Indiana Bulletin - February 2022

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THE BULLETIN

Volume 48 • Number 2

February, March, April 2022

Brought to you by the Indiana Nurses Foundation (INF) and the Indiana State Nurses Association (ISNA) whose

dues paying members make it possible to advocate for nurses and nursing at the state and federal level.

Quarterly publication direct mailed to approximately 2,300 RNs and electronically via email to 65,000+ RNs licensed in Indiana.

MESSAGE from the PRESIDENT

Emily B. Sego

DNP, RN, NEA-BC

Last year at this time, we

were headed into 2021 with

a renewed sense of hope and

healing. It is hard to believe

that it has already been 1 year

since the COVID vaccine was

approved for emergency use.

As we begin 2022, that sense

of renewed hope and healing

has been challenged with

Omicron, staffing shortages, and

decreased bed capacity at our

hospitals.

Many of us have now

experienced the death of friends and loved ones due

to COVID or have had to care for a family member with

COVID. Many of us have even battled this virus ourselves.

My family and I have been lucky enough to escape

COVID up until last month when my father tested positive

and ended up in the ER struggling to breathe. He was

admitted to the ICU, but due to having no beds he sat

in the ER for 3 days. As I write this, he is on day 12 in

the hospital and do not anticipate him leaving for another

week.

For those of you who have been on this side of the

fence, I think we would agree on how very different it

feels. This is not the kind of healthcare we are used to

and before I share some of my observations, I want to

acknowledge that everyone who has taken care of my

father has been amazing. Did we have to wait a little

longer when we pushed the call light? Yes, but once staff

answered they were very attentive and listened. Staff

took more time to make sure everything was done before

leaving the room. However, the moral distress while sitting

in the ER was palpable. Vocera badges were going off

constantly and you could see the nurses trying to prioritize

in their head. Often, our nurse would get a call and

emergently leave the room amid my father talking because

she was being called to another critical patient in another

room. Each time the nurse returned visibly disappointed

that my father’s care was interrupted. The mental health

of our nurses continues to concern me and from what I am

current resident or

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Permit No. 14

hearing, it is taking months for our nurses to get in to see

a mental health specialist. ISNA continues to reach out to

local mental health organizations in Indiana and work with

the American Nurses Association to bring more mental

health resources to our nurses. While we continue to focus

on building our network of support, please reach out with

requests and ideas for future mental health partnerships.

Over the last 12 days of visiting with my father, I have

also come to realize how important visitation is when it

comes to the health of our patients. Currently, he is in a

room with no windows on the doors. Although he has a

window to the outside, it is blocked by a wall. I cannot

begin to imagine sitting in a room with nothing to look at

and not having the opportunity to have a family member

or visitor present. I am so grateful we can at least have

2 visitors a day. It gives us the ability to take shifts to be

there with him and still be able to go home and take care

of ourselves. Limiting to one visitor would be difficult for

us as it would require us to choose between caring for

ourselves or leaving him all alone.

Communication is also the best when families can

visit. We have found it very difficult to get information

when not physically onsite. EHR portals are a great place

to find information, but family members should not be

left to interpret results on their own. There are numerous

studies now published as to the negative consequences

on patients, families, and staff when restrictive visitation

policies are in place. I encourage nursing leaders to look

at recent studies published that compare various visitation

policies and their relationship to patient outcomes. Nurses

should be advocates for visitation policies developed

based on evidence and not fear. I believe safety can be

maintained without extreme measures for visitation. We

have learned a lot over the last two years and now have

enough data to support more holistic visitation policies for

COVID patients.

Lastly, I want to applaud the kind of teamwork I have

seen. After 911, New Yorkers shared how neighbors

became closer to one another and how everyone pitched

in to help begin the process of rebuilding. This is what I

have been seeing as I sit with my dad. After a procedure,

the procedural nurse stayed in the room with the PCU

nurse and said, “I want you to be comfortable with the

way he looks before I leave this room.” And prior to her

leaving she even asked, “Can I help you with anything

before I leave?” The nurse proceeded to list out a few

things and the Endoscopy nurse stayed without

any hesitation and assisted. Another evening,

very close to shift change, the tech realized she

was going to need assistance and called the nurse

in to help. The nurse came in immediately and

did not bat an eye. These moments of teamwork

truly warmed my heart. After all we have been

through our nurses and healthcare teams are

coming together to ease the pressure and burden,

surrounding our teams every day. I am truly proud

and humbled to be able to witness all of this from

a different seat. A seat that none of us want to

find ourselves, yet allows us to look through a

different lens and gain a new perspective we

might otherwise be blind to.

INSIDE

ANA’s proposed policy solutions to

address the nurse staffing shortage crisis

Page 7

Get to Know Your 2021-2023 ISNA Board

Page 8

What Happens To Your Nursing

Credentials When You Retire

Page 9

Importance of Client Education in

the Face of Misinformation

Page 10

Policy Brief Regarding Nurses Spreading

Misinformation about COVID-19

Page 11

Top Ten Ways to be an Antiracist in Nursing

Page 12

Calling All Pronouns

Page 13

Pulse of the Nation’s Nurses Survey Series

Pages 14-17

Honor a Nurse

Page 17

Message from the INF President

Page 18

National Rural Health Day

Page 19

Think like an expert witness

to avoid falls liability

Page 20

Drink Less, Live More

Page 21


2

The Bulletin February, March, April 2022

Katherine Feley, DNP, RN, NE-BC

Chief Executive Officer

The last two years have

been challenging in many ways

and the future ahead of us

remains uncertain. What has

been evident throughout these

challenging times is that nurses

continue to prevail. I am proud

of Indiana Nurses for what

we have accomplished and

overcome, and the unwavering

care that has been provided

during this unpredictable time.

The new year brings

an opportunity for a fresh start. Now is the time to

reposition, dig your heels in, and plan for success

both personally and professionally. Success may be

overcoming obstacles, more self-care, reconnecting

with an old mentor, or achieving that certification you

have always wanted. Whatever that might be, ISNA is

here to support you.

ISNA shapes our future strategies and

programs based on what our nurses want and

our environmental landscape. Our members drive

the work of our organization. We are not a private

company representing nurses, but we are a managed

professional association here to support the nursing

profession, and most importantly YOU. ISNA was

started 119 years ago, and we are still governed by

nurses as we were the day in which we launched. Our

calling is to build upon the voice of nurses who have

advanced Indiana nursing since 1903.

Now is the time to elevate your voice as we are being

heard. ISNA and our community has been recognized

more during the last two years than in my lifetime, if

not longer. For the 20th consecutive year, nurses are

once again ranked #1 in Gallup’s annual Most Honest

and Ethical Professions Poll. Nurses ranking in this

year’s poll directly reflects the trust the American

public has in nurses and the work they continue to do

to earn that trust, even amid a persistent pandemic.

The current backdrop has highlighted the voice of the

CEO NOTE

A Fresh Start

nurse and I encourage you to use this social elevation

to raise our profession and bring focus to necessary

improvements. Nurses are showing up through

television, social media, and written materials in which

care givers and representatives of our profession

haven’t been in the past. I encourage you to share your

concerns related to our work environments, patient

and staff safety, safe staffing, and any other nursing

obstacle you may be facing.

Suggestions for Planning to be Heard

Now is the time to:

• post a letter to the ISNA membership through

the Bulletin sharing your concerns and comments

related to current events. Differing opinions are

welcome.

• share your passion as a member of the renewed

ISNA Advocacy Committee

• share your voice at an upcoming open ISNA

Board meeting. More information can be found at

https://indiananurses.nursingnetwork.com

• contact your legislator. Find them here http://iga.

in.gov/legislative/find-legislators/.

• plan to join your local boards, councils,

commissions, and other decision making bodies

set to advance our communities. Didn’t make the

election? Introduce yourself. Participate from a

seat in the audience, and most importantly plan

for the next available appointment.

ISNA is committed to advocating on behalf of

nurses and we continue to focus on the demands of

nurses including changes in care and care delivery, as

well as the nursing pipeline. We continue to imagine

what “better” will look like in our environments,

well-being, and in the care being delivered to fellow

Hoosiers.

We continue to grow in influence and

accomplishments. Our members always moving us

forward. ISNA membership is only $15/month or

$0.50 a day. What is your profession worth? What do

you need to succeed? Turn up the volume of your voice

through ISNA Membership!

We’re listening. We want to hear from you.

THE BULLETIN

An official publication of the Indiana Nurses Foundation and

the Indiana State Nurses Association, 2915 North High School

Road, Indianapolis, IN 46224-2969. Tel: 317/299-4575. Fax:

317/297-3525. E-mail: info@indiananurses.org. Web site:

www.indiananurses.org

Materials may not be reproduced without written permission from

the Editor. Views stated may not necessarily represent those of the

Indiana Nurses Foundation or the Indiana State Nurses Association.

ISNA Staff

Katherine Feley, DNP, RN, NE-BC, CPPS, CEO

Blayne Miley, JD, Director of Policy and Advocacy

ISNA Board of Directors

Emily Sego, President; Brian Arwood, Vice President; Barbara Kelly,

Treasurer; Angela Mamat, Secretary; Directors: Shalini Alim, Jolynn

Kuehr, Leah Scalf, Susan Waltz, and Recent Graduate Director,

Andrea Jacobs

ISNA is a multi-purpose professional association serving

registered nurses since 1903. ISNA is a constituent member of

the American Nurses Association.

ISNA Mission Statement

ISNA works through its members to promote and influence

quality nursing and health care.

ISNA Pillars

ISNA accomplishes its mission through unity, advocacy,

professionalism, and leadership.

Address Change

The INF Bulletin obtains its mailing list from the Indiana Board of

Nursing. Send your address changes to the Indiana Board of Nursing

at Professional Licensing Agency, 402 W. Washington Street, Rm

W072, Indianapolis, IN 46204 or call 317-234-2043.

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mail to The Bulletin, 2250 W. 86th Street, Ste 110, Indianapolis,

IN. 46260 or E-mail to info@indiananurses.org.

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February, March, April 2022 The Bulletin 3

POLICY PRIMER

Blayne Miley, JD

Director of Policy & Advocacy

bmiley@indiananurses.org

The 2022 Indiana General Assembly session is in

full swing. This is not a budget year, so lawmakers are

scheduled to conclude the session by March 14th. Below

you will find summaries of some of the health-related

bills that have been introduced in the 2022 Indiana

General Assembly session (SB designates a Senate bill,

HB designates a House bill). As we go to press in mid-

January, these bills have just been published and the

legislature is starting to hold committee hearings. House

bills have until January 31st to pass the House and

Senate bills have until February 1st to pass the Senate.

At iga.in.gov, you can lookup full details of all the bills;

committee schedules, livestreams, and video recordings;

and your state legislators and their contact information. We need more nurses to

share their expertise with their state legislators, and you can help by contacting

your state legislators regarding any bill of interest to you! You are welcome to email

me (bmiley@indiananurses.org) with any questions or comments on any of the

bills listed. HBs that have passed the House and Senate bills that have passed

the Senate are still active in the legislative process. For bills that are still active,

generally it is time to contact your state senator regarding HBs and your state

representative regarding SBs.

Members of ISNA receive weekly updates through our e-newsletter, the

ISNAbler, so you can stay current on what is happening at the Statehouse that

impacts your profession. Additionally, at the end of 2021, ISNA posted two new

video series for our members, accessible under the Advocacy tab of the ISNA

website (www.indiananurses.org). First, we have a five-part series providing an

overview of health policy:

• Who are your legislators?

