West Virginia Nurse - January 2022



Nurses working together

for a healthy West Virginia

The official publication of the West Virginia Nurses Association

Quarterly publication distributed to approximately 19,600 RNs & LPNs in West Virginia.

January, February, March 2022 Volume 23 • No. 1



President’s Message. ............. 1

Call for Nominations. ............. 2

2022 West Virginia Nurse Deadlines.... 2

Executive Director’s Message. ...... 3

Innovative Thinking: Where

necessity requires new

methods of teaching. ........ 4-5

Open Letter about COVID-19 ...... 6

Recap of 2021 Legislative Session. .. 7

Legislation to Create a Palliative

Care Benefit in WV Medicaid

is Anticipated in 2022. ......... 7

National Maternal Health and

Midwifery Legislative Update. . . 8-9

National NP Legislative Updates. .... 9

Real Talk About Burnout. .......... 9

Your Membership Dollars at Work. . 10

Nurse Honor Guard

Honors Colleagues. ........... 11

Editor’s Corner. ................ 11

Celebrating Nurse Authors:

Book review of Healing Hoppy

by Cathy Carson. ............. 12

Membership Update. ........... 13

Conferences & Meetings ......... 13

Compassion Fatigue in Health Care . 14

COVID-19 and Mental Health:

Self-care for nursing staff. ...... 15

current resident or

Presort Standard

US Postage


Permit #14

Princeton, MN


The West Virginia Nurses

Association is committed to

supporting nurses working in

WV so that all West Virginians can

have access to good health care.

I’m writing this message at

the end of November. The WV

legislative session begins on

January 12 and ends March 12,

2022. And we are beginning to

plan for our Day at the Capitol

and our Policy Summit. This is Joyce Wilson

the busiest time of year for the


Since the end of the 2021 legislative session, the Health

Policy and Legislative (HP&L) Committee members have

been updating the HP&L Position Statement. The updated

statement has been approved and is available on the WVNA

website: WVNA Legislative Policy Updates. The 2022 WVNA

Legislative Agenda has also been approved. It is as follows:

• Promotion and passage of a Safe Staffing and

Transparency bill

• APRN Full Practice Authority, to include Schedule II

medications and Schedule III medications with one refill


Codifying the existing Executive Orders for Schedule

II and III medications (which APRNs have been safely

prescribing since 2020)

• CRNA Full Practice Authority*

• Removal of Certificate of Need (CON)

• Requirement for a Nationally Certified School Nurse

(NCSN) in every school

The WVNA Legislative Agenda always complies with, and

is complementary to, the WVNA HP&L Position Statement.

*For some clarification: nurse anesthetists (CRNAs) are

APRNs but are subject to physician supervision in WV,

unlike the other APRN groups — nurse practitioners, nursemidwives,

and clinical nurse specialists — meaning that

CRNAs lack Full Practice Authority (FPA). APRNs in WV have

had FPA since 2016, with some limitations such as inability to

prescribe Schedule II and III medications.

WVNA membership is growing, and members are more

involved with association work than ever before. Being a

Legislative Leader (LL) is a great avenue for members

to be active in their own districts.

The role of the LL is to keep in touch with the

state legislators from their own district by emailing,

phone calls, or meeting in person. (Following them

on social media is helpful, too.) As the LL knows the

legislators better than anyone, WVNA listens to LLs

when deciding which legislators to recommend to

the WVN-PAC for endorsement in the elections. LLs

are encouraged to come to the Capitol during session

if possible, but it is not required.

Another responsibility of LLs is to engage other

nurses in your district. Keep them informed of our

HP&L Statement and legislative agenda so that they better

understand nurse issues in the Mountain State. Ask them to

contact their legislators and help them stay “on message.”

Most importantly, encourage them to join the WVNA. We

need all nurses at the discussion table.

The LL districts correspond exactly to the WV state

senatorial districts; the assigned legislators include the

senators and the delegates that are within each district.

The legislative map has been redrawn with the census

report and the redistricting. If you are already an LL, your

district legislators have most likely changed. Here is a link

to information about the redistricting that has taken place:

WV Legislature Redistricting 2021.

There is no limit on the number of LLs allowed in each

district; the more nurses involved, the stronger our influence

at the Capitol. Crystal Chapman is the chairperson of the

Legislative Leaders. You’ll find her contact info on page 2

of every issue of West Virginia Nurse. You’ll find Crystal to be

informative and approachable.

On October 21, the Association held a successful virtual

Membership Assembly/ Conference and Board Meeting.

Once again, we worked with Ngage Management for

logistical support. They have really helped us thrive in the

virtual platform world.

The results of the elections for VP and Secretary were

announced at the WVNA Board Meeting. Vice President Lori

Chaffins was re-elected. The new Secretary is Sara Vincelli.

Sara took office at the December 14, 2021, board meeting.

I had the pleasure of traveling to Canaan Valley Resort

on a beautiful fall day to speak to the West Virginia

Association of School Nurses (WVASN) about the WVNA.

School nurses play a crucial role in providing access to care

to WV schoolchildren. They see first-hand the impact that

the opioid crisis has had on the physical and behavioral

health of our kids. And, like every other nursing realm, they

are severely short-staffed. The nurses that are serving the

schoolchildren of WV are making sacrifices to make sure that

the kids have what they need. School nurses, on behalf of

WVNA and all WV nurses, thanks to all of you for all you do.

West Virginia Nurses Association has been forming

workgroups and coalitions with other nursing organizations,

including WV Center for Nursing (WVCFN), West Virginia

Organization of Nursing Leaders (WVONL), WV RN Board

of Nursing (BON), Chief Nursing Officers (CNOs) from

CAMC and Thomas Hospitals in Charleston, and the West

Virginia Hospital Association (WVHA). Our focus is on a work

environment that is safe and has the best outcomes for

nurses working in WV and for patients and their families.

Surveys are being conducted to collected data to

help us better understand what nurses need right now

and what is happening to make them leave the state

to practice or to leave the profession altogether. Please

participate in the surveys if you have the opportunity.

Contact us if you do not receive an email to participate in

the surveys and would like to.

President’s Message continued on page 2

Page 2 West Virginia Nurse January, February, March 2022

Call for Nominations

Julie Huron, BSH, LNHA / Executive Director

The West Virginia Nurses Association will be electing

new officers to its board of directors in the early fall of

2022. The positions that will be open are President-Elect,

Treasurer, Early Career Nurse, Voting Delegate to the ANA

Membership Assembly, and two committee positions on

the WVNA Nominations and Awards Committee.

Those interested in running for these positions should

submit a letter of intent, a current CV, a biography or

biosketch, and a photo. Applicants must be a nurse

licensed in West Virginia and a full member in good

standing of both WVNA and ANA. Information is due to

WVNA by May 1, 2022, and nominee information will be

published in the West Virginia Nurse July 2022 issue.

Positions open and functions of the officers


The President-Elect shall assume all the duties of

the President in the President’s absence and shall serve

as a board liaison for committee chairs, and shall be a

member of both the Health Policy & Legislation (HP&L)

Committee and the West Virginia Nurses Political Action

Committee (WVN-PAC).


The Treasurer shall be the chair of the Finance

Committee, shall be accountable for the fiscal affairs of

WVNA and provide reports and interpretation of WVNA’s

financial condition, and shall present at the annual

meeting of the Membership Assembly, as well as at the

quarterly Board of Directors meetings.

President’s Message, continued from page 1

Please contact us if you have a story of when you felt

unsafe at work, either physically, professionally, or any

other way. Share the positives as well. Let us know if you

were involved in a situation that was handled in a way that

changed things for the better, and you felt that your voice

was heard.

As I’m writing this, families are getting together for their

first in-person Thanksgiving holiday in a year and a half. But

there is a new COVID variant looming on the horizon and

there are concerns that because of the gatherings there will

be another surge in cases, hospitalizations, and deaths.

By the time you read this the holidays will be a memory,

and hopefully the worries of a new surge of COVID will be


When we look at the history of this great country, we see

times of great suffering and struggles. We also see great

Available positions:

We currently have full time, part time and

per diem nursing positions available.

$15k bonus with 3 year commitment

We offer competitive pay and benefits

including medical, dental, vision, PTO, 401k,

tuition reimbursement and more!

Contact Human Resources at

(330) 386-2022 or apply online at


Early Career Nurse:

The membership shall elect an Early Career Nurse,

who has earned initial licensure as a registered nurse no

longer than four years prior to their election, to serve a

term of two years as a voting director member of the


ANA Voting Delegate:

The Voting Delegate to the ANA Membership

Assembly shall represent WVNA at the ANA

Membership Assembly meeting for two years and

report back to the association.

Nominations and Awards Committee:

Two committee members shall be elected to

implement and oversee that the policies and

procedures set forth by the WVNA Board of Directors

and adopted by the Membership Assembly for

conducting valid elections are followed, and to

implement the policies and procedures set forth by the

WVNA Board of Directors for bestowing awards.

Additional information can be found at

www.wvnurses.org. Please send your letter of

intent, current CV, a biography, and a photo to

centraloffice@wvnurses.org. Please use Microsoft

Word attached to your email for application

submission, and send your photo as a JPG file

attached to your email. Let us know if you have

questions about these requirements. We are looking

for great nurses who want to help West Virginia

nurses and the cause of nurses in general!

resilience and perseverance. The level of resilience and

perseverance in our great state of WV has always been a high

mark. Together we will come through this, and history will

write the story of how we, the nurses of WV, worked the long

hours and saw it through for our people, and how we banded

together to find ways to make working conditions better and

safer for ourselves and for future WV nurses.

Warmest New Year greetings to you, my nursing


Joyce Wilson, RN

2022 West Virginia

Nurse Deadlines

WV Nurse is a quarterly newspaper available

in both print (for WVNA members) and electronic

form (for all who sign up for it). The due dates

for the rest of 2022 are:

• April 2022 issue: material due to WV Nurse by

February 22, 2022

• July 2022 issue: material due to WV Nurse by

May 23, 2022

• October 2022 issue: material due to WV Nurse

by August 22, 2022

West Virginia Nurse exists to tell your story.

For submission information, see p. 2.






West Virginia Nurse

Official Publication of the

West Virginia Nurses Association

P.O. Box 1946 | Charleston, WV 25327

Phone: 866.986.8773 or 866.WVNURSE

Email: centraloffice@wvnurses.org

Webpage: www.wvnurses.org

Published quarterly every January, April, July, and October for the West

Virginia Nurses Association, a constituent member of the American

Nurses Association.

The opinions contained herein are those of the individual authors and do

not necessarily reflect the views of the Association.

WV Nurse reserves the right to edit all materials to its style and space

requirements and to clarify presentations.

WVNA Mission Statement

The mission of the WVNA is to support WV nurses and to work for a

healthier West Virginia.

