Ohio Nurse December 2021


Volume 15 | Number 1 | Dec. 2021

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

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

Is Getting Certified Your New

Year’s Resolution? ONA Can Help.

Page 3

What’s inside this issue?

The New Norm:

After COVID-19

Page 5

The Mahoney Award: The Origin

Lataya De Jesus, MS, DNP Candidate

Nursing is a profession of caring for patients and

ourselves, including embracing our interpersonal

similarities and differences. The Mahoney Award

is a prestigious award given to an individual nurse

or group of nurses in recognition of their significant

contributions to the integration of interracial

relationships within the nursing profession. What

an honor to have nurses throughout the country

exhibit the qualities attributed to the recipients of

this award.

One may ask about the origin of the Mahoney

award. The award, named after Mary Eliza

Mahoney, a free child, born the eldest of three,

in the Dorchester neighborhood of Boston,

Massachusetts on May 7, 1879. She became

the first professionally trained African American

nurse in 1879, paving the way for greater racial

equity in nursing. Her parents were originally from

North Carolina. They moved north prior to the

Civil War as freed African Americans. Mahoney

became interested in pursuing a nursing career

in her teen years. She pursued her education at

Boston’s Phillips Street School and immediately

began working as a practical nurse without formal

nursing training. She supplemented her income by

working at the New England Hospital for Women

and Children in Roxbury, Massachusetts where she

worked as a maid, laundress, cook, and nurse’s

aide over a span of 15 years.

In March of 1878, Mahoney, now 33 years

old, was accepted into the graduate nursing

program at the New England Hospital. The

program was a rigorous 16-month, 16-hour day

program consisting of lectures, clinically working

on the wards at the hospital, and providing home

health care for patients. Forty-two students

were accepted into the program, however, due

to the intensity and demands of the program

only four students endured until completion.

Mahoney successfully completed the program

and graduated on August 1, 1879, making history

as the first African American nurse in US history

to earn a professional nursing license. These

times experienced high levels of discrimination in

public nursing, forcing Mahoney to consider other

avenues to pursue her career. After graduating,

she decided to devote the next 40 years as a

private nurse to the most prominent families

in Boston. She became the director of Howard

Orphanage Asylum for black children in Kings

Park, Long Island in New York near the end of

her career. Ms. Mahoney, widely known for her

patience, kindness, efficiency, and caring bedside

manner, dedicated her life to nursing and never


In 1896, she became a member of, what is now

the American Nurses Association (ANA) consisting

mainly of white members. Mahoney co-founded

the National Association of Colored Graduate

Nurses (NACGN), organized in New York in 1908

to advocate for the equality of African American

nurses. She gave the welcoming address at the

first NACGN convention in 1909. Her speech

highlighted the inequalities for African Americans

in nursing education. She elicited support from the

organization’s members who elected her to be the

national chaplain and made her a lifetime member.

Her efforts to expand the nursing profession

resulted in doubling the number of African American

nurses from 1910 to 1930. Mahoney continued to

advocate for women’s rights after her retirement in


Mahoney had a three-year long battle with

breast cancer which she succumbed on January

4, 1926 at the age of 81. She was buried in

Woodlawn Cemetery in Everett, Massachusetts.

Mary Mahoney left a legacy that is recognized

by numerous awards and honors in her name.

The Mary Mahoney Award was created by the

National Association of Colored Graduate Nurses

(NACGN) in 1936 honoring nurses who have

shown their dedication to expanding equity in the

nursing profession. The NACGN merged with the

American Nurse’s Association (ANA) in 1951 and

continues to award the Mahoney award to nurses

annually for excellence in nursing. In 1976 and

1993, Mahoney was inducted into the Nursing

Hall of Fame and the National Women’s Hall of

Fame, respectively. Helen S. Miller, a Mahoney

Award recipient, led a fundraiser supported by

the National Society for Professional and Student

Nurses, Chi Eta Phi, and the ANA. The fundraiser

garnered the funds needed to erect a monument to

Mahoney at her gravesite making her burial ground

a memorial site. The memorial was completed in

1973 and still stands to this day as a testament

to Mahoney’s legacy. It is an honor for those who

have and will be recognized as exemplifying the

character of Mary Mahoney.


Mary Eliza Mahoney. (2019, August 8). Black Past.



Mary Eliza Mahoney. (2020, September 20). Nursing

Theory. https://nursing-theory.org/famous-nurses/


Spring, K. A. (2017). Mary Eliza Mahoney. Biography: Mary

Eliza Mahoney. https://www.womenshistory.org/


current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

Inside this Issue

The Mahoney Award: The Origin.............1

New Nurses [Start Here]..................2

Is Getting Certified Your New Year’s

Resolution? ONA Can Help ................3

Ask Nurse Jesse........................4

The New Norm: After COVID-19.............5

A New Normal for Ohio Universities........ 6-7

The Retired Nurses Forum presents

Healthcare Issues Potpourri .............8

ONA’s Policy Footprint.................. 8-9

Challenges in the Nursing Workforce,

Graduate Nursing Education,

and Future of Nursing. ............. 10-13

E-Cigarette and Subsequent Smoking Use.... 14-15

Page 2 Ohio Nurse December 2021

Medical Disclaimer:

This publication’s content is provided for

informational purposes only and is not

intended as medical advice, or as a substitute

for the medical advice of a physician, advanced

practice registered nurse or other qualified

healthcare professional.


The official publication of the

Ohio Nurses Foundation

3760 Ridge Mill Drive

Hilliard, OH 43026

(614) 969-3800

Web site: www.ohionursesfoundation.org

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A new CE series for newer nurses, the New

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of valuable info specifically for new nurses.

Topics include job searching, social media,

protecting your license, delegation, collective

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The Ohio Nurses Association is accredited as

a provider of nursing continuing professional

development by the American Nurses

Credentialing Center’s Commission on

Accreditation. (OBN-001-91).

Articles appearing in the Ohio Nurse are

presented for informational purposes only and

are not intended as legal or medical advice

and should not be used in lieu of such advice.

For specific legal advice, readers should

contact their legal counsel.

2021-2023 Ohio Nurses Foundation

Board of Directors



TREASURER: Janet Corbin

SECRETARY: Benitha Garrett

DIRECTORS: Michelle Croker,

Lukas Killian, Rob Weitzel


Registered Nurses - ALL AREAS including


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Must have MSN, DNP or PhD degree

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contact Arthur L. Davis Publishing Agency, Inc.,

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4081, sales@aldpub.com. ONF and the Arthur L.

