One Profession. Many Roles.
The Official Publication of the Arizona Foundation for the Future of Nursing
Quarterly Publication distributed to over 58,000 Registered Nurses in Arizona
Vol. 75 • Number 1
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Brought to you by the Members of AzNA. For more information on the benefits of membership, please visit www.aznurse.org.
Kindness: The Domino Effect
By Ronnie Sheridan Ed.D., MSN/ED, RN
I love critical care and mental health nursing. I
have worked in both for over 25 years. Teaching
nursing students is my greatest love. It is a pathway
that one chooses not for money, prestige, or less
work. It is chosen because you want to make a
difference in nursing.
I realized that by teaching nursing students, I
could reach more lives. The truth is that I thought
it was my knowledge of critical care and mental
health that spread knowledge to create a legacy
of saved lives. But, after years of teaching, student
feedback, and the pandemic, I have another view:
Showing kindness is as simple as a smile and
“how can I help you?” to your colleagues. It’s
forgiveness and understanding. It’s supporting
and caring for one another. It is being kind even
in the hardest of times.
Kindness has a domino effect. I know this to be
true as each day I go into class or clinical, I walk
in full of energy, smiles, and kind words. I share
stories of empathy, kindness, and the power of a
smile or a backrub. I LIVE kindness as a role model
for each student so that they may carry it with
them to their units and share it the way a stack
of dominoes perfectly falls and goes the distance.
The pandemic and seeing nurses strongly come
together made me realize that kindness and a
positive attitude are my greatest gifts to students.
It is that which they mention the most to me; the
thing they say makes a difference. As one student
texted, “I asked myself what she would do.” I
smiled, I raised my head high, and I saved lives.”
Be the Domino Effect of kindness.
Kelly Victor, RN, has been a nurse for 20+
years. Her motto for life and her patients is
“because nice matters” and she models it
every day. This is her license plate.
Call for Article Submission
Submit your article or research for publication in AzNA’s quarterly print publication.
The Arizona Nurse is distributed to over 58,000+ RNs in the state.
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We encourage short summaries and brief abstracts for research or scholarly contributions
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on the AzNA website at www.aznurse.org/Guidelines.
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Submission of articles constitutes agreement to allow changes made by editorial staff and
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Submit your article to firstname.lastname@example.org.
Sharon McKee at Gateway Community
College is proud of her accomplishments.
She started nursing at the age of 17 as an
LPN and finished with a PhD.
Laurel Bilbo’s two favorite things are
being a nurse and a grandma. This plate
showcases both her role as “Oma” to her
grandson and as an RN.
Do you have a nurse pride license plate you
want to share? Send it to email@example.com.
You might be on our next front page!
current resident or
U.S. Postage Paid
Permit No. 14
President's Message ...............2
CEO’s Message ..................3
Annual Report 2021 ...............4
Preventing Delirium in Pediatric
Intensive Care Unit Patients .........5
A Message from the AzNA PAC .......6
It’s Time to Recognize a
Nurse-Patient Evidentiary Privilege ...6
Support of nurses’ wellness ...........7
Call for Volunteers .................7
Think like an expert witness
to avoid falls liability .............8
Members on the Move ..............9
Evolution of an Online
Interactive Experience ...........10
A Study of the Mind ..............10
Honoring Arizona’s Fallen Heroes .....10
Nursing New Year’s Resolutions ......11
Stepping into the Patient’s Shoes:
Providing Better, Safer Patient Care ..12
The Great R(N)esignation ...........13
Two Year Anniversary Members ......14
AzNA’s Superstars ...............14
New & Returning AzNA Members ....15
Page 2 • Arizona Nurse January, February, March 2022
As I think about what
I would most like to
share with you in my first
President’s Message, I
can’t help but review the
arc of past, present, and
future. This has been a
tumultuous few years, and
by all accounts, the roller
coaster shows no signs of
stopping anytime soon.
So, what can we do? In
times of uncertainty, it is
human nature to seek out
The Future is Now
the comfort and safety of our community. Many
of you have heard me describe AzNA as my tribe.
My hope is that AzNA becomes your tribe, too. An
insular community where we support each other
through the tough times and stand together to
share our nursing voice. The world is listening to
us like never before, and AzNA amplifies our voice.
So, what should we be saying? A big topic on
everyone’s mind of late is workforce development.
What is being done to attract future nurses, educate
them effectively, and orient them into the nursing
role? I was struck recently by an article I read that
described the future nurse. Dr. Marla Weston (2021)
writes about all the unique skills that today’s gradeschooler
has acquired: using video conferencing
platforms while deftly communicating through
verbal, chat, and paper-based mediums;
multitasking across technology platforms and
devices while maneuvering firewalls and security
In Memory of...
Barbara Palley Fargotstein,
AzNA Member, passed
away on Monday, October
4, 2021 after a courageous
battle with West Nile Virus.
protocols; focusing on what is happening in the
online world while attending to (or tuning out) the
myriad distractions of daily life. To me, these are
the same skills that we all have learned and that
our future nurses will need to master. This is true
especially as we focus on keeping people out of
hospitals, managing complex illnesses at home,
and identifying subtle changes in conditions that
warrant a closer examination.
Merely identifying the skills our future workforce
needs is only half the battle. The more pressing
task before us today is improving recruitment
and retention. This work begins in primary and
secondary education, where we must now work
to attract nursing graduates of 2030 and beyond.
We also need to promote innovation in nursing
programs through simulation, virtual reality, and
unique clinical models that deliver knowledge
while adding value to our clinical partners across
the state. Finally, we need to support nurses
just beginning their careers, providing needed
resources and guidance to thrive in their roles
while mitigating burnout and compassion fatigue.
And we also must protect our experienced nurses,
giving them what they need to keep coming to
work and shepherding new generations into the
This work requires us to focus on the entire
lifecycle of a new nurse, recognizing that it takes
many years, countless people, and significant
resources to create the nurse of the future. A job
perfectly suited for our nursing tribe. We need to
rally around the issues and work together to create
the solutions needed to change course. Each one of
us has specialized expertise and a book of stories
that, when pulled together, provide the roadmap
we need. This call to action is timed perfectly with
the start of the next legislative session in Arizona.
I hope you will lend your voice to help AzNA
advocate for the future of the profession and the
wellbeing of our communities. Please, join my
Weston, M. (2021). Today’s first grader is tomorrow’s
nurse. Medium. https://medium.com/calling-theleadership-circle/todays-first-grader-is-tomorrows-nurse-c0caa88f9ece
Arizona Nurse Editorial Board
Carol Peyton Bryant, DNP, RN, ACNP, CCRN
Rebekah Christopher, RN
Sierra Holloway, MSN, RN
Anna Hustin, MSN, RN, NE-BC
Sherry Ray, EdD, MSN, RN, CHSE
Sue Roe, DPA, MS, BSN, RN
Melisa Salmon, MSN, RN, CCRN, MBA
Alicia Shields, MSN, RN, CENP, DNP-student
Krystal Tobin, BSN, RN-BC
Christy Torkildson, PhD, RN, PHN, FPCN
Melissa Zuber, BSN, RN
The editorial board of the Arizona nurses is comprised of
members of the Arizona Nurses Association, who review all
submissions, provide expert advice on content, attract new authors,
and encourage submissions.
If you are interested in serving on the editorial board, please
contact firstname.lastname@example.org for more information.
Rhonda Anderson, DNSc, RN, FAAN, FACHE
Pat Mews, MHA, RN, CNOR
Chloe Littzen, BSN, RN
Sharon Rayman, MS, RN, CCTC, CPTC
Fran Roberts, PhD, RN, FAAN
Tim Mislan, MS, RN
Dawna Cato, PhD, RN
Board of Directors
Heidi Sanborn, DNP, RN, CNE
Amanda Foster, MSN, APRN, FNP-C
Beth Hale, PhD, RN
Governmental Affairs Officer:
Heather Ross, PhD, DNP, ANP-BC, RN, FAANP
Sonia Blau, BSN, RNC-OP, CDP
Robert “Bill” Adams, MSN, RN, CDCES, NHDP-BC
Selina Bliss, PhD, RN, CNE, RN-BC
Dawna Cato, Phd, RN, NPD-BC, Chief Executive Officer
Wendy Knefelkamp, Director of Operations
Madi Moyer, Communications Specialist
The Arizona Nurse (ISSN 0004-1599) is the official publication
of the Arizona Foundation for the Future of Nursing (AzFFN), peer
reviewed and indexed in Cumulative Index for Nursing and Allied
Health Literature. Arizona Nurse Author Guidelines are available
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No material in the newsletter may be reproduced
without written permission from the Chief Executive Officer.
