Arizona Nurse - October 2021

One Profession. Many Roles.
The Official Publication of the Arizona Foundation for the Future of Nursing
Arizona Nurse
Quarterly Publication distributed to over 58,000 Registered Nurses in Arizona
Vol. 74 • Number 4
OCTOBER 2021
We’re Working for You! JOIN US TODAY
Brought to you by the Members of AzNA. For more information on the benefits of membership, please visit www.aznurse.org.
Let’s Reconnect
NURSE PRIDE
Lokelani Ahyo, RN
2020…sigh…Let’s not sugar coat it… It was a
horrible year!
It’s now 2021, and we are faced with all
kinds of new issues, from the Delta Variant to
increased suicide rates, to nurses leaving the
profession. Many of us find ourselves facing
a sense of hopelessness. I understand. I have
been feeling some of the same things, but you
know what???
We MUST move on.
We must reconnect. We must reconnect
with each other and reconnect with ourselves.
How do we do that? Well…we must do it
safely.
Throughout 2020 virtual work became a
reality in many ways. So, we should use it.
Let’s have a get-together via Zoom. Let’s plan
a painting party on Skype. Let’s call our family
members and Facetime with them.
I know of families that used the opportunity
to share knowledge by connecting with
children and grandchildren every other Sunday
to teach them about investing and finances.
Each person who had knowledge in a specific
area shared information using a presentation
program while sharing their screen. Multiple
generations participated and even the older
folks learned new techniques from the younger
tech-savvy family members.
I also know of friends who got together
every Thursday night. One week they decided
to make a charcuterie board. In preparation
for their get-together, they each ordered their
food from Instacart and had it delivered. Using
Facebook messenger (because not all of them
had iPhones with Facetime) they connected,
made their charcuterie boards, had a drink, and
enjoyed an evening of comradery, even though
they couldn’t be in the same building.
In terms of reconnecting with ourselves…
Well, it’s time for some reflection. These past
couple of years have really thrown many of us
down a mental health care wormhole. Self-care
is a buzzword that is becoming overused, BUT
it is still important!
So…what can we do to reconnect with
ourselves? Journal. Journaling is an excellent
way to release the chaos in your brain, to get
some of those feelings out of your body. Yoga,
particularly Kundalini Yoga or Pranayama Yoga,
are excellent ways to reconnect with your life
force, energy, and breath. Creativity activities
are also helpful to release unused energy and to
awaken the brain. Creativity can be expressed
in many ways such as painting, cooking, writing,
and even cleaning and doing yard work.
Physical activity is also an excellent way to
reconnect with yourself. You receive emotional
and physical benefits from activities such as
walking, tai chi, weightlifting, and dancing.
Finally, go to school and reconnect with your
passion for learning. There are online classes
for just about everything. Reconnect with your
brain and your desire for knowledge in areas
such as sign language, literature, anthropology,
digital arts, computer security, or take on an
MSN or DNP program. There is no limit to your
ability to reconnect with yourself.
It’s time to make things happen and find
ourselves amid the chaos. Let’s find new (and
old) ways to reconnect with ourselves and with
others.
Rochelle B. is a nurse and a Star Wars fan
and this plate shows her love for both.
Peggy, BSN, RN says she is so proud to be
a Pediatric Nurse and displays her license
plate with pride!
Kristi Dawson shares,
“My whole life I can always remember that
I wanted to take care of laboring moms and
the day I was hired as a new grad into this
department, I bought this plate!”
Do you have a nurse pride license plate you
want to share? Send it to info@aznurse.org.
You might be on our next front page!
current resident or
Non-Profit Org.
U.S. Postage Paid
Princeton, MN
Permit No. 14
INSIDE
President's Message .................... 2
CEO’s Message ....................... 3
AzNA PAC .......................... 3
Will Your Next Prescription be
for the Pharmacy or the Farmacy? .......4-6
Members on the Move ................... 6
Documenting nursing
assessments in the age of EHRs .......... 7
American Academy of Nursing’s
“Have You Ever Served?” Campaign ...... 9
The Joy of School Nursing
During COVID-19 ................... 10
A Requiem for Florence ................. 10
What Really Works in Preventing Falls ........11
Patricia Johnson, a Trailblazer
in Neonatal Care ................... 12
Ask Nurse Melissa .................... 13
AzNA’s Superstars .................... 14
Two Year Anniversary Membrs ............ 14
New & Returning Members .............. 15
How Nurse Leaders May
Combat Workplace Bullying ........... 16
Member Highlight ..................... 17
Board Announcement .................. 17
Providing Competent, Supportive Care
for People Who are Transgender ...... 18-19
Achieving the Elusive “Work-Life Balance” ..... 19

Page 2 • Arizona Nurse October, November, December 2021
PRESIDENT’S MESSAGE
A Time to Reflect
As I complete my second
and final term as your AzNA
President, it is time to reflect.
Since we are a dynamic and
responsive organization that
supports the advancement
of the nursing profession
to promote a healthy
Arizona, as I look back, the
accomplishments have been
many in the last four years:
Less is more: After Selina Bliss, RN
much input from the
membership, the chapter bylaws and finances
have been streamlined for our geographical and
Special Interest Chapters thereby making the
work for our volunteer leaders much less, so
more time may be spent on chapter activities.
More is good: AzNA created the Organizational
Affiliates model with two affiliate membership
options to bring together specialty nursing
organizations as a unified voice for nursing
practice in Arizona.
Change is good: We consolidated the five
Special Interest Chapters into three, to include
the Emerging Nurse Professional, Nurse
Educator, and Nurse Practitioner Council
Chapters. Two of the geographical chapters
consolidated, merging the Greater Phoenix
Chapter and the East Valley Chapter into the
newly formed Central Arizona Chapter, still
known as Chapter 1.
Charge less, get more: The value pricing
pilot with ANA was a success and now it costs
you only $15.00 a month to maintain three
concurrent memberships, including the ANA,
AzNA, and your geographical and/or Special
Interest Chapters.
Look to the future: Upon Robin Schaeffer’s
retirement, the AzNA Board brought on Dawna
Cato and updated the position from Executive
Director to that of our Chief Executive Officer.
Most intimidating: Writing this President’s
Message quarterly for the Arizona Nurse
knowing that it reached over 87,000 nurses in
the state of Arizona. I tried not to think about it.
Biggest satisfaction: Seeing one of my
President’s Messages on the bulletin board in
the nurses’ lounge at our local hospital.
Proudest accomplishment: Providing the
Success Pays Program for AzNA members. To
advance nursing practice and professional
development by increasing the number of
certified nurses in the workforce, Arizona
Call for Article Submission
Submit your article or research for publication in AzNA’s quarterly print publication.
The Arizona Nurse is distributed to over 58,000+ RNs in the state.
AzNA welcomes submission of nursing and health related news items and original articles.
We encourage short summaries and brief abstracts for research or scholarly contributions
with an emphasis on application.
To promote inclusion of submitted articles, please review the article guidelines available
on the AzNA website at www.aznurse.org/Guidelines.
An “article for reprint” may be considered if accompanied by written permission from the
author and/or publisher as needed. Authors do not need to be AzNA members.
Submission of articles constitutes agreement to allow changes made by editorial staff and
publishers. See article guidelines for more information.
Submit your article to info@aznurse.org.
nurses now have the opportunity to take a
certification exam or renew their certification
through the American Nurses Credentialing
Center (ANCC) with less cost and anxiety.
Members can take an exam up to two times and
are charged a reduced rate only if they pass the
exam. A bonus is the Sasmor Scholarship Fund
which pays for the first ten AzNA members per
year who successfully pass their certification
exams.
Most significant challenge: Without a
doubt, it is COVID-19. From this challenge,
AzNA formed and led the Nursing SMART -
“Situation Monitoring Response Team” with our
organizational affiliates and major professional
organizations in Arizona to form a rapid response
group to address crises as they hit Arizona as a
result of COVID-19. From this group arose the
RNconnect 2 Well-Being text messaging system
where nurses receive supportive messages
that connect them to self-care resources. To
communicate the benefits of this program, the
Hearts for Nurses initiative sewed over 7,000
quilted hearts to put in the hands of nurses as
a physical keepsake and a thank you for their
incredible work.
Hardest part: Advocating through the AzNA
Public Policy Committee to pass legislation on
the federal and state levels that impacts the
nursing profession and patient care. While
we had some good bills get through his last
legislative session, we have more work to do
introducing new legislation next year.
Most exciting: Attending and participating
in the ANA Membership Assembly for the first
time where I got to participate with hundreds
of others along with the governing and voting
body of ANA to determine policy and positions
for the Association.
Reason to celebrate: ANA extended the Year
of the Nurse from 2020 into 2021 which means
we have another year dedicated to recognizing
and honoring the positive contributions of the
nursing profession.
On this note, let us all take time to reflect on
our accomplishments. While it takes a village
to raise a child and all kinds of members to run
the oldest and largest nursing association in
Arizona, it has been an honor to be part of this
professional organization that is considered the
voice of nursing in Arizona.
Selina Bliss, RN, PhD, CNE, RN-BC, ANEF
Past-President – AzNA
Arizona Nurse Editorial Board
Carol Peyton Bryant, DNP, RN, ACNP, CCRN
Kim Callahan, RN
Rebekah Christopher, RN
Anna Hustin, MSN, RN, NE-BC
Sherry Ray, EdD, MSN, RN, CHSE
Melisa Salmon, MSN, RN, CCRN, MBA
Alicia Shields, MSN, RN, CENP, DNP-student
Melissa Zuber, BSN, RN
The editorial board of the Arizona nurses is comprised of
members of the Arizona Nurses Association, who review all
submissions, provide expert advice on content, attract new authors,
and encourage submissions.
If you are interested in serving on the editorial board, please
contact info@aznurse.org for more information.
Chair:
Rhonda Anderson, DNSc, RN, FAAN, FACHE
Vice Chair:
Pat Mews, MHA, RN, CNOR
Secretary:
Chloe Littzen, BSN, RN
Scholarship Chair:
Sharon Rayman, MS, RN, CCTC, CPTC
Elected Trustee:
Carol Stevens, PhD, RN
Elected Trustee:
Kimberly Behrens-Grieser
Elected Trustee:
Phillip Guarrera
Executive Director:
Dawna Cato, PhD, RN, NPD-BC
Board of Directors
President:
Heidi Sanborn, DNP, RN, CNE
Secretary:
Amanda Foster, MSN, APRN, FNP-C
Treasurer:
Beth Hale, PhD, RN
Governmental Affairs Officer:
Heather Ross, PhD, DNP, ANP-BC, RN, FAANP
Director-At-Large:
Sonia Blau, BSN, RNC-OP, CDP
Director-At-Large:
Robert “Bill” Adams, MSN, RN, CDCES, NHDP-BC
Past President:
Selina Bliss, PhD, RN, CNE, RN-BC
Staff
Dawna Cato, Phd, RN, NPD-BC, Chief Executive Officer
Wendy Knefelkamp, Director of Operations
Debby Wood, Senior Project Coordinator
Madi Moyer, Communications Specialist
The Arizona Nurse (ISSN 0004-1599) is the official
publication of the Arizona Foundation for the Future of Nursing
(AzFFN), peer reviewed and indexed in Cumulative Index for
Nursing and Allied Health Literature. Arizona Nurse Author
Guidelines are available at www.aznurse.org. Call 480.831.0404
or info@aznurse.org for more information.
