Georgia Nursing January 2022

“Nurses shaping 

the future of 

professional nursing 

for a healthier Georgia.” 

Since 1907 

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 Nursing 

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 

internationally. 

“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 

2022.” 

The Georgia Nursing Hall of Fame inaugural 

inductees are: 

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:// 

www.eventbrite.com/e/georgia-nursing-hall-of- 

fametm-inaugural-inductees-ceremony-tickets- 

158739093903?aff=ebdssbdestsearch 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

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 

Index 

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 

GEORGIA 

NURSING 

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 

immunity. 

5 Wash your hands or use hand sanitizer 

frequently. 

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 

concerns. 

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. 

With gratitude, 

Erica Mills, PhD, RN, NPD-BC 

President-Elect, Georgia Nurses Association 

Board of Directors 2021-2023 

News from the 

Foundation 

The Georgia Nurses Foundation (GNF) awarded a 

Kathryn Chance Suggs Leonard Scholarship of $2,000 

this year to Morgan Clark-Youngblood. 

Congratulations Morgan! 

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 

GeorgiaNurses.org. 

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 

Vacant, Secretary 

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 

Delegate-At-Large 

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 

GNF President 

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. 

GNA/GNF 

3032 Briarcliff Road, Atlanta, GA 30329 

www.georgianurses.org, gna@georgianurses.org 

(404) 325-5536 

FOLLOW GNA 

GNF President Wanda Jones and Morgan 

@georgianurses 

facebook.com/ganurses 

@GeorgiaNurses 

Georgia Nurses Association

Calllliing 

A 

No Otheer. 

Liikee 

January, February, March 2022 Georgia Nursing • Page 3 

CEO CORNER 

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 

association. 

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 

amazing success. 

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 

permits. 

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. 

New Beginnings 

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.


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. 

wgriggs@healthyfuturega.org 

More information and evidence: https:// 

healthyfuturega.org/2021/09/29/a-new-survey-onhealth-care-affordability-finds-georgians-are-comingup-short/ 

Advocacy Update 

AMAZING 

REMARKABLE 

AWESOME 

American Renal Associates 

Our Staff Make the Difference! 

Opportunities for dialysis nurses in 

Augusta and Macon areas. 

Email resume to Brittany Winter 

at bwinter@americanrenal.com 

Tim Davis 

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. 

com/watch?v=InTG499rTOo 

Comments from Dr. Little begin at the 3hr and 10min mark.


Should nurse injectors 

carry liability insurance 

coverage and if yes 

what is best way to 

locate a reputable 

company? 

Hi HT, 

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 

internet search. 

Best Wishes, 

Hahnah


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 

well-being. 

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. 

References: 

American Nurses Association, Nursing: Scope and Standards of Practice, 4th ed., Silver Springs, MD, 

American Nurses Association, 2021. 

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2021 Honor A Nurse 

Honoree 

Marilyn Williams 

Mitchell 

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 

Wanda Jones, BSN, RN, MSN, FNP-BC 

GNF President 

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 

www.bentonhouse.com/careers/


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 

immediate action. 

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 

healthcare crisis. 

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 

consider returning. 

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 

hospitals. 

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 

Hospitals. 

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georgianursesassociation


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. 

Falls facts 

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 

single year. 

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 

negative outcome? 

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 

occurred. 

Prevention 

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 

record. 

Was there liability? 

If a patient falls, an expert witness will likely want 

to know the answers to the following questions


(developed by Patricia Iyers) when deciding if liability 

may exist: 

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) 

reveal? 

• Did the nurse communicate the findings to the 

patient’s provider? 

• Were X-rays ordered and performed? 

• Was there an injury? If so, how soon was it 

treated? 

• 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 

cranial bleeding? 

Following up after a fall: 

• Was there a change in mental status after the 

fall? 

• 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 

successful: 

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 

regular intervals. 

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 

ordered. 

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. 

Reducing risk 

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) 

RESOURCES 

Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice. StatPearls. 

2020. www.ncbi.nlm.nih.gov/books/NBK470573. 

Centers for Disease Control and Prevention. Important facts about 

falls. www.cdc.gov/homeandrecreationalsafety/falls/adultfalls. 

html. 

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:// 

www.myamericannurse.com/preventing-falls-hospitalizedpatients. 

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/ 

afp/2017/0815/p240.html. 

Disclaimer: The information offered within this article reflects 

general principles only and does not constitute legal advice by 

Nurses Service Organization (NSO) or establish appropriate or 

acceptable standards of professional conduct. Readers should 

consult with an attorney if they have specific concerns. Neither 

Affinity Insurance Services, Inc. nor NSO assumes any liability for 

how this information is applied in practice or for the accuracy of this 

information. 