Subscription price: included in AzNA membership or $30 per
year. The purpose of the Arizona Nurse is to communicate
with AzNA members and non-members in order to 1) advance
and promote professional nursing in Arizona, 2) disseminate
information and encourage input and feedback on relevant
nursing issues, 3) stimulate interest and participation in AzNA
and 4) share information about AzNA activities.
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Responsibility for errors in advertising is limited to corrections
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Advertisements do not imply endorsement nor approval
by the Arizona Foundation for the Future of Nursing (AzFFN)
of the product advertised, the advertisers or the claims made.
AzFFN shall not be held liable for any consequences resulting
from the purchase or use of advertised projects. AzFFN,
AzNA and Arthur L. Davis Publishing Agency, Inc. reserve the
right to reject advertisements. Rejection of an advertisement
does not imply that the offering or product for advertisement
is without merit, lacks integrity, or that this association
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The Arizona Nurses Association is a constituent member
of the American Nurses Association.
January, February, March 2022 Arizona Nurse • Page 3
Are we maintaining the public’s trust?
In December of 2020,
the Gallup Poll once
again demonstrated that
Professional Nursing is the
“most trusted profession”
with 89% of respondents
scoring very high/high for
honesty and ethics (Saad,
2020). This rating has
remained consistent for
the past 19 years, except
following the September
11th attack where
firefighters took the lead.
This coveted recognition should not be dismissed as
inconsequential. It is a huge responsibility to maintain
the status of the “most trusted profession.” We must
ensure that individuals seeking care continue to trust
their nurse to uphold the tenets of honesty, integrity,
and ethical comportment to maintain the delivery
of safe, quality patient care; that we have all come to
At this time, our healthcare providers are stretched
to capacity and maintaining or exceeding a standard
level of care has become exceedingly difficult. Our
profession continues to experience moral injury and
distress causing nurses to experience physical and
psychological harm (ANA, 2021.) According to the
American Association of Critical Care Nurses (AACN),
nurses are leaving the profession at unprecedented
rates, putting patient safety at significant risk (2021).
The current healthcare environment and future risks
to receiving safe quality care increases the need for
our profession to remain the most trusted and to
carefully consider our actions as we move into 2022
The American Nurses Association (ANA) provides
ethical guidance during times of crisis. Foundational
documents inclusive of the Code of Ethics for Nurses
state that we “establish relationships of trust and
provide nursing services according to need, setting
aside any bias or prejudice” (ANA, 2015). Of significant
concern to the disintegration of trust is misinformation
and disinformation. According to Johns Hopkins
Center for Health Security (2021), misinformation and
disinformation can undermine the response to the
COVID-19 public health crisis. Currently, our profession
is the “most trusted” profession to disseminate clear,
concise, relevant, and accurate information for public
protection. However, we cannot maintain this status
if we are not ensuring that our professional opinions
align with evidence-based research and credible
sources of information. We encourage all nurses to
maintain this status by learning and disseminating
accurate COVID-19 vaccine information, following the
nurse practice act and employer’s policies, and seeking
professional development from reliable sources. In
addition, recognize physical or psychological signs of
distress in self or others and seek out tools, strategies
and/or professional support.
The Arizona Nurses Association continues to
advocate for resources and funding to address the
current and emerging challenges we face. We are
working hard to prepare for the next legislative
session and collaborating with associations,
organizations, regulators, and leaders with vested
interests in the healthcare industry. We encourage
Arizona nurses to become engaged in the work
AzNA is doing though committee membership
and advocacy. For more information contact
American Association of Critical-Care Nurses. (2021).
Hear Us Out Campaign Reports Nurses’ COVID-19
American Nurses Association. (2020.) Nurses, Ethics and
The Response to The COVID-19 Pandemic. https://
ANA Enterprise. (2021). COVID-19 Survey Series Results.
ANA Enterprise. https://www.nursingworld.org/
ANA Enterprise. (2015). Code of Ethics for Nurses
with Interpretive Statements. American Nurses
Kirk Sell, T., Hosangadi, D., Smith, E., Trotochaud, M.,
Vasudevan, P., Kwik Gronvall, G., Rivera, Y., Sutton,
J., Ruiz, A. & Cicero, A. (2021). National Priorities
to Combat Misinformation and Disinformation
for COVID-19 and Future Public Health Threats:
A Call for a National Strategy. Johns Hopkins
Center for Health Security. https://www.
Saad, L. (2020). U.S. Ethics Ratings Rise for Medical
Workers and Teachers. Gallup. https://news.gallup.
Page 4 • Arizona Nurse January, February, March 2022
Annual Report 2021
2021 by the Numbers
• Educated members on the legislative process and the valuable voice of nurses in the
public policy arena
• Supported the passing of bills that enhanced the health of the people of Arizona and
provide necessary resources to nurses across the state
• Featured AzNA members and their nursing journeys across all social media
• Elected new leaders to both the AzNA Board of Directors and each individual AzNA
Chapter’s Board of Directors
• Expanded opportunites to foster connection and collaboration through an in-person
convention and many virtual events
• Awarded scholarships to nursing students to allow for continued education of
future nurses and leaders of the profession
• Donation of 120,000 boxes of Girl Scout Cookies from Girl Scouts Arizona
Cactus-Pine Council for donation to frontline nurses across Arizona
• Sponsorship of the March of Dimes 2021 Heroes in Action Award
• Collaboration with Better Place Forests to create a Heroes Memorial in conjunction
with the Fallen Nurse Ceremony
Revenue: $525,000 Expenses: $477,000
CE Review Fees
Upcoming in 2022
CE Review Unit
Launched New Programs
• RNconnect: re-launched in January with new messaging
• Fallen Nurse Tribute: an event to honor Arizona nurses who have lost their lives
• School Nurse Access Program (ASAP): collaboration with various organizations
with a goal to increase the number of school nurses in the state
In early 2022, AzNA will
debut its new podcast!
This podcast series will
include discussions about
the nursing profession and
healthcare in general. Stay
tuned for information on
how you can get involved!
Save the date for some
exciting AzNA events
happening in 2022.
2/16/2022 - Healthcare at the Capitol Day
7/30/2022 - NP Symposium
9/29-10/1/2022 - AzNA Annual Convention
January, February, March 2022 Arizona Nurse • Page 5
Preventing Delirium in Pediatric Intensive Care Unit Patients
Delirium is a concern in many intensive care
unit settings and has been recognized as having
potential implications in the pediatric population.
This problem was identified by a pediatric intensive
care unit (PICU) nurse who floated to an adult
intensive care unit and noticed that they screened
their patients for delirium. After searching the
literature, she found that this topic was emerging
as an area of concern in the pediatric realm as well.
Sadly, pediatric delirium is an under-recognized,
untreated problem, but can be avoided (Holly, et
Evidence is strong that delirium can be quite
costly for PICU patients. Systematic reviews suggest
that pediatric delirium increased patient duration
of stay, cost, and even resulted in mortality (Holly,
et al., 2018). However, prevention is possible with
early detection, staff education, implementation of
screening tools, and preventative interventions.
Nurses are heavily involved in pediatric patient
care and as such they are in an optimal position
to recognize delirium characteristics and reduce
risk (Holly, et al., 2018). Recognition of delirium
and education on this topic are key in preventing
detrimental outcomes for high acuity pediatric
Nurse-driven evidence-based projects can lead
to a technology improvement where a delirium
screening tool can be incorporated into a nurse
charting system. This process was implemented in
one Scottsdale pediatric intensive care unit with
success. The first objective of this project was to
provide extensive education on delirium to the staff
(assessment of knowledge occurred with a pre- and
post-test). Then the Cornell Assessment of Pediatric
Delirium (CAPD), a valid, rapid, observational
nurse screening tool was implemented into nurse
charting to help with the detection of delirium
in the PICU setting (Traube, et al., 2017). This
technology improvement project also focused on
directing nurses to apply preventative interventions
and to follow up on action items such as provider
notification if a screening was positive.