Davis Publishing Agency, Inc. reserve the right

to reject any advertisement. Responsibility for

errors in advertising is limited to corrections in

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Acceptance of advertising does not imply

endorsement or approval by the Ohio Nurses

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advertisers, or the claims made. Rejection of

an advertisement does not imply a product

offered for advertising is without merit, or that

the manufacturer lacks integrity, or that this

Foundation disapproves of the product or its

use. ONF and the Arthur L. Davis Publishing

Agency, Inc. shall not be held liable for any

consequences resulting from purchase or use

of an advertiser’s product. Articles appearing

in this publication express the opinions of the

authors; they do not necessarily reflect views

of the staff, board, or membership of ONF.


December 2021 Ohio Nurse Page 3

Is Getting Certified Your New Year’s Resolution? ONA Can Help.

Brittany Turner, MSN, RN, CNEcl

Getting certified in your nursing specialty is an important step in your

nursing career. Becoming certified demonstrates your commitment to

nursing and your specialty. There are many different certifications, and

a nurse can hold more than one. There are certifications that focus on

specialty care of specific patient populations, as well as certifications that

focus on skills outside of direct patient care. Certifications are available

from many different certifying bodies such as the American Nurses

Credentialing Center (part of the ANA Enterprise), Association of Critical-

Care Nurses, Emergency Nurses Association, National League for Nursing,

and many others.

Finding the Certification for You

If you have yet to identify the certification that would best suit your

career and needs, you can explore your options with online searches and

by asking those in your specialty what certification(s) they have found to be

most helpful. Nurse.com has a list of certifications available here: https://


Ohio Nurses Association members are also American Nurses

Association members. Therefore, all ONA members get member pricing on

any certifications offered by ANA. This member benefit offers a significant

savings. There are also member discounts for certification prep materials.

If you aren’t yet an ONA member, you can become one prior to paying for

your test and save big!

Get Ready

Once you have a certification in mind, it is time to start prepping.

ONA’s webinar Identifying and Breaking Down Barriers to Becoming

Certified is the perfect place to start. It is available to view online at


or by searching “certified” in the search bar on the

CE4nurses homepage at https://ce.ohnurses.org/

Including a timeline in your goal setting can help you achieve your goals.

Certified Nurses Day is coming up on March 19th. What a perfect date to

include in your personalized goal plan. Maybe this is the date you will have

your certification selected by, or the date you set for yourself to have the

webinar above completed. Whatever you choose, having dates assigned to

your goals will help you succeed!

The Ohio Nurses Association CE team wishes all nurses a great year full

of learning and well wishes for accomplished goals!

We’re looking for RNs that

want to make a difference

• Premier behavioral healthcare facilities

in the Columbus region

• Full and part-time positions available

• Flexible scheduling

• Engaged and visible nursing leaders

• Robust staff to patient ratios

• Career growth opportunities with

the organization

Page 4 Ohio Nurse December 2021

Public Service Loan Forgiveness

• Simplify what it means for a payment to

qualify for PSLF.

• Eliminate barriers for military service

members to receive PSLF.

• Review Denied PSLF Applications and

Identify and Correct Errors in PSLF


Ask Nurse Jesse:

Nurse Jesse, I heard that there may be new

options for student loan forgiveness for nurses

who work in the public sector. How can I learn



The Department of Education announced

in October 2021 that the Public Service Loan

Forgiveness (PSLF) program will be changing.

These changes allow for previously rejected

applications to be reviewed and re-processed and

include expanding eligibility for forgiveness.

The program updates will:

• Implement a Limited PSLF Waiver to

count all prior payments made by student

borrowers toward PSLF, regardless of loan

program (this includes loans and payment

plans that were not previously eligible).

o The deadline to apply to take advantage of

this waiver is October 31, 2022

From the Department of Education:

“Your employer still needs to be a

governmental organization, a 501(c)(3)

organization, or a not-for-profit organization that

provides a designated public service to get PSLF

under normal rules and the Limited PSLF Waiver.”

Source: https://www.ed.gov/news/press-releases/


For more information and to find out if you may

qualify, visit:

• https://studentaid.gov/announcementsevents/pslf-limited-waiver

• https://www.ed.gov/news/press-releases/


Additionally, if you are a current AFT member:

“The AFT will help you navigate this new

process with our partner Summer. Working with

Summer, AFT members already have saved $500

million on student loans. Summer helps AFT

members take the steps necessary to qualify

for PSLF, including under the just-announced

temporary waiver. AFT members can sign up for

a free account with Summer here: https://www.


If you are a borrower who works in public

service and want individualized help from a PSLF

expert, you can join the AFT as an associate

member now and access a Summer account:


The Ohio Nurses Foundation is now

accepting applications for all ONF

scholarships! Use the link below to view

the complete list of the available 2022

scholarships and their corresponding

applications. All winners will be awarded at

the Nurses Choice Awards in the spring.

The deadline for all applications is January

15, 2022. http://ohionursesfoundation.org/


December 2021 Ohio Nurse Page 5

The New Norm: After COVID-19

Jondra Long, MS, BSN, RN, CHSE & Kris Cope, DNP, RN, NE-BC

Prior to COVID, we walked around knowing there were diseases we could

contract, yet we did not think about the possibility that they could kill us. Travel

has changed especially public transportation. Cho and Park (2021), recall

that overcrowding impedances were previously evaluated through a random

parameter mixed logit model. Now that volume is down and new cleaning

procedures are required because of the pandemic, policies and procedures for

public transportation have changed for the safety of their passengers (Cho &

Park, 2021).

Restaurants have also taken a huge hit because of COVID. According to

Wallace (2021) when indoor dining was cancelled, local family restaurants

relied on carryout and delivery to stay open. If they had outdoor seating, with

the six foot social distancing mandate, less patrons could be served. This was

very difficult for small food businesses. Amazon and grocery stores ran low on

supplies and came up with no touch grocery loaders or truck drivers that would

deliver to your home or car. The convenience of this service may continue for

mothers with children and the elderly that had a difficult time maneuvering the

grocery prior to COVID.

In healthcare, COVID hit in many ways. Patients avoided care for routine

screenings and chronic conditions. The Centers for Disease Control and

Prevention (CDC) estimated that 32% of adults in the United States did not

seek routine services because of fears surrounding the virus (Czeisler et al.,

2020). Although we are still in the midst of the pandemic, some of the new

practices could become new habits. As advocates for public health and routine

screenings, we can only hope that this does not set us back.

