integrate 

cultural humility in nursing practice (Hook, 2014). 

Self-reflection is a lifelong process of serious thought 

about your own character, actions, and motives, and 

reflexivity is about what you do with the knowledge 

you garner from being reflective. It allows an 

individual to acknowledge their own biases, and to 

be open to who they are, and to understand how 

they feel about another individual’s persona. What 

makes your patients, co-workers, and colleagues 

who they are is complex, so to really learn all you 

need to know about them, you must engage in active 

and mutual listening. 

Mindful active listening is an interpersonal 

talent (Hook, 2014) which allows you to gain a 

better understanding of the patients you serve, the 

students you teach, and the people you encounter 

daily. People are more than the hue of their 

skin, their sexual orientation, or their religious 

affiliation. While these differences may govern how 

others view a person, they do not define the whole 

person. For example, patients are not just their 

diagnosis. It is pivotal that you consider how the 

social determinants of health impact them. Inquire 

as to barriers that impede them from receiving 

safe, equitable quality care, know their preferred 

pronouns when addressing them, and learn about 

the communities in which they live. 

In academia, students should not be referred to 

as “that student who is always late for class.” Gain 

an understanding of how social determinants of 

education can be a barrier to success. Address 

your students’ cultural linguistic needs, their workschool-life 

unbalances, and other challenges that 

may inhibit learning. It is imperative that we focus 

on factors outside of the classroom be it online, or 

in a building, that significantly impact and impede 

the success of students, especially those individuals 

from marginalized populations. You must become 

an active component of the social change. Join the 

diversity, equity, and inclusion movement, and use 

your voice to influence policies at every level. 

There seems to be a gap in our intentions and 

our actions as it applies to social justice and equity.


Systemically, creating a pipeline of agents of cultural humility who will then 

mentor others will help close the chasm that currently exists. We must move 

away from simply writing a diversity statement denouncing racism and other 

acts of discrimination and oppression and take on a more active role. Chief 

nurse executives, directors of nursing, deans of schools of nursing, and chief 

diversity officers are positioned to change organizational policies and hold 

people accountable for their acts of racism, oppression, and microaggressions. 

“Microaggressions are those every day, subtle, intentional –and oftentimes 

unintentional– interactions or behaviors that communicate some sort of bias 

toward historically marginalized groups” (Limbong, 2020). 

The number of marginalized groups have grown exponentially and so have 

the microaggressions towards those groups. Microaggressions often occur 

when people allow their biases to victimize an individual or groups of people 

from marginalized populations in a way that leaves their victims feeling 

uncomfortable or insulted. Taking a defensive stance, the victimizer may tell 

the person they are being overly sensitive, even when it is not oversensitivity. 

Often the remarks are because the victimizer has learned a stereotype or has 

not learned enough about the person’s culture to engage in culturally sensitive 

communication. Often the remarks are painful since they seem to attack the 

person’s membership in a group that is known to be discriminated against. 

Chester M. Pierce coined the term microaggressions in 1970 to describe the 

subtle insults and putdowns experienced by African Americans (American 

Psychology Association, 2009) but microaggressions can be targeted at anyone 

from a marginalized group (Park & Holtschneider, 2021). 

Barnes et al. (2020) posed this overarching question, “when do we move 

beyond simply defining over and over again what diversity is, to engaging in 

how we are going to invest in humanity by practicing humility, equity, and 

inclusion daily?” This is a thought-provoking inquiry that we must ask ourselves 

constantly as we encounter people who challenge us to move outside of our 

comfort zone. According to Barnes et al. (2020), it is only through the scope of 

cultural humility –which leads to civility– that equity and inclusion is realized. 

Incorporating cultural humility in your practice requires you to exude an egoless, 

nonthreatening, approachable demeanor when engaging with diverse groups. 

Diversity, Equity, and Inclusion in the Nursing Work Environment 

Diversity. There are many ways to foster an environment of diversity in 

the work environment. Promoting diversity in the workplace does not include 

tokenism (Njie-Carr, et al., 2020). According to the authors, tokenism is when you 

hire a small number of people from marginalized or underrepresented groups to 

give the appearance a diverse workforce. There are several definitions of diversity 

depending on the lenses from which it is viewed. Most people think of diversity 

of identities such as race and gender, ethnicity, religion, nationality, or sexual 

orientation however, one can have diversity of work and life experiences, viewpoints, 

backgrounds, and even strengths or weaknesses. A diverse healthcare organization 

means you have the presence of differences of identity (Tan, 2019) as well as 

other aspects of diversity such as a person’s way of thinking, their personality, 

and leadership style, and their personal and professional experiences throughout 

the organization. An organization can be diverse without being inclusive and a 

company can be inclusive without being equitable. 

Equity. There is a common misconception that equity and equality are 

synonymous; they are not. Equity is an approach that ensures everyone 

has access to the same resources, treatment, and opportunities according 

to their needs (See Figure 1). It is all about fairness. Equity recognizes that 

disadvantages and barriers exist, and as a result, not all people start at the 

same place (Tan, 2019). People from marginalized populations may require 

more resources to succeed and cross the bridge to closing the achievement 

gap. Equity ensures people are treated according to their needs irrespective of 

gender, sexual orientation, ethnicity, and race or any other group they may be 

categorized in. Equitable employers engage in fair promotions. 

Inclusion. Even with a diverse team it does not mean that everyone feels 

welcome or valued or that they are given the opportunity to succeed. Inclusivity 

in the workplace (Figure 1) is about all employees feeling and being valued, and 

welcomed within your team, or workplace. Educator Verna Myers stated it in 

simple terms. She said, “diversity is being asked to the party; inclusion is being 

asked to dance” (Cho, 2019). It is everyone’s responsibility to ensure employees 

feel included. Inclusive environments in the workplace introduce policies for 

honoring a variety of cultural and religious practices, foster a company culture 

where every voice is welcome, heard, and respected, and recognize and build a 

multigenerational workforce (Chow, 2021). 