No material in the newsletter may be reproduced
without written permission from the Executive Director.
Subscription price: included in AzNA membership or
$30 per year. The purpose of the Arizona Nurse is to
communicate with AzNA members and non-members in
order to 1) advance and promote professional nursing in
Arizona, 2) disseminate information and encourage input
and feedback on relevant nursing issues, 3) stimulate
interest and participation in AzNA and 4) share information
about AzNA activities.
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.
Responsibility for errors in advertising is limited to corrections
in the next issue or refund of price of advertisement.
Advertisements do not imply endorsement nor approval
by the Arizona Foundation for the Future of Nursing (AzFFN)
of the product advertised, the advertisers or the claims
made. AzFFN shall not be held liable for any consequences
resulting from the purchase or use of advertised projects.
AzFFN, AzNA and Arthur L. Davis Publishing Agency, Inc.
reserve the right to reject advertisements. Rejection of an
advertisement does not imply that the offering or product
for advertisement is without merit, lacks integrity, or that
this association disapproves of the offering or product.
The Arizona Nurses Association is a constituent
member of the American Nurses Association.

October, November, December 2021 Arizona Nurse • Page 3
CEO’S MESSAGE
AzNA PAC
The Arizona Nurses
Association continues to be
hard at work advocating for
Arizona Nurses to promote
a Healthy Arizona. Through
legislation we contributed
to many bills, however
of significance is HB2454
which allows health care
providers to utilize telehealth
on an expanded basis as
was allowed by Governor’s
Executive Order during the
pandemic. SB1377 ensures
Dawna Cato,
AzNA CEO
providers are given appropriate consideration for
emergency care during COVID-19, including acts
or omissions because of a lack of staffing, facilities,
equipment, supplies or other resources that are
attributable to the state of emergency and that
render the health provider unable to provide the
level or manner of care to a person that otherwise
would have been required in the absence of the
state of emergency. HB2633 is a major success for
AzNA as it accomplishes something the Arizona
nursing profession has been waiting on for 30 years!
HB2633 allows Nurse Practitioners and Clinical Nurse
Specialists to order home health care for Medicaid
patients. A full 2021 legislative report can be found at
2021 Leg Report AzNA (ymaws.com).
In addition to advocacy at the state level, we
engaged with many local news, radio, and print
media to address current issues and trends amongst
our profession in the state. We are thrilled that the
AzNA is viewed as the voice of Arizona nurses. Our
media presence includes, Arizona Family, Phoenix
Business Journal, Arizona Republic, and AZ Central
to name a few. The work of the AzNA Board of
Directors, members and staff is a continuous cycle
of proactive and reactive responses to current and
emerging demands. The collective representation of
our members within and amongst a variety of practice,
academic and regulatory settings demonstrates that
nurses in Arizona are highly engaged and active within
the healthcare industry. This was recognized by a
report indicating Arizona as the best state for nurses
in 2021. 1 Finally, the Arizona Nurses Association was
ranked within the top 10 Associations for number of
paid members. 2 Clearly nurses within our state and
AzNA members are more engaged, informed, and
active in the professional community. Now is our
time to shine and propel the profession forward with
innovation, energy and commitment to the patient,
populations, and communities we serve.
To this end, over the past several months we
have invested in rebuilding the Arizona Foundation
for the Future of Nursing (AzFFN). AzFFN is
the philanthropic arm of the Arizona Nurses
Association. The Mission is to “Ensure Arizona has
a sustainable nursing workforce to provide quality
care for the health and wellness of our diverse and
growing population.” Overseen by the Board of
Trustees (BOT), the AzFFN is a 501c(3) focused on
scholarships, workforce development and support,
and leadership. Initiatives such as RNconnect
(text RNconnect to 60298) provide tools, tips and
resources for psychological well-being. Partnerships
with organizations such as Better Place Forest,
who generously donated a garden for a “Heroes
Memorial” 3 and AZ Cactus Pine Girl Scouts who
generously donated approximately 120,000 cases
of cookies that were distributed across the valley!
We are not done, more innovative and creative
partnership are being established everyday to help
us meet our strategic goals under the focus areas of
workforce, scholarship and leadership. 4
Although we have had many challenges over the
past several months, our profession has continued
to grow stronger, more resilient and demonstrate
an increased capacity to care for Arizona residents.
Arizona Nurses have engaged in leadership from
the bedside to the boardroom by supporting our
emerging professionals, our colleagues, and our
interdisciplinary teams. We have heard stories
of hardship as well as stories of true selflessness
and heroism. Nurses remain the backbone of
the healthcare industry and as the most trusted
profession and the largest segment of the healthcare
industry, we have a moral and ethical obligation
to continue to lead, advocate and advance the
profession. For further information on how you can
get involved visit www.aznurse.org.
Resources:
The best (and worst) states for nurses in 2021,
according to WalletHub (advisory.com) Arizona
named best state for nurses - State of Reform |
State of Reform
Arizona Association of Realtors No. 1 on Professional
Associations List - Phoenix Business Journal
(bizjournals.com)
Arizona Nurses Association and Better Place Forests
Partner to Recognize Fallen Nurses, Healthcare
Workers in Arizona | Business Wire
Scholarship Opportunities - Arizona Nurses
Association (aznurse.org)
A Message from
the AzNA PAC
The purpose of the AzNA PAC is to endorse
candidates for the Arizona Legislature based upon
the principles of the AzNA Public Policy Agenda.
AzNA-PAC encourages nurses to become active
and effective in shaping public policy through
the electoral process. With the legislative session
approaching, one way nurses can begin to get
involved with AzNA-PAC is through donations.
The AzNA PAC raises money for a variety of causes
including the education of nurses about politics and
contribution to selected campaigns.
Our elected legislators make laws and now, more
than ever, we need laws that not only help us manage
and mitigate the effects of the COVID-19 pandemic
but laws that enhance a culture of health that will
enable the people of Arizona to live the healthiest
lives possible. That is just what nurses do.
The PAC is gearing up for 2022 elections and
needs your donations now. Save the date for our
Spring 2022 Casino Night Fundraiser in April or
don’t wait and become a PAC subscriber today by
going to https://www.aznurse.org/page/PACdonate.
Don’t miss out – become a monthly subscriber and
know your donations are going towards electing the
right people at the right time for the right job.
CORRECTION:
The article, “Courage in Everyday Practice” by
Carol Dobos, PhD, RN-BC, NEA-BC, printed
in the July 2021 edition was not accompanied
with the correct reprint permissions. Reprint
permission should read:
Copyright © 2021. HealthCom Media.
Used with permission. All rights reserved.
myamericannurse.com/
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For more information and to apply, visit https://dxl.dixie.edu/rn-bsn/
Program questions, call 435.879.4519 or
email dru.bottoms@dixie.edu

Page 4 • Arizona Nurse October, November, December 2021
Will Your Next Prescription be for the
Pharmacy or the Farmacy?
Joanne Evans, RN
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
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. Nearly
40% of older adults take five or more prescription
drugs (Martin et al., 2019). All medications, whether
over-the-counter or prescription medications, may
have side effects, including nausea, fever, chills,
headaches, itching, wheezing, tightness in the
chest, vomiting, red and irritated eyes, and the list
goes on. Pharmaceutical companies are the ones
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, decreases 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.
In a research study conducted at ten corporate
locations in the U.S., those participants practicing
plant-based nutrition (PBN) showed improvement
in body weight, blood sugar levels, and emotional
state, including depression and anxiety (Agarwal et
al., 2015). In another study, diets that were higher in
plant foods and lower in animal foods were associated
with a lower risk of cardiovascular morbidity and
mortality in a general population, and the longer
the participants adhered to a healthy plant-based
diet, the lower their risk of cardiovascular disease
(Esselstyn et al., 2014). Research shows that obese
patients who followed a plant-based diet had more
weight loss than those who followed a vegetarian
and non-vegetarian diet that included dairy, eggs,
fish, or meat at two-month and six-month intervals
(Turner-McGrievy et al., 2015).
What specifically is PBN? What does it include?
• Vegetables – dark greens, dark yellows and
orange, sweet potato, etc.
• Whole Grains – pasta, rice, corn, whole grain
bread, tortilla, etc.
• Fruit – whole fruit, which is better than juice
due to fiber
• Legumes – beans, peas, lentils, tofu, soymilk,
chickpeas, etc.
• Nuts and seeds
• Limited processed foods
• Avoiding oil, flour, and sugar
According to the American Association of
Colleges of Nursing (2021), there are over 3 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 PBN.
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 results
showed 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).
In talking with nurses around the country, there
seem to be many reasons nurses do not share
information about PBN. Some of the primary
reasons reported include nurses thought 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).

October, November, December 2021 Arizona Nurse • Page 5
When I spoke with nurses around the U.S., they
shared that this form of nutritional information was
not presented in nursing schools. All the nurses
who were 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. Some learned about it after
their illness and others 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.
Another group of nurses 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
- Talking with colleagues about plant-based
nutrition
- Having plant-based food at all meetings and
conferences
- Hosting monthly potlucks or lunches with
colleagues and community groups -Showing
movies on PBN and discuss the information
provided
- 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
• Having discharge and care plans include
plant-based nutrition
• Requesting PBN guest speakers in
educational settings for undergraduate
and graduate-level nursing programs
• Incorporating PBN into all discussions
about chronic diseases
• Collaborating with other health care
providers interested in plant-based nutrition
• Encouraging hospitals to have plant-based
foods at all meals
• Hosting a free online 10-day plant-based
program https://www.drmcdougall.com/
health/education/free-mcdougall-program/
or hosting a free 21-day (PCRM) online
plant-based program – including menus,
recipes, cooking classes, and additional
Information - https://kickstart.pcrm.org/en
There are several groups available for nurses
interested in learning more about plantbased
nutrition. The Physicians Committee for
Responsible Medicine (PCRM) hosts the Nurses
Nutrition Network, which provides educational
programs for nurses (https://www.pcrm.org/goodnutrition/nutrition-for-clinicians/nurses-nutritionnetwork).
