Indiana Bulletin - February 2022
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THE BULLETIN<br />
Volume 48 • Number 2<br />
<strong>February</strong>, March, April <strong>2022</strong><br />
Brought to you by the <strong>Indiana</strong> Nurses Foundation (INF) and the <strong>Indiana</strong> State Nurses Association (ISNA) whose<br />
dues paying members make it possible to advocate for nurses and nursing at the state and federal level.<br />
Quarterly publication direct mailed to approximately 2,300 RNs and electronically via email to 65,000+ RNs licensed in <strong>Indiana</strong>.<br />
MESSAGE from the PRESIDENT<br />
Emily B. Sego<br />
DNP, RN, NEA-BC<br />
Last year at this time, we<br />
were headed into 2021 with<br />
a renewed sense of hope and<br />
healing. It is hard to believe<br />
that it has already been 1 year<br />
since the COVID vaccine was<br />
approved for emergency use.<br />
As we begin <strong>2022</strong>, that sense<br />
of renewed hope and healing<br />
has been challenged with<br />
Omicron, staffing shortages, and<br />
decreased bed capacity at our<br />
hospitals.<br />
Many of us have now<br />
experienced the death of friends and loved ones due<br />
to COVID or have had to care for a family member with<br />
COVID. Many of us have even battled this virus ourselves.<br />
My family and I have been lucky enough to escape<br />
COVID up until last month when my father tested positive<br />
and ended up in the ER struggling to breathe. He was<br />
admitted to the ICU, but due to having no beds he sat<br />
in the ER for 3 days. As I write this, he is on day 12 in<br />
the hospital and do not anticipate him leaving for another<br />
week.<br />
For those of you who have been on this side of the<br />
fence, I think we would agree on how very different it<br />
feels. This is not the kind of healthcare we are used to<br />
and before I share some of my observations, I want to<br />
acknowledge that everyone who has taken care of my<br />
father has been amazing. Did we have to wait a little<br />
longer when we pushed the call light? Yes, but once staff<br />
answered they were very attentive and listened. Staff<br />
took more time to make sure everything was done before<br />
leaving the room. However, the moral distress while sitting<br />
in the ER was palpable. Vocera badges were going off<br />
constantly and you could see the nurses trying to prioritize<br />
in their head. Often, our nurse would get a call and<br />
emergently leave the room amid my father talking because<br />
she was being called to another critical patient in another<br />
room. Each time the nurse returned visibly disappointed<br />
that my father’s care was interrupted. The mental health<br />
of our nurses continues to concern me and from what I am<br />
current resident or<br />
Non-Profit Org.<br />
U.S. Postage Paid<br />
Princeton, MN<br />
Permit No. 14<br />
hearing, it is taking months for our nurses to get in to see<br />
a mental health specialist. ISNA continues to reach out to<br />
local mental health organizations in <strong>Indiana</strong> and work with<br />
the American Nurses Association to bring more mental<br />
health resources to our nurses. While we continue to focus<br />
on building our network of support, please reach out with<br />
requests and ideas for future mental health partnerships.<br />
Over the last 12 days of visiting with my father, I have<br />
also come to realize how important visitation is when it<br />
comes to the health of our patients. Currently, he is in a<br />
room with no windows on the doors. Although he has a<br />
window to the outside, it is blocked by a wall. I cannot<br />
begin to imagine sitting in a room with nothing to look at<br />
and not having the opportunity to have a family member<br />
or visitor present. I am so grateful we can at least have<br />
2 visitors a day. It gives us the ability to take shifts to be<br />
there with him and still be able to go home and take care<br />
of ourselves. Limiting to one visitor would be difficult for<br />
us as it would require us to choose between caring for<br />
ourselves or leaving him all alone.<br />
Communication is also the best when families can<br />
visit. We have found it very difficult to get information<br />
when not physically onsite. EHR portals are a great place<br />
to find information, but family members should not be<br />
left to interpret results on their own. There are numerous<br />
studies now published as to the negative consequences<br />
on patients, families, and staff when restrictive visitation<br />
policies are in place. I encourage nursing leaders to look<br />
at recent studies published that compare various visitation<br />
policies and their relationship to patient outcomes. Nurses<br />
should be advocates for visitation policies developed<br />
based on evidence and not fear. I believe safety can be<br />
maintained without extreme measures for visitation. We<br />
have learned a lot over the last two years and now have<br />
enough data to support more holistic visitation policies for<br />
COVID patients.<br />
Lastly, I want to applaud the kind of teamwork I have<br />
seen. After 911, New Yorkers shared how neighbors<br />
became closer to one another and how everyone pitched<br />
in to help begin the process of rebuilding. This is what I<br />
have been seeing as I sit with my dad. After a procedure,<br />
the procedural nurse stayed in the room with the PCU<br />
nurse and said, “I want you to be comfortable with the<br />
way he looks before I leave this room.” And prior to her<br />
leaving she even asked, “Can I help you with anything<br />
before I leave?” The nurse proceeded to list out a few<br />
things and the Endoscopy nurse stayed without<br />
any hesitation and assisted. Another evening,<br />
very close to shift change, the tech realized she<br />
was going to need assistance and called the nurse<br />
in to help. The nurse came in immediately and<br />
did not bat an eye. These moments of teamwork<br />
truly warmed my heart. After all we have been<br />
through our nurses and healthcare teams are<br />
coming together to ease the pressure and burden,<br />
surrounding our teams every day. I am truly proud<br />
and humbled to be able to witness all of this from<br />
a different seat. A seat that none of us want to<br />
find ourselves, yet allows us to look through a<br />
different lens and gain a new perspective we<br />
might otherwise be blind to.<br />
INSIDE<br />
ANA’s proposed policy solutions to<br />
address the nurse staffing shortage crisis<br />
Page 7<br />
Get to Know Your 2021-2023 ISNA Board<br />
Page 8<br />
What Happens To Your Nursing<br />
Credentials When You Retire<br />
Page 9<br />
Importance of Client Education in<br />
the Face of Misinformation<br />
Page 10<br />
Policy Brief Regarding Nurses Spreading<br />
Misinformation about COVID-19<br />
Page 11<br />
Top Ten Ways to be an Antiracist in Nursing<br />
Page 12<br />
Calling All Pronouns<br />
Page 13<br />
Pulse of the Nation’s Nurses Survey Series<br />
Pages 14-17<br />
Honor a Nurse<br />
Page 17<br />
Message from the INF President<br />
Page 18<br />
National Rural Health Day<br />
Page 19<br />
Think like an expert witness<br />
to avoid falls liability<br />
Page 20<br />
Drink Less, Live More<br />
Page 21
2<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Katherine Feley, DNP, RN, NE-BC<br />
Chief Executive Officer<br />
The last two years have<br />
been challenging in many ways<br />
and the future ahead of us<br />
remains uncertain. What has<br />
been evident throughout these<br />
challenging times is that nurses<br />
continue to prevail. I am proud<br />
of <strong>Indiana</strong> Nurses for what<br />
we have accomplished and<br />
overcome, and the unwavering<br />
care that has been provided<br />
during this unpredictable time.<br />
The new year brings<br />
an opportunity for a fresh start. Now is the time to<br />
reposition, dig your heels in, and plan for success<br />
both personally and professionally. Success may be<br />
overcoming obstacles, more self-care, reconnecting<br />
with an old mentor, or achieving that certification you<br />
have always wanted. Whatever that might be, ISNA is<br />
here to support you.<br />
ISNA shapes our future strategies and<br />
programs based on what our nurses want and<br />
our environmental landscape. Our members drive<br />
the work of our organization. We are not a private<br />
company representing nurses, but we are a managed<br />
professional association here to support the nursing<br />
profession, and most importantly YOU. ISNA was<br />
started 119 years ago, and we are still governed by<br />
nurses as we were the day in which we launched. Our<br />
calling is to build upon the voice of nurses who have<br />
advanced <strong>Indiana</strong> nursing since 1903.<br />
Now is the time to elevate your voice as we are being<br />
heard. ISNA and our community has been recognized<br />
more during the last two years than in my lifetime, if<br />
not longer. For the 20th consecutive year, nurses are<br />
once again ranked #1 in Gallup’s annual Most Honest<br />
and Ethical Professions Poll. Nurses ranking in this<br />
year’s poll directly reflects the trust the American<br />
public has in nurses and the work they continue to do<br />
to earn that trust, even amid a persistent pandemic.<br />
The current backdrop has highlighted the voice of the<br />
CEO NOTE<br />
A Fresh Start<br />
nurse and I encourage you to use this social elevation<br />
to raise our profession and bring focus to necessary<br />
improvements. Nurses are showing up through<br />
television, social media, and written materials in which<br />
care givers and representatives of our profession<br />
haven’t been in the past. I encourage you to share your<br />
concerns related to our work environments, patient<br />
and staff safety, safe staffing, and any other nursing<br />
obstacle you may be facing.<br />
Suggestions for Planning to be Heard<br />
Now is the time to:<br />
• post a letter to the ISNA membership through<br />
the <strong>Bulletin</strong> sharing your concerns and comments<br />
related to current events. Differing opinions are<br />
welcome.<br />
• share your passion as a member of the renewed<br />
ISNA Advocacy Committee<br />
• share your voice at an upcoming open ISNA<br />
Board meeting. More information can be found at<br />
https://indiananurses.nursingnetwork.com<br />
• contact your legislator. Find them here http://iga.<br />
in.gov/legislative/find-legislators/.<br />
• plan to join your local boards, councils,<br />
commissions, and other decision making bodies<br />
set to advance our communities. Didn’t make the<br />
election? Introduce yourself. Participate from a<br />
seat in the audience, and most importantly plan<br />
for the next available appointment.<br />
ISNA is committed to advocating on behalf of<br />
nurses and we continue to focus on the demands of<br />
nurses including changes in care and care delivery, as<br />
well as the nursing pipeline. We continue to imagine<br />
what “better” will look like in our environments,<br />
well-being, and in the care being delivered to fellow<br />
Hoosiers.<br />
We continue to grow in influence and<br />
accomplishments. Our members always moving us<br />
forward. ISNA membership is only $15/month or<br />