Implicit Bias 

The term implicit bias was first coined by social psychologists Mahzarin 

Banaji and Tony Greenwald in 1995 (Ruhl, 2020). In Banaji and Greenwald’s 

(1995) influential research paper they introduced their theory of implicit 

social cognition which proposed that social behavior was largely influenced by 

unconscious associations and judgments. According to the authors, implicit bias 

(implicit social cognition) refers to the attitudes or stereotypes that affect one’s 

understanding, actions, and decisions in an unconscious manner. These biases 

Southwestern VA Mental Health Institute 

SWVMHI is a 179 bed state-of-the-art inpatient Mental Health 

facility located in the beautiful mountains of Southwestern 

Virginia and is part of Virginia’s Dept. of Behavioral Health 

and Developmental Services. 

Nursing employees make a valuable difference in the lives of 

the individuals served on our Acute Admissions, Long- term 

Adult, or Geriatric Units. 

www.virginiajobs.peopleadmin.com 

Visit the website or use the QR Code above to apply today! 

Excellent Benefits Include: 

* $5,000 Sign-On Bonus for Registered Nurses 

* $1,000 Sign-On Bonus for Active Virginia 

Certified Nurse Aides 

* Shift Differential, Weekend and Holiday 

Supplements 

* Employer/Employee funded Retirement 

* State Life Insurance 

* Minimum of 28 Days of Paid Time Off/Yr. 

can be both favorable and unfavorable and are usually activated involuntarily 

and without an individual’s awareness or intentional control (Ruhl, 2020) 

and are often caused by stereotypes. Unconscious bias can lead to incivility, 

harassment, discrimination, people feeling excluded, being less productive 

and disengaged. It interrupts or dismantles diversity efforts, impacts employee 

development, and negatively affects staff retention. Professionals who desire to 

learn more about implicit biases and implicit bias training may visit the Project 

Implicit website at https://implicit.harvard.edu/implicit/. 

Read the following Lived Case Events to determine if you can identify 

microaggressions, racism, oppression, acts of humility, implicit or explicit bias, 

lack of cultural awareness and sensitivity and stereotypes. 

Lived Case Experience 1 

Tessimika Jefferson has an appointment for a colonoscopy. As the two nurses 

at the gastroenterologist office are preparing for the procedures for the day, 

they review the list of patients who are scheduled. They both start laughing 

when they see Tessimika’s name. Nurse One says, “I don’t know why these 

Black people come up with all these crazy names; why can’t they just name the 

child Sarah or Linda.” Nurse Two replies, “I started laughing because I knew 

you would say that; her mama’s name must be Tessie, and her daddy’s name is 

Michael.” “I have a friend who is African American, and I asked her why some 

Black people make up such hard to pronounce names, and my friend said she 

thinks it is generational. I have always appreciated the creativity that African 

Americans use in naming their children; I find it refreshing and, well, simply 

different.” “She said when Black people were brought to this country and 

enslaved, they were stripped of everything including their names and given 

common names, so she felt it was somehow related to that.” When Tessimika 

arrived for her appointment the two nurses were shocked; she was not Black, 

she was a middle-aged White woman. 

(In this Lived Case Event you cannot assume that Nurse One is racist because 

she laughed at the patient’s name. However, she does demonstrate explicit bias 

by her overt racist comments. By laughing with Nurse One, Nurse Two seems to 

go along with her instead of letting her know her comments sound racist. This 

is a missed opportunity for Nurse Two to speak out against Nurse One’s racist 

comments. Nurse Two does seem to have an element of cultural awareness. 

She was inquisitive about the naming of African American children enough to 

ask someone she trusted although it should not be a topic of discussion. There 

are stereotypes in this case event. When you stereotype you are inferring that 

all members of a group have the same range of characteristics. You must never 

assume someone’s persona based on their name). 

Continuing Education continued on page 14 

FACULTY OPENINGS 

Adult Health BSN Faculty 

Clinical Adjunct Faculty (Adult, Women’s Health) 

Adult Health BSN Faculty positions are 9-month full-time beginning September 

2021 in the Department of Nursing for the freshman-entry BSN program. Full 

time positions are tenure-track or clinical track. 

Clinical adjunct faculty positions are available for fall 2021 (med-surg) and spring 

2022 (fundamentals, med-surg, women’s health) to facilitate clinical learning in 

regional health systems. 

To view full job postings, position requirements, and the application process, 

go to https://www.rmc.edu/departments/nursing/employmentopportunities. 

Randolph-Macon College, founded in 1830, is a selective, primarily residential 

liberal arts college with an enrollment of 1500 students located in the northern 

suburbs of Richmond, Virginia and 90 miles south of Washington, DC. R-MC 

seeks faculty committed to advancing inclusion and equity. 

www.rmc.edu/ 

departments/nursing



Continuing Education continued from page 13 


Nurse One: “I love talking to you; you’re not like 

the rest of them.” 

Nurse Two: “Hmmm, what do you mean?” 

Nurse One: “You speak so well, I mean, you’re so 

articulate and you just act different. No one has to 

ask you to do anything. Most of the other nurses 

are so lazy and they use too much slang even when 

they talk to the patients. I can’t figure out what some 

of the foreign nurses are saying half the time and 

don’t know why they can’t find work in their own 

country in the first place. And I’ve heard that they 

make more money than we do and are willing to 

do anything to get paid. You would think that our 

bosses would treat people who are from this country 

better than they do immigrants, but they don’t. 

Sometimes I wish they would all go back where 

they came from and stop taking our jobs, but then 

I wouldn’t have anyone to dump my worst patients 

on.” 

Nurse Two: “I’m really uncomfortable with this 

conversation.” 