• Legislative process

• Nurse regulatory landscape

• Effective advocacy

• Navigating the Indiana General Assembly website

respective board. Recipients may be required to agree to provide services in a

health workforce shortage area for a number of years determined by the health

department. The bill creates an advisory board to counsel the health department

on eligibility criteria, recommended professions, amounts of the award, and areas

of need within professions. The advisory board will have 17 members, comprised

of state government reps, healthcare stakeholders (Indiana Hospital Association,

Indiana Rural Health Association, etc.), and one nurse.

APRNs

SB 140: APRN signature authorization

Prohibits insurers from requiring authorization for covered early intervention services

under an individualized family service plan signed by an advanced practice registered

nurse (APRN). Provides APRN signature authority for intrastate motor carrier drivers

who are insulin dependent diabetics and drivers subject to epileptic seizures. Allows all

APRNs to make orders/referrals for physical therapy, instead of just nurse practitioners.

Adds an APRN to the providers who may perform an examination for purposes

of worker’s compensation claims. Allows an APRN to affirm that an applicant has a

temporary disability for purposes of a waiver from continuing education requirements

to work on certain lift devices. Requires a health insurance plan to provide coverage for

diabetes self-management training ordered by an APRN.

Policy Primer continued on page 22

Second, ISNA conducted interviews with the chairs of three prominent legislative

committees in the run-up to the start of the 2022 session. We have video

interviews of:

• Senator Ed Charbonneau, Chair of the Senate Health & Provider Services

Committee

• Representative Brad Barrett, Chair of the House Public Health Committee

• Representative Tim Brown, Chair of the House Ways & Means Committee

Student subscribers of the ISNAbler can email bmiley@indiananurses.org for

access to the videos.

Nursing Workforce

HB 1003 Nursing workforce pipeline

(1) Repeal the requirement that a majority of faculty for prelicensure nurse

education programs must be full-time, allowing any percentage to be part-time; (2)

Increase the amount of clinical simulation allowed to be used by prelicensure nurse

education programs from 25% to up to 50%, based on NCLEX scores; (3) Reduce

the required experience for clinical preceptors from 3 years to 18 months; (4)

Make permanent the expanded eligibility that allows nurses pursuing graduate

education to serve as clinical faculty in associate’s programs, which currently

expires in 2023; (5) Prohibit the Board of Nursing from limiting enrollment

increases or enrollment at new campuses if the program has been operating for

five years and has over an 80% NCLEX pass rate; (6) Expand the pathways to

licensure for foreign-educated nurses to add Credentials Evaluation Services (CES)

and VisaScreen.

HB 1088 Health workforce student loan repayment

Imposes a surcharge on health profession licenses to fund student loan

repayment. The surcharge is $10 for license fees of $100 or less and $20 for

license fees of more than $100. The funds collected are divided evenly between

the health department and the respective health profession boards, minus the

costs of administering the program. Each health profession board shall receive

funds based on the percentage of health profession licensees that are under that


4

The Bulletin February, March, April 2022

Pediatricians, Child and Adolescent Psychiatrists and Children’s

Hospitals Declare National Emergency in Children’s Mental Health

Media Contact: Gillian Ray (202) 753-5327

AAP, AACAP and CHA call on policymakers

at all levels of government to act swiftly to

address mental health crisis

WASHINGTON, DC—Today, the American Academy

of Pediatrics (AAP), the American Academy of Child

and Adolescent Psychiatry (AACAP) and the Children’s

Hospital Association (CHA), together representing more

than 77,000 physician members and more than 200

children’s hospitals, declared a national state of emergency

in child and adolescent mental health and are calling on

policymakers to join them.

The COVID-19 pandemic has taken a serious toll on

children’s mental health as young people continue to face

physical isolation, ongoing uncertainty, fear and grief. Even

before the pandemic, mental health challenges facing

children were of great concern, and COVID-19 has only

exacerbated them.

“Children’s mental health is suffering. Young people

have endured so much throughout this pandemic and

while much of the attention is often placed on its

physical health consequences, we cannot overlook the

escalating mental health crisis facing our patients,” said

AAP President Lee Savio Beers, M.D., FAAP. “Today’s

declaration is an urgent call to policymakers at all levels of

government—we must treat this mental health crisis like

the emergency it is.”

The numbers paint an alarming picture. Between

March and October 2020, the percentage of emergency

department visits for children with mental health

emergencies rose by 24% for children ages 5-11 and 31%

for children ages 12-17. There was also a more than 50%

increase in suspected suicide attempt emergency

department visits among girls ages 12-17 in early 2021 as

compared to the same period in 2019.

Additionally, many young people have been impacted

by loss of a loved one. Recent data show that more than

140,000 U.S. children have experienced the death of

a primary or secondary caregiver during the COVID-19

pandemic, with children of color disproportionately

impacted.

“We were concerned about children’s emotional and

behavioral health even before the pandemic. The ongoing

public health emergency has made a bad situation

worse. We are caring for young people with soaring rates

of depression, anxiety, trauma, loneliness, and suicidality

that will have lasting impacts on them, their families, their

communities, and all of our futures. We cannot sit idly by.

This is a national emergency, and the time for swift and

deliberate action is now,” said AACAP President, Gabrielle

A. Carlson, M.D.

Amy Wimpey Knight, president of CHA added, “We

are facing a significant national mental health crisis in our

children and teens which requires urgent action. In the

first six months of this year, children’s hospitals across the

country reported a shocking 45% increase in the number

of self-injury and suicide cases in 5- to 17-year-olds

compared to the same period in 2019. Together with the

AAP and the AACAP, we are sounding the alarm on this

mental health emergency.”

In the declaration, the groups emphasize the

disproportionate toll on young people in communities of

color and how the ongoing struggle for racial justice is

inextricably tied to the worsening mental health crisis.

“Children and families across our country have

experienced enormous adversity and disruption. The

inequities that result from structural racism have

contributed to disproportionate impacts on children from

communities of color,” the groups stated in the declaration.

The organizations are urging policymakers to take

several actions, such as increasing federal funding to

ensure all families can access mental health services;

improving access to telemedicine; supporting effective

models of school-based mental health care; accelerating

integration of mental health care in primary care

pediatrics; strengthening efforts to reduce the risk of

suicide in children and adolescents; and addressing

workforce challenges and shortages so that children can

access mental health services no matter where they live.

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American Academy of Pediatrics

The American Academy of Pediatrics is an organization

of 67,000 primary care pediatricians, pediatric medical

subspecialists and pediatric surgical specialists dedicated

to the health, safety and well-being of infants, children,

adolescents and young adults.

American Academy of Child and Adolescent Psychiatry

The American Academy of Child and Adolescent

Psychiatry (AACAP) promotes the healthy development

of children, adolescents, and families through advocacy,

education, and research. Child and adolescent

psychiatrists are the leading physician authority on

children’s mental health. For more information, please

visit www.aacap.org.

Children’s Hospital Association

The Children’s Hospital Association is the national

voice of more than 200 children’s hospitals, advancing

child health through innovation in the quality, cost

and delivery of care. For more information visit

www.childrenshospitals.org.

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February, March, April 2022 The Bulletin 5

ANA Urges US Department of Health and Human Services

to Declare Nurse Staffing Shortage a National Crisis

Sep 1st 2021

MEDIA CONTACTS:

Shannon McClendon | 301-628-5391

shannon.mcclendon@ana.org

Keziah Proctor | 301-628-5197

keziah.proctor@ana.org

SILVER SPRING, MD – The American Nurses

Association (ANA), representing the interests of

the nation’s 4.2 million nurses, urges the U.S.

Department of Health and Human Services (HHS) to

declare the current and unsustainable nurse staffing

shortage facing our country a national crisis. In a

letter to HHS Secretary Xavier Becerra, ANA calls

for the Administration to acknowledge and take

concrete action to address the current crisis-level

nurse staffing shortage that puts nurses’ ability to

care for patients in jeopardy.

“The nation’s health care delivery systems are

overwhelmed, and nurses are tired and frustrated

as this persistent pandemic rages on with no end in

sight. Nurses alone cannot solve this longstanding

issue and it is not our burden to carry,” said ANA

President Ernest Grant, PhD, RN, FAAN. “If we truly

value the immeasurable contributions of the nursing

workforce, then it is imperative that HHS utilize all

available authorities to address this issue.”

ANA calls on the Administration to deploy these

policy solutions to address the dire nurse staffing

shortage crisis. HHS must:

• Convene stakeholders to identify short- and

long-term solutions to staffing challenges to

face the demand of the COVID-19 pandemic

response, ensure the nation’s health care

delivery system is best equipped to provide

quality care for patients, and prepared for the

future challenges.

• Work with the Center for Medicare and

Medicaid Services (CMS) on methodologies

and approaches to promote payment equity

for nursing services and remove unnecessary

regulatory barriers to APRN practice.

• Educate the nation on the importance of the

COVID-19 vaccine to provide resources for

widespread administration of the COVID-19

vaccine and any subsequent boosters.

• Sustain a nursing workforce that meets current

and future staffing demands to ensure access

to care for patients and prioritize the mental

health of nurses and other health professionals.

• Provide additional resources including recruitment

and retention incentives that will attract students

to the nursing profession and retain skilled

nurses to the demands of patient care.

“ANA stands ready to work with HHS and other

stakeholders on a whole of government approach

to ensure we have a strong nursing workforce today

and in the future,” said Dr. Grant. “Our nation must

have a robust nursing workforce at peak health

and wellness to administer COVID-19 vaccines,

educate communities, and provide safe patient care

for millions of Americans. We cannot be a healthy

nation until we commit to address underlying,

chronic nursing workforce challenges that have

persisted for decades.”

# # #

The American Nurses Association (ANA) is the

premier organization representing the interests of

the nation’s 4.3 million registered nurses. ANA

advances the profession by fostering high standards

of nursing practice, promoting a safe and ethical

work environment, bolstering the health and wellness

of nurses, and advocating on health care issues that

affect nurses and the public. ANA is at the forefront

of improving the quality of health care for all. For

more information, visit www.nursingworld.org.

Using Your Nursing

Network to Conduct a

Political Environmental Scan

American Nurses Advocacy

Institute Update

Denise Kerley MSN, RN, CNRN, AG-CNS

ISNA Member

Transform Lives

Jean Ross MHA, BSN, RN

ISNA Member

In October 2021, ISNA members Denise Kerley

MSN, RN, CNRN, AG-CNS, and Jean Ross MHA,

BSN, RN reported on their experience as the

American Nurse Advocacy Institute 2021-2022

representatives. They chose a project focused on

nurse staffing. When faced with how to collect and

share the voice of Indiana nurses around their views

of safe staffing, they have learned to lean into their

nursing network.

ISNA CEO, Katie Feley DNP, RN, NE-BC, has given

leadership and space to support the ideas Denise and

Jean want to tackle during their time with ANAI. Late

September, ISNA sent a JotForm to begin collecting

the names of interested nurses in Indiana who want to

participate in a future study. To date, 56 nurses have

signed up to participate!

During the past three months, Katie, Denise, and

Jean have reached out to mentors, co-workers, and

community connections to gather a list of vested

stakeholders around nurse staffing, retention, and

pipeline. Denise and Jean seek to design a survey to

get to the heart of the right questions to ask Indiana

nurses. The knowledge they desire is to understand

better the factors that influence nurse perception

of safe staffing, and the advocacy opportunities to

change the course of nurse staffing in Indiana.

Denise and Jean greatly appreciate the support

and guidance of Jennifer Embree DNP, RN, NE-BC,

CCNS, FAAN who connected Denise, Jean and ISNA

to resources to perform a literature review. The next

step is to review the literature to design a survey of

questions. Their goal is to begin interviewing and

surveying nurses by late February.

