Arizona Nurse - January 2022


One Profession. Many Roles.

The Official Publication of the Arizona Foundation for the Future of Nursing

Arizona Nurse

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

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.

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.

AzNA welcomes submission of nursing and health related news items and original articles.

We encourage short summaries and brief abstracts for research or scholarly contributions

with an emphasis on application.

To promote inclusion of submitted articles, please review the article guidelines available

on the AzNA website at

An “article for reprint” may be considered if accompanied by written permission from the

author and/or publisher as needed. Authors do not need to be AzNA members.

Submission of articles constitutes agreement to allow changes made by editorial staff and

publishers. See article guidelines for more information.

Submit your article to

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

You might be on our next front page!

current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

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.

Heidi Sanborn

AzNA President

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.

Arizona Nurse Editorial Board

Carol Peyton Bryant, DNP, RN, ACNP, CCRN

Rebekah Christopher, RN

Sierra Holloway, MSN, RN

Anna Hustin, MSN, RN, NE-BC

Megan Nichols

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 for more information.


Rhonda Anderson, DNSc, RN, FAAN, FACHE

Vice Chair:

Pat Mews, MHA, RN, CNOR


Chloe Littzen, BSN, RN

Scholarship Chair:

Sharon Rayman, MS, RN, CCTC, CPTC

Elected Trustee:

Fran Roberts, PhD, RN, FAAN

Elected Trustee:

Tim Mislan, MS, RN

Elected Trustee:

Kimberly Behrens-Grieser

Elected Trustee:

Phillip Guarrera


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

Past President:

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

at Call 480.831.0404 or for

more information.

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.

For advertising rates and information, please contact

Arthur L. Davis Publishing Agency, Inc., PO Box 216, Cedar

Falls, Iowa 50613, (800) 626-4081,

Responsibility for errors in advertising is limited to corrections

in the next issue or refund of price of advertisement.

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

disapproves of the offering or product.

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.

Dawna Cato,


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

and beyond.

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.



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.


Page 4 • Arizona Nurse January, February, March 2022

Annual Report 2021

2021 by the Numbers





Scholarships Awarded

Amplified Voices

• 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


Cultivated Leadership

• 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

Expanded Partnerships

• 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



770 New


3800+ Total


Revenue: $525,000 Expenses: $477,000



CE Review Fees


Membership Dues




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

Kelsey Randall

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

al., 2018).

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

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

YC is an equal opportunity employer.


invites applications for the position of:

Associate Professor, Nursing




For more information and to apply:

Click on Work @ YC


It’s Time to Recognize a Nurse-Patient

Evidentiary Privilege

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

information. 6

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

negative outcome?

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 &

Injuries) initiative.

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

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

to others?

• Were measures implemented to prevent


• Approximately how soon was the

individual found after they had sustained

a fall?

• What was done at the time of the fall?

• Was the patient appropriately monitored

after the fall to detect injuries?

• What did the assessment (including vital

signs) reveal?

• Did the nurse communicate the findings

to the patient’s provider?

• Were X-rays ordered and performed?

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


• 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

cranial bleeding?

• Was there a change in mental status after

the fall?

• Were additional assessments and

monitoring done as follow up?

• Was the patient’s risk for falls reassessed

after the fall and the plan of care revised

to minimize the risk of future falls?

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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

regular intervals.

Communicate assessment results. Notify the

patient’s provider of the fall and results of the

assessment. The provider may order X-rays for

further evaluation. Remember to mention if the

patient is taking anticoagulants, particularly in the

case of a potential head injury, so the appropriate

scans can be ordered.

Revise the plan. As soon as possible, after the fall,

work with the team to reassess risk factors, revisit the

falls reduction plan, and revise the plan as needed.

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.

Reducing risk

Unfortunately, patient falls are not completely

avoidable. However, developing a well-conceived

prevention plan can help reduce the risk, and taking

appropriate actions after a fall can help mitigate

further injury. Both prevention and post-fall 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





Bono MJ, Wermuth HR, Hipskind JE. Medical

malpractice. StatPearls. 2020. www.ncbi.nlm.

Centers for Disease Control and Prevention.

Important facts about falls.



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

research methodologies.

• 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

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.

Yuma, AZ



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

or call 1-800-247-1500.

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We are tasked with providing health care for the

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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

Your Journey Starts Here!


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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.

Elise Pati

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

the individual.

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. 10.1097/NCN.0b013e3182419134

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

of perspective.

