Ohio Nurse - June 2021

Volume 14 | Number 3 | June 2021 

Quarterly publication direct mailed to approximately 10,000 RNs in Ohio 

and delivered electronically via email to 260,000+ RNs and LPNs in Ohio 

What is a Nurse Leader? 

Page 10 

What’s inside this issue? 

Pharmacy or Farmacy? 

Page 12 

A Shared Vision: Critical to Success 

Shirna Gullo, DNP, MSN, BSN, RN 

Kettering College 

An old Jewish proverb states, “Without a vision, 

the people perish.” Consequently, why is visionary 

leadership so vital to the very life of an institution? 

It is because it provides the momentum needed to 

encourage nurses to strive for the highest standards 

of excellence. No longer will status quo, mediocrity, 

or a getting by attitude suffice because these cannot 

compete with excellence. 

This vision must be articulated in such a way 

that others will be willing to embrace and take 

ownership in the vision, goals, and purposes the 

leader wants to attain whether it is an organization, 

the employees, patients, students, or any customer 

(Rowland & Rowland, 1997). Not only must the 

vision be articulated, but it should also be something 

imagined and sought for now but created in the 

future (Roussel, 2013). Marquis and Houston (2017) 

emphasized that a vision statement “is a description 

in words that conjures up a picture for all group 

members of what they want to accomplish together. 

It is critical, then, that organization leaders recognize 

that the organization will never be greater than the 

vision that guides it” (p. 171). You can apply this 

description whether your role is a nurse or a nurse 

leader. Ask yourself the question, What type of 

visionary picture are you conjuring up for others to 

visualize? 

Although at times, the vision may become 

delayed, disrupted, or distorted because of the 

unlimited demands being placed upon institutions 

internally and externally; nevertheless, the effective 

and driven nurse administrator can and must keep 

the vision alive! 

A valuable learning tool that can be used to 

remember what characterizes a visionary is cited 

below: 

V - Vitality, 

I - Individual consideration 

Intellectual stimulation 

Idealized influence 

Inspirational motivation 

S - Shared 

I - Innovativeness 

O - Originality 

N - Networking 

S. Gullo (copyright 2006) 

V – Vitality. The lively energy and animated 

enthusiasm expressed and needed to reach goals; 

having the potential to live and develop (Merriam- 

Webster, n.d.; Oxford Illustrated American Dictionary 

(1998) As a nurse, administrator, or educator, do 

you still get excited about the content that is being 

presented in the classroom or boardroom, whether 

it is presented virtually or face-to-face? We must 

be excited about the message, the mission, the 

subject, and the content that we are delivering if we 

want to see a positive cascade effect. If we are not 

enthusiastic about what we are presenting, how can 

we expect others to catch the flame, seize the vision, 

or take ownership! We need a renewed passion 

for our discipline which has great potential to make 

nurses and future nurses want to learn more. It 

certainly beats the alternative. 

I – Remember the Four I’s (Bass & Avolio, 1994; 

Moon et al., 2019) 

1) Individual consideration – Keep in mind that the 

workforce is increasingly diverse, and everyone 

learns differently. No longer are traditional 

classroom settings the only platform for 

learning. Distance education (online learning) 

is now in the forefront for all organizations. 

In addition, other variables and differences 

may be in age, intellectual levels, cultural 

backgrounds, ethnicities, etc. Nevertheless, we 

are to encourage the strong, strengthen those 

who are challenged, and educate all groups 

with everything we’ve got. 

2) Intellectual stimulation – this is where we 

promote and are intentional about professional 

development, challenging nurses to continue 

to learn new information, skills, and ideas 

for personal and professional growth. Be the 

epitome of lifelong learning by synthesizing 

theory, research, and practice. 

3) Idealized influence – Role modeling is a key 

characteristic of the leader, especially the 

transformational leader. A good example 

is set and no settling for the status quo 

because… “someone is always watching.” This 

“transformational leader builds trust and acts 

with integrity” (Bass & Avolio, 1994 as cited in 

Moon et al., 2019 p. 2). 

4) Inspirational motivation – To uplift, encourage, 

and to empower with resources and information. 

Utilizing internal and external motivation to 

go above and beyond what is required. The 

individual’s attitude is matchless because 

they are self-directed, focused, downright 

relentless and won’t stop until the goal has been 

accomplished. 

S – Shared – sharing the vision with others 

(students, the organization, employees in all roles, 

and stakeholders). A vision that is not shared will 

never truly live. It will surely die. We need to share it, 

speak it, live it, and walk it, like a Sermon in Shoes. 

Jones et al., (2019) emphasized that “those closest 

to the problem are in the best position to solve the 

problem” (p. 1). 

I – Innovativeness – incorporating new methods 

and ideas. The adage, my way or the highway “has to 

go.” Some might continue to say, “This is the way we 

have always done it here.” Change is no longer on 

the horizon but forced change has come. Thanks to 

the COVID-19 pandemic, those who do not respond 

appropriately and effectively to it, will always be 

left behind. The innovative nurse leader, educator, 

and clinical practitioner will effectively utilize 

every means possible to convey and reinforce the 

mission, vision, philosophy, standards, or concepts 

(if in a classroom setting) that must be presented. 

Technology has improved greatly as well to meet 

emergent challenges in online teaching, learning, 

and healthcare delivery for all disciplines. 

O – Originality – allowing the creativeness, 

newness, and freshness of ideas. We should be 

open to change and not be closed minded. We don’t 

have to embrace or implement internally everything 

that someone presents. We have an obligation to 

hear it, see it, try it, and evaluate it. Do not dispose of 

a new idea, process, policy, procedure, etc. until you 

have explored it. 

N – Networking – working with other colleagues 

to find the best and most effective evidence-based 

practices. We must be willing to reach out to obtain 

and learn about other resources in all forms to 

assess and evaluate if they could be instrumental 

in helping us accomplish and execute our visionary 

A Shared Vision continued on page 3 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

Inside this Issue 

A Shared Vision: Critical to Success ....... 1, 3 

Message from the Chair..................2 

Upcoming Events .......................2 

Legislative Happenings...................4 

Ask Nurse Jesse........................5 

Happy Nurses Year!.................... 6-7 

Non-Frontline Nurses (Also!) 

Help in Fight Against COVID-19........ 8-10 

What is a Nurse Leader?.................10 

The Ohio Nurses Foundation Awards $100,000 

to Conduct Nurses Moral Injury Research... 11 

Will Your Next Prescription be for 

the Pharmacy or the Farmacy?....... 12-13 

2021 Health Value Dashboard.......... 14-15 

Mobilization Myths CE................ 16-19 

COVID-19 Vaccinations: Knowledge vs. Myth ...22

Page 2 Ohio Nurse June 2021 

MESSAGE FROM THE CHAIR 

The Sacred Breath Project 

As the chair of the Ohio 

Nurses Foundation (ONF), 

I am pleased to announce 

another important partnership. 

ONF formed a collaboration 

with Kent State University’s 

Wick Poetry Center. 

The project is titled 

“Sacred Breath: Voices of 

Ohio Nurses in Response 

to COVID-19.” The project 

gives nurses a safe platform 

Susan Stocker, RN 

ONF Chair 

to share their feelings they’ve experienced 

while caring for others during the pandemic. It’s 

important to capture the authentic voices of our 

colleagues. We need to understand the lived 

experiences of nurses so we can learn what we 

need to do differently. The emotions experienced 

won’t end with the pandemic. “Nurses have vital 

insight into how they’re coping, the toll this work 

has on their personal and professional lives and 

what, if anything has helped them make sense of 

this troubling time.” says David Hassler, Director of 

the Wick Poetry Center. 

This digital community arts project offers 

Ohio nurses a place to pause and reflect. By 

visiting www.sacredbreathproject.com, nurses 

can seek inspiration, share their stories and write 

expressively about their experiences. While on the 

website, you will be able to read the contributions 

of nurses from around Ohio. 

Please visit www.sacredbreathproject.com to 

share your voice and to find comfort in knowing 

you are not alone. 

OHIO NURSE 

The official publication of the 

Ohio Nurses Foundation 

3760 Ridge Mill Drive 

Hilliard, OH 43026 

(614) 969-3800 

Web site: www.ohionursesfoundation.org 

Articles appearing in the Ohio Nurse are 

presented for informational purposes only and 

are not intended as legal or medical advice 

and should not be used in lieu of such advice. 

For specific legal advice, readers should 

contact their legal counsel. 

Available positions: 

We currently have 24 full time, 

3 part time and 6 per diem nursing 

positions available. 

We offer competitive pay and benefits 

including medical, dental, vision, PTO, 

401k, tuition reimbursement and more! 

Contact Human Resources at 

(330) 386-2022 

UPCOMING EVENTS 

SAVE THE DATE 

September 3rd – 16th Annual Nursing 

Professional Development Conference 

“Excel in NPD Practice” 

A live-virtual event 

October 4th 

Cornelius Leadership Conference 


October 4th-7th – 2021 Ohio Nurses 

Association Convention 


To view or register for all ONA events visit: 

https://ohnurses.org/ona-events/ 

The Ohio Nurses Association is accredited as 

a provider of nursing continuing professional 

development by the American Nurses 

Credentialing Center’s Commission on 

Accreditation. (OBN-001-91). 

Are you looking to make a career 

change? Southwest Healthcare has 

an opening for a MA/LPN! 

Our nursing staff provide care to adults with severe and persistent 

mental illness. This MA/LPN position is a Full-time position divided 

between both Morrow and Delaware County, and is both community 

and office based to coordinate and provide care to patients. 

Phlebotomy experience is required. You will room patients, perform 

patient checks, reconcile medications, provide patient education, 

make referrals, and ensure proper linkage to resources. You will also 

work as part of an interdisciplinary team and will see patients on 

an individual basis who are diagnosed with chronic mental illness. 

You will be responsible for providing effective education, selfmanagement 

tools and support, and timely healthcare delivery to 

achieve optimal health outcomes. 

Requirements: Ohio MA/LPN license is required. Previous 

experience in behavioral healthcare and/or nursing care 

management is preferred. The regular work schedule is Monday - 

Friday 8am-5pm and you get to work 2 days at the Delaware office 

and 3 days at the Long Street office. 

If you’re interested in learning more about 

Southeast Healthcare, go to 

southeasthc.org/employment/ 

2020-2022 Ohio Nurses Foundation 

Board of Directors 

CHAIRPERSON: Susan Stocker 

VICE PRESIDENT: Shelly Malberti 

TREASURER: Annie Bowan 

SECRETARY: Joyce Powell 

DIRECTORS: 

Paula Anderson 

Gina Severino 

CEO / PRESIDENT: 

Lisa Ochs 

The Ohio Nurse is published quarterly in 

March, June, September, and December. 

Address Changes: The Ohio Nurse obtains its 

mailing list from the Ohio Board of Nursing. Send 

address changes to the Ohio Board of Nursing: 

17 South High Street, Suite 400 

Columbus, OH 43215 

614-466-3947 

www.nursing.ohio.gov 

For advertising rates and information, please 

contact Arthur L. Davis Publishing Agency, Inc., 

PO Box 216, Cedar Falls, Iowa 50613, (800) 626- 

4081, sales@aldpub.com. ONF 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 Ohio Nurses 

Foundation of products advertised, the 

advertisers, or the claims made. Rejection of 

an advertisement does not imply a product 

offered for advertising is without merit, or that 

the manufacturer lacks integrity, or that this 

Foundation disapproves of the product or its 

use. ONF and the Arthur L. Davis Publishing 

Agency, Inc. shall not be held liable for any 

consequences resulting from purchase or use 

of an advertiser’s product. Articles appearing 

in this publication express the opinions of the 

authors; they do not necessarily reflect views 

of the staff, board, or membership of ONF. 

Medical Disclaimer: This publication’s 

content is provided for informational 

purposes only and is not intended as 

medical advice, or as a substitute for the 

medical advice of a physician, advanced 

practice registered nurse or other 

qualified healthcare professional.

June 2021 Ohio Nurse Page 3 

A Shared Vision continued from page 1 

plan. We cannot do it alone because “leadership 

does not happen in a vacuum (Tavelin et al., 2019). 

Interprofessional collaboration in all settings is vital 

for success. We must be in a mode of continuous 

quality improvement in all that we do. Integrating 

this mind set into your culture helps to ensure that 

the vision remains in sight, eagerly embraced, and 

effectively executed. 

So go ahead and move forward in 2021 with a 

new VISION! 

References 

Bass, B. & Avolio, B. (1994). Improving organizational 

effectiveness through transformational leadership. 

Sage. 

Jones, C. B., Finkler, S. A., Kovner, C. T., & Mose, J. N. 

(2019). Financial management for nurse managers 

and executives. Elsevier. 

Marquis, B. & Huston, C. (2017). Leadership roles and 

management functions in nursing: Theory and 

application (9th ed.).Wolters Kluwer. 

Merriam-Webster. (n.d.). Vitality. In Merriam-Webster.com 

dictionary. Retrieved February 3, 2021, from https:// 

www.merriam-webster.com/dictionary/vitality 

Moon, S.E., Van Dam,P.J., & Kitsos, A. (2019).Measuring 

transformational leadership in establishing nursing 

care excellence. Healthcare (Basel), 7(4):132. doi: 

10.3390/healthcare7040132. 

Oxford Illustrated American Dictionary (1998). Dorling 

Kindersley Publishing, Inc.; Oxford University Press. 

Roussel, L. (2013). Management and leadership for nurse 

administrators (6th ed). Jones and Bartlett Learning. 