$0.50 a day. What is your profession worth? What do<br />
you need to succeed? Turn up the volume of your voice<br />
through ISNA Membership!<br />
We’re listening. We want to hear from you.<br />
THE BULLETIN<br />
An official publication of the <strong>Indiana</strong> Nurses Foundation and<br />
the <strong>Indiana</strong> State Nurses Association, 2915 North High School<br />
Road, <strong>Indiana</strong>polis, IN 46224-2969. Tel: 317/299-4575. Fax:<br />
317/297-3525. E-mail: info@indiananurses.org. Web site:<br />
www.indiananurses.org<br />
Materials may not be reproduced without written permission from<br />
the Editor. Views stated may not necessarily represent those of the<br />
<strong>Indiana</strong> Nurses Foundation or the <strong>Indiana</strong> State Nurses Association.<br />
ISNA Staff<br />
Katherine Feley, DNP, RN, NE-BC, CPPS, CEO<br />
Blayne Miley, JD, Director of Policy and Advocacy<br />
ISNA Board of Directors<br />
Emily Sego, President; Brian Arwood, Vice President; Barbara Kelly,<br />
Treasurer; Angela Mamat, Secretary; Directors: Shalini Alim, Jolynn<br />
Kuehr, Leah Scalf, Susan Waltz, and Recent Graduate Director,<br />
Andrea Jacobs<br />
ISNA is a multi-purpose professional association serving<br />
registered nurses since 1903. ISNA is a constituent member of<br />
the American Nurses Association.<br />
ISNA Mission Statement<br />
ISNA works through its members to promote and influence<br />
quality nursing and health care.<br />
ISNA Pillars<br />
ISNA accomplishes its mission through unity, advocacy,<br />
professionalism, and leadership.<br />
Address Change<br />
The INF <strong>Bulletin</strong> obtains its mailing list from the <strong>Indiana</strong> Board of<br />
Nursing. Send your address changes to the <strong>Indiana</strong> Board of Nursing<br />
at Professional Licensing Agency, 402 W. Washington Street, Rm<br />
W072, <strong>Indiana</strong>polis, IN 46204 or call 317-234-2043.<br />
<strong>Bulletin</strong> Copy Deadline Dates<br />
All ISNA members are encouraged to submit material for<br />
publication that is of interest to nurses. The material will be<br />
reviewed and may be edited for publication. To submit an article<br />
mail to The <strong>Bulletin</strong>, 2250 W. 86th Street, Ste 110, <strong>Indiana</strong>polis,<br />
IN. 46260 or E-mail to info@indiananurses.org.<br />
The <strong>Bulletin</strong> is published quarterly every <strong>February</strong>, May, August<br />
and November. Copy deadline is December 15 for publication in<br />
the <strong>February</strong>/March/April The <strong>Bulletin</strong>; March 15 for May/June/<br />
July publication; June 15 for August/September/October, and<br />
September 15 for November/December/January.<br />
If you wish additional information or have questions, please<br />
contact ISNA headquarters.<br />
For advertising rates and information, please contact Arthur L.<br />
Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa<br />
50613, (800) 626-4081, sales@aldpub.com. ISNA and the<br />
Arthur L. Davis Publishing Agency, Inc. reserve the right to<br />
reject any advertisement. Responsibility for errors in advertising<br />
is limited to corrections in the next issue or refund of price of<br />
advertisement.<br />
Acceptance of advertising does not imply endorsement or approval<br />
by the <strong>Indiana</strong> Nurses Foundation of products advertised, the<br />
advertisers, or the claims made. Rejection of an advertisement<br />
does not imply a product offered for advertising is without merit,<br />
or that the manufacturer lacks integrity, or that this association<br />
disapproves of the product or its use. ISNA and the Arthur L.<br />
Davis Publishing Agency, Inc. shall not be held liable for any<br />
consequences resulting from purchase or use of an advertiser’s<br />
product. Articles appearing in this publication express the<br />
opinions of the authors; they do not necessarily reflect views of<br />
the staff, board, or membership of ISNA or those of the national<br />
or local associations.<br />
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<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 3<br />
POLICY PRIMER<br />
Blayne Miley, JD<br />
Director of Policy & Advocacy<br />
bmiley@indiananurses.org<br />
The <strong>2022</strong> <strong>Indiana</strong> General Assembly session is in<br />
full swing. This is not a budget year, so lawmakers are<br />
scheduled to conclude the session by March 14th. Below<br />
you will find summaries of some of the health-related<br />
bills that have been introduced in the <strong>2022</strong> <strong>Indiana</strong><br />
General Assembly session (SB designates a Senate bill,<br />
HB designates a House bill). As we go to press in mid-<br />
January, these bills have just been published and the<br />
legislature is starting to hold committee hearings. House<br />
bills have until January 31st to pass the House and<br />
Senate bills have until <strong>February</strong> 1st to pass the Senate.<br />
At iga.in.gov, you can lookup full details of all the bills;<br />
committee schedules, livestreams, and video recordings;<br />
and your state legislators and their contact information. We need more nurses to<br />
share their expertise with their state legislators, and you can help by contacting<br />
your state legislators regarding any bill of interest to you! You are welcome to email<br />
me (bmiley@indiananurses.org) with any questions or comments on any of the<br />
bills listed. HBs that have passed the House and Senate bills that have passed<br />
the Senate are still active in the legislative process. For bills that are still active,<br />
generally it is time to contact your state senator regarding HBs and your state<br />
representative regarding SBs.<br />
Members of ISNA receive weekly updates through our e-newsletter, the<br />
ISNAbler, so you can stay current on what is happening at the Statehouse that<br />
impacts your profession. Additionally, at the end of 2021, ISNA posted two new<br />
video series for our members, accessible under the Advocacy tab of the ISNA<br />
website (www.indiananurses.org). First, we have a five-part series providing an<br />
overview of health policy:<br />
• Who are your legislators?<br />
• Legislative process<br />
• Nurse regulatory landscape<br />
• Effective advocacy<br />
• Navigating the <strong>Indiana</strong> General Assembly website<br />
respective board. Recipients may be required to agree to provide services in a<br />
health workforce shortage area for a number of years determined by the health<br />
department. The bill creates an advisory board to counsel the health department<br />
on eligibility criteria, recommended professions, amounts of the award, and areas<br />
of need within professions. The advisory board will have 17 members, comprised<br />
of state government reps, healthcare stakeholders (<strong>Indiana</strong> Hospital Association,<br />
<strong>Indiana</strong> Rural Health Association, etc.), and one nurse.<br />
APRNs<br />
SB 140: APRN signature authorization<br />
Prohibits insurers from requiring authorization for covered early intervention services<br />
under an individualized family service plan signed by an advanced practice registered<br />
nurse (APRN). Provides APRN signature authority for intrastate motor carrier drivers<br />
who are insulin dependent diabetics and drivers subject to epileptic seizures. Allows all<br />
APRNs to make orders/referrals for physical therapy, instead of just nurse practitioners.<br />
Adds an APRN to the providers who may perform an examination for purposes<br />
of worker’s compensation claims. Allows an APRN to affirm that an applicant has a<br />
temporary disability for purposes of a waiver from continuing education requirements<br />
to work on certain lift devices. Requires a health insurance plan to provide coverage for<br />
diabetes self-management training ordered by an APRN.<br />
Policy Primer continued on page 22<br />
Second, ISNA conducted interviews with the chairs of three prominent legislative<br />
committees in the run-up to the start of the <strong>2022</strong> session. We have video<br />
interviews of:<br />
• Senator Ed Charbonneau, Chair of the Senate Health & Provider Services<br />
Committee<br />
• Representative Brad Barrett, Chair of the House Public Health Committee<br />
• Representative Tim Brown, Chair of the House Ways & Means Committee<br />
Student subscribers of the ISNAbler can email bmiley@indiananurses.org for<br />
access to the videos.<br />
Nursing Workforce<br />
HB 1003 Nursing workforce pipeline<br />
(1) Repeal the requirement that a majority of faculty for prelicensure nurse<br />
education programs must be full-time, allowing any percentage to be part-time; (2)<br />
Increase the amount of clinical simulation allowed to be used by prelicensure nurse<br />
education programs from 25% to up to 50%, based on NCLEX scores; (3) Reduce<br />
the required experience for clinical preceptors from 3 years to 18 months; (4)<br />
Make permanent the expanded eligibility that allows nurses pursuing graduate<br />
education to serve as clinical faculty in associate’s programs, which currently<br />
expires in 2023; (5) Prohibit the Board of Nursing from limiting enrollment<br />
increases or enrollment at new campuses if the program has been operating for<br />
five years and has over an 80% NCLEX pass rate; (6) Expand the pathways to<br />
licensure for foreign-educated nurses to add Credentials Evaluation Services (CES)<br />
and VisaScreen.<br />
HB 1088 Health workforce student loan repayment<br />
Imposes a surcharge on health profession licenses to fund student loan<br />
repayment. The surcharge is $10 for license fees of $100 or less and $20 for<br />
license fees of more than $100. The funds collected are divided evenly between<br />
the health department and the respective health profession boards, minus the<br />
costs of administering the program. Each health profession board shall receive<br />
funds based on the percentage of health profession licensees that are under that
4<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Pediatricians, Child and Adolescent Psychiatrists and Children’s<br />
Hospitals Declare National Emergency in Children’s Mental Health<br />
Media Contact: Gillian Ray (202) 753-5327<br />
AAP, AACAP and CHA call on policymakers<br />
at all levels of government to act swiftly to<br />
address mental health crisis<br />
WASHINGTON, DC—Today, the American Academy<br />
of Pediatrics (AAP), the American Academy of Child<br />
and Adolescent Psychiatry (AACAP) and the Children’s<br />
Hospital Association (CHA), together representing more<br />
than 77,000 physician members and more than 200<br />
children’s hospitals, declared a national state of emergency<br />
in child and adolescent mental health and are calling on<br />
policymakers to join them.<br />
The COVID-19 pandemic has taken a serious toll on<br />
children’s mental health as young people continue to face<br />
physical isolation, ongoing uncertainty, fear and grief. Even<br />
before the pandemic, mental health challenges facing<br />
children were of great concern, and COVID-19 has only<br />
exacerbated them.<br />
“Children’s mental health is suffering. Young people<br />
have endured so much throughout this pandemic and<br />
while much of the attention is often placed on its<br />
physical health consequences, we cannot overlook the<br />
