Utah Nurse - January 2022

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Volume 31 • Number 1 January, February, March 2022

UTAH NURSE

The Official Publication of the Utah Nurses Association

Quarterly publication distributed to approximately 38,000 RNs and LPNs in Utah.

Inside

Research

Participation

Opportunity

Page 2

Remembering

Dr. Catherine

Coverston

Page 4

News &

Notices from

ANA

Page 5

www.utnurse.org

Timpanogos Regional Hospital

Achieves Magnet® Recognition

Magnet recognition is the highest national honor for nursing excellence.

FOR IMMEDIATE RELEASE

MEDIA CONTACT:

Brittany Glas (385)666-7137 Cell

Brittany.Glas@Mountainstarhealth.com

OREM, UTAH – November 2021 – Timpanogos

Regional Hospital achieved Magnet recognition

in November as a reflection of its nursing

professionalism, teamwork and superiority in patient

care. The American Nurses Credentialing Center’s

Magnet Recognition Program® distinguishes

organizations that meet rigorous standards for nursing

excellence.

With this credential, Timpanogos Regional Hospital

joins the global community of Magnet-recognized

organizations. Just a small, and select group of U.S.

health care organizations have achieved Magnet

recognition.

“Magnet recognition provides our community with

the ultimate benchmark to measure the quality of

patient care,” said Sandy Ewell, Chief Nursing Officer.

“Achieving Magnet recognition reinforces the culture of

excellence that is a cornerstone of how we serve our

community. It’s also tangible evidence of our nurses’

commitment to providing the very best care to our

patients, of which we are extremely proud.”

Research demonstrates that Magnet recognition

provides specific benefits to health care organizations

and their communities, such as:

• Higher patient satisfaction with nurse

communication, availability of help, and receipt of

discharge information.

• Higher job satisfaction among nurses.

• Superior nurse sensitive outcomes such as

fewer falls with injury, pressure ulcers, and blood

stream infections.

• Better patient ratios and higher nurse retention

rates.

Magnet recognition is the gold standard for nursing

excellence and is a factor when the public judges health

care organizations. U.S. News & World Report’s annual

showcase of “America’s Best Hospitals” includes Magnet

recognition in its ranking criteria for quality of inpatient care.

The Magnet Model provides a framework for nursing

practice, research, and measurement of outcomes.

Through this framework, ANCC evaluates applicants

across a number of components and dimensions to

gauge an organization’s nursing excellence.

The foundation of this model comprises various

elements deemed essential to delivering superior patient

care. These include the quality of nursing leadership and

coordination and collaboration across specialties, as well

as processes for measuring and improving the quality

and delivery of care.

Timpanogos continued on page 2

current resident or

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US Postage

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Content

2 From the Editor

2 Publication Information

2 Research Participation Opportunity

3 President’s Message

4 Close Calls

4 WELCOME New Members 2021

4 In Memoriam

4 Remembering UNA Past President,

Dr. Catherine Coverston

4 Congratulations to U

5 News & Notices from ANA

5 GRC Report

6-7 Challenges in the Nursing Workforce,

Graduate Nursing Education,

and Future of Nursing


Utah Nurse • Page 2 January, February, March 2022

PUBLICATION

The Utah Nurse Publication Schedule for 2022

Issue Material Due to UNA Office

April, May, June 2022, Edition - March 3, 2022

Guidelines for Article Development

The UNA welcomes articles for publication.

There is no payment for articles published in the

Utah Nurse.

1. Articles should be Microsoft Word using a

12 point font.

2. Article length should not exceed five (5)

pages

8 x 11

3. All references should be cited at the end

of the article.

4. Articles (if possible) should be submitted

electronically.

Submissions should be sent to:

uneditor@utnurse.org or

Attn: Editorial Committee | Utah Nurses Association

4505 S. Wasatch Blvd., Suite 330B

Salt Lake City, UT 84124 | Phone: 801-272-4510

To submit a Letter to the Editor, include your

name and contact information. (Due to sensitive

issues the UNA can elect to publish anonymously.)

Research Participation

Opportunity

Be part of an important nursing research study.

How do you evaluate information as a nurse?

If you are currently working as a nurse and

have an LPN license or higher, please consider

completing this anonymous survey by March 1,

2022, which should take fewer than 15 minutes:

https://tinyurl.com/nurses22.

At the end of the survey is a separate link

where you can enter to win one of twenty $20

gift cards to Amazon.com. We estimate that your

odds of winning a card are 5.2%. In addition,

at the end of the survey you may indicate your

willingness to participate in a 45-minute interview

via Zoom. Interview participants will receive a $25

gift card.

If you have questions, please contact the principal

investigator: Brandon Patterson, Technology

Engagement Librarian at the Eccles Health Science

Library, b.patterson@utah.edu or 801-585-3563. This

research study “Nurses’ Evaluation of Information

Sources” (Utah: IRB_00145787, BYU: IRB2021-

349, SUU: IRB #09-112021d) is being conducted

by librarians at the University of Utah, Brigham Young

University, and Southern Utah University.

Thank you in advance!