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:// medicine#nav-0

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

(Chaddha, 2015).

• 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.

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.

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.

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!

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.


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.


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.



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

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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.



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

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To apply or for more information, please visit our

website at:

“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

and resilience.

(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

University Press.

NSI Nursing Solutions Inc. (2021). 2021 NSI National health care retention & RN

staffing report.


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.

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

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Gallup, NM 87301

RMCHCS is an EEOC Employer

Now Hiring for Registered Nurses for the

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Page 14 • Arizona Nurse January, February, March 2022


Maria Martinez


Tasha May

Cave Creek

Kathleen Harrington


Denise Dion

Katelyn Thornton

Blaire Zamboni

Chester, MD

Jill Graf

Columbia, MO

Alexandra Kenuam


Kelli Neal

Durham, NC

Freylen Erna Nonato

El Mirage

Esthela Palacios



Shawn Bowker

Fountain Hills

Mary Poquette


Rochelle Franks

Felicia McClean

Christy Torkildson

Kevin Turnage


Patricia Birmingham

Cynthia Decesare

Briane Mape

Pamela Paduano

Kristal Pierce

Kelly Waldo

Golden Valley

Scott Ewing

Two Year Anniversary Members

September - November 2021


Lori Hagen

Nika Hickey

Elizabeth Lorenzo

Christian Pineda

Purity Sang

Verna Schad

Stephanie Selvig

April Warden

Green Valley

Jill Bachman

Keams Canyon

Denise Blackrock


Mary Beck

Fides Cueto

Autumn Sexton


Darlene Brown

Augustin Harelimana

Litchfield Park

Francine DeFurio

Mary Garbacz

Lisa Hernandez

Dawn Walker


Kaileen Martin


Cheri Beers

Amanda Brown

Stephanie Castillo

Cynthia Christakis

Natalie Heywood

Sara Hill

Amanda Lewis

Denise Meitl

Stephanie Niemyjski

Anthony Olorunsola

Heidi Parker

Melodi Priddy

Amaryllis Randle

Lisa Rueter

Dree Wilkinson-May

Morehead City, NC

Deborah Shubick

Oro Valley

Tonia Isotalo

Kaylani Jackson


Brianne Hardman


Linda Baines

Beverly Easterwood

Amanda Shackelford

Maricris Tallant


Jennifer Alexander

Shizuka Barclay

Patricia Burrill

Breanne Carmack

Nelida Fructuozo

Robyn Hale

Robert Jozwiak

Penny Lee

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Katherine Roat

Corie Rogers

Kuldeep Singh

Komal Singh

Sara Smith

Annette Sotelo

Lachelle Torre


Roshelle Bekaye


Jennifer Hemphill

Colleen Wilson

Queen Creek

Joyce Rosette

Rio Rico

Vanessa Aguirre


Julie Easterday


Bethany Biardi

Krista Cash

James Hinkle

Cheryl Hurley

Kaitlyn Mann

Michele Norris

Jennifer Pack

Stephanie Ressler

Zia Tyree

Show Low

Elizabeth Klein

Spokane, WA

Martha Thomas

Sun Lakes

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Hazel Beckham

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Le Borman

Stephanie Sein


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Felix Canez

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Rebecca Hoover

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Sarah Santa Cruz

Yanina Shames

Rachel Taiepisi

Barbara Taylor


Claudia Sanchez

Laura Ybarra


Holly Franklin


Lisa Skow

Window Rock

Emmeline Thompson


Shawnita Castaneda

Judith Reaves

Celiamarie Renteria

Jeffrey Riocasa

Roxana Silvas

Tarisai Zivira

AzNA’s Superstars

Happy Anniversary to our dedicated

AzNA members celebrating these

special milestones for this past quarter:

September – November 2021

5-Year Members

Maryam Abdishoo

Jonathan Arthur

Janet Boury

Seania Bristol

Karen Butterbaugh

Lynn Byrd

Irene Connor

Megan Cristea

Molly Dayzie

Diann Dewitt

Michele Grigaitis-


Noelle Guiriba

Kristie Hobbs

Karen Johnson

Randi Keesee

Brenda Keith

Kellie Konrad

Rachel Kumar

Jessica Martinez-


Connie McGinness

Sally Moffat

Sharon Morgan

Nicole Murray

Leslie Newell

Aimee Nipper

Kristi Nolan

Evangeline Pablo

Grace Paul

Brittnee Penman

Adrienne Poirier

Trudy Redshirt

Claudette Rhoades

Leslie Seeley

Kimberly Shea

Diana Shenefield

Roxanne Carla Tenorio

Danielle Waggoner-


Heather M Walker

Melody Williams

Taylor Zweifel

10-Year Members

Janet Bennett

Shannon Dirksen

Heather Gammon

Craig Harris

Teresa Lahey

Diana Lazenby

Rochelle Mohamed

Ashlyn Schaub

Rosa Scott

Tanie Sherman

15-Year Members

Leslie Dalton

Charles Hathaway

Elizabeth Hunt

Brandy Plumb

20-Year Members

Alyson Coppin

Denise Link

Katherine Willett


25+-Year Members

Donna Adams

Marsha Ashurst

Marilyn Bagwell

May Bruner

Ellen Cavanaugh

Debra Claycomb

Kathryn DiPierro

Rose Emery

Dana Epstein

Carol Feingold

Therese Flood

Ann Guthery

Carol Heimann

Judy Herriman

Mary Herring

Karen Holder

Evelyn Jacobs

Denise Johnson

Marilyn Lindell

Patricia Maurer

Susan Motta

Deirdre Mountjoy

Peter Peil

Pamela Reed

Lori Rehder

Dorothy Riley

Cheryl Schmidt

Sharon Sheehan-


Carol Stevens

Mary Walters

Barbara White

Jean Wictor

January, February, March 2022 Arizona Nurse • Page 15

New & Returning AzNA Members

September - November 2021


Leslie Buzbee

Jeannie Smith

Apache Junction

Miranda Dunkelbarger


Michelle Gordon

Maria Theresa Magat

Stephen Magno Magat

Emily Neumann

Bullhead City

Suzette Paulino

Katie-Marie Pawlowski

Cave Creek

Charlene Grove

Kathleen Martin

Courtney Mellen


Stella Bernard

Susan Cardona

Sarah Davis

Dulce De Leon

Rachael Hacke

Elizabeth Matsumoto

Madelyn Neales

Jwan Odisho

Kelsey Randall

Sarita Vijay


Tara Duncan


Karen Baehr


Avery Brain

Stephen Neville

Fort Mohave

Ray Serafino


George Carrillo

Rebecca Ferguson

Chandler Haywood

Sophia Jolly

Haleigh Maudsley

Reeshma Mohammed

Kristin Porter

Sara Reynolds

Christina Ross

Patricia Sharma

Paula Strickland

Angela Stuff

Kelsey Wilborn

Ethel Winfunke


Rhonda Burcham

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Amber Jimenez

Yenari Moses

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Juliet Wences


Arlina Jasmin Enclonar

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Corinn Herrell

Stacey Lindgren-


Angelica Mercy`

Angela Moreno

Tracy Rousan

Tonia Wallace

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Sherry Beattie

Stephanie Reinoso

Kingman, KS

Kathleen Prilliman


Heather Kies

Litchfield Park

Jacque Carroll

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Cody Salge


Daniel Gust


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Patrick Dunn

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David Kolstad

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New River

Karen Ofafa

Oro Valley

Andrea Craig

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Paradise Valley

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Queen Creek

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San Francisco, CA

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San Tan Valley

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Hollie Brown

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Marvin Depas

Sophy Dunda

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Alisha Gonzalez

Robert Harmsen

Brian Hernandez

Holly Hill

Tiffany Molina

jennifer Neiss

Or contact Dina Steinberg at 928-668-1822.

Clara Oehlert

Grace Opiyo

Lisa Patton

Jennifer Petersen

Jenny Ramirez

Rebecca Rohrer


Layla Bradley

Brittany Lohmann


Leslie Fusaro


Anna Murray


Claudia Arvizo

Leeann Cuevas

Casey Long

Christal Ott

Rhonda Salgado

Nicole Stiffler

Ivan Vega

Meet the Nursing Leadership team at

Wickenburg Community Hospital!

Established in 1926, and like the tenacious Western spirit that built

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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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Dairy Nourishes Network

National Dairy Council’s Dairy Nourishes Network brings together food, nutrition and health

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also being mindful of the planet. Join here

Science Summaries

This is a sample of the Science Summaries published by National Dairy Council ® .

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• Dairy in Healthy Eating Plans: Click Here

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Food Models

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Nutrition Education Resources

Standards-based Nutrition Curriculum

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