escalating mental health crisis facing our patients,” said<br />
AAP President Lee Savio Beers, M.D., FAAP. “Today’s<br />
declaration is an urgent call to policymakers at all levels of<br />
government—we must treat this mental health crisis like<br />
the emergency it is.”<br />
The numbers paint an alarming picture. Between<br />
March and October 2020, the percentage of emergency<br />
department visits for children with mental health<br />
emergencies rose by 24% for children ages 5-11 and 31%<br />
for children ages 12-17. There was also a more than 50%<br />
increase in suspected suicide attempt emergency<br />
department visits among girls ages 12-17 in early 2021 as<br />
compared to the same period in 2019.<br />
Additionally, many young people have been impacted<br />
by loss of a loved one. Recent data show that more than<br />
140,000 U.S. children have experienced the death of<br />
a primary or secondary caregiver during the COVID-19<br />
pandemic, with children of color disproportionately<br />
impacted.<br />
“We were concerned about children’s emotional and<br />
behavioral health even before the pandemic. The ongoing<br />
public health emergency has made a bad situation<br />
worse. We are caring for young people with soaring rates<br />
of depression, anxiety, trauma, loneliness, and suicidality<br />
that will have lasting impacts on them, their families, their<br />
communities, and all of our futures. We cannot sit idly by.<br />
This is a national emergency, and the time for swift and<br />
deliberate action is now,” said AACAP President, Gabrielle<br />
A. Carlson, M.D.<br />
Amy Wimpey Knight, president of CHA added, “We<br />
are facing a significant national mental health crisis in our<br />
children and teens which requires urgent action. In the<br />
first six months of this year, children’s hospitals across the<br />
country reported a shocking 45% increase in the number<br />
of self-injury and suicide cases in 5- to 17-year-olds<br />
compared to the same period in 2019. Together with the<br />
AAP and the AACAP, we are sounding the alarm on this<br />
mental health emergency.”<br />
In the declaration, the groups emphasize the<br />
disproportionate toll on young people in communities of<br />
color and how the ongoing struggle for racial justice is<br />
inextricably tied to the worsening mental health crisis.<br />
“Children and families across our country have<br />
experienced enormous adversity and disruption. The<br />
inequities that result from structural racism have<br />
contributed to disproportionate impacts on children from<br />
communities of color,” the groups stated in the declaration.<br />
The organizations are urging policymakers to take<br />
several actions, such as increasing federal funding to<br />
ensure all families can access mental health services;<br />
improving access to telemedicine; supporting effective<br />
models of school-based mental health care; accelerating<br />
integration of mental health care in primary care<br />
pediatrics; strengthening efforts to reduce the risk of<br />
suicide in children and adolescents; and addressing<br />
workforce challenges and shortages so that children can<br />
access mental health services no matter where they live.<br />
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· Bachelor of Science in Nursing<br />
· RN to BSN<br />
· Master of Science in Nursing<br />
· Post MSN Certificate<br />
· Doctor of Nursing Practice<br />
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American Academy of Pediatrics<br />
The American Academy of Pediatrics is an organization<br />
of 67,000 primary care pediatricians, pediatric medical<br />
subspecialists and pediatric surgical specialists dedicated<br />
to the health, safety and well-being of infants, children,<br />
adolescents and young adults.<br />
American Academy of Child and Adolescent Psychiatry<br />
The American Academy of Child and Adolescent<br />
Psychiatry (AACAP) promotes the healthy development<br />
of children, adolescents, and families through advocacy,<br />
education, and research. Child and adolescent<br />
psychiatrists are the leading physician authority on<br />
children’s mental health. For more information, please<br />
visit www.aacap.org.<br />
Children’s Hospital Association<br />
The Children’s Hospital Association is the national<br />
voice of more than 200 children’s hospitals, advancing<br />
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<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 5<br />
ANA Urges US Department of Health and Human Services<br />
to Declare Nurse Staffing Shortage a National Crisis<br />
Sep 1st 2021<br />
MEDIA CONTACTS:<br />
Shannon McClendon | 301-628-5391<br />
shannon.mcclendon@ana.org<br />
Keziah Proctor | 301-628-5197<br />
keziah.proctor@ana.org<br />
SILVER SPRING, MD – The American Nurses<br />
Association (ANA), representing the interests of<br />
the nation’s 4.2 million nurses, urges the U.S.<br />
Department of Health and Human Services (HHS) to<br />
declare the current and unsustainable nurse staffing<br />
shortage facing our country a national crisis. In a<br />
letter to HHS Secretary Xavier Becerra, ANA calls<br />
for the Administration to acknowledge and take<br />
concrete action to address the current crisis-level<br />
nurse staffing shortage that puts nurses’ ability to<br />
care for patients in jeopardy.<br />
“The nation’s health care delivery systems are<br />
overwhelmed, and nurses are tired and frustrated<br />
as this persistent pandemic rages on with no end in<br />
sight. Nurses alone cannot solve this longstanding<br />
issue and it is not our burden to carry,” said ANA<br />
President Ernest Grant, PhD, RN, FAAN. “If we truly<br />
value the immeasurable contributions of the nursing<br />
workforce, then it is imperative that HHS utilize all<br />
available authorities to address this issue.”<br />
ANA calls on the Administration to deploy these<br />
policy solutions to address the dire nurse staffing<br />
shortage crisis. HHS must:<br />
• Convene stakeholders to identify short- and<br />
long-term solutions to staffing challenges to<br />
face the demand of the COVID-19 pandemic<br />
response, ensure the nation’s health care<br />
delivery system is best equipped to provide<br />
quality care for patients, and prepared for the<br />
future challenges.<br />
• Work with the Center for Medicare and<br />
Medicaid Services (CMS) on methodologies<br />
and approaches to promote payment equity<br />
for nursing services and remove unnecessary<br />
regulatory barriers to APRN practice.<br />
• Educate the nation on the importance of the<br />
COVID-19 vaccine to provide resources for<br />
widespread administration of the COVID-19<br />
vaccine and any subsequent boosters.<br />
• Sustain a nursing workforce that meets current<br />
and future staffing demands to ensure access<br />
to care for patients and prioritize the mental<br />
health of nurses and other health professionals.<br />
• Provide additional resources including recruitment<br />
and retention incentives that will attract students<br />
to the nursing profession and retain skilled<br />
nurses to the demands of patient care.<br />
“ANA stands ready to work with HHS and other<br />
stakeholders on a whole of government approach<br />
to ensure we have a strong nursing workforce today<br />
and in the future,” said Dr. Grant. “Our nation must<br />
have a robust nursing workforce at peak health<br />
and wellness to administer COVID-19 vaccines,<br />
educate communities, and provide safe patient care<br />
for millions of Americans. We cannot be a healthy<br />
nation until we commit to address underlying,<br />
chronic nursing workforce challenges that have<br />
persisted for decades.”<br />
# # #<br />
The American Nurses Association (ANA) is the<br />
premier organization representing the interests of<br />
the nation’s 4.3 million registered nurses. ANA<br />
advances the profession by fostering high standards<br />
of nursing practice, promoting a safe and ethical<br />
work environment, bolstering the health and wellness<br />
of nurses, and advocating on health care issues that<br />
affect nurses and the public. ANA is at the forefront<br />
of improving the quality of health care for all. For<br />
more information, visit www.nursingworld.org.<br />
Using Your Nursing<br />
Network to Conduct a<br />
Political Environmental Scan<br />
American Nurses Advocacy<br />
Institute Update<br />
Denise Kerley MSN, RN, CNRN, AG-CNS<br />
ISNA Member<br />
Transform Lives<br />
Jean Ross MHA, BSN, RN<br />
ISNA Member<br />
In October 2021, ISNA members Denise Kerley<br />
MSN, RN, CNRN, AG-CNS, and Jean Ross MHA,<br />
BSN, RN reported on their experience as the<br />
American Nurse Advocacy Institute 2021-<strong>2022</strong><br />
representatives. They chose a project focused on<br />
nurse staffing. When faced with how to collect and<br />
share the voice of <strong>Indiana</strong> nurses around their views<br />
of safe staffing, they have learned to lean into their<br />
nursing network.<br />
ISNA CEO, Katie Feley DNP, RN, NE-BC, has given<br />
leadership and space to support the ideas Denise and<br />
Jean want to tackle during their time with ANAI. Late<br />
September, ISNA sent a JotForm to begin collecting<br />
the names of interested nurses in <strong>Indiana</strong> who want to<br />
participate in a future study. To date, 56 nurses have<br />
signed up to participate!<br />
During the past three months, Katie, Denise, and<br />
Jean have reached out to mentors, co-workers, and<br />
community connections to gather a list of vested<br />
stakeholders around nurse staffing, retention, and<br />
pipeline. Denise and Jean seek to design a survey to<br />
get to the heart of the right questions to ask <strong>Indiana</strong><br />
nurses. The knowledge they desire is to understand<br />
better the factors that influence nurse perception<br />
of safe staffing, and the advocacy opportunities to<br />
change the course of nurse staffing in <strong>Indiana</strong>.<br />
Denise and Jean greatly appreciate the support<br />
and guidance of Jennifer Embree DNP, RN, NE-BC,<br />
CCNS, FAAN who connected Denise, Jean and ISNA<br />
to resources to perform a literature review. The next<br />
step is to review the literature to design a survey of<br />
questions. Their goal is to begin interviewing and<br />
surveying nurses by late <strong>February</strong>.<br />
If any nurse in <strong>Indiana</strong> would like to add their name<br />
as a future participant, please reach out to ISNA at<br />
[katie@indiananurses.org] or sign-up at https://form.<br />
jotform.com/212514604688054. To learn more,<br />
Denise and Jean will be presenting at ISNA’s Virtual<br />
Annual Policy and Advocacy Conference: Elevating Our<br />
Profession & Our Environment Jan 28, <strong>2022</strong>.<br />
While advancing your Career<br />
Doctor of Nursing Practice<br />
The Hybrid-Online DNP program at Saint Mary’s College can help you take your patient<br />
care to the next level. Our award-winning curriculum teaches<br />
you how to use communication as a tool to help improve the<br />
health of your community on a schedule that works for you.<br />
Visit our website: https://grad.saintmarys.edu<br />
or email us at graduateadmission@saintmarys.edu<br />
for more information about how to get started!