If any nurse in Indiana would like to add their name

as a future participant, please reach out to ISNA at

[katie@indiananurses.org] or sign-up at https://form.

jotform.com/212514604688054. To learn more,

Denise and Jean will be presenting at ISNA’s Virtual

Annual Policy and Advocacy Conference: Elevating Our

Profession & Our Environment Jan 28, 2022.

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6

The Bulletin February, March, April 2022

ANA Letter to Department of Health and Human Services


February, March, April 2022 The Bulletin 7

ANA’s proposed policy solutions to address

the nurse staffing shortage crisis

HHS Must Convene Stakeholders to

Identify Short- and Long-Term Solutions

to Staffing Challenges.

ANA urges HHS to convene all stakeholders

for a robust discussion of staffing challenges and

potential solutions. These challenges are not solely

contained within the nursing profession, especially

as the health care delivery system continues to

evolve towards a more integrated system. As such,

it is crucial that the agency convenes, in addition

to nurses, hospitals, physicians, other health care

personnel, state and federal government officials,

and key stakeholders to examine, identify, and then

implement real solutions to the nursing shortage.

The focus of these discussions must be to identify

the current challenges and both short- and longterm

solutions. Short-term solutions will allow us

to adequately face the demand of the COVID-19

pandemic response. Long-term solutions will ensure

the nation’s health care delivery system is best

equipped to provide quality care for patients and

stands ready for the future challenges. ANA implores

HHS to have these critical conversations and stands

ready to work with the agency to facilitate them.

HHS must work with CMS to take steps

to appropriately acknowledge nurses in

reimbursement methodologies, ensuring

payment equity for nursing services

provided to patients.

The COVID-19 pandemic response has made clear

that APRNs and RNs are indispensable to providing

the care that patients need now and in the future.

For instance, APRNs are a significant source of

primary care, especially in rural and underserved

areas. Further, RNs are responsible for a wide array

of direct care and care coordination services in

community settings as well as hospitals and longterm

care facilities. These health care services are

key in ensuring access to care, a critical aspect of

addressing health inequity. However, there must be

parity in how these vital services are reimbursed.

Recognition through appropriate payment for

nursing services is critical in ensuring a resilient

nursing workforce ready and able to meet future

needs. It is long overdue for nursing services to

be separated from “room and board,” as currently

considered by the Medicare program. Nurses

provide vital services to patients across the care

continuum and the health care delivery system must

recognize their critical role through appropriate

reimbursement. ANA urges HHS to work with CMS

to consider methodologies and approaches that will

ensure payment equity for nursing services.

In light of the rise of Coronavirus variants

and increased COVID-19 contraction, HHS

must provide additional resources including

recruitment and retention incentives and

support to bolster the nursing workforce to

meet current demands for critical health

care services.

Hospitals are quickly reaching capacity limits

due to the surge of COVID-19 cases and the nursing

shortages across the country. It is imperative that

HHS continue its thoughtful pandemic leadership

and utilize all available authorities to address

this issue. Nurses are still in need of resources

to combat the pandemic and ANA continues to

call on the Administration to act in response.

Standing on the front lines, our nation’s nurses are

becoming increasingly burned out as the pandemic

continues to weigh heavily on them. We are seeing

large numbers of nurses leaving the profession as

a result. This only results in further strain on the

nursing workforce, which was already in a supply

crisis before the pandemic.

ANA appreciates the Administration’s thoughtful

pandemic response to date through issuance of

waivers and other resources to bolster nurses’

ability to provide vital health care services amid the

challenges faced by the health care system.

ANA urges HHS to remove unnecessary

regulatory barriers to APRN practice

In various ways, certain Medicare payment rules

restrict APRN practice above and beyond their

state scope-of-practice rules. Examples include

unnecessary supervision requirements, as well as

payment restrictions for certain Medicare services

provided by APRNs. Such restrictions limit access to

care and beneficiaries’ choice of qualified provider.

Several of these federal practice restrictions have

been waived during the COVID-19 public health

emergency (PHE). As experiences resulting from

these waivers demonstrate, allowing APRNs to

practice to the full extent of their state license

translates to needed system capacity and expanded

access for patients. We continue to call on CMS to

grant permanent regulatory relief for APRN practice,

so that access is not constricted when the PHE ends.

HHS must continue to educate the nation

on the importance of the COVID-19 vaccine

and provide support and resources for

widespread administration of the vaccine

and any subsequent boosters.

Vaccines are critical to the control and prevention

of infectious disease transmission. Nurses play a

critical role in educating the public and fellow health

care colleagues, as well as in the administration

of COVID-19 vaccines. Currently, the nation faces

significant vaccine hesitancy while cases of the

Delta variant increase rapidly, straining an already

strained nursing workforce. HHS must continue to

provide resources and support efforts to educate the

public on the importance of getting the COVID-19

vaccine.

In addition, it was recently announced that

boosters for the already vaccinated will be available.

HHS must provide the necessary resources to

states and localities for successful distribution

and administration of the booster vaccine doses.

The agency must also educate the public on the

importance of receiving the booster doses, when

appropriate. The vaccine is an important component

of COVID-19 mitigation efforts—especially in an

effort to keep patients out of hospitals facing

capacity challenges. ANA urges HHS to provide

support and resources for continued education

and ongoing distribution and administration of the

vaccine across the country.

HHS must ensure a resilient nursing

workforce that meets current and future

staffing demands and ensures access to

care for patients.

Prior to the COVID-19 pandemic, nurses already

experienced tremendous levels of stress in their dayto-

day work. The pandemic has further intensified

the feelings of exhaustion, anxiety and being

Visit nursingALD.com today!

overwhelmed especially with respect to patients

that are dying and having to inform and comfort

their surviving family members. It is vital the nation

prioritizes the mental health of nurses and other

health professionals who are caring for our most

vulnerable patients. ANA actively advocates to

reduce stigma around seeking help for mental health

and substance use disorders for health professionals

as well as their patients.

Moreover, nurses also must be treated and

compensated appropriately as they provide care

under extraordinary circumstances, so that the

next generation is encouraged to enter the field

and ensure the nation’s readiness for public health

emergencies. Appropriate compensation ensures

that the health care delivery system retains the

nurses needed to provide care to patients. We

are seeing examples throughout the country of

nurses leaving their communities for the higher

compensation offered by travel nurse agencies. This

only serves to further local staffing strains, often in

the most underserved communities.

However, a resilient workforce is achieved not

only by adequate pay, as the working environment

must also allow nurses to flourish in their

profession. Nurses are professionals providing

critical health care services to patients—they

should not have to fight for allotted breaks and

other challenges created by antiquated views of

the profession. All too often, we hear of staffing

plans not being enforced, resulting in long shifts

and strains on nurses providing care. Nurses know

best the provisions that they and their team need,

from patient complexity to layout of the nursing

unit. This is just another instance where health

care delivery and outcomes would be improved by

greater nurse involvement. It is crucial for nurses to

take on leadership roles, in all settings, to meet the

demands of our ever-changing health care system,

including being permitted to practice to the full

extent of their education, training and licensure.

Lastly, the introduction of electronic health

records (EHR) has proved to be burdensome,

detracting from patient-centered care.

Documentation and required recording of various

questions is time consuming, which leaves less

time for nurses to connect with patients. HHS

should reevaluate current and future requirements

and ensure the right balance is struck between

the positive impact of EHR in comprehensive,

coordinated care and provider burden.

To ensure a future workforce that meets all the

needs and demands of patient care, it is crucial

that we not only attract students to the nursing

profession but retain skilled nurses throughout

their careers. Effective workforce planning and

policymaking require better data collection and

an improved information infrastructure. ANA

encourages HHS to work with nurses to identify

approaches to bolstering a resilient nursing workforce

ready to meet the demands of today and tomorrow’s

health care delivery system.

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8

The Bulletin February, March, April 2022

Get to Know Your 2021-2023 ISNA Board

Bami M Adeniyi – New

Graduate Director at Large

Pronunciation:

Bah/ mi Ade/knee/yi

Pronouns: She/her

I’m a second-generation

nurse and I’m the oldest

child by nine years.

Pamela Hunt – Treasurer

Pronunciation: /p/a/m/eh/l/ah/

Pronouns: She/Her/Hers

ISNA is positioned to be the

unified voice for nursing.

Bringing visibility to the

amazing art and science of

our profession. Let’s work

together!

Leah Scalf – Secretary

Pronunciation: LEE/uh

Pronouns: She/Her

I am proud to share that

I am one of Dr. Sharron

Crowder’s Eagles. I enjoy

serving in various nursing

focused leadership roles as

I am building a legacy for

future nurses.

Shalini Alim –

Director at Large

Pronunciation:

sh/ah/l/ee/n/ee

Pronouns: She/her/hers

I enjoy spending time with

my family-hikes, outdoors or

just hanging out.

Steven Koons –

Director at Large

Pronunciation:

st/ee/v/uh/n or STEE-vun

Pronouns: He/They

I love cats, dogs, hiking and

facing controversial topics

in nursing head on. I have

a Master’s in Healthcare

Innovation.

Emily Sego – President

Pronunciation: Sea-go

Pronouns: She/Her/Hers

I am trying to travel to

all 50 states by the time

I am 50. I have 18 to

go. COVID has slowed my

progress down.

Brian Arwood –

President Elect

Pronunciation: b/r/ai/ən

Pronouns: he/him/his

Out of the two bald guys

on the board, I’m the one

with glasses. My wife and

I have five children (four

daughters and one son)

and my long-term goal

is to teach at a four-year

university where they will all attend and receive

tuition discounts.

Deb Lyons –

Director at Large

Pronunciation: Deb/or/ah

Pronouns: She/hers

I was in gymnastics while

I was pregnant and able to

do back hand springs when

I was six months pregnant

with my first daughter who

was a gymnast when she

grew up!

Rachel Spalding –

Director at Large

Pronunciation: /rey/chul/

Pronouns: She/Her/Hers

Loves to watch baking

and cooking competitions,

loves all things high

fashion, loves to travel,

and most importantly

LOVES NURSING! I am so

excited to have the honor

of representing Indiana’s

Nurses with my voice!


February, March, April 2022 The Bulletin 9

What Happens To Your Nursing Credentials When You Retire

Joanne Evans MEd, RN, PMHCNS-BC

ISNA Member

For about 12 years, I was

employed at ANCC and then

decided to retire in 2017.

During my time there, I was

responsible for developing

educational programs in all

specialties to assist nurses

in passing a wide range of

ANCC certification exams.

I was very aware of all the

challenges nurses experienced

in preparing for these

examinations and also how

proud nurses were when they

received the certificate in their specialty in the mail.

Certification was a way of nurses showing their

expertise and professionalism in a specific area. It was

a commitment to nursing excellence and quality patient

care. Nurses were able to renew their certification

every five years and many had been doing this renewal

process for many years. I actually just completed my

ninth renewal application as a clinical nurse specialist.

When I retired from ANCC, I became a consultant

so renewed my certification but I spoke with many

retired nurses who were very disappointed to lose

their identify as a certified nurse when they stopped

practicing full time nursing. Since I had extensive

experience developing review programs for nurses to

become certified, I approached the Director of ANCC

Certification to see if we could create a certification and

recognition for retired nurses. I was very excited when I

was asked to develop this new recognition certification

which would allow nurses to continue to keep their

certification credentials. It was a way of letting others

know all they had accomplished throughout their

nursing career. I was also adamant that nurses did not

need to take one more exam. They had already proven

themselves time and time again.