WVNA Executive Board

President: Joyce Wilson joycewilsonfnp@gmail.com

President-Elect: Teresa Hovatter contessiaenterprises@gmail.com

Vice President: Lori McComas Chaffins messenger2772@gmail.com

Treasurer: Roger Carpenter rcarpenter@hsc.wvu.edu

Secretary: Sara Vincelli sara.vincelli@hsc.wvu.edu

Immediate Past President: Toni DiChiacchio dichiacchio@yahoo.com

Legislative Leader Representative:

Crystal Chapman chapmanclynn@yahoo.com

Early Career Nurse: Luke Velickoff lukevelickoff@gmail.com

Committee Chairs

APRN Congress Chair: Jodi Biller jodibiller@gmail.com

Health Policy & Legislative Chair:

Toni DiChiacchio dichiacchio@yahoo.com

PAC Chair: Open position

Immediate Past PAC Chair: Joyce Wilson joycewilsonfnp@gmail.com

Membership Chair: Anitra Ellis amellis33@icloud.com

Nominations and Awards Chair:

Toni DiChiacchio dichiacchio@yahoo.com

Nursing Workforce Initiative: Open position

ANA Membership Assembly Delegate:

Moira Tannenbaum moiratan@hotmail.com

Ad Hoc DEI Committee Chair:

Sara Vincelli sara.vincelli@hsc.wvu.edu

WVNA Staff

Julie Absher Huron, Executive Director, centraloffice@wvnurses.org

WV Nurse Staff

Moira Tannenbaum, Editor, moiratan@hotmail.com

West Virginia Nurse Copy Submission Guidelines

All WVNA members are encouraged to submit material for

publication that is of interest to nurses. The material will be reviewed

and may be edited for publication. There is no payment for articles

published in the West Virginia Nurse.

Article submission is accepted in Microsoft Word or similar format.

Copy submission via email: Please attach a Microsoft Word (or similar) file

to email. We ask that you not paste the text of the article into email. Please do

not embed photos in Word files; please send photos as separate JPEG files.

Please do not convert the file to a PDF. When sending pictures, please

provide a description identifying the people in the pictures and note who

the photographer was, if relevant.

Approximately 1,600 words equal a full page in the paper. This does

not account for headlines, photos, special graphics, pull quotes, etc.

Submit material to:

West Virginia Nurse

PO Box 1946, Charleston, WV 25327

Email: centraloffice@wvnurses.org

For advertising rates and information, please contact Arthur L. Davis Publishing

Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.

com. WVNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to

reject any advertisement. Responsibility for errors in advertising is limited to

correction in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the

West Virginia Nurses Association 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. WVNA 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 WVNA or those of the

national or local associations.

January, February, March 2022 West Virginia Nurse Page 3

Executive Director’s Message

Julie A. Huron

WVNA Executive Director

Happy New Year, West

Virginia Nurses!

I am someone who loves

all seasons of the year; even

the cold and dreary weather

serves a purpose for me.

I have seen graphics that

winter is a natural season of

hibernation – a reminder to

slow down, rest, and take

care of ourselves. Possibly, I

welcome the season changes Julie A. Huron

because I believe there are

always great things about to come or that there is

hope in the next season. Whatever it is, seasonal

change works for me.

WVNA just experienced our first virtual fall

conference, “Rise Through COVID,” that included

our WVNA Membership Assembly. This was a new

event for WVNA, and it was an attempt to have more

members and nurses attend. The fall conference was

held on Thursday, October 21, 2021, and the event

was held on a virtual platform (our new normal). We

had approximately 90 attendees (some groups were

together on one line). We realize that nurses continue

to need tools, resources, and support, and our goal

for the event was to cast a lifeline to help nurses rise

through the fall surge of COVID-19.

The conference content included mental health

first aid, with a personal story from a nurse who

experienced the loss of a family member who

completed suicide. Our guests were courageous in

sharing their personal stories and exposing their

vulnerability to us all. It was a powerful and humbling

presentation. We also had a panel discussion on

workforce that included WVNA Immediate Past-

President Toni DiChiacchio as moderator, WVONL

president-elect Lya Stroupe, WVHA president/CEO

Jim Kauffman, and WV Center for Nursing executive

director Jordyn Reed.

WVNA has worked throughout 2021 to bring all

nursing and health care organizations together so that

we can share stories and work on solutions together.

The fall conference included sessions on work-life

balance; a session on diversity, equity, and inclusion; a

session for students; and poster presentations.

The Membership Assembly portion of the

fall conference included the election results and

announcement of WVNA new officers. We ratified the

2022 Health Policy & Legislative Statement, approved the

2022 WVNA budget, and discussed updates to the WVNA

policy and procedure policy and procedure manual.

The WVNA fourth quarter work during October,

November, and December included our fall

conference event and planning for our February

Nurses Day at the West Virginia Capitol (February

10, 2022). This will be an event for WVNA Legislative

Leaders and the WVNA HP&L Committee, planning

for our spring Virtual Policy Summit (this will be in

late March), and attending numerous meetings with

stakeholders and nursing organizations.

WVNA receives numerous requests to sign on to

letters that show WVNA nurses’ support regarding

certain organization issues or supporting certain

public health measures. We use our HP&L Statement

as our guiding document as we make decisions

regarding signing on or not. Over one last week in

December 2021, WVNA and nursing organizations

signed on to the Open Letter about COVID-19

from West Virginia Health Leaders: Please Get

Vaccinated and Boosted (you can read it on page

six of this issue and it is on our website, too: Sign-On

Letter Please Get Vaccinated and Boosted). I sent this

letter to the WVNA board for review, as well as to all

nursing partners who are Organizational Affiliates of

WVNA. Timeliness of response is always a factor, but

that is how letters of support work.

The WVNA DEI committee will be hosting

listening sessions similar to those the American

Nurses Association held in early 2021. The National

Commission to Address Racism in Nursing began

on January 25, 2021, when nursing organizations

across the country came together to launch the

project. This group is led by the American Nurses

Association (ANA), National Black Nurses Association

(NBNA), National Coalition of Ethnic Minority Nurse

Associations (NCEMNA), and the National Association

of Hispanic Nurses (NAHN).

The formation of the commission happened

because for years, nurses individually have been

raising concerns to condemn all forms of racism. The

WVNA Diversity Equity and Inclusion Committee

(DEI Committee) will lead the coordination of these

listening session events in 2022. If this is something of

interest to you, and if you would like to be involved,

please contact Julie at the WVNA central office.


We have added new membership benefits with

WVNA/ANA – if you haven’t seen them yet, check it

out now. (This can save you money!) The link is on our

website, and you can access the information here.

• Fitness: Active Fit Direct - our members now have

access to Active & Fit Direct, a fitness membership

program that costs $25/month (plus fees & taxes).

Members can join fitness centers in Active & Fit

Direct’s network, which includes brands like Gold’s

Gym, YMCA, SNAP Fitness, and Curves. Plus, the

Active & Fit Direct program includes access to over

4,000+ digital workout videos and offers healthy

lifestyle one-on-one coaching.

• Student loans: Laurel Road specializes in helping

nurses by offering special interest rates that

allow them to potentially save thousands of

dollars. Refinancing might help you consolidate

your loans into one manageable amount with one

— potentially lower —interest rate.

Our goal is to grow membership in WVNA again in

2022. If you are a member, thank you! If you have friends

who don’t know about WVNA, please direct them to

Julie or to the Membership Committee Chair, Anitra

Ellis. Anitra’s contact info is on page 2 of every issue of

WV Nurse. We want all WV nurses to know about WVNA,

what we do, how we advocate for nurses and how we

work together for nurses and patients of West Virginia.

Visit nursingALD.com today!

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Page 4 West Virginia Nurse January, February, March 2022

Innovative Thinking: Where Necessity

Requires New Methods of Teaching

Christy Barnhart, DHSc, MSN, RN, CHSE


This article looks at the challenges in nursing schools

everywhere when the pandemic began in March of 2020

and how simulation helped meet the learning needs

of the nursing students at the WVU School of Nursing

(SON). Nursing schools everywhere were sending the

students home to complete the semester virtually

online. This change was a sudden shift from “normal”

to one that no one was expecting to occur. How do we

finish clinical hours? How will the seniors complete the

needed hours to graduate in May?

With so many uncertainties of the who, what,

why, when, and where, it was time for simulation in

nursing education to shine and lead the way for use

in technology to engage learning throughout the

pandemic. These new changes/adaptations were

enlightening to new methods to be useful now and for

future learning sessions. Learning management systems

helped optimize learning, which enabled faculty and

students to think outside the box.

Simulation is used for nursing education whether

or not there is a pandemic because it is a safe place for

students to learn by making mistakes. Students can

make mistakes, learn from them during the simulation,

and use guided reflection to evaluate their strengths

and weaknesses. Simulation education allows for

safe patient outcomes because the students correct

mistakes before the mistakes reach the patient (Weberg

et al., 2021).

Simulation in Nursing Education

Simulation and skills training occur throughout the

curricular progression of nursing school. Nursing schools

can use simulation education to substitute for clinical

learning, up to 50% (Wolters Kluwer, 2017). Students can

learn new nursing skills in the skills lab before practicing

these skills on the patients at the hospital. Some of the

learned skills are tested in the lab to ensure student

competency levels before practicing on the patients.

Nursing students are placed into a realistic situation

where the application of the learned skills is evaluated.

The realistic situations or simulations are to be treated

as a typical clinical day. Students are prebriefed before

going into the room with peers. During pre-brief, the

faculty discusses broad objectives, role assignments, and

scene/scenario-patient information/room orientation.

After the students see their simulated patients, they

return to the classroom for a facilitated debriefing

session (Hanshaw & Dickerson, 2020).

Broad objectives

Some broad objectives include patient safety,

critical thinking strategies/actions, and communication.

Patient safety consists of a discussion about falls

prevention, medication safety, and infection control

(Mitchell & Assadi, 2021). An example of a question

for students is “When you think about patient safety,

what are some things that come to mind?” Students

typically mention side rails, a clutter-free environment,

bed in the low position, the six patient rights, and hand


We discuss using critical thinking while providing

care and appropriate nursing interventions for the

presenting patient problem. The faculty discuss the

importance of communication with the patient and

family and the health care team and how conversations

can differ. References are made to government resources

such as those from Agency for Healthcare Research

and Quality (2018) and how/when the nurses use SBAR

(Situation Background Assessment Recommendation)

and IPASStheBATON (Introduction, Patient, Assessment,

Situation, Safety Concerns, Background, Actions, Timing,

Ownership, and Next).

Students face different patient situations when

entering the simulation room. Beforehand, it is

important to discuss the functionality of the manikins

(pulses, pupillary response, chest rise and fall, heart

sounds, lung sounds, abdominal sounds, etc.) and

the limitations of the manikin (can’t walk or move


Patient problems require nursing interventions,

and students are expected to utilize critical thinking

strategies to apply to the given situation. An example of

using critical thinking is that the manikin patient has a

blood pressure of 100/50 and a heart rate of 58 beats per

minute; they are due for metoprolol 50 mg by mouth.

The student should retake the vital signs and call the

lead clinician if the heart rate isn’t greater than 60 bpm.

The student would be expected to use SBAR when

communicating a patient problem to the clinician.

Communication is an essential skill to practice

while in the lab, as it is essential to relay important

patient information to get prompt and effective

treatment for the patient. Using SBAR is a vital student

goal in the simulation lab and beyond. Students use

SBAR to relay patient problems to the lead clinician,

pharmacist, and other health care team members.