This risk management information was provided by Nurses 

Service Organization (NSO), the nation's largest provider of nurses’ 

professional liability insurance coverage for over 550,000 nurses 

since 1976. The individual professional liability insurance policy 

administered through NSO is underwritten by American Casualty 

Company of Reading, Pennsylvania, a CNA company. Reproduction 

without permission of the publisher is prohibited. For questions, 

send an e-mail to service@nso.com or call 1-800-247-1500. www. 

nso.com.


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 

NOW HIRING 

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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. 

Design 

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 

communication. 

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Major Findings 

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 

95%. 

Discussion 

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. 

References 

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/ 

nna.0b013e31819894b7 

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. 

org/10.1016/j.nedt.2020.104471 

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. 

wolterskluwer.com/en/expert-insights/turning-new-nurses-into 

critical-thinkers 

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. 

Vol26No01Man06 

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_ 

Analysis_Vol62_web.pdf 

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_ 

Practice_Analysis.pdf 

McLeod, S. (2017, February 5). Kolb’s learning styles and experiential 

learning cycle. Retrieved from https://www.simplypsychology. 

org/learning-kolb.html 

Sentinel U. (2020, November 30). Nursing prioritization exercises. 

https://www.sentinelu.com/solutions/prioritization-anddelegation/ 

Skalsky, K. (n.d.). Skalsky Clinical Judgment Scale validity. American 

Sentinel University 

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- 

280. doi:10.3928/01484834-20170421-04


An Ethic of Justice Viewed through the Lens of an Ethic of Care: How 

Nurse Leaders May Combat Workplace Bullying 

Gloria Matthews, DNP, RN, CNL, CDE 

University of Oklahoma Medical Center 

Valerie Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A 

University of Oklahoma Health Sciences Center 

Fran & Earl Ziegler College of Nursing, 

Lawton Campus 

Reprinted with permission from 

Oklahoma Nurse May 2021 issue 

The purpose of this paper is to present integration of 

two ethical approaches to combat workplace bullying 

within a clinical setting from an advance nursing 

practice leadership perspective. A description of ethic 

of care and ethic of justice is presented and critically 

appraised as it relates to managing workplace bullying. 

The importance of the application of the ethic of justice 

through the lens of the ethic of care will be elucidated. 

Description and Application to Workplace 

Bullying 

A failure of nursing leadership to address workplace 

bullying demonstrates a lack of compassion and 

organizational injustice. Bullying is the repeated and 

persistent, abusive mistreatment by one or more 

perpetrators towards one or more victims that is 

marked by threatening, humiliating or intimidating 

conduct, work interference, or verbal abuse (Fink- 

Samnick, 2018). Bullying is a systemic problem 

and reflects behavior patterns and surreptitious 

characteristics of a culture of violence that contributes 

to various expressions and manifestations of violence 

within an organization (Smit & Scherman, 2016). The 

Joint Commission (2008) notes that intimidating and 

disruptive behaviors contribute to medical errors, poor 

patient and staff satisfaction, staff turnover and poor 

collaborative work environments. 

Ethic of Care 

The ethic of care is a moral approach characterized 

by contextual, holistic empathy and is based on 

caring, strengthening and maintaining interpersonal 

relationships. It emphasizes the importance of insight 

gained from being open and receptive to the realities 

and needs of others (Simola, 2003). The ethic of care 

aligns with the authentic, servant and transformational 

leaders who put followers’ interests above their own 

and influence followers through building relationships, 

developing a collective vision, and attending to 

the needs and growth of their followers (Groves & 

LaRocca, 2011). 

Most occurrences of bullying are learned behaviors 

directed by reactions to stress and organizational 

norms and, therefore, can be unlearned (Berry et al, 

2016). Leaders guided by an ethic of care model take 

decisive action when confronted with behaviors that 

do not adhere to expected conduct. In combating 

workplace bullying, effective leaders are proficient 

in communication and competent in coaching, 

staff development, maintaining high standards of 

conduct, and fostering an environment of trust and 

mutual respect (Parker, Harrington, Smith, Sellers, and 

Millenbach, 2016). 

Bullying is an attempt to intimidate and gain 

power over someone else. Structural empowerment 

is an effective technique to mitigate the effects and 

incidents of bullying (Lachman, 2014). Effective nurse 

empowerment can be obtained through shared 

governance to minimize power imbalances and 

enhance shared responsibility and transparency in 

decision making (Berry et al, 2016; Parker et al, 2016). 