Masks have become the new norm and the most controversial. To wear or not

to wear a mask, that is the question now. With the media daily reporting on the

Delta Variant, the public is not as compliant any longer. One reason is when it

was announced that masks were not necessary if vaccinated, the public stopped

wearing masks. Stores no longer required them if vaccinated. The public began

to remember what it was like to not wear a mask. No one wants to put it back on,

yet here we are.

The CDC is now recommending even fully vaccinated individuals should wear

a mask indoors, as of July of this year (Doucleff, 2021). How does one know who

is vaccinated? Chicago FBI warns their residents about vaccination fraud cards

that they are seeing in the public (FBI, 2021). When individuals have recently

been allowed to go to a mass gathering if they showed their vaccination card

or proof of testing negative for COVID, those unvaccinated found a counterfeit

vaccination card to get into the venue. Presently Chicago has another large

outbreak of COVID.

According to Blais et al. (2012), one’s “eyes are not the window to basic

emotions”, but it’s your mouth that has the most “discriminative motions

across expressions” (Blais et al., 2012, p. 2830). So the face coverings

do not allow us to know what others are thinking or feeling. Those with

impaired hearing can’t read lips anymore. This is causing social disruption

in communication and the ability to communicate with others. In my

professional opinion, I believe after COVID we will have several social

issues from face coverings.

With COVID, we are now aware that there are diseases that can kill us,

but prevention is the key to survival. We can decease our exposure to these

killer disease by following the CDC guidelines (CDC, 2021). Education to

our patients and their families on proper wearing of face masks and social

distancing need to be reinforced. We cannot tell if someone is vaccinated

because they are not wearing a mask now. We cannot expect that everyone

carries their vaccination card. So, enforcing wearing of face masks and

social distancing when indoors must continue to be mandated to keep us all

safe, for our protection and that of our families. We need to encourage the

return and continuance of activities intended to keep us safe, healthy, and

happy. We need to create our own “new norm”.


Blais, C., Roy, C., Fiset, D., Arguin, M., & Gosselin, F. (2012). The eyes are not the window to

basic emotions. Neuropsychologia, 50(12), 2830–2838. https://www.sciencedirect.com/


Centers for Disease Control and Prevention. (2021). Delta variant: What we know about the

science. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

Cho, S. H., & Park, H. C. (2021). Exploring the behavior change of crowding impedance on

public transit due to COVID-19 Pandemic: Before and after comparison. Transportation

Letters, 13(5/6), 367-374. https://doi.org/10.1080/19427867.2021.1897937

Czeisler, M. É., Marynak, K., Clarke, K. E. N., Salah, Z., Shakya, I., Thierry, J. M., Ali, N.,

McMillan, H., Wiley, J. F., Weaver, M. D., Czeisler, C. A., Rajaratnam, S. M. W., & Howard,

M. E. (2020). Delay or avoidance of medical care because of COVID-19-related concerns

- United states, June 2020. MMWR. Morbidity and Mortality Weekly Report, 69(36), 1250-

1257. https://doi.org/10.15585/mmwr.mm6936a4

Doucleff, M. (2021, July 30). Vaccinated people can spread the Delta Variant,

CDC research indicates. [Radio broadcast transcript]. NPR. https://www.npr.


Federal Bureau of Investigation. (2021, May 13). FBI-Chicago warns Illinois residents about

COVID-19 vaccination card fraud. https://www.fbi.gov/contact-us/field-offices/chicago/


Wallace, T. (2021). Restaurants praying for a post-lockdown party. Daily Telegraph (London), 8.

Page 6 Ohio Nurse December 2021

A New Normal for Ohio Universities

Lataya De Jesus, MS, DNP Student

The COVID-19 pandemic has changed the

world of education. A new sense of normal

is emerging as America adjusts. Universities

across Ohio follow suit by re-opening their

doors last Autumn semester by welcoming back

students, faculty, and staff. While colleges are

excited to have students return to in-person

classes, there are challenges, restrictions, and

requirements necessary to promote the safety

and well-being for those returning to campus. The

Ohio State University (OSU), the University of

Cincinnati (UC), and Ohio University (OU) shared

information regarding their university reopening

and the effect COVID-19 had on the education in

their respective Colleges of Nursing.

Most universities have institutional requirements

initiated prior to the start of the semester in

preparation for students and staff to return to

campus. COVID vaccinations are required with a

deadline to become fully vaccinated. Requests for

exemptions are available for those who qualify but

those individuals receiving an exemption require

weekly COVID testing. Fully vaccinated students

or those granted an exemption can attend inperson

classes and campus activities. UC created

an interesting step for students taking classes on

campus. They are required to document the seat

they occupy during class. This documentation

allows for easy contact tracing by identifying

students in close proximity to the COVID positive

student. CDC guidelines are being followed

requiring anyone who tests positive to quarantine

for a minimum of 10 days. Other measures several

universities have initiated include wearing masks

indoors (and at-all times for the unvaccinated

individual), maintaining a safe social distance, and

limiting group assignments/ gatherings to small

groups, unless outdoors.

The protective measures universities have in

place have proven to be effective. COVID positive

rates are declining as COVID vaccination rates

increase throughout universities. Universities

have seen impressive declines in COVID student

and staff infections since the semester began.

OSU’s vaccination rates are up to over 90% since

on-campus learning has resumed. OSU’s COVID

positive cases reflect a decrease to 1.19% at

the time of the writing of this article. The 7-day

average is 1.57% which is down from 2.29% in

Autumn, 2020 (Dashboard, 2021). UC has seen

a drop in COVID positive cases with the 7-day

average decline from 23.8% to 6.05% from early

September to late October, respectively (Covid-19

dashboard, 2021).

It is widely known that nursing education,

at the undergraduate and graduate levels, has

been impacted by the pandemic. The Colleges

of Nursing at Ohio universities has adjusted their

teaching strategies accordingly. It was previously

difficult for students to complete clinical rotations.

However, this semester, the challenges of finding

clinical sites are reduced. University reputation

for producing quality nurses and practitioners

is a strength and benefit for organizations that

has lessened the burden in acquiring clinical

placement. At many organizations, nursing

students can complete clinical rotations if they

adhere to the COVID requirements of the facility.