When educating patients regarding the plan of

care, students need to be aware of the patient’s

comprehension of the plan and provide information

that can be understood by the patient and family (in

layperson’s terms).

Role assignments

Students are broken into groups and assigned roles.

The roles consist of an assessor, medication administrator

(intravenous and oral medications), and communicator

(educates the patient and family members and calls the

lead clinician or other health care team members regarding

patient issues). Different roles can involve students

outside the scenario (parent, respiratory therapist, or the

rapid response team). Some nursing students who are

not participating in the simulation are observers and are

expected to participate in a debriefing. These observers can

participate in the second simulation scenario, wherein the

first group has a chance to observe and then participate in

the debrief.

Scene/scenario-patient information/room orientation

Setting the stage for the student helps to give the tools

needed to have a successful learning experience. The scene

involves the location of the scenario (hospital room, clinic,

home visit, health care provider’s office, emergency room,

telehealth, etc.). This information is vital for the student to

prepare for patient care.

Providing the scenario to the student, not only by

reading it like a hand-off report but also by going over

the information on the computer and how to access

information when the faculty member steps out of the

room, can be helpful and create a successful experience.

Orienting the students to the information and where to

find the labs, medications, history and physical, etc., can be

helpful information to make decisions within the scenario.

An orientation to the patient’s room lets the students

know where to find essential equipment needed for the

scenario. Teaching the student communicator how to use

the phone can allow the students to make appropriate

phone calls while in the simulated experience. Showing

the student how to move the bed/stretcher up and down

and where the IV line is located on the manikin can allow

the students to enter the simulated patient’s room with

confidence to provide safe and effective care.

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January, February, March 2022 West Virginia Nurse Page 5

Facilitated debriefing

Facilitated debriefing is done immediately after

the scenario (Macdiarmid et al., 2020). This is when the

faculty evaluates the students’ critical thinking strategies

while participating in the scenario. The faculty allows

the students to explore their feelings of the scenario and

the actions made by the students. Students are asked:

How do you think that went in your patient’s room?

After that question, students are asked: Can you tell me

what was going on with your patient? What did you do

for the patient? Would you do anything differently after

thinking about it for a little bit? These questions allow

students to evaluate their strengths and weaknesses

and enable the faculty to determine student gaps in

knowledge. After debriefing, sometimes students may

need a skills refresher after identifying a knowledge

deficit (Hanshaw & Dickerson, 2020).

Simulation in Nursing Education

During the Pandemic

Nursing education had some challenges facing

the pandemic in March of 2020. Students were sent

home from universities and had no clinical. Creating

learning activities in the virtual world to simulate

clinical experiences was a challenge. Faculty were

able to utilize videos of patient situations/simulations

and use this for critical thinking exercises to immerse

the student in realistic situations that needed

prompt action. This experience allowed for facilitated

discussions regarding the patient’s safety, and in

the “live” virtual simulations, students were able to

interact with the standardized patient via a telehealth



Clinical faculty created videos to play for students

during a clinical day; the SON simulation team created

virtual charting capabilities. Videos were created for

instruction and demonstration purposes for class

orientation in the summer and fall semesters of 2020

by the director of nursing simulation at WVU and

posted on the learning management system.

The students replayed the videos throughout the

semester. Faculty also created videos for the simulation

elective course. The purpose was to generate discussion

among students on the discussion board about

appropriate prioritization patient care.

Here is a collection of five video clips that formed

one day’s assignment.

https://youtu.be/IzGZtok-E-o (shortness of breath)

https://youtu.be/vHjH9CxDo4A (pain complaint)

https://youtu.be/KnLJR4oovj0 (fall)

https://youtu.be/3CRCo-IpO8Y (needs to go to the


https://youtu.be/ORm6qtrtjNo (bleeding)

After viewing the scenarios, students answered the

following questions:

1. Who is your priority, and why?

2. List – in order of importance – which patients

you will see from 1-5 and give rationales.

3. Do you anticipate any issues with any of the patients?

4. Is there anything that you can delegate? To whom?

The Use of Technology to Engage Learning

In conclusion, the use of technology to engage

learning is effective. The pandemic allowed for WVU

School of Nursing to increase the use of technology.

These new or additional uses of technology opened

the door to possibilities for the future of simulation

education. Now faculty has more options to

offer learners different methods of learning new

information. Maybe this will be the end of any “off

days” for students, which could prevent them from

missing important course material and clinical


Faculty can video their lectures and post them for

students. Clinical faculty can have video modules for

students who miss clinical. Nursing education can be

evolving, adaptable, and advancing, which in the long

term can positively affect patient outcomes by making

our students more prepared.


Agency for Health care Research and Quality. (AHRQ). (2018, July: last

review). TeamSTEPPS essentials course. https://www.ahrq.gov/


Hanshaw, S. L., & Dickerson, S. S. (2020). High fidelity simulation

evaluation studies in nursing education: A review of the

literature. Nurse Education in Practice, 46, 102818. https://doi.


Macdiarmid, R., Neville, S., & Zambas, S. (2020). The experience of

facilitating debriefing after simulation: A qualitative study.

Nursing Praxis Aotearoa New Zealand, 36(3), 51–60. https://doi.


Mitchell, A., & Assadi, G. (2021). Using simulation exercises to

improve student skills and patient safety. British Journal

of Nursing, 30(20), 1198–1202. https://doi.org/10.12968/


Weberg, D., Chan, G. K., & Dickow, M. (2021). Disrupting nursing

education in light of covid-19. OJIN: The Online Journal of Issues

in Nursing, 26(1). https://doi.org/10.3912/ojin.vol26no01man04

Wolters Kluwer. (2017, January 15). Nursing landscape. Up to 50% of

clinical hours can be replaced by simulations. https://www.


Virtual “Live” Simulations

Virtual telehealth visits became another method of

facilitating nursing students to care for a patient’s problem

differently. A standardized patient is an actor trained to

portray the role of a patient and patient condition. The

students would attend these sessions via Zoom and would

go through the pre-briefing and debriefing process as they

would if they were attending an in-person session. The

feedback from the students was positive and proved to

motivate them to learn.

Page 6 West Virginia Nurse January, February, March 2022

December 14, 2021

Open Letter about COVID-19 from West Virginia

Health Leaders: Please Get Vaccinated and Boosted

One year ago, we wrote to you when the first COVID-19 vaccine was on its way to our Mountain State. The authorization of a safe

and effective vaccine was a milestone time in our careers, bringing hope and relief during this life-changing pandemic.

A year later, we have seen hundreds of thousands of West Virginians choose COVID-19 vaccination, alongside millions

across the United States and billions around the world. For more than a year, COVID19 vaccines have had the most

rigorous safety monitoring of any vaccines in U.S. history. The scientific and medical evidence continues to reinforce that

vaccination is safe, and it is highly effective at reducing risk of hospitalization and death from COVID-19.

We trust COVID-19 vaccines because we have followed the science, and we see firsthand each day the role vaccination plays

in protecting ourselves, our loved ones, and our patients. Without a doubt, countless lives have been saved through COVID-19

vaccination. This is why we have chosen to get the vaccine and why we recommend it to our patients.

We have made strides toward improving public health in the face of an ever-changing pandemic. We still have a pressing

concern, though: West Virginia’s COVID-19 vaccination rates are among the lowest in the nation, increasing our hospitalization rates

from COVID-19.

When vaccination rates in a community are low, the virus that causes COVID-19 can more easily spread and change into new

strains—these are the “variants” you may be hearing about, such as Delta or Omicron. New variants could be more contagious,

cause more severe illness, or could even develop in ways that allow it to overcome the vaccines that are working so strongly for us

now. The spread of variants has contributed to recent increases in hospitalizations and deaths in West Virginia.

We know that the overwhelming majority of people who are now hospitalized or pass away from COVID-19 are

unvaccinated. Although no vaccine is 100% effective at preventing disease or complications from disease, the COVID-19

vaccines are our strongest tool to protect against severe illness and death.

If you have not yet chosen vaccination, please get vaccinated. West Virginians 5 years of age and older can now get protected

against COVID-19. And if you were vaccinated more than 6 months ago with Pfizer or Moderna COVID-19 vaccines, or more than

2 months ago with a Johnson & Johnson COVID-19 vaccine, please get a booster shot. Boosters are an important step to maintain

maximum protection against the virus and its variants.

Vaccines are readily available at multiple locations across all 55 counties. You can learn more and find a location near you at


One year ago, we wrote to you about how we wept with the families we cared for and served, watching them struggle with

severe illness and death from COVID-19 complications.

Many who survived continue to have symptoms weeks and months later—what you may have heard referred to as “long COVID.”

The images and memories of these West Virginians – some of whom are our neighbors, colleagues, patients, or loved ones - remain

and will stay with us for our lifetimes.

It is devastating to see people suffer from what is now a vaccine-preventable illness. Yet just as we were a year ago, we remain

hopeful. We know now more than ever that the COVID-19 vaccine is our key to protect ourselves and end this pandemic—only if we

all choose it. West Virginians, protected yourself and others from COVID-19. Please get vaccinated and boosted.

Open Letter to West

Virginians from West

Virginia Health Care

Leaders: We Trust the

COVID-19 Vaccine

December 14, 2020

West Virginia has

experienced landmark days

in the pandemic response this

past week as the U.S. Food

and Drug Administration

(FDA) granted Emergency Use

Authorization for a COVID-19

vaccine. As we write this,

thousands of COVID-19 vaccine

doses are being loaded and

shipped to states across our

nation, including ours. As

health care and public health

leaders in the Mountain State,

we are breathing sighs of relief

because we are confident that

this vaccine is safe, effective,

and is our best hope for ending

the current pandemic...

Flashback to Dec. 14, 2020 –

and a similar letter

Sincerely (listed alphabetically),

Sven Berg, MD, MPH

Chief Executive Officer, Quality Insights

Kenneth Canipe, PharmD, BCPS, BCCCP

President, West Virginia Society of Health System


Lisa M. Costello, MD, MPH, FAAP

President, West Virginia Chapter, American Academy of


D. Scott Davis, PT, MS, EdD, OCS

President, West Virginia Physical Therapy Association

V.J. Davis, RS, MS

President, West Virginia Association of Local Health


Laura Davisson, MD, MPH, FACP

Governor, American College of Physicians, West

Virginia ChapterAssociate Professor of Medicine,

WVU School of Medicine

Matthew C. Delph, MD

West Virginia State Society of Anesthesiologists

Shawn Eddy

President, West Virginia Health Care Association

Sherri P. Ferrell

CEO, West Virginia Primary Care Association

Suzanne Gharib, MD

President, West Virginia State Rheumatology Society

Melissa Jensen, MSPA, PA-C, and

Megan Ross, MPH, CHES

Co-Chairs, West Virginia Immunization Network

Jim Kaufman

President and CEO, West Virginia Hospital Association

Samantha Knapp, BSN, RN

West Virginia Association of School Nurses

Howard Lafferty, DO

President, West Virginia Academy of Family Physicians

Sharon L. Lansdale, RPh, MS

President/CEO, Center for Rural Health Development, Inc.