Rowland, H. & Rowland, B. (1997). Nursing administration 

handbook. (4th ed.). Aspen. 

Tafvelin, S., Nielsen, K., von Thiele, S., & Stenling, A. 

(2019). Leading well is a matter of resources: Leader 

vigour and peer support augments the relationship 

between transformational leadership and burnout. 

Work & Stress, 33(2), 156–172. https://doi-org.proxy. 

kc.edu/10.1080/02678373.2018.1513961 

CE.OHNURSES.ORG 

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LEGISLATIVE HAPPENINGS 

Tiffany Bukoffsky, MHA, BSN, RN 

The Ohio Nurses Association (ONA) has been 

actively engaged in the new legislative session that 

began in January of this year. Six months into the 

134th General Assembly proves that this cycle will 

be both busy and exciting for nurses in the state of 

Ohio. ONA is currently involved in several pieces of 

legislation. The following update is current as of May 

24th, 2021. 

House Bill 163 – Prohibit Nurse Mandatory Overtime 

House Bill 163 will prohibit the use of mandatory 

overtime as a condition of employment for nurses 

working in hospitals. This bill allows nurses to 

continue to work overtime hours if he/she feels 

safe to continually provide that care. This bill is a 

reintroduction of legislation that ONA supported in 

the last two General Assemblies. Unfortunately, the 

mandatory overtime bill did not move in the Senate 

during last year’s Lame Duck, after successfully 

passing the House of Representatives with majority 

support. ONA is back at it and has been working 

with two new sponsors to achieve full success 

Answer your calling 

in Public Health 

Join our nursing team as part of an 

accredited health department in NW Ohio. 

Benefits include: Vacation leave your first year; Paid 

holidays & sick leave, health insurance and public 

retirement system. Part time and full time available. 

www.allencountypublichealth.org 

Help pregnant mothers thrive! 

Nurse-Family Partnership at 

Nationwide Children’s Hospital in Columbus, OH 

is looking for RNs, with a special interest in racially 

and culturally diverse RNs, to join our growing 

evidence-based home visitation program. 

Apply at www.familysafetyandhealing.org/careers. 

during this legislative session. Representative Al 

Cutrona (R-Canfield) and Representative Bride Rose 

Sweeney (D-Cleveland) introduced HB 163 on March 

2nd, 2021 and provided sponsor testimony on March 

17th in the House Commerce & Labor Committee. 

Additionally, ONA provided proponent testimony 

in the same committee on March 24th. The bill 

received opponent testimony and was unanimously 

voted out of committee (12-0) on April 21st. ONA 

is hopeful the bill will be voted out of the House the 

week of May 24th. 

Senate Bill 129 – Prohibit Hospital from 

Requiring Nurse Overtime 

Senate Bill 129 is a companion bill to House Bill 

163 and is the exact same language introduced in 

the House. Senator Tim Schaffer (R-Lancaster) 

and Senate Nickie Antonio (D-Lakewood) 

introduced SB 129 on March 16th, 2021 and the 

bill was referred the Senate Health Committee 

where it awaits its first hearing. Companion bills 

are used to expedite the legislative process and 

ONA is working with the bill’s sponsors to educate 

members of the Senate to move this bill as quickly 

as possible. 

House Bill 110 – State Operating Budget 

Every two years, the Governor and state 

legislature is responsible for putting together and 

passing the state operating budget. January began 

a new legislative session, so both the administration 

and legislature have been tasked with approving this 

budget by June 30th, 2021 so it can take effect July 

1st. The budget bill is chalked full of appropriations 

as well as legislative priorities, including language 

that would create a statewide hospital licensing 

system through the Ohio Department of Health 

(ODH). While Ohio hospitals are currently required 

to register with ODH and several service lines are 

subject to individual unit licensure requirements, 

hospital themselves are not required to hold a 

license, leaving Ohio as the only state in the 

country to not license hospitals. ONA fully supports 

a statewide hospital licensing system and would 

like to see additional regulation and inspection 

requirements that ensure all hospitals are meeting 

appropriate standards of patient service and safety. 

HB 110 was introduced on February 16th, 2021 by 

Representative Scott Oelslager (R-North Canton) 

and has been receiving hearings in various House 

Finance subcommittees and is now being heard in 

the full House Finance Committee. ONA testified in 

support of creating a hospital licensing system in the 

House Finance Committee on March 11th. The bill 

was voted out of the House of Representatives and 

has continued its legislative process in the Senate. 

ONA provided written testimony in the Senate 

Health Committee on May 5th. HB 110 will go to 

Conference Committee after the Senate passes its 

version of the budget and the differences between 

the two chambers will be hashed out within this 

Conference Committee. The operating budget bill 

must be signed by the Governor by June 30th. 

Senate Bill 22 – Establish Legislative Oversight 

Over Governor’s and Health Orders 

Senate Bill 22 transfers public health authority 

from the Governor to the legislature and blocks 

the local and state health agencies’ ability to 

respond to public health emergencies, even 

beyond COVID-19. SB 22 was introduced by 

Senator Terry Johnson (R-McDermott) and 

Senator Rob McColley (R-Napoleon) on January 

26th, 2021. The bill quickly made its way through 

the legislative process, passing the Senate on 

February 17th by a vote count of 25-8, and then 

the House on March 10th by a vote count of 57-38. 

The Governor vetoed SB 22 on March 23rd, but 

the legislature had the 3/5 majority to override the 

Governor’s veto on March 24th. The new law will 

take effect June 23rd of this year. ONA had not 

taken a formal position on SB 22, however, ONA 

opposed SB 311 of the last General Assembly, 

which was a bill similar to language in SB 22. The 

Governor’s office contacted ONA on March 23rd, 

requesting a letter of support for the imminent 

veto. Several healthcare organizations sent 

letters of support and ONA joined them prior to the 

Governor’s official veto the evening of the 23rd. 

The House and Senate overrode the Governor’s 

veto on March 24th and the bill will take effect on 

June 23rd, 2021. 

TSgt Leonel Lopez 

leonel.lopez.3@us.af.mil 

937-717-8530 

airforce.com/nurse


Nurse Jesse, 

What if I want to retire or inactivate my nursing license? 

Answer: 

Per the Ohio Board of Nursing website: 

“If you no longer intend to practice or work as a nurse in Ohio, your license 

or certificate can be placed on inactive status through the Ohio eLicense 

System. It is important to remember that if your license is inactive, you cannot 

work in Ohio until you apply to reactivate your license. And, if APRNs inactivate 

their RN license, their APRN license will be automatically inactivated, as well. 

To get started, follow the steps below. 

• Go to eLicense.ohio.gov. 

• Log into your account. 

• Click the “Options” link on the appropriate license panel. 

• Select “Inactivate License”. 

• Complete the information and click “Submit”.” 

(Ohio Board of Nursing, 2021) 

If you have additional questions about your license, you may contact the 

Ohio Board of Nursing at: licensure@nursing.ohio.gov. 

Resources: 

APRN CE Rules: https://codes.ohio.gov/ohio-administrative-code/rule-4723-8-10 

OBN CE Information: https://nursing.ohio.gov/licensing-certification-ce/ and https:// 

nursing.ohio.gov/licensing-certification-ce/rn-aprn-lpn/ 

To browse CE activities: www.ce4nurses.org 

Ask Nurse Jesse: 

“I am an APRN; do I need to renew my RN license too? What CE do I 

need?” 

Answer: 

2021 is a licensure renewal year for Ohio RNs and APRNs. 

Here’s What You Need to Know: 

• Licensure renewal period begins July 1st, 2021. 

• RN and APRN licenses must be renewed by October 31, 2021. 

o For APRNs, both the RN license and the APRN license must be 

renewed during the renewal period. 

o From the Ohio Board of Nursing: 

▪ Important: APRN licenses cannot be issued, renewed, 

reactivated or reinstated without an active RN license. The RN 

license must also be renewed before an individual’s APRN 

license is eligible for renewal. 

• APRN’s who complete the RN license renewal will then be prompted 

to also renew the APRN license 

• Licenses renewed after September 15th, 2021 will be charged a late 

fee. 

• Failure to renew your nursing license will result in a lapsed license. 

• Practicing without a valid, active license is illegal and will be subject to 

disciplinary action. 

• The Ohio Board of Nursing’s primary communication for re-licensure will 

be via email, so please check that your email address is current with the 

Board. 

• 24 contact hours are needed for RN licensure renewal, including at 

least one (1) contact hour of Category A (nursing law and rules) nursing 

continuing professional development. 

- For information on exceptions, please see OAC 4723-14. 

For Ohio APRNs, an additional 24 contact hours of nursing continuing 

professional development must be completed. 

Per OAC 4723-8-10: 

APRNs must complete 24 contact hours (in addition to the 24 contact 

hours required for the RN license). 

For APRNs that are designated as a CNS, CNM, or CNP, at least 12 of the 

24 contact hours must be in the topic of advanced pharmacology from a 

provider or institution recognized by the Board (such as ONA). 

• Proof of continuing education is not required with the original renewal 

application. This information is requested only if chosen for audit by the 

Board. During the renewal you will sign an attestation that you will have 

taken the required CE by October 31, 2021. 

Looking for an advanced pharmacology course? 

Check out: 

- Essentials of Schedule II Pharmacology and Prescribing for Ohio 

APRNs (4 Category A, Advanced Pharmacology Contact Hours) 

- Through Thick & Thin: Anticoagulant Safety (1 Advanced Pharmacology 

Contact Hour)* 

- Don’t Sugar Coat It! Insulin Safety (1 Advanced Pharmacology Contact 

Hour)* 

- Supporting Appropriate Antibiotic Use (1 Advanced Pharmacology 

Contact Hour)* 

*These courses are FREE for ONA members! 

The Ohio Nurses Association is accredited as a provider of nursing 

continuing professional development by the American Nurses Credentialing 

Center’s Commission on Accreditation. (OBN-001-91)


HAPPY NURSES YEAR! 

Jeri A. Milstead, PhD, RN, NEA-BC, FAAN, ANA Hall of Fame 

What do you know about the ‘mother of nursing?’ 

Take this quiz to find out if Florence Nightingale: 

1. Was born poor but worked her way into society. 

2. Was named for a city in Italy. 

3. Was a member of the British Army. 

4. Obtained her nursing education in Germany. 

5. Was a member of a religious community (i.e., a nun). 

6. Took a group of nurses to Turkey to care for soldiers. 

7. Used the germ theory as the basis for nursing care. 

8. Was a statistician. 

9. Was honored with a medal presented by Queen Elizabeth. 

10. Died in the 20th century. 

TRUE 

FALSE 

Answers to Quiz above: 1-F; 2-T; 3-F; 4-T; 5-F; 6-T; 7-F; 8-T; 9-F; 10-T 

This article will chronicle some of Nightingale’s life and career as viewed 

by historians. Mary Grant Seacole, a Black nurse who lived and worked in the 

same frame also is recognized for her nurse-healer career. 

Florence Nightingale was born on May 12, 1800 in Florence, Italy and was 

named for that city. Her parents were members of a traditional aristocratic 

Victorian society in which women did not work outside the home, were not 

formally educated, and were expected to marry and have children. 

They opposed her desire to be a nurse. In the 1800s, nurses often were 

barmaids, groupies who followed soldiers. The provision of ‘nursing care’ 

entailed little more than providing alcohol (external and internal) and 

bleeding (to let out the vapors—the gases or ethers thought to cause 

disease). Although ‘germs’ were known as early as 1025, Pasteur’s theory 

was not widely acknowledged until the second half of the 19th century. 

Nurse education was rudimentary. A few women in the Victorian era 

began to reform social inequities. Nightingale’s role as advocate became a 

passion and she persuaded her family to allow her to attend Kaiserswerth, 

a hospital in Germany where fresh air, personal comfort, and good nutrition 

were the underlying principles of healthcare. 

Nightingale’s Notes on Nursing: What it is and what it is not (1859) 

revealed her strong belief (based on years of astute observation) that 

disease is a ‘reparative’ process, that is, the body’s way of correcting years 

of physical and mental assaults. She posited that assuring fresh air, noise 

control, sunlight, nutritious food, and variety in surroundings were within a 

nurse’s purview. She charged nurses with managing patient care by strict 

personal and environmental cleanliness. She was specific: no carpets or 

wallpaper, damp-dusting only, windows open to the outside air, etc. 

When the Crimean War broke out between Russia and the Ottoman 

Empire (modern-day Turkey), Great Britain, and France in the mid-1800s, 

the military reported that more soldiers died of dysentery, typhus, typhoid, 

and malnutrition than injuries. Nightingale pressed her father to use his 

political influence and took a group of nurses from Britain to the Crimea to 

care for the soldiers. Upon arrival, she found hundreds of cots side-by-side 

with few chamber pots, no running water, and no access to sunshine, clean 

air, or food. She and her nurses immediately set about to create ventilated, 

clean, sanitary conditions and ordered nutritious food. The mortality rate 

declined quickly and significantly. Because she kept accurate records 

and understood the significance of statistics, Nightingale used pie charts 

and other visual aids to demonstrate the impact of her methods to military 

officials and policy makers. She became well-known for her persistence,


knowledge, and political acumen (Selunders, 2021). She established 

standards of care and incorporated psychological needs of patients (www. 

brittanica.com/biography/Florence-Nightingale). 

Nightingale was not the only nurse in the Crimea. Mary Grant Seacole, 

was born in Kingston, Jamaica in 1805 and, thus was a British citizen. 