Implementation allows for the CAPD screening
tool to be completed and documented on all PICU
patients in this hospital each shift. Furthermore,
preventative interventions for delirium are
applied and score trends are monitored in
documentation. Following project completion,
doctors and nurses now round together and
collaborate to decrease the rates of pediatric
delirium. Since January 2021, over 270 PICU
patients have been screened for delirium on this
unit. Twenty-six patients were identified as having
positive screenings. Physician collaboration with
nursing to reduce risk in these patients has been
initiated to improve outcomes.
Holly, C., Porter, S., Echevarria, M., Dreker, M.,
& Ruzehaji, S. (2018). CE: Original research:
Recognizing delirium in hospitalized children:
A systematic review of the evidence on risk
factors and characteristics. The American
Journal of Nursing, 118(4), 24-36. doi:10.1097/01.
Traube, C., Silver, G., Kearney, J., Patel, A., Atkinson,
T. M., Yoon, M. J., Greenwald, B. (2014). Cornell
assessment of pediatric delirium. Critical
Care Medicine, 42(3), 656-663. doi:10.1097/
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Page 6 • Arizona Nurse January, February, March 2022
A Message from
the AzNA PAC
The purpose of the AzNA PAC is to endorse
candidates for the Arizona Legislature based upon
the principles of the AzNA Public Policy Agenda.
AzNA-PAC encourages nurses to become active
and effective in shaping public policy through
the electoral process. With the legislative session
approaching, one way nurses can begin to become
involved with AzNA-PAC is through donations.
The AzNA PAC raises money for a variety of
causes including the education of nurses about
politics and contribution to selected campaigns.
Our elected legislators make laws and now, more
than ever, we need laws that not only help us manage
and mitigate the effects of the COVID-19 pandemic
but laws that enhance a culture of health that will
enable the people of Arizona to live the healthiest
lives possible. This is just what nurses do.
The PAC is gearing up for 2022 elections and
needs your donations now. Save the date for our
Spring 2022 Casino Night Fundraiser in April or
don’t wait and become a PAC subscriber today
by going to https://www.aznurse.org/page/
PACdonate. Don’t miss out – become a monthly
subscriber and know your donations are going
towards electing the right people at the right time
for the right job.
To see the full job description and
qualifications, please see our job
posting on nursingnow.com.
YC is an equal opportunity employer.
invites applications for the position of:
Associate Professor, Nursing
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AT THE PRESCOTT CAMPUS
IN PRESCOTT, AZ
For more information and to apply:
Click on Work @ YC
It’s Time to Recognize a Nurse-Patient
Michael D. Moberly
The physician-patient privilege enables physicians
to maintain the confidentiality of sensitive information
about their patients’ health. 1 The privilege is intended
to ensure that patients receive the best medical
treatment possible “by encouraging full and frank
disclosure of medical history and symptoms.” 2
Although a nurse-patient privilege would serve
precisely the same purpose, 3 this privilege has never
been recognized in Arizona. 4
A nurse’s inability to claim the protection of an
evidentiary privilege might cause some patients to
withhold information essential to their care. 5 The
implications of this situation are clear. In the absence
of a privilege,
[t]he patient’s only surefire means to prevent . .
. disclosure would be to forgo turning over the
confidential information in the first place. This is
not a realistic option because a patient cannot
expect delivery of medical services without
disclosing such data. . . . In order to receive
treatment, a patient must reveal personal
The Gomez Case
The only reported Arizona case in which the
potential recognition of a nurse-patient privilege
was addressed is the nearly century-old decision of
a federal appellate court in Southwest Metals Co. v.
Gomez. 7 The court in Gomez refused to extend the
protection of Arizona’s statutory physician-patient
privilege to a nurse who assisted a physician during
a medical procedure. Because the relevant statutory
language limits the privilege’s application to physicians
and surgeons, the court concluded that any extension
of its protection to nurses is the prerogative of the
legislature, and could not be accomplished through
an expansive judicial interpretation of the statute. 8
The Tucson Medical Center Case
The Arizona legislature has shown no inclination
to extend the protection of the physician-patient
privilege to nurses. However, Arizona’s state
courts have occasionally interpreted the privilege
expansively in order to protect patient privacy. 9 In
Tucson Medical Center v. Rowles, 10 for example, the
Arizona Court of Appeals held that the privilege’s
protection encompasses information contained in a
patient’s hospital records, even though those records
invariably reflect nurse-patient communications. 11
In reaching this result the court concluded that it
was not bound by the narrow interpretation of the
privilege in the Gomez case. 12
The physician-patient privilege is premised on the
assumption that patients will be more forthcoming
about their health conditions if they know their
communications with their physicians can be kept
confidential. 13 Because this assumption is equally
applicable to communications between nurses and
patients, 14 there is no persuasive reason for failing to
extend to nurses the protection of a privilege that has
long been enjoyed by physicians. 15
Michael D. Moberly is an attorney in the Phoenix
office of Ryley, Carlock & Applewhite.
1. The Arizona legislature has adopted physician-patient
privilege statutes applicable in both civil and
criminal proceedings. See Ariz. Rev. Stat. Ann. §§ 12-
2235 & 13-4062(4).
2. Lewin v. Jackson, 492 P.2d 406, 410 (Ariz. 1972).
3. See Rebecca J. Pierce, Comment, Statutory Solutions
for a Common Law Defect: Advancing the Nurse
Practitioner-Patient Privilege, 47 J. Marshall L. Rev.
1077, 1087 (2014) (“[T]he necessity of encouraging
people to divulge private medical information is not
limited to communications between physicians and
patients, but extends to communications between
nurses and patients.”).
4. Arizona is not alone in this regard, as “many states
that support a physician-patient privilege do not
recognize a general nurse-patient privilege.” Id. at
5. See Peter A. Winn, Confidentiality in Cyberspace:
The HIPAA Privacy Rules and the Common Law, 33
Rutgers L.J. 617, 622 (2002) (“[N]urses . . . have long
known that fear of disclosure of health information
may cause people to withhold information, to lie, or
to avoid treatment altogether.”).
6. Doe v. Guthrie Clinic, Ltd., 5 N.E.3d 578, 583 (N.Y. 2014)
(Rivera, J., dissenting).
7. 4 F.2d 215 (9th Cir. 1925).
8. See id. at 217, 218.
9. See State v. Zeitner, 436 P.3d 484, 491 (Ariz. 2019) (noting
that “Arizona courts have expanded the physicianpatient
privilege beyond its original testimonial
10. 520 P.2d 518 (Ariz. Ct. App. 1974).
11. See Johnston v. Miami Valley Hosp., 572 N.E.2d 169,
171 (Ohio Ct. App. 1989) (“Since nurses often spend
more time than physicians with hospital patients,
their notes often comprise the bulk of the hospital
12. See Tucson Med. Ctr., 520 P.2d at 521 n.1.
13. See Carondelet Health Network v. Miller, 212
P.3d 952, 954 (Ariz. Ct. App. 2009).
14. See Pierce, supra note 3, at 1086 (“The reasons
underlying the physician-patient privilege apply
with equal, if not more, force to communications
between nurses and patients.”).
15. See Hermanson v. MultiCare Health Sys., Inc., 475 P.3d
484, 491 (Wash. 2020) (“[B]ased on the similar work
nurses and physicians conduct with their patients,
‘policy considerations . . . dictate application
of a privilege for registered nurses similar to the
physician privilege.’” (quoting Substitute S.B. Rep.
4107, 49th Legis., Reg. Sess., at 1 (Wash. 1985))).
Wellness Directors Needed
Hiring Full Time
and Part Time
LPNs & RNs
To apply, email
January, February, March 2022 Arizona Nurse • Page 7
Support of nurses’ wellness critical to healthcare
Jennifer Berube, PhD, RN
Health, wellness, and self-care are priorities for nurses. Health
incorporates the components of physical and mental well-being. Core
skills related to self-care include mindfulness, emotional intelligence,
self-compassion, and intention. Dimensions of wellness include physical,
intellectual, emotional, social, spiritual, occupational, financial, and
environmental domains. Included in this are aspects related to a healthy
workplace environment. As such, it is essential for nurses to engage
in health-and wellness-promoting activities and for healthcare work
environments to support health and wellness.
