the future of
for a healthier Georgia.”
The Official Publication of the Georgia Nurses Foundation (GNF).
Quarterly publication distributed to approximately 58,000 RNs in Georgia.
Brought to you by the Georgia Nurses Foundation
(GNF) and the Georgia Nurses Association (GNA), whose
dues-paying members make it possible to advocate for
nurses and nursing at the state and federal level.
Visit us online at www.georgianurses.org
Volume 82 • Number 1 • January, February, March 2022
Georgia Nurses Foundation Announces Inaugural Inductees for the
Georgia Nursing Hall of Fame
The Georgia Nurses Foundation (GNF) has released
the names of the inaugural class for the Georgia
Nursing Hall of Fame.
The 10 inductees are exemplary Georgia registered
nurses who made a mark or are making exploits in
the profession of nursing locally, nationally, and/or
“As GNF President, I am so happy to see the Georgia
Nursing Hall of Fame come to fruition,” stated GNF
President Wanda Jones, BSN, RN, MSN, FNP-BC. “We
have been planning this program for over two years
to honor and showcase the many nursing legends in
Georgia. Due to the pandemic, we decided to not hold
the induction ceremony in 2020. We are so looking
forward to finally seeing it become a reality in February
The Georgia Nursing Hall of Fame inaugural
Lisa Eichelberger, PhD, RN
Connie Buchanan, MS, NP-C, FNP
Lucy Marion, PhD, FAAN, FAANP, RN
Joyce McMurrain, BSN, RN
Candice Saunders, FACHE, RN
Tim Porter O’Grady, DM, EdD, APRN, FAAN, FACCWS
Joyce Barlow, MBA, MHA, RN
Mary N. Long
Lucy Rogers, CNHA, CSA, FACHCA, CHC, CCE, RN
Mary E. Walker
Tickets for the induction ceremony and sponsorship
opportunities are available at Georgia Nursing Hall
of Fame Inaugural Inductees Ceremony Tickets,
Thu, Feb 10, 2022 at 6:30 PM | Eventbrite. https://
current resident or
U.S. Postage Paid
Permit No. 14
Message from your new President-elect. ..2
News from the Foundation. ...........2
CEO CORNER. .....................3
GNF PRESIDENT’S MESSAGE. .........3
A New Survey on Health Care
Affordability Finds Georgians are
“Coming Up Short”. ..............4
Ask A Nurse Attorney. ............5
2021 Honor A Nurse. .................8
What if Every Patient had Quality
Access to Care?. .....................9
Think like an expert witness to avoid falls
liability ........................... 12
Virtual Simulation: Impact on Clinical
Judgment. ........................ 14
GNA Personal Benefits ............... 18
Membership. ...................... 19
Page 2 • Georgia Nursing January, February, March 2022
Volume 82 • Number 1
Message from your new President-elect
Happy New Year!
It is my hope that you and your family had a fun,
safe and healthy holiday season. Many families
returned to celebrating in person while many families
continue to mourn lost loved ones. From the bottom
of our hearts, the Georgia Nurses Association (GNA)
is thinking of each person who has been affected
by the pandemic over the past two years. The news
reminds us of the need to continue to protect ourselves
and those who we cherish. It is not unusual to hear
the great debate going on amongst friends, family
members, coworkers, and the like. The decision to be
vaccinated versus the choice to remain unvaccinated
has divided the nation and abroad. Boosters have
sparked even more debate.
As the conspiracies and mistrust rage on, remember
whatever you decide, your immune system is your first
line of defense, especially in the winter months. Here
are some tips you can use to keep your immune system
in good condition:
1 Stop smoking if you are a smoker.
2 Make sure your diet consists of plant-based
items such as fruits and vegetables.
3 Get moving! Stay active.
4 Take time to rest. Sleep is important to
5 Wash your hands or use hand sanitizer
On another note, Georgia’s 2022 Legislative Session
will commence on January 11th and conclude on day
40. The GNA has an ambitious legislative platform that
we believe will address some of the priority needs of
our profession. We welcome your feedback, your input,
and your participation. Do not hesitate to contact us
at the GNA office or by email with your questions or
The board of directors are poised and ready to
represent the nurses of Georgia under the “Gold
Dome.” We will periodically send out calls for your
participation as we work to better working conditions
for nurses in Georgia. Your stories, your experiences,
and your insight are all invaluable.
As your newly elected President-Elect, I would like to
thank each of you for your vote for me, I am forever
grateful for your trust and belief in my skills and ability
to serve in this capacity.
Erica Mills, PhD, RN, NPD-BC
President-Elect, Georgia Nurses Association
Board of Directors 2021-2023
News from the
The Georgia Nurses Foundation (GNF) awarded a
Kathryn Chance Suggs Leonard Scholarship of $2,000
this year to Morgan Clark-Youngblood.
The Georgia Nurses Foundation and Georgia
Nurses Association Nursing Scholarship Awards
provide financial assistance
to qualified applicants who
may be enrolled full- or parttime
in an accredited nursing
program. Interested students
must have a GPA of at least
a 2.5 (undergraduate) or 3.0
(graduate) on a 4.0 scale
in prior nursing education.
For more information, visit
Communications Director: Charlotte Báez-Díaz
GEORGIA NURSES FOUNDATION BOARD OF TRUSTEES
Wanda Jones, BSN, RN, MSN, FNP-BC, President
Orlin Marquez, DNP, MBA, APRN, FNP-BC, Vice President
Shawn Little, CNE, DNP, RN, Treasurer
Catherine Futch, RN, MN, NEA-BC, CHC, FACHE,
Immediate Past President
Evelyn M. Olenick, DNP, RN, NEA-BC, Member
Sherry Sims, RN, Member
Mary Gullatte, PhD, RN, ANP-BC, AOCN, FAAN, Member
Natalie Jones, MSN, RN, NPD-BC, Member
Gerald Hobbs, RN, Member
Brenda B. Rowe, RN, MN, JD, Member
Katelyn Little, RN, BSN, Member
Dina Hewett, PhD, RN, NEA-BC, Member
Matt Caseman, Ex-Officio Member
GEORGIA NURSES ASSOCIATION BOARD OF DIRECTORS
President - Dina Hewett, PhD, RN, NEA-BC
President-Elect & ANA Delegate-At-Large
Erica Mills, PhD, RN, NPD-BC
Secretary & ANA Delegate-At-Large
Barbara Austin, MN, RN
Treasurer & 1st Alternate ANA Delegate-At-Large
Rachel E. Myers, PhD, RN, CDCES
Director of Leadership Development & 2nd ANA
Linda Morrow, DPN, MSN, MBA, NE-BC, CPHQ
Director Legislation/Public Policy
Elizabeth K. Bolton-Harris, DNP, ACNP-BC, CHFN
Director Nursing Practice & Advocacy
Joy L. King-Mark, DNP, MBA, APRN, NP-C
Director Advanced Practice Registered Nurse
Victoria Gordon, MSN, RN, CNM
Director Staff Nurse
Natasha Laibhen-Parkes, PhD, RN, CPN
Director Membership Development
Bree Becker, MSN, FNP-C, RNC-MNN
Director New Graduate
Emily Kathryn Lewis, BSN, RN
Wanda Jones, BSN, RN, MSN, FNP-BC
For advertising rates and information, please contact Arthur L.
Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626-4081. GNF and the Arthur L. Davis Publishing
Agency, Inc. reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited to corrections in
the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or
approval by the Georgia Nurses Foundation of products
advertised, the advertisers, or the claims made. Rejection of an
advertisement does not imply a product offered for advertising
is without merit, or that the manufacturer lacks integrity, or
that this association disapproves of the product or its use. GNF
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 GNF or
those of the national or local associations.
Georgia Nursing is published quarterly every January, April,
July and October for the Georgia Nurses Foundation, a
constituent member of the American Nurses Association.
3032 Briarcliff Road, Atlanta, GA 30329
GNF President Wanda Jones and Morgan
Georgia Nurses Association
January, February, March 2022 Georgia Nursing • Page 3
GNF PRESIDENT’S MESSAGE
Matt Caseman, GNA CEO
As we head towards 2022, GNA continues to
progress and evolve because of our members’
dedication and hard work. First and foremost, a
new GNA Board of Directors was elected, and Dr.
Dina Hewett took over as GNA President from
Richard Lamphier. Dina has been a champion for the
profession, and we are excited to have her leading
Georgia’s oldest and largest professional nursing
Richard, who fearlessly led GNA through the
pandemic, a monumental task indeed, will not be
going far from GNA. In fact, we are pleased to
announce he will be the new Executive Director of
our Peer Assistance Program (GNA-PAP) which received $150,000 in the state
budget for a much-needed expansion. Established in the 1980s, GNA-PAP is
nurses helping nurses with the disease of substance use disorder. Participants,
who are drug tested weekly, meet in groups with a facilitator for many months
until they get back on their feet. Thousands of Georgia’s nurses have been
helped over the years through our PAP and I could not be prouder of its
Regarding legislative advocacy, lawmakers will be back in session in January
and GNA will be working the hallways and corridors under the Gold Dome in
Atlanta to advance our priorities. SB 19, and companion legislation HB 371,
would require hospitals and ambulatory surgical centers to utilize surgical
smoke evacuation systems during surgical procedures. Smoke produced during
surgery has been proven toxic and an extreme detriment to the health of our
operating room nurses.
Another focus during the 2022 legislative session is our APRNs. HB 340
would create a separate APRN license, allow APRNs and PAs to do Home
Health Service orders, and allow the Board of Nursing to collect nursing
workforce data. HB 369 would allow APRNs and PAs to write prescriptions for
Schedule II in an emergency for an amount not to exceed five days. HB 369
also includes a section on allowing APRNs/PAs to authorize disability parking
Front and center is also the nursing shortage. GNA recently testified before
the House Human Relations and Aging Committee on safe staffing and patient
safety, and the need to recruit and retain bedside nurses. Georgia had the 5th
worse nursing shortage in the country in 2019, and the pandemic has only
exacerbated an already dire situation. GNA, along with other stakeholders, will
be working to help ease the shortage during the 2022 General Assembly.
Lastly, to honor our nurse legends from Georgia, the Georgia Nurses
Foundation will be hosting the first annual Georgia Nursing Hall of Fame
on February 10th in a ceremony at Piedmont Atlanta Hospital atrium and
auditorium from 6 pm to 10 pm. The ten inaugural inductees have been
announced and tickets for the ceremony are available for purchase on our
website. Seating is limited. Please join us for what is sure to be a great night
recognizing our state’s most accomplished nurses.
We will also be holding an in-person annual conference in the Fall of 2022.
Location and date have yet to be determined. With Zoom fatigue at an all-time
high, I think many agree that it is long overdue that we gather face to face.
As always, thank you for your continued support of GNA/GNF and
everything you do for our community.
Wanda Jones, MSN, FNP-BC, RN
As I begin my second term as your GNF President, I am
looking forward to the great things we will accomplish in
the next two years. Several projects were started in the past
two years but had to be put on hold due to COVID-19.
I am so honored and privileged to know that the
Georgia Nursing Hall of Fame Inaugural Inductees
Ceremony will finally take place on February 10, 2022.
Three judges outside of Georgia selected ten exemplary
nurses who have met the required criteria for selection.
These inductees will be the inaugural class for GNF’s Hall
of Fame. It will be an exciting time to honor these nurses
at Piedmont Hospital Marcus Heart Center. A limited
number of tickets for this event, so please look on the
GNA website for details to purchase your tickets. This will be a time we can honor
these nurses who have made a difference for nurses and nursing in the state of
Georgia, nationally and internationally.
In addition, I am excited to report that the Georgia Center for Nursing Excellence
(GCNE), led by Patricia Horton, RN, MN, MBA, CMC, CEEO, has acquired its
articles of incorporation and is moving forward with various projects, starting with
the hosting of the first Georgia Nursing Workforce Summit on January 20th and
21st. Please go to GCNE’s website (www.gcnex.org) to learn more about the 2022
Summit and other agenda items.
Furthermore, GNF is planning on a golf tournament in the spring and Bobby
Albert has committed to help us with this golf tournament. With our previous
tournaments, before 2020, a fun time was had by all the participants.
Lastly, we have a new diverse Board of Trustees that I am very honored to be
able to work with. Their expertise and knowledge will only enhance the Foundation
moving forward with new and innovative ideas.
In closing, as I am writing this article, Thanksgiving is only a few days away. At
this time of the year, we need to give thanks and blessings for our family, friends,
work, health, and our freedom. I truly hope that everyone had a wonderful
Thanksgiving with their family and friends, ate lots of healthy food, and finally
talked with one another.