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 well-positioned 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
Pharmacy or the Farmacy continued on page 6

Page 6 • Arizona Nurse October, November, December 2021
MEMBERS
ON THE MOVE
AzNA would like to recognize members Virginia Prendergast and Jayme Ambrose, who were
named 2021 Phoenix Business Journal Health Care Heroes Finalists. Virginia Prendergast is the Senior
Director of Advanced Practice Nursing at Barrow Neurological Institute and was recognized in the
Nursing category. Jayme Ambrose is the CEO of Adobe Care and Wellness and was recognized in the
Innovator category. Congratulations!
Are you an AzNA Member with an accomplishment to highlight?
To see the full job description and
qualifications, please see our job
posting on nursingnow.com.
YC is an equal opportunity employer.
Send to info@aznurse.org.
YAVAPAI COLLEGE
invites applications for the position of:
Associate Professor, Allied Health
HIRING FOR POSITION
AT THE PRESCOTT VALLEY CENTER
IN PRESCOTT VALLEY, AZ
For more information and to apply:
www.yc.edu/hr
Click on Current Job Opportunities
928-776-2217
HumanResources@yc.edu
AskHR@yuc.edu
Pharmacy or the Farmacy continued from page 5
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!
References
Agarwal, U., Mishra, S., Xu., J., Levin, S., Gonzales, J., &
Barnard, N. D. (2015). A multicenter randomized
controlled trial of a nutrition intervention
program in a multiethnic adult population in
the corporate setting reduces depression and
anxiety and improves quality of life: The GEICO
Study. American Journal of Health Promotion,
29(4), 245-5. doi: 10.4278/ajhp.130218-QUAN-72
American Association of Colleges of Nursing. (2021).
Nursing fact sheet. https:// www.aacnnursing.
org/news-Information/fact-sheets/nursing-factsheet
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/
diabetes-statistics
Esselstyn, C. B. Gendy, G., Doyle, J., Golubic, M.,
& Roizen, M. F. (2014). A way to reverse CAD?
Journal of Family Practice; 63(7):356-64.
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/
Turner-McGrievy, G. M., Davidson, C. R., Wingard,
E. E., Wilcox, S., & Frongillo, E. A. (2015).
Comparative effectiveness of plant-based diets
for weight loss: A randomized controlled trial of
five different diets. Nutrition, 31(2), 350-8. https://
doi.org/10.1016/ j.nut.2014.09.002
U.S. Food and Drug Administration. (2018). Fact Sheet
– FDA at a glance. https://www.fda.gov/ aboutfda/fda-basics/fact-sheet-fda-glance
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October, November, December 2021 Arizona Nurse • Page 7
Documenting nursing assessments in the age of EHRs
Georgia Reiner, MS
Nurses have grown accustomed to documenting
assessment results in electronic health records
(EHRs), rapidly clicking responses to assessment
checklist questions. However, at times, nurses
may complete this documentation without giving
enough thought to those responses because
they want to move on to their “real” work: caring
for patients. But failing to properly complete
documentation can put nurses at risk.
Dangers of improper documentation
The danger of failing to properly document
nursing assessments in the EHR is threefold. First,
nurses might base their assessment on the checklist,
not the patient, which can lead to an incomplete
assessment, especially if the nurse inadvertently
clicks something as being done when it hasn’t.
Second, nurses might fail to adequately document
a finding if it does not match the available options in
the checklist. Third, nurses might fail to document
assessments when a patient’s condition changes
or fail to document practitioner notification of the
change. All three scenarios can leave nurses open
to professional liability lawsuits or action against
their license.
Proper EHR documentation
You can take several steps to ensure you’re
documenting assessments and other information
correctly in the EHR:
• Follow basic documentation principles.
Document promptly, accurately, and without
opinions about patients or providers. When
making a correction to previously recorded
information, include the reason for the
change. Remember that the EHR provides a
date and time for each entry, providing a clear
documentation trail.
• Adhere to policies, procedures, regulations,
and guidelines. In the event of a legal action,
one of the first steps an attorney will take is to
determine if you followed your organization’s
policies and procedures related to nursing
assessments and documentation, as well as
any relevant state, federal, or local guidelines,
and guidelines from professional associations.
• Complete an effective assessment. You won’t
have the information you need for the EHR
unless you perform a quality assessment.
Don’t simply consider what a computer
checklist tells you to include.
• Document changes in the patient’s condition.
Remember to enter changes to the patient’s
status into the computer and include if you
notified the provider of the change.
• Be patient-centered. The ability to document
at the patient’s bedside can save time and
improve accuracy, but only if you keep
your focus on the patient instead of on the
computer. Consider telling patients what you
are entering into the computer, which can
help ensure the information is accurate.
• Copy and paste cautiously. The copy and paste
feature in EHRs can be a time-saver, but errors,
including errors of omission, can easily occur.
Think about what is appropriate for copying
and pasting and review notes carefully.
• Beware of autofill and templates. Like copy and
paste, the autofill feature can save time by
avoiding repetitive entries, but you need to
verify that the information automatically filled
in is correct. Similarly, templates for regular
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occurrences can help save time and ensure
needed information is collected, but you still
need to be aware of individual patient needs
and assessment findings.
• Use notes appropriately. Sometimes what you
need to document as an assessment finding
isn’t in a checklist or pull-down menu. Don’t
choose the “next best” option; doing so can
lead to miscommunication and clinical and
billing errors. A better approach is to add a
succinct note to the patient’s record.
• Don’t ignore alerts. Alerts are there to help
you make better decisions when it comes to
patient care. On the other hand, too many
alerts may lessen their efficacy, leading to
“alert fatigue”. Talk with your manager or
informatics contact to discuss settings.
• Don’t assume the EHR is always right. The EHR
isn’t infallible. If, for example, results of a test
don’t seem to match the patient’s symptoms,
follow up with the provider – the test may
need to be redone.
A partnership
Rather than having an adversarial relationship with
the EHR, nurses should consider the EHR as a care
partner. By serving as a repository of data, providing
alerts as needed, and facilitating communication,
the EHR can help ensure quality patient care—and
reduce nurses’ risk of legal action.
RESOURCES
Balestra ML. Electronic health records: Patient care
and ethical and legal implications for nurse
practitioners. J Nurs Pract. 2017;13(2):105-111.
ECRI Institute. Copy/Paste: Prevalence, Problems,
and Best Practices. Special Report. 2015. www.
Contact:
Myra Francisco, RN – Nurse Recruiter
505.726.8549 | myra.francisco@ihs.gov
http://bit.ly/gsu-rn
ecri.org/Resources/HIT/CP_Toolkit/CopyPaste_
Literature_final.pdf.
Kelley T. Electronic Health Records for Quality
Nursing and Health Care. Lancaster, PA: DEStech
Publications; 2016.
Pagulayan J, Eltair S, Faber K. Nurse documentation
and the electronic health record. Am Nurs
Today. 2018;13(9):48-52, 54.
Partnership for Health IT Patient Safety. Health IT Safe
Practices: Toolkit for the Safe Use of Copy and
Paste. 2016. https://d84vr99712pyz.cloudfront.
net/p/pdf/hit-partnership/copy-paste-toolkit.pdf.
Tsou AY, Lehmann CU, Michel J, et al. Safe practices
for copy and paste in the EHR. Appl Clin Inform.
2017;8(1):12-34.
Disclaimer: The information offered within this article
reflects general principles only and does not constitute
legal advice by Nurses Service Organization (NSO)
or establish appropriate or acceptable standards of
professional conduct. Readers should consult with an
attorney if they have specific concerns. Neither Affinity
Insurance Services, Inc. nor NSO assumes any liability
for how this information is applied in practice or for the
accuracy of this information.
This risk management information was provided by
Nurses Service Organization (NSO), the nation’s
largest provider of nurses’ professional liability
insurance coverage for over 550,000 nurses since 1976.
The individual professional liability insurance policy
administered through NSO is underwritten by American
Casualty Company of Reading, Pennsylvania, a CNA
company. Reproduction without permission of the
publisher is prohibited. For questions, send an e-mail to
service@nso.com or call 1-800-247-1500. www.nso.com.
Georgia Reiner, MS, CPHRM, is a Senior Risk Specialist
with the Nurses Service Organization (NSO)
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October, November, December 2021 Arizona Nurse • Page 9
American Academy of Nursing’s
“Have You Ever Served?” Campaign
Cheryl K. Schmidt, RN
The American Academy of Nursing launched a program in 2015 called
“Have You Ever Served?” This outreach program was designed to educate
health care providers and veterans throughout the United States about
the types of screening questions that should be embedded into electronic
health records in both the Veterans Administration and civilian health care
organizations. It also describes the health conditions related to military
service during different eras, including the following:
Exposure Risks Diseases Locations
Radiation Exposure/
Nuclear Weapons
Agent Orange Exposure
Camp Lejeune Water
Contamination (1/1/57-
12/31/87)
Transfusions prior to
1992, exposures to
blood, shared personal
items
Exposure to Open Air
Burn Pits
Gulf War Syndrome
Depleted Uranium
Various cancers
Various cancers,
diabetes, heart disease,
neuropathy, spina
bifida in biologic
children
Various cancers,
infertility, miscarriage,
renal toxicity
Hepatitis C
Respiratory illnesses,
wide variety of cancers
Fibromyalgia, chronic
fatigue, GI problems,
cognitive impairment,
various cancers,
neurodegenerative
diseases like ALS, MS
Respiratory and kidney
diseases from inhaling/
ingesting heavy metals
e.g., World War II, Gulf
War, etc.
e.g., Korea, Vietnam
Camp Lejeune, NC;
similar problems may
have occurred in other
military locations
Vietnam
Vietnam, Iraq,
Afghanistan; now
seeing similar illnesses
in firefighters
Gulf wars
Gulf Wars, Bosnia,
Afghanistan
After I was inducted into the American Academy of Nursing in 2012, I joined
the Special Interest Group that explored issues related to the military. I served in
the Army Nurse Corps Reserves for 22 years (1974-1996) and was injured while
deployed for Operation Desert Storm in 1990-1991. As a disabled veteran, I have
talked with many other veterans and health care providers about the “Have You
Ever Served?” campaign. During the past year, I started reading about diseases
that firefighters were developing that were very similar to those resulting from
exposure to the Burn Pits in the Middle East. I have shared information about
the campaign with Fire Chiefs and any firefighters I meet and give them copies
of the pocket card describing the campaign. I also shared it with Senator Paul
Boyer (R-District 20), who sponsored SB 1450, which is intended to add language
supporting screening and workman’s compensation for firefighters. I am also
concerned about others who respond to fires, such as law enforcement and the
American Red Cross, who do not wear protective turn-out gear like firefighters do.
If anyone is interested in learning more about the “Have You Ever Served?”
campaign, please visit HaveYouEverServed.com.
Cheryl K. Schmidt, PhD, RN, CNE, ANEF, FAAN is a Clinical Professor at Arizona
State University,
Edson College of Nursing and Health Innovation
To access electronic copies of the
Arizona Nurse, please visit
http://www.nursingALD.com/publications
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Page 10 • Arizona Nurse October, November, December 2021
The Joy of School Nursing During
COVID-19 (No, Seriously!)