To qualify for the retired nurse recognition

certification, a nurse

planned to not actively practice nursing

held a current and unrestricted nursing license

was certified with ANCC and was in good

standing

submitted an application, up to one year after

the expiration of their last certification renewal

date

The application is available online at https://www.

nursingworld.org/certification/retired-recognition/

This recognition certification is available to nurses,

whether or not they are ANA members. Once a nurse

completes the retired nurse recognition application

for retired nurses and it is approved, they can use the

word “retired” after their credentials. For example -

FNP-BC–retired, or RN-BC- retired, etc.

This “retired” signature can then be used for

business cards, curriculum vitae or resumes. It cannot

be used for patient charts or records, after a signature

or on professional names badges. In addition to a

congratulatory letter from ANCC, retired nurses receive

a wall certificate and a complementary mug with the

ANCC logo.

Certified nurses have made a significant

contribution to the nursing profession as well as to

their patients, students, organizations and colleagues.

With this recognition, they can continue to let others

know of their accomplishment as a certified nurse by

using their credential with the word “retired.” When

you are ready to retire, just know you do not need to

lose your credentials but can apply for the “retired”

recognition certification and continue to let others

know of your expertise as a retired credentialed

nursing professional.

When I retired from ANCC, I began talking with

other retired nurses both nationally and internationally

and found their stories inspirational. With one of my

colleagues, I co-authored Redefining Retirement

for Nurses published by Sigma Theta Tau later in

2017. We interviewed 26 nurses from around the US

and globally and discussed how they continued to

find meaning in their lives when retired. We shared

their stories about professionalism and how some

continued to be employed in nursing or volunteered

in nursing positions. Others became more involved

with family and friends while some considered the

advantages and disadvantages of relocating. Making

financial decisions was relevant to them all. Another

opportunity for several nurses was to take risks and go

on new ventures or even doing something completely

different from nursing. Then there were those who

found a combination of all the above activities suited

them best. Redefining Retirement for Nurses can

be found on the Sigma Theta Tau Marketplace or on

Amazon. This is a book for those not sure of all the

opportunities available to nurses once they decide to

retire from their fulltime nursing position. Nurses have

had a wide variety of experiences and will continue to

find ways to enjoy this next phase of their lives.

Valle Vista Health System is seeking full time and part time

REGISTERED NURSES

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898 East Main Street, Greenwood, IN 46143

E-mail: Simone.Wimberly@uhsinc.com

Visit our website: www.vallevistahospital.com

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10

The Bulletin February, March, April 2022

Importance of Client Education in the Face of Misinformation

Megan Rach, Ruben Rider-Leck, & Stefani Nemet

Purdue BSN Nursing Students,

Estimated graduation date of 2024

Now more than ever, nurses play a key role in

patient education. When media articles misinterpret

research or put their own spin on the facts, it can

be confusing and mislead people. Complex medical

research is easy to misinterpret which can have a

profound effect on the expectations of patients.

When research is incorrectly reported by the media,

it can lead patients to making false assumptions. It is

critical that nurses are prepared to address inaccurate

information patients’ have obtained via inaccurate

media reports. This will improve their understanding

of their health and help them seek out proper medical

care when necessary.

An example of an article misinterpreting research is

entitled, “Could we soon have super hero NIGHT VISION?

Brain implants could give us a ‘sixth sense’ by making

us see infrared” written by Richard Gray and published

by Daily Mail. Gray claims that humans will soon be able

to have night vision. Gray bases his conclusions on a

research paper written by Hartmann et al. (2016). Gray

states this discovery will be revolutionary in the field of

medicine claiming humans will be able to acquire night

vision and even have their eyesight restored. However,

review of the actual research paper and other similar

studies reveal this is not the case.

There have been several experiments testing

infrared light and prosthetics in rodents. One study

found that implants can be used to allow rats to

identify infrared light (Thompson et al., 2013).

Another study found that adult mammalian brains

have sufficient plasticity to support such an implant

(Hartmann et al., 2016). Thus, research has concluded

that infrared implants could be adapted to an adult

mammalian brain (Thompson et al., 2013; Hartmann

et al., 2016). However, infrared light prosthetics have

not been tested in humans. In fact, little is known

about the impact of infrared light on the human brain

other than it increases some brain wave activities while

decreasing others (Shan et al., 2016). In fact, the

study of infrared implants and the human brain has

been cited as an area requiring further study (Shan et

al., 2016; Nirenburg & Pandarith, 2012). Research

is still grappling with the creation of a functional and

sensible optical implant to restore vision for visible

wavelengths of light (Nirenburg & Pandarith, 2012).

Thus, the idea of creating optical implants supporting

infrared night vision is still far from reality and requires

significant additional development (Hartmann et

al., 2016). The only conclusion that can accurately

be stated is that the adult mammalian brain has the

capacity to accept new information sources from

infrared light and optical implants (Thompson et al.,

2013; Hartmann et al., 2016).

With the actual research laid bare, it can be easy

to see how Gray’s article could lead to the spread of

disinformation. The research is complex and difficult

to comprehend, which makes it easy to misinterpret

and come to inaccurate conclusions. This article

provides an example of why nurses must be able to

look beyond media headlines and reports and read

research publications. As trusted health professionals,

nurses must be prepared to provide the facts when

patients ask about media reports such as this one.

Patients are exposed to a variety of complex medical

advancements via media reports, often shared through

social media sites. Complex advancements are

easily misinterpreted thereby giving patients’ a false

perception of modern medicine and what is possible

for current medical professionals. When patients seek

out medical care it is critical that nurses educate them

on these misconceptions. This will help the patient

become more confident in their treatment and medical

care teams. As one of the most trusted professions,

nurses are a natural beacon for patients. Thus, it is a

nurse’s job to be knowledgeable when patients come

to us to seek out medical education.

References

Gray, R. (2016, March 17). Could we soon have superhero

NIGHT VISION? Brain implants could give us a ‘sixth sense’

by making us see infrared. DailyMail.com. https://www.

dailymail.co.uk/sciencetech/article-3496895/Could-soonsuperhero-NIGHT-VISION-Brain-implants-rats-sixth-sensemaking-infrared.html

Hartmann, K., Thomson, E., Zea, I., Yun, R., Mullen, P.,

Canarick, J., Huh, A., & Nicolelis, M. Embedding a

panoramic representation of infrared light in the adult rat

somatosensory cortex through a sensory neuroprosthesis.

The Journal of Neuroscience, 36(8), 2406 –2424. https://

www.doi.org/10.1523/JNEUROSCI.3285-15.2016

Nirenberg, S., & Pandarinath, C. (2012). Retinal prosthetic

strategy with the capacity to restore normal vision.

Proceedings of the National Academy of Sciences of the

United States of America, 109(37), 15012-7. http://www.doi.

org/10.1073/pnas.1207035109

Shan, Y.-C., Fang, W., Chang, Y.-C., Chang, W.-D., & Wu, J.-H.

(2021). Effect of near-infrared pulsed light on the human

brain using electroencephalography. Evidence-Based

Complementary & Alternative Medicine (ECAM), 2021, 1–11.

https://doi.org/10.1155/2021/6693916

Thomson, E., Carra, R. & Nicolelis, M. (2013). Perceiving

invisible light through a somatosensory cortical prosthesis.

Nature Communications, 4(1), 1-7. https://doi.org/10.1038/

ncomms2497

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February, March, April 2022 The Bulletin 11

Leading Nursing Organizations Issue Policy Brief Regarding

Nurses Spreading Misinformation about COVID-19

POSTED 11/16/2021

NCSBN and seven other leading nursing organizations have

issued a policy brief to address the misinformation being

disseminated about COVID-19 by nurses.

FOR IMMEDIATE RELEASE

Media Contact: Dawn M. Kappel

Director, Marketing & Communications

312.525.3667 direct | dkappel@ncsbn.org

CHICAGO – NCSBN and seven other leading nursing

organizations* have issued a policy brief to address the

misinformation being disseminated about COVID-19

by nurses. The brief notes that when nurses identify

themselves by their profession, they are professionally

accountable for the information they provide to the

public.

It is an expectation of the U.S. boards of nursing, the

profession, and the public that nurses uphold the truth,

the principles of the American Nurses Association Code

of Ethics for Nurses and highest scientific standards

when disseminating information about COVID-19 or any

other health-related condition or situation.

The brief concludes by stating, “Nurses are urged to

recognize that dissemination of misinformation not only

jeopardizes the health and well-being of the public but

may place their license and career in jeopardy as well.”

The brief in its entirety may be read here.

*Accreditation Commission for Education in Nursing (ACEN),

American Nurses Association (ANA), American Organization for

Nursing Leadership (AONL) National League for Nursing (NLN),

NLN Commission for Nursing Education Accreditation (CNEA),

National Student Nurses’ Association (NSNA) and Organization for

Associate Degree Nursing (OADN)

About NCSBN

Empowering and supporting nursing regulators across the world in

their mandate to protect the public, NCSBN is an independent, notfor-profit

organization. As a global leader in regulatory excellence,

NCSBN champions regulatory solutions to borderless health care

delivery, agile regulatory systems and nurses practicing to the

full scope of their education, experience and expertise. A world

leader in test development and administration, NCSBN’s NCLEX®

Exams are internationally recognized as the preeminent nursing

examinations.

NCSBN’s membership is comprised of the nursing regulatory

bodies (NRBs) in the 50 states, the District of Columbia and

four U.S. territories. There are three exam user members and 27

associate members that are either NRBs or empowered regulatory

authorities from other countries or territories.

The statements and opinions expressed are those of NCSBN and

not individual members.

###


12

The Bulletin February, March, April 2022

Project ECHO® on Racism

in Nursing Series Launches

March, 2022!

Project ECHO® on Racism in Nursing is being conducted as

part of the ongoing work of the National Commission to Address

Racism in Nursing, a multi-organizational collaborative of leading

nursing organizations to examine the issue of racism within nursing

nationwide and the impact on nurses, patients, communities, and

healthcare systems to motivate all nurses to confront systemic

racism. Through ECHO®, the National Commission is offering this

free tele-mentoring program that connects nurses with Diversity,

Equity, and Inclusion (DEI) experts using brief lectures and casebased

learning, and discussion.

The National Commission’s Project ECHO® on Racism in

Nursing will serve as a forum for nurses to increase their knowledge

about how racism “shows up” in the profession and in healthcare

and improves the skills needed to confront systemic racism and

empowers nurses to become allies.

The 2022 Spring/Summer Project ECHO®: Addressing Racism in

Nursing will include:

• Eight one-hour sessions from March-June 2022

• Virtually delivered by subject matter expert faculty and mentors

• Case presentation and discussion

• Short lecture on a topic related to racism in nursing. Topics will

include:

o Understanding unconscious bias and Microaggressions

o Tools to address racism in clinical practice: Confronting

racism on the unit and at the bedside

o Nursing Code of Ethics and Ethical implications of racism:

Understanding the ethical responsibilities to the profession

and patients

o Courageous conversations and Allyship: addressing

unknowing perpetrators and enablers of racism

o Handling retaliation: When to fight and when to walk away

o Navigating the burden of representation and Combating

Imposter syndrome

o Racism in academia: building a supportive academic

environment and navigating new graduate challenges

o Lessons Learned: historical context, contemporary context,

where do we go from here?

Questions? practice@ana.org

Register for the 2022 Spring/Summer ECHO to Address Racism

in Nursing at https://www.nursingworld.org/practice-policy/workforce/

clinical-practice-material/project-echo/

To access electronic copies of

The Bulletin, please visit

http://www.NursingALD.com/publications


February, March, April 2022 The Bulletin 13

Calling All Pronouns

Steven Koons MHI, BSN, RN (He/They)

ISNA Board of Directors

Why Pronouns Matter

Have you ever interacted

with someone who referred

to you by a name different

than what you go by?