*Notice. This survey is not affiliated with the

Utah Nurses Association.

LPN: Completion of a licensed practical nurse

program with a valid, unrestricted Utah LPN

license. Valid driver’s license.

Are you ready to be a part of something special?

At Clearfield Job Corps Center in Clearfield, UT, we

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Offering a $2,400 Hiring Incentive

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FROM THE

EDITOR

Andrew Nydegger, DNP, RN, CNE

Over the past two years

I have had the privilege to

share my thoughts regarding

nursing with all of you as

the editor of Utah Nurse

Newsletter. I am grateful

to the many people that

have contributed articles,

ideas, and inspiration to help

elevate the profession of

Nursing. Although I am sad

to be leaving this position, I

am excited about the great

work Andrea Braithwaite

will accomplish going forward. Andrea has an amazing

passion for nursing. She will definitely take this role to

new heights.

As I think about the past two years and think about

the coming years, my mind turns towards the importance

of holistic nursing and self-care. These are two crucial

points needed to combat the nursing shortage. When

we teach our patients and communities how to live more

healthy (physically, mentally, spiritually, and socially), we

will decrease the need for tertiary care, increase attitude

and perceptions of health and create a more healthy

workforce that is ready to take on future challenges.

If you are a leader in your organization, please help

advocate for these two principles. It can be small steps if

needed, but I would encourage you to be bold and start

the big conversations that need to happen. We all feel the

effect of burnout. Let’s move towards a more sustainable

profession where nurses feel valued and respected.

Again thank you all for the support over the past

few years. I look forward to serving all of you in other

capacities

Timpanogos continued from page 1

About Timpanogos Regional Hospital

Established in 1998, Timpanogos Regional Hospital is

a 122-bed hospital located in Orem, Utah. The hospital

provides advanced spine care, joint replacement services

and cardiovascular care. Timpanogos Regional Hospital

is part of MountainStar Children’s Services and has not

only a multi-specialty pediatric offering, but also a fullystaffed

pediatric intensive care unit (PICU). The hospital

is well known for award-winning maternity care that

includes maternal-fetal medicine and a Level III NICU.

Timpanogos Regional Hospital has been identified as a

Top 100 Hospital by IBM Watson Health for 2020 and is

now Magnet Recognized by the ANCC.

About ANCC’s Magnet Recognition Program

The Magnet Recognition Program — administered by

the American Nurses Credentialing Center, the largest

and most prominent nurses credentialing organization

in the world — identifies health care organizations that

provide the very best in nursing care and professionalism

in nursing practice.

The Magnet Recognition Program is the highest

national honor for nursing excellence and provides

consumers with the ultimate benchmark for measuring

quality of care. For more information about the Magnet

Recognition Program and current statistics, visit www.

nursingworld.org/magnet.

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

2021 BOARD OF DIRECTORS

President

Sharon K. Dingman, DNP, MS, RN

First Vice President Stacey Shelley, RN, MSN, MBA-HCM, NE-BC

Second Vice President Andrew Nydegger, DNP, RN, CNE

Secretary

Peggy Anderson, DNP, MS, RN

Treasurer Linda Hofmann, PhD, RN, NEA-BC, NE-BC

Director At Large Claire L. Schupbach, BSN, RN, CPC

Director At Large Teresa Garrett, DNP, RN, APHN-BC

Director At Large

Brenda Freymiller, BSN, MBA, RN

Director At Large

CJ Ewell, MS, APRN-BC

STAFF MEMBERS

Executive Director

Editor

COMMITTEE

CHAIRS & LIAISONS

Liz Close, PhD, RN

Andrew Nydegger, DNP, RN, CNE

By-Laws

Liz Close, PhD, RN

Finance

Linda Hoffman, PhD, RN, NEA-BC, NE-BC

Government Relations

CJ Ewell, MS, APRN-BC

Diane Forster Burke, MS, RN

Kathleen Kaufman, MS, RN,

Membership

Anmy Mayfield, DNP, APRN, FNP-C

Nominating

Linda Flynn, DNP, RN, CNE

Sharifa Al-Qaaydeh PhD, RN

Events Committee

Stacey Shelley DNP, MSN,

MBA-HCM, RN, NE-BC

UTAH NURSES FOUNDATION

President

Jodi Waddoups, MSN-Ed, NPD-BC, RN-BC, CPPS

ANA MEMBERSHIP

ASSEMBLY REPRESENTATIVES

Aimee McLean, MSN, RN-BC

Sharon K. Dingman, DNP, MS, RN

PRODUCTION

Publisher

Arthur L. Davis Publishing Agency, Inc.

Editor and Publisher are not responsible nor liable for editorial or

news content.

Utah Nurse is published four times a year, January, April, July and

October, for the Utah Nurses Association, a constituent member

of the American Nurses Association. Utah Nurse provides a

forum for members to express their opinions. Views expressed

are the responsibility of the authors and are not necessarily those

of the members of the UNA.

Articles and letters for publication are welcomed by the editorial

committee. UNA Editorial Committee reserves the right to accept

of reject articles, advertisements, editorials, and letters for the

Utah Nurse. The editorial committee reserves the right to edit

articles, editorials, and letters.