The American Nurses Association Code of Ethics, Provision 5 states
that nurses owe the same duties to self as to others, including their
responsibility to promote health and safety. However, according to a
recent survey, 68% of nurses reported they put the health, safety and
wellness of patients before their own and 82% of nurses are reportedly
at a significant level of risk for workplace stress. Prior to the pandemic,
nurses had reported suboptimal physical and mental health, which
has been exacerbated by the effects of the pandemic. The health and
well-being of nurses is essential, so much so that the American Nurses
Association, in coordination with the World Health Organization, marked
2020 the Year of the Nurse - which was extended through 2021 due to
the impact of the pandemic. Two corresponding health and wellness
initiatives from the American Nurses Foundation include the Well-Being
Initiative and the Healthy Nurse Healthy Nation Initiative.
As we know, nurses are aware of health, wellness, and self-care
strategies but often fail to apply these in daily life and nursing practice.
Beyond affecting nurses, this is significant because poor health can affect
the delivery of healthcare. Factors such as poor physical and mental
health, stress, burnout, fatigue, and distress can impact quality and safety.
Self-care for nurses and workplace wellness initiatives can address these
issues. Self-care for nurses has been associated with positive outcomes,
such as increased resilience and decreased compassion fatigue and
burnout. There is also an association between workplace wellness
support and improved health and wellness.
In addition to nurses engaging in self-care practices, a healthy
workplace environment is also essential to promoting nurses’ health
and wellness and fostering self-care. A recent survey found 25% of
nurses had been physically assaulted at work by a patient or patient’s
family member, 9% of nurses were concerned for their physical safety
at work, and about half of nurses reported they had been bullied in
some manner in the workplace. Important components related to safe
Call for Volunteers
AzNA is in need of volunteers for the following committees:
Public Policy Committee - Members of the Public Policy
Committee are active from January-April. Each week, committee
members will review and discuss proposed legislation through
live Zoom sessions or pre-submitted comments. The decisions
made through discussion are then recommended to the
Executive Policy Team.
RNconnect Committee - Members of the RNconnect Committee
will be responsible for creating the theme and messaging that
is sent through the RNconnect text service. Service on this
committee will total 1-2 hours a month.
2022 Convention Planning Committee - Members of the
Convention Planning Committee will meet beginning in
January 2022. This committee will be in charge of developing
a theme, researching appropriate speakers and planning other
aspects of the fall convention. This committee meets for about
9 months prior to the event as needed.
Fallen Heroes Tribute Planning Committee - Members of the
Fallen Heroes Tribute Planning Committee will help plan a
tribute for the fallen nurses and healthcare workers of Arizona.
The tribute will take place in May 2022 at Better Place Forests
Sign up to volunteer with one of these committees by
completing the form on this page.
workplace environments from the American Nurses Association include
safe staffing, health and safety, and ending and preventing nurse abuse,
violence, incivility, and bullying. The American Association of Critical
Care Nurses (AACN) identifies the following as the hallmarks of a healthy
workplace environment: skilled communication, true collaboration,
effective decision making, appropriate staffing, meaningful recognition
and authentic leadership. They report these techniques have led to
improvements in quality of patient care, appropriate staffing, intent to
stay, moral distress, and nurse satisfaction.
It was recently reported that 67% of nurses have access to worksite
wellness health promotion programs. According to the American Nurses
Association, health care work settings that invest in safety, health, and
well-being can improve recruitment, retention, and satisfaction, and
help maintain a sustainable workforce, all of which are necessities in
today’s healthcare environment. There are many strategies to support
health and wellness for nurses within the workplace environment. The
American Nurses Association recommends that nurses take advantage
of what employers already offer and assist in securing more health and
well-being opportunities in the workplace.
Jennifer Berube, Ph.D., is an assistant professor in Trine University’s RNto-BSN
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Page 8 • Arizona Nurse January, February, March 2022
Think like an expert witness to avoid falls liability
Georgia Reiner, MS, CPHRN
An 88-year-old patient slips on the floor,
falling and breaking his hip. Your immediate
concern is getting him the help he needs, but
you also wonder if you could be legally liable
for what happened. By thinking like an expert
witness, you can help determine if this concern
is valid and whether you could have taken steps
to avoid the situation in the first place. But first,
you need to understand some background
Elements of malpractice
To be successful in a malpractice lawsuit,
plaintiffs must prove four elements:
1. Duty. A duty existed between the
patient and the nurse: The nurse had a
responsibility to care for the patient.
2. Breach. The duty to care was breached.
To determine if negligence occurred, the
expert witness would consider whether
the nurse met the standard of care, which
refers to what a reasonable nurse with
similar training and experience would do
in a particular situation.
3. Injury. The patient suffered an injury. Keep
in mind that an injury can be defined as not
only physical injury but also psychological
injury or economic loss.
4. Causation. The breach of duty caused the
injury: Did the act or omission cause the
Expert witnesses will consider these four
elements as they review the case, and they will
ask multiple questions (see Was there liability?).
The questions primarily address prevention and
what was done after the fall occurred.
The following steps can help prevent falls
and, if documented correctly, prove that the
nurse took reasonable steps to protect the
patient from injury:
Take a team approach. Registered nurses, licensed
practical/vocational nurses, and certified nursing
assistants are ideal members for a team dedicated
to creating a falls reduction plan for each patient.
Assess the risk. A comprehensive assessment
is essential to identify—and then mitigate—falls
hazards. This starts with assessing the patient for
risk factors such as history of a previous fall; gait
instability and lower-limb weakness; incontinence/
urinary frequency; agitation, confusion, or impaired
judgment; medications; and comorbid conditions
such as postural hypotension and visual impairment.
Keep in mind that assessment should be ongoing
during the patient’s care because conditions
may change. It’s also important to consider the
environment, particularly in the home setting.
An excellent resource for assessing communitydwelling
adults age 65 and older is the CDC’s
STEADI (Stopping Elderly Accidents, Deaths &
Develop a plan. Once the assessment is
complete, the patient care team, including the
patient and their family, can develop a fallsreduction
plan based on the patient’s individual
risk factors. The plan should address locations that
are at greatest risk, such as bedside, bathrooms,
and hallways, and then detail action steps.
Communicate. It’s not enough to create a plan;
communication is essential for optimal execution.
All care team members, including patients and their
families, need to be aware of the patient’s fall risk
and the falls reduction plan. The STEADI initiative
has falls prevention brochures for patients and
family caregivers at www.cdc.gov/steadi/patient.
html. The falls risk reduction plan, communication
with others, and education provided should all be
documented in the patient’s health record.
If a fall occurs
Despite nurses’ best efforts, a patient may fall.
An expert witness will scrutinize how the nurse
responded to the event. The following steps will
help to reduce the risk of a lawsuit or the chance
that a lawsuit is successful:
Was there liability?
If a patient falls, an expert witness will
likely want to know the answers to the
following questions (developed by Patricia
Iyers) when deciding if liability may exist:
• Was the patient identified as being at risk
for falls? How was that risk communicated
• Were measures implemented to prevent
• Approximately how soon was the
individual found after they had sustained
• What was done at the time of the fall?
• Was the patient appropriately monitored
after the fall to detect injuries?
• What did the assessment (including vital
• Did the nurse communicate the findings
to the patient’s provider?
• Were X-rays ordered and performed?
• Was there an injury? If so, how soon was it
• If the patient hit his head, was the chart
reviewed to determine if mediations
included an anticoagulant? If on an
anticoagulant, was this information
communicated to the provider so head
scans could be performed to check for
• Was there a change in mental status after
• Were additional assessments and
monitoring done as follow up?
• Was the patient’s risk for falls reassessed
after the fall and the plan of care revised
to minimize the risk of future falls?