It is noteworthy that a challenge that continues

for undergraduate nursing students is finding

preceptors. Many staff RNs have been unable

to precept nursing students due to the current

nursing shortage and patient load.

Some benefits of the COVID pandemic have

been noted. Telehealth has become the norm.

Several of these universities are ahead of the

curve by already having experience with training

their students on telehealth, but there is now

an increased emphasis for graduate nurses.

COVID allowed universities to improve their

ability to deliver high-quality care by transiting

and expanding telehealth education. These

universities are in resounding agreement, that

telehealth is a reality for healthcare delivery and

that students be equipped with the skills and

knowledge to provide an effective level of care

now and post-graduation.

Additionally, the increased utilization of

simulation labs continues. Faculty realize that

some educational components were not viable

online now use this platform since students

have proven their ability to understand specific

concepts via online education. Faculty have been

innovative by creating supplemental education

not previously considered prior to the pandemic.

It is important to highlight that the OSU College

of Nursing has made provider wellness a priority

throughout the COVID pandemic and they intend

to continue embracing their motto “Live Well”. Ohio

colleges expressed understanding regarding the

stressors that the pandemic has had on student

and faculty well-being and have demonstrated that

understanding in their flexibility while maintaining

the necessary educational rigor required.

Instruction has not varied regarding the

care of the COVID patient at these institutions.

There is a consensus that infection control

measures are reinforced through education.

The focus continues to be on epidemiology,

pathophysiology, the health of the individual,

patient, and population. The real-world example

of COVID-19 has been a teaching tool to help

students embrace these major concepts and their

importance in maintaining health and wellness.

Nurses are resilient, flexible, adaptable, and

they overcome. The challenges of COVID-19

are being faced head-on and nursing education


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Accredited by the Higher Learning Commission and approved by Ohio Board of Nursing (OBN) and Ohio Department

of Higher Education. Specialty accreditation by the Accreditation Commission for Education in Nursing (ACEN).

December 2021 Ohio Nurse Page 7

What the Professors Had to Say…

“The way our students were educated prior

to the pandemic provided the foundation for the

transitions to new approaches that were required

by the pandemic. The faculty are committed to

retaining new strategies that promote student

learning as we transition into educating students

in the face of the pandemic.” – Dr. Cindy



“Our students were able to successfully

complete their educational programs in both the

spring of 2020 and in the spring of 2021. That

speaks volumes. They graduated competently and

we’re very proud of that.” – Dr. Cindy Anderson,


“Even though nurse faculty were impacted both

professionally and personally by the pandemic

and the rapid, unexpected transition to on-line

learning, nurse faculty proved themselves to

be flexible and resilient in the adoption of new

teaching and learning strategies to optimize

student experiences.” – Dr. Marjorie Vogt, PhD,


“Nursing is the foundation and backbone of

health care and covid care has put enormous

stress on this profession. Nurses are intelligent,

resilient, and care deeply for their patients and

have shown up every day of this pandemic to do

their job and care for the patients and families

and this dedication is amazing.” – Dr. Christine


Special thanks to Dr. Cindy Anderson, PhD,


Professor and Senior Associate Dean for

Academic Affairs and Educational Innovation at

The Ohio State University, Dr. Christine Colella

DNP, APRN-CNP, FAANP, Professor, Interim

Associate Dean and Executive Director, Graduate

programs at the University of Cincinnati, Dr.

Gillian H. Ice, Ph.D., M.P.H., Professor of Social

Medicine and Special Assistant to the President

for Public Health Operations at Ohio University,

and Dr. Marjorie Vogt, PhD, DNP, CNP, CNE,

FAANP, Clinical Professor at Ohio University for

sharing information regarding their university’s

response to reopening this semester (Autumn,

2021) and changes to nursing education.


Covid-19 dashboard. (October, 2021). University of

Cincinnati. Retrieved November 3, 2021, from



Dashboard. (2021, October 18). Safe and Healthy

Buckeyes. Retrieved November 3, 2021, from


Page 8 Ohio Nurse December 2021

ONA’s Policy Footprint

First Published in 2016 by Jan Lanier, JD, RN & Tiffany Bukoffsky, MHA,


Updated in November 2021 by

Tiffany Bukoffsky, MHA, BSN, RN

We can all agree that nursing has come a long way since the days of

Florence Nightingale. We have not only become a powerful voice as a

profession, but are the most trusted profession in the United States year

after year. With a powerful voice comes the responsibility to be a strong and

engaged advocate. Registered nurses in Ohio have a long-standing tradition

of making an impact on legislation in our state and to pave the way for our

fellow colleagues now and in the future.

The Ohio Nurses Association (ONA) was formed in 1904 “to secure

legislation for the advancement of the nursing profession in Ohio”, including

legislative campaigns for nursing registration and improved standards for

education of professional nurses.

One of ONA’s primary accomplishments in our state was the

implementation of the Nurse Practice Act on April 27, 1915. This key piece of

legislation formed the Nurses’ Examining Committee, now known as the Ohio

Board of Nursing. Since then, we have actively engaged in the Ohio policymaking

process and have changed the face of nursing in our state. Below

is a compilation of ONA’s legislative successes over the last two and a half


• Creation of the Nursing Education Assistance Loan Program (1990)

• Recognition of advanced practice nurses—nurse practitioners, clinical

nurse specialists, certified registered nurse anesthetists, and certified

nurse-midwives (1996)

• Needle stick safety legislation (1999)

• Prescriptive authority for nurse practitioners, clinical nurse specialists, and

nurse-midwives, (2000)

• Creation of the Nursing Education Grant Program (2003)

• Preservation of the role of registered nurses when the creation of

alternative providers was proposed by various state agencies (2003, 2005,

2007, 2009, 2012—ongoing)

• Establishment of a no-interest loan through the Bureau of Workers’

Compensation to facilitate the purchase of lift assist equipment (ceiling

lifts) in long-term care and acute care facilities. The American Nurses

Association provided ONA with an award for advocacy around safe lift

devices. (2005)

December 2021 Ohio Nurse Page 9

• When the General Assembly created

medication aides for long-term care and

assisted living facilities, ONA made certain

these individuals would be required to meet

stringent education expectations and be

governed by the Board of Nursing (2005 &


• Elimination of smoking in public places as

part of a coalition with other health care and

environmental interest groups (2006)

• Establishment of staffing standards in

accordance with ANA principles (2008)