Nurse One: “How can you be uncomfortable; I told 

you; you aren’t like them. You should feel honored by 

the compliment.” ©V.McDaniel 

(In this Lived Case Event there are 

microaggressions, (i.e., you are not like the rest; 

you’re so articulate), lack of cultural awareness and 

sensitivity [I can’t figure out what some of the foreign 

nurses are saying] and blatant unadulterated racism 

and oppression [you would think that our bosses 

would treat people who are from this country better 

than they do immigrants; sometimes I wish they 

would all go back where they came from and stop 

taking our jobs]. It is Nurse One’s desire to oppress 

people who do not look like her. Nurse Two took the 

appropriate stance, but she should take it a bit further 

and report the behavior to the appropriate supervisor 

and there should be policies in place to address the 

encounter). 


Danford has been working for his healthcare 

organization (HCO) for more than 20 years. The HCO 

has just started a diversity, equity, and inclusion 

(DEI) committee and the vice president has asked 

Danford to be the chairperson. He is excited about 

the opportunity but is not sure he is the right 

person to chair the committee. As Danford reflects, 

he thinks about his own biases, the research he 

has conducted on DEI, the training he has had on 

implicit bias, and the DEI organizations in which 

he holds membership. Mostly, he thinks about his 

many talks with his co-worker, Marie and how much 

he has learned about her culture and the culture of 

people from marginalized groups during their daily 

lunch breaks. He asks Marie if she would like to 

co-chair the committee with him and she says yes. 

Danford goes to administration and is baffled when 

his idea is met with resistance, especially when 

the vice president asks, “what does that gal know 

about DEI?” “Who is going to take her seriously with 

those braids in her hair? Tell her to wear her hair 

more professionally then maybe I will reconsider.” 

Danford sees this as a teachable moment and starts 

to tell the vice president that he probably shouldn’t 

refer to Marie as ‘gal,’ and how inappropriate it is 

to exclude someone for how they wear their hair. 

Danford is unyielding. He continues to tell the vice 

president the significance of having Marie on the 

DEI committee. The vice president gives in. Danford 

cannot wait to tell Marie the good news. ©V.McDaniel 

(There are many terms that are offensive to 

people from marginalized groups. Not only is the vice 

president culturally insensitive, but he also has no 

concept of cultural awareness or humility. Hair-based 

racial discrimination is real and the vice president’s 

microaggressions [gal, and the comment about 

Marie’s hair] and biases are insulting, hurtful, and 

inappropriate. In addition, he assumes that Marie is 

incapable of co-chairing the committee because she is 

from a culture different from his. He is a leader and 

the expectations for a person serving in this position 

are that of a role model. Danford practiced cultural 

humility. He engaged in self-reflection and spoke up 

when the vice president discriminated against Marie). 

By now you may be thinking you will have to 

“walk on eggshells” to communicate with or engage 

with people from other cultures. You do not, but 

you will need to practice cultural humility in each 

encounter. Reflect on your communication and 

actions and ask yourself the following questions 

(Masters et al., 2019): 

• Was I biased in my communication; did I allow 

implicit biases to control the encounter? 

• Did I learn anything from the people during the 

encounter? 

• Will I use what I learned to improve future 

encounters? 

• Did I treat the person(s) I encountered with 

respect? 

• How was cultural humility relevant in my 

encounter? 

Inquisitive reflection is not meant to make you 

second guess every encounter, instead it is meant 

to help you make sense of the experience in relation 

to yourself, and others. The controversy regarding 

cultural competence versus cultural humility may 

continue for years to come however, incorporating 

intercultural sensitivity in every encounter requires 

extensive practice. 

Additional Learning 

Most people think of race when they hear 

marginalized groups, but racial and cultural 

minorities are only one group. There are so 

many marginalized groups. Read the following 

case studies. Can you identify the marginalized 

individual or groups? 

Case Study 1 

Jake has lived all his teenage life feeling as 

though he does not belong in the body staring back 

at him when he looks in the mirror. Jake identifies 

as transgender. He has expressed to his parents 

his desire to transition into the gender that feels 

right to him. Although his mother embraces him 

and accepts his decision, his father is having a hard 

time accepting Jake who wears clothing that many 

in society identify as female attire. Jake’s father is 

a devout Christian and believes it is a sin for Jake 

to live as a woman and asks Jake to see a mental 

health professional. Jake refuses and instead drives 

his car into a department store window narrowly 

escaping injury to himself and others. He said he 

wanted to die and that he may try to harm himself 

again. He is sent to a psychiatric facility and when 

he arrives, the healthcare professional assesses him. 

Jake insists on being addressed with she-her-hers 

pronouns and asks to be called Jasmine. Jake is 

extremely upset when he is stripped of his wig, and 

dress, and forced to wear male clothing. The staff 

refused to call him Jasmine. Against much protest, 

Jake is placed on an all-male unit. Jake complains 

that his rights have been violated. Were you able 

to identify the marginalized group(s)? How could 

cultural humility be applied to this situation? 

©V.McDaniel 

Case Study 2 

Java is a first-year nursing student at a public 

university who identifies as multiracial. She lives in 

public housing, uses public transportation, and lives 

on a fixed income. She has a noticeable disability 

that she openly discusses. She is a greatly confident 

student in her class of 20, but for the last month 

she has been reticent and detached from her peers. 

She also has been arriving late to class and she 

leaves immediately after class ends. Her professor 

has attempted to discuss her tardiness after class 

but each time Java rushes off, telling her professor 

that she cannot miss her transportation home. 