Address editorial comments and inquiries to

office@utnurse.org or to

Utah Nurses Association, Attn: Editorial Committee

434 Ascension Way, Room 516, Murray, UT 84123

No parts of this publication may be reproduced without

permission.

Subscription to the print version of the Utah Nurse is included

with membership to the Utah Nurses Association/American

Nurses Association. Complimentary electronic copies are sent

to all Utah nurses and posted on the Utah Nurses Association

website at www.utnurse.org. Subscription to the print version is

available for $25/year. Address such requests to the UNA Office

at the address above or email office@utnurse.org. Circulation

39,000. Per Utah state regulation, any licensee address change

should be reported to the Board of Nursing at DOPL at (801)

530-6628 or via their website at https://doppl.utah.gov/licensing/

nursing.html.

All address changes should be directed to DOPL at (801) 530-

6628.

For advertising rates and information, please contact Arthur L.

Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa

50613, (800) 626-4081, sales@aldpub.com. UNA and the Arthur

L. Davis Publishing Agency, Inc. reserve the right to reject any

advertisement. Responsibility for errors in advertising is limited to

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

Acceptance of advertising does not imply endorsement

or approval by the Utah Nurses Association of products

advertised, the advertisers, or the claims made. Rejection of an

advertisement does not imply a product offered for advertising

is without merit, or that the manufacturer lacks integrity, or that

this association disapproves of the product or its use. UNA and

the Arthur L. Davis Publishing Agency, Inc. shall not be held

liable for any consequences resulting from purchase or use of an

advertiser’s product. Articles appearing in this publication express

the opinions of the authors; they do not necessarily reflect views

of the staff, board, or membership of UNA or those of the national

or local associations.


January, February, March 2022 Utah Nurse • Page 3

PRESIDENTS MESSAGE

The year 2022 will be a year

for ANA and the now 51 Nursing

State Organizations to focus on

inclusivity in preparing for the

Future of Nursing 2020-2030:

Charting a Path to Achieve

Health Equity” implementations.

As we know, the Covid-19

pandemic has exposed many

opportunities and “serious

inequities in our healthcare

systems” needing our attention.

We participated virtually in

meetings with the Utah Nurses

Association, the American Nurses Association, affiliate

organizations and numerous Utah focus committees in the

past nearly two years.

The ANA Leadership Summit 2021 functions as an

advisory body that encompasses the business meeting

of the Leadership Council as well as professional

development, informed guidance, focused advice; and/

or recommendations on professional nursing issues and

organizational matters in collaboration with the ANA Board

of Directors and includes the Virtual Leadership Summit

Business Annual Meeting. Each year the UNA President

and UNA Executive Director attend the three-day Virtual

Leadership Council Conference meetings.

On Day One we participated in Professional Development

presentations; Day 2 there is a Bi-Monthly Policy/GOVA,

NPWE, Center of Ethics, and Healthy Nurse Healthy Nation;

followed by the Leadership Council Governance meeting;

the ANA Board of Directors Open Business Session; a

Professional Development Day of Continuing Education;

and we joined in a celebration of the recognition video from

ANA to five State Nurses Associations for 100+ years of

existence and active participation. UNA joined virtually in

congratulations and appreciation for their achievements.

As I prepared for the first 2022 UNA Quarterly News

Letter, I was impressed with reading more about the value

of understanding the communication style of “Inclusive

Leadership” presented the first day of the Leadership

Summit. Dr. Marsha Hughes-Rease, MSN, MSOD, PCC

shared the value of being authentic as a contributor to

organizational effectiveness of diversity and the value of

our individual impact on our organizations performance

toward improving our work environments. The reminder that

understanding the validity of feedback, expressions, and

opinions or others influences and multiple perspectives are

essential in our ability to empathetically communicate with

one another.

When we see an issue from multiple perspectives, we

honor the value of another person and their contributions. To

value another’s point of view demonstrates our caring about

their well-being. Inclusive leadership embodies authentic

perspectives of one another when our actions are in line with

what we promise. To do your best and then do better is a

personal development outcome coupled with measurable

goals achieved. As we find commonality, we can identify

as leaders ways to adjust our conversations to be inclusive

with others points of view on shared opportunities for open

communication with one another and success.

As our attention is drawn to solutions and inclusivity, we

are not alone in meeting needs of our patients, colleagues

and our own (self). Our membership in UNA/ANA is a way for

us to stay up to date on nursing issues and our accountability

to one another and our work environment teams. To stay

engaged in our membership and continue to handle “unusual

circumstances” in our meetings and elsewhere will build

our relationships. It is interesting to remember as individuals

“we have different experiences in the same environment”

which gives us options for further discussions and building

relationships. This is perhaps one of the most helpful

reflections for me to consider as we begin our UNA inclusivity

initiative in 2022.

We can create our opportunities as nurses to succeed

in further development of our desirable work environments.

The way we communicate every day with one another in an

inclusive manner builds and maintains our authentic ways of

being successful teams.