Jacquelyn Martin, RN
Recently, my daughter was sent home from
preschool with a runny nose and cough. She’s a
teething toddler, and these symptoms are expected.
Still, I dutifully took her to her pediatrician to rule out
COVID. He laughed and wrote us a note for school. As
a parent, it was inconvenient, yet in my daily work as a
school nurse, I was having these same conversations
with parents and sending students home with
congestion or fatigue - innocuous symptoms that,
in years past, would not have warranted a sick day.
In fact, I used to have a little speech I would give to
students with colds, about how colds can linger for
up to a month and, basically, they need to power
through.
Pre-pandemic school nurses administered daily
meds and treatments, assessed injuries, checked
throats for swollen tonsils and scalps for lice and
provided students, staff, and families with education
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about health concerns. With COVID, we still do all
that, but we’re also at the frontlines of triaging COVID
symptoms, contact tracing, and leading school health
policy. And, as stressful as it has been, I have loved
every minute of it (almost!). I am so proud that
throughout the pandemic, my school has had no
school-transmission of COVID-19. I attribute this
to nursing leadership resulting in evidence-based
policy.
When the pandemic first started, I saw it as an
opportunity for nurses to educate our populations
about basic infection prevention methods like proper
handwashing and masking (and later, vaccination).
As nurses, we know how to search for and interpret
credible information and deliver effective education.
Nurses should also use these skills to become
involved in health policy-making at all levels.
School nurses can keep our communities healthy
even amidst a pandemic. We must simply power
through… but with a mask!
A Requiem
for Florence
Matthew J. Parker
With a BA in English Lit from Arizona State
University and an MFA in creative writing from
Columbia, I know a lot of poets. So when I got an
idea last October to supply short, original poems to
our hard-working nurses here in Arizona and indeed
across the country in the midst of this pandemic, I
messaged a handful of them on Facebook.
Not a single one wrote me back, let alone
provided a poem. Their willful silence reminded me
that there really is something to the label of the elite
that’s often plastered on the literary, even though I
was never really one of them. Indeed, I was working
construction at the time and had just volunteered
for the AstraZeneca Vaccine. It was there I met a
Nurse named Jamie with an Albert Einstein tattoo.
She was a stand-in for all of you.
So I wrote this poem myself, hoping it brings a
note of hope to her and all of our brave nurses
and frontline workers who find themselves again
trapped in the trenches. Amid yet another gathering
of darkness, I offer this token to remind you all that
messages of renewal often come from the tiniest of
creatures.
Nightingale
They say stars only shine at night,
but I know better.
I’ve seen them during the day
in scrubs
flitting from bed to bed
from EU to ICU
worn as their masks
carrying their own light, their own fire
unto a world gone dim
it’s a calling, they say
like birds who also sing by night.
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October, November, December 2021 Arizona Nurse • Page 11
What Really Works in Preventing Falls
Jacquelyn Martin, RN
Many nursing interventions aimed at fallprevention
like bed alarms (Chan et al., 2017;
Timmons et al., 2019), toileting programs (Fehlberg et
al., 2017), encouraging non-slip footwear (Hartung &
Lalonde, 2017), one-on-one observation ( Fehlberg
et al., 2017; Greeley et al., 2020), and patient mobility
and safety education (Luzia et al., 2018; Naseri et
al., 2019; Zachary et al., 2020) do not significantly
reduce the number of adult in-patient fall events
or fall-related injuries. Therefore, my objective
was to identify statistically significant, nursing-led
fall-reduction interventions that can feasible and
independently be implemented by nursing staff.
I searched for recent, peer-reviewed articles
on nursing-led interventions addressing adult,
in-patient fall prevention and then screened for
content, quality, evidence level, and bias, leaving
only the highest quality articles which returned
statistically significant results. Five articles met
these inclusion criteria. When considering practice
change, three themes emerged: hourly nursing
rounding, keeping eyes on patients, and using an
interdisciplinary approach.
Hourly Rounding. Jones et al. (2019) found that
hourly rounding was effective in reducing falls
across hospital settings (p

Page 12 • Arizona Nurse October, November, December 2021
Patricia Johnson, a Trailblazer in Neonatal Care
Shannon E. Perry, RN
Arizona started transporting infants to St.
Joseph and Good Samaritan Hospitals in Phoenix
for specialty care in 1967. Shortly thereafter,
Tucson Medical Center and the University of
Arizona Health Sciences Center established
newborn intensive care units and started
receiving transported infants (Perry, 2021).
Regionalization of perinatal care throughout the
country became widespread in the 1970s and
premature and sick infants were transported to
specialty nurseries.
Specially trained nurses became essential to
provide care for these high-risk infants. Slovis and
Comerci (1974) described a program to prepare
nursery nurses as neonatal nurse practitioners
(NNPs). The program consisted of 24 hours
of teaching by physicians at the crib side and
approximately two months of supervised clinical
experience. Only two nurses were in this initial
class, but the program was deemed a success.
The first NNP prepared at the graduate level was
Patricia Johnson (Johnson, 2002). An experienced
neonatal and pediatric intensive care nurse,
Johnson designed a graduate curriculum to test
the feasibility of an advanced-practice role in a
NICU. She managed her group of neonates during
a seven-week internship. Johnson maintained
a traditional resident physician schedule by
working seven days a week and in-house every
third night. At the end of the internship, she
designed a method to evaluate the trial. The
management she provided was compared to that
provided by resident physicians for ten similar
neonates. The results were evaluated by blinded
chart review by ten leading neonatologists in
the West. These results provided evidence that
an advanced practice nurse could give care
comparable to that provided by the resident
physicians (Johnson, 2002).
From Johnson’s groundbreaking educational
preparation and practice, the roles in specialty
care of neonates have proliferated. Today there
are over 7,000 certified low-risk neonatal intensive
care nurses, 30,000 certified neonatal intensive
care nurses, 7,900 certified NNPs (About NCC,
2021), and 1,700 certified neonatal clinical nurse
specialists (AACN, n.d.).
Since graduation in 1974, Johnson has
functioned as an NNP in several settings
providing care to neonates, transporting infants,
and supervising other NNPs. She has served
as faculty and clinical preceptor in several
universities. Johnson earned a Master of Public
Health in 2002 and a Doctorate in Nursing
Practice in 2008.
Johnson has a long list of professional
publications, holds membership in a number
of professional associations, and has served
in numerous leadership positions. Her honors
include the Distinguished Service Award and
Distinguished Leader in Neonatal Nursing Award
from Nurses Association of Neonatal Nurses
(NAAN), the NNP Excellence in Practice Award
from National Association of Neonatal Nurse
Practitioners (NANN/NANNP). She was an
inaugural inductee into the Neonatal Nursing
Hall of Fame of the Academy of Neonatal Nursing
(P. Johnson, curriculum vitae, October 10, 2020).
Johnson noted that her biggest challenge
as an NNP was early in her career when she
was pioneering the NNP role among so many
physicians and nurses who were not in favor
of nurses expanding their roles in patient
management. What she likes most about being
an NNP is the opportunity to use her skills to help
a baby survive and attend births of babies with
initial needs and problems (P. Johnson, personal
communication, April 23, 2021).
Johnson believes there is a future for NNPs
because more and more physicians prefer not
to participate in the hands-on management of,
and the detailed processing of the management
plan for, high-risk neonates. She hopes more
nurses will consider pursuing a career as NNPs
but is not convinced that a DNP is required for
this role. However, she promotes the education
and tools provided in the DNP curriculum to
optimize nurses’ contributions to improving
care (P. Johnson, personal communication, April
23, 2021).
Currently, Johnson is an NNP with staff
privileges and NNP Coordinator at Valleywise
Health/AZ Children’s Center in Phoenix. She
is responsible for clinical management of
newborns in all levels of care and for teaching
and mentoring residents.
Dr. Patricia Johnson, DNP, MPH, APRN,
NNP, was a trailblazer in neonatal care and has
continued to contribute to the care of these
vulnerable infants. Many NNPs and families owe
her a debt of gratitude. Kudos to her!
References
About NCC. (2021). Retrieved from https://www.
nccwebsite.org/about-ncc.
American Association of Critical-Care Nurses (AACN).
(n.d.). Certification exam statistics and cut scores.
Retrieved from https://www.aacn.org/certification/
preparation-tools-and-
Johnson, P. J. (2002). The history of the neonatal nurse
practitioner: Reflections from “Under the looking
glass.” Neonatal Network, 21(5), 51-59.
Perry, S. E. (2021). Regionalization of premature infant
care in Arizona and the nurses who helped
make it happen: Frances L. Mast and Sister Alice
Montgomery. Arizona Nurse, 74 (1), 9.
Slovis, T. L., & Comerci, G. D. (1974). The neonatal nurse
practitioner. American Journal of Diseases of
Children, 128, 310-314.
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October, November, December 2021 Arizona Nurse • Page 13
Ask Nurse Melissa
“Nursing has always been a profession with high stress moments. Over the past 18
months, some of us feel as though our entire shift is high stress. What recommendations
do you have for staying positive and resilient even in the middle of a shift?”
First of all, we have all experienced high stress moments, days, weeks,
months–so know you are absolutely not alone. I think we all have been in the
cloud of stress for the past 18 months as we work through the pandemic. In the
Oscar nominated film Minari, a grandma is in a creek with her grandson planting
vegetables. when the grandson sees a snake on a branch he throws rocks at it to
scare it away. The grandma says, “David, it’s better to see it than to have it hide.
Things that hide are more dangerous and scary.” I can see the similarity to what
we are facing today, we see the danger, and our sympathetic nervous system
kicks in to help us flee danger.
Our situation in healthcare is different. The danger isn’t leaving us quickly. So
many of us have been in fight or flight mode for 18 months. This situation is called
adrenaline fatigue. Our bodies were not made to run from danger for weeks on
end, let alone a year and as half. Our adrenal glands are working overtime. Let’s
use the advice of grandma. We see the snake, it has been in front of us for 18
months and it isn’t going away. We have been overworking ourselves throwing
rocks at this snake hoping to get it to leave us alone. We need a mind shift,
individually & collectively, to adapt to the ‘snake’ being out in our environment. It
is better to accept this virus is here and we are facing it, instead of the virus hiding
in the shadows, leaving us to guess when it might come out again. We need to
take ourselves out of this sympathetic response and give our mind some respite.
We see the threat and we can exist around it.
Here are a couple ways we can adapt and protect our mental health:
Someone’s urgency is not your emergency. Yes, of course, we will utilize our
critical thinking and correctly prioritize patient needs - needs, not wants. A
patient needs medication in a timely manner. A patient wants you to find her
favorite crime show. See the difference. Healthcare has become so customer
service driven, that nurse’s feel an expectation to give everything they have to
their patients. We can professionally limit-set expectations at the beginning of a
shift by encouraging the patients to do most of their care by asking, “who does
that for you at home?”, “how would you manage this at home?” These questions
help the patient see outside of their stay at the hospital and brainstorm how they
will do their ADLs at home.