Skill development is an important weapon in the 

battle against bullying. Strategies such as cognitive 

rehearsal, skills-based training, and role-playing 

have been successful in raising staff awareness and 

combating bullying (Balevre, Balevre, & Chesire, 2018; 

Parker et al., 2016). 

Normative leadership models such as 

transformational, servant and authentic leadership 

constructively address the bullying by modeling an 

ethic of care perspective and seeking to facilitate 

followers’ self-actualization. The assumption is that 

ethical leadership styles promote social cohesion, 

professionalism, and empowerment (Webster, 2016). 

Ethic of Justice 

The ethic of justice is a moral approach that is 

characterized by justice, fairness, reciprocity and the 

protection of individual rights. Individuals demonstrate 

impartiality and the ability to reason abstractly through 

the application of formal, logical and impartial rules 

(Simola, 2003). The ethic of justice aligns with the 

transactional leader who influences followers by 

control, reward and corrective transactions (Groves & 

LaRocca, 2011). 

Structural empowerment is gained through 

establishment of an ethical infrastructure that 

reinforces ethical principles and behavioral expectations 

of members of the organization (Einarsen, Mykletun, 

Einarsen, Skogstad, & Salin, 2017). Aligned with the 

ethic of justice, organizations establish standardized 

policies, procedures and documents such as codes of 

ethics, procedures for handling complaints and zero 

tolerance policies (Einarsen et al., 2017). 

Hutchinson (2009) posits that rather than focusing 

on the individual, leaders should direct corrective 

measures towards the act of bullying itself and gain 

insight into work group and organizational factors that 

enable the behavior. The focus is on reintegration and 

restoration of social relationships within the context of 

a supportive group, such as a restorative circle, where 

the attention is placed on repairing harm rather than 

blame and punishment. 

Reflection on Integration of Ethical Approaches 

It is important for leaders to integrate the two 

ethical perspectives by distributing justice within a 

caring framework (Sorbello, 2008). Organizations and 

leaders must clarify and communicate that bullying is 

unacceptable. If corrective actions fail, termination is an 

acceptable consequence to continued behavior (Lee et 

al., 2014). At times, leaders must implement corrective 

actions and uphold values and policies set forth by the 

organization, but it is in the delivery and intent that 

determines a caring leader. 

Conclusion 

Combating bullying requires a multidimensional 

approach. By establishing a relationship-based ethics 

of care perspective, along with visible 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. 

References 

Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018). Nursing 

professional development anti-bullying project. Journal for 

Nurses in Professional Development, 34(5), 277-282. https://doi. 

org/10.1097/NND.0000000000000470 

Berry, P. A., Gillespie, G. L., Fisher, B. S., & Gormley, D. K. (2016). 

Recognizing, confronting, and eliminating workplace bullying. 

Workplace Health & Safety, 64(7), 337-341. https://doi. 

org/10.18291/njwls.v7i1.81398 

Einarsen, K., Mykletun, R. J., Einarsen, S. V., Skogstad, A., & Salin, 

D. (2017). Ethical infrastructure and successful handling of 

workplace bullying. Nordic Journal of Working Life Studies, 7(1), 

37–54. https://doi.org/10.18291/njwls.v7i1.81398 

Fink-Samnick, E. (2018). The new age of bullying and violence 

in health care: part 4: managing organizational cultures and 

beyond. Professional Case Management, 23(6), 294–306. 

https://doi.org/10.1097/NCM.0000000000000324 

Groves, K., & LaRocca, M. (2011). An empirical study of leader 

ethical values, transformational and transactional leadership, and 

follower attitudes toward corporate social responsibility. Journal 

of Business Ethics, 103(4), 511–528. https://doi.org/10.1007/ 

s10551-011-0877-y 

Hutchinson, M. (2009). Restorative approaches to workplace 

bullying: Educating nurses towards shared responsibility. 

Contemporary Nurse, 32(1–2), 147–155. https://doi.org/10.5172/ 

conu.32.1-2.147 

Lachman, V. D. (2014). Ethical issues in the disruptive behaviors 

of incivility, bullying, and horizontal/lateral violence. Medsurg 

Nursing, 23(1), 56-60. 

Parker, K. M., Harrington, A., Smith, C. M., Sellers, K. F., & 

Millenbach, L. (2016). Creating a 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/ 

NND.0000000000000224 

Simola, S. (2003). Ethics of justice and care in corporate crisis 

management. Journal of Business Ethics, 46(4), 351-361. https:// 

doi.org/10.1023/A:1025607928196 

Smit, B., & Scherman, V. (2016). A case for relational leadership 

and an ethics of care for counteracting bullying at schools. 