Page 4 • Georgia Nursing January, February, March 2022
A New Survey on Health Care Affordability Finds Georgians are
“Coming Up Short”
By Whitney Griggs, Policy Analyst
The high cost of medical
care has long been a concern
for Georgians and a frequent
topic of conversation among
policymakers and industry
leaders. Therefore, it’s no
surprise to learn that many
Georgians struggle to pay for
health care or worry about
their ability to pay for care
in the future. A new survey
conducted by Altarum’s
Healthcare Value Hub, in
consultation with Georgians for a Healthy Future, gives
surprising new data on exactly how much Georgians
struggle with the cost of healthcare.
The purpose of Altarum’s Consumer Healthcare
Experience State Survey (CHESS) is to provide
advocates, policymakers, and industry leaders with
a better understanding of consumers’ struggles with
health care costs, reveal the cost-drivers that need to
be addressed in Georgia, and provide support for
system changes and policy solutions to improve health
care affordability for consumers.
The Georgia CHESS revealed that almost seven
in ten (68%) respondents struggled with health
care affordability burdens in the past 12 months.
These burdens included being uninsured due to high
premium costs (48%), delaying or forgoing care due
to cost (58%), and struggling to pay medical bills
(50%). The survey also found that four in five (80%)
of respondents worried about affording care in the
future, especially care related to aging or medical
emergencies. Unsurprisingly, those with incomes
below $50,000 struggled the most to afford care.
However, health care cost challenges also affected
families higher up the income ladder, with over half
(56%) of residents with incomes of $100,000 or more
struggling to afford care. When people are forced to
delay or forgo health care due to cost, their conditions
often become much more difficult and expensive to
treat down the road. Additionally, taking on debt or
choosing between necessities to pay for care affects
individuals and family’s financial security and wellbeing
for years to come. The survey found strong,
bipartisan support for legislative action to address high
medical costs. These actions include expanding health
insurance options to make health insurance affordable
and accessible for everyone, making it easier to switch
plans if an insurer drops your provider, showing fair
prices for procedures, and requiring insurers to provide
up-front cost estimates to consumers. The results of the
Georgia CHESS demonstrate the need for policymakers
and stakeholders to address high costs across all areas
of health care – from coverage to care to prescription
drugs. Additionally, consumers need more protection
from high health care costs and robust, easy-tounderstand
tools to navigate the costs associated
with care. Lawmakers can apply the CHESS results to
their efforts in the 2022 legislative session, using the
information to pass laws that eliminate cost as a barrier
to care for Georgians, protect Georgians from rising
health care costs, and require system-level changes so
consumers can better tell what the actual cost of their
care will be.
More information and evidence: https://
American Renal Associates
Our Staff Make the Difference!
Opportunities for dialysis nurses in
Augusta and Macon areas.
Email resume to Brittany Winter
Sr. Director of Membership & Government Affairs
On Wednesday, December 8, 2021, Georgia Nurses Foundation Treasurer Dr.
Shawn Little spoke to the House Rural Development Council about the need for
more support for schools of nursing in order to grow Georgia’s new nurse pipeline.
In addition to some innovative ideas centered around how the state can invest in
schools of nursing, she also offered feedback relating to the recently proposed
Board of Nursing rule changes for schools of nursing and their potential impact.
You can watch the Rural Development Council meeting at https://www.youtube.
Comments from Dr. Little begin at the 3hr and 10min mark.
January, February, March 2022 Georgia Nursing • Page 5
Should nurse injectors
carry liability insurance
coverage and if yes
what is best way to
locate a reputable
Thank you for your question. Any healthcare
professional who provides patient care is susceptible
to a medical malpractice lawsuit or professional license
complaint. Therefore, all nurses who provide patient
care should be covered by a professional liability
insurance policy. If you are an employee of a healthcare
facility, then you may be covered by your employer’s
group professional liability insurance policy. However,
you should always ask to make sure. Notably, you
should also ensure that the employer’s policy includes
license protection benefits, which covers the cost of
your legal defense if a complaint is filed against your
nursing license with the State Board of Nursing. If you
are an independent contractor, then you should obtain
your own individual professional liability insurance
coverage. It is important to note that individual
insurance policies typically provide license protection
benefits. You can locate an individual insurance policy
by using an online search engine and key search terms
such as “individual liability insurance policy for nurses.”
There are policies that cost as little as $250- $300
per year! You can find these policies by doing a quick
Page 6 • Georgia Nursing January, February, March 2022
Report from the GNA Nursing Professional Development Units:
New Scope and Standards of Practice
Lynn Rhyne, MN, RNC-MNN
I always struggle to develop an article for Georgia
Nursing that justly demonstrates the importance of nursing
continuing professional development for nurses. As I have
just received my 2021 update of the ANA Nursing: Scope
and Standards of Practice, I thought this would be a timely
update of nurses’ “Bible.”
The Nursing: Scope and Standards of Practice are
updated every six years. The definition of nursing has been
reordered from 2015 and includes the art and science of
caring, compassionate presence and recognition of the
connection of all humanity.
“Nursing integrates the art and science of caring and
focuses on the protection, promotion, and optimization of health and human
functioning of illness and injury; facilitation of healing; and alleviation of suffering
through compassionate presence. Nursing is the diagnosis of human responses
and advocacy in the care of individuals, families, groups, communities, and
populations in recognition of the connection of all humanity (ANA, 2021, p. 1).
The Scope of Nursing Practice describes the who, what, where, when, why, and
how associated with nursing practice and roles (ANA, 2021, p. 3). The Standards are
comprised of Professional Nursing Practice and Professional Performance.
The Standards of Professional Nursing Practice provide nurses with insight into
the actions and behaviors that nurses must demonstrate competently regardless of
the practice setting. These are known as authoritative statements of nursing practice
(ANA, 2021, p.4).
A new standard was developed related to advocacy for the profession, healthcare
consumer, and the communities we serve with an emphasis on a commitment for
social justice in healthcare to address the social determinants of health and promote
The Standards of Practice focus on a competent level of nursing practice
demonstrated by the critical thinking model known as the nursing process. This
model represents significant actions taken by nurses and forms the foundation
of nurse’s decision-making, practice, and provision of care (ANA, 2015, p. 73).
All nurses know the process of assessment, diagnosis, outcomes identification,
planning, implementation, and evaluation. Within the fifteen standards are
competencies the registered nurse must demonstrate.