• Defeated efforts to limit the rights of public

employees (including nurses) to bargain

collectively (2011)

• Authority for nurses in pronouncement of

death in certain circumstances (2013)

• Enhancement of the penalty for assaulting

nurses or other health care workers in

hospitals (2013)

• Authority for APRNs to hold admission

privileges (2013)

• Minimized limits on the prescribing of

schedule II controlled substances (2014)

• Authority for APRNs with prescriptive

authority to delegate medication

administration to trained individuals in certain

settings (2015)

• Preservation of an independent Board of

Nursing rather than having an umbrella

agency take on the regulation of nurses


• An Ohio nursing license plate that provides

scholarships for nursing students and grant

funding for nurse researchers (2017)

• Additional reporting mechanism for staffing

plans, where hospitals need to submit plans

to the Ohio Department of Health every other

year, which must be posted on a public-facing

website (2017)

• Implementation of a statewide hospital

licensing system and additional regulation

and inspection requirements (2021)

Going forward, ONA will continue to be the

leading voice for professional nursing in Ohio.

If we could take a glimpse into the future of what

professional nursing will look like in our state, it

might include some of the following:

• Ensure all hospitals are meeting appropriate

standards of patient safety through the Ohio

Administrative Code and hospital licensing

rule-making process

• Stronger staffing language that further

secures patient safety

• Mandatory overtime restrictions

• Enhanced and modernized language that

allows APRNs to work to their full scope of

education, training, and certification

• Stronger workplace violence protections

NYC STD Prevention Training Center

We provide a continuum of education, resources,

consultation and technical assistance to health care

providers and clinical sites. www.nycptc.org

• Free CNE web-based training on clinical sexual health prevention,

diagnostic and treatment issues

• Free clinical guidance regarding STI cases; no identifying patient data is

submitted www.stdccn.org

• Clinical guidance tools regarding the 2021 CDC STI treatment guidelines

• Virtual and on-site technical assistance regarding quality improvement,

clinic implementation and best practices around sexual health provision

KEEWAYDIN in Vermont


If you are a qualified nurse who enjoys working with kids,

consider a summer at Songadeewin of Keewaydin for girls or

Keewaydin Dunmore for boys on beautiful Lake Dunmore in the

heart of the Green Mountains of Vermont. We successfully ran

Covid-free camps in 2021. Vaccination required. Keewaydin’s

website is www.keewaydin.org. Contact Ellen Flight at (802)

352-9860 or by email at ellen@keewaydin.org

Page 10 Ohio Nurse December 2021

Challenges in the Nursing Workforce, Graduate Nursing Education, and Future of Nursing

Georgianna Thomas, D.Ed., MSN, RN

Somi Nagaraj, DNP, MSN, RN, CSSGB, CONTL

Reprinted with permission from Illinois The Nursing

Voice September 2021 issue

The healthcare sector is an intricate, albeit

fundamental, part of ancient and modern societies.

It comprises a long list of agents, from the individual

seeking healthcare services to the medical staff

and nurses, all operating within a legal framework

involving providers, consumers, insurance

companies, government, medical schools, nursing

schools, and regulatory institutions (Amorim Lopes et

al., 2015).

The healthcare market is always composed

of both suppliers of health services and patients

demanding their services. On the one side is the

workforce of physicians, nurses, and remaining

clinical staff educated according to standards and

criteria, ready to assist those in need. On the other

side stand the forces that drive the demand for

medical services, strongly related to demographic,

socioeconomic, and epidemiological factors.

Analyzing these two market forces is a critical step in

assessing whether the available health care human

resources are enough in quantity and skills to meet

the current and future demand in due time and may

lay solid foundations for further research, considering

perhaps changes to the existing health policy

framework (Amorim Lopes et al., 2015).

A high degree and extent of uncertainty affect

supply and demand: asymmetric information between

physicians, nurses, and patients, restrictions on

competition, an aging workforce in all areas, strong

government interference, and supply-induced

demand are some of the most glaring differences

that can be pinpointed. These may be relevant

when assessing the impact of any policy involving

Healthcare Human Resource [HHR] planning

(Amorim Lopes et al., 2015).


Supplying human capital with the appropriate

expertise to enable workers to perform and satisfy

the demand for health care is no simple task. The

time and effort required to equip HHR, especially

physicians and advanced nurse practitioners,

exceeds most other professions. In some particular

healthcare professions, the set of necessary skills

to qualify for medical practice is acquired through

extensive academic learning, which involves

enrollment in long courses that may take up decades

to complete due to a strict licensing process. The

analysis of the medical and nurse education process

is relevant but may be insufficient, as several other

factors may affect the efficiency and effectiveness

of the care services delivered (Amorim Lopes et al.,


Despite the limitations, some measures to

overcome imbalances in the quantity (number) of

physicians and nurses have already been identified

in the health policy literature (Chopra et al., 2008),

namely the following: increasing the number of

domestic- and foreign-trained medical graduates

or increasing the number of medical and nursing

schools and classroom sizes; increasing the

enrollment limits; reducing the requirements for entry

to medical and nursing schools; raising the wages

December September 2021 2021 Ohio Ohio Nurse Page 11 17

of the medical and nursing staff, as well as the perspectives for their future

career path; or reducing the costs of attending medical and nursing school,

which may encourage potential students to enroll. These proposals are shortterm

measures to alleviate the immediate stress put on the healthcare system

triggered by an undersupply of personnel and may not be suitable for tackling

long-term imbalances due to huge shortages or surpluses of medical and

nursing staff (Amorim Lopes et al., 2015).


Demand for health care is a derived demand (Grossman, 1972), which means

that people do not seek health care services as a final good for consumption but

as an intermediate service allowing them to be healthy and to improve their stock

of health capital (well-being). They want to improve their health, and to do so;

they seek healthcare services (Amorim Lopes et al., 2015).

The concept of needs in health care is not consensual in the health literature,

with a semantic confusion arising from its use in health economics (Hall &

Mejia, 2009). While the economic or effective demand translates the actual,

observed demand, usually measured in terms of service utilization ratios such

as bed occupancy rates, number of inpatients, the needs component tries to fully

encompass the epidemiological conditions that characterize a given population,

measured through morbidity and mortality rates or by the opinion of a panel of

experts, and how that may translate into a given quantity of required healthcare

services. Therefore, we see that the classical concept of economic demand

may not reflect the biological needs of the population, as it may leave out the

necessities of the population regardless of their ability to pay (Amorim Lopes et

al., 2015).