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Assess the patient. Examine the patient for any
obvious physical or mental injuries. Do not move
the patient if a spinal injury is suspected until
a full evaluation can be made. Be particularly
alert for possible bleeding if the patient is taking
anticoagulants. When appropriate, ask patients
why they think they fell and continue monitoring at
Communicate assessment results. Notify the
patient’s provider of the fall and results of the
assessment. The provider may order X-rays for
further evaluation. Remember to mention if the
patient is taking anticoagulants, particularly in the
case of a potential head injury, so the appropriate
scans can be ordered.
Revise the plan. As soon as possible, after the fall,
work with the team to reassess risk factors, revisit the
falls reduction plan, and revise the plan as needed.
It’s important that actions are taken to prevent future
falls and that those actions are documented.
Document. Each step should be documented in
the patient’s health record, especially all assessment
results and provider notifications.
Unfortunately, patient falls are not completely
avoidable. However, developing a well-conceived
prevention plan can help reduce the risk, and taking
appropriate actions after a fall can help mitigate
further injury. Both prevention and post-fall followup
not only benefit patients but also reduce the risk
of a lawsuit. \
January, February, March 2022 Arizona Nurse • Page 9
Article by: Georgia Reiner, MS, CPHRM, Senior
Risk Specialist, Nurses Service Organization
ON THE MOVE
Bono MJ, Wermuth HR, Hipskind JE. Medical
malpractice. StatPearls. 2020. www.ncbi.nlm.
Centers for Disease Control and Prevention.
Important facts about falls. www.cdc.gov/
Centers for Disease Control and Prevention.
STEADI: Materials for healthcare providers.
CNA, NSO. Nurse Professional Liability Exposure
Claim Report: 4th Edition. 2020. www.nso.
Dykes PC, Adelman J, Adkison L, et al. Preventing
falls in hospitalized patients. Am Nurs
Today. 2018;13(9):8-13. https://www.
Iyer P. Legal aspects of documentation. In: KG
Ferrell, ed. Nurse’s Legal Handbook. 6th ed.
Wolters Kluwer; 2015.
Van Voast Moncada L, Mire GL. Preventing
falls in older persons. Am Fam Physician.
Dr. Ellen Poole, of Glendale, a Chamberlain University Professor at their Phoenix campus, has been
recognized as Arizona’s Distinguished Nurse of the Year (2021) by the March of Dimes as part of their
Heroes in Action campaign. The Distinguished Nurse of the Year awardee is selected from candidate
finalists representing 15 nursing categories. Dr. Poole, PhD, RN, CPAN, CNE, FASPAN, who has a specialty
in perianesthesia nursing, is being recognized for contributing to patient care, community service, and
advocacy. She has been a Chamberlain nursing professor for almost 14 years, where she is dedicated
to serving a diverse student population. In addition to teaching undergraduates, she teaches graduate
programs that prepare students to become advanced practice nurses and nurse leaders.
Some of her accomplishments include:
• Induction into the inaugural class of the Fellows of the American Society of Perianesthesia Nurses in
2018 in recognition of her leadership, education and research contributions to the specialty.
• Researched various topics in Perianesthesia Nursing, from family presence to patient education, for
over 30 years
• Published and presented nationally and internationally on critical care skills, staffing issues, and
• Being a member of almost 20 professional nursing organizations, including the American Society of
Perianesthesia Nurses and the Arizona Nurses Association.
Congratulations to AzNA member Dr. Ellen Poole for being named Arizona’s Distinguished Nurse
of the Year for 2021.
Are you an AzNA Member with an accomplishment to highlight?
Send to firstname.lastname@example.org.
Disclaimer: The information offered within this
article reflects general principles only and does
not constitute legal advice by Nurses Service
Organization (NSO) or establish appropriate or
acceptable standards of professional conduct.
Readers should consult with an attorney if they
have specific concerns. Neither Affinity Insurance
Services, Inc. nor NSO assumes any liability for
how this information is applied in practice or for
the accuracy of this information.
We have 1 RN Position & 1 RN-Case Manager position
open within our 5-clinic primary care system.
This risk management information was provided by
Nurses Service Organization (NSO), the nation’s
largest provider of nurses’ professional liability
insurance coverage for over 550,000 nurses since
1976. The individual professional liability insurance
policy administered through NSO is underwritten
by American Casualty Company of Reading,
Pennsylvania, a CNA company. Reproduction
without permission of the publisher is prohibited.
For questions, send an e-mail to email@example.com
or call 1-800-247-1500. www.nso.com.
Join other post-acute care nurses and healthcare
professionals to share best practices, expand your
knowledge, and make lasting connections.
Register now at AAPACN.org
We are tasked with providing health care for the
underserved. We are the largest Medicare and Medicaid
provider in this area. The RN position is in San Luis area,
the RN-Case Manager position is in the
central Yuma area.
Apply directly & download resume & application:
For questions: Debra Hunter, HR Director
928.329.5474 or firstname.lastname@example.org
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Page 10 • Arizona Nurse January, February, March 2022
Evolution of an Online Interactive Experience
Amanda Brown, MSN-Ed, RN, Shannon Campbell
DNP, M. Adm, RN, PCCN-K, Matt Clerc, MSN-Ed, RN,
FGNLA, Mark Garcia, MSN-Ed, RN
In late 2018, a team of hospital-based Medical-
Surgical educators discovered that, unlike their
peers, new graduate nurses living more than 3
hours from their organization’s simulation lab
did not attend the medical-surgical academy
simulation. Attending simulation is important
because it allows learners to hone skills and
abilities while making errors without harming
real patients (Lavoie & Clark, 2017). The team
recognized this importance and wanted to
ensure that all learners attending the academy
received the same educational experience.
Durmaz, Dicle, Cakan, and Cakir (2012)
found that education provided in a computer
simulation was equivalent to that provided in
an actual simulation laboratory. The team took
this information and proposed converting the
pre-existing simulation scenarios into a format
that could be provided in an online interactive
experience (OIE) to all enrolled nurses.
The vision for the OIE was to use PowerPoint®
to create instructor-facilitated “choose your own
adventure” scenarios that could be presented
online through a Learning Management System
(LMS), Skype, or Teams meeting. As the scenario
progressed, learners would be provided with 3 to
4 potential actions such as assessing the patient or
calling a provider and were asked to choose what
action to take. Each chosen action took the learners
to a new slide that would continue the scenario.
Based on the learner’s choices, the patient would
decline or improve until the scenario met one of
multiple possible conclusions.
The initial OIE pilot occurred in-person in
November 2018. The instructors presented the
newly built OIEs in two different sessions to 63
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learners. During the initial pilot, it was noted that
some action choices were never chosen while others
were always chosen. It was also noted that one of the
OIEs was more in-depth than the other two. Postpilot
evaluations were positive, with learners rating
the effectiveness of the OIE at 3.5/4, which was the
same as pre-pilot simulation evaluations.
In early 2019, the OIE officially replaced
simulation for all learners enrolled in the medicalsurgical
academy. In the first quarter of 2019,
the educators created more robust and realistic
scenarios by modifying action choices and adding
additional content. They also acted out, recorded,
and embedded videos of portions of the scenarios.
Throughout 2019, the results demonstrated
continued success of the OIE with an average rating
at 3.6/4. In 2020, no significant changes were made
to the OIEs, and evaluation ratings were consistent
at 3.6/4. Data from 2021 is not yet complete, but
preliminary results show that learners rate the OIE
as the most effective portion of the academy, with
a current average rating of 3.51/4.
Before the 1970’s, mind and body were treated
as two separate entities in healthcare. It is later, that
Dr. Herbert Benson scientifically demonstrated
the relationship between mind and body using
the sympathetic and parasympathetic nervous
systems. He coined the term relaxation response:
the interaction between body and mind to calm
down (parasympathetic), opposite of the fight
or flight response (sympathetic) (Benson, 2006).
This illustrated how it is the mental and emotional
capacities of the mind that initiate a respective
response from the body.
Many healthcare professionals define medicine
only in terms of the physical body. Yet, it is the mind
who directs how the body takes medication, it is the
mind who directs the body to seek help, and it is the
mind who is the defining factor in the body’s will to
fight for survival.