South African Journal of Education, 36(4), 1-9. http://www. 

sajournalofeducation.co.za/index.php/saje/article/view/1312/668 

Sorbello, B. (2008). The nurse administrator as caring person: A 

synoptic analysis applying caring philosophy, Ray’s ethical theory 

of existential authenticity, the ethic of justice, and the ethic of 

care. International Journal of Human Caring, 12(1), 44-49. 

10.20467/1091-5710.12.1.44 

The Joint Commission. (2008). Behaviors that undermine a 

culture of safety. (Sentinel Event Alert, Issue 40). http://www. 

jointcommission.org/assets/1 /18/SEA_40.pdf 

Webster, M. (2016). Challenging workplace bullying: the role of 

social work leadership integrity. Ethics & Social Welfare, 10(4), 

316–332. https://doi.org/10.1080/17496535.2016.1155633


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 

all nurses. 

References 

American Nurses Association. (2015). What is the nursing code of 

ethics? https://nurse.org/education/nursing-code-of-ethics/ 

Department of Health and Human Services, Office of Disease 

Prevention and Health Promotion. (n.d.). Healthy people. 

Lesbian, gay, bisexual, and transgender health. https://www. 

healthypeople.gov/2020/topics-objectives/topic/lesbian-gaybisexual-and-transgender-health 

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/ 

transcare.ucsf.edu/files/Transgender-PGACG-6-17-16.pdf 

Deutsch, M.B, Bowers, M.L., Radix, A., & Carmel, T.C. (2019). 

Transgender medical care in the United States: A historical 

perspective. In J.S. Schneider, V.M.B. Silenzio, & Erikson-Schroth, 

L. (Eds.). The GLMA Handbook on LGBT Health (1, 83-131). Santa 

Barbara, CA: Praeger. 

Fenway Institute, National LGBT Health Education Center. (2016). 

Providing inclusive services and care for LGBT people. https:// 

www.lgbtqiahealtheducation.org/publication/learning-guide/ 

Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How 

many adults identify as transgender in the United States? UCLA 

School of Law, William Institute. https://williamsinstitute.law. 

ucla.edu/publications/trans-adults-united-states/ 

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & 

Keisling, M. (2011). Injustice at every turn: A report of the 

National Transgender Discrimination Survey. https://www. 

transequality.org/sites/default/files/docs/resources/NTDS_Report. 

pdf 

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, 

and transgender people: Building a foundation for better 

understanding. http://www.nationalacademies.org/hmd/ 

Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and- 

Lambda Legal. (2016). Transgender rights toolkit. https://www. 

lambdalegal.org/issues/transgender-rights 

McDowell, A. & Bower, K. (2016). Transgender health care for 

nurses: An innovative approach to diversifying nursing curricula 

to address health inequalities. Journal of Nursing Education, 

55(8), 476-479. DOI 10.3928/01484834-20160715-11 

Safer, J. D., Coleman, E., Feldman, J., Garofal, R., Hembree, W., 

Radix, A., & Sevelius, S. (2017). Barriers to health care for 

transgender individuals. Current Opinion in Endocrinology, 

Diabetes, and Obesity, 23(2), 168-171. DOI: 10.1097/ 

MED.0000000000000227 

Singh, S., & Durso, L. E. (2017). Widespread discrimination continues 

to shape LGBT people's lives in both subtle and significant ways. 

Center for American Progress. https://www.americanprogress. 

org/issues/lgbt/news/2017/05/02/429529/widespreaddiscrimination-continues-shape-lgbt-peoples-lives-subtlesignificant-ways/

January, February, March 2022 Georgia Nursing • Page 17


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Preliminary rates mean a delivery of personalized rates 

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AHA is a company that, for almost 30 years, has 

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MEMBERSHIP 

As a GNA Member, you have … 

• The opportunity to serve as a GNA Board and/or Committee 

Member* 

• 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 

Webinars 

• The LARGEST discount on initial ANCC certification ($120/full 

members only) 

• The LARGEST discount on ANCC re- certification ($150/full 

members only) 

• 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 

Insurance 

• Nurses Service 

Organization 

• Matchwell 

• Education Loan Finance 

• Commerce Bank 

• Grand Canyon University 

• Snazzy Traveler, and more! 

Georgia Nurses Association 

Political Action Committee 

(GN-PAC) 

About GN-PAC: 

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 

Nurses Association. 

TO DONATE VISIT: 

https://georgianurses.nursingnetwork. 

com/page/75371-gn-pac 

I Want to Get Involved: 

Joining and Creating a GNA Chapter 

Are you interested in Palliative Care? Nurse 

Navigation? Informatics? 

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 

preferences. 

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 

resources. 

Visit http://www.georgianurses.org/?page= 

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 

roster. 

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

Georgia Nursing January 2022

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