Perhaps you go by a certain

nickname around close

friends and family, but it

would be odd for a coworker

or acquaintance to use that

nickname? This is a great

example of appropriateness

and comfortability regarding

an individual’s name and

identity. We easily accept that when an individual

introduces themselves to you, the name they share

is how you should address them—pronouns are no

different. We all have varying levels of comfortability

on familiarity with others, and referring to another

individual by the name and pronouns they have

shared with you shows respect for their identity.

While you may read the previous paragraph and

think, “Of course I would refer to someone by their

name and pronouns,” have you considered that you

may have unintentionally misgendered someone

based on your own assumptions? It is a common

mistake to perceive an individual as masculine or

feminine and refer to that person by the pronouns

that align with the gender you assumed. However,

others may identify differently than what you

perceive them as, and there are a few tips to avoid

misgendering others which I will share below.

Breaking It Down

For example, my name is Steven and I go by He/

They—this means that I identify in the masculine

he/him/his pronouns and the gender neutral they/

them/their pronouns. I always share my name as

Steven; however, I have often been referred to

as Steve, Stevie, and various other names. While

some choose to use these common nicknames

for the name I share with them, I have always felt

uncomfortable being called by these nicknames—

the main reason being, these nicknames do not

align with my identity. This would be the same if you

were to refer to a person by pronouns with which

they do not identify.

The first tip to avoid misgendering is to default

to gender neutral they/them/their pronouns if an

individual has not shared their pronouns with

you. While this may feel a little unnatural, try this

exercise: If you were to walk into a coffee shop and

see an unattended laptop on a table, how would you

think of the owner? Most people would think along

the lines of, “I see someone left THEIR laptop.

I hope THEY remember and it gets back to THEM

safely.”

The second tip is to share your pronouns with

individuals if you are comfortable—make it a natural

part of your introduction. “Hi, I’m Steven and I go

by He/They.” If you need help practicing pronouns

or discovering yours, see some of the resources

attached below.

The third tip is that if you are struggling with

someone’s pronouns, default to using their name.

Using the name a person has shared with you is just as

validating as using their pronouns.

The final tip is that if you mess up on someone’s

pronouns, don’t panic or make an issue of it—correct

yourself and move on. By pausing and correcting, you are

showing the person that you acknowledge the mistake and

will continue working on addressing them appropriately.

Resources for Pronouns

The following are various resources to learn more

about pronouns, gender, and being an ally. Normalizing

these discussions is paramount to the visibility and

legitimization of marginalized individuals who do not

identify within the binary or identify as transgender.

Furthermore, it shows an understanding and appreciation

for those within the LGBTQIA2S+ community to fully

be themselves. If you would like to participate in further

discussion or receive additional resources, feel free to

reach out to me directly at skoons.rn@gmail.com.

• https://www.mypronouns.org/what-and-why

• https://www.mypronouns.org/resources

• https://transstudent.org/graphics/pronouns101/

• https://transstudent.org/graphics/

• https://www.glsen.org/sites/default/files/GLSEN%20

Pronouns%20Resource.pdf

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14

The Bulletin February, March, April 2022

Pulse of the Nation’s Nurses Survey Series:

Mental Health and Wellness Taking the Pulse on Emotional Health,

Post-Traumatic Stress, Resiliency, and Activities for Strengthening Wellbeing

Survey 3, September 2021

To date, over 710,000 Americans have died due to COVID-19. Nurses

report increased levels of stress, exhaustion, and burnout, while healthcare

organizations struggle with new surges and growing staffing shortages. As a

continuation of the Pulse on the Nation’s Nurses Survey Series, and a follow-up

to the first and second Mental Health and Wellness surveys conducted in Spring

and Winter of 2020 and the COVID Impact survey conducted in Winter 2021,

the American Nurses Foundation has fielded another non-incentivized survey.

The goal was to determine any changes and further impact of the pandemic on

the mental health and wellness of nurses, with additional enquiries concerning

emotional health, post-traumatic stress, resiliency, and stigma around seeking

professional mental health support. Between August 20 - September 2, 2021,

9,572 nurses completed or partially completed this survey.

RESPONDENT PROFILE

The Foundation fielded this survey to nurses across the entire continuum of care.

Seventy-seven percent of respondents identified as White, 10% Black or African

American, 5% Hispanic or Latino, and 4% Asian. Thirty-six percent of respondents

indicated being 55 or older. Nine-out-of-ten said they are currently employed, with 80%

indicating being employed full-time. Four percent of respondents said they are now

retired. Over half of respondents indicated their primary work location is an acute care

hospital from small to large; 11% primary, ambulatory, or outpatient care facilities; and

7% schools of nursing. Seventy-six percent of respondents indicated they provide direct

care to patients, and 80% said they have had or may have had direct exposure to a

COVID-19 positive patient.

SURVEY BACKGROUND

The American Nurses Foundation and Joslin Marketing launched a nonincentivized

online survey to nurses across the United States. The August 2021

survey was the fourth in the Pulse on the Nation’s Survey Series on Mental

Health and Wellness. The first survey was completed, or partially completed,

by 10,997 between June 5 - July 6, 2020. The second survey was completed,

or partially completed, by 12,881 between December 4-30, 2020. The COVID-

Impact survey was completed, or partially completed, by 22,316 between January

and February 2021. The most recent survey was launched between August 20 -

September 2, 2021. The survey was completed or partially completed by 9,572

nurses, with a ± 1.0% margin of error at a 99% confidence level. At least 88%

surveyed responded to all mental health related questions.

Figure 1 – Heat map of respondent’s most recent place of employment, August 2021

34% OF NURSES SAY THEY ARE NOT EMOTIONALLY HEALTHY

In the August 2021 survey, a new question was added to determine the current

emotional health of nurses. The findings reveal 34% of nurses are either not or not at

all emotionally healthy. By comparison, in the recent American Organization for Nursing

Leadership (AONL) COVID-19 Longitudinal Study, 25% of nurse leaders indicated they

are not or not at all emotionally healthy. i When analyzing the data by roles, the studies are

consistent concerning nurse managers, a segment tracked in both studies. In the AONL

study, 34% of nurse managers indicated they are not or not at all emotionally healthy,

compared to 36% of nurse managers in the Foundation’s survey, within the accepted

variance.

Other statistically significant data points are evident. Notably, 18% of Black or African

American respondents said they are not or not emotionally healthy, compared to 36% of

respondents who did not select Black or African American. Relevant gaps are also clear

among roles and age brackets. Younger nurses and nurses closer to the point-of-care

have more emotional distress than their peers. Notably, 51% of nurses age 25-34 say

they are not or not at all emotionally healthy, compared to 21% of nurses 55 or older.

When asked to identify feelings experienced in the past 14 days, a critical 51% of nurses

under 25-years old indicated feeling depressed, compared to 24% of nurses 55 or older.

By role, the following are not or not at all emotionally healthy:

• 52% of intensive or critical care nurses

• 46% of emergency department nurses

• 44% of medical-surgical nurses

• 40% of acute care (hospital) nurses

• 36% of nurse managers

By age, the following are not or not at all emotionally healthy:

• 51% of 25-34

• 47% of under 25

• 42% of 35-44

• 35% of 45-54

• 21% of 55 or older

Figure 2 – Nurses indicate their current emotional health, August 2021


February, March, April 2022 The Bulletin 15

42% OF NURSES HAVE EXPERIENCED TRAUMA AS

RESULT OF COVID-19

Nurses were asked whether they experienced an

extremely stressful, disturbing, or traumatic event as

result of COVID-19. According to data, 42% indicated

they have experienced some form of trauma, with

6% indicating they prefer not to answer and 52%

indicating they have not had a traumatic event.

When looking at race and ethnicity, a significant

49% of Latino and Hispanic respondents indicated

experiencing a traumatic event. In line with emotional

health, gaps are also evident among roles and

age, with intensive or critical care and emergency

department nurses affected most.

Figure 4 - Nurses indicate how much they have been bothered by post-traumatic stress, August 2021

what activities had higher correlations to those who said

they were emotionally or very emotionally healthy, over not

or not at all emotionally healthy.

Figure 3 - Nurses indicate whether they have experienced

an extremely stressful, disturbing, or traumatic event as

result of COVID-19, August 2021

By role, the following have experienced an extremely

stressful, disturbing, or traumatic event:

• 68% of intensive or critical care nurses

• 62% of emergency department nurses

• 45% of acute care (hospital) nurses

• 44% of medical-surgical nurses

• 42% of nurse managers

By age, the following have experienced an extremely

stressful, disturbing, or traumatic event:

• 52% of 25-34

• 48% of 35-44

• 45% of under 25

• 43% of 45-54

• 33% of 55 or older

Respondents who experienced a traumatic event

were provided the abbreviated PCL-C 6-Item Checklist

ii

Using the panel, respondents are asked to indicate

how much they have been bothered by post-traumatic

stress in the past month. The scale from “Not At All”

to “Extremely” is given numerical values from 1-5. A

combined score of 14 or more suggests difficulties

with post-traumatic stress, and further assessment

and possibly referral for treatment is indicated. In

this study, the average score for nurses who have

experienced a traumatic event is 16.55. The findings

are an alarming indicator of the extent of trauma

among nurses, and the extent of post-traumatic stress

as result, particularly with difficulty concentrating

(2.94) and with feeling distanced or cut off from other

people (2.97).

50% OF NURSES CONSIDER LEAVING THEIR

POSITION

In the August 2021 survey, 50% of nurses

indicated they intend to stay in their position in

the next six months, with 21% saying they intend to

leave and 29% saying they may leave. When looking

at segments by age, the problem becomes even more

concerning, with 31% of those under 35 indicating

intent to leave. The data is consistent with Press

Ganey’s recent Flight Risk Analysis that reported 30%

of nurses born after 1986 were more likely to quit than

older nurses. iii

For all ages, intent to leave is being driven by mental

health, staffing, and organizational issues. When asked

why nurses intend to leave, 47% of respondents said

because work is negatively affecting their health and

well-being, 41% because of staffing shortages, and

31% because of a lack of support from their employer

during the pandemic. Twenty-five percent also said

they intend to leave because they are unable to provide

quality care consistently, and 13% for retirement. Also

of note, self-reported burnout has increased by an

alarming 350% since the first survey in June-July of

2020.

Figure 5 - Nurses indicate whether they intend to leave

their position in the next six months, August 2021

By role, the following intend to leave their position

within the next six months:

• 35% of emergency department nurses

• 32% of long-term care nurses

• 30% of intensive or critical care nurses

• 27% of acute care (hospital) nurses

• 26% of case management nurses

• 25% of psychiatric, mental health nurses

• 22% of primary, ambulatory, outpatient nurses

• 21% of cardiovascular nurses

• 21% of nurse practitioners

• 19% of nurse managers

• 14% of certified nurse specialists

• 11% of nurse educators, academia

• 9% of school nurses

By age, the following intend to leave their position within

the next six months:

• 31% of under 25

• 31% of 25-34

• 22% of 35-44

• 20% of 45-54

• 17% of 55 or older

HEALTHY DIET, ACCURATE COVID-19 INFORMATION

LINKED TO EMOTIONAL HEALTH

When looking for solutions to the problem, 71%

of respondents indicated spending time with friends

and family was an activity that has been helpful in

strengthening well-being. This was followed by 57% who

selected leisure or entertainment (e.g. reading, movies, art,

music) and 55% who selected spending time in nature or

with animals. These numbers, however, are not entirely

conclusive. To better understand the efficacy of activities

for strengthening well-being, the scores were analyzed

against weighted emotional health scores to understand

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The analysis identified the top five activities for

strengthening well-being with the highest multiplier:

1. Maintaining a healthy diet (2.1x)

2. Receiving accurate COVID-19 information (1.9x)

3. Religious community, spiritual direction (1.8x)

4. Practicing or receiving expressions of gratitude (1.5x)

5. Regular exercise (1.5x)

Notably, the third most selected activity (spending

time in nature or with animals) does not appear in

the top five, or top ten, once the data is correlated to

emotional heath. In fact, a higher percentage of those

who are not emotionally healthy selected spending time

in nature or with animals, compared to those who are

emotionally healthy. It is important to note, however,

that correlation does not necessarily suggest cause. For

instance, maintaining a healthy diet is directly correlated

to higher emotional health scores. This could mean that

respondents who maintain a healthy diet are more likely to

be emotionally healthy, or vice versa. Further analysis on

this topic could provide more insights into causality.