UNA is joining with other Utah nursing leaders as we

move forward on nurse wellbeing, health-care in the wake

of higher levels of anxiety, burnout, stress, depression and

work place violence. Nurse resilience is important and 2022

the Healthy Nurse Healthy Nation initiative will be a focus

for UNA. UNA’s Government Relations Committee (GRC)

is preparing for the 2022 Utah Legislative Session, which

begins the end of January 2022. We invite your participation.

UNA’s focus on being agile as a complex nursing

organization will assist us to identify ways to improve our

inclusive interactions with others. We will identify ways of

being more than status quo by asking clarifying questions,

to be continually listening to understand and acknowledging

our value as a nurse, and we share our experiences with

one another. Sharing our stories is a powerful experience to

promote understanding of another’s way of being and our

vulnerability.

In conclusion, through understanding and practicing

inclusion we will recognize that our chosen words, facial

expressions, and our body language; our choice to listen

to one another define us; and along with being audience

centric, knowledgeable and authentic in our ability to adapt to

another’s needs, values, interests and identifying what we all

have in common is a wonderful way to be!

Thanks to all Utah nurses for the care you provide to

patients and to one another. Take Care!

The Future of Nursing 2020-2030: Carting a Path to

Achieve Health Equity, with Susan Hassmiller, PhD, RN,

FAAN and Janelle Sokolowich, PhD, RN. https://podcasts.

apple.com/us/podcast/the-future-of-nursing-2020-2030-

charting-a-path/id1526198297?i=1000535970166

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weber.edu/nursing


Utah Nurse • Page 4 January, February, March 2022

CLOSE CALLS

UNA Executive Director,

Dr. Liz Close, speaks to YOU!

This column shares resources on a regular basis to highlight

services provided free to all nurses and those services that

are offered only with UNA/ANA membership. UNA and

ANA consider it a professional courtesy to offer a variety of

contemporary resources to all nurses across the country

regardless of membership status. UNA/ANA membership

dues help support these offerings but also assist in providing

significant discounts for members on a variety of professional

and personal services.

In each quarterly issue of the Utah Nurse this column

features examples of free and member-only services to support

your ongoing engagement and professional development in

nursing. Consider joining UNA/ANA to support our mission and

to receive full member-only benefits! Go to the “Membership”

menu tab on the UNA Website for more information.

WELCOME NEW MEMBERS 2021

(July 16 – September 15, 2021)

Dianna L. Anderson

Laurie D. Crookston

Daniel Fitzgerald

Stacey A. Flint

Julie Peila Gee

Sookie Goldsberry

Elizabeth Harwell

Jennifer Ann Hawkins

Jex Hepworth

Trevor Koufax

Hightower

Deborah O. Himes

Jamie Jones

Laura Kay Jones

Marlyse Miller

Emmy Patterson

Ann Reed

Nicholas B Richmond

Kenneth Ray Robinson

Marcella B Rowley

Toni D Smolka

Kay Terry

Jennifer Lacey Tindell

Billiejo Tingey

Amber Vega

Free Resource for ALL Nurses

The ANA Center for Ethics and Human Rights

The Center is committed to addressing the complex ethical and human rights issues

confronting nurses and designing activities and programs to increase the ethical competence

and human rights sensitivity of nurses. Through the Center, ANA’s abiding commitment to the

human rights dimensions of health care is demonstrated.

The American Nurses Association (ANA) Center for Ethics and Human Rights was

established to help nurses navigate ethical and value conflicts, and life and death decisions,

many of which are common to everyday practice. The Center develops policy designed

to address issues in ethics and human rights at the state, national, and international levels.

Through its highly visible information, activities, and programs, the Center promotes the

ethical competence and human rights sensitivity of nurses in all practice settings and

demonstrates ANA’s abiding commitment to human rights.

Resources for UNA/ANA Members

Members automatically receive access to the following valuable resources to inform

current practice, education, research and policy:

ANA Publications

• American Nurse - Monthly journal (10 print/2 digital) featuring peer-reviewed

clinical, practical, practice-oriented, career and personal editorial.

• OJIN—The Online Journal of Issues in Nursing - Peer-reviewed, posted online

three times a year

• SmartBrief – Relevant nursing news delivered to your inbox every weekday.

Professional Tools

• ANA Mentorship Program

• CINAHL®

• Global Disease Alert Map

• Medication Safety Tools and Resources

• Essential Nursing Resources

Critical ANA Foundational Documents

IN MEMORIAM

Catherine Louise Brewer Manning Ledbetter (1952-2021)

Kathy Jean Neil (1955-2021)

Remembering UNA Past President,

Dr. Catherine Coverston

Catherine Coverston (1948 – 2021)

The Utah Nurses Association mourns the loss of Utah

nurse leader, educator and past President of the Utah

Nurses Association (2015), Catherine Coverston, PhD,

RNC. Dr. Covertson obtained her PhD in Nursing at the

University of Utah and was an instructor and associate

professor of nursing at Brigham Young University for 23

years, garnering the respect of her colleagues and earning

the love of her students. Her research and clinical activities

helped save the lives of thousands of mothers and infants.