Java’s professor feels she is not suitable for nursing 

because good time management skills are essential 

for nurses to be successful. The professor expresses 

her concerns with her colleagues and lets them know 

she will suggest that Java reconsider her career in 

nursing. When the professor meets with Java, she 

immediately asks her if she is sure she wants to 

pursue a nursing career. She reminds her of her 

disability and her tardiness. Java is mortified. She 

lets the professor know that her mother died a year 

earlier, and she is the sole caregiver for her father 

who was recently given a month to live. In addition, 

she uses public transportation and the bus only 

runs every hour. Were you able to identify the 

marginalized group(s)? What are the cultural 

aspects associated with this case study? Did 

the professor consider social determinants of 

education? ©V.McDaniel 

To share your thoughts on this article, please 

email Kristin Jimison at kjimison@virginanurses. 

com. 

References 

Banaji, M. R., & Greenwald, A. G. (1995). Implicit 

gender stereotyping in judgments of fame. Journal 

of Personality and Social Psychology, 68(2). 181-198. 

http://web.mit.edu/cortiz/www/Diversity/PDFs/ 

Banjai%20and%20Greenwald,%202005.pdf 

Barnes, C. D., Rutledge, C., & Parker, T. S. (2020). Conflict 

recovery: Cultural humility and civility in education. 

Rowman & Littlefield 

Campinha-Bacote, J. (2018, December 4). Cultural 

competemility: A paradigm shift in the cultural 

competence versus cultural humility debate – Part I. 

The Online Journal of Issues in Nursing 24(1). https:// 

doi:10.3912/OJIN.Vol24No01PPT20 

Campinha-Bacote, J. (1998). The process of cultural 

competence in the delivery healthcare services: 

A culturally competent model of care (3rd ed.). 

Transcultural C.A.R.E. http://transculturalcare.net/ 

the-process-of-cultural-competence-in-the-delivery-ofhealthcare-services/ 

Cho, J. L. (2019, January 11). “Diversity is being invited 

to the party; inclusion is being asked to the dance.” 

https://www.cleveland.com/business/2016/05/ 

diversity_is_being_invited_to.html 

Chow, C. (2021). 15 ways to improve diversity and inclusion 

in the workplace. https://socialchorus.com/blog/15- 

ways-to-improve-diversity-and-inclusion-in-theworkplace/ 

Covey, S. (1990). The seven habits of highly effective people: 

Powerful lessons in personal change. Free Press 

Cross, T. L., Bazron, B. J., Dennis, K. W., & Issaacs, M. 

R. (1989). Towards a culturally competent system of 

care. National Institute of Mental Health, Child and 

Adolescent Service System Program (CASSP). https:// 

files.eric.ed.gov/fulltext/ED330171.pdf 

DeAngelis, T. (2009). Unmasking ‘racial microaggressions.’ 

American Psychology Association, 40(2). https://www. 

apa.org/monitor/2009/02/microaggression 

Fitzgerald, E. (2019, April 10). An intersectionality 

approach to the process of cultural competemility – 

Part II. The Online Journal of Issues in Nursing 24(2). 

https://doi: 10.3912/OJIN.Vol24No02PPT20 

Foronda, C. (2020). A theory of cultural humility. 

Journal of Transcultural Nursing, 31(1), 7-12. https:// 

doi:10.1177/1043659619875184 

Foronda, C., Reinholdt, M. M., & Ousman, K. 

(2016). Cultural humility: A concept analysis. 

Journal of Transcultural Nursing, 27(3), 210-217. 

DOI:10.1177/1043659615592677 

Greene-Moton, E., & Minkler, M. (2020). Cultural 

competence or cultural humility? Moving beyond 

debate. Health Promotion Practice, 20(1), 142-145. 

https://doi:10.77/1524839919884912 

Hook, J. N. (2014). Engaging clients with cultural 

humility. Journal of Psychology and Christianity, 33, 

277-280. http://www.thefreelibrary.com/Engaging+ 

clients+with+cultural+humility.-a0385805845 

Leininger, M., & McFarland, M. R. (2002). Transcultural 

nursing: Concepts, theories, research, and practice (3rd 

ed.). McGraw-Hill 

Limbong, A. (2020). Microaggressions are a big deal: How 

to talk them out and when to walk away. https://www. 

npr.org/2020/ 06/08/872371063/microaggressions-area-big-deal-how-to-talk-them-out-and-when-to-walk-away 

Masters, C., Robinson, D., Faulkner, S., Patterson, E., 

McIlraith, T., & Ansari, A (2019). Addressing biases 

in patient care with the 5Rs of cultural humility, a 

clinician coaching tool. Journal of General Internal 

Medicine, 34, 627-630. https://link.springer.com/ 

article/10.1007/s11606-018-4814-y 

Nadan, Y. (2017). Rethinking ‘cultural competence’ 

in international social work. International 

Social Work, 60(1), 74-83. https://doi. 

org/10.1177/0020872814539986 

National Collaborating Centre for Determinants of Health 

(2020). Marginalization. https://nccdh.ca/glossary/ 

entry/marginalized-populations 

Njie-Carr, V. P. S., Neimann, Y. F. & Sharps, P. (2020). 

Disparities in the academy: accounting for the elephant. 

Dorrance. 

Park, C. W., & Holtschneider, M. E. (2021). Touchpoints – 

Reframing the approach to microaggressions in the 

interprofessional learning environment. Journal of 

Nurses in Professional Development, 117-119. https:// 

doi:10.1097/NND.0000000000000717 

Ruhl, C. (2020, January 1). Implicit or unconscious bias. 

