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
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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.
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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.
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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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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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