Make yourself a priority. This is a broken record, we’ve heard this so many
times. But let it sink in. You deserve to eat your meals, drink your water, and go
to the restroom as everybody else--I have to say this because I see you sitting
quickly charting, checking your watch to challenge yourself on how long you
can hold it before you absolutely need a restroom break. In my experience,
letting my patients know that I have given report to another nurse so I can go
eat, take a break, helps the patient humanize me and my needs. Nurses have
the reputation of always being there and giving it their all. We need to humanize
these statements, and realize we have needs that must be addressed to do our
job well.
Resilience is accepting your new reality, even if it’s less good than the one you
had before. You can fight it, you can do nothing but scream about what you’ve
lost, or you can accept that and try to put together something that’s good.
Challenge yourself this month to see your value and take care of yourself.
Establish your limits and communicate with your patients professionally what
boundaries need to be made. If you make a conscious effort to be grounded
in the moment and practice someone’s urgency is not your emergency, and
making yourself a priority, then you will notice that your attitude will improve, the
tension in your shoulders will release, and you will be able to place yourself into
the profession you love.
In this together -
♥ Melissa
Have a question for Nurse Melissa? Email info@aznurse.org with
“Nurse Melissa” in the subject line.
Terros Health is a healthcare company focusing on the
WHOLE PERSON providing primary care and specializing in
mental health and substance use treatment for over 50 years.
With 7 Federally Qualified Community Health Centers and Recovery
Health Centers throughout the Phoenix and surrounding area, we are
hiring Registered Nurses for several positions including:
– Lead RN/ACT RN – Tempe, AZ
– Lead RN – MAT (Medication Assisted Treatment) – Glendale, AZ
– Lead RN – Justice Program – west Phoenix, AZ
– ACT RN – west Phoenix, AZ
– LTE/Temp RN – Tempe, Glendale and west Phoenix, AZ (Hourly)
Outpatient – Integrated Care (Primary Care & Mental Health) |
AZ RN License Required | EXCELLENT SALARY | Comprehensive
Benefits Package Including: Medical, Dental, Vision, Life, Disability,
and 401K, etc. | Generous PTO/PST: 4+ Weeks plus holidays.
(All RN positions, except for LTE positions come with $2000 Bonus)
Please view our website for additional
RN and NP positions.
Apply online at: WWW.TERROSHEALTH.ORG
Meet the Nursing Leadership team at
Wickenburg Community Hospital!
Established in 1926, and like the tenacious Western spirit that built
Wickenburg, at our rural Community Hospital and Clinics, taking care of
our patients, families, and community comes first. Our team is committed
to providing quality, health, and wellness services to our residents and
surrounding communities within approximately 3,300 square miles.
Being a smaller organization, Wickenburg Community Hospital offers the
opportunity for more personal care to our patients while being close
enough to a major city to enjoy all that Phoenix has to offer.
If you have the passion for caring for patients “Out Wickenburg Way,”
explore the possibilities!
Or contact Dina Steinberg at 928-668-1822.
For more information: Contact Dawn Golden at
DAWN.GOLDEN@TERROSHEALTH.ORG
TERROS HEALTH | 3003 N CENTRAL AVE, #400 | PHOENIX, AZ 85012

Page 14 • Arizona Nurse October, November, December 2021
AzNA’s Superstars
Happy Anniversary to our dedicated
AzNA members celebrating these
special milestones for this past quarter:
June – August 2021
5-Year Members
Tiffany Anderson
Steven Bailor
Mary Baldrige-Murphy
Tina Barney
Amanda Beaumont
Roberta Boon
Denise Bugg
Juliana Carr
Cathy Emerdinger
Pamela Gift
Rita Gonzalez
Miriam Gonzalez Del
Bosque
Diana Grandstaff
Consuelo Grant
Elizabeth Hamann
Kristina Hefner
Debra Herington
Anna Hershkowitz
Renee Hultz-Brown
Bonita Jones
Elizabeth Keesler
Rachael Kimes
Arlie Lowrie
Keila Maldonado
Kristina Mathena
Rebecca Milam
Connie Miller
Melissa Moritz
Karen Moskal
Sahilu Musa
Susan Neder
Sherrie Palmieri
Caroline Parkinson
Stacey Pierce
Crisann Pignatiello
Evelyn Pillor
Mary Quinn
Dawn Shoemaker
Karen Swain
Stefanie Walker-Leu
Valerie Weaver
Jane Werth
Lori Williams
Tasha Wood
10-Year Members
Caryn Bajo
Candy Boyes
Michelle Carlin
Evelyn Cesarotti
Kathie Crane
Linda Dietrich
Alexander Forbis
Merna Graham
Julie Jenkins
Debra Jur
Deborah Kirwin
Martha Lizarraga
De Garza
Kim Maryniak
Tyanna Montijo
Janice Morgan
Carolyn Murdaugh
Danielle Orr
Julie Qashu
Elizabeth Savino
Celeste Scalf
Julie Scott
Deborah Spear
Kelly Stclair
Judy Stilwell
Lynn Untermeyer
Heather Walborn-
Mcdaniel
15-Year Members
Nancy Claflin
Phyllis Click
Sharon Kusne
Robin Parry
Amber Porter
Robin Schaeffer
Victoria Voit
Michelle Weller
20-Year Members
Michelle Onacki
25+-Year Members
Sheryl Allred
Susan Anderson
Marianne McCarthy
James Mitchell, Jr.
Ana Ohmart
Jo Ridenour
Lea Way
Pima County Health Department
is seeking a Public Health
Nurse in a specific populationfocused
geographical area. This
position is distinguished from other
Patient Care Services and nursing
classifications by its primary focus on
the prevention of illness, injury and
disability and the promotion and maintenance of health of
client populations, rather than direct patient care. Minimum
Qualifications: Bachelor of Science degree in Nursing (BSN)
from a nationally accredited college or university or Masters
of Science (MS) in Nursing or a Master's of Science in
Nursing (MSN) degree from a nationally accredited college
or university with at least one course (3 or 4 semester units/
credits) in community or public health nursing.
Apply Online at:
www.governmentjobs.com/careers/pima. For more
information contact Human Resources at 520-724-8028.
Anthem
Keith Buhs
Apache Junction
Barbara Wilson
Avondale
Maricar Helera
Buckeye
Cheryn Lewis
Christie Watkins
Bullhead City
Courtney Kelly
Camp Verde
Shannon Wolfe
Casa Grande
Brandon Beardsley
William Griffith
Lizzie Moeti
Cave Creek
Jillian Amoroso
Chandler
Loren Buss
Jeffrey Gonzales
Lidice Nava
Sharon Yenny
Cornville
Charles Loveless
Corpus Christi, TX
Kelli Garrett
Cottonwood
Claudia Converse
Betty Daugherty-
Luttrell
Kimberly Gould
Cypress, TX
Aimee Wright
Dewey
Cheryl Lattimer
Flagstaff
Sarah Hoefle
Heidi Kelley
Helen Valder
Gilbert
Chikaodi Banor
Lauren Douglas
Theresa Gorraiz
Pamela Horner
Kayla Hutson
Annie Jacob
Candice Moore
Sharly Thomas
Patricia Timmons
Two Year Anniversary Members
June – August 2021
Glendale
Chelsey Becenti
Carol Bryant
Luz Camacho
Brad Christmas
April Fox
Susanna Liljenstolpe
Bethany Mainville
Wilhelmina Sagoe
Annor
Globe
Denise Hansen
Sabra Van Orsdol
Golden Valley
Sean Lhuillier
Goodyear
Cinthya Henao
Corinn Herrell
Darla Keith
Elissa Ver Hey
Kingman
Elizabeth Garrison
Laveen
Latasha Freeman
Litchfield Park
Donna Barisich
Luci M Hanus
Lake Havasu City
Heather Hefner
Macon
Danielle McBride
Marana
Sandra Robles
Maricopa
Blaire Buchanan
Kayode Wemimo
Mesa
Linda Banuelos
Jodi Bray
Penny Browne
Michelle Gomez
Anna Kirby
Megan Milligan
Nancy Mitchell
Emily Tyler
Luzetta Whipple
Mindi Woodruff
Mohave Valley
Olivia Gessey
Owasso
Amy Evers
Peoria
Patricia Ayemoba
Lea Herold
Briana Huang
Christina Lopez
Rico Segun
Kathy Stolz
Jaimee Vasquez
Rebecca Walpole
Erich Widemark
Phoenix
Lisa Anderson
Ruta Boyd
jolene Boydston-
Letzler
Sara Brenza
Kathleen Burrows
Hara Dembowski
TESSA Farley
Ronald French JR
Cynthia Golek
Kathleen Hunnicutt
Kara Larter
Sierra Martinez
Sarah Miranda
Amylee Nelson
Julia Olson
Candice Onusz
Tamara Parks
Allison Popa
Henry Sargent
Jody Sheets
Joe Varela III
Denise Voiles
Prescott
Laurie Beauprey
Queen Creek
Shannon Chittenden
Jennifer Huls
Rio Verde
Sara McCavitt
Rock Point
Ivan Jones
Sahuarita
John Sparks
Saint Johns, FL
Julie Poppe
San Tan Valley
Trisha Danielson
Faith Phillips
Scottsdale
Valerie Brady
Deirdre Freeman
Samantha Hapitas
Jamie Howard
Allison Levine
Jennifer Miller
Bree Owens
Patrice Roy
Seattle, WA
Reyna Navarro
Sanchez
Show Low
Ronald Klug
Sierra Vista
Micheal Kaiser
Snowflake
Tammie Resendez
Sun City
Germaine Priest
Surprise
Yajaira Acosta
Marsha Bonnell
Ashley Krasner
Justine McLellan
Victoria Nugent
Kelly Ortiz
Jennifer Roque
Janeth Sanchez
Maria Theodore
Sepulchre
Tempe
Christina Geer
Jami Mahan
Lauren Mason
The Colony, TX
Chelsea Schenck
Toledo, IL
Zachary Backlin
Tucson
Jocelyn Abbott
Wendy Bitselley
Rosemary Bolza
Charles Elam
Megan Grace
Debra Jackley
Carla Kowalewski
Susana Marr
Gale Odion
Angela Randolph
Cindy Rishel
Marilynn Ruffin
Milton Spivack
Tracie Weber
Carolina Wilson
Valley Farms
Tanya Schell
Waddell
Chip Ortiz
Bonnie Voges
Winslow
Rhonda Davis-Begay
Wittmann
Ashley Artibey
Yuma
Deborah Aders
Lauren Dennis
Bonnie Irr
Jessica Short

October, November, December 2021 Arizona Nurse • Page 15
New & Returning AzNA Members
June – August 2021
Avondale
Deb Neville
John Njoroge
Buckeye
Timothy Fitzpatrick
Kimberly Ghering
Jamie Pemberton
Amanda Reyes
Susan Thompson
Casa Grande
Darcy Cuny
Samantha Kakar
Cave Creek
Teresa Erickson
Beth Gross
Jessica Kuretich
Carley Mccarthy
Leslie Wojtowicz
Chandler
Susan Bray
Joseph Castillo
Maria Cramer
Jessica Crawford
Carole Garrett
Alexandra Gray
Geoff Ibe
Margaret Komar
Casey Krassow
Flora Lerma
SErgio Navarro
Lisa Radesi
Melissa Rietz
Karen Stevenson
Cottonwood
Mary Anne Robertson
Dewey
Mary Kay Graves
Flagstaff
Michael Hillburn
Madeline Tilley
John Turner
Fort Defiance
Faith Laurence-Leslie
Gilbert
Jennifer Brooks
Tekoya Calixte