RESILIENCY MIXED AMONG NURSES

A new question was added to the Foundation’s August

2021 survey to establish a benchmark resiliency score

for all nurses. On a 0-10 scale, nurses were asked to rate

their ability to recover or adjust to the impact COVID-19

has had on their well-being, with 10 being extremely well.

The average score for all nurses was 6.64. When analyzing

based on emotional health, the weighted average was

7.96 for emotionally and very emotionally healthy nurses;

the weighted average was 5.12 for not and not at all

emotionally healthy nurses.

Figure 6 – On a scale of 0-10, nurses rate their ability to

recover / adapt to the pandemic, August 2021

Again, when analyzing the data based on segments,

gaps appear among roles and age, with younger

nurses being hit hardest, and nurses in intensive or

We provide a continuum of education, resources,

consultation and technical assistance to health care

providers and clinical sites. www.nycptc.org

Survey Series continued on page 16

NYC STD Prevention Training Center

• Free CNE web-based training on clinical sexual health prevention,

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• Virtual and on-site technical assistance regarding quality improvement,

clinic implementation and best practices around sexual health provision


16

The Bulletin February, March, April 2022

Survey Series continued from page 15

critical care. The score for 55 or older, for instance,

is 31% higher than nurses under 25. Similarly,

nurse educators or academia score 28% higher than

intensive or critical care nurses.

By age, average resiliency score:

• Under 25 5.61

• 25-34 5.69

• 35-44 6.21

• 45-54 6.64

• 55 or older 7.34

By role, average resiliency score:

• Intensive or critical care nurses 5.76

• Emergency department nurses 6.04

• Medical-surgical nurses 6.08

• Acute care (hospital) nurses 6.22

• Cardiovascular nurses 6.36

YOUNG NURSES REPORT STIGMA AROUND

SEEKING MENTAL HEALTH SUPPORT

While many organizations have advocated for

nurses to seek professional mental health support,

the reality of stigma must be considered. In the

August 2021 survey, respondents were asked

to identify, if anywhere, where they experience

stigma around mental health support. The data

shows that over a third of nurses experience some

sort of stigma with seeking mental health support,

including 17% stigma with themselves, 10% with

family, and 8% with colleagues. When analyzing

the data by race, a statistically significant 75% of

Black or African American respondents indicated

they do not experience stigma, compared to 63%

of White respondents, 58% of Hispanic or Latino

respondents, and 53% of Asian respondents.

Among White respondents, 18% indicated they

experience stigma with themselves. Among Asian

respondents, a statistically significant 17%

indicated they experience stigma with family, and

4% with friends.

When analyzing the data by role, there is moderate

significance. A higher percentage of nurse educators

and academia respondents said they do not experience

stigma, while critical or intensive care, emergency

department, and medical-surgical nurses indicated

higher levels of stigma with themselves. Markedly, a

higher percentage of psychiatric and mental health

nurses indicated experiencing stigma around seeking

mental health support with their colleagues. More

critically is the widening gap among age brackets. A

statistically significant number of younger respondents

indicated stigma with themselves and their family, with

a significant number under 25-years old indicating

stigma with their friends.

CONCLUSION

As society adapts to the long-term effects of

COVID-19, the mental health and well-being of nurses

cannot be ignored. Today, 34% of nurses are not

emotionally healthy, with substantially high numbers

among emergency department, critical care, and young

nurses. Critically, 42% of nurses have experienced

trauma as result of COVID-19. The experience cannot

be undone, but post-traumatic stress can be relieved

with proactive organization support and government

aid.

Since the Foundation’s first mental health and

wellness survey in June-July 2020, self-reported

burnout has increased by 350%. Only half of nurses

indicate they intend to stay in their position, a 16%

drop since the February COVID-Impact survey.

Significantly, 31% of nurses under 35, and 35% of

emergency department nurses, indicate they intend

to leave. When asked why, nurses named the negative

affect work has on their health and well-being, staffing

shortages, and lack of support from their employer.

Nurses exiting because of staffing shortages creates a

conundrum that calls on creative solutions to reverse,

especially as aging nurses near retirement and younger

nurses show signs of distress.

Over one-third of nurses are now 55 or older,

and young nurses meant to fill their shoes struggle

disproportionately with mental health. This cannot

be overstated if organizations are to avoid crises.

Among those under 35, data reveals elevated stress,

depression, and anxiety; increased suicidal thoughts;

Figure 7 - Nurses indicate, if anywhere, where they experience stigma around seeking mental health support,

August 2021

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February, March, April 2022 The Bulletin 17

Congratulations!

Heidi Hinkle, MSN, RN, CPHQ

Figure 8 - Nurses indicate experience of stigma around seeking mental health support

with analysis by age segments, August 2021

increased reports of trauma; lower emotional health and resiliency scores; and

higher intent to leave. This duality of aging nurses and vulnerable young nurses is

a red flag for organizations, policymakers, and the broader community. Work-life

balance must be reinforced and all nurses in need of help must be encouraged,

and given time, to seek professional mental health support.

As society returns to a relative “new normal,” greater awareness and recognition

of nurses’ contributions must be raised at the organization, government, and

community level. In the near future and looking further ahead, proactive initiatives

must be implemented to solve the staffing shortage. A long road of relief, recovery,

and rebuilding awaits those willing to meet the challenge, but the problems point

to actionable solutions. Based on data from this study, both qualitative and

quantitative, organizations can begin first by rebuilding broken trust. They can

then turn their focus to providing proper support to their nurses, while building new

staffing models that underline nurse well-being. Most of all, organizations can make

mental health, and addressing stigma around seeking mental health support, a

priority.

American Nurses Foundation Mental Health and Wellness Survey Report |

American Nurses Foundation & Joslin © 2021

i COVID-19 Impact Longitudinal Study, American Organization for Nursing Leadership and Joslin

Marketing, February 2021.

ii Abbreviated PCL-C, Blue Cross Blue Shield Tennessee, 2021. https://www.bcbst.com/docs/

providers/Behavioral-health-toolkit/pcl-c-shortened.pdf.

iii Gleeson, Cailey. “Analysis Shows Nearly 30% of Nurses at Risk of Leaving Their Organization.”

Becker’s Hospital Review, 30 Sep. 2021. https://www.beckershospitalreview.com/nursing/

analysis-shows-nearly-30-of-nurses-at-risk-of-leaving-profession.html.

You have been honored by Rachel Spalding through the Indiana Nurses

Foundation Honor a Nurse Program. As an honoree deserving recognition, we would

like to recognize you for the support and professionalism you have shown unto

others:

“It is my great pleasure to honor Heidi Hinkle, Director of Professional Practice

at Good Samaritan in Vincennes, IN. Heidi has been instrumental by organizing

and maintaining our “Buddy Program” that has supplemented staffing needs

throughout the pandemic. She has been innovative and creative in promoting and

operationalizing our buddies to provide needed support throughout the organization.

Heidi also has led our Magnet 4 Europe initiative in collaboration with Dr. Linda

Aiken and the UPenn Center for Health outcomes and Policy Research. Heidi gave

an international presentation in September 2021 describing her collaboration with

Good Samaritan’s European partner to have staff who have cared for Covid patients

along with Good Samaritan staff, to share their experiences virtually with a chaplain

as facilitator. It was very healing for staff from both hospitals and had a significant

impact on many other hospitals in the same program. During Covid, Heidi has

accomplished so much for the good of the nursing profession and has committed

herself tirelessly to serve. It is evident that she has a servant’s heart.”

The Foundation’s Honor a Nurse Program recognizes nursing professionals who

have made a difference as a friend, mentor, caregiver, or teacher. Contributions

made through donations support the Foundation’s mission in giving back to Indiana

nurses. A donation has been made in your name in support of the “Nurses in

Need” program.

The Indiana Nurses Foundation, and Indiana State Nurses Association, salutes

you as a significant contributor to the nursing profession.

Sincerely,

Sincerely,

Jo May

Jo May

President, Indiana Nurses Foundation


18

The Bulletin February, March, April 2022

MESSAGE from the INF PRESIDENT

INF Board Extends Term as We Strategize for a Stronger 2022 and Beyond

Jo May, DNP, RN, RN-BC

President Indiana Nurses Foundation

As we look back on 2021, the Indiana Nurses

Foundation appreciates your generosity and your

compassion. Donations made to the INF bring hope to

nurses through certification achievement, professional

development, and grants to improve health for Hoosiers. A

big change in 2021 included the addition of contribution

designation. In response to the COVID-19 pandemic, and

with your request, the INF has responded by launching

the Nurses in Need Fund. We are grateful for our generous

donors’ support, serving fellow colleagues financially but

most importantly hope at a time when we all need it the

most. Here is a break down of 2021 Program Designation:

the INF Bylaws would end in February after 24 months of service, however we

did not conclude our strategic planning for future work of the INF. We are still

in process of planning to be stronger and positioned to give back even more in

2022. Have you thought about your board seat on the Foundation board? Please

follow us through the ISNA social media channels to learn of upcoming board

opportunities.

If every member of ISNA contributed just $22 in 2022 to help build the

legacy of Indiana Nursing through the Indiana Nurse Foundation we could give

approximately $54,000 in the future! Donate today through our Text to Donate –

Text ‘Nurses” to 74121, Honor a Nurse by recognizing a nurse in the next Bulletin

with a donation made in their name, or share a general donation through our

IndianaNurses.NursingNetwork.com website.

We look forward to sharing more INF highlights, recognition, and successes this

year!

A Quick 2021 Total Contribution Snapshot:

In case you missed us, the INF was

recently featured in the Indianapolis

Business Journal’s 2022 Giving Guide

which highlights philanthropic opportunities

through Indiana. You can find a copy at

https://issues.ibj.com/ibj/supplements/

giving-guide/2022/ . You’ll find us on page

48. The best part of being included in

this publication, shared with over 40,000

readers, is the fact that we get to highlight

some of our previous and distinguished

recipients. We want to share double the

amount of photos in 2022! Which headshot

will you be sending in?

As we plan ahead for 2022, the INF

board has voted to extend the current

2020-2022 term for an additional three

months. The current term as written in


February, March, April 2022 The Bulletin 19

Linda Webb, MBA, BSN,

RN, NEA-BC, Chief Nursing

Officer, Pulaski Memorial

Hospital Recognized as a

“Community Star” on the

11th Annual National

Rural Health Day

Linda Webb, Chief Nursing

Officer (CNO) and ISNA

Member has been named

Indiana’s 2021 Community

Star, the National Organization

of State Offices of Rural Health

(NOSORH) recently announced.

Linda, an ISNA and ANA

dual member since 2012,

has served as the CNO of

Pulaski Memorial Health for

26 years. Webb has been a

past board member of the

Indiana Organization of Nursing

Executive, serving in various seats including President.