President, National Association of EMS Physicians,

West Virginia Chapter

Manuel Molina, MD

West Virginia Orthopedic Society

Eleisha J. Nickoles, DDS

President, West Virginia Dental Association

L. Michael Peterson, DO, FACEP

President, West Virginia College of Emergency Physicians

Kara Piechowski, PharmD, BCPS, BC-ADM, CTTS

Director, Tobacco-Free Me West Virginia

Beth Redden, MS, APRN, CNM

President, West Virginia Affiliate of American College of


Michael Robie, DO

President, West Virginia Osteopathic Medical Association

Shon Rowan, MD

Chair, West Virginia Section of American College of

Obstetricians and Gynecologists

Susan Russell, MSN, NE-BC, RN-BC

West Virginia Association for Nursing Leadership

Angie Settle, DNP, APRN, BC, FNP

CEO/Executive Director, West Virginia Health Right, Inc.

Gregory Schaefer, DO, FACS

President, West Virginia Chapter of the

American College of Surgeons

Shafic Sraj, MD

President, West Virginia State Medical Association

Lauren W. M. Swager, MD

Division Director, Child and Adolescent Psychiatry,

WVU Medicine, Department of Behavioral Medicine

and Psychiatry

Matt Walker

Director, West Virginia Independent Pharmacy Association

Joyce Wilson, APRN, MSN, RN, FNP-C

President, West Virginia Nurses Association

January, February, March 2022 West Virginia Nurse Page 7

Recap of the 2021 West Virginia Legislative Session

Teresa Hovatter, BSN, RN, TTS, MSOL

WVNA HP&L Committee Chair and WVNA President-Elect

The West Virginia Nurses Association (WVNA) advocates for the nurses of West Virginia

as well as for the health and well-being of West Virginians. The policy positions that WVNA

has taken reflect the needs expressed by WVNA members and the nurses who participated

in our surveys. WVNA’s Health Policy & Legislation (HP&) statement guides the legislative

agenda and direction of WVNA to best serve WV nurses and West Virginians. The 2022 HP&L

statement was ratified at our Membership Assembly in October 2021 and can be found on

the WVNA website.

As we look ahead to the 2022 legislative session, here is a recap of the 2021

WV legislative session – to remind all of us who were there (in person, by Zoom,

by email, by phone, or by reading WVNA information), and to pique the interest

of those who were not. Many West Virginia nurses pay particularly close attention

to bills sponsored by House Majority Leader Amy Summers, RN, and by Delegate

Heather Tully, RN.

Bills That Passed and Were Signed into Law

HB 2368 – Mylissa Smith’s Law – creating patient visitation privileges. This bill is named in

honor of the late Mylissa Smith, RN. Lead Sponsor: Delegate D. Jeffries. You can read more

about the story behind the bill at Governor Justice Signs Mylissa Smith’s Law.

HB 2672 – Relating to posting of safety information in hospitals.

The purpose of this bill is to require a hospital to post the contact information for the

Office for Health Facility Licensure and Certification, to notify citizens about how to file a

complaint. Lead Sponsor: Delegate Tully.

SB 277 – “COVID-19 Jobs Protection Act.”

WVNA, along with AARP, vehemently advocated for the removal of the immunity for

willful misconduct and reckless or intentional infliction of harm. Amendments to make the

bill safer were added.

SB 334 – Establishing license application process for needle exchange programs. Lead

Sponsor: Senator Tarr.

SB 714 – Relating to physician assistant practice act; was amended in House to include

the ability of both PAs and APRNs to prescribe three days of Schedule II medications. Lead

Sponsor: Senator Takubo.

Bills That Died

HB 2344 – Modify statute related to licensed veterinary technician, modifying the

definition of “registered veterinary technician” from “technician” to “nurse.” (WVNA

vehemently opposed.)

Lead Sponsor: Delegate J. Pack. This bill died in the House Agriculture and Natural

Resources Committee.

HB 2363 – “Best Interests of the Child Protection Act of 2021,” regarding shared child

custody. This bill died in the Senate Judiciary Committee.

HB 2674 – CRNA: Relating to the administration of anesthetics. This bill passed the House;

in the Senate Health Committee. it was completely changed from addressing CRNA scope of

practice, to instead allowing three days of prescribing Schedule II medications for APRNs. It

was referred to the Senate Rules Committee, where it died. Lead Sponsor: Delegate Tully.

HB 2707 – APRN: Relating to prescriptive authority for advanced practice registered

nurses; legislate executive orders. Lead Sponsor: Delegate Tully. This bill died waiting to be

placed on the House Health Committee agenda.

HB 2796 – Supplemental appropriations bill. The purpose of this bill was to provide relief

for nurses who become ill from COVID-19 while caring for patients, using excess surplus

funds paid from nursing licensure fees. Lead Sponsor: Majority Leader Summers. This bill died

waiting to be placed on the Senate Finance Committee agenda.

HB 2869 – To remove any mask mandate in West

Virginia. Lead Sponsor: Senator Jeffries. This bill died in the

House Judiciary Committee.

SB 568 – Eliminate [COVID-19] mask mandate; relating to

emergency powers of Governor. This bill died in the Senate

Government Organization Committee. Lead Sponsors:

Senators Azinger and Karnes.


The HP&L Committee held a Legislative Leader (LL)

training on November 9, 2021. The training was recorded

for current and prospective LLs. If you have any questions about locating the recording,

please reach out to Julie Huron, WVNA executive director, at centraloffice@wvnurses.org.

Legislation to Create a

Palliative Care Benefit in WV

Medicaid is Anticipated in 2022

Chris Zinn, MSc, BSN, RN

Executive Director, Hospice Council of West Virginia

New legislation will be introduced in the next West Virginia

legislative session (which begins in January 2022) to create a

palliative care benefit in WV Medicaid. This bill comes from

the work of the WV State Advisory Coalition on Palliative Care.

The coalition has consulted experts and studied palliative care

legislation from California, Hawaii, and Maine, and has decided

that Maine’s approach is best suited to West Virginia.

The draft palliative care bill directs the WV Department of

Health and Human Resources to apply for a waiver or a State

Plan Amendment so that interdisciplinary palliative care will be

funded for people with serious illness. This benefit differs from

the hospice benefit, as palliative care beneficiaries may still be

Chris Zinn

receiving curative treatment and may live longer. The Medicaid

Hospice benefit is limited to patients whose physicians certify that they have less than six

months to live. This can be a significant barrier to accessing support when it is needed. (For

more information on the Medicaid Hospice benefit, see Medicaid Hospice benefit.)

This legislation would greatly benefit West Virginians with serious illness such as

advanced cancer, heart disease, lung disease, and neurologic diseases. Currently, palliative

care is provided by physicians, APRNs, and PAs, but there is no way to bill for RNs and other

professionals whose services may be needed to support patients and families. Studies in

other states have shown that palliative care can be cost-neutral, as hospitalizations and

emergency room visits are prevented when palliative care teams are involved.

1 A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section,

2 designated §9-5-29, all relating to requiring coverage and reimbursement of specified

3 palliative care benefits by the West Virginia Medicaid program.


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Page 8 West Virginia Nurse January, February, March 2022

National Maternal Health and Midwifery

Legislative Update

Moira Tannenbaum, MSN, APRN, CNM

Co-Treasurer, WV ACNM Affiliate

West Virginia’s nurse-midwives and many midwives nationally have been

discussing two pieces of legislation that could improve the landscape for us and the

families we serve; talking up a piece of legislation to help postpartum nurses in the

workforce; and celebrating the passage and signing into law of a bill to help mothers

who are veterans.

The first is the Midwives for MOMS Act (HR 3352/S 1697), which was introduced

in the House and the Senate in May 2021 and has bipartisan support. “MOMS” here

stands for “Maximizing Optimal Maternity Services.” Yes, those cute bill names are

designed to attract attention and to help people remember the bill in the large ocean

of other bills.

The Midwives for MOMS Act would increase funding for midwifery education,

not just for certified nurse-midwives (CNMs), but also for midwives with the “sibling

credential” to CNMs, which is certified midwives (CMs), as well as for certified

professional midwives (CPMs). Both CMs and CPMs are sometimes identified as “direct

entry midwives,” meaning that they entered the midwifery profession “directly,”

without a stop in the nursing profession.

The funding would focus on midwifery students from historically underserved

communities, including Black and Indigenous People of Color (BIPOC), and including

students at Historically Black Colleges and Universities (HBCUs), by prioritizing

grant funding to midwifery educational programs that demonstrate their focus on

bolstering and increasing racial and ethnic diversity in their student body. The goal is

to further a more diverse midwifery workforce to better serve the needs of historically

marginalized childbearing families and to serve all childbearing families by increasing

the number of midwives.

To do this, the Midwives for MOMS Act would establish two new funding streams

under Title VII and Title VIII of the Public Health Service Act. Funding would be

designated for accredited midwifery education programs. Funding for CMs and CPMs

would fall under Title VII (“Health Professions and Training Programs”) while funding

for CNMs would fall under Title VIII (“Nursing Workforce Development Programs”).

If you’re like me, you may be a little rusty on the Public Health Service Act (PHSA)

but might want to know more about it to better advocate for this bill or merely to

understand it.

The PHSA was passed in 1944, in the middle of World War II. Along the way, it has

had many amendments, such as:

• Title X, passed in 1970 during the Nixon Administration, which established

“Family Planning and Population Services” funding;

• The Health Insurance Portability and Accountability Act (known widely as

HIPAA), passed in 1996 under the Clinton Administration;

• The Newborn Screening Saves Lives Act of 2007, passed during the George W.

Bush Administration (which funds the newborn metabolic screenings now found

in all states); and

• The Affordable Care Act (ACA) of 2010, passed during the Obama Administration.

The second piece of legislation is the BABIES Act (HR 3337/S 1716). This bill would

require the Centers for Medicare & Medicaid Services (CMS) to establish “Medicaid

demonstration model birth centers” in up to six states. It would pay for birth center

care prospectively (going forward throughout prenatal care), instead of waiting till

the end of the pregnancy episode and paying in one lump sum then. That payment

model is very difficult for the many birth centers which are small businesses and is

partly responsible for the low percentage of birth centers who can accept as many

Medicaid patients as they would like to serve. This bill’s cute name stands for “Birth

Access Benefitting Improved Essential Facility Services” (i.e., “BABIES”). Birth center care

— referring to care in freestanding birth centers — is also more difficult to access for





It’s a great time to begin your

WVU Medicine nursing career.




Donna Monroe, RN

WVU Medicine Camden Clark

(L to R) Senator Susan Collins of Maine, Senator Tammy Duckworth of

Illinois, U.S. President Joe Biden.

many families participating with Medicaid due to low reimbursement rates compared

with what hospitals receive for the same basic services.

To date, none of the West Virginia Congressional delegation (Rep. McKinney, Rep.

Mooney, Rep. Miller, Sen. Capito, or Sen. Manchin) has signed on to the Midwives for

MOMS Act or BABIES Act as a cosponsor. However, both bills have bipartisan support

and bicameral support. Bicameral support means they have co-sponsors in both

chambers: in this case, the U.S. House and the U.S. Senate.