An integrated approach uses a dynamic, system-level perspective covering

key drivers of supply and demand that includes manpower planning and

workforce development is critical to overcoming such challenges (Stordeur

et al., 2010). The importance of paying attention to needs is also continuously

stressed, as changes in the health patterns of the populations take place

(Tomblin et al., 2009). The impact of microeconomic and organizational changes

in productivity and the skill mix, of the evolution of demand for healthcare

services, and also of the evolution of health diseases and its potential impact

on the health system. The given quantity of workers may provide more or less

healthcare services depending on their productivity and skill mix, influencing the

conversion from headcounts to full-time equivalents (FTEs). Such conversion

is critical to properly assess the healthcare workforce, as a significant number

of physicians and nurses work part-time only. For this reason, FTE is a more

accurate measure as it normalizes headcounts. On the demand side, economic

(effective) demand can be initially measured by analyzing utilization indicators.

How this demand will evolve in the future will then be subject to typical economic

factors such as demography and the growth of the income/GDP (Amorim Lopes

et al., 2015).

In parallel, potential needs can be assessed by incorporating the incidence

and prevalence of diseases and then mapping a given disease to an estimate

of FTE requirements. Whether future supply forecasts should tackle all of the

estimated needs is a decision left to the consideration of the policymaker, as

the analysis does not incorporate financial constraints. Despite the abundance

of approaches and techniques to determine supply and need for professionals,

none of the methodologies has ultimately proved to be superior (Ricketts, 2011).

Recent studies testing current forecasting models show that there is still

plenty of room for improvement given the gap between projected and actual

results (Greuningen et al., 2013). It becomes even clearer that workforce

planning should be accurate and performed in due time, given the attritions and

the delays in enacting policies in the healthcare sector. Adapting medical and

nursing schools, altering legislation, and changing roles is an effort that may take

years to bring forth. Therefore, planning has to target a long enough time horizon

to be useful and applicable and has to be done pre-emptively (Amorim Lopes et

al., 2015).

Accurate HHR planning requires an approach that is both integrated and

flexible, featuring supply and demand (potential and effective) and incorporating

less tangible factors, such as skill mix and productivity (Amorim Lopes et. al.,



Looking at the area of academia, there are many issues at hand that

present challenges for nursing education at the doctoral level. Having enough

faculty to provide quality education to those interested in pursuing a doctoral

degree in nursing relies on competent individuals. Presently there are two

types of doctoral degrees one can earn, both are terminal degrees, and

both allow nurses to continue to practice in the clinical field. The Doctor of

Nursing Practice (DNP) has a clinical focus that allows the nurse to possess

expert knowledge to influence healthcare outcomes across direct patient

care, advocating for healthcare policy implementation, and collaborating

with organizational leadership (Leveck, 2020, Chism 2010). The Doctor of

Philosophy (PhD) focuses on research in advancing the nursing profession

and change the quality of patient care and outcomes in the field. PhD nurses

also teach and mentor nurses at the college and university level, growing the

next cohorts of professional nurses. There is a difference between these two

degrees in their primary foci and length of education (registerednursing.com).

However, the DNP degree has become the more sought-after degree, and

individuals who have earned it are considered equal at many institutions in

academia in relation to tenure attainment and administrative positions. It was

more common to see the individual with a PhD in the academic setting. However,

individuals seeking this degree are decreasing in number, and some individuals

are having difficulty completing their dissertation. This adds to the faculty

shortage we continue to experience in the profession. There is a distinction

Challenges in the Nursing Survey Workforce Findings continued on page 12 18

Page 12 Ohio Nurse December 2021

Challenges in the Nursing Workforce continued from page 11

between the two degrees and needs to be recognized and valued in advancing

new nurses, however, the DNP graduate is more prepared for the clinical arena.

According to Drs. Di Fang and Karen Kesten, one-third of the current nursing

faculty workforce in all levels of education are expected to retire by 2025 (ANA

Fact Sheet, 2020). This will certainly have an effect on the numbers of students

who will be accepted when they apply for nursing education overall.

Continuous changes in the nursing and medical fields have been rapidly

evolving because of technology and studies such as the genome project.

Graduate student feedback to courses and discussions with clinical affiliates

to the college/university are two ways that information can be ascertained in

relation to curricular issues for content. Accreditation standard revisions and

the recently adopted Essentials with emphasis on outcomes and competencies

in learning have also added to many of the changes schools are making to

revise overall curriculums (AACN, 2021). Learning theories are used to expose

students to various learning experiences. Online teaching, simulation, interprofessional

learning, case studies, and other teaching formats take much time

to prepare and grade and may not all be familiar for present faculty to fulfill.

Interdisciplinary education (IPE) among the various healthcare providers

is expected to be utilized in schools. This type of education provides shared

experiences that allow for better understanding, improved engagement, and

clearer insight into cooperation in the work environment and quality patient care.

This activity in schools with major medical affiliations has an edge in providing

this type of learning while many smaller colleges and universities struggle to

gain this opportunity. Many IPE opportunities that do exist are noted through

simulation-enhanced activity (Fawaz, 2018). Although simulation is helpful, realtime

situations may affect the learner differently when exposed.

The Ohio Department of Rehabilitation and Correction are

looking for medical professionals in the following areas:

Technology has become more influential in our lives, especially after the

past year and a half of pandemic experiences. However, online education is

not a new concept in education. Use of learning platforms, Zoom meetings,

Wiki’s, Google docs, social media, Electronic Health Records, and so on have

not been mastered by all in education, faculty, or student. Many students like

the idea behind online learning in that they can study at their own pace often

or at a time that is most convenient for them. This strategy for education allows

for flexibility to view course material in both an asynchronous and, at times,

synchronous format. Faculty find this learning takes more time in their schedule

for preparation and grading than when classes met traditionally. Class size is

not always capped. Lack of support staff with course development and difficulty

managing technological changes have been identified as barriers to distance

education (Iwasiw et al., 2020). This becomes frustrating to both teacher and

student in that the partnership that develops in learning is not fully developed.

Future of Nursing

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,

study sponsored by Robert Wood Johnson Foundation identified, that a nation

cannot thrive fully until everyone can live their healthiest possible life, and

helping people live their healthiest life is and has always been the essential

role of nurses. The ultimate goal is to achieve health equity in the United States

built on strengthened nursing capacity and expertise (National Academies of

Sciences, Engineering, and Medicine, 2021).