Mind and body make up the individual, but
healthcare treats these two faculties as separate
entities. Mind and body constantly strive to stay
in harmony with each other. Mind has the power
to move the body, and the body rejuvenates the
mind. The connection between the mental and the
physical is a powerful thing, and it deserves a place
of greater acknowledgement in healthcare.
To treat both mind and body requires one
to change their perspective of healthcare. The
skill a healthcare worker performs affects the
body of a patient, but how the healthcare worker
performs this skill affects the mind of an individual.
Subjective healthcare considers the complete
body in order to manage the disease; but Holistic
healthcare considers “The complete person,
physically, psychologically, socially, and spiritually,
in the management and prevention of a disease”
(Henderson, 2014). Acknowledging the connection
of mind and body, acknowledges the humanity in
Holistic healthcare requires an objective
perspective in order to understand without
judgment and keep an awareness of the individual.
A Study of the Mind
At the start of this journey, the education team
wanted to provide a consistent online educational
experience to all learners enrolled in the academy.
Over time, the OIEs have evolved into complex
online experiences where learners effectively
apply critical thinking and clinical reasoning
to realistic scenarios. In the future, the team
envisions the OIEs evolving into an online course
for learners to complete at their own pace and as
often as they wish.
Durmaz., A, Dicle, A., Cakan, E., Cakir, S. (2012).
Effect of screen-based computer simulation
on knowledge and skill in nursing students’
learning of preoperative and postoperative care
management: A randomized controlled study.
Computers, Informatics, Nursing (30)4, 196-203.
Lavoie, P., Clarke, S. (2017). Simulation in nursing
education. Nursing Management, (48)2, 16-17. https://
This intentional perspective is empathy. It requires
empathy to have an “objective awareness of [their]
thoughts and feelings and their possible meaning”
(Wiseman, 1996). Sympathy relates to the pain, but
empathy chooses to walk with that person in their
In order to walk with someone in their pain, one
must hear their story.
Unfortunately, society’s limited perspective of
the healthcare system prevents the ability for both
healthcare worker and patient to empathize with
the other’s position. Society rarely acknowledges
the humanity that is at the core of healthcare,
because of a lack of understanding of what
healthcare incorporates. A patient’s individuality is
a primary factor in the hospital bed, and their mind
is what accepts or rejects their circumstance. As a
healthcare worker, understanding what is going
on in the hospital bed is drastically different than
understanding what it means to be in the hospital
bed. The healthcare system structures perspective
through a diagnosis on a chart, but the chart will
only reveal so much. The healthcare system will be
transformed when seeing a patient or healthcare
worker as more than their label. This is the power
A patient who is acknowledged as an individual
will trust the caregiver with their vulnerability,
because now there is a connection between patient
and provider that extends beyond the medicine.
Empathy is what acknowledges the individual and
is the connection that builds trust in healthcare.
The connection that empathy creates causes a
breakthrough in social barriers and treats both mind
and body. This is the power of empathy.
Brower V. (2006). Mind-body research moves towards
the mainstream. EMBO Reports. https://doi.
Henderson, R. (2014). Holistic medicine. Patient. https://
Wiseman, T. (1996). A concept analysis of empathy.
Journal of Advanced Nursing, 23.6, 1162–1167.
Honoring Arizona’s Fallen Heroes
On May, 12, 2021, National Nurses Day, AzNA held its first annual tribute to honor the
fallen nurses and healthcare heroes of Arizona. In preparation for the tribute of 2022, we
ask that you consider submitting the names of any nurses that have lost their lives during
the pandemic so that we may honor them. The upcoming tribute will take place at Better
Place Forests in Flagstaff, where a ‘Heroes Memorial’ has been set up to honor Arizona’s
fallen nurses and healthcare heroes. More details will be released about the tribute closer to
May 2022. You can find more information about the event and the name submission form at
January, February, March 2022 Arizona Nurse • Page 11
Nursing New Year’s Resolutions:
The Evidence-Based Benefits of Taking Care of Yourself
Jacquelyn Martin, BSN, RN
With the New Year comes promises to be our “new best selves.”
Unfortunately, being the busy and selfless nurses that we are, our
resolutions often get pushed behind the needs of others. However, study
after study shows that nurses’ health reflects and impacts their patients. In
fact, nurses’ mental and physical health directly affects job performance,
satisfaction, and patient outcomes (Cheng et al., 2020; Giorgi et al., 2018).
This can be attributed to the integrative nursing principle that people are
whole systems and inseparable from their environments (Koithan, 2018).
As part of a complex system, improving our individual health improves
the health of the system. Therefore, we might say healthier nurses result
in healthier patients.
We can take ownership of our health by practicing self-care. Self-care
helps regulate emotions for nurses in stressful workplaces (Orellana-
Rios et al., 2018; Slatyer et al., 2018), making us more clear-headed in
the face of challenges. Engaging in self-care can also lead to improved
job satisfaction for nurses (Chen et al., 2020; Giorgi et al., 2018). When
we practice self-care, we model healthy behavior for our colleagues and
patients, fostering a healing environment.
Self-care is not just spa days and sangria. For nurses, self-care is
maintaining a balance between work and life. This means occasionally
taking a day off to see your child’s school performance or going to lunch
with a friend visiting from out of town. Scheduling a day off to enjoy nonwork
life shows that these life events are as important as work. Having a
healthy work-life balance might also mean bringing non-work activities
into the workplace, like scheduling a team lunch or hosting a baby shower
for a staff member. The perspective that work and life are a cohesive unit,
rather than two separate activities done at two different times, can create
a more empathetic, tighter-knit workplace.
Self-care doesn’t have to last a whole weekend or even a day. Evidencebased
integrative healing therapies like meditation, nutritious eating,
aromatherapy, breathing exercises, massage, and yoga can reduce
anxiety and improve your mood in just minutes (Lusk & Khan-John, 2018).
Utilizing holistic self-care allows nurses to reconnect with themselves,
familiarize themselves with alternative therapies which may benefit their
practice, can improve overall health (Rheume & Mullen, 2017), mediate
work-related stress (Orellana-Rios et al., 2018; Slatyer et al., 2018), and
improve workplace outcomes (Hodges et al., 2017).
This New Year, resolve to try one of these easy, short integrative selfcare
• Move: Research by Harvard, University of Michigan, and the National
Institutes of Health show that simply getting up and moving once
every 30-60 minutes, like your smartwatch reminds you to; has been
shown to increase blood flow and metabolism; improve mood,
focus, and energy; and decreases your risk for diabetes, heart
disease, and cancer (Dall, 2015). Trade your traditional meeting for
a walking meeting, do 5 minutes of desk yoga, or try a short walking
• Breathe: Recent research has shown that breathing with intention
– counting your inhales and exhales, elongating your breath, and
trying specific breathing techniques like Ujjayi breathing– can
improve depression and anxiety (Tiwari & Baldwin, 2012), reduce
pain and fatigue (Dhruva et al., 2012), and improve heart health
• Nourish: Nourishing is not just eating good food. Nourishing yourself
is giving your body what it needs to be healthy. Nourish your mind
with a positive mantra. Nourish your skin and mind by taking a mindful
shower, where you concentrate on breathing and being present in
the moment rather than a rushed rinse. Mindfulness meditation is
clinically effective in the treatment of anxiety (Bandelow et al., 2017),
and can be quick, easy, and enjoyable. Nourish your tired brain with
a nap which can boost brain health (Johns Hopkins University, 2021)
and mental agility (Curley, 2021). And, yes, nourish your body with
delicious food you enjoy.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety
disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107 https://doi.
Chaddha, A. (2015). Slow breathing and cardiovascular disease. International
Journal of Yoga, 8(2), 142-143. https://doi.org/10.4103/0973-6131.158484
Cheng, H., Yang, H., Ding, Y., Wang, B. (2020). Nurses’ mental health and patient
safety: An extension of the Job Demands-Resources model. Journal of
Nursing Management, 28(3), 653-663. https://doi.org/10.1111/jonm.12971
Curley, B. (2021). Afternoon naps boost your mental agility - here’s why.
Dall, P. (2015). Will Apple watches really make us healthier if we stand up every
hour? The Conversation.https://theconversation.com/will-apple-watchesreally-make-us-healthier-if-we-stand-up-every-hour-37551
Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., &
Hecht, F. M. (2012). Yoga breathing for cancer chemotherapy- associated
symptoms and quality of life: Results of a pilot randomized controlled trial.