It’s not too late to drop your U.S. representative and the two WV senators (Capito

and Manchin) a line and ask them to support these two bills. If you’ve forgotten who

your U.S. representative is, check out this handy link: Find Your U.S. Representative.

Nearly nine million nurses, dental assistants, dental hygienists, and other

workers who are moms would benefit from the federal PUMP for Nursing Mothers

Act (HR 3110/S 1658) if it passes the legislature. PUMP stands for “Providing Urgent

Maternal Protections.” You can download a fact sheet on the PUMP Act from the U.S.

Breastfeeding Coalition’s website here: U.S. Breastfeeding Committee Handouts. This

bill passed the U.S. House with strong bipartisan support (276-149) in October 2021

and is waiting for a U.S. Senate hearing.

The PUMP Act would clean up some loopholes that exclude many workers from

the previous “pumping in the workplace” act, known as the Break Time for Nursing

Mothers Law of 2010, which is part of the federal Fair Labor Standards Act (FLSA). Break

Time for Nursing Mothers Law.

Interestingly, none of WV’s members of Congress (McKinley, Mooney, or Miller)

voted yes on the PUMP Act. If you agree that nurses and dental hygienists should be

able to express milk for their baby at work, just as other workers are able to, please

contact Sens. Manchin and Capito and ask for their support of the PUMP Act for

Nursing Mothers (HR 3110/S 1658). Wouldn’t it be great to get WV support for the bill in

the U.S. Senate and get this bill passed? One of the worst things in a busy day at work

for me is realizing that a colleague who was supposed to pump, did not pump.

Many midwives are also enthusiastic backers of the Black Maternal Health

Momnibus, a package of bills designed by the Congressional Black Maternal Health

Caucus to address the Black maternal health crisis in the U.S. One of the caucus’s

founders is a nurse advocate in the U.S. House: Rep. Lauren Underwood, RN, of Illinois.

Black Maternal Health Caucus Momnibus Act of 2021.

And yes, “Momnibus” is yet another cute name: a play on the word “omnibus” used

in legislative bills – where it means two or more unrelated items – combined with the

word “mom.”

The first bill from the Momnibus to pass and be signed into law is the Protecting

Moms Who Served Act of 2021 (S. 796), which President Biden signed on November

30, 2021.

This bill attracted positive attention in West Virginia, where roughly ten percent

of the population are veterans (State of WV, 2018). The bill was also notable for its

sponsorship by two women senators, representing both major parties, with one a

military veteran. These are Sen. Susan Collins of Maine, a Republican, and Sen. Tammy

Duckworth of Illinois, a Democrat, who is a combat veteran. Sen. Collins represents a

state with an even higher percentage of veterans than WV’s: over eleven percent of

the adult population of Maine are veterans, per 2017 figures (U.S. Dept. of Veterans

Affairs, n.d.). As for Senator Duckworth’s home state of Illinois, only six percent of the

population are veterans (U.S. Dept. of VA, n.d.-2).

How the WV congressional delegation voted on S. 796: All three members of the

U.S. House from WV (Rep. McKinley, Rep. Mooney, and Rep. Miller) voted Yea, and the

bill passed the U.S. Senate by unanimous consent.

The Protecting Moms Who Served Act will study the unique maternal health risks

facing pregnant and postpartum veterans, and support Veterans Affairs (VA) maternity

care coordination programs by investing $15 million. Here’s more news on the

Protecting Moms Who Served Act, from Sen. Collins’s website: Protecting Moms Who


January, February, March 2022 West Virginia Nurse Page 9

The leadership of the WV Affiliate of the American

College of Nurse-Midwives (WV-ACNM) is optimistic

about all three of these pending bills because of

the bipartisan cooperation, and overjoyed that the

Protecting Moms Who Served Act is now law.

Back here at home in the Mountain State,

WV-ACNM is grateful to WVNA for promoting

one of our most important “state legislative

agenda” items, the removal of the Certificate of

Need (CON) program. You’ll find that removing

the CON is listed on WVNA’s 2022 legislative

agenda, outlined on p. 1 of this issue of

West Virginia Nurse.

The CON is a clear barrier to opening additional

birth centers in West Virginia. For many years now, WV

has had just one birth center. It is part of FamilyCare

Health Centers and located in Charleston; recently

it moved from Putnam County where it had been

for many years. You can read more about WV CNMs’

concern about the CON Program on p. 9 of the

January 2021 issue of West Virginia Nurse; the link is

here: West Virginia Nurse link from WVNA website.


State of West Virginia, Department of Veterans Assistance.

(2018). Annual veterans’ report. https://veterans.



U.S. Department of Veterans Affairs. (n.d.). State summaries:




U.S. Department of Veterans Affairs. (n.d.-2). State

summaries: Maine. https://www.va.gov/vetdata/docs/



Editor’s Note: The WV ACNM Affiliate is an

organizational affiliate partner of WVNA. You can read

about this program at WVNA Organizational Affiliate


The writer represents the American Association

of Birth Centers (AABC) on the United States

Breastfeeding Committee (USBC), a supporter of the

PUMP for Nursing Mothers Act.

National Legislative Updates

(Focused on Nurses and Nurse Practitioners)

Jodi Biller, MSN, APRN, FNP-C

WVNA Health Policy & Legislative Committee


After months of negotiations, on November 19, 2021,

the U.S. House of Representatives passed H.R. 5376, the

“Build Back Better Act,” by a vote of 220 to 213, with

all House Democrats except one (Rep. Jared Golden

of Maine) voting in favor of the bill, and all House

Republicans voting against the bill.

The legislation has now moved on to the U.S. Senate.

As WV Nurse is going to press, the legislation is not

moving forward.

By the time this edition of West Virginia Nurse is in

your hands or on your phones, matters could look

different. While the over 2,000-page bill encompasses

many policy areas, I want to showcase several key

health care-related provisions directly related to

practice. I am grateful to the American Association

of Nurse Practitioners (AANP) for the summary.

Specifically, Build Back Better would:

• Create a new hearing benefit under Medicare

Part B, beginning January 1, 2023, for hearing aids

for individuals with moderately severe, severe,

or profound hearing loss in one or both ears.

Eligibility is once every five years, if furnished

through a written order by a physician, qualified

audiologist, qualified hearing aid professional,

physician assistant, nurse practitioner, or clinical

nurse specialist qualified to write such order by

the state.

• Provide $50 million for Health and Human

Services (HHS) to conduct studies on the

appropriateness of establishing minimum nursing

staff-to-resident ratios in skilled nursing facilities


• Provide $2 billion in funding for the National

Health Service Corps (NHSC). Nurse practitioners

(NPs) are the second largest provider group in

Real Talk About Burnout

Bree Becker, MSN, NP-C, RNC-MNN


Reprinted with permission from

Georgia Nursing April 2021 issue

Recently I was putting my son to bed. We read one of my

favorite children’s books, The Giving Tree by Shel Silverstein.

Despite reading this story many times, I was struck by the

visceral sadness of the tale. It’s a children’s story with a simple

plot. A boy is climbing a tree (personified as a woman),

and he happily swings from her branches, devouring her

apples and enjoying all the comfort the tree provides.

Readers follow the boy on his journey through adolescence,

adulthood, and then as a tired elderly man. Throughout his

life, the boy takes, and the tree gives. Whatever his needs are

at each stage of his life, the tree is happy to provide a piece

of herself to help. She gives her branches for shade, then

her wood to help build a house. Finally, with her resources

depleted, she dwindles to a stump. And even then, she

manages to provide a place for the boy, who is now an

elderly man, to sit.

I realized the tree’s exhausted state represents how

many nurses feel. For us, The Giving Tree is an all-too-familiar

story. The depleted tree personifies the exhaustion and

burnout most of us are experiencing today. I receive daily

articles that reference burnout and company ads that offer

a solution specifically for me. But at the end of the day,

the responsibility of executing the proposed solution falls

back on me. “Here is something else for you to do to help

you with your burnout.” Burnout was identified as an issue

decades ago, and is only getting worse. Despite public

awareness, nurses are still being asked to do more with less.

The pandemic highlighted nurses’ struggle with the mental

and physical toll of the job. Instead of offering a cliched

intervention for burnout, I want to have a real conversation.

Let’s ask hard questions. Let’s stop pretending we know how

to fix a problem that’s plagued us for decades.

My personal problem with many of the resources

designed to address burnout is that it creates more work for

me. Now don’t get me wrong, I like learning about yoga and

I actually believe things like exercise and diet have a positive

effect on your mental health. But the reason I feel exhausted

as a nurse is not because I don’t exercise or eat healthy. I

have always adopted a healthy lifestyle even before I was a

nurse. I do think that my healthy lifestyle allowed me to push

myself physically and mentally as a nurse. The long hours,

constant stress, and erratic schedule didn’t catch up with me

for a decade. But I eventually burned out. And no amount

of green smoothies or yoga could cure me. I found myself

becoming overly cynical, feeling like I was not making an

impact, and dreading work.

Burnout is the symptom of a larger disease: it’s the

result of poor processes within institutions and the larger

healthcare system overall. Nurses experienced burnout long

before this pandemic. The pandemic has only cast a light on

an ugly truth most of us have been aware of for a long time.

If burnout is not the health care worker’s problem alone to

solve, who is responsible for solving it?

Here are real problems, I don’t have the answers. But

I know we are too fragile to continue this way. Last year,

I was clueless about the horror the world was about to

experience due to COVID. While I knew our medical system

was broken and that health care workers were being

stretched beyond capacity, I didn’t realize what a pandemic

would do to our profession. I didn’t realize how vulnerable

we are. The future is now. The what-ifs and maybes are

reality. We can’t afford to hobble along anymore. We have

to be willing to talk about the real issues and the first step is

asking hard questions.

I know I can’t fix this today and I know I can’t fix this

alone. To me, it’s a fight worth fighting. And maybe, by the

time I retire, nurses won’t suffer the way I’ve seen my peers

suffer over the last decade. And maybe, unlike The Giving

Tree, nurses won’t give until we are depleted and we will be

empowered to care for ourselves the way we care for others.

Photo courtesy Architect of the Capitol

that program, ranking behind behavioral and

mental health providers.

• Provide $500 million in funding for the Nurse

Corps, which includes funding for NPs.

• Provide $500 million in funding to enhance and

modernize nursing education programs and

increase the number of faculty and students,

particularly in underserved areas. This provision

is based on the Future Advancement of Academic

Nursing Act (FAAN Act), S. 246, which AANP

supports. Senator Jeff Merkley of Oregon is the

lead sponsor.

• Provide $25 million in funding to support training

of health professionals in palliative and hospice

care, foster patient and family engagement,

integration of palliative and hospice care with

primary care and other appropriate specialties,

and collaboration with community partners to

address gaps in health care for individuals in need

of palliative or hospice care.

• Includes $20 million in funding to nursing

schools, health care facilities, programs leading

to certification, partnerships of such schools and

facilities, and programs and initiatives to develop

and implement programs to train and educate

individuals in palliative care in educational, hospital,

hospice, home, or long-term care settings.