Her mother was a local curandera or healer who used herbs, poultices, 

and other remedies to minister to the sick and prevent illness (www. 

maryseacoletrust). Seacole took up her mother’s calling, traveled to Cuba, 

Haiti, and throughout the Bahamas and became a business woman. During 

a cholera pandemic in Panama, she used mustard plasters, calomel, 

emetics, and warm compresses to provide care and comfort to the sick. 

Remember: the germ theory did not appear until the late 1800s. When 

the Crimean War began, Seacole volunteered to join the British Army but 

was rejected—she believed because of racial prejudice. Undeterred, she 

established the British Hotel, a place of respite and rehabilitation for the 

soldiers, at the edge of the battlefield (www.brittanica.com/biography/Mary- 

Seacole). Seacole was as well-known in the UK as Nightingale. She was 

named the Greatest Black Briton in 2004 and a statue was erected in her 

honor in London in 2016. 

Nightingale was the first woman awarded the Order of Merit by Queen 

Victoria. The Nightingale Museum in London, England, contains many 

artifacts and tributes and the Reynolds-Finley Historical Library at the U. 

of Alabama Birmingham houses a collection of 50 actual letters written 

between 1853 and 1893 by this esteemed nurse (www.library). The 

Nightingale Foundation and the White Rose Appeal present opportunities to 

donate to educational scholarships for British nurses (Haynes, 2020). The 

website of the National Archives of the United Kingdom offers educational 

‘lessons’ that propose questions, present role play scenarios, display many 

pictures, and recount her history (www.national archives). 

Nightingale could not have imagined the growth of nursing during the 

century-plus after her death. Her broad liberal arts education coupled 

with her knowledge of then-known science and understanding of political 

influence provided a foundation for eventually elevating nursing to a 

profession. Likewise, Seacole could not have foreseen the awareness 

today of the emergence of pharmaceuticals and bio-supplements based 

on research of herbs and plants. Both would be amazed at the modern 

scope of practice, range of roles, policy involvement, and evidence-based 

research. They also would be astounded at the level of organized health 

care worldwide. 

The role of the nurse in healthcare has expanded far beyond hospital/ 

long-term-care direct care. The National Academies of Science, 

Engineering, and Medicine report, The Future of Nursing 2020-2030 

(2021), identified eight competencies (pp. 275, 276) required of nurses to 

transform the profession and healthcare and move toward greater equity for 

all: vision, multisectoral partnerships, leading change, innovation, teaming 

across boundaries, equity, creating new systems/structures, and mentoring. 

Is it time we re-visit the legacies of our early founders? 

Where do you think nurses will be needed in the next 10 years? What is 

your current role? How has it changed in the past 10 years? What prompted 

you to make a change or stay where you were? What education or training 

have you completed in order to stay current? In what ways has your vision 

of nursing changed since you graduated? What steps have you taken 

toward your next goal? Describe someone who has helped you along the 

way. What are you doing to lead the change toward 2030? 

Resources 

Haynes, S. (May 12, 2020). How Florence Nightingale paved the way for the heroic 

work of nurses today. Time. www.Time.com/5835159/,-nightingale-legacynurses/ 

National Academies of Science, Engineering, and Medicine. (2021). The future of 

nursing 2020-2030: Charting a path to achieving health equity. Washington, 

D.C.: The National Academies Press. https://doi.org/10.17:26/25982. 

Nightingale, F. (1859). Notes on Nursing: What it is and what it is not. London, 

England:Nightingale. 

Selunders, L. (2021). Florence Nightingale Lady of the Lamp. Brittanica. www. 

brittanica.com/biography/Florence-Nightingale/Homecoming-and-legacy 

www.brittanica.com/biography/Mary-Seacole 

www.library.uab.edu/locations/Reynolds/collections/Florence-nightingale 

www.maryseacoletrust.org.uk/learn-about-Mary-Seacole/ 

www.nationalarchives.gov.uk/education/resources/florence-nightingale 

The Ohio Department of Rehabilitation and Correction are 

looking for medical professionals in the following areas: 

LICENSED PRACTICAL NURSE, REGISTERED 

NURSE, and NURSE PRACTITIONER 

Who We Are… 

Guided by a single mission “To reduce recidivism among those we touch,” the Ohio Department 

of Rehabilitation and Correction believes that everyone is capable of positive change. Our staff 

embrace these core values and serves as role models for pro-social behavior conveying an attitude 

of dignity and respect in the treatment of others. 

What We Do… 

The Ohio Department of Rehabilitation and Correction has been tasked with front line crime 

reduction through rehabilitative treatment and programming efforts provided in a safe, secure and 

humane correctional environment and effective community supervision. Our goal is to protect the 

public through helping individuals turn away from crime and become productive, contributing 

members of our communities, ensuring a safer Ohio for all Ohioans now and in the future. 

To learn more about our agency, please visit our website at www.drc.ohio.gov. 

• Health Care Benefits include medical, behavioral, dental, vision, prescription drug 

• Education Assistance 

• Paid Holidays 

• Paid Vacation, Sick and Personal Leave 

• Retirement Benefits 

• Life Insurance 

• Wellness Incentives 

• Worker’s Compensation 

• Employee Assistance Program 

• LPN’s starting hourly pay will be $23.68 

• RN’s starting hourly pay will be $30.03 

• Nurse Practitioner’s starting pay is determined by a number of factors and will be 

advertised on individual posting announcements. 

Applications are accepted online at: www.careers.ohio.gov. On this website you will find the Career 

Center that will help you search for current job openings and tips on how to apply, how to contact 

hiring agencies, interviewing skills, and much more in the Frequently Asked Questions (FAQs) section. 

Contact us at: 

DRC.OfficeOfCorrectionalHealthcare@odrc.state.oh.us.


Non-Frontline Nurses (Also!) Help in Fight Against COVID-19 

Lucinda Cave MSN RN NPD-BC, 

with much help from the nurse storytellers 

highlighted in the article 

‘The Year of the Nurse’ was extended for a 

reason. For months we saw nurses worldwide, 

heavily garbed in protective gear, turning ventilated 

patients prone, administering copious medications, 

and sadly, face-timing with family members as 

loved ones breathed their last. We’ve ‘listened’ 

as they’ve shared their stories on social and 

mass news media, we’ve empathized as they’ve 

described unimaginable scenarios, and we’ve felt 

professional pride when we’ve heard stories of 

strength, resilience, community, and success over 

COVID-19. Nurses’ mighty contributions against 

the pandemic fight have been phenomenal and 

deserve to be recognized and celebrated by all for 

years to come. 

But what about non-frontline nurses - retirees, 

nurses in academia, or those who work in other 

non-direct care settings? How have they navigated 

the Covid terrain? What kinds of contributions have 

they made? What are some of their stories? 

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To find out, Ohio Nurses Association (ONA) 

recently queried its members as the “Question of 

the Month” feature on the ‘ONA Connect’ social 

media site. What triggered this question was 

simple online and casual conversation among 

nurses about COVID-19. Many expressed guilt 

over not being able to work in a hospital and do 

more. (“I’m in a high-risk group.” “I’ve got another 

job elsewhere.” “My family needs me,” etc.). 

However, some were doing more, lots more, and 

Ohio Nurse wanted to discover exactly what. To 

be sure, answers trickled in, rather than flooded, 

but those that arrived indicated contributions 

throughout all phases of the pandemic. 

Sewing Masks 

It seems ages ago, but early on, when PPE was 

scarce for healthcare workers, let alone the public, 

masks were difficult to find. Judith Beeler MSN 

RN retrieved her sewing machine and stitched up 

80 masks. She made 20 for University Hospitals 

using a kit and specific directions provided by the 

northeast Ohio healthcare system. Finding a userfriendly 

pattern at a fabric store, she created 20 more 

to give to friends and church members, then made 

40 additional to donate to a youth program. After 

receiving the masks, the youth in the program were 

able to venture into their communities to perform 

service for others. 

Covid Screening and Note Writing 

Pre-COVID-19, Shirley Hemminger MSN RN had 

been volunteering at an extended care facility near 

her home, helping to transport patients for meals and 

activities, and visiting a hospice patient. Lockdown put 

a quick stop to those activities, but Ms. Hemminger 

arrived at the facility daily from mid-March, 2020, 

through the end of July, to take temperatures and 

screen staff as they arrived for work. 

“Residents responded to lockdown differently,” 

noted Ms. Hemminger, but “mildly demented 

residents seemed to suffer most.” Loneliness 

was, indeed, an issue. To help combat this, Ms. 

Hemminger mounted a note writing campaign, 

sending out ‘Thinking of You’ cards to residents 

who seemed to be having a particularly difficult 

time. Since she saw firsthand how these quick 

greetings brightened a person’s day, Ms. Hemminger 

encouraged her friends (many of them nurses) to do 

the same, or to send out generic greetings for the 

same purpose to any nursing home or extended care 

facility. 

Educating Staff for New COVID-19 Care Roles 

As COVID-19 cases increased, and the world 

was beginning to understand how dire the pandemic 

would become, people in clinical areas often 

changed roles to care for the increased numbers 

of COVID-19 patients. Non-Frontline nursing 

professional development specialists were likely the 

group who prepared staff for these role transitions. 

Brandy Spoon, MSN Ed., RN a nurse education 

coordinator from Knox Community Hospital 

described how she educated clinical and non-clinical 

staff. She felt that even during the darkest times, the 

nursing staff came together, and built their sense of 

teamwork and community. 

Stephanie Kubitza MSN RN NPD-BC described 

one such program involving educating and preparing 

staff for role changes at University Hospitals: 

“Helping Hands” was launched as a supportive 

program to deal with the surge of COVID-19 patients 

and successfully remains in effect, albeit in smaller 

numbers, today. In order to mobilize and utilize 

staff whose clinical areas were temporarily closed, 

and also to share in providing compassionate care 

to areas with increased patient volumes, many


departments allotted a portion of their clinical and 

non-clinical staff’s work responsibilities to assisting 

in busy inpatient and outpatient care areas. As a 

Nursing Professional Development Specialist, I was 

one of five members of the UH System Nursing 

Education Department who was selected to be a 

member of Helping Hands, an experience which 

certainly highlighted the UH team spirit! 

Depending on whether the person’s background 

was clinical or non-clinical, the Nursing Education 

Department at UH System Hospitals oriented staff 

to a limited number of both clinical and non-clinical 

responsibilities. Before their first assignment, skill 

checklists were created, and reviewed with each 

person who provided assistance in either a clinical or 

non-clinical role. Additionally, it was the expectation 

that the Helping Hands were not assigned to 

diagnosed COVID-19 patients. 

The hallmark and beauty of this program was 

in it’s truly “Helping Hands” format, i.e., staff were 

only asked to assist in other patient care areas 

as their comfort level with skills or responsibilities 

enabled them to. Therefore, OB and Pediatric RNs, 

LPNs, and Patient Care Nursing Assistants worked 

on Medical-Surgical units, providing additional 

support to patient care areas who had decreased 

staff numbers on any given day. The charge nurses 

were always very welcoming and happy to learn 

they were receiving a Helping Hand employee 

and the receiving staff were grateful. I vividly 

remember one Med-Surg RN asking for the name 

of an OB RN who assisted with an IV start. She 

planned to acknowledge her abilities positively and 

formally. Furthermore, Helping Hands included all 

departments. Members of nursing administration 

worked on patient care units side-by-side with direct 

care bedside nurses. 

Together with UH Entity Educators at UH 

Cleveland Medical Center, I participated in orienting 

both the clinical and non-clinical staff to their 

responsibilities on their first day in the program 

and delivering them to their respective assigned 

units. Every RN/PCNA can relate to the anxiety of 

being floated to another area of the hospital, and 

part of our role was to round on them several times 

throughout their shift and answer any questions. 

On shifts with decreased numbers of Helping 

Hands, I assisted with patient care responsibilities, 

and it was rewarding to obtain vital signs, provide 

companionship, and assist with identified hygiene 

and/or nutritional needs. Surprisingly, on subsequent 

days, I found myself returning to check on previous 

patients. 

Mental Health Support for 

Frontline Nurses and Students 

In addition to her scholarly work, Barbara Yoost, 

MSN, RN, CNE, ANEF, decided to mentor three 

new nurses who sought a listening ear and guidance 

during the pandemic. Although it was challenging to 

listen to their concerns, Ms. Yoost felt she was able 

to contribute to the nurses’ mental and emotional 

health. Some of their stories were admittedly, ‘gut 

wrenching’. During one three-week period, an ICU 

nurse had experienced only one surviving patient 

discharged from the unit. A psych mental health 

nurse was instructed by her manager not to wear a 

mask for fear of traumatizing patients. Ms. Yoost 

feels her discussions with the young nurses were 

robust and congruent with current research findings. 

Nurses who care for COVID-19 patients need to 

talk with nurse colleagues rather than seek support 

solely from family members or friends who are not 

nurses. 

Edward Herzog, MSN, APRN, assisted nursing 

students with their COVID-19-related anxiety and 

stress. As faculty at Kent State College of Nursing, 

he recalled this aspect while at the same time 

converting coursework to all-online and creating new 

theory and clinical experiences. It was challenging, 

but “as nurses always do, we made it work,” he 

pointed out. 

Educating Peers, Friends, and General Public 

about COVID-19 

Now retired, Mr. Herzog is a co-administrator of a 

COVID-19 Facebook page and contributes regularly 

to another. He focuses on correcting misinformation, 

explaining pandemic-related research and technical 

information to lay persons, and sharing the latest 

research. He also uses his own page for similar 

purposes. 