Simply Psychology. https://www.simplypsychology.org/ 

implicit-bias.html 

Selig, S., Tropiano, E., & Green-Moton, E. (2006). Teaching 

cultural competence to reduce health disparities. Health 

Promotion Practice, 7(3 Suppl.), 247S-255S. https:// 

doi:10.1177/1524839906288697+ 

Tan, T. Q. (2019). Principles of Inclusion, Diversity, Access, 

and Equity. The Journal of Infectious Diseases, 220(Suppl 

2). https://doi:10.1093/infdis/jiz198 

Tervalon, M., & Murray-Garcia, J. (1998). Cultural 

humility versus cultural competence: A critical 

distinction in defining physician training outcomes in 

multicultural education. Journal of Health Care for the 

Poor and Underserved, 9, 117-125. https://doi:10.1353/ 

hpu.2010.0233 

Yeager, K. A. & Bauer-Wu. S. (2013). Cultural humility: 

Essential foundation for clinical researchers. Applied 

Nursing Research, 26(4). https://www.ncbi.nlm.nih.gov/ 

pmc/articles/PMC3834043/pdf/nihms510949.pdf



Telehealth and Social Media Usage Since COVID-19: How the 

Pandemic Has Forced Healthcare Change in 2020 

Bryan R. Werry RN, BSN, CCRN 

FNP Graduate Student 

College of Nursing, Gonzaga University 

bwerry@zagmail.gonzaga.edu 

Reprinted with permission RN Idaho, February 2021 

Telehealth and Telemedicine 

Eight years ago, I was introduced to the concept 

of telehealth, and the potential use of technology 

as a means of delivering medical and behavioral 

healthcare at a distance to rural areas and 

large agricultural communities. According to 

The National Organization of Nurse Practitioner 

Faculties (NONPF), telehealth is defined as “the 

use of technology to provide healthcare services 

at a distance including direct patient care, remote 

monitoring, and education” (Rutledge et al., 2018, p. 

1). Telehealth includes both clinical and nonclinical 

aspects of healthcare, such as administration and 

financial services, while telemedicine is a narrower 

term limited to the provision of clinical services. 

Although the concept of telemedicine seemed logical 

and within our nation’s technological capabilities, 

there have always been stringent conditions 

and regulations regarding its use. For example, 

reimbursement from the Centers for Medicare & 

Medicaid Services (CMS) and other health insurance 

companies has been complicated and inadequate. 

These conditions clearly discouraged providers from 

utilizing telehealth technology in practice. 

Regulations and reimbursement practices 

quickly changed due to the circumstances of the 

COVID-19 pandemic. Recently, the U.S. Congress 

passed the Emergency COVID Telehealth Response 

Act, which allowed all providers the ability to 

furnish telemedicine services eligible for Medicare 

reimbursement (U.S. Congress, May 1, 2020). 

This act improved access to health care during 

the pandemic by providing compensation of 

medical services without face-to-face interaction. 

Jerich (2020) noted, “The relaxation of telehealth 

regulations in response to the COVID-19 pandemic 

has triggered a wave of interest and support, with 

patients noting the convenience, discretion, and 

safety of virtual care as a major selling point” (p. 1). 

Increased Use of Telehealth 

Even prior to the pandemic, there has been an 

increase of telemedicine-related services across all 

sectors of healthcare. Advancements in technology, 

electronics, computers, and the internet have made 

healthcare delivery possible through telemedicine 

(Claypool, 2019). A few years ago, NONPF suggested 

that telehealth be incorporated into the core 

curriculum of nurse practitioner (NP) education, so 

students could become knowledgeable and proficient 

at delivering healthcare in this manner (Rutledge 

et al., 2018). Presently, the COVID-19 pandemic has 

forced us into a situation that warrants the use of 

telemedicine in order to safely deliver healthcare. 

According to Webel et al. (2020), the response to 

COVID-19 has included an astonishing increase in 

telemedicine usage and applications. For example, 

since the outbreak of COVID-19, my stepfather, a 

psychiatrist, has conducted the majority of his patient 

visits through the application doxy.me. This provides 

him a safe, reliable, and fairly easy way to deliver 

healthcare while maintaining social distancing. Prior 

to the pandemic, my stepfather only used telemedicine 

to deliver care to patients in rural areas. Puro and 

Feyereisen (2020) reported that prior to COVID-19, 

rural areas were already utilizing telemedicine as 

a means to deliver healthcare. They concluded that 

urban areas hard-hit by the pandemic have the 

potential to improve outcomes by exploiting this same 

capability. The COVID-19 pandemic has opened up a 

sort of “Pandora’s Box” of developments in technology 

use that leads to the question: How can providers best 

use technology during this pandemic to improve both 

business practices and benefit patient outcomes? 

Social Media in Healthcare: 

Implications for Practice 

Increased Use of Social Media 

Social media has become ubiquitous in our 

culture, with more and more users being added 

daily. According to Ventola (2014), the term “social 

media” has a “constantly evolving” definition but 

can be loosely defined as “internet-based tools that 

allow individuals and communities to gather and 

communicate; to share information, ideas, personal 

messages, images, and other content; and, in some 

cases, to collaborate with other users in real time” 

(p. 491). Ventola (2014) identified categories of social 

media tools as: 

Social networking (Facebook, MySpace, Google 

Plus, Twitter), 

Professional networking (LinkedIn), 

Media sharing (YouTube, Flickr), 

Content production (blogs [Tumblr, Blogger] and 

microblogs [Twitter]), 

Knowledge/information aggregation (Wikipedia), 

and 

Virtual reality and gaming environments (Second 

Life). 

Ventola reported that over 70% of healthcare 

organizations, systems, and companies use social 

media to their benefit, with the most popular being 

Facebook, Twitter, and YouTube. 

Benefits of Social Media in Healthcare 

The benefits of social media are multiple. It can 

be used locally, regionally, nationally, and even 

world-wide. For example, a healthcare provider 

(HCP) working as an infectious disease specialist 

out of London, England, can utilize a social media 

application to connect with another HCP in a thirdworld 

country like Somalia. Another example is how 

certain medical and surgical procedures can now 

be streamed via YouTube. Social media signals a 

new era of communication and networking, where 

HCPs can exchange information and knowledge 

at an unparalleled rate (Ventola, 2014). I recently 

performed a Google search (www.google.com) and 

found that Facebook alone has over a billion users. 