The Standards of Professional Performance provide an understanding of the
competency of behavior in the professional role, including activities related to
ethics, advocacy, respectful and equitable practice, communication, collaboration,
leadership, education, scholarly inquiry, quality of practice, professional practice
evaluation, resources stewardship, and environmental health (ANA, 2021, p. 74).
Each of these performance standards are described in detail.
An ANA Workgroup developed the ANA Professional Nursing Model that
represents the “synergy of nurse’s caring, values, wisdom, and energy undergirded
by ethical principles and situation ethics” (ANA, 2021, p. 9). The model is depicted
by a flame with caring, values, wisdom, and energy within the flame with ethics
providing the base of the flame upon which all the roles of nursing are grounded in.
The model provides an in-depth analysis of ethics.
The synopsis of the Nursing: Scope and Standards of Practice is my own
interpretation of them. They must be read thoroughly by each person to develop
an understanding and appreciation of them. They have been revised many times
since I have been practicing as a professional registered nurse and each revision has
provided more insight into professional practice and competent behaviors.
American Nurses Association, Nursing: Scope and Standards of Practice, 4th ed., Silver Springs, MD,
American Nurses Association, 2021.
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by
location and credentials.
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Page 8 • Georgia Nursing January, February, March 2022
2021 Honor A Nurse
November 5, 2021
In memory of nurse Marilyn Williams Mitchell.
Ms. Williams Mitchell has been honored by her niece
Lisa Oldham Sassaman through the Georgia Nurses
Foundation Honor a Nurse Program. Mrs. and Mr. Betty
and Don Parks also honored nurse Mitchell.
The Foundation's Honor a Nurse Program provides
a way to let individuals recognize nursing professionals
who have made a difference in the lives of others as a
friend, mentor, caregiver, or teacher. Proceeds from this
program go to the Foundation's scholarship program
and provide funding for nursing related activities.
The Georgia Nurses Foundation salutes Ms. Williams
Mitchell for her contribution to the nursing profession.
Wanda Jones, BSN, RN, MSN, FNP-BC
Benton House and Benton Village, assisted living and
memory care communities, are looking for qualified
professionals for the following positions:
LPN | Med Tech | CNA | CMA
Locations in Augusta, Covington, Decatur, Douglasville,
Grayson, Newnan, Stockbridge, Sugar Hill, and Woodstock.
Applicants must be able to successfully pass a drug screening and background check.
Ideal candidates will have Geriatric and Long Term Care experience. Three shift
options are available at some locations.
We offer a comprehensive benefits package including Health, Dental, Vision, Life
Insurance, PTO and 401(k) plan.
Only those truly committed to growth need apply. Apply online at
January, February, March 2022 Georgia Nursing • Page 9
What if Every Patient had Quality Access to Care?
By Monty Veazey, President/CEO Georgia Alliance
of Community Hospitals
In the spring of 2020, Laconyea Lynn of Albany went to
Phoebe Putney Memorial Hospital with fatigue.
Ms. Lynn woke up after six weeks on a ventilator and
learned she’d had COVID-19, a disease she’d never heard
of. She was among the first in the nation to catch the
virus – and among the last to find out what it was. In total,
she spent 72 days at Phoebe, walking out amid a tunnel
of cheering nurses anxious to celebrate a survivor after
witnessing so much heartache.
In the first 100 days of the pandemic, Phoebe had
2,728 positive COVID tests and 914 hospital admissions. Every bed was full. Offices
were turned in to patient rooms. With PPE in short supply, staff sewed masks.
Ms. Lynn was one of many struck by the virus. Albany became one of the first
COVID hotspots, and its healthcare professionals at Phoebe found themselves on
the front lines of a war with an unknown enemy. Survivors like Ms. Lynn were able
to go back to their lives because they received compassionate, around-the-clock
care from Georgia’s frontline healthcare workers.
The COVID crisis shined a light on the heroic efforts of nurses, but it also exposed
some of the significant challenges facing our industry and its workforce that require
Coming out of COVID, we must tell our stories of triumph. But we must also get
help to solve the problems we face, or we run the serious risk of not having the
healthcare infrastructure – both people and places – that we need to tackle the next
First is the shortage of nurses and doctors that led to the state of Georgia
and our hospitals bidding for skilled nurses against other states and healthcare
institutions. These shortages are long-standing, but COVID and its relentless
consumption of healthcare resources brought the issue to a crisis point.
This caused financial stress to institutions and personal stress to the professionals
whose dedication to service pushed many beyond their personal limits.
Georgia must redouble our efforts to address these shortages, and Community
Hospitals are working to create new training programs to help. For example,
Tift Regional Health System and Phoebe are partnering with Abraham Baldwin
Agricultural College to create new nursing programs that identify expert
practitioners and train them to become preceptors for nursing students.
Efforts such as these are a great start, but there’s much more to do. Georgia
hospitals today face a nurse shortage of more than 25,000. To fill such a yawning
gap will require a focused partnership from healthcare providers, state government
and educational institutions. We must create incentives that inspire more bright
young people to join this noble profession and encourage those who have left to
Part of creating a welcoming atmosphere is taking a stand for the safety and
dignity of healthcare workers.
That’s why Georgia’s hospitals are leading to stop the violence against healthcare
workers that has spiked during the pandemic. We have worked with legislators
to create the Senate Study Committee on Violence Against Health Care Workers
and made the case for legislation to address the issue. We take seriously our
responsibility to provide a safe workplace for all the professionals who work in our
And just as we must protect our healthcare workers so must we also protect their
workplaces by fighting back efforts to repeal the CON laws that ensured Georgians
maintain access to nearby hospitals.
Together, we must stand strong and let our leaders know the importance to our
communities of our hospitals and the “essential workers” who saved thousands of
lives during the pandemic.
That includes Georgians such as Laconyea Lynn of Albany.
Veazey, of Tifton, is the president and CEO of the Georgia Alliance of Community
RNs & LPNs
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Page 10 • Georgia Nursing January, February, March 2022
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Page 12 • Georgia Nursing January, February, March 2022
Think like an expert witness to avoid falls liability
An 88-year-old patient slips on the floor, falling and
breaking his hip. Your immediate concern is getting
him the help he needs, but you also wonder if you
could be legally liable for what happened. By thinking
like an expert witness, you can help determine if this
concern is valid and whether you could have taken
steps to avoid the situation in the first place. But first,
you need to understand some background information.