Kristina Castor
Marie Ceus
Nicola Ciarelli
Rianne Cruthis
Adella Deharo
Kerry Fowler
Linee Hawkes
Paul Kostura
Krislyn McCollam
Margaret Plas
Vanessa Plumley
Perla Quinones
Kimberly Shoop
Jenna Smith
Jonathan Thomas
Ansan Thomas
Jason Warren
Glendale
Jacqueline Jimenez
Scott Kent
Lindsay Navarro
Danielle Sawyer
Michelina Stazzone
Cassandra Yoo
Golden Valley
Marcie Turner
Cornelison
Goodyear
Katherine Gallegos
Jennifer Peterson
Green Valley
Rubye Nasser
Sona Siegel
Kingman
Joan Alford
Jennifer Binker
Naomi Brown
Anthony Olave
Laveen
Deandrea Washington
Litchfield Park
Kimberly Bunta
Clarrissa Gober
Marana
Karin Blasko
P. Noel Harrell
Maricopa
Donna Campbell
Shannon Diaz
Jennifer Facurib
Mesa
Michelle Antolik
Lorena Bachelier
Marcus Daniels
Mikaela Deans
Kimberlee Ellison
Elizabeth Espy
Elizabeth Haws
David Miller
Eileen Muery
Victoria Sanchez
Paige Spencer
Leandra Yazzie
Oro Valley
Christine Breda
Mary Lou Monahan
Sonya Taylor
Parker
Amythest Osuna
Peoria
Sara Frank
Angel Johnson
Lisa Lalone
Connor Mattingly
Brinda Patel
Cindy Roberts
Phoenix
Punam Bhakta
Melonie Blancaneaux
Danielle Bowlin
Jennifer Elliott
Lauren Furlong
Pauline Goss
Heather Healy
Penelope Heisler
Jose Hernandez Millen
Melissa Jones
Angela Lober
Brittany Madden
Jackie Mohr
Reyna Murillofellers
Hortense Noble
Stacy Nolasco
Neil Patel
Susan Pendergast
Chera Plante
Sunny St. John
Brittni Sunbury
Rebecca Tolino
Maria Tomasello
Andrea Vasquez
Patricia Weiland
Cassandra Welling
Lynette Wiltgen
Pinetop
Anastassiya Schurman
Prescott
Kelly Burkitt
Deborah Davis
Jamie Suffriti
Queen Creek
Gina Keedy
Sahuarita
Celina Ruiz
San Tan Valley
Michele Hudson
Patricia Hughes
Libby Rumary
Scottsdale
Tyler Aman
Robert Cucci
Caroline Fisher
Alexis Hale
Belinda Hodder
Sarah Legrand
Moira Lynn
Erika McCormick
Camille Morua
Terri Noyes
Theresa Raskauskas
Lois Schwartz
Sedona
Shirlee Snyder
Sells
Charles Burt
Show Low
Emma Dewitt
Marilyn King
Sierra Vista
Laurie Brown
Candy Mungarro-
Rubio
Sun City
Cheryl Moss
Surprise
Kimberlee Angel
Lisa Blue
Jackwalyn Brush
Lynn Fletcher
Shera Tonazzi
Tempe
Lyndsey Wyrybkowski
Tolleson
Christina Brown
Tuba City
Davina Baheshone
Tucson
Abdirahman Abdi
Jameela Ameen
Cynthia Anchondo
Darunee Armenta
Carol Bradley
Marylorelei Caraveo
Daniel Chafetz
Amanda Davis
Griselda Delgado
Connie Doner
Andrea Evenson
Timian Godfrey
Janine Hinkley
David Johnsrud
Dawn Kasarda
Sara Kellogg
Gladys Loyola
Sean Materi
Rachel Minnich
Catharine Nienhouse
Sandra Olson
Jaime O’Rourke
Gina Pierce
Rachael Porter
Jessica Rainbow
Marcus Romaniuk
Nicole Stewart
Alvin Tormes
Wanda Whitman
Cheryl Young
Waddell
Travis White
Wittman
Tujuana Land
Yuma
Lea Jerpseth
Heather Padilla
Erin Picolet

Page 16 • Arizona Nurse October, November, December 2021
An Ethic of Justice Viewed through the Lens of an Ethic of
Care: How Nurse Leaders May Combat Workplace Bullying
Gloria Matthews, DNP, RN, CNL, CDE
University of Oklahoma Medical Center
Valerie Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A
University of Oklahoma Health Sciences Center
Fran & Earl Ziegler College of Nursing,
Lawton Campus
Reprinted with permission from
Oklahoma Nurse May 2021 issue
The purpose of this paper is to present
integration of two ethical approaches to combat
workplace bullying within a clinical setting from an
advance nursing practice leadership perspective.
A description of ethic of care and ethic of justice
is presented and critically appraised as it relates
to managing workplace bullying. The importance
of the application of the ethic of justice through
the lens of the ethic of care will be elucidated.
Description and Application to Workplace Bullying
A failure of nursing leadership to address
workplace bullying demonstrates a lack of
compassion and organizational injustice.
Bullying is the repeated and persistent, abusive
mistreatment by one or more perpetrators
towards one or more victims that is marked by
threatening, humiliating or intimidating conduct,
work interference, or verbal abuse (Fink-
Samnick, 2018). Bullying is a systemic problem
and reflects behavior patterns and surreptitious
characteristics of a culture of violence that
contributes to various expressions and
manifestations of violence within an organization
(Smit & Scherman, 2016). The Joint Commission
(2008) notes that intimidating and disruptive
behaviors contribute to medical errors, poor
patient and staff satisfaction, staff turnover and
poor collaborative work environments.
Ethic of Care
The ethic of care is a moral approach
characterized by contextual, holistic empathy and
is based on caring, strengthening and maintaining
interpersonal relationships. It emphasizes the
importance of insight gained from being open
and receptive to the realities and needs of
others (Simola, 2003). The ethic of care aligns
with the authentic, servant and transformational
leaders who put followers’ interests above their
own and influence followers through building
relationships, developing a collective vision,
and attending to the needs and growth of their
followers (Groves & LaRocca, 2011).
Most occurrences of bullying are learned
behaviors directed by reactions to stress and
organizational norms and, therefore, can be
unlearned (Berry et al, 2016). Leaders guided by
an ethic of care model take decisive action when
confronted with behaviors that do not adhere
to expected conduct. In combating workplace
bullying, effective leaders are proficient in
communication and competent in coaching,
staff development, maintaining high standards of
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Apply directly & download resume & application:
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928.329.5474 or dhunter@sunset-chc.org
MYSUNSETHEALTH.ORG
conduct, and fostering an environment of trust
and mutual respect (Parker, Harrington, Smith,
Sellers, and Millenbach, 2016).
Bullying is an attempt to intimidate and
gain power over someone else. Structural
empowerment is an effective technique to
mitigate the effects and incidents of bullying
(Lachman, 2014). Effective nurse empowerment
can be obtained through shared governance to
minimize power imbalances and enhance shared
responsibility and transparency in decision
making (Berry et al, 2016; Parker et al, 2016).
Skill development is an important weapon
in the battle against bullying. Strategies such as
cognitive rehearsal, skills-based training, and
role-playing have been successful in raising staff
awareness and combating bullying (Balevre,
Balevre, & Chesire, 2018; Parker et al., 2016).
Normative leadership models such as
transformational, servant and authentic
leadership constructively address the bullying
by modeling an ethic of care perspective and
seeking to facilitate followers’ self-actualization.
The assumption is that ethical leadership styles
promote social cohesion, professionalism, and
empowerment (Webster, 2016).
Ethic of Justice
The ethic of justice is a moral approach that is
characterized by justice, fairness, reciprocity and
the protection of individual rights. Individuals
demonstrate impartiality and the ability to
reason abstractly through the application of
formal, logical and impartial rules (Simola, 2003).
The ethic of justice aligns with the transactional
leader who influences followers by control,
reward and corrective transactions (Groves &
LaRocca, 2011).
Structural empowerment is gained through
establishment of an ethical infrastructure that
reinforces ethical principles and behavioral
expectations of members of the organization
(Einarsen, Mykletun, Einarsen, Skogstad, &
Salin, 2017). Aligned with the ethic of justice,
organizations establish standardized policies,
procedures and documents such as codes of
ethics, procedures for handling complaints and
zero tolerance policies (Einarsen et al., 2017).
Hutchinson (2009) posits that rather than
focusing on the individual, leaders should direct
corrective measures towards the act of bullying
itself and gain insight into work group and
organizational factors that enable the behavior.
The focus is on reintegration and restoration
of social relationships within the context of a
supportive group, such as a restorative circle,
where the attention is placed on repairing harm
rather than blame and punishment.
Reflection on Integration of Ethical Approaches
It is important for leaders to integrate the two
ethical perspectives by distributing justice within a
caring framework (Sorbello, 2008). Organizations
and leaders must clarify and communicate that
Pima County Health Department
is seeking a Licensed Practical
Nurse. Under the direction
of a health care professional
duties include but not limited to
administering specified medications
(excluding IV medication),
immunization and treatments as
directed by a health care professional ensuring to note time
and amount in medical charts; assisting Registered Nurses
and physicians in performing physical examinations and
other assignments; takes, monitors and records vital signs;
dresses and changes dressings on wounds and administers
standard medical test etc. Minimum Qualifications: Licensed
to practice as a Licensed Practical Nurse in the State of
Arizona.
Apply Online at:
www.governmentjobs.com/careers/pima. For more
information contact Human Resources at 520-724-8028.
bullying is unacceptable. If corrective actions
fail, termination is an acceptable consequence
to continued behavior (Lee et al., 2014). At times,
leaders must implement corrective actions and
uphold values and policies set forth by the
organization, but it is in the delivery and intent
that determines a caring leader.