You can read more about the framework of Build

Back Better at White House Build Back Better.


number of career opportunities for clinical

and non-clinical candidates. As a member

of the WVU Medicine team, we offer:

■ Competitive Compensation

■ Tuition Repayment & Tuition Assistance

■ Growth Opportunities

■ Comprehensive Benefits (within 30 days of hire)

We are an EOE/AA Employer. All qualified applicants will receive consideration for

employment and will not be discriminated against on the basis of disability, veteran

status or other protected status.




Page 10 West Virginia Nurse January, February, March 2022

Your Membership Dollars at Work

Roger Carpenter, PhD, RN, NE-BC, CNE

WVNA Treasurer

The purpose of this column is to inform you, as

a WVNA member, of the impact of your $15/month

WVNA membership fee.

WVNA has a strong and stable financial portfolio.

WVNA is a nonprofit professional organization, not

an investment organization. The purpose of keeping

a strong financial portfolio is to be able to give back

to the members and support the mission of WVNA:

To support West Virginia nurses and to work for a

healthier West Virginia.

Your annual membership fee supports the


• Continuing education for nurses in West Virginia

• Contracting with an expert lobbyist, which

is essential to advocating policy to the WV

legislature on issues impacting the health and

safety of WV residents

• Supporting the WVNA website — a rich source

of information for WVNA members

• Social media to promote WVNA and WVNA


To maintain integrity of WVNA funds, an

independent certified financial professional routinely

audits WVNA financial activities to monitor for

adherence to standards for nonprofit organizations,

and the responsible stewardship of WVNA funds.

Here is a summary of the Treasurer’s Report for

the 3rd quarter of 2021 (July 1, 2021 – September 30,


Total assets, beginning of 3rd quarter: $165,393.66

Income: + $24,836.40

Expenses: - $22,089.02

Total assets, end of 2nd quarter: $168,141.04

Major income, 3rd quarter: $20,012 .01 (membership dues)

Major expense, 3rd quarter: $4,000 .00 (website services)

One way you can start taking advantage of being a WVNA

member this quarter is to stay tuned for news of our Tuesday

meetings at 7 pm and legislative alerts during the main

legislative session. We’ll help you stay tuned to where your

voice as a WV nurse is needed.

Thank you for supporting the West Virginia Nurses


WVNA 2022 Annual Budget

Roger Carpenter, PhD, RN, NE-BC, CNE

WVNA Treasurer

The annual budget for the WVNA in 2022 was presented at the WVNA Membership Assembly on October

21, 2021, and was approved. I have provided the 2021 budget for comparison.

The biggest change from 2021 to 2022 is a decrease in the projected income from the lobbyist fundraiser.

The amount of $5000 is more consistent with what is raised by this event. There are minor changes in

budgeted expenses, mainly due to increasing the number of events hosted by WVNA.

The next budget period runs from January 1 to December 31, 2022.


2021 Budget 2022 Budget

Career Center/Advertising $ 1,000.00 $ 2,000.00

Lobbyist Fundraiser $ 10,000.00 $ 5,000.00

Misc. $ 3,000.00 $ 5,000.00

Dues Revenue $ 85,000.00 $ 85,000.00

Conference Revenue $ 20,000.00 $ 20,950.00

Grants $ -


$ 119,000.00 $ 117,950.00

ANAI $ 1,000.00 $ 1,000.00

Bank & CC Fees $ 800.00 $ 800.00

Donations $ 300.00 $ 300.00

Dues & Subscription $ 1,500.00 $ 1,000.00

Fees - Misc $ 500.00 $ 1,500.00

Website $ 3,000.00 $ 3,000.00

Insurance $ 500.00 $ 500.00

– Non Dues Revenue,

Fall Education & events

RN-to-BSN Program



• Most affordable RN-BSN in West Virginia

• Work while completing your degree

• 24/7 access to courses

• Small class sizes and individual feedback

For more information or questions:

Please email kfrum@wvup.edu.


Lobbyist $ 17,000.00 $ 17,000.00

Meetings $ 2,550.00 $ 4,000.00

Other Expenses $ 1,000.00 $ 1,000.00

Outside Expenses $ 56,550.00 $ 56,550.00

Postage & Delivery $ 200.00 $ 200.00

Professional Fees $ 10,000.00 $ 7,000.00

Rent $ 18,000.00 $ 1,800.00

Supplies $ 1,000.00 $ 1,000.00

Taxes $ 500.00 $ 500.00

Telephone $ 500.00 $ 500.00

Travel & Conferences $ 3,500.00 $ 3,500.00

Unity Day Expense $ 14,000.00 $ 14,000.00

Office Expense $ 2,000.00 $ 2,000.00

WV Nurse editor $ 800.00 $ 800.00

– $2175*26 Payperiods

$ 119,000.00 $ 117,950.00

January, February, March 2022 West Virginia Nurse Page 11

Editor’s Corner

Moira Tannenbaum, MSN, APRN, CNM, CCHP

Editor, West Virginia Nurse

Nurses, Pandemic, and Money

Something I’ve thought a lot about recently is the mindset of nurses who

experience a dramatic boost in their earnings due to becoming travel nurses – largely

due to the pandemic – or due to receiving “hazard pay” to stay in their current position

or work extra shifts. What will it feel like to go back to working for “regular” nurse

wages? And will this necessarily happen? Or with the nursing shortage a firm fixture

on the international horizon, will nurses manage to leverage it to universally higher


Sometimes after a bad day at work, I find myself thinking, “OK, you got through

that block of time. Now you have X more dollars coming.” Usually I am so busy that I

don’t have time to think along those lines. But sometimes on the commute home, I’ll

Nurse Honor Guard Honors Colleagues

Tatem Childers Grimm, MSHRM / Charleston Area Medical Center

On Friday, December 3, 2021, at the Charleston Coliseum and Convention Center,

the Charleston Area Medical Center (CAMC) Nurse Honor Guard performed its first

ceremony to honor fellow nurses who died in recent years.

The purpose of the nurse honor guard is to pay tribute to nurses at the time of

their death by performing the Nightingale Tribute at funeral or memorial services.

This service is similar to a military tribute, and officially releases the nurse from their

nursing duties, while honoring their dedication to the nursing profession.

At the ceremony, Chief Nursing Officer of CAMC Heidi Edwards said:

“I am inspired by every nurse who commits their life to nursing excellence so

they may impact the lives of their patients, family, and community members. A final

farewell is a small way to say thank you and be able to join with others to honor and

appreciate their service and compassion during a beautiful life lived.”

Currently, the CAMC Nurse Honor Guard will perform tribute ceremonies for CAMC nursing

staff and retirees who have passed on, and plans expand the program as demand for it grows.

L to R: Tina Stamper

(nursing practice director of

innovation & informatics),

Jennifer Ferrell (director

of nursing practice,

quality, & education),

Tina Powers (nurse

manager), John Snyder

(nurse manager), Heidi

Edwards (Chief Nursing

Officer), Christina Thompson

(director of nursing practice

& resource management),

Dianna Branham (nurse manager), Martha Hicks (clinical management

coordinator), and Kendra Tackett (nurse manager).

catch myself thinking of the money I just made. Thinking, “OK, I am emotionally and

physically wrung out, but I did a good job as a nurse (or did the best I could under the

circumstances) and will bring money home.”

With more nurses making more money, are there going to be more of us thinking, “I

can afford that vacation/new gadget/out-of-state nursing conference/larger donation

to a charitable foundation” or whatever it may be? This is a good thing and nurses

well deserve this. Certainly colleagues of ours in health care who routinely make more

money than nurses do have “things” in more abundance – subjectively, at least, that’s

how it seems to me.

Of course, this is another layer onto the situation we all know first-hand: the

immeasurable stresses nurses have faced for decades, now worsened by the COVID-19.

Will making more money even help?

Maybe nurses will be able to afford to work fewer hours but get the same takehome

pay as they did before a pay raise? Maybe this is part of the answer to the

nursing shortage: better work-life balance by having fewer hours at work. Maybe some

nurses who left will come back if they can work less and earn more.

If you’re looking for ideas to help your coworkers cope, or help yourself cope, please

make sure to read the article from nurses in Georgia, Missouri, and Nebraska in this

issue (see pps. 9, 14, and 15).

What’s Something New for ‘22?

In 2022, I’m looking forward to a WVNA “virtual race” in the Mountain State, and

proud that this was my idea. I kept nudging our executive director, Julie Huron: “Come

join me in a virtual race.” Finally she said yes, and we trekked with three others over

the Rockies in November and December. The scenery was great!

A virtual race is a combination of incentive to exercise, an app to track exercise, and

a fun thing to do with a group of people – some of whom you may already know, and

some of whom you don’t know yet. Julie took the bold step of trying something new

and was hooked. Stay tuned and you too can join us.

Integrated Care (Behavioral Health & Primary Care)


If your passion is caring for people – then we want you!

Positions available in the following counties:

Cabell, Clay, Kanawha, Putnam, Mason, Wayne, and Lincoln.

Apply Online:


or call 304-412-6940


Minnie Hamilton Health System, located in Grantsville, WV, has

an exciting opportunity for a high-performance individual and is

currently seeking applicants for:

Full Time– Regular, 36+ hours per week, Registered Nurse

(RN) in the emergency room and med surge settings.

MHHS offers a competitive salary with shift differential, as well as tuition

assistance and an excellent benefit package including: health, dental,

vision, life insurance, 401k, paid time off.

For more information visit


Page 12 West Virginia Nurse January, February, March 2022

Celebrating Nurse Authors:

Book Review of Healing Hoppy by Cathy Carson

Patricia Dekeseredy, MScN, RN

Healing Hoppy was written

by Cathy Carson, a nurse

of 37 years and a certified

holistic nurse and healing

touch certified practitioner,

with illustrations by Charity


This story tells the tale of

Hoppy, the frog who had lost

his “hoppity-hop.” He didn’t

feel like hopping, singing, or

even enjoying his lunch. He

Patricia Dekeseredy

felt sad and didn’t have the

energy to play with his friends. Frog Pond, where he

lives, was not a healthy pond. It had become dirty, and

the plants were yellow and wilted. After a short visit with

Caitie, the school nurse (who is a cat), Hoppy and his

parents set off on a journey to the Healing Pond, where

the water is clean, and the plants grow strong and tall. All

the young frogs there are kept healthy by their holistic

healer friends. At Healing Pond, Hoppy and his parents

learn about aromatherapy from a skunk, acupuncture

from a porcupine, herbal medicine from a bear, yoga

from a dog, mindfulness from an owl, and healing touch

from a squirrel. Each animal shares their special healing

gift with Hoppy. Hoppy begins to feel better and returns

home to Frog Pond. He invites his new friends to come

and share their healing talents with others at Frog Pond

so everyone can feel healthier. He also plans to clean up

Frog Pond and plant flowers and berries, so no one loses

their hoppity-hop again.

As nurses may recognize, Hoppy’s story is rooted

in Nightingale, and embraces Jean Watson’s Theory

of Human Caring. The caring-healing relationship

among Hoppy, his parents, and the holistic caregivers

is prevalent throughout the book and displayed by the

little heart-winged fairies embedded in the illustrations.