COVID-19 Vaccinations 

Several non-frontline nurses described their 

efforts in providing COVID-19 vaccinations to the 

public. Mary Lipovan, MBA, MSN, RN is the 

Director of Public Health & Transitional Care at 

Western Reserve Area Agency on Aging (AAA) 

which involves a leadership role for community/ 

social service/advocacy activities. Governor 

DeWine tasked AAAs to support vaccination 

clinics coordinated by the Ohio National Guard. 

All 12 AAAs across the state of Ohio have forged 

new relationships with public health partners at the 

municipal, county and regional levels to provide 

education, information and resources to eligible 

adults who want a COVID-19 vaccination and/ 

or information on COVID-19 testing. Ms. Lipovan 

is also part of a cross-agency team to pilot 

homebound vaccinations in Cuyahoga County. 

Linda Warino RN has been volunteering with her 

County Health Department to administer COVID-19 

vaccines. She has found it very interesting and 

rewarding and has been very impressed with how 

organized the whole system is working. 

Stephanie Kubitza MSN RN NPD-BC participated 

as a ‘Helping Hand’ vaccinator and observer in the 

University Hospitals Walker Center Community public 

vaccine clinic. Patients, especially the elderly and 

their accompanying family members, overwhelmingly 

expressed relief and gratitude after receiving their 

vaccines. They were also highly complementary of the 

entire process. 

Besides RNs, there were secretaries, members 

of the Volunteer Department, Executive Assistants, 

paramedics, IT specialists, pharmacists, and MDs, to 

Non-Frontline Nurses continued on page 10


Non-Frontline Nurses continued from page 9 

name a few, working together to ensure patient safety 

and an efficient, effective vaccine process. Ms. Kubitza 

enjoyed the opportunity to meet other UH employees 

and reconnect with former colleagues. At the end of a 

shift at the vaccine clinic or in the hospital as a Helping 

Hand, she felt she was truly making a difference, and 

experienced that sense of satisfaction that all nurses 

can relate to after a busy productive shift! 

After getting her first dose of vaccine, Barbara 

Yoost, MSN, RN, CNE, ANEF started vaccinating 

as a member of the Medical Reserve Corp (MRC) for 

both Cleveland Public Health Department (CPHD) and 

Cuyahoga County Health Departments (CCHD). Since 

March 3rd, she has vaccinated over 1000 people during 

72 hours of volunteer service at six different locations. 

Both agencies offer clinics in areas with the most need 

and are experiencing excellent turnout. On one day, 

the CCHD vaccinated over 2000 at their clinic! 

“It feels good to contribute in a safe and professional 

way to the fight against COVID-19,” declared Ms. 

Yoost. She planned to continue vaccinating people in 

Cuyahoga County until the end of May, then continue 

with the Ottawa County MRC during the summer. 

A link to Ohio MRC is provided at the end of this 

article for anyone interested in finding out more about 

volunteering to give vaccinations. 

Food Delivery Volunteers 

Throughout the pandemic, due to business 

closings and unemployment, many Ohioans required 

additional food assistance. And non-frontline nurses 

have been there to help. Mary Lipovan, MBA, MSN, 

RN mentioned that Western Reserve Area Agency 

on Aging nurses have supported numerous food 

and grocery giveaways in all five Northeast Ohio 

counties they serve. Shirley Hemminger MSN RN 

also has assisted with food giveaways by placing 

boxes of fresh produce donated from the Cleveland 

Food Bank, into the trunks of people’s cars. These 

pop-up food giveaways have taken place throughout 

the greater Cleveland area. Ms. Hemminger was 

recruited for this volunteer service through Greater 

Cleveland Volunteers, an organization that recruits 

and matches volunteers with needs of over 100 local 

non-profit agencies. A link to their website follows 

this article for anyone interested in finding out more. 

After Vaccines... After Lockdown 

Many of the stories Ohio Nurse received mentioned 

how grateful and appreciative others were after nonfrontline 

nurses had been able to help them. And 

in equal share, nurses reported the benefits they 

received themselves when they volunteered or 

helped to fight COVID-19 in any way. Perhaps one 

heartwarming story best expresses these positive 

feelings. Shirley Hemminger MSN RN volunteered 

to help in an extended care facility when it reopened 

once again, allowing visitors. She wheeled a resident 

who had mild dementia out of her room to see her 

husband and daughter for the first time in months. 

And . . . the resident no longer recognized them, as 

she had pre-pandemic. The husband was devastated, 

tears of frustration streaming down his face. Ms. 

Hemminger summoned an appropriate staff member 

who worked with the resident and family, asking 

key questions, providing cues. Suddenly, an earlier 

memory was triggered, and the resident once again 

knew her husband and daughter. They had a second 

tearful reunion, this time with tears of joy. 

Into the COVID-19 Future 

Thankfully, the COVID-19 picture is improving, 

with cases, hospitalizations and deaths finally on 

the downturn. But more still needs to be done before 

we’re finished with this pandemic – vaccines, public 

information, support for colleagues, and for those 

most affected. Opportunities for non-frontline nurses 

continue to abound. 

For Ohio nurses interested in volunteering with 

Ohio Responds/Medical Reserve Corps. Please visit: 

https://www.ohioresponds.odh.ohio.gov 

Greater Cleveland nurses can find out about volunteer 

activities by visiting: https://greaterclevelandvolunteers.org 

Kris Cope, DNP, RN, NE-BC 

Think about that nurse leader who inspired you 

most. What was it about that person that you remember 

most? Perhaps it was the way they were able to do 

many difficult things and still make it look easy. Maybe 

it was the way they treated you or others. Regardless 

of the reason, if a nurse leader made a positive impact 

on you or your nursing career it is most likely that 

they have characteristics that model the role of the 

professional nurse. 

There can be many roles and responsibilities of a 

nurse leader. Some of the responsibilities of a nurse 

manager include creating and managing schedules, 

managing budgets, training staff, and completing 

performance appraisals. All of these are important 

tasks; however, they do not make a nurse a leader. 

In nursing, a leader should be able to effectively 

work with individuals and teams to ensure safe and 

effective care is accomplished. Not only should the 

leader advocate for the patient, but for all patients 

beyond the bedside, to create policy change at local, 

state, and national levels. The leader with involvement 

in professional organizations can be an advocate for 

What is a Nurse Leader? 

the nursing profession, through support of standards 

of practice, quality of care, education, and political 

advocacy. It is not enough to be concerned about 

staffing and competency. Leaders also need to 

ensure safe working environments, free from hazards 

including workplace violence. He or she will also 

recognize the health and wellbeing of the nurse, as 

nurse that is not healthy can affect quality of care and 

patient outcomes. 

A nurse leader should encourage innovation in 

practice, for self and others, and create a culture of 

awareness for growth. The Code of Ethics for Nurses 

includes many of these ideas and more, such as 

research and scholarly inquiry, professional practice 

standards, and lifelong learning (American Nurses 

Association (ANA), 2015). Although not new, Provision 

8 of the Code of Ethics states “The nurse collaborates 

with other health professionals and the public to protect 

human rights, promote health diplomacy, and reduce 

health disparities” (ANA, 2015, p.31). The leader should 

recognize the growing need for a diverse work force in 

order to provide the necessary collaborative structure. 

A leader is also charged with addressing the social 

determinants of health to improve health equity as seen 

in the recent publication The Future of Nursing 2020- 

2030: Charting a Path to Achieve Health Equity. “Nurse 

leaders can play an important role in acknowledging 

the history of racism within the profession and in 

helping to dismantle structural racism and mitigate the 

effects of discrimination and implicit bias on health” 

(National Academies of Sciences, Engineering, and 

Medicine, 2021, p. 11). Leaders will foster growth 

for new diverse leaders and encourage the use of 

innovative methods to close gaps related to health 

disparities. 

So, think again about that leader that inspired you. 

Think about yourself as a nurse. Then think about not 

only the qualities that make you a good nurse, but think 

about the qualities, roles, and responsibilities that would 

make you a great leader. 

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

nurses with interpretive statements. https://www. 

nursingworld.org/coe-view-only 

National Academies of Sciences, Engineering, and Medicine. 

(2021). The future of nursing 2020-2030: Charting a 

path to achieve health equity. The National Academies 

Press. https://doi.org/10.17226/25982. 

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The Ohio Nurses Foundation Awards $100,000 to Conduct Nurses Moral Injury Research 

A Study of the Well-Being of Ohio Nurses Who Have Cared for Patients During COVID-19 

Nurses are up against major obstacles every 

day: workplace violence; burnout; unsafe staffing; 

COVID-19; and other traumatic events. Many of 

these have a lasting impact that go beyond the 

bedside, leading to moral injury within the profession. 

Moral injury, often described as a consequence 

of continual acts that go against one’s morality, is 

a phenomenon sweeping the profession, which is 

why the Ohio Nurses Foundation announced the 

winners of a $100,000 award to support important 

research on moral injury in nursing. The research 

will be conducted by a team of researchers spanning 

multiple universities. 

“After months of preparation, the Ohio Nurses 

Foundation is pleased to announce the recipients 

of the $100,000 Moral Injury Research Award. This 

exemplary team of researchers includes Joyce J. 

Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, Case 

Western Reserve University, Minjin Kim, Ph.D., 

RN, University of Cincinnati, Sharon Tucker, PhD, 

APRN-CNS, PMHCNS-BC, NC-BC, FNAP, FAAN, 

The Ohio State University, Dónal O’Mathúna, PhD, 

MA. B.Sc. (Pharm), The Ohio State University, Jin 

Jun, PhD, RN, The Ohio State University, and Grant 

A. Pignatiello, PhD, RN, Case Western Reserve 

University. When selecting the research group, it 

was important to the Foundation for the research 

team to be from Ohio and focused on how registered 

nurses in all practice settings across the state are 

experiencing moral injury, especially after Covid-19,” 

said Dr. Susan Stocker, chair of the Ohio Nurses 

Foundation. 

The research team, who call themselves “Ohio’s 

Moral Injury Team,” are composed primarily of 

registered nurse investigators prepared at the doctoral 

level. The research will focus on how registered nurses 

in all practice settings across the state of Ohio are 

experiencing moral injury in the workplace. 

“Nursing is a hazardous occupation. Nurses’ health 

and well-being have been negatively affected by the 

work environment and their personal lives for decades. 

Known to be self-sacrificing, nurses’ put their own 

needs last, which has been clearly demonstrated 

during the Covid-19 pandemic. Moral injury is one 

outcome of the self-sacrificing that deeply impacts 

nurses’ well-being,” explained Dr. Sharon Tucker, Ohio 

State University, member of the research team. 

The research will not only collect data on moral 

injury in nursing, but will also encourage nurses to 

share their story. As Dr. Joyce Fitzpatrick, of Case 

Western University explained, “Narrative Nursing 

is a unique intervention that empowers nurses to 

share their collective experiences, building a strong 

professional bond among participants. We will use this 

intervention to help Ohio nurses who cared for patients 

and families during the COVID-19 pandemic toward the 

goal of enhancing nurses’ wellbeing and resilience.” 

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Dr. Minjin Kim, University of Cincinnati, continued, 

“Narrative nursing is a promising approach to 

foster healing and well-being of nurses who 

suffered mental stress and trauma during the 

COVID-19 pandemic. We believe our intervention 

can create cohesion, solidarity, and resilience by 

allowing nurses to share and reflect their individual 

experiences during the pandemic while engaging in 

other nurses’ collective struggles.” 

If you are an Ohio registered nurse and would like 

to participate in the study, please contact Michelle 

Donovan, mdonovan@ohnurses.org, Ohio Nurses 

Foundation. 

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Michelle A. Uhler 

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Registration No. 06-11-1801B


Will Your Next Prescription Be for the Pharmacy or the Farmacy? 

Joanne Evans MEd, RN, PMHCNS-BC 

Adapted from the Indiana Nurse Association Bulletin 

Almost 2500 years ago, Hippocrates said, “Let food be thy medicine and 

medicine be thy food” (Smith, 2004). These words are still relevant today. 

The leading causes of death in the United States from disease are heart 

disease, followed by cancer, chronic lung disease, stroke, Alzheimer’s, diabetes, 

and chronic kidney disease. (National Center of Health Statistics, 2021). 

Diabetes is increasing at a rapid rate in the U.S. (Diabetes Research Institute, 

2020). According to the Food and Drug Administration (FDA), over 20,000 

prescription drug products are approved for marketing (U.S. Food and Drug 

Administration, 2018). The National Health and Nutrition Examination Survey 

in 2015–2016 shows 45.8% of the U.S. population uses prescription drugs 

(Martin, et al., 2019). All medications, whether over-the-counter or prescription 

medications, may have side effects. It is the pharmaceutical companies that 

benefit the most from people being sick. 

Is it possible that some chronic diseases could be prevented or reversed 

through nutrition? There has been extensive research for well over 40 years 

showing how food can be used to treat and sometimes reverse many chronic 

diseases. Campbell and Campbell (2006), Esselstyn (2008), McDougall (2013), 

Greger (2015), and Barnard (2020) have all discussed this in their publications. 

Their research shows that plant-based nutrition prevents and reverses heart 

disease, diabetes, and some cancers, decrease cholesterol, and reduces blood 

sugar levels. Plant-based nutrition also decreases obesity and complications 

from being overweight and improves mood, sleep, energy, depression, and 

anxiety; reverses many chronic diseases and increases work productivity. 

What specifically does plant-based nutrition include (PBN)? 

● Vegetables – dark greens, yellows and orange, sweet potato, etc. 

● Whole Grains – pasta, rice, corn, whole grain bread, tortilla, etc. 