6<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
ANA Letter to Department of Health and Human Services
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 7<br />
ANA’s proposed policy solutions to address<br />
the nurse staffing shortage crisis<br />
HHS Must Convene Stakeholders to<br />
Identify Short- and Long-Term Solutions<br />
to Staffing Challenges.<br />
ANA urges HHS to convene all stakeholders<br />
for a robust discussion of staffing challenges and<br />
potential solutions. These challenges are not solely<br />
contained within the nursing profession, especially<br />
as the health care delivery system continues to<br />
evolve towards a more integrated system. As such,<br />
it is crucial that the agency convenes, in addition<br />
to nurses, hospitals, physicians, other health care<br />
personnel, state and federal government officials,<br />
and key stakeholders to examine, identify, and then<br />
implement real solutions to the nursing shortage.<br />
The focus of these discussions must be to identify<br />
the current challenges and both short- and longterm<br />
solutions. Short-term solutions will allow us<br />
to adequately face the demand of the COVID-19<br />
pandemic response. Long-term solutions will ensure<br />
the nation’s health care delivery system is best<br />
equipped to provide quality care for patients and<br />
stands ready for the future challenges. ANA implores<br />
HHS to have these critical conversations and stands<br />
ready to work with the agency to facilitate them.<br />
HHS must work with CMS to take steps<br />
to appropriately acknowledge nurses in<br />
reimbursement methodologies, ensuring<br />
payment equity for nursing services<br />
provided to patients.<br />
The COVID-19 pandemic response has made clear<br />
that APRNs and RNs are indispensable to providing<br />
the care that patients need now and in the future.<br />
For instance, APRNs are a significant source of<br />
primary care, especially in rural and underserved<br />
areas. Further, RNs are responsible for a wide array<br />
of direct care and care coordination services in<br />
community settings as well as hospitals and longterm<br />
care facilities. These health care services are<br />
key in ensuring access to care, a critical aspect of<br />
addressing health inequity. However, there must be<br />
parity in how these vital services are reimbursed.<br />
Recognition through appropriate payment for<br />
nursing services is critical in ensuring a resilient<br />
nursing workforce ready and able to meet future<br />
needs. It is long overdue for nursing services to<br />
be separated from “room and board,” as currently<br />
considered by the Medicare program. Nurses<br />
provide vital services to patients across the care<br />
continuum and the health care delivery system must<br />
recognize their critical role through appropriate<br />
reimbursement. ANA urges HHS to work with CMS<br />
to consider methodologies and approaches that will<br />
ensure payment equity for nursing services.<br />
In light of the rise of Coronavirus variants<br />
and increased COVID-19 contraction, HHS<br />
must provide additional resources including<br />
recruitment and retention incentives and<br />
support to bolster the nursing workforce to<br />
meet current demands for critical health<br />
care services.<br />
Hospitals are quickly reaching capacity limits<br />
due to the surge of COVID-19 cases and the nursing<br />
shortages across the country. It is imperative that<br />
HHS continue its thoughtful pandemic leadership<br />
and utilize all available authorities to address<br />
this issue. Nurses are still in need of resources<br />
to combat the pandemic and ANA continues to<br />
call on the Administration to act in response.<br />
Standing on the front lines, our nation’s nurses are<br />
becoming increasingly burned out as the pandemic<br />
continues to weigh heavily on them. We are seeing<br />
large numbers of nurses leaving the profession as<br />
a result. This only results in further strain on the<br />
nursing workforce, which was already in a supply<br />
crisis before the pandemic.<br />
ANA appreciates the Administration’s thoughtful<br />
pandemic response to date through issuance of<br />
waivers and other resources to bolster nurses’<br />
ability to provide vital health care services amid the<br />
challenges faced by the health care system.<br />
ANA urges HHS to remove unnecessary<br />
regulatory barriers to APRN practice<br />
In various ways, certain Medicare payment rules<br />
restrict APRN practice above and beyond their<br />
state scope-of-practice rules. Examples include<br />
unnecessary supervision requirements, as well as<br />
payment restrictions for certain Medicare services<br />
provided by APRNs. Such restrictions limit access to<br />
care and beneficiaries’ choice of qualified provider.<br />
Several of these federal practice restrictions have<br />
been waived during the COVID-19 public health<br />
emergency (PHE). As experiences resulting from<br />
these waivers demonstrate, allowing APRNs to<br />
practice to the full extent of their state license<br />
translates to needed system capacity and expanded<br />
access for patients. We continue to call on CMS to<br />
grant permanent regulatory relief for APRN practice,<br />
so that access is not constricted when the PHE ends.<br />
HHS must continue to educate the nation<br />
on the importance of the COVID-19 vaccine<br />
and provide support and resources for<br />
widespread administration of the vaccine<br />
and any subsequent boosters.<br />
Vaccines are critical to the control and prevention<br />
of infectious disease transmission. Nurses play a<br />
critical role in educating the public and fellow health<br />
care colleagues, as well as in the administration<br />
of COVID-19 vaccines. Currently, the nation faces<br />
significant vaccine hesitancy while cases of the<br />
Delta variant increase rapidly, straining an already<br />
strained nursing workforce. HHS must continue to<br />
provide resources and support efforts to educate the<br />
public on the importance of getting the COVID-19<br />
vaccine.<br />
In addition, it was recently announced that<br />
boosters for the already vaccinated will be available.<br />
HHS must provide the necessary resources to<br />
states and localities for successful distribution<br />
and administration of the booster vaccine doses.<br />
The agency must also educate the public on the<br />
importance of receiving the booster doses, when<br />
appropriate. The vaccine is an important component<br />
of COVID-19 mitigation efforts—especially in an<br />
effort to keep patients out of hospitals facing<br />
capacity challenges. ANA urges HHS to provide<br />
support and resources for continued education<br />
and ongoing distribution and administration of the<br />
vaccine across the country.<br />
HHS must ensure a resilient nursing<br />
workforce that meets current and future<br />
staffing demands and ensures access to<br />
care for patients.<br />
Prior to the COVID-19 pandemic, nurses already<br />
experienced tremendous levels of stress in their dayto-<br />
day work. The pandemic has further intensified<br />
the feelings of exhaustion, anxiety and being<br />
Visit nursingALD.com today!<br />
overwhelmed especially with respect to patients<br />
that are dying and having to inform and comfort<br />
their surviving family members. It is vital the nation<br />
prioritizes the mental health of nurses and other<br />
health professionals who are caring for our most<br />
vulnerable patients. ANA actively advocates to<br />
reduce stigma around seeking help for mental health<br />
and substance use disorders for health professionals<br />
as well as their patients.<br />
Moreover, nurses also must be treated and<br />
compensated appropriately as they provide care<br />
under extraordinary circumstances, so that the<br />
next generation is encouraged to enter the field<br />
and ensure the nation’s readiness for public health<br />
emergencies. Appropriate compensation ensures<br />
that the health care delivery system retains the<br />
nurses needed to provide care to patients. We<br />
are seeing examples throughout the country of<br />
nurses leaving their communities for the higher<br />
compensation offered by travel nurse agencies. This<br />
only serves to further local staffing strains, often in<br />
the most underserved communities.<br />
However, a resilient workforce is achieved not<br />
only by adequate pay, as the working environment<br />
must also allow nurses to flourish in their<br />
profession. Nurses are professionals providing<br />
critical health care services to patients—they<br />
should not have to fight for allotted breaks and<br />
other challenges created by antiquated views of<br />
the profession. All too often, we hear of staffing<br />
plans not being enforced, resulting in long shifts<br />
and strains on nurses providing care. Nurses know<br />
best the provisions that they and their team need,<br />
from patient complexity to layout of the nursing<br />
unit. This is just another instance where health<br />
care delivery and outcomes would be improved by<br />
greater nurse involvement. It is crucial for nurses to<br />
take on leadership roles, in all settings, to meet the<br />
demands of our ever-changing health care system,<br />
including being permitted to practice to the full<br />
extent of their education, training and licensure.<br />
Lastly, the introduction of electronic health<br />
records (EHR) has proved to be burdensome,<br />
detracting from patient-centered care.<br />
Documentation and required recording of various<br />
questions is time consuming, which leaves less<br />
time for nurses to connect with patients. HHS<br />
should reevaluate current and future requirements<br />
and ensure the right balance is struck between<br />
the positive impact of EHR in comprehensive,<br />
coordinated care and provider burden.<br />
To ensure a future workforce that meets all the<br />
needs and demands of patient care, it is crucial<br />
that we not only attract students to the nursing<br />
profession but retain skilled nurses throughout<br />
their careers. Effective workforce planning and<br />
policymaking require better data collection and<br />
an improved information infrastructure. ANA<br />
encourages HHS to work with nurses to identify<br />
approaches to bolstering a resilient nursing workforce<br />
ready to meet the demands of today and tomorrow’s<br />
health care delivery system.<br />
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8<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Get to Know Your 2021-2023 ISNA Board<br />
Bami M Adeniyi – New<br />
Graduate Director at Large<br />
Pronunciation:<br />
Bah/ mi Ade/knee/yi<br />
Pronouns: She/her<br />
I’m a second-generation<br />
nurse and I’m the oldest<br />
child by nine years.<br />
Pamela Hunt – Treasurer<br />
Pronunciation: /p/a/m/eh/l/ah/<br />
Pronouns: She/Her/Hers<br />
ISNA is positioned to be the<br />
unified voice for nursing.<br />
Bringing visibility to the<br />
amazing art and science of<br />
our profession. Let’s work<br />
together!<br />
Leah Scalf – Secretary<br />
Pronunciation: LEE/uh<br />
Pronouns: She/Her<br />
I am proud to share that<br />
I am one of Dr. Sharron<br />
Crowder’s Eagles. I enjoy<br />
serving in various nursing<br />
focused leadership roles as<br />
I am building a legacy for<br />
future nurses.<br />
Shalini Alim –<br />
Director at Large<br />
Pronunciation:<br />
sh/ah/l/ee/n/ee<br />
Pronouns: She/her/hers<br />
I enjoy spending time with<br />
my family-hikes, outdoors or<br />
just hanging out.<br />
Steven Koons –<br />
Director at Large<br />
Pronunciation:<br />
st/ee/v/uh/n or STEE-vun<br />
Pronouns: He/They<br />
I love cats, dogs, hiking and<br />
facing controversial topics<br />
in nursing head on. I have<br />
a Master’s in Healthcare<br />
Innovation.<br />
Emily Sego – President<br />
Pronunciation: Sea-go<br />
Pronouns: She/Her/Hers<br />
I am trying to travel to<br />
all 50 states by the time<br />
I am 50. I have 18 to<br />
go. COVID has slowed my<br />
progress down.<br />
Brian Arwood –<br />
President Elect<br />
Pronunciation: b/r/ai/ən<br />
Pronouns: he/him/his<br />
Out of the two bald guys<br />
on the board, I’m the one<br />
with glasses. My wife and<br />
I have five children (four<br />
daughters and one son)<br />
and my long-term goal<br />
is to teach at a four-year<br />
university where they will all attend and receive<br />
tuition discounts.<br />
Deb Lyons –<br />
Director at Large<br />
Pronunciation: Deb/or/ah<br />
Pronouns: She/hers<br />
I was in gymnastics while<br />
I was pregnant and able to<br />
do back hand springs when<br />
I was six months pregnant<br />
with my first daughter who<br />
was a gymnast when she<br />
grew up!<br />
Rachel Spalding –<br />
Director at Large<br />
Pronunciation: /rey/chul/<br />
Pronouns: She/Her/Hers<br />
Loves to watch baking<br />
and cooking competitions,<br />
loves all things high<br />
fashion, loves to travel,<br />
and most importantly<br />
LOVES NURSING! I am so<br />
excited to have the honor<br />
of representing <strong>Indiana</strong>’s<br />
Nurses with my voice!