The healing effects of harmony between the natural

environment and health are evident throughout the

book and supported by the beautiful watercolor

drawings of Charity Casterline.

Notably, the story setting is North Carolina, rich with

Appalachian culture. The tradition of herbal medicine

remains strong today in the Appalachian mountain

region. Bert, the bear, teaches us about foraging

for plants and berries native to the area that hold

healing properties. American ginseng, red clover, and

elderberries are foraged and identified for health and

healing benefits.

The book is suitable for all ages, but targeted at

children. At 64 pages, it might bit a little long for a quick

bedtime story. Still, breaks in the story might encourage

conversations about complementary and alternative

healing and easily read in sections. This timely book is

a gentle reminder not to forget the healing benefits of

kindness and caring for yourself and others, especially

during challenging times.

Publication information:

Publisher: iUniverse (March 29, 2021).

Paperback: 64 pages. ISBN-13: 978-1532091117

January, February, March 2022 West Virginia Nurse Page 13



Julie Absher Huron, Executive Director

During the months of October and

November, and through December 8, 2021,

WVNA welcomed 50 new/reinstated members.

The WVNA is the voice for all West Virginia

nurses, and we welcome your voice as well as

your coworkers’ voices and input. We share your

stories with health care stakeholders, legislators,

and elected representatives. This is how we

make changes that affect nurses and healthcare.

Please watch for our news and announcements,

our ENews, our social media posts, and our

emails. You can also find information on our

website at wvnurses.org/nursing-news. We

invite you to become a legislative leader, join

committees, attend meetings, and remind you

to please share your voice when surveys or

public comments are needed.

We want to help you succeed and continue

to succeed in your nursing career. Beyond

that, we want to help you achieve work/life

balance, so important for nurses. Get involved

and get to know us!

Conferences & Meetings

By now, the WV Nurse staff, like everyone else, is accustomed to events going virtual when we thought they were

going to be IRL (in real life), and vice versa. Conferences are listed here whether they are virtual, hybrid, in-person, or to

be determined. For any conference you’re interested in attending, WVNA recommends checking for updates on their

website and staying current on their social media and/or on any email list, for even more frequent updates. Think about

trip cancellation insurance, too, if you’re planning to travel to a conference. We are always on the lookout for tried-andtrue

conferences as well as new ones, so drop us a line at centraloffice@wvnurses.org.

January 25–27, 2022 (Tuesday–Thursday)

13th International Nursing Conference &

Global Summit IV

A virtual event for Filipino nurses around the globe!

Philippine Nurses Association of America, Inc.

January 27–28, 2022 (Thursday–Friday)

Association of Camp Nurses

Camp Nurse Symposium 2022

Virtual event

2022 ACN Conference

March 6–8, 2022 (Sunday–Thursday)

Washington, DC

American Academy of Nurse Practitioners (AANP)

Annual Health Policy Conference

AANP Health Policy Conference

June 9–12, 2022 (Thursday–Sunday)

American Psychiatric Nurses Association (APNA)

20th Annual Clinical Psychopharmacology Institute

Reston, Va.

APNA 20th Annual Clinical Psychopharmacology Institute

June 21–June 26, 2022 (Tuesday–Sunday)

American Academy of Nurse Practitioners (AANP)

National Conference

Orlando, Fla.

AANP 2022 Annual Conference

June 25–29, 2022 (Saturday–Wednesday)

Association of Women’s Health Obstetric & Newborn

Nurses (AWHONN)

Aurora, Colo.

AWHONN 2022 Convention

• Karen Auxier

• Julie Barr

• Denisse Bishara

• Anastasia Carmen

• Krista Casto

• Denise Chaney

• Marcia Clark

• Emily Cloxton

Virginia Conrad

• Rachel Crihfield

• Lisa Davis

• Tanja Davis

• Judy Eggleton

• Amanda Fei

• Andrea Heath

• Peggy Huffman

• Brenda Isaac

• Jacquelyn Johnson

• Melissa Johnson

• Cheryl Jones

• Andrea Ketterman

• Samantha Knapp

• Cristi Kwei

• Courtney Laney

• Cassie Latimer

• Lesley Lerose

• Joshua Lewis

• Jessica Maynard

• Holly McDowell

• Sabrina McKinney

• Adam Meade

• Kimberly Narkevic

• Charlene Newsome

• Krista Nutter

• Chioma Onyenakazi

• Caitlin Preece

• Monica Preolitti-Thomas

• David Price

• Linda Quintrell

• Tara Ramsey

• Charlotte Reed

• Breanna Rich

• Susan Russell

• Suzanne Simmons

• Angela Stevenson

• Kendra Swiger

• Christine Taylor

• Rey Valdez

• Shasta Ward

• Jennifer Wise

March 14–17, 2022 (Monday–Thursday)

National Association of Clinical Nurse Specialists (NACNS)

Virtual and in person Baltimore, Md.

NACNS 2022 Conference

April 27–30, 2022 (Wednesday–Saturday)

Society of Pediatric Nurses

Anaheim, Ca. / virtual if need be

SPN 2022 Conference

May 10–12, 2022 (Tuesday–Thursday)

Global Reproductive and Sexual Health Summer Institute

“Chronic Conditions in Women’s Health: Through a

Global Lens”

All virtual format

UM Global Sexual and Reproductive Health Conference

May 22–25, 2022 (Sunday–Wednesday)

American Nephrology Nurses Association

Ft. Worth, Texas

ANNA 2022 Symposium

May 22–26, 2022 (Sunday–Thursday)

American College of Nurse–Midwives (ACNM)

67th Annual Meeting & Exhibition

Chicago, Ill. / virtual & hybrid options available

ACNM 2022 Annual Meeting

May 23–24, 2022 (Monday–Tuesday)

International Conference on Nursing Ethics and Nurse-

Nurse Relationships

Montreal, Canada

Nursing Ethics and Nurse-Nurse Relationships Conference

July 2022 (date TBD)

National Association of Hispanic Nurses (NAHN)

Annual Conference

Miami, Fla.

NAHN 2022 Annual Conference

July 21–23, 2022 (Thursday–Saturday)

Philadelphia Trans Wellness Conference


Philly 2022 Trans Health Conf. (PTWC)

July 26–31, 2022 (Tuesday–Sunday)

National Black Nurses Association (NBNA)

50th Annual Conference and Institute

Chicago, Ill.

NBNA 2022 Conference

August 12–16, 2022 (Friday–Tuesday)

American Association of Nurse Anesthesiology (AANA)

Annual Congress

Chicago, Ill.

AANA Annual Congress 2022

September 15–18, 2022 (Thursday–Sunday)

American Association of Birth Centers (AABC)

Annual Birth Institute

San Diego, Ca.

AABC 2022 Birth Institute

September 22–24, 2022 (Thursday–Saturday)

United States Lactation Consultant Association (USLCA)

Norfolk, Va.

USLCA 2022 Conference

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Page 14 West Virginia Nurse January, February, March 2022

Developing a Peer Support Program to

Mitigate Compassion Fatigue in Health Care:

A Quality Improvement Project

Rebecca S. Chambers, MSN, RN, NEA-BC

Reprinted with permission from

Missouri Nursing News, January 2021

Nurses are tasked with providing exceptional care for patients and families

above all other priorities. However, we may encounter roadblocks when nurses

themselves need care. It does not matter what discipline, role, or unit; we all

have the potential to be negatively affected by the work we do. Caregivers are at

risk for compassion fatigue, defined as emotional exhaustion, depersonalization,

inability to work effectively and provide empathetic care (Crewe, 2017).

Compassion fatigue can be related to exposure to a patient’s trauma or simply

being a witness to another’s despair (Sinclair et al, 2017). As compassion fatigue

takes hold, nurses can quickly lose their empathy for patients, families, and

colleagues and quality of care can suffer (Swensen, 2018). The Compassion

Fatigue Awareness Project (2017) notes that this can also lead to conflict

amongst staff, increased absences, turnover, lateral violence, and inability to

honor commitments. The Compassion Fatigue Awareness Project is a great

resource which seeks to educate professionals about compassion fatigue, risk

factors, signs and symptoms, as well as recommendations for wellness.

Organizational resources may not be as available or sufficiently robust to

address the needs of employees suffering from compassion fatigue. At our

institution, we decided to utilize our most valuable resource, our own staff, to fill

this gap by developing our Care for Caregivers program. Through this program,

we had high hopes of developing a more empathetic culture. We began by

developing a steering team of five individuals who each expressed a particular

interest in preventing compassion fatigue, some due to a personal experience

of their own. The team included physician and nursing leadership as well as

front-line staff members. The bulk of the efforts came from one front-line staff

member and a single nurse manager. Over a period of one year (2013-2014), this

steering team trained over 90 peer supporters to cover the needs of employees

at our 195-bed academic pediatric hospital. Our hospital employs approximately

1,500 individuals, so this was a small, but mighty group of peer supporters.

Training consisted of peer support techniques such as active listening,

normalizing emotions, reframing the situation, sharing stories, and offering

ideas for coping mechanisms and self-care. Referrals to the peer support

program began on a paper form but quickly transitioned to an online submission

format to allow for a timelier response. Referrals are routed to two members

of the steering team who then assign referrals to trained peer supporters. Peer

supporters are asked to contact the individual who was referred within 48-

72 hours. Referrals are assigned to supporters in like roles or units, to provide

a frame of reference and hopefully, benefit from an existing relationship.

Supporters are encouraged to identify themselves as members of the Care

for Caregivers team to ensure that their knowledge of the event was through

secure channels. Confidentiality and respect are emphasized at every step of

the process; we want staff to feel comfortable confiding in their peer supporter

without fear of gossip or judgment. We maintain program utilization data

including number of referrals made, vague reason for referral, role of individual

referred, and role of individual who submitted referral. We intentionally do not

keep any identifying information related to persons or events. The majority of

referrals result from traumas and patient deaths, though we have seen a steady

increase in workplace violence, possibly associated with higher levels of stress in

our community. Most referrals are placed by peers or direct managers, 50% and

31% respectively. Anonymous referrals and self-referrals are permitted though

these referrals comprise less than 10% of overall referrals.

Since the program’s inception, 1,035 team members have been referred

for support; our largest group of recipients are nurses, encompassing 71.4%

of referrals. Care has also been offered to physicians, support staff such

as respiratory therapists and pharmacists, as well as ancillary teams —

environmental services and security. We do not ask peer supporters to report

back on the content of any discussions they have though we do encourage them

to reach out to the steering team if they feel the employee needs more support

that they can provide safely. Additional resources available include the employee

assistance program, professional debriefings, and pastoral care.

While the bulk of the work is conducted by the peer support team, everyone

in the organization plays a role. All staff are offered an awareness of the program

through new employee orientation and staff meetings. Peer supporters are

given monthly information about the program to help encourage referrals as

well as proactive ways to support their teams. Leaders are invited to participate

by identifying team members who may be interested in becoming a peer

supporter, making referrals as needed, and attending program events.