As Associate Dean of the College of Nursing, she made

key changes to the curriculum to benefit students which

resulted in a streamlined admissions process.

Congratulations to U

The UNA would like to sincerely congratulate Catherine Hiatt and the

University Hospital surgical teams for their work to earn the Go Clear award

from AORN. This was a tremendous achievement in the protection of staff and

patients in surgery.

Rep. Rosemary Lesser (MD ret.) will sponsor a bill this coming legislative

session (2022) that will require that all surgical settings have a smoke evacuation

policy in place. Please watch for this bill and lend your support. Thank you, and

again, congratulations.

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January, February, March 2022 Utah Nurse • Page 5

GRC REPORT

Diane Forster-Burke MS, RN

The Legislators are filing bills and although we can

see the titles on the legislative website (www.le.utah.

gov), we cannot see any of the details. The 2022 Bill

Tracker on the UNA website is beginning to list bills

that we are watching.

In the previous GRC report, I highlighted our

Surgical Smoke Evacuation bill (Lesser), Resolution

to ratify the ERA (Riebe), Funding for Students with

Disabilities (Judkins), and that UNA joined with UNP to

sign our support for the “All Co-Pays Count” initiative.

Adding to this list, we are now watching the

following bills:

• Healthcare Worker Protection Amendments

(Spendlove) that would allow for increased penalties

for anyone convicted of assaulting a healthcare

worker anywhere in a hospital or provider’s office.

The current law increases the penalty for assaults

in the Emergency Department only. Spendlove’s bill

would increase penalty from a Class B to a Class A

Misdemeanor.

Nurse Practice Act Amendments (Lisonbee)

that would remove the language specifying a

deadline for nursing education programs to

become nationally accredited. This amendment

was added in 2020 as a non-accredited nursing

education program had a bill to specifically

permit them to have more time to become

accredited. The NPA as currently written doesn’t

permit an accredited program to open a new

program leading to licensure. A new program

must have at least a year of graduates for

national accreditation to take place. In previous

years, there was language in the NPA that gave

DOPL the ability to grant provisional approval to a

new program not yet accredited.

• The Period Project (Lisonbee) that would have

feminine hygiene products available in schools to

students for free. There is some data that young

women are unable to attend classes because

they lack feminine hygiene products. https://kutv.

com/news/local/bill-will-propose-free-menstrualproducts-in-school-restrooms-across-utah.

• Contraception for Inmates (Dailey-Provost)

would secure continued funding for providing

contraception medications for inmates. Last

year, this bill was passed and it now has

proven effective as women use contraception

medication for a variety of medical reasons.

There will be more bills that we will watch and

give testimony either supporting or opposing. We

use SLACK as a tool to communicate about bills to

understand whether UNA should support or oppose a

bill. If you are interested in working on the GRC, please

email Dr. Close (UNA Exec. Director) in the UNA office.

Please note that the Nurses’ Day at the Legislature

will be Jan 28th.

HEARTS: Health & Arts Presents the Musical

NIGHTINGALE:

REGARDING THE LIFE AND PASSION

OF MISS FLORENCE NIGHTINGALE

This film adaptation from the stage musical by Pamela Gerke; music, book & lyrics by

Pamela Gerke, was created during the pandemic with all performers filming and recording

music separately. The result is a stunning achievement in film editing that is both educational

about an important part of healthcare history and a loving testament to one of the founders

of the nursing profession. This is a free film available HERE.

NEWS & NOTICES FROM ANA

World Continuing Educational Alliance Partners

with ANA and ANCC

On Innovative Nursing Education Project

The World Continuing Education Alliance (WCEA),

a social impact technology company that works in

partnership with the International Council of Nurses,

has partnered with ANA and the American Nurses

Credentialing Center (ANCC) to improve access to quality

evidence-based training for nurses in low-and middleincome

countries using innovative technology solutions.

Through this collaborative partnership, WCEA

will distribute ANA created educational content and

resources as part of its ongoing work to increase the

professional practice of nursing, while improving patient

outcomes, globally. Read more.

Join January 19 and 20, 2022: ANA Sponsored

Health Equity Summit

Health Equity Summit 2022

The Hastings Center, Association of American Medical

Colleges Center for Health Justice, American Nurses

Association, and American Medical Association announce

“Righting the Wrongs: Tackling Health Inequities” a

two-day virtual conference taking place January 19th

and 20, 2022. The two-day conference will focus on

historical events and decisions that have led to major

health inequities in the United States and strategies

that health systems and clinicians can adopt to reduce

inequities and racism from U.S. health care. Registration

is open to the public. Be part of the solution and RSVP

your spot today at https://HealthEquitySummit.org.

Graduate Nurse Internship Opportunities in the

Office of Occupational Medicine and Nursing for

Summer 2022

Occupational Safety and Health Administration

(OSHA) announces that applications are now being

accepted for the Graduate Nurse Internship in the

Office of Occupational Medicine and Nursing during the

summer of 2022. A highly motivated graduate nurse who

wants to learn about and contribute to the development

and application of the occupational health policy at

the national level may apply. Full details, including

information on applying and important dates, can be

found here. For questions, contact Dr. Virginia Weaver

at weaver.virginia.m@dol.gov or Melanie Hayes at

hayes.melanie@e@dol.gov at the OSHA Graduate Nurse

Internship and Occupational Medicine Resident Elective

Programs. Application period closes February 22,

2022.


