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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U.S. Postage Paid
Princeton, MN
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.
Bulletin Copy Deadline Dates
All ISNA members are encouraged to submit material for
publication that is of interest to nurses. The material will be
reviewed and may be edited for publication. To submit an article
mail to The Bulletin, 2250 W. 86th Street, Ste 110, Indianapolis,
IN. 46260 or E-mail to info@indiananurses.org.
The Bulletin is published quarterly every February, May, August
and November. Copy deadline is December 15 for publication in
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September 15 for November/December/January.
If you wish additional information or have questions, please
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Acceptance of advertising does not imply endorsement or approval
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does not imply a product offered for advertising is without merit,
or that the manufacturer lacks integrity, or that this association
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consequences resulting from purchase or use of an advertiser’s
product. Articles appearing in this publication express the
opinions of the authors; they do not necessarily reflect views of
the staff, board, or membership of ISNA or those of the national
or local associations.
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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
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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
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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
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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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