The committee developed a framework identifying the key areas for

strengthening the nursing profession to meet the challenges of the decade ahead.

These areas include the nursing workforce, leadership, nursing education, nurse

well-being, and emergency preparedness and response, as well as responsibilities

of nursing with respect to structural and individual determinants of health (National

Academies of Sciences, Engineering, and Medicine, 2021).

In 1998 the Pew Health Professions Commission, a group of healthcare

leaders charged with assisting health policymakers and educators teaching

health professionals to meet the changing needs of healthcare systems,

completed a report listing competencies healthcare providers of the future

would need. The competencies are listed in the Fourth Report of the Pew Health

Professions Commission (O’Neal & Pew Health Professions Commission, 1998).

The book To Err Is Human: Building a Safer Health System (Kohn, Corrigan,

& Donaldson, 1999) brought national attention to the issue of patient safety by

discussing the number of people who die each year from medical errors. This,

in turn, sharpened the focus of patient safety in nursing education (Scheckel,


Despite the practice setting in which students learn nursing care, it will include

using various technologies and knowledge of informatics to assist with patient

care. These technologies can include but are not limited to medical devices

patients will use to provide self-care, as well as information retrieval, clinical

information management, and documentation technologies (Scheckel, 2008).



Who We Are…

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

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

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

of dignity and respect in the treatment of others.

What We Do…

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

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

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

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

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

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

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

• Education Assistance

• Paid Holidays

• Paid Vacation, Sick and Personal Leave

• Retirement Benefits

• Life Insurance

• Wellness Incentives

• Worker’s Compensation

• Employee Assistance Program

• LPN’s starting hourly pay will be $22.99, plus 3% supplement and may be eligible for

shift differential

• RN’s starting hourly pay will be $30.03, plus 3% supplement and may be eligible for

shift differential

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

advertised on individual posting announcements.

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

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

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

Contact us at:



TVBH has immediate openings for Registered Nurses,

both full and part-time, in its inpatient Acute and Forensic

facilities. TVBH is a multi-service behavioral healthcare

organization providing trauma informed, recovery based,

team oriented behavioral healthcare services. Nurses

interested in providing excellent care to psychiatric

acutely ill or forensic patients are invited to apply. We

offer an extensive orientation, outstanding benefit

package, negotiable salaries, stability, and regular salary

increases, and






TVBH is a qualified facility for the Nurse Education Loan

Repayment Program (NELRP).

Interested applicants should forward apply using

www.careers.ohio.gov, fax to (614) 752-0386, or call

(614) 752-0333 or e-mail @ jared.meadows@mha.ohio.gov .

TVBH is a non-smoking facility. EOE M/F/D

December 2021 Ohio Nurse Page 13

Students’ use of these devices has important implications for improving their

clinical judgment (Newman & Howse, 2007). Nurses are also being exposed

to the use of variety of clinical management systems, like patient surveillance

systems many of which have implications for ensuring quality and safety.

A significant movement that accompanied the curriculum revolution involved

using pedagogies to ensure students could think critically in clinical practice.

Traditionally, students who learned the nursing process were thought to be

learning critical thinking. During the past few decades, the nursing process has

been challenged as the best approach to developing students’ critical thinking

(Scheckel, 2008). However, current research in nursing education suggests

that students also need to engage in thinking processes that promote reflective

thinking, where they build practical knowledge, embodied thinking, where they

learn the importance of intuition and pluralistic thinking, where they consider a

clinical situation using many perspectives (Scheckel & Ironside, 2006).


As nurses assume increasing responsibility for patient care in primary care

settings, the combination of increased clinical and systems knowledge, as well

as the capability to apply and evaluate evidence to practice innovations, can

only have a positive impact. The presence of DNP-prepared APRNs in primary

care will expand educational opportunities. In the short term, the DNP-prepared

APRNs can mentor the MSN-prepared APRNs within the system. Equally

important is the opportunity for enhanced preceptor education for nursing

students in primary care (Dunbar-Jacob et al., 2013).

Indeed, the preparation of the DNP will influence the perception of health

care systems regarding the added value of DNP education. If graduates of such

programs bring an increased depth of knowledge and skill to the clinical arena,

the DNP will likely flourish. If graduates bring little more than what is offered by

master’s-level education, the DNP will not be an attractive addition to the clinical

arena. Thus, the quality of the preparation of the DNP will influence the adoption

of the DNP practitioner and administrator by health care systems (Dunbar-Jacob

et al., 2013).


Challenges in building DNP programs include the identification of qualified

faculty for each specialty, qualified capstone advisors, and qualified clinical

preceptors. A further challenge is the simultaneous education of master’s

cohorts and DNP cohorts. The challenges by requiring faculty to obtain a

doctoral degree, developing critical academic–service partnerships in mentoring

students for practicum and capstone projects, and discontinuing MSN advanced

practice specialty programs while focusing on the BSN-to-DNP and MSN-to-

DNP programs. High-quality DNP academics and DNP clinicians are crucial

to help meet these challenges. Each educational program must assess its

challenges and strategies for addressing those challenges. How we proceed will

determine the impact of our programs on the future of the health care system

(Dunbar-Jacob, Nativio, & Khalil, 2013).

In academia, both the PhD and DNP prepared nurses can work together to

ensure quality education for our nursing students. Both need an educational

foundation to be learned to be successful educators. The distinction of the PhD

concentrating on teaching theory and research to assist nursing to maintain its

scientific foundation and the DNP concentrating on the clinical skills and acting

as preceptor/clinical educator at any level of nursing appear to be the ideal

partnership to develop. Both nurses can assist academia and the clinical arena

in staying current and developing innovative care measures to provide quality

care to clients. When looking at the definitions noted at the beginning of this

work, this collaboration in teaching nurses fits what was noted.