Utah Nurse • Page 6 January, February, March 2022

Challenges in the Nursing Workforce, Graduate

Nursing Education, and Future of Nursing

Georgianna Thomas, D.Ed., MSN, RN

Somi Nagaraj, DNP, MSN, RN, CSSGB, CONTL

Reprinted with permission from

Illinois The Nursing Voice September 2021 issue

The healthcare sector is an intricate, albeit

fundamental, part of ancient and modern societies.

It comprises a long list of agents, from the individual

seeking healthcare services to the medical staff

and nurses, all operating within a legal framework

involving providers, consumers, insurance companies,

government, medical schools, nursing schools, and

regulatory institutions (Amorim Lopes et al., 2015).

The healthcare market is always composed of both

suppliers of health services and patients demanding

their services. On the one side is the workforce

of physicians, nurses, and remaining clinical staff

educated according to standards and criteria, ready

to assist those in need. On the other side stand the

forces that drive the demand for medical services,

strongly related to demographic, socioeconomic, and

epidemiological factors. Analyzing these two market

forces is a critical step in assessing whether the

available health care human resources are enough

in quantity and skills to meet the current and future

demand in due time and may lay solid foundations for

further research, considering perhaps changes to the

existing health policy framework (Amorim Lopes et al.,

2015).

A high degree and extent of uncertainty affect

supply and demand: asymmetric information between

physicians, nurses, and patients, restrictions on

competition, an aging workforce in all areas, strong

government interference, and supply-induced demand

are some of the most glaring differences that can be

pinpointed. These may be relevant when assessing

the impact of any policy involving Healthcare Human

Resource [HHR] planning (Amorim Lopes et al., 2015).

Supply

Supplying human capital with the appropriate

expertise to enable workers to perform and satisfy

the demand for health care is no simple task. The

time and effort required to equip HHR, especially

physicians and advanced nurse practitioners, exceeds

most other professions. In some particular healthcare

professions, the set of necessary skills to qualify

for medical practice is acquired through extensive

academic learning, which involves enrollment in

long courses that may take up decades to complete

due to a strict licensing process. The analysis of the

medical and nurse education process is relevant but

may be insufficient, as several other factors may affect

the efficiency and effectiveness of the care services

delivered (Amorim Lopes et al., 2015).

Despite the limitations, some measures to

overcome imbalances in the quantity (number) of

physicians and nurses have already been identified

in the health policy literature (Chopra et al., 2008),

namely the following: increasing the number of

domestic- and foreign-trained medical graduates or

increasing the number of medical and nursing schools

and classroom sizes; increasing the enrollment limits;

reducing the requirements for entry to medical and

nursing schools; raising the wages of the medical

and nursing staff, as well as the perspectives for their

future career path; or reducing the costs of attending

medical and nursing school, which may encourage

potential students to enroll. These proposals are shortterm

measures to alleviate the immediate stress put on

the healthcare system triggered by an undersupply of

personnel and may not be suitable for tackling longterm

imbalances due to huge shortages or surpluses

of medical and nursing staff (Amorim Lopes et al.,

2015).

Demand

Demand for health care is a derived demand

(Grossman, 1972), which means that people do

not seek health care services as a final good for

consumption but as an intermediate service allowing

them to be healthy and to improve their stock of health

capital (well-being). They want to improve their health,

and to do so; they seek healthcare services (Amorim

Lopes et al., 2015).

The concept of needs in health care is not

consensual in the health literature, with a semantic

confusion arising from its use in health economics

(Hall & Mejia, 2009). While the economic or effective

demand translates the actual, observed demand,

usually measured in terms of service utilization ratios

such as bed occupancy rates, number of inpatients,

the needs component tries to fully encompass the

epidemiological conditions that characterize a given

population, measured through morbidity and mortality

rates or by the opinion of a panel of experts, and how

that may translate into a given quantity of required

healthcare services. Therefore, we see that the

classical concept of economic demand may not reflect

the biological needs of the population, as it may leave

out the necessities of the population regardless of their

ability to pay (Amorim Lopes et al., 2015).

An integrated approach uses a dynamic, systemlevel

perspective covering key drivers of supply

and demand that includes manpower planning and

workforce development is critical to overcoming such

challenges (Stordeur et al., 2010). The importance

of paying attention to needs is also continuously

stressed, as changes in the health patterns of the

populations take place (Tomblin et al., 2009). The

impact of microeconomic and organizational changes

in productivity and the skill mix, of the evolution of

demand for healthcare services, and also of the

evolution of health diseases and its potential impact on

the health system. The given quantity of workers may

provide more or less healthcare services depending

on their productivity and skill mix, influencing the

conversion from headcounts to full-time equivalents

(FTEs). Such conversion is critical to properly assess

the healthcare workforce, as a significant number

of physicians and nurses work part-time only. For

this reason, FTE is a more accurate measure as

it normalizes headcounts. On the demand side,

economic (effective) demand can be initially measured

by analyzing utilization indicators. How this demand

will evolve in the future will then be subject to typical

economic factors such as demography and the growth

of the income/GDP (Amorim Lopes et al., 2015).