With such a large audience, social media has 

the potential for a tremendous impact on patient 

empowerment and outcomes. It can facilitate 

dialogue between sizable groups of providers 

and patients, as it offers quick and widespread 

communication (American Hospital Association, 

2018). In a systematic review of social media in 

healthcare, Smailhodzic et al. (2016) reported that 

patients found social media to be a helpful tool for 

social, emotional, and informational support in 

healthcare. 

Social Media Obstacles 

The negative aspects of social media include 

potential loss of privacy, being targeted for promotions 

and labeling, and addiction to social media itself. 

These disadvantages are complicated by numerous 

factors. First, there are no encompassing social 

media standards to guide its appropriate use in 

healthcare. The American Nurses Association’s (ANA) 

social media guidelines and tips specify that nurses 

must use the same professional standards online 

as in other circumstances and also need to develop 

organizational policies and ensure privacy settings 

are in place when using technology (ANA Enterprise, 

n.d.). The American Medical Association’s (AMA) 

Journal of Ethics recommends that online behavior 

should reflect “offline professional conduct found inperson” 

as a starting point (Kind, 2015, p. 442). They 

also suggest that social media guidelines should help 

users address opportunities and challenges that arise 

in new platforms. 

Although many HCPs would never deliberately 

commit a violation of patient privacy, many end 

up doing so by simply posting online about their 

day at work (Sewell, 2019). Patient privacy is also 

under the constant threat of unauthorized users 

trying to illegally access sensitive information. 

Malicious security breaches include: social media 

intrusions, identity thefts, phishing scams, malware, 

misinformation, and misuse of sensitive medical 

information. While most providers do maintain 

high ethical standards when using social media, 

this does not guarantee that the platform will 

exist without issues and non-professional behavior 

(Claypool, 2019). 

Facilitating Patient Use of Social Media in the 

Pandemic 

At the hospital where I work as a critical care 

nurse, mandatory physical distancing requirements 

are in place and have resulted in restrictions to 

visitation rights for patients/families and limitations 

on staff meetings. These policy changes have led


to greater use of technology applications such as 

secure work chats and use of Facetime and Zoom 

to help our patients communicate with loved ones. 

On my current unit, the staff often connect family/ 

friends on a tablet at a scheduled time. Once all 

participants are accounted for, we place the tablet on 

a secure stand next to the bedside, and the family 

can interact with their loved one while we assume 

care of other patients. The process is not perfect but 

overall has been well received. 

Patients throughout the U.S. are not limited to 

a single avenue of social media for encounters with 

their providers. The variety in online communication 

methods is rapidly increasing, and patients can 

often choose the platform they prefer. Although the 

opportunities for social media seem promising, there 

are still many obstacles and challenges to overcome. 

Examples include limited access to the internet or 

devices (computers and smartphones) and limited 

user knowledge regarding such technology. These 

barriers are typically more prevalent in the poorer/ 

rural communities (Koonin et al., 2020). 

From my experience working in an ICU 

during this pandemic, families have been able 

to communicate with their loved ones infected 

with COVID-19 through social media, the most 

popular choice being Facetime. My co-workers and 

I welcome the use of such communication options, 

as we witness firsthand the feeling of isolation and 

helplessness our patients are experiencing. In the 

past, many clinicians were wary about using social 

media as a method of communicating with patients 

and their families (Ventola, 2014). However, it is now 

considered commonplace amongst hospitals/clinics, 

colleges, businesses, and many other organizations. 

Users are finding that it provides a sense of 

community and sharing that was unimaginable 

years ago (Sewell, 2019). 

I predict that social media and telehealth will 

continue to see favorable acceptance by providers; 

the public’s response and acceptance during the 

pandemic suggests that its use will continue to grow. 

However, as we gain access to more technology and 

scientific evidence, there is also a growing need 

to govern and legislate the appropriate use of the 

information available (Kind, 2015). Evaluating the 

safety, privacy, and quality of information being 

delivered remains a cause for concern. 

Conclusion 

With the rapid advancement of telehealth and 

the use of social media, it seems clear that a high 

percentage of patients and providers will continue 

to use this technology after the COVID-19 pandemic 

comes to an end. Koonin et al. (2020) found that 

consumers use social media as a complement 

rather than a replacement to healthcare services. 

Whether a provider is treating the patient faceto-face 

or online, the standards of professional 

behavior should remain the same: Providers should 

maintain their integrity, respect, and compassion 

for others. If committed to these principles, HCPs 

will be able to use social media for educational 

purposes, networking, quality improvement 

initiatives, satisfaction surveys, and measuring 

outcomes (Kind, 2015). As long as social media and 

telehealth are consistent with current models of 

ethics, such as the ANA Code of Ethics for Nurses 

with Interpretive Statements (ANA, 2015), these 

technological advancements will augment what 

providers are capable of offering (Sulmasy et al., 

2017). The COVID-19 pandemic has been a tragedy 

and struggle for so many people worldwide. However, 

one silver lining is the opportunity to evaluate the 

success of telemedicine and the ways that it has 

helped us provide better medical services during this 

challenging time. 

The author reports he has no conflicts of interest 

with this content. 

References 

American Hospital Association. (2020, October 

9). Social media policy. https://www.aha.org/ 

standardsguidelines/2018-04-02-american-hospitalassociation-social-media-policy 

American Nurses Association. (2015). Code of ethics for 

nurses with interpretive statements. https://www. 

nursingworld.org/practice-policy/nursing-excellence/ 

ethics/code-of-ethics-for-nurses/coe-view-only/ 

American Nurses Association (ANA) Enterprise. (n.d.) 