From 2007 to 2016, the fall death rate for older
adults in the United States increased by 30%,
according to data from the CDC. Each year, three
million older adults are treated in emergency
departments (EDs) for fall injuries, and more than
800,000 people are hospitalized each year because
of injuries related to a fall. These falls extract a high
price—more than $50 billion for medical costs in a
Nurse professional liability claims involving falls are
identified in the Nurse Professional Liability Exposure
Claim Report: 4th Edition. The report notes that many
of the closed claims analyzed in the report dataset
which involved falls occurred because the nurse failed
to follow fall-prevention policies and procedures.
Further, the report states that falls most frequently
occurred in inpatient hospital, surgical services, and
aging services settings, as well as in patients’ homes.
Given the statistics and the many places falls can
occur, a fall is not an uncommon occurrence in a
nurse’s career. A fall does not automatically mean the
nurse is liable; for that to happen, key elements of
malpractice need to be present.
Elements of malpractice
To be successful in a malpractice lawsuit, plaintiffs
must prove four elements:
1 Duty. A duty existed between the patient and
the nurse: The nurse had a responsibility to care
for the patient.
2 Breach. The duty to care was breached; in other
words, the nurse may have been negligent. To
determine if negligence occurred, the expert
witness would consider whether the nurse met
the standard of care, which refers to what a
reasonable clinician with similar training and
experience would do in a particular situation.
3 Injury. The patient suffered an injury. Even if
a duty existed and it was breached, if no injury
occurred, it’s unlikely the lawsuit would be
successful. Keep in mind, however, that injury can
be defined as not only physical injury, but also
psychological injury or economic loss.
4 Causation. The breach of duty caused the
injury—the injury must be linked to what the
nurse did or failed to do. This can be summed up
in one question: Did the act or omission cause the
Expert witnesses will consider these four elements as
they review the case, and they’ll ask multiple questions
(see Was there liability?). The questions primarily
address prevention and what was done after the fall
The following steps can help prevent falls and,
if documented correctly, prove that the nurse took
reasonable steps to protect the patient from injury:
Take a team approach. Registered nurses, licensed
practical/vocational nurses, and certified nursing
assistants are ideal members for a team dedicated to
creating a falls reduction plan for each patient.
Assess the risk. Whether in the hospital,
rehabilitation facility, clinic, or home, a comprehensive
assessment is essential to identify—and then
mitigate—falls hazards. This starts with assessing the
patient for risk factors such as history of a previous fall;
gait instability and lower-limb weakness; incontinence/
urinary frequency; agitation, confusion, or impaired
judgment; medications; and comorbid conditions such
as postural hypotension and visual impairment. It’s also
important to consider the environment, particularly
in the home setting. For example, throw rugs are a
known falls hazard.
An excellent resource for assessing communitydwelling
adults age 65 and older is the CDC’s STEADI
(Stopping Elderly Accidents, Deaths & Injuries) initiative,
which is an approach to implementing the American
and British Geriatrics Societies’ clinical practice
guideline for fall prevention. The initiative provides
multiple resources for clinicians, such as a fall risk
factors checklist with the categories of falls history;
medical conditions; medications; gait, strength, and
balance (including quick tests for assessing); vision; and
postural hypotension. Keep in mind that assessment
should be ongoing during the patient’s care because
conditions may change.
Develop a plan. Once the assessment is complete,
the patient care team, including the patient and their
family, can develop a falls-reduction plan based on the
patient’s individual risk factors. The plan should address
locations that are at greatest risk, such as bedside,
bathrooms, and hallways, and detail action steps.
Sample action steps include giving patients nonslip
footwear, making sure call lights are within reach,
removing throw rugs from the home, and providing
exercises to improve balance.
Communicate. It’s not enough to create a plan;
communication is essential for optimal execution.
All care team members, including patients and their
families, need to be aware of the patient’s fall risk and
the falls reduction plan.
Communication also includes education. The STEADI
initiative has falls prevention brochures for patients
and family caregivers at www.cdc.gov/steadi/patient.
html. Families often are underutilized as a resource for
helping to prevent falls. They may know the best way
to approach patients who are reluctant to follow fallsreduction
recommendations and can take the lead to
reduce home-related risks. The falls risk reduction plan,
communication with others, and education provided
should all be documented in the patient’s health
Was there liability?
If a patient falls, an expert witness will likely want
to know the answers to the following questions
January, February, March 2022 Georgia Nursing • Page 13
(developed by Patricia Iyers) when deciding if liability
Before the fall:
• Was the patient identified as being at risk for
falls? How was that risk communicated to others?
- What medications did the patient receive? Do
they have side effects that may increase the
risk of a fall?
- Were there specific conditions present that
could increase the risk of a fall?
• Were measures implemented to prevent falls?
- Was the patient capable of using the call light
and was it used to call for assistance?
- Was the bed in the lowest position?
- Were the lights on in the room or under the
bed to help light the area at night?
- Was the patient given antiskid slippers?
Immediately after the fall:
• How soon was the individual found after he
had sustained a fall (it’s not always possible to
establish an exact time)?
• What was done at the time of the fall?
• Was the patient appropriately monitored after the
fall to detect injuries?
• What did the assessment (including vital signs)
• Did the nurse communicate the findings to the
• Were X-rays ordered and performed?
• Was there an injury? If so, how soon was it
• If the patient hit their head, was the chart
reviewed to determine if mediations included
an anticoagulant? If on anticoagulant, was this
information communicated to the provider so
head scans could be performed to check for
Following up after a fall:
• Was there a change in mental status after the
• Were additional assessments and monitoring
done as follow up?
• Was the patient’s risk for falls reassessed after the
fall and the plan of care revised to minimize the
risk of future falls?
If a fall occurs
Despite nurses’ best efforts, a patient may fall. An
expert witness will scrutinize how the nurse responded
to the event. The following steps will help to reduce
the risk of a lawsuit or the chances that a lawsuit is
Assess the patient. Examine the patient for any
obvious physical or mental injuries. For example,
check vital signs; look for bleeding, scrapes, or signs of
broken bones; ask the patient about pain; and check
mental status. Do not move the patient if a spinal injury
is suspected until a full evaluation can be made. Be
particularly alert for possible bleeding if the patient is
taking anticoagulants. When appropriate, ask patients
why they think they fell and continue monitoring at
Communicate assessment results. Notify
the patient’s provider of the fall and results of the
assessment. The provider may order X-rays for further
evaluation. Remember to mention if the patient is
taking anticoagulants, particularly in the case of a
potential head injury, so the appropriate scans can be
Revise the plan. As soon as possible after the fall,
work with the team to reassess risk factors, revisit the
falls reduction plan, and revise the plan as needed.