In parallel, potential needs can be assessed

by incorporating the incidence and prevalence of

diseases and then mapping a given disease to an

estimate of FTE requirements. Whether future supply

forecasts should tackle all of the estimated needs is a

decision left to the consideration of the policymaker, as

the analysis does not incorporate financial constraints.

Despite the abundance of approaches and techniques

to determine supply and need for professionals, none

of the methodologies has ultimately proved to be

superior (Ricketts, 2011).

Recent studies testing current forecasting models

show that there is still plenty of room for improvement

given the gap between projected and actual results

(Greuningen et al., 2013). It becomes even clearer that

workforce planning should be accurate and performed

in due time, given the attritions and the delays in

enacting policies in the healthcare sector. Adapting

medical and nursing schools, altering legislation, and

changing roles is an effort that may take years to bring

forth. Therefore, planning has to target a long enough

time horizon to be useful and applicable and has to be

done pre-emptively (Amorim Lopes et al., 2015).

Accurate HHR planning requires an approach that

is both integrated and flexible, featuring supply and

demand (potential and effective) and incorporating

less tangible factors, such as skill mix and productivity

(Amorim Lopes et. al., 2015).

Academia

Looking at the area of academia, there are many

issues at hand that present challenges for nursing

education at the doctoral level. Having enough faculty

to provide quality education to those interested

in pursuing a doctoral degree in nursing relies on

competent individuals. Presently there are two types

of doctoral degrees one can earn, both are terminal

degrees, and both allow nurses to continue to practice

in the clinical field. The Doctor of Nursing Practice

(DNP) has a clinical focus that allows the nurse to

possess expert knowledge to influence healthcare

outcomes across direct patient care, advocating for

healthcare policy implementation, and collaborating

with organizational leadership (Leveck, 2020, Chism

2010). The Doctor of Philosophy (PhD) focuses on

research in advancing the nursing profession and

change the quality of patient care and outcomes in the

field. PhD nurses also teach and mentor nurses at the

college and university level, growing the next cohorts

of professional nurses. There is a difference between

these two degrees in their primary foci and length of

education (registerednursing.com). However, the DNP

degree has become the more sought-after degree,

and individuals who have earned it are considered

equal at many institutions in academia in relation

to tenure attainment and administrative positions.

It was more common to see the individual with a

PhD in the academic setting. However, individuals

seeking this degree are decreasing in number, and

some individuals are having difficulty completing

their dissertation. This adds to the faculty shortage

we continue to experience in the profession. There is

a distinction between the two degrees and needs to

be recognized and valued in advancing new nurses,

however, the DNP graduate is more prepared for the

clinical arena.

According to Drs. Di Fang and Karen Kesten,

one-third of the current nursing faculty workforce

in all levels of education are expected to retire by

2025 (ANA Fact Sheet, 2020). This will certainly have

an effect on the numbers of students who will be

accepted when they apply for nursing education

overall.

Continuous changes in the nursing and medical

fields have been rapidly evolving because of

technology and studies such as the genome

project. Graduate student feedback to courses and

discussions with clinical affiliates to the college/

university are two ways that information can be

ascertained in relation to curricular issues for content.

Accreditation standard revisions and the recently

adopted Essentials with emphasis on outcomes and

competencies in learning have also added to many

of the changes schools are making to revise overall

curriculums (AACN, 2021). Learning theories are used

to expose students to various learning experiences.

Online teaching, simulation, inter-professional learning,

case studies, and other teaching formats take much

time to prepare and grade and may not all be familiar

for present faculty to fulfill.

Interdisciplinary education (IPE) among the various

healthcare providers is expected to be utilized in

schools. This type of education provides shared

experiences that allow for better understanding,

improved engagement, and clearer insight into

cooperation in the work environment and quality

patient care. This activity in schools with major

medical affiliations has an edge in providing this

type of learning while many smaller colleges and

universities struggle to gain this opportunity. Many

IPE opportunities that do exist are noted through

simulation-enhanced activity (Fawaz, 2018). Although

simulation is helpful, real-time situations may affect the

learner differently when exposed.

Technology has become more influential in our

lives, especially after the past year and a half of

pandemic experiences. However, online education

is not a new concept in education. Use of learning

platforms, Zoom meetings, Wiki’s, Google docs, social

media, Electronic Health Records, and so on have not

been mastered by all in education, faculty, or student.

Many students like the idea behind online learning in

that they can study at their own pace often or at a

time that is most convenient for them. This strategy for

education allows for flexibility to view course material

in both an asynchronous and, at times, synchronous

format. Faculty find this learning takes more time

in their schedule for preparation and grading than

when classes met traditionally. Class size is not

always capped. Lack of support staff with course

development and difficulty managing technological

changes have been identified as barriers to distance

education (Iwasiw et al., 2020). This becomes

frustrating to both teacher and student in that the

partnership that develops in learning is not fully

developed.