The organization was surveyed by the Agency for Healthcare Research &

Quality in 2014 and again in 2016. In 2014, 56% respondents shared that they

experienced a patient safety event that caused anxiety, depression, or concern

about their ability to perform their job — only 16% of those respondents felt

adequately supported by the hospital. In 2016, 15% of respondents experienced

such an event while 83% felt adequately supported by the hospital.

We have been able to maintain a core group of 75-90 peer supporters and

have been able to encompass a more diverse group — including physicians and

ancillary team members. For the first few years of the program, we offered four

training sessions per year — now we are able to maintain a sufficient amount of

peer supporters with one or two sessions per year. Peer supporters are provided

monthly communication about the program. Our daily leadership huddle

provides a reminder for leaders to submit referrals for events within the last 24


As our program matures, we have been able to offer a more proactive

approach in addition to our referral response. Monthly sessions are provided on

self-care, techniques for mindfulness, and resilience. Popular activities include

yoga and meditation. Participation in our monthly programs averages from 20-

60 employees and we are exploring methods to bring these activities to the

bedside to reach more staff in their own work environments.

Our program incurs very little cost. Initially, we spent about $250 per

year, funded by our own bake sales. In 2019, our Care for Caregivers program

became part of our employee appeal and now garners donations from our

own employees. Most of our funds are spent on supplies for self-care activities

(journaling, art therapy, etc.) and candy offered for program publicity. Several

staff members donate their talents in yoga and guided meditation. The generous

gift of a private donor this past year has allowed us to hire a program manager

with professional counseling experience. In the future, we plan to provide a

quiet space for employees to decompress after challenging events or have a

forum to learn self-care techniques whenever it is convenient. We will continue

to follow employee engagement data related to support of the organization

during traumatic events as well as program utilization, first year turnover, and

employee retention. Culture change is a slow process. However, dedicated

efforts from the front-line coupled with leadership support can make a

tremendous difference.


Crewe, C. (2017). The Watson room: Managing compassion fatigue in clinical nurses on

the front line. Virginia Henderson Global Nursing Repository. http://hdl.handle.


Sinclair, S., Raffin-Bouchal, S., Venturato, L., Mijovic-Kondejewski, J., & Smith-MacDonald,

L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature.

International Journal of Nursing Studies, 69, 9-24. doi: 10.1016/j.ijnurstu.2017.01.003.

Swensen, S.J. (2018). Esprit de corps and quality: Making the case for eradicating burnout.

Journal of Healthcare Management (63)1, 7-11, doi: 10.1097/JHM-D-17-00197.

The Compassion Fatigue Awareness Project. (2020, October 15). https://www.


January, February, March 2022 West Virginia Nurse Page 15

COVID-19 and Mental Health:

Self-Care for Nursing Staff

Gráinne Ráinne Clancy, BN, MIACP;

D’Arcy D. Gaisser, DNP, MS, RN, ANP-BC; and

Grace Wlasowicz, PhD, RN, PMHNP-BC,


Reprinted with permission from Nebraska Nurse

May 2021 issue

Along with incalculable loss, the coronavirus

(COVID-19) outbreak has had devastating effects on

the mental health of people with COVID-19, their

families, and the community at large. Health care

workers face tremendous stress, both emotionally

and physically, from the grueling work hours and the

threat of contracting the virus at work.

This article addresses the potential mental health

issues for health care workers that may emerge from

this pandemic as well as treatment options and selfcare

activities that promote recovery.

COVID-19 and mental health

Nurses working on the front lines of the COVID-19

pandemic may experience various mental health

problems. Here are a few examples:

• Chronic stress. Nurses are continuously fearful

of contracting COVID-19, infecting others,

encountering prejudice from the public

due to working as a nurse, and dealing with

inadequate supplies of PPE. 1 Stress becomes

chronic when it is overwhelming and cannot

be resolved, resulting in relationship, health,

and sleep problems. 2-5 People with chronic

stress experience intense emotions that can

feel overwhelming and result in thinking

negatively. 6 Nurses on the front lines in

COVID-19 hotspots report feeling like a

graduate nurse again, filled with uncertainty

and worry. 7

• Acute stress disorder. Nurses with acute stress

disorder may have trouble sleeping, worry

constantly, and experience persistent negative

thoughts about their role in the traumatic

event, such as thinking “I should have done

more to help.” 8 When we experience trauma,

we detach from the memory. We ignore our

emotions to protect against the pain, but

these emotions reappear over time and impact

our lives. 9 The nurse may respond to a minor

irritation as if it were a life-threatening event. 10

Nurses may feel they are in a dreamlike state

that impacts their ability to think, process

their emotions, and respond appropriately to

situations. 11 If signs and symptoms of acute

stress disorder persist for more than a month,

posttraumatic stress disorder (PTSD) may be

diagnosed. 12

• PTSD. Nurses are not strangers to caring for

critically ill patients who die. 8 However, the

number of patients dying amid a surge in

COVID-19 cases is causing health care workers

to feel powerless, which can lead to PTSD.

PTSD can develop after direct or indirect

exposure to a traumatic event, such as hearing

about a traumatic event involving a family

member, friend, or colleagues. Those with PTSD

experience recurrent intense and disturbing

thoughts and feelings stemming from one

or more traumatic events. 10,13,14 Nurses with

PTSD may relive an event through flashbacks

or nightmares, and they may feel sadness,

fear, anger, guilt, shame and detachment

or estrangement from other people. 14 Many

traumatized individuals have a robust and

unconscious inclination to go inward, often

to re-experience their distressing thoughts,

painful memories, and uncomfortable

sensations. 15 They may have an exaggerated,

startled response to certain situations and

develop problems with concentration and

sleep. 5

The nursing team’s role

When nurses struggle personally, we tend to be

critical of our colleagues or management and withdraw

from others. Such a change in personality is often an

indicator of struggle. It is often a team member who

will notice that you are not your usual self and may be

struggling with anxiety and stress. Asking yourself or a

colleague three simple questions can raise awareness

about a possible problem:

• Am I ok? Are you ok?

• Do you feel you cannot give anymore?

• Do you feel your work is ineffective? 16

If you are struggling, speak with your colleagues,

acknowledging those feelings and thoughts in

the first instant. If you feel you are not performing

effectively in your workplace, talk with your manager

and state your opinions on being ineffective.

Everyone has limits, and sometimes just taking a week

off might be sufficient.

Nurses who continue to feel this way should discuss

it with their primary healthcare provider and their

employer and review the options available. A range of

supports may be available from your employer or your

professional organization. 17,18 Some nurses may want

the support of a counselor. It is a strength to realize that

you are struggling with your mental health and need


Early psychological intervention does make a

difference. 19 Each of us has a limit to stress, and it is

important not to compare your stress levels to those of

another person. There is strength in being vulnerable

and showing our thoughts and emotions. Brené Brown

defines vulnerability as uncertainty, risk, and emotional

exposure. 20

Topping off emotional reserves

Nurses on the COVID-19 front lines are plagued by

drained emotions, loneliness, and fear. These are normal

reactions to an unfamiliar, uncertain environment.

Transitioning away from work at the end of the day is

essential for nurses to top off their emotional reserves.

If you have had a particularly stressful day,

acknowledging and discarding any negative thoughts

or feelings can help improve sleep quality. Having a

ritual to signal the end of work is essential. Here are

some suggestions:

• Take a shower. Visualize all the worries of the day

disappearing down the drain.

• Write down any thoughts or feelings in a notepad.

• Watch a favorite TV program.

• Read a book.

• Listen to your favorite music.

• Contact a friend.

• Write down three things you were grateful for


Final thoughts

The COVID-19 pandemic is an unprecedented

event in our lifetimes that will have untold mental

health implications for nurses and other healthcare

professionals on the front lines, both in the short

and long term. Although scientists and healthcare

professionals know more about the disease and how

to treat it now, nurses in current COVID-19 hotspots

will still be treating patients with a serious and rapidly

spreading disease while possibly contending with

shortages of PPE, equipment, and treatments. 21

Nurses will need to receive support from their team,

practice optimal self-care strategies, take measures to

replenish their emotional reserves, and learn how to

transition mentally from work to home after their shift.

Recognizing stress and learning how to cope will help

nurses protect their mental health as we move forward

during this pandemic.


1. Wann W. America is running short on masks, gowns and

gloves. Again. The Washington Post. 2020. www.


2. Mariotti A. The effects of chronic stress on health: new

insights into the molecular mechanisms of brainbody

communication. Future Sci OA. 2015;1(3):FSO23.

3. American Psychological Association. How stress affects

your health. 2019. www.apa.org/helpcenter/stressfacts.

4. Heidt T, Sager HB, Courties G, et al. Chronic variable

stress activates hematopoietic stem cells. Nat Med.


5. Kabat-Zinn J. Full Catastrophe Living. 15th anniversary ed.

New York, NY: Piatkus; 2004:249.

6. Newman MG, Llera SJ, Erickson TM, Przeworski A,

Castonguay LG. Worry and generalized anxiety

disorder: a review and theoretical synthesis of

evidence on nature, etiology, mechanisms, and

treatment. Annu Rev Clin Psychol. 2013;9:275-297.

7. Gonzalez D, Nasseri S. ‘Patients have panic in their

eyes’: voices from a Covid-19 unit. The New York

Times. 2020. www.nytimes.com/2020/04/29/



8. Hayes C. Coronavirus: front-line NHS staff ‘at risk of

PTSD’. BBC News. 2020. www.bbc.com/news/uk-


9. Muller R. Trauma and the Struggle to Open Up. New York,

NY: WW Norton & Company; 2018:33.

10. Van Der Kolk B. The Body Keeps the Score. London:

Penguin; 2014:156-157, 166.

11. Bolton EE, Jordan AH, Lubin RE, Litz BT. Prevention of

posttraumatic stress disorder. In: Gold SN, ed. APA

Handbooks in Psychology. APA Handbook of Trauma

Psychology: Trauma Practice. Washington, DC:

American Psychological Association; 2017:483-497.

12. Psychology Today. Acute stress disorder. 2019. www.


13. American Psychiatric Association. Diagnostic and

Statistical Manual of Mental Disorders. 5th ed.

Arlington, VA: American Psychiatric Association;


14. American Psychiatric Association. What

is posttraumatic stress disorder? 2020.


15. Levine P, Blakeslee A, Sylvae J. Reintegrating

fragmentation of the primitive self: discussion

of “somatic experiencing.” Psychoanal Dialogues.


16. Highfield J. Am I OK? Intensive Care Society. 2020.



17. World Health Organization. Coronavirus disease

(COVID-19) outbreak: rights, roles and

responsibilities of health workers, including

key considerations for occupational safety and

health. 2020. www.who.int/publications/i/item/


18. American Association of Critical-Care Nurses.

Well-being Initiative. 2020. www.aacn.org/


19. World Health Organization. WHO guidelines on

conditions specifically related to stress. 2013.



20. Brené Brown. Vulnerability. 2020. www.brenebrown.


21. Frank S. As coronavirus slams Houston hospitals,

it’s like New York “all over again.” The New York

Times. 2020. www.nytimes.com/2020/07/04/us/


This article has been adapted for space and

originally appeared in the September 2020 issue of

Nursing © 2020 Wolters Kluwer Health, Inc.

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.

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