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 9<br />
What Happens To Your Nursing Credentials When You Retire<br />
Joanne Evans MEd, RN, PMHCNS-BC<br />
ISNA Member<br />
For about 12 years, I was<br />
employed at ANCC and then<br />
decided to retire in 2017.<br />
During my time there, I was<br />
responsible for developing<br />
educational programs in all<br />
specialties to assist nurses<br />
in passing a wide range of<br />
ANCC certification exams.<br />
I was very aware of all the<br />
challenges nurses experienced<br />
in preparing for these<br />
examinations and also how<br />
proud nurses were when they<br />
received the certificate in their specialty in the mail.<br />
Certification was a way of nurses showing their<br />
expertise and professionalism in a specific area. It was<br />
a commitment to nursing excellence and quality patient<br />
care. Nurses were able to renew their certification<br />
every five years and many had been doing this renewal<br />
process for many years. I actually just completed my<br />
ninth renewal application as a clinical nurse specialist.<br />
When I retired from ANCC, I became a consultant<br />
so renewed my certification but I spoke with many<br />
retired nurses who were very disappointed to lose<br />
their identify as a certified nurse when they stopped<br />
practicing full time nursing. Since I had extensive<br />
experience developing review programs for nurses to<br />
become certified, I approached the Director of ANCC<br />
Certification to see if we could create a certification and<br />
recognition for retired nurses. I was very excited when I<br />
was asked to develop this new recognition certification<br />
which would allow nurses to continue to keep their<br />
certification credentials. It was a way of letting others<br />
know all they had accomplished throughout their<br />
nursing career. I was also adamant that nurses did not<br />
need to take one more exam. They had already proven<br />
themselves time and time again.<br />
To qualify for the retired nurse recognition<br />
certification, a nurse<br />
planned to not actively practice nursing<br />
held a current and unrestricted nursing license<br />
was certified with ANCC and was in good<br />
standing<br />
submitted an application, up to one year after<br />
the expiration of their last certification renewal<br />
date<br />
The application is available online at https://www.<br />
nursingworld.org/certification/retired-recognition/<br />
This recognition certification is available to nurses,<br />
whether or not they are ANA members. Once a nurse<br />
completes the retired nurse recognition application<br />
for retired nurses and it is approved, they can use the<br />
word “retired” after their credentials. For example -<br />
FNP-BC–retired, or RN-BC- retired, etc.<br />
This “retired” signature can then be used for<br />
business cards, curriculum vitae or resumes. It cannot<br />
be used for patient charts or records, after a signature<br />
or on professional names badges. In addition to a<br />
congratulatory letter from ANCC, retired nurses receive<br />
a wall certificate and a complementary mug with the<br />
ANCC logo.<br />
Certified nurses have made a significant<br />
contribution to the nursing profession as well as to<br />
their patients, students, organizations and colleagues.<br />
With this recognition, they can continue to let others<br />
know of their accomplishment as a certified nurse by<br />
using their credential with the word “retired.” When<br />
you are ready to retire, just know you do not need to<br />
lose your credentials but can apply for the “retired”<br />
recognition certification and continue to let others<br />
know of your expertise as a retired credentialed<br />
nursing professional.<br />
When I retired from ANCC, I began talking with<br />
other retired nurses both nationally and internationally<br />
and found their stories inspirational. With one of my<br />
colleagues, I co-authored Redefining Retirement<br />
for Nurses published by Sigma Theta Tau later in<br />
2017. We interviewed 26 nurses from around the US<br />
and globally and discussed how they continued to<br />
find meaning in their lives when retired. We shared<br />
their stories about professionalism and how some<br />
continued to be employed in nursing or volunteered<br />
in nursing positions. Others became more involved<br />
with family and friends while some considered the<br />
advantages and disadvantages of relocating. Making<br />
financial decisions was relevant to them all. Another<br />
opportunity for several nurses was to take risks and go<br />
on new ventures or even doing something completely<br />
different from nursing. Then there were those who<br />
found a combination of all the above activities suited<br />
them best. Redefining Retirement for Nurses can<br />
be found on the Sigma Theta Tau Marketplace or on<br />
Amazon. This is a book for those not sure of all the<br />
opportunities available to nurses once they decide to<br />
retire from their fulltime nursing position. Nurses have<br />
had a wide variety of experiences and will continue to<br />
find ways to enjoy this next phase of their lives.<br />
Valle Vista Health System is seeking full time and part time<br />
REGISTERED NURSES<br />
• $10,000 Sign on/Retention Bonus<br />
• Excellent Salary, Shift Differentials & Benefits<br />
Join our winning team! Contact or visit us today!<br />
Simone Wimberly, Director of Human Resources<br />
898 East Main Street, Greenwood, IN 46143<br />
E-mail: Simone.Wimberly@uhsinc.com<br />
Visit our website: www.vallevistahospital.com<br />
EOE
10<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Importance of Client Education in the Face of Misinformation<br />
Megan Rach, Ruben Rider-Leck, & Stefani Nemet<br />
Purdue BSN Nursing Students,<br />
Estimated graduation date of 2024<br />
Now more than ever, nurses play a key role in<br />
patient education. When media articles misinterpret<br />
research or put their own spin on the facts, it can<br />
be confusing and mislead people. Complex medical<br />
research is easy to misinterpret which can have a<br />
profound effect on the expectations of patients.<br />
When research is incorrectly reported by the media,<br />
it can lead patients to making false assumptions. It is<br />
critical that nurses are prepared to address inaccurate<br />
information patients’ have obtained via inaccurate<br />
media reports. This will improve their understanding<br />
of their health and help them seek out proper medical<br />
care when necessary.<br />
An example of an article misinterpreting research is<br />
entitled, “Could we soon have super hero NIGHT VISION?<br />
Brain implants could give us a ‘sixth sense’ by making<br />
us see infrared” written by Richard Gray and published<br />
by Daily Mail. Gray claims that humans will soon be able<br />
to have night vision. Gray bases his conclusions on a<br />
research paper written by Hartmann et al. (2016). Gray<br />
states this discovery will be revolutionary in the field of<br />
medicine claiming humans will be able to acquire night<br />
vision and even have their eyesight restored. However,<br />
review of the actual research paper and other similar<br />
studies reveal this is not the case.<br />
There have been several experiments testing<br />
infrared light and prosthetics in rodents. One study<br />
found that implants can be used to allow rats to<br />
identify infrared light (Thompson et al., 2013).<br />
Another study found that adult mammalian brains<br />
have sufficient plasticity to support such an implant<br />
(Hartmann et al., 2016). Thus, research has concluded<br />
that infrared implants could be adapted to an adult<br />
mammalian brain (Thompson et al., 2013; Hartmann<br />
et al., 2016). However, infrared light prosthetics have<br />
not been tested in humans. In fact, little is known<br />
about the impact of infrared light on the human brain<br />
other than it increases some brain wave activities while<br />
decreasing others (Shan et al., 2016). In fact, the<br />
study of infrared implants and the human brain has<br />
been cited as an area requiring further study (Shan et<br />
al., 2016; Nirenburg & Pandarith, 2012). Research<br />
is still grappling with the creation of a functional and<br />
sensible optical implant to restore vision for visible<br />
wavelengths of light (Nirenburg & Pandarith, 2012).<br />
Thus, the idea of creating optical implants supporting<br />
infrared night vision is still far from reality and requires<br />
significant additional development (Hartmann et<br />
al., 2016). The only conclusion that can accurately<br />
be stated is that the adult mammalian brain has the<br />
capacity to accept new information sources from<br />
infrared light and optical implants (Thompson et al.,<br />
2013; Hartmann et al., 2016).<br />
With the actual research laid bare, it can be easy<br />
to see how Gray’s article could lead to the spread of<br />
disinformation. The research is complex and difficult<br />
to comprehend, which makes it easy to misinterpret<br />
and come to inaccurate conclusions. This article<br />
provides an example of why nurses must be able to<br />
look beyond media headlines and reports and read<br />
research publications. As trusted health professionals,<br />
nurses must be prepared to provide the facts when<br />
patients ask about media reports such as this one.<br />
Patients are exposed to a variety of complex medical<br />
advancements via media reports, often shared through<br />
social media sites. Complex advancements are<br />
easily misinterpreted thereby giving patients’ a false<br />
perception of modern medicine and what is possible<br />
for current medical professionals. When patients seek<br />
out medical care it is critical that nurses educate them<br />
on these misconceptions. This will help the patient<br />
become more confident in their treatment and medical<br />
care teams. As one of the most trusted professions,<br />
nurses are a natural beacon for patients. Thus, it is a<br />
nurse’s job to be knowledgeable when patients come<br />
to us to seek out medical education.<br />
References<br />
Gray, R. (2016, March 17). Could we soon have superhero<br />