The Journal of Alternative and Complementary Medicine, 18(5), 473-479.
Giorgi, F., Notarnicola, I., Petrucci, C., & Lancia, L. (2018). Can sleep quality and
burnout affect the job performance of shift-work nurses? A hospital crosssectional
study. Journal of Advanced Nursing, 74(3), 698-708. https://doi.
Harvard University. (2017). Don’t just sit there, move more! https://www.health.
Hodges, S., Riley, L., Dickson, T., & Mitchell, A. (2018). A systematic literature
review of noise and nurse stress levels in intensive care units. Journal
of Education, Society and Behavioural Science, 27(3), 1-7. https://doi.
Johns Hopkins University. (2021). Can a nap boost brain health? https://www.
Koithan, M.. (2018) Chapter 1: Concepts and principles of integrative
nursing. In M. J. Kreitzer & M. Koithan (Eds.), Integrative nursing
(2nd ed., online). Oxford University Press. https://doi.org/10.1093/
Lusk, P., & Kahn-John, M. (2018) Chapter 16: Integrative nursing management
of anxiety. In M. J. Kreitzer & M. Koithan (Eds.), Integrative nursing
(2nd ed., online). Oxford University Press. https://doi.org/10.1093/
National Institute of Health. (2012, Dec). Don’t just sit there! Move for your
Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y., Anton, A., Sinclair, S., &
Schmidt, S. (2018). Mindfulness and compassion-oriented practices at work
reduce distress and enhance self-care of palliative care teams: A mixedmethod
evaluation of an “on the job” program. BMC Palliative Care, 17(3).
Rheaume, A., & Mullen, J. (2017). The impact of long work hours and shift work
on cognitive errors in nurses. Journal of Nursing Management, 26(1), 26-32.
Slatyer, S., Craigie, M., Heritage, B., Davis, S., & Rees, C. (2018). Evaluating
the effectiveness of a brief Mindful self-care and resiliency (MSCR)
intervention for nurses: A controlled trial. Mindfulness, 9, 534–546. https://
Tiwari, N., & Baldwin, D. (2012). Yogic breathing techniques in the management
of anxiety and depression: Systematic review of evidence of efficacy and
presumed mechanism of action. Mind and Brain: The Journal of Psychiatry,
University of Michigan. (2021). Time to move research. https://hr.umich.edu/
Page 12 • Arizona Nurse January, February, March 2022
Stepping into the Patient’s Shoes:
Providing Better, Safer Patient Care
Jacquelyn Martin, BSN, RN
As patients or family members, we experience
healthcare so differently from when we are in our
roles as nurses. Never have I felt this more than
when my mom was recently hospitalized before
she passed away. This experience put me on the
other side of patient quality and safety. No longer
was I delivering safe, quality care; I was basically
begging for it.
In his humorous, piercing address at the 2003
Institute for Healthcare Improvement National
Forum, Don Berwick, MD, underscores this
sentiment, reflecting on how as a patient, he was
his best and oftentimes only advocate. While he
was receiving ongoing (and pretty bad) care for
an injured knee, he found that with each transfer,
parts of his records were lost, resulting in duplicate
care (and billing). He went so far as to “steal” his
own medical records so that he could give his
providers a complete history. He revealed that,
while illegal, the ‘Berwick knee imaging retrieval
system’ was highly effective.
To Berwick’s point, as nurses, we know that it’s
often the squeakiest wheel that gets the grease
or the loudest and most tenacious patient/family
member who gets more attentive care. In the case
Live, work and play in beautiful Flagstaff, AZ.
Partnering for better health.
of my mom, she was transferred multiple times to
different facilities; each time, her medication list
was re-entered with an error. My mom happened
to be one of those rare individuals with the
black-box adverse reaction of suicidal ideation
when given SSRIs. However, with each transfer,
somehow, Zoloft kept reappearing on her med
list. Twice she suffered adverse reactions from
this errant medication, becoming emotionally
unstable in an already stressful scenario. Yet, the
problem persisted unless I called multiple times
to correct it.
As full-time nurses and sometimes-patients, we
know this is unacceptable. Unfortunately, 7000-
9000 Americans die annually from medication
errors, and a total of 7 million will suffer some
adverse effects costing more than $40 billion each
year (Tariq et al., 2021). Berwick jokingly points out
that pilots are expected to land the plane safely
100% of the time, whereas there is an acceptable
margin of error in healthcare - a margin of error
that is measured in people’s lives. Why isn’t it the
goal of every facility and provider to have 100%
improved outcomes or 0% accidental fatality?
Shouldn’t we at least strive for this?
In our practices, we as nurses can realistically
support the levels of quality and safety we’d
expect for our family members. First, we can
facilitate the provision of swift and effective care,
not repeating the same tests and diagnostics with
each provider, and quickly discharging patients.
Even after my mom had been discharged to home
with hospice care, she was left to languish in the
hospital for days because her doctors all needed
to sign the discharge order. These were some of
her last days, and every minute mattered. Faster
care and communication could have resulted in a
better experience for her.
Second, we can be efficient and accurate
communicators - with the patient and their
caregivers, with our colleagues, and with
the rest of the patient’s care team. This
means conducting impeccable medication
reconciliations, histories, and physicals, passing
this valuable information on, and passing it on
correctly. Eighty percent of adverse events can
be traced to miscommunications during handoffs
and transfers (Reisenberg, 2021). All the
information about the patient’s health should
be accurately documented in the patient’s chart,
and we must ensure that patients know how
to access their health information. Enhanced
nursing coordination of care reduces waste and
also improves both patient and nurse satisfaction
(Williams et al., 2019). Better communication
between nurses and with families is key in
reducing errors (Joint Commission, 2007).
Finally, and most importantly, we can afford our
patients the dignity and respect which we would
expect as patients. Berwick demonstrated the
vulnerability he felt as a patient by including in his
professional talk a real photo of him in a hospital
gown. Many women who have had a baby in a
hospital will recognize the look of defeat in his
eyes - a look that comes from relinquishing all
privacy and autonomy, being poked and prodded
by strangers, and not even having a say in what you
wear, what you eat, where you are allowed to walk,
and when you can go home. It is a helpless feeling,
but we can reduce this for our patients. Research
has shown that caring, mind-body interventions
- like choices at mealtime and wearing “regular”
clothes - speed patient recovery and improve
outcomes (Bazuin & Cardon, 2011; Watson, 2010),
and make for a more positive experience for both
patient and provider (Watson, 2010).
Therefore, knock before entering, ask before
touching, explain before doing, and remember
that our patients are people - people who are sick
and in pain and who hope to heal - even if that
healing is not curative, but simply going home.
Consider the human touch of care and comfort
that facilitates their healing. Offer warm blankets
and cold water, help them charge their phones,
and spend that extra few minutes to ask the names
of their children or grandchildren. In essence,
take the time to make a human connection.
Bazuin, D., & Cardon, K. (2011). Creating healing intensive
care environments: Physical and psychological
considerations in designing critical care areas.
Critical Care Nursing Quarterly, 34(4), 259- 267.
Berwick, D. M. (2013). Chapter 1: My right knee.
Promising Care: How We Can Rescue Health Care
by Improving It. John Wiley & Sons, Incorporated.
ProQuest Ebook Central, https://ebookcentral.
The Joint Commission. (2007). Improving America’s
hospitals: The Joint Commission’s annual report on
quality and safety.
Reisenberg, L. A. (2012). Shift-to shift handoff research:
Where do we go from here. Journal of Graduate
Medical Information, 4(1), 48.
Tariq, R. A., Vashisht, R., Sinha, A., Scherbak, Y. (2021,
July 25). Medication dispensing errors and
prevention. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing. https://www.ncbi.nlm.
Watson, J. (2010, March 09). Healing environments and
Jean Watson’s theory of caring [Video]. Retrieved
Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C.,
Egginton, J., Finney Rutten, L. J., &
Jacobson, R. M. (2019). Sustainable care coordination:
a qualitative study of primary care provider,
administrator, and insurer perspectives. BMC
health services research, 19(1), 92. https://doi.