She currently serves as chairman of the West Central

Patient Safety Coalition in Indiana, President of the

Four County Counseling Center board, and is an active

member of Pulaski County Drug-Free Council and St.

Peter’s Catholic Church. Linda supports several initiatives

to address tobacco prevention and cessation, human

trafficking, mental health, social determinants of health,

reducing patient harm, and improving maternal health

and reducing infant mortality.

On the third Thursday of November every year,

NOSORH, the member association for each of the

50 State Offices of Rural Health, leads National

Rural Health Day (NRHD). NRHD is an annual day of

celebration that shines a light on those who serve the

vital health needs of the estimated 57 million people

living in rural America. On November 18, the 11th annual

NRHD, NOSORH honored and celebrated Linda Webb’s

incredible contributions to rural health by sharing their

story in the official book of Community Stars.

Beginning in 2015, NOSORH made a nationwide call

for Community Star nominations, seeking individuals,

organizations, and coalitions making a positive impact

in rural communities. This year, nominations cover

every state, making this the first time in the recognition

program’s history for sharing 50 inspiring stories,

including Webb’s.

The 2021 Community Stars eBook will be published

on the official NRHD website, powerofrural.org, on

November 18, 2021.

Please help ISNA in congratulating and thanking

Linda for her dedication to improving Hoosier healthcare.

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20

The Bulletin February, March, April 2022

Think like an expert witness to avoid falls liability

Georgia Reiner, MS, CPHRM

An 88-year-old patient slips on the floor, falling and

breaking his hip. Your immediate concern is getting him

the help he needs, but you also wonder if you could

be legally liable for what happened. By thinking like an

expert witness, you can help determine if this concern

is valid and whether you could have taken steps to avoid

the situation in the first place. But first, you need to

understand some background information.

Falls facts

From 2007 to 2016, the fall death rate for older

adults in the United States increased by 30%, according

to data from the CDC. Each year, 3 million older adults

are treated in emergency departments (EDs) for fall

injuries, and more than 800,000 people are hospitalized

each year because of injuries related to a fall. These falls

extract a high price—more than $50 billion for medical

costs in a single year.

Nurse professional liability claims involving falls are

identified in the Nurse Professional Liability Exposure

Claim Report: 4th Edition. The report notes that many

of the closed claims analyzed in the report dataset

which involved falls occurred because the nurse failed

to follow fall-prevention policies and procedures. Further,

the report states that falls most frequently occurred in

inpatient hospital, surgical services, and aging services

settings, as well as in patients’ homes.

Given the statistics and the many places falls can

occur, a fall is not an uncommon occurrence in a nurse’s

career. A fall does not automatically mean the nurse is

liable; for that to happen, key elements of malpractice

need to be present.

Elements of malpractice

To be successful in a malpractice lawsuit, plaintiffs

must prove four elements:

1. Duty. A duty existed between the patient and the

nurse: The nurse had a responsibility to care for the

patient.

2. Breach. The duty to care was breached; in other

words, the nurse may have been negligent. To

determine if negligence occurred, the expert

witness would consider whether the nurse met the

standard of care, which refers to what a reasonable

clinician with similar training and experience would

do in a particular situation.

3. Injury. The patient suffered an injury. Even if a duty

existed and it was breached, if no injury occurred,

it’s unlikely the lawsuit would be successful. Keep

in mind, however, that injury can be defined as not

only physical injury, but also psychological injury or

economic loss.

4. Causation. The breach of duty caused the injury—

the injury must be linked to what the nurse did

or failed to do. This can be summed up in one

question: Did the act or omission cause the

negative outcome?

Expert witnesses will consider these four elements as

they review the case, and they’ll ask multiple questions

(see Was there liability?). The questions primarily address

prevention and what was done after the fall occurred.

Prevention

The following steps can help prevent falls and,

if documented correctly, prove that the nurse took

reasonable steps to protect the patient from injury:

Take a team approach. Registered nurses, licensed

practical/vocational nurses, and certified nursing

assistants are ideal members for a team dedicated to

creating a falls reduction plan for each patient.

Assess the risk. Whether in the hospital, rehabilitation

facility, clinic, or home, a comprehensive assessment is

essential to identify—and then mitigate—falls hazards.

This starts with assessing the patient for risk factors

such as history of a previous fall; gait instability and

lower-limb weakness; incontinence/urinary frequency;

agitation, confusion, or impaired judgment; medications;

and comorbid conditions such as postural hypotension

and visual impairment. It’s also important to consider

the environment, particularly in the home setting. For

example, throw rugs are a known falls hazard.

An excellent resource for assessing communitydwelling

adults age 65 and older is the CDC’s STEADI

(Stopping Elderly Accidents, Deaths & Injuries) initiative,

which is an approach to implementing the American and

British Geriatrics Societies’ clinical practice guideline for

fall prevention. The initiative provides multiple resources

for clinicians, such as a fall risk factors checklist with

the categories of falls history; medical conditions;

medications; gait, strength, and balance (including quick

tests for assessing); vision; and postural hypotension.

Keep in mind that assessment should be ongoing during

the patient’s care because conditions may change.

Develop a plan. Once the assessment is complete, the

patient care team, including the patient and their family,

can develop a falls-reduction plan based on the patient’s

individual risk factors. The plan should address locations

that are at greatest risk, such as bedside, bathrooms, and

hallways, and detail action steps. Sample action steps

include giving patients nonslip footwear, making sure

call lights are within reach, removing throw rugs from the

home, and providing exercises to improve balance.

Communicate. It’s not enough to create a plan;

communication is essential for optimal execution. All care

team members, including patients and their families,

need to be aware of the patient’s fall risk and the falls

reduction plan.

Communication also includes education. The STEADI

initiative has falls prevention brochures for patients

and family caregivers at www.cdc.gov/steadi/patient.

html. Families often are underutilized as a resource for

helping to prevent falls. They may know the best way

to approach patients who are reluctant to follow fallsreduction

recommendations and can take the lead to

reduce home-related risks. The falls risk reduction plan,

communication with others, and education provided

should all be documented in the patient’s health record.

If a fall occurs

Despite nurses’ best efforts, a patient may fall. An

expert witness will scrutinize how the nurse responded to

the event. The following steps will help to reduce the risk

of a lawsuit or the chances that a lawsuit is successful:

Assess the patient. Examine the patient for any

obvious physical or mental injuries. For example, check

vital signs; look for bleeding, scrapes, or signs of broken

bones; ask the patient about pain; and check mental

status. Do not move the patient if a spinal injury is

suspected until a full evaluation can be made. Be

particularly alert for possible bleeding if the patient is

taking anticoagulants. When appropriate, ask patients

why they think they fell and continue monitoring at

regular intervals.

Communicate assessment results. Notify the patient’s

provider of the fall and results of the assessment.

The provider may order X-rays for further evaluation.

Remember to mention if the patient is taking

anticoagulants, particularly in the case of a potential

head injury, so the appropriate scans can be ordered.

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

work with the team to reassess risk factors, revisit the

falls reduction plan, and revise the plan as needed. For

example, footwear may need to be changed, the amount

of sedatives the patient is receiving may need to be

reduced, or more lighting may need to be added to a

hallway. It’s important that actions are taken to prevent

future falls.

Document. Each step should be documented in the

patient’s health record, especially all assessment results

and provider notifications. The expert witness can then

see that the nurse followed a logical progression, with

thorough evaluation and follow-up. Never alter a patient’s

health record entry for any reason, or add anything to a

record that could be seen as self-serving, after a fall or

other patient incident. If the entry is necessary for the

patient’s care, be sure to accurately label the late entry

according to your employer’s policies and procedures.

Reducing risk

Unfortunately, patient falls are not completely

avoidable. However, developing a well-conceived

prevention plan can help reduce the risk, and taking

appropriate actions after a fall can help mitigate further

injury. Both prevention and post-fall follow up not only

benefits patients, but also reduces the risk that the nurse

will be on the losing side of a lawsuit.

Article by: Georgia Reiner, MS, CPHRM, Senior Risk

Specialist, Nurses Service Organization (NSO)

RESOURCES

Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice.

StatPearls. 2020. www.ncbi.nlm.nih.gov/books/

NBK470573.

Centers for Disease Control and Prevention. Important facts

about falls. www.cdc.gov/homeandrecreationalsafety/falls/

adultfalls.html.

Centers for Disease Control and Prevention. STEADI: Materials

for healthcare providers. 2020. www.cdc.gov/steadi/

materials.html.

Was there liability?

If a patient falls, an expert witness will likely

want to know the answers to the following

questions (developed by Patricia Iyers) when

deciding if liability may exist:

Before the fall:

• Was the patient identified as being at risk

for falls? How was that risk communicated to

others?

– What medications did the patient receive?

Do they have side effects that may

increase the risk of a fall?

– Were there specific conditions present that

could increase the risk of a fall?

• Were measures implemented to prevent falls?

– Was the patient capable of using the

call light and was it used to call for

assistance?

– Was the bed in the lowest position?

– Were the lights on in the room or under

the bed to help light the area at night?

– Was the patient given antiskid slippers?

Immediately after the fall:

• How soon was the individual found after he

had sustained a fall (it’s not always possible

to establish an exact time)?

• What was done at the time of the fall?

• Was the patient appropriately monitored after

the fall to detect injuries?

• What did the assessment (including vital

signs) reveal?

• Did the nurse communicate the findings to

the patient’s provider?

• Were X-rays ordered and performed?

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

treated?

• If the patient hit their head, was the chart

reviewed to determine if mediations included

an anticoagulant? If on anticoagulant, was

this information communicated to the

provider so head scans could be performed to

check for cranial bleeding?

Following up after a fall:

• Was there a change in mental status after the

fall?

• Were additional assessments and monitoring

done as follow up?

• Was the patient’s risk for falls reassessed

after the fall and the plan of care revised to

minimize the risk of future falls?

CNA, NSO. Nurse Professional Liability Exposure

Claim Report: 4th Edition. 2020. www.nso.com/

nurseclaimreport.

Dykes PC, Adelman J, Adkison L, et al. Preventing falls

in hospitalized patients. Am Nurs Today. 2018;13(9):8-

13. https://www.myamericannurse.com/preventingfalls-hospitalized-patients.

Iyer P. Legal aspects of documentation. In: KG Ferrell,

ed. Nurse’s Legal Handbook. 6th ed. Wolters Kluwer;

2015.

Van Voast Moncada L, Mire GL. Preventing falls in older

persons. Am Fam Physician. 2017;96(4):240-247.

https://www.aafp.org/afp/2017/0815/p240.html.

Disclaimer: The information offered within this article

reflects general principles only and does not constitute

legal advice by Nurses Service Organization (NSO)

or establish appropriate or acceptable standards of

professional conduct. Readers should consult with an

attorney if they have specific concerns. Neither Affinity

Insurance Services, Inc. nor NSO assumes any liability

for how this information is applied in practice or for the

accuracy of this information.

This risk management information was provided by

Nurses Service Organization (NSO), the nation’s

largest provider of nurses’ professional liability

insurance coverage for over 550,000 nurses since

1976. The individual professional liability insurance

policy administered through NSO is underwritten by

American Casualty Company of Reading, Pennsylvania,

a CNA company. Reproduction without permission of the

publisher is prohibited. For questions, send an e-mail to

service@nso.com or call 1-800-247-1500. www.nso.com.


