Georgia Nursing January 2022

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“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.


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.

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.


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

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


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

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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Page 8 • Georgia Nursing January, February, March 2022

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/


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

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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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.

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


January, February, March 2022 Georgia Nursing • Page 13

(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.


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

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


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,

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


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

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


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

customized auto and home insurance.*

Go to https://www.libertymutual.com/

americannurses to apply now or find out more

information on Auto and Home insurance or call 855-

948-6267.

*Savings validated by new customers who switched

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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.

com/ana-csna-nurse-malpractice?refid=iiNW0T4i

Watch the announcement video at https://

vimeo.com/477619765/c825b287b3

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.

1044212-00001-00

Prudential Financial, Inc. (NYSE: PRU), a financial

services leader, has operations in the United States,

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and talented employees are committed to helping

individual and institutional customers grow and protect

their wealth through a variety of products and services.

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

news.prudential.com.

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.

nursingworld.org/membership/memberbenefits/personal-benefits/student-debt-videoregistration/

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/

http://careers.kindredathome.com


January, February, March 2022 Georgia Nursing • Page 19

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

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