RN | LPN | NA
Contact the Phoenix VA Healthcare System Nurse Recruiter
Randy Belieu, MSN | (602) 277-5551 Ext 6520
Nurse Positions Available!
• RN • LPN • Student Assigned • Substitute Nurses
Must have authorization to work in U.S. as defined by
the Immigration Reform Act of 1986 and current AZ RN
or LPN license. Great Schedule, Excellent Benefits!
To apply or for more information, please visit our
website at: www.dvusd.org
“A” Rated Pre-K–12 School District
January, February, March 2022 Arizona Nurse • Page 13
The Great R(N)esignation: Using Integrative Nursing
Principles to Promote Resilience and Retention
Lorre Laws, PhD, RN
The persistent COVID-19 pandemic profoundly affects healthcare
systems and the nurses employed by them. In response to the pandemic
care delivery demands and organizational challenges, some nurses are
transitioning out of direct patient care positions or leaving the profession
altogether. The pandemic magnifies the systemic and organizational factors
contributing to compassion fatigue, burnout, moral suffering, and injury
(Rushton, 2018). Nurses are stretched to or beyond their breaking point,
contributing to The Great R(N)esignation.
Hospital nurse turnover recently increased to 19.5%, with nearly 40%
of hospitals anticipating the need to increase RN staff. A third of hospitals
report an RN vacancy rate of more than 10%. Nurse turnover rates are just
under 19%, contributing to significant hospital revenue losses. To fill each
RN vacancy, it takes 3 months and $28-51,00 dollars, on average. Hospitals,
seeking to address this financial stress, seek to reduce the number of travel
RNs that cost approximately $154,200 each (NSI Nursing Solutions Inc., 2021;
Raso et al., 2021).
Hospital nurses are leaving their hospital positions in favor of travel RN
positions that provide autonomy to self-direct work-life balance and earn
substantially more income. Nurses in their first year of practice are particularly
vulnerable to the pandemic’s effects. Research suggests that nearly half of firstyear
RNs are considering leaving the profession or their organizations (Ulupinar
& Aydogan, 2021).
Organizational and hospital interventions are needed to stabilize the RN
workforce (Raso et al., 2021). No setting is exempt from these challenges.
Noteworthy, states in the south and west will experience the most intense
nursing shortages (American Association of Colleges of Nursing, 2020). It’s a
perfect storm for Arizonans and the nurses who care for them.
One organizational strategy to mitigate an RN exodus and better support
those who may join The Great R(N)esignation movement is to put integrative
nursing principles into action. Integrative nursing is a whole person/whole
system approach to care, including the organizational care of RNs (Kreitzer &
Koithan, 2019). Consistent with Florence Nightingale’s perspective, hospitals
can position their nurses in the best possible conditions to support their
professional wellness, resilience, and retention. The following RN focused
integrative nursing principles have the potential to respond to the challenges of
nurse vacancies, turnover, anticipated shortages, and provide support for RNs:
(1) RNs are whole people in body-mind-spirit whose health and wellbeing
are influenced by their environments, including organizational
(2) RNs have the innate capacity for professional health and wellbeing.
Hospitals can place RNs in optimal work conditions to promote health
(3) Nature has restorative properties that contribute to RN wellbeing.
Hospitals can use biophilic designs and incorporate nature into practice
settings (where appropriate) to optimize these properties.
(4) Integrative nursing is person-centered and relationship-based. Hospitals
and nurses together must co-create diverse, equitable, and inclusive
partnerships to promote RN and organizational wellness.
(5) Hospitals and RNs use a wide range of evidence-based traditional and
integrative modalities to optimize RN and organizational wellness.
(6) Prioritize the health and wellbeing of RNs in body-mind-spirit so
they may provide high quality and safe care for patients. Nurses and
organizations support one another to develop resilience and rekindle
the healer’s heart that initially drew them to the nursing profession.
We are living in very uncertain times. The prolonged stress of the
pandemic affects every dimension of life. We, as healers, teachers, and
nurses, have tremendous opportunities to lead the change we want to see
in our profession. May we individually and collectively use our voices and
embrace the integrative nursing principles to ensure our wellbeing and
longevity in the country’s most trusted profession.
Lorre Laws, PhD, RN is an assistant clinical professor at The University of Arizona
College of Nursing
American Association of Colleges of Nursing. (2020). Nursing shortage. https://www.
Kreitzer, M. J., & Koithan, M. (Eds.). (2019). Integrative nursing (2nd ed.). Oxford
NSI Nursing Solutions Inc. (2021). 2021 NSI National health care retention & RN
staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_
Raso, R., Fitzpatrick, J. J., & Masick, K. (2021). Nurses’ intent to leave their position and
the profession during the COVID-19 pandemic. JONA: The Journal of Nursing
Administration, 51(10), 488-494. https://doi.org/10.1097/NNA.0000000000001052
Rushton, C. H. (Ed.). (2018). Moral resilience: Transforming moral suffering in
healthcare. Oxford University Press.
Ulupinar, S., & Aydogan, Y. (2021). New graduate nurses’ satisfaction, adaptation
and intention to leave in their first year: A descriptive study. Journal of Nursing
Come join our team! Opportunities
available in our Winslow and Dilkon
locations. Our Winslow location is just 45
minutes east of Flagstaff and a few hours
north of Phoenix. You can go from Standing
in the Corner of Winslow, Arizona to hiking
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To view our open positions
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View our current openings and/or
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We offer a great working
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Contact Brian Lalio
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Gallup, NM 87301
RMCHCS is an EEOC Employer
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1 hour from Grand Canyon, Monument Valley,
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Page 14 • Arizona Nurse January, February, March 2022
Freylen Erna Nonato
Two Year Anniversary Members
September - November 2021
Morehead City, NC
Ana Ben Shabat
Sarah Santa Cruz
Happy Anniversary to our dedicated
AzNA members celebrating these
special milestones for this past quarter:
September – November 2021
Roxanne Carla Tenorio
Heather M Walker
January, February, March 2022 Arizona Nurse • Page 15
New & Returning AzNA Members
September - November 2021
Maria Theresa Magat
Stephen Magno Magat
Dulce De Leon
Arlina Jasmin Enclonar
San Francisco, CA
San Tan Valley
Maria Carmen Freeny
Aaron del Pino
Or contact Dina Steinberg at 928-668-1822.
Meet the Nursing Leadership team at
Wickenburg Community Hospital!
Established in 1926, and like the tenacious Western spirit that built
Wickenburg, at our rural Community Hospital and Clinics, taking care of
our patients, families, and community comes first. Our team is committed
to providing quality, health, and wellness services to our residents and
surrounding communities within approximately 3,300 square miles.
Being a smaller organization, Wickenburg Community Hospital offers the
opportunity for more personal care to our patients while being close
enough to a major city to enjoy all that Phoenix has to offer.
If you have the passion for caring for patients “Out Wickenburg Way,”
explore the possibilities!
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Health Professional Webinars
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Dairy Nourishes Network
National Dairy Council’s Dairy Nourishes Network brings together food, nutrition and health
professionals to discuss how dairy foods are part of nourishing people and communities, while
also being mindful of the planet. Join here
This is a sample of the Science Summaries published by National Dairy Council ® .
Click here to see more on NDC’s website.
• Dairy in Healthy Eating Plans: Click Here
• Dairy and Type 2 Diabetes: Click Here
• Cardiovascular Disease: Click Here
• Yogurt and Your Health: Click Here
• Cheese and Your Health: Click Here
National Dairy Council’s food models can help make teaching nutrition easy and fun. They are
versatile, printer-friendly and bring the 2015 Dietary Guidelines for Americans (DGA) and MyPlate
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Nutrition Education Resources
Standards-based Nutrition Curriculum
Dairy Council ® of Arizona has partnered with Dairy Council ® of California to bring AZ teachers
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The Dairy Council © of Arizona and Nevada provides award winning, age-specific nutrition education
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Dairy Council ® of Arizona provides nutrition education materials on a variety of topics. Click here
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Dairy Toolkit - A Moo-velous Resource and
This toolkit for educators and parents is packed with information about many aspects of dairy: nutrition,
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Please download this toolkit and feel free to print and share any of the materials you find here.