NIGHT VISION? Brain implants could give us a ‘sixth sense’<br />
by making us see infrared. DailyMail.com. https://www.<br />
dailymail.co.uk/sciencetech/article-3496895/Could-soonsuperhero-NIGHT-VISION-Brain-implants-rats-sixth-sensemaking-infrared.html<br />
Hartmann, K., Thomson, E., Zea, I., Yun, R., Mullen, P.,<br />
Canarick, J., Huh, A., & Nicolelis, M. Embedding a<br />
panoramic representation of infrared light in the adult rat<br />
somatosensory cortex through a sensory neuroprosthesis.<br />
The Journal of Neuroscience, 36(8), 2406 –2424. https://<br />
www.doi.org/10.1523/JNEUROSCI.3285-15.2016<br />
Nirenberg, S., & Pandarinath, C. (2012). Retinal prosthetic<br />
strategy with the capacity to restore normal vision.<br />
Proceedings of the National Academy of Sciences of the<br />
United States of America, 109(37), 15012-7. http://www.doi.<br />
org/10.1073/pnas.1207035109<br />
Shan, Y.-C., Fang, W., Chang, Y.-C., Chang, W.-D., & Wu, J.-H.<br />
(2021). Effect of near-infrared pulsed light on the human<br />
brain using electroencephalography. Evidence-Based<br />
Complementary & Alternative Medicine (ECAM), 2021, 1–11.<br />
https://doi.org/10.1155/2021/6693916<br />
Thomson, E., Carra, R. & Nicolelis, M. (2013). Perceiving<br />
invisible light through a somatosensory cortical prosthesis.<br />
Nature Communications, 4(1), 1-7. https://doi.org/10.1038/<br />
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<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 11<br />
Leading Nursing Organizations Issue Policy Brief Regarding<br />
Nurses Spreading Misinformation about COVID-19<br />
POSTED 11/16/2021<br />
NCSBN and seven other leading nursing organizations have<br />
issued a policy brief to address the misinformation being<br />
disseminated about COVID-19 by nurses.<br />
FOR IMMEDIATE RELEASE<br />
Media Contact: Dawn M. Kappel<br />
Director, Marketing & Communications<br />
312.525.3667 direct | dkappel@ncsbn.org<br />
CHICAGO – NCSBN and seven other leading nursing<br />
organizations* have issued a policy brief to address the<br />
misinformation being disseminated about COVID-19<br />
by nurses. The brief notes that when nurses identify<br />
themselves by their profession, they are professionally<br />
accountable for the information they provide to the<br />
public.<br />
It is an expectation of the U.S. boards of nursing, the<br />
profession, and the public that nurses uphold the truth,<br />
the principles of the American Nurses Association Code<br />
of Ethics for Nurses and highest scientific standards<br />
when disseminating information about COVID-19 or any<br />
other health-related condition or situation.<br />
The brief concludes by stating, “Nurses are urged to<br />
recognize that dissemination of misinformation not only<br />
jeopardizes the health and well-being of the public but<br />
may place their license and career in jeopardy as well.”<br />
The brief in its entirety may be read here.<br />
*Accreditation Commission for Education in Nursing (ACEN),<br />
American Nurses Association (ANA), American Organization for<br />
Nursing Leadership (AONL) National League for Nursing (NLN),<br />
NLN Commission for Nursing Education Accreditation (CNEA),<br />
National Student Nurses’ Association (NSNA) and Organization for<br />
Associate Degree Nursing (OADN)<br />
About NCSBN<br />
Empowering and supporting nursing regulators across the world in<br />
their mandate to protect the public, NCSBN is an independent, notfor-profit<br />
organization. As a global leader in regulatory excellence,<br />
NCSBN champions regulatory solutions to borderless health care<br />
delivery, agile regulatory systems and nurses practicing to the<br />
full scope of their education, experience and expertise. A world<br />
leader in test development and administration, NCSBN’s NCLEX®<br />
Exams are internationally recognized as the preeminent nursing<br />
examinations.<br />
NCSBN’s membership is comprised of the nursing regulatory<br />
bodies (NRBs) in the 50 states, the District of Columbia and<br />
four U.S. territories. There are three exam user members and 27<br />
associate members that are either NRBs or empowered regulatory<br />
authorities from other countries or territories.<br />
The statements and opinions expressed are those of NCSBN and<br />
not individual members.<br />
###
12<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Project ECHO® on Racism<br />
in Nursing Series Launches<br />
March, <strong>2022</strong>!<br />
Project ECHO® on Racism in Nursing is being conducted as<br />
part of the ongoing work of the National Commission to Address<br />
Racism in Nursing, a multi-organizational collaborative of leading<br />
nursing organizations to examine the issue of racism within nursing<br />
nationwide and the impact on nurses, patients, communities, and<br />
healthcare systems to motivate all nurses to confront systemic<br />
racism. Through ECHO®, the National Commission is offering this<br />
free tele-mentoring program that connects nurses with Diversity,<br />
Equity, and Inclusion (DEI) experts using brief lectures and casebased<br />
learning, and discussion.<br />
The National Commission’s Project ECHO® on Racism in<br />
Nursing will serve as a forum for nurses to increase their knowledge<br />
about how racism “shows up” in the profession and in healthcare<br />
and improves the skills needed to confront systemic racism and<br />
empowers nurses to become allies.<br />
The <strong>2022</strong> Spring/Summer Project ECHO®: Addressing Racism in<br />
Nursing will include:<br />
• Eight one-hour sessions from March-June <strong>2022</strong><br />
• Virtually delivered by subject matter expert faculty and mentors<br />
• Case presentation and discussion<br />
• Short lecture on a topic related to racism in nursing. Topics will<br />
include:<br />
o Understanding unconscious bias and Microaggressions<br />
o Tools to address racism in clinical practice: Confronting<br />
racism on the unit and at the bedside<br />
o Nursing Code of Ethics and Ethical implications of racism:<br />
Understanding the ethical responsibilities to the profession<br />
and patients<br />
o Courageous conversations and Allyship: addressing<br />
unknowing perpetrators and enablers of racism<br />
o Handling retaliation: When to fight and when to walk away<br />
o Navigating the burden of representation and Combating<br />
Imposter syndrome<br />
o Racism in academia: building a supportive academic<br />
environment and navigating new graduate challenges<br />
o Lessons Learned: historical context, contemporary context,<br />
where do we go from here?<br />
Questions? practice@ana.org<br />
Register for the <strong>2022</strong> Spring/Summer ECHO to Address Racism<br />
in Nursing at https://www.nursingworld.org/practice-policy/workforce/<br />
clinical-practice-material/project-echo/<br />
To access electronic copies of<br />
The <strong>Bulletin</strong>, please visit<br />
http://www.NursingALD.com/publications
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 13<br />
Calling All Pronouns<br />
Steven Koons MHI, BSN, RN (He/They)<br />
ISNA Board of Directors<br />
Why Pronouns Matter<br />
Have you ever interacted<br />
with someone who referred<br />
to you by a name different<br />
than what you go by?<br />
Perhaps you go by a certain<br />
nickname around close<br />
friends and family, but it<br />
would be odd for a coworker<br />
or acquaintance to use that<br />
nickname? This is a great<br />
example of appropriateness<br />
and comfortability regarding<br />
an individual’s name and<br />
identity. We easily accept that when an individual<br />
introduces themselves to you, the name they share<br />
is how you should address them—pronouns are no<br />
different. We all have varying levels of comfortability<br />
on familiarity with others, and referring to another<br />
individual by the name and pronouns they have<br />
shared with you shows respect for their identity.<br />
While you may read the previous paragraph and<br />
think, “Of course I would refer to someone by their<br />
name and pronouns,” have you considered that you<br />
may have unintentionally misgendered someone<br />
based on your own assumptions? It is a common<br />
mistake to perceive an individual as masculine or<br />
feminine and refer to that person by the pronouns<br />
that align with the gender you assumed. However,<br />
others may identify differently than what you<br />
perceive them as, and there are a few tips to avoid<br />
misgendering others which I will share below.<br />
Breaking It Down<br />
For example, my name is Steven and I go by He/<br />
They—this means that I identify in the masculine<br />
he/him/his pronouns and the gender neutral they/<br />
them/their pronouns. I always share my name as<br />
Steven; however, I have often been referred to<br />
as Steve, Stevie, and various other names. While<br />
some choose to use these common nicknames<br />
for the name I share with them, I have always felt<br />
uncomfortable being called by these nicknames—<br />
the main reason being, these nicknames do not<br />
align with my identity. This would be the same if you<br />
were to refer to a person by pronouns with which<br />
they do not identify.<br />
The first tip to avoid misgendering is to default<br />
to gender neutral they/them/their pronouns if an<br />
individual has not shared their pronouns with<br />
you. While this may feel a little unnatural, try this<br />
exercise: If you were to walk into a coffee shop and<br />
see an unattended laptop on a table, how would you<br />
think of the owner? Most people would think along<br />
the lines of, “I see someone left THEIR laptop.<br />
I hope THEY remember and it gets back to THEM<br />
safely.”<br />
The second tip is to share your pronouns with<br />
individuals if you are comfortable—make it a natural<br />
part of your introduction. “Hi, I’m Steven and I go<br />
by He/They.” If you need help practicing pronouns<br />
or discovering yours, see some of the resources<br />
attached below.<br />
The third tip is that if you are struggling with<br />
someone’s pronouns, default to using their name.<br />
Using the name a person has shared with you is just as<br />
validating as using their pronouns.<br />