Conclusion
Combating bullying requires a
multidimensional approach. By establishing a
relationship-based ethics of care perspective,
along with visible organizational-based
regulatory sanctions in communication and
ethic of justice, organizations can create and
sustain a respectful working environment for
the prevention of workplace bullying. The
integration of the divergent ethical perspectives
of an ethic of care and an ethic of justice provides
an environment of collegiality, transparency and
support for improved patient-related and nurserelated
outcomes.
References
Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018).
Nursing professional development anti-bullying
project. Journal for Nurses in Professional
Development, 34(5), 277-282. https://doi.
org/10.1097/NND.0000000000000470
Berry, P. A., Gillespie, G. L., Fisher, B. S., & Gormley,
D. K. (2016). Recognizing, confronting, and
eliminating workplace bullying. Workplace
Health & Safety, 64(7), 337-341. https://doi.
org/10.18291/njwls.v7i1.81398
Einarsen, K., Mykletun, R. J., Einarsen, S. V.,
Skogstad, A., & Salin, D. (2017). Ethical
infrastructure and successful handling
of workplace bullying. Nordic Journal of
Working Life Studies, 7(1), 37–54. https://doi.
org/10.18291/njwls.v7i1.81398
Fink-Samnick, E. (2018). The new age of
bullying and violence in health care: part
4: managing organizational cultures and
beyond. Professional Case Management,
23(6), 294–306. https://doi.org/10.1097/
NCM.0000000000000324
Groves, K., & LaRocca, M. (2011). An empirical study
of leader ethical values, transformational and
transactional leadership, and follower attitudes
toward corporate social responsibility. Journal
of Business Ethics, 103(4), 511–528. https://doi.
org/10.1007/s10551-011-0877-y
Hutchinson, M. (2009). Restorative approaches to
workplace bullying: Educating nurses towards
shared responsibility. Contemporary Nurse,
32(1–2), 147–155. https://doi.org/10.5172/
conu.32.1-2.147
Lachman, V. D. (2014). Ethical issues in the disruptive
behaviors of incivility, bullying, and horizontal/
lateral violence. Medsurg Nursing, 23(1), 56-60.
Parker, K. M., Harrington, A., Smith, C. M., Sellers,
K. F., & Millenbach, L. (2016). Creating a nurseled
culture to minimize horizontal violence in
the acute care setting: A multi-interventional
approach. Journal for Nurses in Professional
Development, 32(2), 56-63. https://doi.
org/10.1097/NND.0000000000000224
Simola, S. (2003). Ethics of justice and care in
corporate crisis management. Journal of
Business Ethics, 46(4), 351-361. https://doi.
org/10.1023/A:1025607 928196
Smit, B., & Scherman, V. (2016). A case for
relational leadership and an ethics of care
for counteracting bullying at schools. South
African Journal of Education, 36(4), 1-9. http://
www.sajournalofeducation.co.za/index.php/
saje/article/view/1312/668
Sorbello, B. (2008). The nurse administrator as caring
person: A synoptic analysis applying caring
philosophy, Ray’s ethical theory of existential
authenticity, the ethic of justice, and the ethic
of care. International Journal of Human Caring,
12(1), 44-49. 10.20467/1091-5710.12.1.44
The Joint Commission. (2008). Behaviors that
undermine a culture of safety. (Sentinel Event
Alert, Issue 40). http://www.jointcommission.
org/assets/1 /18/SEA_40.pdf
Webster, M. (2016). Challenging workplace bullying:
the role of social work leadership integrity.
Ethics & Social Welfare, 10(4), 316–332. https://
doi.org/10.1080/17496535.2016.1155633

October, November, December 2021 Arizona Nurse • Page 17
Member Highlight!
Recently, AzNA began a new monthly social
media series to highlight its members. Read the
excerpts below about the members who were
highlighted in August and September. Keep an eye
on your email, members are chosen at random to be
featured and the next one could be you!
Board Announcement
The newly elected board members were announced on October 1 at AzNA’s Annual
Membership Meeting.
Meet Candace Angel,
member for 8 years and
August’s highlighted
member.
Candace has been a nurse
for 9 years and currently
works as a Virtual Clinical
Manager for Florence Inc..
Previously, she worked as an
Associate Director at Banner
Boswell Hospital.
Candace Angel Candace’s favorite
memory from her nursing
career so far is the day she became a nurse. She was
so proud that she achieved her goal of returning to
school and becoming a nurse.
She loves being a member of AzNA because it
allows her to keep up to date on what’s happening
in the nursing profession. She thinks it’s important
to be part of a nursing organization like AzNA.
Thanks for being a member Candace!
We would like to congratulate the following AzNA members for being elected or re-elected
to their positions with the AzNA Board of Directors:
- Heidi Sanborn, DNP, RN, CNE – President
- Amanda Foster, BSN, RN - Secretary
- Heather Ross, PhD, DNP, ANP-BC, RN, FAANP – Director of Governmental Affairs
- Sonia Basel Blau, BSN, RNC-OP, CDP – Director at Large
Board members continuing their service include:
- Beth Hale, PhD, RN – Treasurer
- Bill Adams, MSN, RN, CDCES, NHDP-BC – Director at Large
Congratulations again to our newly elected and continuing board members. We are excited
to work with you to advance the profession of nursing in Arizona.
Meet LeShawne Elliott,
member for 5 months and
September’s highlighted
member!
LeShawne has been an
RN for almost two years
and an LPN for 6 years. She
currently works at Banner
Estrella Medical Center.
LeShawne’s favorite
nursing memory is the time
LeShawne Elliot she helped a patient with a
newly diagnosed condition
realize that, with a few lifestyle changes, he could
and would overcome it!
She loves being a member because she’s new to
Arizona and AzNA has allowed her to become more
aware and involved in her new community.
Welcome to Arizona, LeShawne, and thanks for
being a member!
Honoring AzNA
Members
Each year AzNA asks members to nominate
deserving individuals for various awards. From these
nominations, winners are chosen and announced
at the Annual AzNA Convention. This year, three
awards were presented:
The Rory Hays Award is presented to an AzNA
member for their significant contributions to
nursing practice and health policy through political
and legislative activity. For 2021, this award was
presented to Denice Gibson.
The Marla Weston Leadership Award is presented
to an AzNA member for significant contributions
to nursing practice and policy through leadership
that embodies the ability to hear and listen to wide
ranging needs and ideas and foster collaboration
among multiple stakeholders to bring about
solutions that advance the nursing profession. For
2021, this award was presented to Robin Schaeffer.
Lifetime Membership is awarded to nurses who
have rendered distinguished service or valuable
assistance to the nursing profession and gone
above and beyond in service to the Arizona Nurses
Association. For 2021, this award was presented to
two winners: Sharon Rayman and Robin Schaeffer.
Through the Arizona Foundation for the Future
of Nursing, two scholarships were also awarded
to support the education of two nursing students.
Congratulations to Emily Ibarra, student at Arizona
State University, and Danielle DiPasqual, student at
Maricopa Community College and Grand Canyon
University.

Page 18 • Arizona Nurse October, November, December 2021
Providing Competent, Supportive Care
for People Who are Transgender
F. Patrick Robinson, PhD, RN, ACRN, CNE, FAAN
Sherry L Roper, PhD, RN
Reprinted with permission from
Illinois The Nursing Voice, June 2021 issue
The idea that gender is binary (male or female)
and determined at birth predominates Western
cultures. However, research evidence and lived
experiences suggest that gender exists on a
spectrum with many options. Some people
identify as a gender different from their gender
determined at birth (Deutsch, 2016). Our traditional
understanding of gender, based on chromosomes
and primary (genitalia) and secondary sex
characteristics, is often called biological sex or
gender (or sex) assigned at birth. Gender identity,
on the other hand, is the innermost concept of
self as male, female, a blend of both, or neither
(Lambda Legal, 2016.).
The majority of people are cisgender, which
occurs when gender assigned at birth and gender
identity are the same. However, the best available
data suggest that approximately 1.4 million adults
do not self-identify with their gender assignments
(e.g., someone assigned female at birth but
identifies as male) (Flores et al., 2016). Transgender
is an umbrella term for this population. A visibly
growing segment of the U.S. population does
not identify with the binary notion of gender.
Nonbinary is a collective term for this population,
but individuals may use terms such as genderqueer,
gender fluid, or gender non-conforming.
There is no standard or correct way to be (or
be seen as) transgender. Some people who are
transgender choose gender-affirming hormone
therapy to achieve masculinizing or feminizing
effects; others do not. Surgery that revises genitals
to conform to gender identity is a critical part of the
transition for many people who are transgender
(Deutsch et al., 2019). Others do not feel that genital
surgery is a necessary part of transition but may
opt for non-genital surgeries to produce desired
characteristics, including breast augmentation
or removal and body contouring procedures. In
other words, the importance of therapy related to
the quality of life varies by individual. Also, some
people who are transgender may want these
services but do not have access to them because
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they are (a) unavailable in the community; (b) not
covered by insurance (even if the individual has
insurance, and many do not), and (c) too expensive.
Remember: there is no one way to “be”
transgender or cisgender. People choose to
express their gender identities in personally
satisfying ways, which may or may not match
social expectations of what it means to look and
behave as a male or female. Some transgender
women choose not to wear makeup or dresses,
and some cisgender men choose to wear their
hair long and earrings.
Health Disparities in People Who are Transgender
Negative attitudes and discrimination toward
the transgender community create inequalities
that prevent the delivery of competent healthcare
and elevate the risk for various health problems
(Grant et al., 2011). In comparison to their cisgender
counterparts, people who are transgender
experience higher incidences of cancer, mental
health challenges, and other health problems
(Department of Health & Human Services, n.d.).
For instance, transgender women, compared
to all other populations, are at the highest risk
of injury from violence and death by homicide.
People who are transgender are also more likely
to smoke, drink alcohol, use drugs, and engage in
risk behaviors (Institute of Medicine, 2011).
Furthermore, discrimination and social stigma
increase poverty and homelessness in people
who are transgender (Safer et al., 2017). The
inability to afford basic living needs may lead to
employment in underground economies, such as
survival sex work or the illegal drug trade, which
place the person who is transgender at an even
higher risk for violence, drug use, and sexually
transmitted infections (Deutsch, 2016).
People who are transgender are more likely to
rely on public health insurance or be uninsured
than the general population. Even those insured
report coverage gaps caused by low-cost
coverage that does not include standard services
for preventative, behavioral health, or genderaffirming
therapies, including hormones (Deutsch
et al., 2019). Lack of access to comprehensive health
care leads some people who are transgender
to seek hormones from the community and
social networks without clinical support and
monitoring, putting them at additional risk for
adverse reactions and complications.
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Researchers suggest that healthcare providers’
inability to deliver supportive and competent
care serves as a powerful mechanism underlying
health disparities (Fenway Institute, 2016). The
experiences of people who are transgender
are often not included in healthcare provider
diversity and inclusiveness training. While
transgender-related content in health professions
basic education programs would effectively
improve provider knowledge, skills, and attitudes,
transgender health has not been prioritized
in nursing education. The result is a nursing
workforce inadequately prepared to care for
people who are transgender (McDowell & Bower,
2016).