● Fruit – whole fruit for fiber 

● Legumes – beans, peas, lentils, tofu, soymilk, chickpeas, etc. 

● Nuts and seeds 

● Limited processed foods 

● Avoiding oil, flour, and sugar 

There are almost 4 million nurses therefore it seems we could make a 

dramatic change in health care for people in the U.S. if we shared information 

about plant-based nutrition. In addition, nurses work in a wide variety of settings 

including hospitals (state, local and private), outpatient offices, regulatory 

agencies, organizations, schools, residential care, and more. 

I have conducted several 21-day plant-based programs utilizing the free, online 

Kickstart Program published by the Physicians Committee for Responsible Medicine 

(2021). The results were published in the American Journal of Nursing (Evans et 

al., 2017) and the Holistic Nursing Association Journal (2015). Laboratory data 

was collected and analyzed, and it found that several participants lowered their 

cholesterol by as much as 59 points within a 21-day period, while others lost weight 

and reported an improvement in energy and sleep. (Evans, 2015). 

There seem to be many reasons nurses do not share information about PBN. 

Some nurses feel they did not know enough and were worried they could not 

answer the patient’s questions; they thought it was too difficult; did not know 

whom to refer patients to; thought it may be too expensive to adhere to a PBN 

diet; and thought patients may not be interested (Evans, 2020). 

All the nurses who interviewed for my book, Cultivating Seeds of Health with 

Plant-Based Nutrition, Nurses Share Educational Approaches to Prevent and 

Reverse Chronic Disease (Evans, 2020), learned about PBN after graduation from 

their nursing programs. Sometimes it was after their own illness or when a family 

member became ill. Several nurses saw their patients taking the recommended 

medications, and they were still not getting well. Others recognized that 

“everything in moderation” was not working. Others read the China Study (2006) or 

saw the movie Forks Over Knives, both of which convinced them that PBN was the 

way to treat many chronic diseases (Evans, 2020). 

Once nurses become knowledgeable about PBN, they have many 

opportunities to share this information, including: 

- Showing movies and talking with colleagues about plant-based nutrition 

- Incorporating PBN into all discussions about chronic diseases 

- Encouraging hospitals to have plant-based foods at all meals 

- Asking more detailed questions about nutrition on intakes with patients, 

including: 

● How many fruits did you eat in the past 24-48 hours? 

● How many vegetables did you eat in the past 24-48 hours? 

● How many portions of dairy food did you eat in the past 24-48 hours? 

● How many portions of meat did you eat in the past 24-48 hours? 

● Have them complete a nutritional assessment - http://4leafsurvey.com 

There are several groups available for nurses interested in learning more 

about plant-based nutrition. PCRM hosts the Nurses Nutrition Network, which 

provides educational programs for nurses (https://www.pcrm.org/good-nutrition/ 

nutrition-for-clinicians/nurses-nutrition-network). 

The American College of Lifestyle Medicine has a nurse support group and 

provides educational presentations open to all nurses. https://lifestylemedicine. 

org/What-is-Lifestyle-Medicine.


Our patients need to have a choice on how they will 

resolve their chronic health issues, and nurses are wellpositioned 

to educate patients on nutritional options 

to help prevent and possibly reverse many chronic 

diseases. Patients should be given all the options 

to make an educated decision about their health. 

Sometimes it starts with medications while they are 

making nutrition and lifestyle changes. Eventually, it 

may be the nutritional changes that reverse the chronic 

disease process. Let 2021 be the year of change! 

Resources 

Some examples of breakfast might be the following: 

● Cold cereal – with soymilk or rice milk with 

berries or another fruit 

● Oatmeal with non-dairy milk with cinnamon and 

raisins 

● Blueberry buckwheat pancakes and meat-free 

bacon 

For lunch, you might consider: 

● Veggie burger with whole grain bun and salad 

● Soy yogurt, fruit, vegetable soup, whole wheat 

bread 

● Hummus wrap with whole wheat pita, shredded 

carrots, cucumber, tomato 

Some options for dinner might include: 

● Black bean chili with cornbread, salad, greens 

● Whole grain pasta marinara with mixed 

vegetables, salad 

● Fajitas with peppers, onions, tomatoes, beans, 

broccoli 

Resources for learning about plant-based 

nutrition are the following: 

● Campbell, T. C., & Campbell,T. (2004). The China 

Study. Startling implications for diet, weight loss 

and long-term health. BenBella Books. 

● Greger, M., & Stone, G. (2015). How not to diet: 

Discover the foods scientifically to prevent and 

reverse disease. Flatiron Books. 

● Greger, M. (2019). How not to diet. Flatiron 

Books. 

● McDougall, J. (2013). The starch solution. 

Rodale Books. 

● Barnard, N. (2018). The vegan starter kit: 

Everything you need to know about plant-based 

eating. Grand Central Publishing. 

● Esselstyn, C. (2007). Prevent and reverse heart 

disease. Avery Publishing. 

Cookbooks include: 

● Campbell, L. (2018). The China study 

cookbook. Benbella Books. 

● Barnard, N. (2010). The get healthy, go vegan 

cookbook: 125 easy and delicious recipes to 

jump-start weight loss and help you feel great. 

Da Capo Lifelong Books. 

● Greger, M. (2017). How not to diet cookbook. 

Flatiron Books. 

● McDougall, J., & McDougall, M. (1999). The 

McDougall quick and easy cookbook: Over 300 

delicious low-fat recipes you can prepare in 

fifteen minutes or less. Plume Publishing. 

● Esselstyn, A., & Esselstyn, J. (2014). Prevent 

and reverse heart disease cookbook. Avery 

Publishers. 

Websites: 

• Dr. Greger - https://nutritionfacts.org 

• American College of Lifestyle - 

https://www.lifestylemedicine.org 

• Dr. McDougall - www.drmcdougall.com 

• Physicians Committee for Responsible 

Medicine - www.pcrm.org 

• Forks Over Knives - 

https://www.forksoverknives.com/ 

Apps: 

● 21-Day Vegan Kickstart – PCRM 

● Forks Over Knives 

● Michael Greger - Dr. Gregers’ Daily Dozen 

Plant-based movies include: 

• Forks Over Knives – especially for diabetes, 

heart disease, and chronic health issues 

• Code Blue – focusing on medical training and 

health care system 

• Game Changers- focus on vegan athletes 

• Eating You Alive - food connected to chronic 

disease 

References 

Barnard, N. (2020). Your body in balance: The new science, 

of food, hormones, and health. Grand Central 

Publishing. 

Campbell, T. C., & Campbell, T. (2006). The China Study. 

Benbella books. 

Diabetes Research Institute. (2020). Diabetes statistics. 

https://www.diabetesresearch.org/diabetesstatistics 

Esselstyn, C. (2008). Prevent and reverse heart disease. 

Avery Publishing. 

Evans, J. (2015). Plant-based nutrition: Will the next 

prescription be from the farmers market or the 

pharmacy. American Journal of Holistic Nursing, 

35(2):28-9. 

Evans, J. (2020). Cultivating seeds of health with 

plant-based nutrition: Nurses share educational 

approaches to prevent and reverse chronic disease. 

https://www.amazon.com/Cultivating-Seeds-Health- 

Plant-based-Nutrition/dp/B08GFSYGJJ 

Evans, J., Magee, A., Dickman, K., Sutter, R., & Sutter, 

C. (2017, March). A plant-based program – nurses 

experience the benefits and challenges of following 

a plant-based diet. American Journal of Nursing, 

117(3), 56-61. 

Greger, M. (2015). How not to diet. Flatiron Books 

Martin, C. B., Hales, C. M., Gu, Q., & Ogden, C. L. 

(2019). Prescription drug use in the United States, 

2015–2016. (Issue Brief No. 334). NCHS Data 

Brief. Hyattsville, MD: National Center for Health 

Statistics. https://www.cdc.gov/nchs/products/ 

databriefs/db334.htm 

McDougall, J. (2013). The Starch solution. Rodale Books. 

National Center of Health Statistics. (2021, March 1). 

Leading causes of death. https://www.cdc.gov/nchs/ 

fastats/leading-causes-of-death.htm 

Physicians Committee for Responsible Medicine (PCRM). 

(2021). Start your journey to health. https://kickstart. 

pcrm.org. 

Smith, R. (2004). Let food be thy medicine. BMJ, 

328(7433). https://www.ncbi.nlm.nih.gov/pmc/ 

articles/PMC318470/ 

U.S. Food and Drug Administration. (2018). Fact Sheet – 

FDA at a glance. https://www.fda.gov/about-fda/fdabasics/fact-sheet-fda-glance 

Over the past year, we have noticed that many employees have rediscovered the importance of time outside of 

the office walls. Some are even hesitant to come back to a job that does not provide the flexibility that many of us 

have become accustomed to. 

Job seekers—whether currently unemployed or not—are looking for a role that provides 

a true work-life balance. At Interim HealthCare, we believe you are your best self and an 

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Page 14 Ohio Nurse June 2021

June 2021 Ohio Nurse Page 15


CONTINUING EDUCATION 

Mobilization Myths: Ohio Nursing Law on Interstate Practice 

Disclosures 

This study was developed by Jessica Dzubak, 

MSN, RN, NPD-BC and Brittany Turner, MSN, 

RN, CNEcl. 

There is no conflict of interest among anyone 

with the ability to control content for this activity. 

1.0 Category A contact hour will be awarded 

with successful completion of this activity. 

Criteria for Successful Completion: Read entire 

article, complete knowledge check questions, 

pass post-test with a score of 80% or greater, 

and complete evaluation. 

Exp. Date: 5/1/2023 

The Ohio Nurses Association is accredited as 

a provider of nursing continuing professional 

development by the American Nurses 

Credentialing Center’s Commission on 

Accreditation. (OBN-001-91) 

as when taking a travel assignment or temporarily 

practicing in another state during an emergency. 

This study will review these concepts and explain 

the current facts, including rules and regulations for 

Ohio nurses around mobilization. 

Overview 

In a 2020 statement, the Ohio Board of Nursing said: 

“The Ohio Board of Nursing (Board) recognizes 

that an adequate and safe nursing workforce is 

vital during times of emergencies, including the 

current COVID-19 pandemic; and the Board is 

aware of the importance of increasing the mobility 

of nurses in a safe and effective manner.” (Ohio 

Board of Nursing, 2020) 

When hospitals and care facilities are inundated 

with a surge of patients during a state of emergency, 

more staff are needed. As we’ve seen with the 

COVID-19 pandemic, when hospitals are experiencing 

this surge and experiencing a large number of nursing 

staff ill, the results can be catastrophic. 

To fully understand Ohio statute related to 

mobilization, a working knowledge of the Ohio law and 

rule structure is required. 

regarding proposed rule changes, and there is a 

formal process involving the Joint Committee for 

Agency Rule Review (JCARR) before any rule is 

changed, added, or removed. The Ohio Nurses 

Association (ONA) has a seat at the table for all rule 

review meetings and contributes input as needed. 

ORC and the Mobilization of Nurses 

Myth or Fact: Only states with a compact license 

allow nurses from out of state to help during a declared 

emergency, such as the COVID-19 pandemic. 

MYTH 

A compact, or multi-state, license is not required 

for non-Ohio nurses to enter the state and practice 

during a declared emergency. 

To combat the potential staffing issues related to 

public health emergencies and natural disasters, the 

Ohio Revised Code (ORC) permits efficient mobilization 

of nurses from other states on a temporary basis under 

declared emergency circumstances. 

ORC 4723.32(G)(7) states: 

This chapter does not prohibit any of the following: 

Among many other things the pandemic has 

taught us, the COVID-19 crisis demonstrated the 

importance of disaster preparedness, healthcare 

professional mobility, and surge staffing plans. Many 

nurses are unaware of the provisions within the Ohio 

Nurse Practice Act, Ohio Revised Code Chapter 

4723, regarding the mobilization of nurses during 

declared emergencies. There are common myths 

and misconceptions about what is required for nurses 

to obtain nursing licenses in multiple states, such 

Scan this code and contact us to 

learn more about what we can do 

to defend your nursing license. 

Graff & McGovern, LPA 

Attorneys & Counselors 

at Law 

604 E. Rich Street, Columbus, Ohio 43215 

www.graffmcgovern.com | 614-228-5800 

What does Ohio nursing law & rule mean to 

you? Have you ever looked at Ohio nursing law & 

rule before? Where can you find this information? 

What is the Ohio Revised Code? 

The Ohio Revised Code (ORC) is the set of laws 

passed by the legislature for the state of Ohio. 

Chapter 4723, titled Nurses, is the Ohio Nurse 

Practice Act – the laws that all licensed nurses in 

the state must follow. All nurses with an Ohio license 

or who are being mobilized into Ohio must review 

the ORC to be familiar with laws, regulations, and 

requirements for practicing nursing in Ohio. Failure to 

practice in accordance with these laws may result in 

disciplinary or legal action. 

What is the Ohio Administrative Code? 

The Ohio Administrative Code (OAC) is the set 

of rules describing how the laws (ORC) are to be 

carried out. Similar to the ORC, the nurses section of 

the Ohio Administrative Code is also 4723. The Ohio 

Board of Nursing is directly responsible for reviewing, 

revising, and adding to the nursing rules in OAC 

4723. The Board hosts interested party meetings 

and public rules hearings to allow for public comment 

(G) The activities of an individual who currently 

holds a license to practice nursing or equivalent 

authorization from another jurisdiction, but only 

if the individual’s activities are limited to those 

activities that the same type of nurse may 

engage in pursuant to a license issued under 

this chapter, the individual’s authority to practice 

has not been revoked, the individual is not 

currently under suspension or on probation, the 

individual does not represent the individual as 

being licensed under this chapter, and one of the 

following is the case: 

(7) The individual is providing nursing care 

during any disaster, natural or otherwise, 

that has been officially declared to be a 

disaster by a public announcement issued 

by an appropriate federal, state, county, or 

municipal official; 

In other words, licensed nurses from other states, 

whose licenses are in good standing, may practice 

nursing in a similar fashion in the state of Ohio 

during a declared emergency, such as the COVID-19 

pandemic. 