The final tip is that if you mess up on someone’s<br />
pronouns, don’t panic or make an issue of it—correct<br />
yourself and move on. By pausing and correcting, you are<br />
showing the person that you acknowledge the mistake and<br />
will continue working on addressing them appropriately.<br />
Resources for Pronouns<br />
The following are various resources to learn more<br />
about pronouns, gender, and being an ally. Normalizing<br />
these discussions is paramount to the visibility and<br />
legitimization of marginalized individuals who do not<br />
identify within the binary or identify as transgender.<br />
Furthermore, it shows an understanding and appreciation<br />
for those within the LGBTQIA2S+ community to fully<br />
be themselves. If you would like to participate in further<br />
discussion or receive additional resources, feel free to<br />
reach out to me directly at skoons.rn@gmail.com.<br />
• https://www.mypronouns.org/what-and-why<br />
• https://www.mypronouns.org/resources<br />
• https://transstudent.org/graphics/pronouns101/<br />
• https://transstudent.org/graphics/<br />
• https://www.glsen.org/sites/default/files/GLSEN%20<br />
Pronouns%20Resource.pdf<br />
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14<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Pulse of the Nation’s Nurses Survey Series:<br />
Mental Health and Wellness Taking the Pulse on Emotional Health,<br />
Post-Traumatic Stress, Resiliency, and Activities for Strengthening Wellbeing<br />
Survey 3, September 2021<br />
To date, over 710,000 Americans have died due to COVID-19. Nurses<br />
report increased levels of stress, exhaustion, and burnout, while healthcare<br />
organizations struggle with new surges and growing staffing shortages. As a<br />
continuation of the Pulse on the Nation’s Nurses Survey Series, and a follow-up<br />
to the first and second Mental Health and Wellness surveys conducted in Spring<br />
and Winter of 2020 and the COVID Impact survey conducted in Winter 2021,<br />
the American Nurses Foundation has fielded another non-incentivized survey.<br />
The goal was to determine any changes and further impact of the pandemic on<br />
the mental health and wellness of nurses, with additional enquiries concerning<br />
emotional health, post-traumatic stress, resiliency, and stigma around seeking<br />
professional mental health support. Between August 20 - September 2, 2021,<br />
9,572 nurses completed or partially completed this survey.<br />
RESPONDENT PROFILE<br />
The Foundation fielded this survey to nurses across the entire continuum of care.<br />
Seventy-seven percent of respondents identified as White, 10% Black or African<br />
American, 5% Hispanic or Latino, and 4% Asian. Thirty-six percent of respondents<br />
indicated being 55 or older. Nine-out-of-ten said they are currently employed, with 80%<br />
indicating being employed full-time. Four percent of respondents said they are now<br />
retired. Over half of respondents indicated their primary work location is an acute care<br />
hospital from small to large; 11% primary, ambulatory, or outpatient care facilities; and<br />
7% schools of nursing. Seventy-six percent of respondents indicated they provide direct<br />
care to patients, and 80% said they have had or may have had direct exposure to a<br />
COVID-19 positive patient.<br />
SURVEY BACKGROUND<br />
The American Nurses Foundation and Joslin Marketing launched a nonincentivized<br />
online survey to nurses across the United States. The August 2021<br />
survey was the fourth in the Pulse on the Nation’s Survey Series on Mental<br />
Health and Wellness. The first survey was completed, or partially completed,<br />
by 10,997 between June 5 - July 6, 2020. The second survey was completed,<br />
or partially completed, by 12,881 between December 4-30, 2020. The COVID-<br />
Impact survey was completed, or partially completed, by 22,316 between January<br />
and <strong>February</strong> 2021. The most recent survey was launched between August 20 -<br />
September 2, 2021. The survey was completed or partially completed by 9,572<br />
nurses, with a ± 1.0% margin of error at a 99% confidence level. At least 88%<br />
surveyed responded to all mental health related questions.<br />
Figure 1 – Heat map of respondent’s most recent place of employment, August 2021<br />
34% OF NURSES SAY THEY ARE NOT EMOTIONALLY HEALTHY<br />
In the August 2021 survey, a new question was added to determine the current<br />
emotional health of nurses. The findings reveal 34% of nurses are either not or not at<br />
all emotionally healthy. By comparison, in the recent American Organization for Nursing<br />
Leadership (AONL) COVID-19 Longitudinal Study, 25% of nurse leaders indicated they<br />
are not or not at all emotionally healthy. i When analyzing the data by roles, the studies are<br />
consistent concerning nurse managers, a segment tracked in both studies. In the AONL<br />
study, 34% of nurse managers indicated they are not or not at all emotionally healthy,<br />
compared to 36% of nurse managers in the Foundation’s survey, within the accepted<br />
variance.<br />
Other statistically significant data points are evident. Notably, 18% of Black or African<br />
American respondents said they are not or not emotionally healthy, compared to 36% of<br />
respondents who did not select Black or African American. Relevant gaps are also clear<br />
among roles and age brackets. Younger nurses and nurses closer to the point-of-care<br />
have more emotional distress than their peers. Notably, 51% of nurses age 25-34 say<br />
they are not or not at all emotionally healthy, compared to 21% of nurses 55 or older.<br />
When asked to identify feelings experienced in the past 14 days, a critical 51% of nurses<br />
under 25-years old indicated feeling depressed, compared to 24% of nurses 55 or older.<br />
By role, the following are not or not at all emotionally healthy:<br />
• 52% of intensive or critical care nurses<br />
• 46% of emergency department nurses<br />
• 44% of medical-surgical nurses<br />
• 40% of acute care (hospital) nurses<br />
• 36% of nurse managers<br />
By age, the following are not or not at all emotionally healthy:<br />
• 51% of 25-34<br />
• 47% of under 25<br />
• 42% of 35-44<br />
• 35% of 45-54<br />
• 21% of 55 or older<br />
Figure 2 – Nurses indicate their current emotional health, August 2021
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 15<br />
42% OF NURSES HAVE EXPERIENCED TRAUMA AS<br />
RESULT OF COVID-19<br />
Nurses were asked whether they experienced an<br />
extremely stressful, disturbing, or traumatic event as<br />
result of COVID-19. According to data, 42% indicated<br />
they have experienced some form of trauma, with<br />
6% indicating they prefer not to answer and 52%<br />
indicating they have not had a traumatic event.<br />
When looking at race and ethnicity, a significant<br />
49% of Latino and Hispanic respondents indicated<br />
experiencing a traumatic event. In line with emotional<br />
health, gaps are also evident among roles and<br />
age, with intensive or critical care and emergency<br />
department nurses affected most.<br />
Figure 4 - Nurses indicate how much they have been bothered by post-traumatic stress, August 2021<br />
what activities had higher correlations to those who said<br />
they were emotionally or very emotionally healthy, over not<br />
or not at all emotionally healthy.<br />
Figure 3 - Nurses indicate whether they have experienced<br />
an extremely stressful, disturbing, or traumatic event as<br />
result of COVID-19, August 2021<br />
By role, the following have experienced an extremely<br />
stressful, disturbing, or traumatic event:<br />
• 68% of intensive or critical care nurses<br />
• 62% of emergency department nurses<br />
• 45% of acute care (hospital) nurses<br />
• 44% of medical-surgical nurses<br />
• 42% of nurse managers<br />
By age, the following have experienced an extremely<br />
stressful, disturbing, or traumatic event:<br />
• 52% of 25-34<br />
• 48% of 35-44<br />
• 45% of under 25<br />
• 43% of 45-54<br />
• 33% of 55 or older<br />
Respondents who experienced a traumatic event<br />
were provided the abbreviated PCL-C 6-Item Checklist<br />
ii<br />
Using the panel, respondents are asked to indicate<br />
how much they have been bothered by post-traumatic<br />
stress in the past month. The scale from “Not At All”<br />
to “Extremely” is given numerical values from 1-5. A<br />
combined score of 14 or more suggests difficulties<br />
with post-traumatic stress, and further assessment<br />
and possibly referral for treatment is indicated. In<br />
this study, the average score for nurses who have<br />
experienced a traumatic event is 16.55. The findings<br />
are an alarming indicator of the extent of trauma<br />
among nurses, and the extent of post-traumatic stress<br />
as result, particularly with difficulty concentrating<br />
(2.94) and with feeling distanced or cut off from other<br />
people (2.97).<br />
50% OF NURSES CONSIDER LEAVING THEIR<br />
POSITION<br />
In the August 2021 survey, 50% of nurses<br />
indicated they intend to stay in their position in<br />
the next six months, with 21% saying they intend to<br />
leave and 29% saying they may leave. When looking<br />
at segments by age, the problem becomes even more<br />
concerning, with 31% of those under 35 indicating<br />
intent to leave. The data is consistent with Press<br />
Ganey’s recent Flight Risk Analysis that reported 30%<br />
of nurses born after 1986 were more likely to quit than<br />
older nurses. iii<br />
For all ages, intent to leave is being driven by mental<br />
health, staffing, and organizational issues. When asked<br />
why nurses intend to leave, 47% of respondents said<br />
because work is negatively affecting their health and<br />
well-being, 41% because of staffing shortages, and<br />
31% because of a lack of support from their employer<br />
during the pandemic. Twenty-five percent also said<br />
they intend to leave because they are unable to provide<br />
quality care consistently, and 13% for retirement. Also<br />
of note, self-reported burnout has increased by an<br />
alarming 350% since the first survey in June-July of<br />
2020.<br />