Nursing Care of People Who Are Transgender
Competent, supportive transgender care
requires nurses to recognize potential biases
and understand gender that may differ from
their current beliefs and social norms. Honest
reflection on these feelings is an essential step
in providing competent transgender care. Using
a lens of cultural humility, where cisgender
nurses acknowledge that they do not adequately
know about being transgender while also being
open to learning, is helpful. In this spirit, open,
transparent inquiry on the part of nurses when
they do not know something (When I speak to
your children, what name should I use to refer
to you?) or how to proceed with care (I need to
place a catheter into your bladder, and I know
you have had gender-affirming surgery. Do you
want to give me any special instructions?) can
build trust.
While gender-affirming care such as
hormones, androgen-blocking agents, and
surgeries require specialist care management,
nurses will encounter transgender patients
in all healthcare areas. Assessing the history
and current status of gender-affirming
therapies is critical to inform safe care. For
example, hormone-induced changes in muscle
and bone mass, along with menstruation
or amenorrhea, can alter gender-defined
reference ranges for laboratory tests such as
hemoglobin/hematocrit, alkaline phosphatase,
and creatinine (Deutsch, 2016). Nurses should
consider the gender assigned at birth (especially
if it is the only gender information to which the
lab has access) and gender-affirming therapyinduced
physiological changes to make valid
inferences about lab values. Nurses should
also ensure that a complete history of the use
of hormones and androgen blockers (including
those obtained from non-licensed providers) is
taken. Nurses should work with other providers
to ensure that hormone therapy does not stop
with hospitalization unless contraindicated by
current pathology or prescribed medications.
Abrupt cessation of hormone therapy can have
a significant and negative impact on emotional
and physiological health.
Systems-Level Policies, Processes, and Advocacy
Professional nurses can play a crucial role
by advocating for policies and processes that
promote safe, effective, and supportive care for
people who are transgender. Misgendering a
patient (making an incorrect assumption about
gender identity) can cause emotional distress
and erode patient-provider trust. Unfortunately,
electronic health records (EHR) often do not
support competent care for people who are
transgender. For instance, healthcare providers
should use a 2-step gender identification
process (Deutsch, 2016). However, many do
not, and EHR systems rarely provide prompts
for the processor space for easy documentation
and access to information derived from the
process. Asking about a patient’s current gender
identity can result in several responses. The
EHR should make checkboxes for a reasonable
number of those responses, including male,

October, November, December 2021 Arizona Nurse • Page 19
female, transgender male, transgender female, and nonbinary. A fill-inthe-blank
is needed for other identifies. The gender assigned at birth
also requires options beyond male or female; people born with external
genitalia, gonads, or both that do not conform to what is typically male
or female (intersex) may have been identified incorrectly at birth. The
EHR should provide an intersex option to this question. Some people
who are transgender are uncomfortable revealing gender assigned
at birth, so decline-to-state should be another option. Note that this
process should be the standard for all patients, not just those assumed
to be transgender.
People who are transgender may use names other than their
legal names (Lambda Legal, 2016). Navigating a legal name change is
complicated and costly. Some people who are transgender do not have
the resources for a legal name change; for others, it may not be safe,
given current social or legal circumstances. Using a patient’s chosen
name and pronouns is critical to patient-centered care. The EHR should
prominently document the patient’s chosen name and pronouns, which
should also be used outside the EHR, including for appointments and
prescriptions. Patients should only have to provide the information
once, decreasing the need to correct providers and improving patientprovider
relationships. EHRs should also contain an organ inventory,
perhaps as part of surgical history, as providers will need to know about
the presence or absence of reproductive and gonadal organs to inform
clinical decision-making. This information must be clear, unambiguous,
and easily accessible in the EHR to inform care and prevent medical and
surgical errors.
Nurses should work within governance processes to ensure that all
institutional policies support transgender patients, staff, and visitors.
Nondiscrimination statements should include gender identity. Policies
about restrooms and staff changing rooms (usually labeled in genderbinary
terms) should state that a person’s gender identity rightly
determines the room to be used and that that right should not require
any proof (e.g., health provider confirmation) related to gender or
gender identity. Finally, clear guidelines concerning non-private room
assignments should include assigning roommates based on gender
identity rather than gender assigned at birth.
Power to Make a Difference
The ANA Code of Ethics obligates nurses to practice “compassion
and respect for the inherent dignity, worth, and unique attributes of
every person” (ANA, 2015, para 1). While some nurses may intentionally
discriminate against people who are transgender, it is more likely
that a lack of knowledge and experience leads to nursing actions that
result in suboptimal care. Nurses play critical roles in transgender care
by (a) providing supportive, affirming care, (b) creating an inclusive
environment, and (c) leading interprofessional teams toward genderaffirming
care. Education and a commitment to understanding the lived
experiences of people who are transgender is, therefore, essential for all
nurses.
References
American Nurses Association. (2015). What is the nursing code of ethics?
https://nurse.org/education/nursing-code-of-ethics/
Department of Health and Human Services, Office of Disease Prevention
and Health Promotion. (n.d.). Healthy people. Lesbian, gay, bisexual,
and transgender health. https://www.healthypeople.gov/2020/topicsobjectives/topic/lesbian-gay-bisexual-and-transgender-health
Deutsch, M.B. (2016). Guidelines for the primary and gender-affirming care of
transgender and gender nonbinary people (2nd ed.). Center of Excellence
for Transgender Health, University of California at San Francisco.
https://transcare.ucsf.edu/sites/transcare.ucsf.edu/files/Transgender-
PGACG-6-17-16.pdf
Deutsch, M.B, Bowers, M.L., Radix, A., & Carmel, T.C. (2019). Transgender
medical care in the United States: A historical perspective. In J.S.
Schneider, V.M.B. Silenzio, & Erikson-Schroth, L. (Eds.). The GLMA
Handbook on LGBT Health (1, 83-131). Santa Barbara, CA: Praeger.
Fenway Institute, National LGBT Health Education Center. (2016).
Providing inclusive services and care for LGBT people. https://www.
lgbtqiahealtheducation.org/publication/learning-guide/
Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How many adults
identify as transgender in the United States? UCLA School of Law, William
Institute. https://williamsinstitute.law.ucla.edu/publications/trans-adultsunited-states/
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M.
(2011). Injustice at every turn: A report of the National Transgender
Discrimination Survey. https://www.transequality.org/sites/default/files/
docs/resources/NTDS_Report.pdf
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and
transgender people: Building a foundation for better understanding.
http://www.nationalacademies.org/hmd/Reports/2011/The-Health-of-
Lesbian-Gay-Bisexual-and-
Lambda Legal. (2016). Transgender rights toolkit. https://www.lambdalegal.org/
issues/transgender-rights
McDowell, A. & Bower, K. (2016). Transgender health care for nurses:
An innovative approach to diversifying nursing curricula to address
health inequalities. Journal of Nursing Education, 55(8), 476-479. DOI
10.3928/01484834-20160715-11
Safer, J. D., Coleman, E., Feldman, J., Garofal, R., Hembree, W., Radix, A., &
Sevelius, S. (2017). Barriers to health care for transgender individuals.
Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 168-171.
DOI: 10.1097/MED.0000000000000227
Singh, S., & Durso, L. E. (2017). Widespread discrimination continues to
shape LGBT people’s lives in both subtle and significant ways. Center
for American Progress. https://www.americanprogress.org/issues/lgbt/
news/2017/05/02/429529/widespread-discrimination-continues-shape-lgbtpeoples-lives-subtle-significant-ways/
Achieving the Elusive
“Work-Life Balance”
Donna L. Castellani, MSN.ED, RN, CNE
Reprinted with permission from
The New Jersey Nurse April 2021 issue
How many of us have often dreamed of having that perfect work-life
balance? Meeting the demands of a heavy workload while maintaining
healthy relationships with family and friends is challenging at best.
Technology that enables constant connection easily allows work to
invade our time at home. Working from home can also blur professional
and personal boundaries (Mayo Clinic, 2020, para 2). We often feel
we may never figure out the perfect routine to eliminate stress and
return joy to our lives. Don’t give up your dream of the perfect worklife
balance! By defining what having a balanced life means to you and
implementing a few strategies, it is possible to achieve the elusive worklife
balance.
Many people define work-life balance using the example of equalizing
a seesaw, with work on one side and the rest of your life on the other
side. It is felt the goal is to equalize both sides, making sure to spend
equal time on each side of the seesaw. The majority of the solutions to
achieving work-life balance stress better management of time at work
so there is more time to spend at home. However, when asked how they
define work-life balance, most people describe it as making a bigger
impact at work without sacrificing personal health or happiness, having
a positive impact on your family’s lives, prioritizing what is important to
you without guilt, shame or apology, having strong boundaries that you
feel good about enforcing, and letting go of trying to do or have it all
(Moulder,2020, para 4). It seems that time itself is not the most important
part to balancing your life in the way the seesaw model suggests. It is
more about feeling content with who you are and the decisions you are
making (Moulder, 2020). It is not something you find; it is something
you must create to meet your lifestyle needs.
It is suggested by the Mayo Clinic that setting limits and caring
for yourself are two essential strategies to implement when creating
a healthy work-life balance (2020). Without set limits, you may not
have time for your family and friends, or to participate in activities
you enjoy. Consider giving yourself enough time to get things done
by not overscheduling yourself. Learn to say “no” to accepting tasks
out of guilt or perceived obligation. Prioritize and shorten your to-do
list. When you are done working for the day: detach from work and
transition to home life by taking a walk or doing a fun activity with your
family. Eat well and include physical activity in your daily routine. Get
adequate sleep. Participate in activities you enjoy which will take your
mind off work and allow you to recharge. Develop a support system
with co-workers who can cover for you – and vice versa – when family
conflicts arise. Enlist trusted friends and loved ones who can pitch in
with childcare or household responsibilities when you need to work
late. Practice mindfulness relaxation techniques to eliminate stress.
Find joy in simple everyday experiences.
Meeting the demands of career and personal life will be an ongoing
challenge. Creating work-life balance is a continuous process as your
family needs and work responsibilities change. It is important that you
periodically examine your lifestyle and make changes as necessary
to make sure you are maintaining the balance that is right for you. By
setting limits, and taking care of yourself, you will be able to finally
achieve your dream of the perfect work-life balance.
References
Moulder, H. (2020). 10 Reasons Why Work Life Balance is Important. Coach
Correction Coaching, http://coursesorrectioncoaching.com/reasons-whywork-life-balance-is-important/#.
Work-life balance: Tips to reclaim control. (2020). Mayo Clinic. http://mayoclinic.
org/healthy-lifestyles/adult-health/in-depth/work-life-balance/art-20048134
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