Page 14 Ohio Nurse December 2021

E-Cigarette and Subsequent Smoking Use and Relationship to

E-Cigarette Quit Attempts Among College Students

Michelle Correa, RN

Reprinted with permission from

Arizona Nurse April 2021 issue

Electronic cigarette (e-cigarette) use increased

three-fold from 2011 to 2013 and continues to gain

prevalence among preteens, adolescents, and young

adults (Centers for Disease Control and Prevention

[CDC], 2014). E-cigarettes, including vape, JUUL,

and wax pens, are defined as a device that does

not contain tobacco but may include nicotine,

flavorings, and other chemicals (National Cancer

Institute, n.d.). With multiple marketing methods,

e-cigarettes dominate in sales by targeting young

and old generations (CDC, 2014). Many youth and

young adults believe that e-cigarettes are cheaper,

cleaner, safer, and healthier than traditional smoking

(Gorukanti et al., 2017; Kong et al., 2015). Related

to these perceptions, many young users (40.36%)

believe that e-cigarettes help people discontinue

cigarette smoking (Gorukanti et al., 2017). Both

non-users, who have never used e-cigarettes

or cigarettes, and e-cigarette users agree that

e-cigarettes do not contain tar, are not addictive nor

considered a tobacco product, and solely produce

vapor with water (Gorukanti et al., 2017).

Though perceived as a “safer” alternative to

cigarettes, e-cigarettes are still not safe. Research

indicates that while e-cigarettes may be a cessation

aid for cigarette smokers, the product may produce

the adverse effect of a nicotine addiction and/or

combustible tobacco product use (Kong et al., 2015;

Pattinson et al., 2018). Individuals not aware of

the consequences of e-cigarettes may exacerbate

current medical problems (i.e., asthma, respiratoryrelated

issues, hypertension, cardiovascular

diseases), continue their nicotine addiction through

e-cigarette use, or initiate a nicotine addiction had

they not smoked before (CDC, 2014). The U.S.

Department of Health and Human Services (2016)

reported consequences related to e-cigarette use,

like addiction, brain development and subsequent

mental health issues, chronic disease development,

and death.

In 2020, I conducted a cross-sectional study

that included an anonymous screening survey

and a survey that assessed e-cigarette use and

non-electronic smoking, e-cigarette withdrawal

and cessation, and non-electronic smoking quit

attempts. I recruited 65 eligible* participants via

flyer advertisements, social media advertisements,

ASU online advertisements, and email notices. The

study revealed that participants who used nonelectronic

smoking also frequently used cigarettes or

marijuana. Participants who used both electronic and

non-electronic smoking preferred using e-cigarettes

to non-electronic forms. Participants who attempted

to quit e-cigarettes believed that they would

successfully withdraw from e-cigarettes by switching

to marijuana or avoiding non-electronic smoking


Using these findings and previous research, youth

and young adults seeking e-cigarette cessation need

nursing education and intervention. We can help this

population quit by applying principles of the nursing

process. Ask patients about their e-cigarette habits,

such as e-cigarette frequency, perceived e-cigarette

harm to self, e-cigarette device, primary flavor use,

nicotine presence, and reason for e-cigarette use. A

more objective scale to assess for e-cigarette use and

potential withdrawal severity is the Fagerström Test

for Nicotine Dependence (Carpenter et al., 2010). Find

the most appropriate nursing diagnosis for the patient,

such as risk-prone health behavior. Use motivational

interview techniques to promote the patient to

self-assess their willingness and readiness to quit

e-cigarettes (Hettema et al., 2005). Therapeutically

communicate with the patient. Hold your judgment

or personal beliefs about the situation because you

are their biggest advocate and ally right now. Offer

them interventions to help them successfully quit

e-cigarettes. Start with less invasive options: avoid

triggers such as people or situations; distract yourself

with a hobby or task; talk to someone who has

experienced what you’re currently experiencing; or

call the substance abuse helpline (Mayo Clinic Staff,

2016; Malucky, 2010; Substance Abuse and Mental

Health Services Administration, 2019). We can also

talk to the provider and ask for medication to help with

the withdrawal process. Medication may help manage

symptoms like anxiety or depression. All these options

give patients the freedom to choose how they want to

December 2021 Ohio Nurse Page 15

quit. They feel in control after a time where they felt

e-cigarettes controlled their life.

We spend the most time with these patients.

We are the first line of defense for identifying and

intervening in an e-cigarette user’s habits. We must

uphold that nurse-patient trust and advocate for our

patients’ health. The more we educate ourselves

about e-cigarettes and inform our patients, the more

promising outcomes for e-cigarette cessation in the

future, like decreasing e-cigarette popularity and

increasing health awareness and promotion.

*Eligibility criteria included that participant must have

been: an ASU student, at least 18 years old, and

“current” e-cigarette user.

Michelle Corerra, BSN, RN, is a nurse with

HonorHealth’s COVID-19/Stroke Unit.

Kong, G., Morean, M. E., Cavallo, D. A., Camenga, D. R.,

& Krishnan-Sarin, S. (2015). Reasons for electronic

cigarette experimentation and discontinuation

among adolescent and young adults. Nicotine and

Tobacco Research, 17(7), 847-854. https://doi-org.


Mayo Clinic Staff. (2016). Quitting smoking: 10 ways to

resist tobacco cravings. Retrieved from https://www.


Malucky, A. (2010). Brief evidence-based interventions

for nurse practitioners to aid patients in smoking

cessation. The Journal for Nurse Practitioners,

6(2), 126-131. https://doi-org.ezproxy1.lib.asu.


National Cancer Institute. (n.d.). NCI dictionary of cancer

terms. Retrieved from https://www.cancer.gov/


Pattinson, J., Lewis, S., Bains, M., Britton, J., & Langley,

T. (2018). Vape shops: Who uses them and what

do they do? BMC Public Health, 18, 541. https://doi.


Substance Abuse and Mental Health Services

Administration. (2019). National helpline. Retrieved

from https://www.samhsa.gov/find-help/nationalhelpline

U.S. Department of Health and Human Services.

(2016). E-cigarette use among youth and young

adults: A report of the surgeon general [PDF file].

Retrieved from https://www.cdc.gov/tobacco/data_




Carpenter, M. J., Baker, N. L., Gray, K. M., & Upadhyaya,

H. P. (2010). Assessment of nicotine dependence

among adolescent and young adult smokers: A

comparison of measures. Addictive Behaviors,

35(11), 977-982. https://doi-org.ezproxy1.lib.asu.


Centers for Disease Control and Prevention. (2014). More

than a quarter-million youth who had never smoked

a cigarette used e-cigarettes in 2013. Retrieved from


Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R. &

Halpern-Felsher, B. (2017). Adolescents’ attitudes

towards e-cigarette ingredients, safety, addictive

properties, social norms, and regulation. Preventive

Medicine, 94, 65-71. https://doi-org.ezproxy1.lib.asu.


Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational

interviewing. Annual Review of Clinical Psychology, 1, 91-

111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833

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