From the Ohio Board of Nursing (2020):


“Ohio law authorizes nursing practice in emergencies 

without an Ohio nursing license, including deployment 

of licensed nurses from other states to Ohio during this 

state and national emergency, as well as the deployment 

of Ohio licensed nurses to similar declared emergency 

areas. Specifically, the Nurse Practice Act, Section 

4723.32(G)(7), Ohio Revised Code (ORC), allows nurses 

who hold an active, valid license in another state to 

practice in Ohio without an Ohio nursing license for the 

duration of any declared disaster of this type, including 

the current COVID-19 declared emergency.” 

This provision eliminates the barrier of mobilizing 

qualified nurses quickly when they are needed most. 

Additionally, because of this exemption to the Ohio 

Nurse Practice Act, programs like the nurse licensure 

Compact are unnecessary to address disasterrelated 

staffing concerns. The opportunity exists for 

nurses to help in the state of Ohio without obtaining 

a permanent license by endorsement or a multi-state 

compact license. While there are time limitations to 

this provision related to the emergency or disaster, it 

addresses critical staffing needs efficiently in a time 

of need. 

An important thing to remember with regards to 

emergency mobilization provisions is the right of 

employers to refuse to hire nurses who do not have 

full, permanent Ohio licenses. It is up to the employer 

which nurses to hire, and law does not require them 

to hire those with temporary licenses or out-of-state 

licenses, even during an emergency. 

Other Ways to Mobilize 

In addition to the ORC provisions, the Ohio Board 

of Nursing released the following information to 

“encourage and facilitate Ohio participation by Ohio 

nurses in disaster relief” (Ohio Board of Nursing, 

2020). 

OBN supports nurses’: 

“...enrollment in the Medical Reserve Corp (MRC)/ 

Red Cross (ARC). The ARC verifies state license 

status, provides emergency relief training, and 

organizes deployment by matching a nurse’s area of 

expertise to the area of need. The ARC has negotiated 

reciprocal licensing agreements with each state, so 

if nurses with active, valid licenses in one state are 

activated through ARC, they are able to practice in 

other states without having a license to practice in that 

state.” 

(Ohio Board of Nursing, 2020). 

True emergencies and public health crises warrant 

additional healthcare staff. Nurses should be aware 

of the provisions available and understand the options 

they have for assisting in a crisis. The ANA Code of 

Ethics (2015) Provision 2 affirms that “the nurse’s 

primary commitment is to the patient, whether an 

individual, family, group, community, or population” 

(ANA, 2015, p. v). The emergency provisions in Ohio 

statute provide opportunities for nurses to carry out this 

commitment in a safe, efficient, and organized way. 

Professional Development Considerations 

A key consideration for all mobilization efforts and 

interstate practice is ensuring adequate knowledge of 

state laws and regulations. Every state has their own 

nurse practice act (NPA), with potential variations in 

scope of practice and licensure requirements. It is 

the nurse’s responsibility to ensure they thoroughly 

understand and abide by the laws and rules of 

the state they are practicing in. Should an error 

or adverse event occur, the fact that the nurse is 

practicing in a ‘new’ state will not be a defense. 

Before practicing in any state, the nurse should 

review the state’s NPA and associated rules and 

clarify any questions or concerns with the state 

board of nursing. 

ANA Code of Ethics (2015) Provision 4 describes 

the accountability all nurses have for their own practice. 

This includes being responsible for assessing their own 

competence, such as when entering a new practice 

area or in the case of mobilization, a new state. Having 

a thorough understanding of the laws and rules in the 

state in which the nurse is practicing is both a legal and 

ethical responsibility that all nurses must take seriously. 

Ohio Requirements 

Some states, including Ohio, have mandatory 

continuing education for licensed nurses related 

to nursing law and rules (Category A). Category A 

is the term that describes an Ohio nursing law and 

rule continuing education course provided by an 

OBN-approved provider. Not all continuing education 

providers are eligible to provide Category A activities. 

To find out of the provider of the CE is approved by 

the OBN, look for an “OBN number” at the end of the 

provider statement. 

Example: 

The Ohio Nurses Association is accredited 

as a provider of nursing continuing professional 

development by the American Nurses Credentialing 

Center’s Commission on Accreditation. (OBN-001- 

91) 

For a course to qualify as Category A, the 

content must focus on aspects of the Ohio Revised 

Code (ORC) and/or Ohio Administrative Code 

(OAC) section 4723. This course is an example of 

a qualifying Category A study, as both ORC 4723 

and OAC 4723 are referenced throughout the study, 

and the content is based around laws and rules for 

nursing practice in Ohio. 

For a nurse looking to mobilize to Ohio, this 

type of course would be beneficial. For nurses 

who are seeking licensure by reciprocity in Ohio, a 

Category A course is a mandatory component of the 

application (Ohio Administrative Code, 4723-14-03, 

1998 & rev. 2021). 

(C) A nurse from another jurisdiction who applies 

for licensure by endorsement to practice as a 

licensed practical nurse or registered nurse in 

Ohio is required to complete two contact hours 

of category A continuing education in order to 

be eligible for licensure. 

This requirement is to ensure that nurses entering 

the state have sufficient knowledge of the law 

regulating nursing practice. It is important that nurses 

take this seriously, as failing to follow the laws and 

rules could not only result in legal or disciplinary 

action but could jeopardize patient safety. 

While all nurses pass the same initial licensing 

exam, the NCLEX only provides a baseline 

competency level. Each state has an individual nurse 

practice act and a specific set of rules governing 

practice in that state. For nurses working in multiple 

states, it is imperative to be aware of each states’ 

unique laws and rules. For example, states have 

varying laws and rules surrounding delegation. It 

would be pertinent for nurses to understand to who 

they may delegate to and under what circumstances. 

In the case of delegation, a licensed nurse may 

understand the basic concepts of delegation, 

but without adequate professional development 

regarding each state’s laws on the subject, they are 

not yet competent to delegate in that respective state. 

This independent study is a Category A activity. 

For more Category A activities, visit https:// 

ce.ohnurses.org/category-a-nursing-law-and-rules 

NCLEX and Licensure 

Myth or Fact: Nurses who want to become travel 

nurses must take the NCLEX each time they need a 

new state license. 

MYTH 

Did you know? Ohio does not require 

practice hours in order to maintain licensure. 

By completing the required CE and renewing 

each renewal period, nurses can keep their Ohio 

nursing license in good standing, even while 

living in other states. 

The NCLEX is a nationwide exam, meaning that 

individual states do not require nurses to pass it each 

time they apply for a license in a different state. Once the 

NCLEX is successfully passed, the nurse does not need 

to take it again. Even if a nurse lets their license lapse 

or turn inactive, they will not need to re-take the NCLEX 

exam to re-instate the license. Therefore, for nurses 

interested in taking a travel nurse assignment, or working 

Mobilization Myths continued on page 18 

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Mobilization Myths continued from page 17 

shorter assignments in order to move around the country, this simplifies things. Many 

states have simplified processes for obtaining licensure by endorsement, or licensure 

by reciprocity, for nurses already licensed in a ‘home’ state. 

In OAC 4723-7-05, the requirements for licensure by endorsement in Ohio 

are laid out. When a nurse meets these requirements and submits the required 

documentation, they can apply for licensure by endorsement to practice in Ohio. 

Licensure by endorsement is a true permanent (with biennial renewal) nursing 

license, official for the state of Ohio. They are not temporary permits. When going 

through the licensure by endorsement process, an out-of-state nurse may receive a 

temporary permit while the application is being processed. 

OAC 4723-7-05: 

(E) An applicant for endorsement as a registered nurse who requests a 

temporary permit to practice nursing as a registered nurse in Ohio shall: 

(1) Have submitted directly from the jurisdiction of the applicant’s original 

licensure by examination, or electronically from the national council of 

state boards of nursing, verification of licensure by examination as a 

registered nurse according to paragraph (A)(5) of this rule; 

(2) Have submitted verification of current, valid licensure as a registered 

nurse directly from any jurisdiction of the national council of state 

boards of nursing, or electronically from the national council of state 

boards of nursing; and 

(3) Submit any other documentation required by the board. 

Safeguards for these temporary permits include: 

• Termination of the temporary permit upon criminal background check, 

if an individual has been convicted of or found guilty of certain crimes or 

violations 

• If the applicant fails to meet the requirements for licensure within one year 

from the date the application was received 

(Ohio Administrative Code, 4723-7-05, 1971 & rev. 2020) 

Mandatory Reporting 

Myth or Fact: All states have mandatory reporting requirements for 

employers who become aware of nursing misconduct, substance dependency, 

and other violations of the nurse practice act. 

MYTH 

As of 2019, eighteen states do not have mandatory reporting rules for nurses. 

“If someone believes a registered nurse has violated some portion of the Nurse 

Practice Act, that person has discretion about whether or not to report the 

alleged violation” (California Research Bureau, 2019, p. 1). In the states that 

do have mandatory reporting requirements, several groups are included as 

‘mandatory reporters’, such as the nurse’s employer and other nurses/licensed 

medical professionals (California Research Bureau, 2019). 

Ohio is a ‘mandatory reporting state’, meaning that employers have the 

obligation to report violations of the nursing laws and rules. 

“The mandatory reporting requirement for employers of nurses was first 

enacted in the Nurse Practice Act in the Fall of 2003. In 2013, the language was 

expanded to include persons who contract with nurses, dialysis technicians, 

medication aides and certified community health workers” (Ohio Board of 

Nursing, 2020, pg. 14). 

Per ORC 4723.34: 

If a person or entity “...that knows or has reason to believe that a current or 

former employee or person providing services under a contract who holds a 

license or certificate issued under this chapter engaged in conduct that would be 

grounds for disciplinary action by the board of nursing under this chapter or rules 

adopted under it shall report to the board of nursing the name of such current 

or former employee or person providing services under a contract. The report 

shall be made on the person’s or governmental entity’s behalf by an individual 

licensed by the board who the person or governmental entity has designated to 

make such reports.” 

These safeguards are in place to protect patients and regulate nursing 

practice in Ohio, which are the main goals of the Ohio Board of Nursing (OBN). 

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On the Ohio Board of Nursing’s website, they state: 

“The Board works to efficiently handle complaints, investigations, and 

adjudications to safeguard the health of the public and in cases involving 

substance use disorder or practice issues, provide alternatives to discipline 

programs, if determined appropriate. The Compliance Unit processes and 

investigates over 7,000 complaints annually including criminal offenses, such as 

theft of drugs, impaired practitioners, sub-standard practice, patient abuse and 

neglect, and other violations of the Nurse Practice Act and administrative rules. 

While the overwhelming majority of Ohio nurses practice with high standards, 

the actions or deficient practice of some have the potential to compromise patient 

safety and the public’s confidence in the profession. The Board plays a critical role 

in impacting the safety of nursing care that touches virtually all Ohioans.” 

For information about the complaint and discipline process with the Ohio Board 

of Nursing, visit http://nursing.ohio.gov/wp-content/uploads/2019/09/92719-guide-tocomplaint-and-investigation-process.pdf 

The following are examples of complaints that can be addressed by the 

Board, from the Winter 2020 edition of Momentum: 

It is important to recognize the implications of the mandatory reporting 

requirements within the context of programs like the multi-state Nurse Licensure 

Compact. Ohio is not currently part of the Compact. Being a Compact state 

means that nurses who hold a multi-state license can practice in that state 

without going through the standard licensing procedures of each individual state. 

While there are some basic background checks done on nurses who apply 

for a Compact license in their home state, there is no requirement to register 

with a Board of Nursing when a nurse uses a Compact license in a state that is 

not their home state. The lack of registration requirements in Compact states, 

coupled with not all states requiring mandatory reporting for practice violations, 

some offenses and unsafe practice could go unreported. This could potentially 

cause public safety concerns. 

• To complete the course and receive your certificate visit ce.ohnurses.org 

and register for the course titled “Mobilization Myths: Ohio Nursing Law 

on Interstate Practice.” You will find this course listed in the catalog. This 

course is free to ONA members. 

• References available within the 

ce.ohnurses.org course. 

“Please refer to Section 4723.28 Ohio Revised Code and the rules in Chapter 

4723 at http://codes.ohio.gov/orc/4723 . 

• Fraud or misrepresentation on a license or renewal application 

• Action by another nursing board or professional licensing agency 

• Felonies 

• Misdemeanors (including drug related crimes, misdemeanors 

committed in the course of practice, or misdemeanors involving gross 

immorality or moral turpitude) 

• Performing duties beyond the scope of the license or certificate 

• Misappropriating or attempting to misappropriate money or anything of 

value in the course of practice 

• Failing to practice in accordance with the standards of safe nursing 

practice or safe dialysis care 

• Violation of standards that promote patient safety (e.g., documentation 

errors, falsifying records, violation of professional boundaries, patient 

emotional or physical abuse, breaches of patient confidentiality) 

• Impairment (mental, physical, or substance use disorders)” 

(Ohio Board of Nursing, 2020, p. 14) 

Conclusion 

Understanding the facts about nurse mobilization is key to making informed 

decisions about their practice. The state of Ohio recognizes the need for efficient 

mobilization of nurses and healthcare staff during official emergencies and public 

health crises. These provisions make programs like the multi-state Licensure 

Compact obsolete for Ohio. Nurses practicing in Ohio, or interested in doing so, 

need to be familiar with these provisions as well as the entire Ohio Nurse Practice 

Act to protect their nursing license and their patients.