Future of Nursing

The Future of Nursing 2020-2030: Charting a

Path to Achieve Health Equity, study sponsored by

Robert Wood Johnson Foundation identified, that a

nation cannot thrive fully until everyone can live their

healthiest possible life, and helping people live their

healthiest life is and has always been the essential

role of nurses. The ultimate goal is to achieve health

equity in the United States built on strengthened

nursing capacity and expertise (National Academies of

Sciences, Engineering, and Medicine, 2021).

The committee developed a framework identifying

the key areas for strengthening the nursing profession

to meet the challenges of the decade ahead. These

areas include the nursing workforce, leadership,

nursing education, nurse well-being, and emergency

preparedness and response, as well as responsibilities


January, February, March 2022 Utah Nurse • Page 7

of nursing with respect to structural and individual

determinants of health (National Academies of

Sciences, Engineering, and Medicine, 2021).

In 1998 the Pew Health Professions Commission,

a group of healthcare leaders charged with assisting

health policymakers and educators teaching

health professionals to meet the changing needs

of healthcare systems, completed a report listing

competencies healthcare providers of the future

would need. The competencies are listed in the Fourth

Report of the Pew Health Professions Commission

(O’Neal & Pew Health Professions Commission, 1998).

The book To Err Is Human: Building a Safer Health

System (Kohn, Corrigan, & Donaldson, 1999) brought

national attention to the issue of patient safety by

discussing the number of people who die each year

from medical errors. This, in turn, sharpened the focus

of patient safety in nursing education (Scheckel, 2008).

Despite the practice setting in which students

learn nursing care, it will include using various

technologies and knowledge of informatics to assist

with patient care. These technologies can include but

are not limited to medical devices patients will use

to provide self-care, as well as information retrieval,

clinical information management, and documentation

technologies (Scheckel, 2008). Students’ use of these

devices has important implications for improving

their clinical judgment (Newman & Howse, 2007).

Nurses are also being exposed to the use of variety of

clinical management systems, like patient surveillance

systems many of which have implications for ensuring

quality and safety.

A significant movement that accompanied the

curriculum revolution involved using pedagogies

to ensure students could think critically in clinical

practice. Traditionally, students who learned the

nursing process were thought to be learning critical

thinking. During the past few decades, the nursing

process has been challenged as the best approach

to developing students’ critical thinking (Scheckel,

2008). However, current research in nursing education

suggests that students also need to engage in thinking

processes that promote reflective thinking, where they

build practical knowledge, embodied thinking, where

they learn the importance of intuition and pluralistic

thinking, where they consider a clinical situation using

many perspectives (Scheckel & Ironside, 2006).

Innovations

As nurses assume increasing responsibility for

patient care in primary care settings, the combination

of increased clinical and systems knowledge, as well

as the capability to apply and evaluate evidence to

practice innovations, can only have a positive impact.

The presence of DNP-prepared APRNs in primary care

will expand educational opportunities. In the short

term, the DNP-prepared APRNs can mentor the MSNprepared

APRNs within the system. Equally important

is the opportunity for enhanced preceptor education

for nursing students in primary care (Dunbar-Jacob et

al., 2013).

Indeed, the preparation of the DNP will influence the

perception of health care systems regarding the added

value of DNP education. If graduates of such programs

bring an increased depth of knowledge and skill to the

clinical arena, the DNP will likely flourish. If graduates bring

little more than what is offered by master’s-level education,

the DNP will not be an attractive addition to the clinical

arena. Thus, the quality of the preparation of the DNP

will influence the adoption of the DNP practitioner and

administrator by health care systems (Dunbar-Jacob et al.,

2013).

Conclusion

Challenges in building DNP programs include the

identification of qualified faculty for each specialty, qualified

capstone advisors, and qualified clinical preceptors. A

further challenge is the simultaneous education of master’s

cohorts and DNP cohorts. The challenges by requiring

faculty to obtain a doctoral degree, developing critical

academic–service partnerships in mentoring students for

practicum and capstone projects, and discontinuing MSN

advanced practice specialty programs while focusing

on the BSN-to-DNP and MSN-to-DNP programs. Highquality

DNP academics and DNP clinicians are crucial to

help meet these challenges. Each educational program

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must assess its challenges and strategies for addressing

those challenges. How we proceed will determine the

impact of our programs on the future of the health care

system (Dunbar-Jacob, Nativio, & Khalil, 2013).

In academia, both the PhD and DNP prepared nurses

can work together to ensure quality education for our

nursing students. Both need an educational foundation to

be learned to be successful educators. The distinction of

the PhD concentrating on teaching theory and research

to assist nursing to maintain its scientific foundation and

the DNP concentrating on the clinical skills and acting as

preceptor/clinical educator at any level of nursing appear

to be the ideal partnership to develop. Both nurses can

assist academia and the clinical arena in staying current

and developing innovative care measures to provide

quality care to clients. When looking at the definitions

noted at the beginning of this work, this collaboration in

teaching nurses fits what was noted.

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