For example, footwear may need to be changed, the
amount of sedatives the patient is receiving may need
to be reduced, or more lighting may need to be added
to a hallway. It’s important that actions are taken to
prevent future falls.
Document. Each step should be documented in the
patient’s health record, especially all assessment results
and provider notifications. The expert witness can
then see that the nurse followed a logical progression,
with thorough evaluation and follow-up. Never alter
a patient’s health record entry for any reason, or add
anything to a record that could be seen as self-serving,
after a fall or other patient incident. If the entry is
necessary for the patient’s care, be sure to accurately
label the late entry according to your employer’s
policies and procedures.
Unfortunately, patient falls are not completely
avoidable. However, developing a well-conceived
prevention plan can help reduce the risk, and taking
appropriate actions after a fall can help mitigate further
injury. Both prevention and post-fall follow up not only
benefits patients, but also reduces the risk that the
nurse will be on the losing side of a lawsuit.
Article by: Georgia Reiner, MS, CPHRM, Senior Risk
Specialist, Nurses Service Organization (NSO)
Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice. StatPearls.
Centers for Disease Control and Prevention. Important facts about
Centers for Disease Control and Prevention. STEADI: Materials for
healthcare providers. 2020. www.cdc.gov/steadi/materials.html.
CNA, NSO. Nurse Professional Liability Exposure Claim Report: 4th
Edition. 2020. www.nso.com/nurseclaimreport.
Dykes PC, Adelman J, Adkison L, et al. Preventing falls in
hospitalized patients. Am Nurs Today. 2018;13(9):8-13. https://
Iyer P. Legal aspects of documentation. In: KG Ferrell, ed. Nurse’s
Legal Handbook. 6th ed. Wolters Kluwer; 2015.
Van Voast Moncada L, Mire GL. Preventing falls in older persons.
Am Fam Physician. 2017;96(4):240-247. https://www.aafp.org/
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
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 email@example.com or call 1-800-247-1500. www.
Page 14 • Georgia Nursing January, February, March 2022
Virtual Simulation: Impact on Clinical Judgment
Amber Kool, MSN, RN
Reprinted with permission
Arizona Nurse April 2021 issue
The need for newly licensed nurses to safely
manage multiple complex patients requires strong
clinical judgment skills to appropriately prioritize and
delegate (Bittner & Gravlin, 2009). Direct patient care
experiences in acute care settings are the typical way
nursing students learn clinical judgment. However,
these clinical experiences do not always provide an
opportunity to collaborate, critical think, or make
independent decisions that will improve patient
outcomes (Lippincott Nursing Education, 2018). The
most recent data from the American Association of
Colleges of Nursing suggests that 80,407 qualified
applicants were not admitted to baccalaureate and
graduate nursing programs with insufficient clinical
sites a contributing factor (2020). The COVID-19
pandemic has significantly limited direct patient care
clinical experiences for nursing students throughout
the U.S. (Logue et al., 2021). There is an urgent need
to develop teaching-learning practices that will
support the development of clinical judgment as both
an augment and substitution for direct care clinicals
(Thobaity & Alshammari, 2020).
This study investigated the impact of a virtual
simulation (VS) (Sentinel U’s Patient Management
and Delegation and Prioritization of Care) on clinical
judgment in a sample of pre-licensure BSN students.
VS utilizes experiential learning as identified by Kolb’s
Experiential Learning Theory (1984) to expose the
learner to a new experience and requires the student
to reflect, thereby integrating the learning into their
knowledge bank (McLeod, 2017). As learners reflect
on their decisions and reasoning, they integrate their
previous experiences and the new knowledge gained
through the VS.
Using a one-group, repeated measures design,
a paired-samples t-test was used to measure the
change in perceived clinical judgment pre to post-
VS intervention. The Skalsky Clinical Judgment Scale
measures the construct using a four-point Likert
Scale, with ten questions, which include assessing
perceived abilities in prioritization, delegation, and
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There was a statistically significant increase
in perceived clinical judgment scores from preintervention
(VS) (M = 32.17, SD = 4.178) to postintervention
(VS) (M = 34.10, SD = 4.992), t (41) =
2.832, p < .007 (two-tailed). The mean increased in
perceived clinical judgment scores was 1.929 with a
The positive results suggest that VS may be useful
to support teaching-learning practices related to
clinical judgment development. Perceived increases in
clinical judgment may make students more confident
and encourage them to practice skills further. Further
research is needed to objectively measure clinical
reasoning and resultant patient outcomes that result
from the use of VS as a teaching-learning strategy.
Implications for Nursing the Nursing Profession
Recent evidence suggests that only 10% of newly
licensed nurses score within an acceptable competency
range using a performance-based (Kavanagh &
Sharpnack, 2021). The most recent practice analyses
by the National Council of States Boards of Nursing
suggest that newly licensed RNs are increasingly
required to make more complex clinical decisions (2015,
2018). COVID-19 exacerbated existing pre-licensure
nursing education challenges by further limiting already
scarce clinical practicum sites (Dewart et al., 2020). VS
may be a useful addition to direct patient care and
high fidelity human patient simulation to learn clinical
reasoning skills. VS may be helpful as an additional
strategy in addressing the critical nationwide shortage
of clinical practicum sites. Also, VS may bridge the gap
in clinical learning experiences during times when other
opportunities may not exist, such as experienced during
the COVID-19 pandemic and in times of emergencies
and natural disasters.
VS may likewise prove beneficial for skill
development or assessment within clinical agency
orientation and continuing competency efforts. Similar
to its use in the academic environment, VS within
practice and continuing education provides a safe
environment to make decisions without potential harm
to patients (Verkuyl et al., 2019). In conclusion, given
the evolving technology that underpins VS and its
increasing fidelity, the interest in and application of
VS in academic and practice environments will likely
increase. Nurse leaders will be challenged to implement
VS in evidence-based ways and monitor and measure
outcomes to assure its value.
American Association of Colleges of Nursing. (2019). Nursing
shortage. Retrieved from https://www.aacnnursing.org/newsinformation/fact-sheets/nursing-shortage
Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation,
and missed care in nursing practice. JONA: The Journal
of Nursing Administration, 39(3), 142-146. doi:10.1097/
Dewart, G., Corcoran, L., Thirsk, L., & Petrovic, K. (2020). Nursing
education in a pandemic: Academic challenges in response to
COVID-19. Nurse education today, 92, 104471. https://doi.
Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in
Competency: A Defining Moment in Nursing Education”
OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1,
Manuscript 2. DOI: 10.3912/OJIN.Vol26No01Man02
Lippincott Nursing Education. (2018, June 7). Turning new
nurses into critical thinkers. Combining Domain Expertise
With Advanced Technology | Wolters Kluwer. https://www.
Logue, M., Olson, C., Mercado, M., McCormies, C.J., (January
31, 2021) “Innovative Solutions for Clinical Education during
a Global Health Crisis” OJIN: The Online Journal of Issues
in Nursing Vol. 26, No. 1, Manuscript 6. DOI: 10.3912/OJIN.
National Council of States Boards of Nursing. (2015). 2014 RN
Practice Analysis: Linking the NCLEX-RN Examination to Practice
- U.S. and Canada. 62. https://www.ncsbn.org/15_RN_Practice_
National Council of States Boards of Nursing. (2018). 2017 RN
Practice Analysis: Linking the NCLEX-RN Examination to Practice
- US & Canada 72. https://www.ncsbn.org/17_RN_US_Canada_
McLeod, S. (2017, February 5). Kolb’s learning styles and experiential
learning cycle. Retrieved from https://www.simplypsychology.
Sentinel U. (2020, November 30). Nursing prioritization exercises.
Skalsky, K. (n.d.). Skalsky Clinical Judgment Scale validity. American
Thobaity, A., & Alshammari, F. (2020). Nurses on the Frontline
against the COVID-19 Pandemic: An Integrative Review. Dubai
Medical, 1-6. https://doi.org/10.1159/000509361
Verkuyl, M., Hughes, M., Tsui, J., Betts, L., St-Amant, O., & Lapum,
J. L. (2017). Virtual gaming simulation in nursing education: A
focus group study. Journal of Nursing Education, 56(5), 274-
January, February, March 2022 Georgia Nursing • Page 15
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,
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
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 &
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
conduct, and fostering an environment of trust and
mutual respect (Parker, Harrington, Smith, Sellers, and
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 &
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 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.
Combating bullying requires a multidimensional
approach. By establishing a relationship-based ethics
of care perspective, along with visible organizationalbased
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 nurse-related outcomes.
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.
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.
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),
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.
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/
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/
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 nurse-led culture to minimize
horizontal violence in the acute care setting: A multiinterventional
approach. Journal for Nurses in Professional
Development, 32(2), 56-63. https://doi.org/10.1097/
Simola, S. (2003). Ethics of justice and care in corporate crisis
management. Journal of Business Ethics, 46(4), 351-361. https://
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.
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.
The Joint Commission. (2008). Behaviors that undermine a
culture of safety. (Sentinel Event Alert, Issue 40). http://www.
Webster, M. (2016). Challenging workplace bullying: the role of
social work leadership integrity. Ethics & Social Welfare, 10(4),
Page 16 • Georgia Nursing January, February, March 2022
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 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 gender-affirming 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.
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 therapy-induced 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, female, transgender male,
transgender female, and nonbinary. A fill-in-the-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 patient-provider 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 gender-binary 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 gender-affirming care. Education and a
commitment to understanding the lived experiences of
people who are transgender is, therefore, essential for
American Nurses Association. (2015). What is the nursing code of
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.
Deutsch, M.B. (2016). Guidelines for the primary and genderaffirming
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/
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://
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.
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.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual,
and transgender people: Building a foundation for better
Lambda Legal. (2016). Transgender rights toolkit. https://www.
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/
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.
January, February, March 2022 Georgia Nursing • Page 17
Page 18 • Georgia Nursing January, February, March 2022
GNA Personal Benefits
For ANA/GNA Members and GNA-Only Members!
Everyone needs Auto and Home insurance – let
ANA take the hassle out of finding the best provider
and best rate. ANA is partnering with Liberty Mutual
to offer auto and home insurance to members with
a quick and convenient application process and
great rates. Members can potentially save $947 with
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Go to https://www.libertymutual.com/
americannurses to apply now or find out more
information on Auto and Home insurance or call 855-
*Savings validated by new customers who switched
to Liberty Mutual between 1/2020-10/2020 and
participated in a countrywide survey. Savings may
vary. Comparison does not apply in MA. Coverage
provided and underwritten by Liberty Mutual Insurance
Company or its affiliates or subsidiaries, 175 Berkeley
Street, Boston, MA 02116.
Nurses need to protect themselves and their
career by maintaining Professional Liability Insurance,
a.k.a. Medical Malpractice Insurance. Do not assume
your employer’s liability insurance will cover you
when a lawsuit or complaint is filed. Nurses Service
Organization (NSO) has a 45+ year history of
defending nursing professionals from allegations of
medical malpractice and licensing complaints. With
over 500,000 nursing professionals insured and 60+
professional nursing association partners, they are the
premier administrator of nurses’ malpractice insurance
in the U.S.
We encourage you to explore NSO’s website, receive
a quick rate quote, and browse the case studies and
articles in NSO’s Learning Center. In the Learning
Center, you will find NSO’s 4th Nurses Claim Report. It
provides statistical data and an analysis of malpractice
and licensing claims, as well as recommendations on
how you can avoid potential problems in your practice.
Learn more about NSO Professional Liability
Insurance for ANA Members at https://www.nso.
Watch the announcement video at https://
ANA’s collaboration with Prudential provides
exclusive insurance plans for ANA Members. Term
Life Insurance can help protect your loved ones in
the event you pass away – and your coverage stays in
place even if your health or employer changes. AD&D
protects you from an accident that results in death or
dismemberment. Both products offer competitive and
affordable rates for ANA members with quick and
simple access – applying takes about 10 minutes and
you can get coverage in as little as 30 days! Products
may not be available in all states.
Go to https://ana.memberenroll.com/index.php to
apply now or find out more information on Term Life
and AD&D insurance.
Prudential Financial, Inc. (NYSE: PRU), a financial
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In the U.S., Prudential’s iconic Rock symbol has stood
for strength, stability, expertise and innovation for
more than a century. For more information, please visit
Laurel Road specializes in helping nurses, with
special interest rates available to nurses that allow
them to save thousands of dollars. 1 Refinancing might
help you consolidate your loans into one, manageable
amount with one, potentially lower interest rate. ANA
members also receive a special 0.25% rate discount or
$300 cash bonus 1 when using this link https://www.
laurelroad.com/partnerships/ana/ and below.