The Role of Technology and the Improvement of Compliance 

with Diabetes Mellitus 

Arica Jones 

BSN, RN (MSN student, Troy University) 

ajones175666@troy.edu 

Reprinted with permission from 

Alabama Nurse May 2021 issue 

Scholarly, peer-reviewed articles and studies 

published within the past five years were examined 

to determine the current state of technology 

for diabetes, as well as its effectiveness. The 

research found that the combination of modern 

technology and education has a profound effect 

on glycemic control and is very promising for 

improving the overall health of patients. Studies 

have heavily incorporated cell phone usage and 

mobile applications to enhance patient health 

by encouraging personal involvement in their 

care, which could ultimately lead to better patient 

outcomes. 

Dobson, R., Carter, K., Cutfield, R., Hulme, A., 

Hulme, R., McNamara, C., Maddison, R., Murphy, 

R., Shepherd, M., Strydom, J., & Whittaker, R. 

(2015). Diabetes text-message self-management 

support program (SMS4BG): A pilot study. JMIR 

Mhealth Uhealth, 3(1), 32. https://doi.org/10.2196/ 

mhealth.3988 

Dobson et al. conducted a nonrandomized 

pilot study designed to 

implement a mobile health intervention 

to control glycemic issues among the 

population in Auckland, New Zealand. Fortytwo 

consenting participants, with type 1 or 

type 2 diabetes, participated over a threemonth 

period. The self-management support 

for blood glucose (SMS4BG) program was 

created to offer mobile health solutions for 

the complications of poor glycemic control. 

In this study, poorly controlled diabetes 

was defined as having a hemoglobin A1c of 

8.6% or greater. Inclusion criteria included 

possessing a mobile phone, being ages 

17-69, and being able to read English. The 

participants were referred from healthcare 

providers at primary healthcare practices, 

secondary care hospitals, and a community- 

based organization. 

The study affirmed that mobile health 

would be beneficial to diabetes management 

due to the high percentage of the 

population that own a mobile device. The 

study consisted of modules that could be 

customized by the participant. They could 

receive anywhere from 30 text messages 

to 461 text messages during the study. 

The core module sent two text messages 

per month and covered topics such as 

diabetes education and stress management. 

Participants could also choose to receive 

additional information, such as smoking 

cessation tips and glucose check reminders. 

Thirty-four of the 42 participants opted into 

the glucose reminders, which ranged in 

frequency from once per week to four times 

per day. The glucose reminder messages 

allowed participants to reply with their blood 

glucose levels, which were then displayed on 

a graph for tracking over time. 

Thirty-nine of the 42 subjects participated 

in the post-study follow-up. A telephone 

interview showed that 100% of participants 

felt the program was useful, and 97% stated 

they would recommend the program to 

others. The study resulted in an average 

improvement of hemoglobin A1c to 7.1%. 

Although this study consisted of a small 

sample size, it is still beneficial due to its 

patient satisfaction rating and overall patient 

outcome. 

Garg, S. K., Shah, V. N., Akturk, H. K., Beatson, 

C., & Snell-Bergeon, J. K. (2017). Role of mobile 

technology to improve diabetes care in adults with 

type 1 diabetes: The remote-T1D study iBGStar® 

in type 1 diabetes management. Diabetes Therapy, 

8(4), 811-819. https://doi.org/10.1007/s13300-017- 

0272-5 

Garg et al. conducted a study to 

determine if mobile technology could lower 

the hemoglobin A1c in people with type 1 

diabetes. The particular device that was 

used in this study was the iBGStar®, which 

is a blood glucose meter. This device is 

unique because it attaches to a smartphone 

and is able to report data directly to the 

physician. This device can also be used in 

conjunction with the Diabetes Manager app, 

which enables it to function as a personal 

glucometer. Garg et al. also assessed the 

fear of hypoglycemia before and after the 

study through a participant questionnaire. 

The study was conducted over a six-month 

period as a stratified block randomization 

that consisted of 100 participants who were 

divided into two groups: a control group and 

an intervention group. The control group 

was given an Accu-Chek Nano® meter, 

while the intervention group was provided 

with the iBGStar®, an iPhone, and the 

Diabetes Manager app. Additionally, all of the 

participants were provided with a Dexcom 

Seven Plus CGM sensor. All participants 

were educated on the use of their assigned 

device and glucose logbooks. They were 

instructed to check their blood glucose levels 

at least three times per day during this sixmonth 

period, and they were not allowed to 

use their own CGMs or take acetaminophen, 

as this would alter the analysis. The 

intervention group’s device was set up to 

send an alert to the patient’s provider if the 

blood glucose level was below 60 or above 

300 at any time. 

The results of the study were measured 

after three months and six months. Although 

both groups showed a decrease in their 

hemoglobin A1c, there was a substantial 

decrease among the intervention group at 

the six-month assessment. Garg et al. also 

reassessed the fear of hypoglycemia at the 

end of the study, but they saw no significant 

difference between the initial scores and 

the final ones. Over 85% of the participants 

in the intervention group were pleased with 

the iBGStar® apparatus. They found it to 

be more convenient and user friendly than 

traditional devices. This study shows how 

mobile technology can improve compliance 

among those with diabetes. A great deal of 

non-compliance comes from not checking 

blood glucose levels. This study implemented 

routine checks of blood glucose levels, which 

made the participants more conscientious of 

their results. This, in turn, can promote the 

start of healthy behaviors. 

Gunawardena, K. C., Jackson, R., Robinett, 

I., Dhaniska, L., Jayamanne, S., Kalpani, S., 

& Muthukuda, D. (2019). The influence of the 

smart glucose manager mobile application on 

diabetes management. Journal of Diabetes 

Science and Technology, 13(1), 75-81. https://doi. 

org/10.1177/1932296818804522 

This randomized controlled study focused 

on the population of Sri Lanka and its 

prevalence of diabetes mellitus. The country 

has seen a 13% increase in cell phone usage 

among the population over the last five 

years. This prompted Gunawardena et al. to 

implement their innovative, technology-based 

study to determine if a smartphone app could 

positively impact those with diabetes. The 

focus of the smart glucose manager (SMG) 

app was to provide consistent feedback, 

which was believed to have a profound effect 

on lowering hemoglobin A1c. The features of 

the app included daily reminders to perform 

glucose checks, to administer insulin and 

other medications, to eat, and to exercise. 

The highlights of the app were the abilities 

for users to store blood glucose levels to be 

graphed over time and to receive feedback 

from medical professionals. 

The study consisted of 67 participants 

between the ages of 18 and 80 years old 

with a hemoglobin A1c of 8.0% or higher who 

also possessed an Android phone. Exclusion 

criteria included those who were pregnant, 

on dialysis, had cognitive impairment, or with 

steroid-induced diabetes. All participants 

had their A1c and BMI checked after three 

months and six months. The control group 

consisted of 32 participants who were 

encouraged to continue their daily diabetes 

management routine. The intervention group 

comprised 35 individuals with access to the 

SMG app. 

The study was deemed successful as both 

groups showed a significant decrease in 

A1c during the first three months. However, 

only the intervention group continued to 

show a reduction in A1c beyond that. This 

study is beneficial because it shows the 

positive effects of technology on the selfmanagement 

of diabetes. 

Hou, C., Carter, B., Hewitt, J., Francisa, T., & 

Mayor, S. (2016). Do mobile phone applications 

improve glycemic control (HbA1c) in the selfmanagement 

of diabetes? A systematic review, 

meta-analysis, and GRADE of 14 randomized 

trials. Diabetes Care, 39(11), 2089-2095. https:// 

doi.org/10.2337/dc16-0346 

The purpose of this study was to 

determine if smartphone applications could 

successfully lower and control hemoglobin 

A1c and improve the self-management of 

diabetes. Hou et al. reviewed 14 previous 

studies that included 1,360 total participants. 

The 14 studies were selected from five 

databases using the keywords cellphones, 

mobile applications, and diabetes mellitus. 

The search was narrowed further to only 

include those studies whose participants 

were over the age of 18, had type 1 or type 2 

diabetes, and did not already use an app for 

diabetes management. Four of the studies 

comprised 509 individuals and examined 

type 1 diabetes, while the remainder focused 

on type 2 diabetes in 851 people. A total of 

12 apps were reviewed in the study: three 

of which were used for type 1 diabetes, and


nine were used for type 2 diabetes. The 

apps for type 1 diabetes were geared toward 

the calculation of insulin based upon blood 

glucose levels, while the apps for type 2 

diabetes centered on the self-management 

of blood glucose levels and providing 

feedback on the self-monitored data. 

Although there was little to no difference in 

the A1c among the participants with type 

1 diabetes, there was significant success 

in reducing the A1c levels of the individuals 

with type 2 diabetes. 

Despite the study’s limitations, it still 

demonstrated that technology can effectively 

control glycemic levels and hemoglobin A1c. 

Further research is needed to determine 

the full impact of technology, but the results 

provide much hope for the future of diabetes 

management. 

Miremberg, H., Ben-Ari, T., Betzer, T., Raphaeli, 

H., Gasnier, R., Barda, G., Bar, J., & Weiner, 

E. (2018). The impact of a daily smartphonebased 

feedback system among women with 

gestational diabetes on compliance, glycemic 

control, satisfaction, and pregnancy outcome: A 

randomized controlled trial. American Journal of 

Obstetrics and Gynecology, 218(4), 453. https://doi. 

org/10.1016/j.ajog.2018.01.044 

This study was implemented to determine 

if a daily smartphone-based feedback 

system could help control glycemic levels 

and improve patient compliance among 

pregnant women with gestational diabetes. 

The population of the study consisted of 

120 participants divided into two groups: 

the control group attended a bi-weekly clinic 

visit, and the intervention group had an app 

installed on their smartphone. During the 

initial visit, the participants were educated 

by a nutritionist and a dietician on the proper 

dietary approaches for their condition, 

and they were also shown how to use a 

glucometer. They were instructed to check 

their blood glucose levels four times per day. 

An exercise regimen was also established 

to aid in the improvement of blood glucose 

levels. Other pregnancy routines were 

followed, such as blood pressure monitoring, 

urinalyses, and non-stress tests. All of the 

participants received the same care, with the 

exception of the smartphone app for those 

individuals in the intervention group. 

This app allowed the participants to log 

their daily blood glucose levels and receive 

daily feedback on these readings. They 

were able to communicate with providers 

within the app for dietary suggestions and 

to make provisions for insulin therapy. At the 

last prenatal visit, participants were given a 

questionnaire to determine their satisfaction 

with the smartphone app. The intervention 

group showed increased compliance, lower 

blood glucose levels, and lower insulin 

therapy use than the control group. 

This study proves that the incorporation 

of technology can help improve compliance 

among patients with diabetes. Although 

this study focused on pregnant women with 

gestational diabetes, the intervention can be 

applied to non-pregnant patients with type 

1 and type 2 diabetes as well. The main 

concern making an app like this affordable 

for the consumer. 

Conclusion: Although DM continues to be a 

daunting disease, astronomical advances for its 

management have been made since its discovery. 

Technology is constantly evolving and im-proving, 

but continued efforts must be made to reduce the 

costs of monitoring equipment and medications. 

This disease is only partly to blame for the current 

health condition of our popula-tion. As healthcare 

workers, we are responsible for staying up to date 

with current technology and research so that we 

can provide better care for our patients and enable 

them to have a healthy future. Understanding 

the inconveniences patients suffering from DM 

face in their daily maintenance routines, applying 

technological applications to mitigate those factors, 

and work-ing with researchers and developers to 

reduce out-of-pocket expenses for patients are 

the best ways to encourage DM compliance and 

achieve positive patient outcomes.


COVID-19 Vaccinations: 

Knowledge vs. Myth to Get Back to A New Normal 

Erin Morgan, DNP, FNP-BC 


Tennessee Nurse May 2021 issue 

In Tennessee, the COVID-19 virus has infected 

826,371 people, and 12,022 individuals have lost 

their lives as of April 13, 2021. The virus has become 

the third leading cause of death in the United States 

for 2020. Now that multiple vaccinations are more 

widely available, nurses can educate the public 

about their options and dispel the myths surrounding 

these important tools to decrease future COVID-19 

infections and deaths. Nurses have remained the 

most trusted profession throughout the pandemic, 

and therefore, must use this position to inform the 

public about their vaccine options. Understandably, 

individuals may remain hesitant to obtain a new 

vaccine when they still have unanswered questions. 

Nurses have always provided detailed education to 

allow individuals to make the most informed choice 

for their health. Information surrounding COVID-19 

vaccination is no different. 

Vaccine Options 

Currently, there are three COVID-19 vaccines 

approved for emergency use authorization 

(EUA) in the United States, two-dose Pfizer or 

Moderna Vaccines and the single-dose Johnson 

and Johnson-Janseen vaccine. Nurses should 

recommend individuals receive any vaccine that 

is available to them. The FDA has deemed all of 

the vaccines safe and effective to prevent infection 

and severe complications from COVID-19. This 

recommendation applies to all individuals, not just 

those who have co-morbidities. As more individuals 

are vaccinated against the virus, the number of 

available individuals COVID-19 can reside continues 

to decrease. 

mRNA Vaccines 

The Pfizer vaccine was first approved for use in 

December 2020, with the Moderna vaccine approval 

following shortly after. Both vaccines require two 

doses; 21 days between Pfizer doses and 28 days 

between Moderna doses. 