Social media. https://www.nursingworld.org/social/ 

Claypool, B. (2020, April 20). Telemedicine and COVID-19: 

6 tips to ace your first visit. Mental Health Weekly, 

30(17), 5–6. https://doi.10.1002/mhw 

Jerich, K. (2020, November 3). Telehealth's uncertain 

future raises alarm bells for cancer patients. Healthcare 

IT News. https://www.healthcareitnews.com/news/ 

telehealths-uncertain-future-raises-alarm-bells-cancerpatients 

Kind, T. (2015, May). Professional guidelines for social 

media use: A starting point. AMA Journal of Ethics 

Clinical, 17(5), 441-447. http://doi.org/10.1001/journalof 

ethics.2015.17.5.nlit1-1505 

Koonin, L., Hoots, B., Tsang, C., Leroy, Z., Farris, K., 

Jolly, B., Antall, P., McCabe, B., Zelis, C., Tong, I., 

& Harris, A. (2020, October 30). Trends in the use 

of telehealth during the emergence of the COVID-19 

pandemic. Morbidity and Mortality Weekly Report, 

69(43), 1595-1599. http://dx.doi.org/10.15585/mmwr. 

mm6943a3externalicon 

Puro, N., & Feyereisen, S. (2020). Telehealth availability in 

U.S. hospitals in the face of the COVID-19 pandemic. 

The Journal of Rural Health, 36(4), 577-583. https://doi. 

org/10.1111/jrh.12482 

Rutledge, C., Pitts, C., Poston, R., & Schweickert, P. 

(2018). NONPF supports telehealth in nurse practitioner 

education. https://cdn.ymaws.com/www.nonpf.org/ 

resource/resmgr/2018_Slate/Telehealth_Paper_2018.pdf 

Sewell, J. (2019). Informatics and nursing: Opportunities 

and challenges (6th ed.). Wolters Kluwer. 

Smailhodzic, E., Hooijsma, W., Boonstra, A., & Langley, 

D. (2016). Social media use in healthcare: A systematic 

review of effects on patients and on their relationship 

with healthcare professionals. BMC Health Services 

Research, 16(442). https://doi.org/10.1186/s12913-016- 

1691-0 

Sulmasy, L. S., Lopez, A. M., & Horwitch, C. A. (2017). 

Ethical implications of the electronic health record: In 

the service of the patient. Journal of General Internal 

Medicine, 32(8), 935-939. 

United States Congress. (2020). Emergency COVID 

Telehealth Response Act. https://www.congress.gov/ 

bill/116th-congress/house-bill/6654?s=1&r=5 

Ventola, L. (2014). Social media and health care 

professionals: Benefits, risks, and best practices. 

Pharmacy and Therapeutics, 39(7), 491-499. 

Webel, E., Miller, S., Astha, V., Janevic, T., & Benn, E. 

(2020). Characteristics of telehealth users in NYC for 

COVID-related care during the Coronavirus pandemic. 

Journal of the American Medical Informatics Association, 

00, 1-6. https://doi.org/10.1093/jamia/ocaa216



The Biopsychosocial Model of Addiction and 

Substance Use Disorder 

Diana Gilmore BSN, RN, DNP 

FNP Student 

Idaho State University 

Reprinted with permission RN Idaho, February 2021 

In 2017, 19.7 million Americans ages 12 and 

older had substance use disorder. Approximately 

74% battled alcohol use, 38% illicit drug use, and 

12.5% fought both. The price tag is high, with 

$740 billion per year from the loss of productivity, 

healthcare expenses, and crime-related costs 

(American Addiction Centers, 2020). In Idaho, from 

2017 to 2018, adults’ illicit drug use increased from 

9.02% to 9.44%, and alcohol use decreased from 

51.3% to 50.2%. However, the use of heroin stayed 

the same at 0.32% and above the national average of 

0.30% (Oregon-Idaho HIDTA, 2018). Understanding 

substance use disorder, its significance, and how the 

application of the biopsychosocial model of addiction 

as an intervention is important when evaluating 

treatment and prevention goals. 

Problem 

The use of illicit drugs and alcohol impacts 

many individuals. Those who start at younger ages 

often have poor health, low academic progress, 

negative relationships, and involvement with the 

justice system. Illicit drugs like heroin and cocaine 

are highly addictive and instigate dependence and 

overdose due to the drive for instant gratification. 

The incidence of illegal substance use increased 

in the United States (U.S.) after the placement of 

restrictions for opioid prescriptions, leading to 

increased overdoses and deaths. Key risk factors 

of dependence are found in the personality, 

environment, and behavior systems that serve as 

instigators to substance use (Vidourek et al., 2018). 

Significance 

The use of alcohol, nicotine, and illicit drugs cost 

the U.S. more than $740 billion a year. In 2016, 

drug overdoses killed over 63,000 Americans, while 

88,000 died from alcohol use. Tobacco is linked to 

an estimated 480,000 deaths per year. Through the 

Health Resources and Services Administration, $94 

million was awarded to health centers to increase 

treatment methods in overlooked areas. However, 

the government and taxpayers’ investment seem to 

be in vain as overdose deaths involving opioids have 

increased by 80% in recent years (National Institute 

on Drug Abuse, 2018). 

The Biopsychosocial Model 

The Biopsychosocial Model of Addiction gives 

weight to biological, psychological, and social 

factors in understanding the development and 

progression of substance use problems and should 

be considered in prevention and treatment efforts. 

Research supports the role of biological factors 

such as genetic predisposition in the development of 

addictive behaviors. Simultaneously, psychological 

and cognitive factors such as outcome expectancies, 

self-efficacy, and readiness to change and social 

factors such as family, peer, and intimate partner 

influences on substance use are equally important 

in the prevention and treatment. Thus, incorporating 

family members into substance use prevention 

programs may be an effective strategy to build 

skills to reduce illicit substance use. Preventing 

and treating addictive behaviors includes observing 

the biological, psychological, and social factors 

that interact to produce and maintain addiction 

disorders. Successful treatment programs can 

benefit from taking a biopsychosocial view of the 

problem of addiction (Skewes & Gonzalez, 2013). 