Laurel Road’s quick and easy online application
allows you to get preliminary rates in minutes –
without impacting your credit and with no obligation
to accept 2 . Laurel Road has no fees to apply. You'll
also have the option to set up automatic payments to
receive an additional 0.25% rate discount. 3
Go to https://www.laurelroad.com/partnerships/ana/
to learn more and check your rates now.
To watch "Student Debt 101 and ANA
Resources" webinar, visit https://www.
All credit products are subject to credit approval.
1) Savings vary based on rate and term of your
existing and refinanced loan(s). Review your loan
documentation for total cost of your refinanced loan
2) Checking your rate with Laurel Road only requires
a soft credit pull, which will not affect your credit
score. To proceed with an application, a hard credit pull
will be required, which may affect your credit score.
Preliminary rates mean a delivery of personalized rates
for those individuals who provide sufficient information
to return a rate.
3) The 0.25% American Nurses Association (ANA)
member interest rate discount is offered for student
loan applications from active ANA members. The rate
discount will end if ANA notifies Laurel Road that
borrower is no longer in good standing. An additional
0.25% interest rate discount is available for making
automatic payments from a bank account by electronic
fund transfer (EFT) ( the AutoPay/EFT Discount). Neither
discount reduces the monthly payment, instead the
discounts are applied to the principal to help pay the
loan down faster. The ANA member interest rate
discount cannot be combined with other offers, except
any discount for making automatic payments.
Laurel Road is a brand of KeyBank National
Association, Member FDIC.
Travel discounts are the #1 requested benefit
program from ANA members. ANA has partnered with
Booking Community to offer members hotel room
rates that are discounted up to 70% -- lower rates
than you will find at any online travel or hotel website.
ANA members get access to amazing deals that are not
available to the public, at over 800,000 participating
Hotels and Resorts Worldwide. Plan a trip and watch
the savings grow – it pays to be an ANA member!
Long Term Care Insurance is increasingly the choice
of ANA Members seeking to protect their hard-earned
assets from the high cost of long-term services along
with the resulting financial spend-down and potential
loss of self-reliance.
Final Expense Insurance, also known as Burial or
Funeral Insurance, is a type of whole life insurance
designed for those over 40 years of age, to cover
funeral expenses and existing bills when you pass.
Through ANA’s partnership with Anchor Health
Administrators (AHA), members receive specialized
advocate services for these much-needed protections.
AHA is a company that, for almost 30 years, has
specialized in working with Nurses/Spouses to provide the
best personal solutions for their planning needs. For more
information on Long Term Care, or Final Expense coverage
and to receive a free, no obligation consultation with a
licensed advocate, visit https://www.anchorltc.com/
January, February, March 2022 Georgia Nursing • Page 19
As a GNA Member, you have …
• The opportunity to serve as a GNA Board and/or Committee
• Access to shared interest and local chapters, and avenues to
connect with leaders in the profession
• Access to free and discounted educational opportunities
• A free subscription to The American Nurse Today - the official
journal of the American Nurses Association (ANA)
• Member-only access to ANA’s Nurse Space
• Free access to The Online Journal of Issues in Nursing (OJIN)
• Access to free and discounted webinars at Navigate Nursing
• The LARGEST discount on initial ANCC certification ($120/full
• The LARGEST discount on ANCC re- certification ($150/full
• Discounts at NursesBook.Org
* Serving as a GNA Board Member is subject to running in and winning the GNA
Board of Directors’ Election for the position of interest.
Become a GNA Member today! GeorgiaNurses.org
Member Lifestyle Benefits
In addition, GNA Members
receive special rates at:
• Mutual of Omaha
• Nurses Service
• Education Loan Finance
• Commerce Bank
• Grand Canyon University
• Snazzy Traveler, and more!
Georgia Nurses Association
Political Action Committee
The Georgia Nurses Association Political Action
Committee (GN-PAC) actively and carefully reviews
candidates for local, state and federal office. This
consideration includes the candidate’s record on
nursing issues and value as an advocate for the nursing
profession. Your contribution to GN-PAC today will
help GNA continue to protect your ability to practice
and earn a living in Georgia. Your contribution will
also support candidates for office who are strong
advocates on behalf of nursing. By contributing $25
or more, you’ll become a supporting member of GN-
PAC. By contributing $100 or more, you’ll become a
full member of GN-PAC! The purpose of the GN-PAC
shall be to promote the improvement of the health
care of the citizens of Georgia by raising funds from
within the nursing community and friends of nursing
and contributing to the support of worthy candidates
for State office who believe, and have demonstrated
their belief, in the legislative objectives of the Georgia
TO DONATE VISIT:
I Want to Get Involved:
Joining and Creating a GNA Chapter
Are you interested in Palliative Care? Nurse
Whatever your nursing passion may be, Georgia
Nurses Association (GNA) can help you connect with
your peers locally and across the state. Becoming
involved in your professional association is the first step
towards creating your personal career satisfaction and
connecting with your peers. Now, GNA has made it
easy for you to become involved according to your own
Through GNA’s new member-driven chapter
structure, you can join multiple chapters and also
create your own chapter based on shared interests
where you can reap the benefits of energizing
experiences, empowering insight and essential
Chapter Chairs to view a list of current GNA Chapters
and Chapters Chair contact information. Connect with
Chapter Chairs to find out when they will hold their
next Chapter meeting!
The steps you should follow to create a NEW GNA
chapter are below. If you have any questions, contact
the membership development committee or GNA
headquarters; specific contact information and more
details may be found at www.georgianurses.org.
1. Obtain a copy of GNA bylaws, policies and
procedures from www.georgianurses.org.
2. Gather together a minimum of 10 GNA
members who share similar interests.
3. Select a chapter chair.
4. Chapter chair forms a roster to verify roster
as current GNA members. This is done by
contacting headquarters at (404) 325-5536.
5. Identify and agree upon chapter purpose.
6. Decide on chapter name.
7. Submit information for application to become a
chapter to GNA Headquarters. Information to be
submitted includes the following:
Chapter chair name and chapter contact
information including an email,
Chapter name, Chapter purpose, and Chapter
8. The application will then go to the Membership
Development Committee who will forward it to
the Board of Directors. The Board will approve or
decline the application and notify the applicant
of its decision.
To become a member of GNA please review and
submit our membership application located on the
homepage of our website at www.georgianurses.org