These two vaccines use messenger RNA to 

provide COVID-19 immunity. This mRNA technology 

has been studied for years and has already been 

used in some cancer treatments. These vaccines 

use mRNA to instruct cells to make a ‘spike protein’ 

similar to that of the COVID-19 virus. The recipient’s 

immune system responds to these new proteins by 

making antibodies. These new antibodies remain 

with the recipient to recognize the similar ‘spike 

protein’ if a COVID-19 infection occurs. The mRNA 

does not change the vaccine recipient’s DNA; 

instead, it trains the immune system how to respond 

if the virus is encountered. 

Side effects for the Pfizer and Moderna vaccines 

include pain or swelling at the vaccine site, fever, 

muscle aches, fatigue, or headache. These 

symptoms may occur after the first or second dose. 

Individuals who have had COVID-19 may have 

more side effects with the first dose. However, many 

individuals who have not had COVID-19 report more 

side effects after a second dose. 

Viral Vector Vaccine 

The Johnson and Johnson-Janssen vaccine is 

the most recent to receive approval. This vaccine 

is a single-dose injection that offers convenience 

and expediency compared to the other two vaccine 

options. This vaccine was tested later during the 

pandemic resulting in differing effectiveness data that 

should not be compared to the Pfizer or Moderna 

vaccines. Additionally, the Johnson and Johnson- 

Janssen vaccine was tested in locations where 

variants of COVID-19 were already circulating, 

affecting results of the study. The use of this vaccine 

was paused to examine six blood clotting events in 

women. Nevertheless, the Johnson and Johnson- 

Janssen vaccine has already been received by 

millions of individuals to date. 

The Johnson and Johnson-Janssen vaccine 

provides immunity through a viral vector instead 

of mRNA. Viral Vectors, non-infectious harmless 

viruses, are used to transmit information to the 

recipient’s immune system. The vector instructs 

the recipients’ immune system how to produce 

antibodies for the ‘spike protein’ recognizable on the 

COVID-19 virus. While considered effective after two 

weeks per the CDC, immunity increases up to 28 

days past the single dose. Viral vector vaccines have 

already been used to treat cancer and the Ebola 

virus. 

Side effects are similar to the previous two 

vaccines and include pain or swelling at the vaccine 

site, fever, muscle aches, fatigue, or headache. The 

CDC recommends that women between the ages 

of 18-50 who receive the Johnson and Johnson- 

Janssen vaccine should be aware of the rare but 

increased risk of thrombocytopenia syndrome. Any 

individual who feels uncomfortable with this risk is 

recommended to obtain one of the other two vaccine 

options. 

Vaccine Hesitancy 

Many patients and fellow nurses have questions 

and concerns about these new vaccinations. 

These apprehensions are valid and may take time 

to overcome. One way to dispel myths and answer 

questions surrounding these vaccines is to provide 

evidence-based education from trusted sources and 

then let the patient or nurse choose for themselves. 

The process was rushed 

All medications and vaccines must go through 

an approval process with the FDA. All three 

vaccinations currently approved have undergone this 

process and received emergency use authorization 

(EUA). This approval does not mean that the steps 

for approval were shortened or skipped; instead, 

it provides approval for widespread use in the 

pandemic when benefit is demonstrated. 

Scientists were able to accelerate the 

development of these vaccines due to several 

factors. Scientists shared information between 

countries and between companies in an 

unprecedented effort to roll out multiple COVID-19 

vaccine options at once. Cooperation occurred in 

the scientific community using methods that were 

already in progress, such as viral vector and mRNA 

technology, developed for a new purpose. Moreover, 

governments provided funding to help cover costs 

for the development of vaccines locally and abroad; 

in the United States, this was titled “Operation 

Warp Speed.” Additionally, many volunteers of 

varying ages and races enrolled in the vaccine trials 

decreasing the time to find participants. Finally, 

vaccine developers were able to move through the 

phases of vaccine development promptly. Phase 

3 trials were completed relatively quickly due to the 

infectious and widespread nature of COVID-19, 

when many participants were exposed, proving 

effectiveness. All of these factors allowed multiple 

vaccines to be developed in a time of great need. 

Millions of individuals have received all three 

vaccines with few severe side effects. Extensive 

monitoring continues for each vaccine, which makes 

these vaccines the most scrutinized in recent history. 

During this writing, Johnson and Johnson- Janssen 

vaccine distribution was paused to examine the 

data for six patients who developed blood clots. 

The pause was brief; however, the examination 

demonstrates the ongoing commitment to safety 

surrounding these vaccines. It is understandable 

for individuals to have questions about a strongly 

recommended new therapy. Providing answers 

and resources to individuals who express concerns 

about the unprecedented process may alleviate their 

concerns. 

I’m healthy and don’t need it 

It is recommended that all individuals receive 

the COVID-19 vaccine when it is available to them. 

The risks associated with COVID-19 are higher than 

the risk associated with any side effects from the 

vaccine at this time, even for those who are young 

and healthy. Each time an individual becomes sick 

with COVID-19, there is a risk of severe disease to 

themselves and passing it along to others around 

them who can also become seriously ill. Vaccination 

is the safest way to obtain immunity to COVID-19 at 

this time. As more individuals become immunized, 

the virus will have fewer places to spread, 

decreasing overall illness and allowing a return to 

normal. 

I had COVID and don’t need the vaccine 

Scientists continue to study how long immunity 

to the disease lasts after a COVID-19 infection. 

While rare, it is possible individuals can become reinfected 

with the virus. Individuals who previously 

had COVID-19 may notice some side effects with the 

first dose of the two-dose Pfizer or Moderna series; 

however, most side effects remain mild. Each time 

an individual becomes sick with COVID-19, there is 

a risk of severe disease, long-term health effects, 

and spreading the disease to others who can also 

become significantly ill. 

Conclusion 

Tennessee’s quickest way to emerge from 

this pandemic is through public health measures 

nurses have pioneered for years: vaccinations, 

handwashing, and education. Nurses themselves 

may have concerns and questions about receiving 

a vaccine after a year of difficulty and division. 

Conversations about COVID-19 vaccines should be 

held in a spirit of acceptance and inquiry, allowing 

individuals to ask questions and feel comfortable 

about the choices they are making for themselves. 

Shaming and embarrassing individuals will only 

foster ongoing resistance and suspicion. Instead, 

nurses should focus on the benefits of vaccination: 

A quicker return to normal, protection of patients and 

loved ones, and the ability to gather with others who 

are vaccinated without masks. 

Reference websites for nurses: 

- https://covidvaccinefacts4nurses.org/ 

- https://www.cdc.gov/coronavirus/2019-ncov/ 

vaccines/vaccine-benefits.html 

- https://www.hopkinsmedicine.org/health/ 

conditions-and-diseases/coronavirus/is-thecovid19-vaccine-safe 

References available upon request. 

Join our team! 

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$6,000k sign-on bonus may be available. 

Visit www.metrohealth.org/careers to apply. 

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Failure to report changes in a patient’s condition 

Omobola Awosika Oyeleye, 

EdD, JD, MSN, MEd, RN-BC, CNE, CHSE 


Nebraska Nurse May 2021 issue 

A nurse’s ability to recognize and respond 

to changes in a patient’s condition is a crucial 

element of professional nursing practice. Failure 

to respond appropriately to clinical changes can 

lead to complications and even death. 1 In a study 

that investigated the impact of communication in 

malpractice lawsuits, communication failure was a 

factor in 32% of cases involving nurses, with most 

involving poor communication with other healthcare 

professionals about the patient’s status. These cases 

often result in huge financial consequences in cost of 

care and legal damages. 2 

Communication 

Communication of a patient’s status has been the 

focus of much attention and research, and various 

communication frameworks have been generated to 

facilitate clinical communication among healthcare 

professionals about patient status. 3,4 Widely used 

examples include SBAR (situation, background, 

assessment, and recommendation) and ISBARR 

(introduction, situation, background, assessment, 

recommendation, and read back). 

In some cases, however, it is not about the nurses’ 

ability to communicate with primary care providers. 

Rather, they are about the competence and decisionmaking 

skills needed that enables a nurse to assess 

a patient’s condition and determine the appropriate 

intervention, including when to escalate care and seek 

the expertise of appropriate personnel. 

Barriers to Communication 

Many factors can play into why nurses may not 

communicate a patient’s status promptly or at all. These 

include a busy schedule, a reluctance to “bother” the 

primary care provider, or a failure to recognize the 

circumstances under which a primary care provider 

should be notified due to a lack of clinical competence. 2 

Nurses need to recognize the severity and emergent 

nature of a patient’s condition. 

A nurse’s failure to recognize an emergency 

indicates a lack of competence in nursing fundamentals 

and a lack of knowledge about the possible physiologic 

consequences. This gap in knowledge can contribute 

to a catastrophic deterioration in the patient’s condition. 

Critical thinking extends beyond mere information, 

attentiveness, and assessment. How do nurses 

acquire the decision-making and critical-thinking skills 

necessary for their practice? The clinical competence 

needed to make decisions, especially in acute 

situations, develops over time as the nurse advances 

from novice to expert. 5 

Implications for practice 

To determine appropriate interventions and 

recognize when it is necessary to escalate care, nurses 

must: 

• accept only patients that they are capable of caring 

for. 6 

• develop the education and skills necessary to 

recognize when the interventions they initiate are not 

effective. 1 

• escalate the patient’s care to a more experienced 

nurse or the healthcare provider when they find that 

a patient’s status change is beyond their capability. 7 

• follow the facility’s chain of command. A nurse’s 

vigilance, recognition of an urgent situation, 

evaluation of changes in the patient’s condition, 

and steps taken to escalate appropriately should 

be evident in the medical record.8 Documentation 

should include the persons consulted and the 

actions that resulted from the consultation. 9 

• be aware that nurses can be held legally liable for 

actions they omit as well as actions they fail to take 

in a timely manner. 7 

Guidelines for practice 

Keep these general guidelines in mind: 

• When documenting adverse events, follow your 

facility’s policies and procedures. The record should 

be objective, including only clinical facts without 

any guesses, assumptions, speculations about the 

cause of the event, or personal opinions. 10 

• Listen to family members’ concerns. They are 

often at the bedside much longer than the clinical 

staff. They know the patient and are likely already 

engaging in the care of the patient at home. They are 

a valuable source of information and their concerns 

should be taken seriously.11 

• Nurses should consider carrying their own liability 

insurance, both for the purposes of legal liability and 

for any disciplinary actions taken by the board of 

nursing. 12 

The failure to report changes in a patient’s condition 

can have serious health consequences for the patient 

as well as legal and financial implications for all 

involved in the care of the patient. But by meeting the 

standards of professional nursing care, nurses can and 

should avoid these costly consequences. 

REFERENCES 

1. Massey D, Chaboyer W, Anderson V. What factors 

influence ward nurses’ recognition of and response 

to patient deterioration? An integrative review of the 

literature. Nurs Open. 2016;4(1):6-23. 

2. Crico Strategies. Malpractice risks in communication 

failures. 2015 Annual benchmarking report. www.rmf. 

harvard.edu/Malpractice-Data/Annual-Benchmark- 

Reports/Risks-in-Communication-Failures. 

3. Institute for Healthcare Improvement. SBAR Tool: 

Situation-Background-Assessment-Recommendation. 

www.ihi.org/resources/Pages/Tools/sbartoolkit.aspx. 

4. Cudjoe KG. Add identity to SBAR. Nurs Made 

Incredibly Easy. 2016;14(1):6-7. 

5. Benner P. From novice to expert. Am J Nurs. 

1982;82(3):402-407. 

6. Buppert C. A “safe harbor” for unsafe nursing 

assignments. Medscape. April 26, 2019. 

7. Nurses Service Organization. Failure to report 

changes in the patient’s medical condition to 

practitioner. 2012. www.nso.com/Learning/Artifacts/ 

Legal-Cases/Failure-to-report-changes-in-thepatients-medical-condition-to-practitioner. 

8. Thielen J. Failure to rescue as the conceptual basis 

for nursing clinical peer review. J Nurs Care Qual. 

2014;29(2):155-163. 

9. American Nurses Association. ANA’s Principles for 

Nursing Documentation: Guidance for Registered 

Nurses. Silver Spring, MD: American Nurses 

Association; 2010. 

10. Austin S. Stay out of court with proper 

documentation. Nursing. 2011;41(4):24-29. 

11. Sherman DW. A review of the complex role of family 

caregivers as health team members and secondorder 

patients. Healthcare (Basel). 2019;7(2):63. 

12. Brous E. Reciprocal enforcement and other collateral 

issues with licensure discipline. J Nurse Pract. 

2017;13(2):118-122. 

This article has been adapted for space and 

originally appeared in the November 2019 issue of 

Nursing © 2019 Wolters Kluwer Health, Inc. 

This risk management information was provided 

by Nurses Service Organization (NSO), the nation’s 

largest provider of nurs-es’ professional liability 

insurance coverage for over 550,000 nurses since 

1976. The individual professional liability insur-ance 

policy administered through NSO is underwritten 

by American Casualty Company of Reading, 

Pennsylvania, a CNA company. Reproduction without 

permission of the publisher is prohibited. For questions, 

send an e-mail to service@nso.com or call 1-800-247- 

1500. www.nso.com.

Ohio Nurse - June 2021

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