Conclusion 

While there is no explanation of the contributors 

to the use of substances that progress into 

abuse and dependency, providers should tap 

into several disciplines to provide holistic care. 

The biopsychosocial model of addiction gathers 

biological, psychological, and social information 

to understand substance use, development, and 

progression. With this information, clinicians are 

better equipped to provide successful treatment 

and build effective multidisciplinary programs for 

overcoming substance dependence. 

References 

American Addiction Centers. (2020). Alcohol and drug 

abuse statistics. https://americanaddictioncenters.org/ 

rehab-guide/addiction-statistics 

National Institute on Drug Abuse. (2018). The science 

of drug use and addiction: The basics. https://www. 

drugabuse.gov/publications/media-guide/science-druguse-addiction-basics 

National Survey on Drug Use and Health. (2018). Key 

substance use and mental health indicators in the 

United States: Results from the 2017 national survey 

on drug use and health. https://www.samhsa.gov/data/ 

sites/default/files/cbhsq-reports/NSDUHFFR2017/ 

NSDUHFFR2017.pdf 

Oregon-Idaho High Intensity Drug Trafficking 

Areas. (2018). Comparative summary of 2017- 

2018 national survey on drug use and health 

results for Idaho. https://static1.squarespace.com/ 

static/579bd717c534a564c72ea7bf/t/5ebab07bb2 

761e6bdc57f922/1589293183892/ORID+HIDTA+- 

+Idaho+NSDUH+2017-2018+Summary.pdf 

Skewes, M. C. & Gonzalez, V. M. (2013). The 

biopsychosocial model of addiction. Principles of 

Addiction. http://dx.doi.org/10.1016/B978-0-12- 

398336-7.00006-1 

Vidourek, R. A., King, K. A., Merianos, A. L., & Bartsch, L. 

A. (2018). Predictors of illicit drug use among a national 

sample of adolescents. Journal of Substance Use, 23(1), 

1–6. https://doi-org.libpublic3.library.isu.edu/10.1080/1 

4659891.2017.1316782 

Sttttttttaaaaaaaatttttttteeeeeewwwwiiiiiddddeeeeee Hoooottttttttllllllliiiiinnnneeeeee CCaaaaaaaallllllllllllll::: 888888000000----888888333888888----8888882333888888 |||| Teeeeeextttttttt::: 8888880004----799999333----99999999999999999999 |||| CChhaaaaaaaatttttttt::: vvvvvaaaaaaaaddddaaaaaaaattttttttaaaaaaaa...oooorrgg/cccchhaaaaaaaatttttttt 

wwwwwwwwwwww...vvvvvssddddvvvvvaaaaaaaalllllllllllllliiiiiaaaaaaaannnncccceeeeee...oooorrgg |||| vvvvvssddddvvvvvaaaaaaaaaaaaaaaa |||| VAAccccttttttttiiiiioooonnnnAAlllllllllllllliiiiiaaaaaaaannnncccceeeeee



Foundation prepares 

for launch of peer-topeer 

support program 

for nurses 

Governor Northam recently signed off on legislation 

ensuring that the Virginia Nurses Foundation, in 

collaboration with the Medical Society of Virginia 

and national HR firm, VITAL WorkLife, will be able 

to launch SafeHaven, a peer-to-peer health and 

wellness program for nurses. What’s special about 

this program, and why it required legislation, relates 

to measures ensuring confidentiality and liability 

protections for participants. 

Specifically, the legislation, originally 

spearheaded by MSV during the 2019 session of 

the General Assembly specific to creation of the 

SafeHaven program for physicians, now establishes 

legal protections in the Virginia Code for nurses 

to seek help for issues related to burnout, career 

fatigue, and mental health reasons without the fear 

of undue repercussions to their nursing license. 

Consultations under SafeHaven are considered 

privileged communications and do not pose a risk 

to the individual’s nursing license. Participants of 

SafeHaven are immune from reporting unless they 

are a danger to themselves or others. 

Look for more information in the August issue 

of VNT or email VNA CEO Janet Wall at jwall@ 

virginianurses.com. 

RNs/LPNs 

needed for leading coed camp in beautiful Pocono Mountains of 

Pennsylvania for children with mild developmental challenges. 

Campers 7-21. June 17-August 9, 2021. 

Excellent air-conditioned accommodations & salary plus room and board. 

Graduating nurses welcome. A Life-Changing Experience! 

CAMP LEE MAR 

www.leemar.com • 215-658-1708 • email: ari@leemar.com 

Mid June - Mid August 

Premier Summer Camp in PA is hiring 

RNs & LPNs 

Full & ½ season 

• Private Room 

• Travel & Licensure Reimbursement 

• Strict COVID Protocols in Place 

Kids Go Free! Competitive Salary 

Online application! www.poyntelle.com 

Call Corey Peters at 718-279-0690 with questions. 

Under investigation 

by the Virginia 

Board of Nursing? 

Eileen M. Talamante, Esq., R.N. 

Eileen is a nurse and an attorney, and is 

here to help you with licensing issues, 

investigations, and disciplinary matters 

before the Virginia Board of Nursing. 

2020 Outstanding 

Advocate Award 

goodmanallen.com 

ETalamante@goodmanallen.com 

(804) 565-3526 

DEDICATED TO SERVING THE LEGAL 

NEEDS OF VIRGINIA NURSES.

Are you ready to nurse greatly? APPL V TODAY! 

Visit info.averett.edu/nursing-masters-nurse-greatly or call 800-448-5233

Virginia Nurses Today - May 2021

Create successful ePaper yourself

Delete template?

Save as template?