Virginia Nurses Today - May 2021

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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 &

Virginia Nurses

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.

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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

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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


Page 4 | May, June, July 2021

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

Virginia Nurses Today | www.VirginiaNurses.com

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.


www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 5

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.


Page 6 | May, June, July 2021

Virginia Nurses Today | www.VirginiaNurses.com


www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 7

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.


Page 8 | May, June, July 2021

VNF President's Message

Virginia Nurses Today | www.VirginiaNurses.com

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/


www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 9

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


Page 10 | May, June, July 2021

Virginia Nurses Today | www.VirginiaNurses.com

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!

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www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 11

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.”


Page 12 | May, June, July 2021

Continuing Education

Virginia Nurses Today | www.VirginiaNurses.com

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

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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.


www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 13

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

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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).

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Page 14 | May, June, July 2021

Virginia Nurses Today | www.VirginiaNurses.com

Continuing Education continued from page 13

Lived Case Experience 2

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).

Lived Case Experience 3

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.

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Page 16 | May, June, July 2021

Virginia Nurses Today | www.VirginiaNurses.com

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


www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 17

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


Page 18 | May, June, July 2021

Virginia Nurses Today | www.VirginiaNurses.com

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

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www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2021 | Page 19

Virginia Nurses

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.

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

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