February, March, April 2022 The Bulletin 21

Drink Less, Live More

Rachel Pritz, RN, MSN

Certified Coach, Certified Enneagram Coach

I was driving to my job as a

nurse manager one day and I

started day dreaming. What if

I got into a car accident, just

a small one of course, but

one that would require other

people to take care of me for a

change. I pulled into work and

woke up from my day dream

in horror. This wasn’t normal

and how did I even get to this

place in life anyway? I was

drinking a bottle of wine most

nights to “get through life”

and this had become problematic. As I got unstuck

from over-drinking, I started talking to about it on

stages and with the teams I coached. At first, it was

vulnerable and scary. Then, people started coming to

me and messaging me after saying “me too.” While

there is comfort in knowing you aren’t alone, it was

also a little frightening to know how many of us in

healthcare were out there. It’s a lot and more than I’d

ever imagined.

What drew you to this read?

I am lucky to have a very close friend that is also

a practicing clinical psychologist. She recently shared

insights and takeaways from the authors on her practice

blog and mentioned them to me the last time she came to

visit. I knew right away it was something I wanted to better

understand and possibly share with nurses.

This book is available on Audible which is a win for me

so that I can multitask. I had a road trip planned and it

was the perfect length to accompany me on my ride. You

know it is going to be good if Brene Brown calls it a “total

game changer.”

The audio version comes with a printable PDF for

working through stressful decisions (cost/benefit analysis)

and additional supportive worksheets. I liked the idea

of exercises in addition to the content so that I could

hopefully apply the methodology to my own life events.

What have you learned from this author?

One of my key takeaways, early in my listening was that

we are all on a journey. Wellness is not an end destination

but is an ongoing process that requires attention and

purposeful action. The authors focus on how to respond,

moving fluidly, through life and the stress response cycle.

Why, if so, do you recommend this book to other nurses?

I recommend this book to nurses, really to any female.

I do not recommend the book to readers that identify as

male as it is written specifically for females, or individuals

that identify as female. I appreciate that the authors clearly

state this in the beginning. I think many of the actions

and processes can be applied to males, however Nagoski

and Nagoski take into consideration that male brains (or

individuals that identify as) can function differently than

females, hence some of these items may not come into

play or be as useful.

A favorite section includes the authors referring to

our own “mad woman in the attic”, the importance of

connecting with your inner voice, and how to build the

relationship in our favor. If you have an inner voice that

consumes you, this may be just the book for you.

I recommend this book as we are all spread thin and

overwhelmed. Stress and stressors are compounding and

occurring non-stop, even more so today that last year and

the year before. Nagoski and Nagoski guide the reader to

move fluidly through stress and stressful circumstances

by preventing us from being stuck in a negative state. We

can process suffering if we know why we are responding

in this way. Meaning is good for us. “People with greater

sense of meaning and purpose in life experience better

health and are more likely to access preventive health

care services to protect that health… A meta-analysis of

the relationship between purpose in life and health found

It makes sense. You have a hard day, or night, at

work and come home exhausted. You just want to

turn off your brain and relax. A global pandemic and

all that has come with it both professionally and

personally, hasn’t made this easier. Not only do you

have all the to-do’s and the emotional toll of being a

healthcare professional, but you also have so many

responsibilities outside of work. Kids, aging parents,

family drama, relationship struggles, etc. We’ve

normalized drinking as a way to cope with all the

stressors that are thrown our way. But, what if you got

curious about the deeper why behind the drinking?

Is this behavior working for you or is it causing you

harm? What are the emotions and thoughts behind the

drinking?

Healthcare professionals everywhere have been

told to practice more self-care as the answer to their

burnout and exhaustion. I remember being told this

too. But what if society sold us a bag of lies about

what self-care really is? It’s so much deeper than

bubble baths and chardonnay. In fact, when I was

swimming in chardonnay that was the exact opposite

of self-care. Here are some of the strategies I used to

help dig me out of the pit of despair. I call it radical

self care. Nothing radical about it, but it does take

time and daily intention. If you truly want to get to the

ISNA’s Bookshelf

Burnout: The Secret to Unlocking the Stress Cycle

by Emily Nagoski, PhD and Amelia Nagoski, DMA

that greater sense of purpose is

associated with 17% lower risk

of all-cause mortality.” (Nagoski

& Nagoski, 2019, Chapter 3,

08:19).

This book is truthful, easy to

read/listen to, and helpful as we

process our current environment

and everyday stress. The book

barely mentions happiness, but

realistically focuses on how to

cultivate joy by working through

your stress, because we all have

it. Most importantly we all have

the power to persevere.

How will you apply what you have learned?

• Nagoski and Nagoski have helped me put labels on

and define stress. They have also shed light on how to

separate stressors from my response to stress. This is

foundational material in monitoring my stress cycles.

• Thinking through the concept of stressors and

response to stress as components of a cycle will

help remind me to close the gap and to work through

either or both cause and the outcome of stressors in

which are in and out of my control.

• A reminder to not be hard on myself while on this

journey and to not use obtaining wellness as a check

off or end game.

• This was a great reminder that I am in control of how

I let stress affect me. Stress is inevitable but how I

manage it is in my control.

• The authors reminded me that adversity or

overcoming difficulties and stressful circumstances

can help me define my own meaning in life, moving

me through coping onto thriving. Post traumatic

growth builds strength and supports handling

additional difficulties that will come my way if I am

completing my stress cycles.

• We make our own meaning to life, which requires

focus and intention. It’s what sustains us. Just like

wellness, it is an ongoing journey.

What is your next book or reading material in your queue?

I’d like to hear or read more from Kristin Neff about

Compassion. She has a Ted Talk that gets referenced

frequently and authored two books, Self-Compassion: The

Proven Power of Being Kind to Yourself, and Fierce Self-

Compassion. I’ve also recently started Moral Resilience,

written by Cynda Hylton Rushton, which I am enjoying and

moving through quickly.

Interested in sharing a recent book, podcast, article, or

show? Email me katie@indiananurses.org

root cause of any harmful numbing behavior, here are

some ways to do it:

• Therapy/Coaches

• Podcasts/Audiobooks

• Self-awareness work (I used the Enneagram)

• Exercise

• Healthy eating

• Spirituality

• Meditation (I use a guided version)

• Deep connections with other humans

• Belonging, not just fitting in

• Healthy boundaries

• Understanding thoughts and emotions and making

space to process them

• Asking for (and at times hiring) help

Ultimately, I decided to stop blaming everyone else

around me and to take accountability for the life I’d

created. No one was stopping me from doing all of the

above, but me. Not my work, my boss, my partner, my

kids, my parents. No one else was responsible but me.

My favorite definition of self-care is creating a life you

don’t have to regularly escape from. Think about what you

are escaping and where you might need help. This is a

personal journey and my guidance might not match what

you need. But the good news here is you already know

what you need if you can just quiet the noise around you.

Here’s what I’ve learned after going from drinking a

bottle of wine per night, to only drinking when I really

want to, which is rare.

• I sleep better - yes, alcohol can get you to sleep,

but you don’t get quality sleep.

• I have much less anxiety. Hangxiety is a real (and

chemical thing).

• My mood is better.

• Alcohol numbed the more negatively perceived

emotions. But it also numbed all the good stuff.

• Alcohol added no value in my life.

• I’ve lost weight. Calories aren’t the only biological

reason for this.

• Shaming yourself doesn’t work. Self-love does.

I thought my journey out of over-drinking would

only impact my drinking. Turns out, this healing and

empowering journey fixed a whole lot of problems in

my life. When we get to the root cause, that’s when the

magic happens.

Rachel Pritz, RN, MSN

www.rachelpritz.com

Instagram: @indyenneagram

Facebook: Rachel Pritz Life Coaching

LinkedIn: Rachel Pritz

Disclaimer: If you believe you are an addict or

alcoholic I encourage you to seek help.


22

The Bulletin February, March, April 2022

Policy Primer continued from page 3

SB 239: Provider disclosure of license

Requires any advertising by a healthcare

provider to include the license type of the provider.

Advertising is broadly defined to include any

communication that promotes services to the

general public. Also requires direct health care

providers to wear a badge displaying their name

and license type. Adds additional titles to the list

reserved for physicians.

SB 250: Terrible for APRNs

Removes APRN signature authority related to

handicap parking placards and death certificates.

Requires APRNs with prescriptive authority to

practice within 75 miles of their collaborator.

Requires an APRN with prescriptive authority to

meet quarterly with their collaborator, either inperson

or via electronic communication. Changes

APRN prescriptive authority from collaboration

to supervision by a physician. Require APRN

prescriptions to include the name, contact

information, and DEA number of their collaborator.

Requires providers to wear badges displaying their

name and license type.

HB 1113: Provider disclosure of license

Requires any advertising by a healthcare

provider to include the license type of the provider.

Advertising is broadly defined to include any

communication that promotes services to the

general public. Also requires direct health care

providers to wear a badge displaying their name

and license type. Adds additional titles to the list

reserved for physicians.

HB 1158: APRN signature and other health matters

Allows APRNs to sign certain individualized

family service plans. Modifies the regulation of

pharmacies and updates Indiana Code sections

related to HIV.

HB 1167: APRN signature for diabetic drivers

Provides APRN signature authority for intrastate

motor carrier drivers who are insulin dependent

diabetics

COVID-19 & Immunizations

SB 3 Agency public health powers

Allows state agencies to continue to obtain

federal emergency funds and to issue standing

orders for vaccines to individuals at least five

years old after Indiana’s declared public health

emergency ends. Extends temporary health

licenses through 3/31/2022.

SB 30: Workplace immunizations

Prohibits employers from requiring an

employee to receive any immunization that poses

a significant risk to the employee’s health or is

against the employee’s religious beliefs. No criteria

is provided for what constitutes a significant risk.

Also prohibits incentive programs that reward

employees for getting vaccinated, unless employees

that opt out due to health risk or religious belief

also receive the reward.

SB 31: Workplace COVID immunizations

Exact same provisions as SB 30, except only

applies to vaccines against COVID-19.

SB 114: Vaccine status

Prohibits vaccine status from being used to

provide a benefit or withhold a good or service.

Applies to all vaccines.

HB 1001: COVID relief funding and vaccine

mandates

Provide state agencies the authority to continue

to seek federal funds they have been receiving

through the public health emergency. Restrict the

ability of employers to require employees to have a

COVID vaccine.

HB 1408: Prohibit COVID vaccine mandates

Employers and government entities cannot have

COVID-19 immunization mandates.

Forensic nurses

HB 1091: Delay forensic medical exams and

human trafficking hotline notices

Prohibits commencement of a forensic medical

examination until after the provider has contacted

the rape crisis center and asking the patient if

they would like the victim advocate present for

the examination once the victim advocate arrives.

Requires all emergency rooms, urgent care centers,

bars, and other establishments to post a notice

for the human trafficking hotline in every restroom

and near the entrance or a conspicuous location in

clear view.

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Department of Health

SB 84: Suicide and overdose fatality reporting

Requires the Department of Health to prepare an

annual report containing: (1) the number of suicides

and overdose fatalities that occurred in each county;

(2) the number of fatalities that occurred during

each month; (3) the age and sexual orientation of

each fatality victim; and (4) the method of suicide or

overdose, including the type of weapon used.

HB 1169: Health Department matters

Requires the Health Department to employ a chief

medical officer and requires the chief medical officer

to be a physician. Updates terminology and adds

services for the health department.

HB 1254: Newborn screenings

Allows an expert advisory committee under the

Health Department to make additions to the list

of required newborn screenings, so that additional

screenings do not require going through the

legislature.

Professional Licensing Agency

SB 260: Organ donor

Anyone applying for or renewing a license with PLA

may become an organ donor as part of the license

process.

HB 1065: Cultural awareness training

Requires licensed health professionals to obtain

two hours of cultural awareness and competency

training every two years.

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February, March, April 2022 The Bulletin 23

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