Figure 5 - Nurses indicate whether they intend to leave<br />
their position in the next six months, August 2021<br />
By role, the following intend to leave their position<br />
within the next six months:<br />
• 35% of emergency department nurses<br />
• 32% of long-term care nurses<br />
• 30% of intensive or critical care nurses<br />
• 27% of acute care (hospital) nurses<br />
• 26% of case management nurses<br />
• 25% of psychiatric, mental health nurses<br />
• 22% of primary, ambulatory, outpatient nurses<br />
• 21% of cardiovascular nurses<br />
• 21% of nurse practitioners<br />
• 19% of nurse managers<br />
• 14% of certified nurse specialists<br />
• 11% of nurse educators, academia<br />
• 9% of school nurses<br />
By age, the following intend to leave their position within<br />
the next six months:<br />
• 31% of under 25<br />
• 31% of 25-34<br />
• 22% of 35-44<br />
• 20% of 45-54<br />
• 17% of 55 or older<br />
HEALTHY DIET, ACCURATE COVID-19 INFORMATION<br />
LINKED TO EMOTIONAL HEALTH<br />
When looking for solutions to the problem, 71%<br />
of respondents indicated spending time with friends<br />
and family was an activity that has been helpful in<br />
strengthening well-being. This was followed by 57% who<br />
selected leisure or entertainment (e.g. reading, movies, art,<br />
music) and 55% who selected spending time in nature or<br />
with animals. These numbers, however, are not entirely<br />
conclusive. To better understand the efficacy of activities<br />
for strengthening well-being, the scores were analyzed<br />
against weighted emotional health scores to understand<br />
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The analysis identified the top five activities for<br />
strengthening well-being with the highest multiplier:<br />
1. Maintaining a healthy diet (2.1x)<br />
2. Receiving accurate COVID-19 information (1.9x)<br />
3. Religious community, spiritual direction (1.8x)<br />
4. Practicing or receiving expressions of gratitude (1.5x)<br />
5. Regular exercise (1.5x)<br />
Notably, the third most selected activity (spending<br />
time in nature or with animals) does not appear in<br />
the top five, or top ten, once the data is correlated to<br />
emotional heath. In fact, a higher percentage of those<br />
who are not emotionally healthy selected spending time<br />
in nature or with animals, compared to those who are<br />
emotionally healthy. It is important to note, however,<br />
that correlation does not necessarily suggest cause. For<br />
instance, maintaining a healthy diet is directly correlated<br />
to higher emotional health scores. This could mean that<br />
respondents who maintain a healthy diet are more likely to<br />
be emotionally healthy, or vice versa. Further analysis on<br />
this topic could provide more insights into causality.<br />
RESILIENCY MIXED AMONG NURSES<br />
A new question was added to the Foundation’s August<br />
2021 survey to establish a benchmark resiliency score<br />
for all nurses. On a 0-10 scale, nurses were asked to rate<br />
their ability to recover or adjust to the impact COVID-19<br />
has had on their well-being, with 10 being extremely well.<br />
The average score for all nurses was 6.64. When analyzing<br />
based on emotional health, the weighted average was<br />
7.96 for emotionally and very emotionally healthy nurses;<br />
the weighted average was 5.12 for not and not at all<br />
emotionally healthy nurses.<br />
Figure 6 – On a scale of 0-10, nurses rate their ability to<br />
recover / adapt to the pandemic, August 2021<br />
Again, when analyzing the data based on segments,<br />
gaps appear among roles and age, with younger<br />
nurses being hit hardest, and nurses in intensive or<br />
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Survey Series continued on page 16<br />
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16<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Survey Series continued from page 15<br />
critical care. The score for 55 or older, for instance,<br />
is 31% higher than nurses under 25. Similarly,<br />
nurse educators or academia score 28% higher than<br />
intensive or critical care nurses.<br />
By age, average resiliency score:<br />
• Under 25 5.61<br />
• 25-34 5.69<br />
• 35-44 6.21<br />
• 45-54 6.64<br />
• 55 or older 7.34<br />
By role, average resiliency score:<br />
• Intensive or critical care nurses 5.76<br />
• Emergency department nurses 6.04<br />
• Medical-surgical nurses 6.08<br />
• Acute care (hospital) nurses 6.22<br />
• Cardiovascular nurses 6.36<br />
YOUNG NURSES REPORT STIGMA AROUND<br />
SEEKING MENTAL HEALTH SUPPORT<br />
While many organizations have advocated for<br />
nurses to seek professional mental health support,<br />
the reality of stigma must be considered. In the<br />
August 2021 survey, respondents were asked<br />
to identify, if anywhere, where they experience<br />
stigma around mental health support. The data<br />
shows that over a third of nurses experience some<br />
sort of stigma with seeking mental health support,<br />
including 17% stigma with themselves, 10% with<br />
family, and 8% with colleagues. When analyzing<br />
the data by race, a statistically significant 75% of<br />
Black or African American respondents indicated<br />
they do not experience stigma, compared to 63%<br />
of White respondents, 58% of Hispanic or Latino<br />
respondents, and 53% of Asian respondents.<br />
Among White respondents, 18% indicated they<br />
experience stigma with themselves. Among Asian<br />
respondents, a statistically significant 17%<br />
indicated they experience stigma with family, and<br />
4% with friends.<br />
When analyzing the data by role, there is moderate<br />
significance. A higher percentage of nurse educators<br />
and academia respondents said they do not experience<br />
stigma, while critical or intensive care, emergency<br />
department, and medical-surgical nurses indicated<br />
higher levels of stigma with themselves. Markedly, a<br />
higher percentage of psychiatric and mental health<br />
nurses indicated experiencing stigma around seeking<br />
mental health support with their colleagues. More<br />
critically is the widening gap among age brackets. A<br />
statistically significant number of younger respondents<br />
indicated stigma with themselves and their family, with<br />
a significant number under 25-years old indicating<br />
stigma with their friends.<br />
CONCLUSION<br />
As society adapts to the long-term effects of<br />
COVID-19, the mental health and well-being of nurses<br />
cannot be ignored. Today, 34% of nurses are not<br />
emotionally healthy, with substantially high numbers<br />
among emergency department, critical care, and young<br />
nurses. Critically, 42% of nurses have experienced<br />
trauma as result of COVID-19. The experience cannot<br />
be undone, but post-traumatic stress can be relieved<br />
with proactive organization support and government<br />
aid.<br />
Since the Foundation’s first mental health and<br />
wellness survey in June-July 2020, self-reported<br />
burnout has increased by 350%. Only half of nurses<br />
indicate they intend to stay in their position, a 16%<br />
drop since the <strong>February</strong> COVID-Impact survey.<br />
Significantly, 31% of nurses under 35, and 35% of<br />
emergency department nurses, indicate they intend<br />
to leave. When asked why, nurses named the negative<br />
affect work has on their health and well-being, staffing<br />
shortages, and lack of support from their employer.<br />
Nurses exiting because of staffing shortages creates a<br />
conundrum that calls on creative solutions to reverse,<br />
especially as aging nurses near retirement and younger<br />
nurses show signs of distress.<br />
Over one-third of nurses are now 55 or older,<br />
and young nurses meant to fill their shoes struggle<br />
disproportionately with mental health. This cannot<br />
be overstated if organizations are to avoid crises.<br />
Among those under 35, data reveals elevated stress,<br />
depression, and anxiety; increased suicidal thoughts;<br />
Figure 7 - Nurses indicate, if anywhere, where they experience stigma around seeking mental health support,<br />
August 2021<br />
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<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 17<br />
Congratulations!<br />
Heidi Hinkle, MSN, RN, CPHQ<br />
Figure 8 - Nurses indicate experience of stigma around seeking mental health support<br />
with analysis by age segments, August 2021<br />
increased reports of trauma; lower emotional health and resiliency scores; and<br />
higher intent to leave. This duality of aging nurses and vulnerable young nurses is<br />
a red flag for organizations, policymakers, and the broader community. Work-life<br />
balance must be reinforced and all nurses in need of help must be encouraged,<br />
and given time, to seek professional mental health support.<br />
As society returns to a relative “new normal,” greater awareness and recognition<br />
of nurses’ contributions must be raised at the organization, government, and<br />
community level. In the near future and looking further ahead, proactive initiatives<br />
must be implemented to solve the staffing shortage. A long road of relief, recovery,<br />
and rebuilding awaits those willing to meet the challenge, but the problems point<br />
to actionable solutions. Based on data from this study, both qualitative and<br />
quantitative, organizations can begin first by rebuilding broken trust. They can<br />
then turn their focus to providing proper support to their nurses, while building new<br />
staffing models that underline nurse well-being. Most of all, organizations can make<br />
mental health, and addressing stigma around seeking mental health support, a<br />
priority.<br />
American Nurses Foundation Mental Health and Wellness Survey Report |<br />
American Nurses Foundation & Joslin © 2021<br />
i COVID-19 Impact Longitudinal Study, American Organization for Nursing Leadership and Joslin<br />
Marketing, <strong>February</strong> 2021.<br />
ii Abbreviated PCL-C, Blue Cross Blue Shield Tennessee, 2021. https://www.bcbst.com/docs/<br />
providers/Behavioral-health-toolkit/pcl-c-shortened.pdf.<br />
iii Gleeson, Cailey. “Analysis Shows Nearly 30% of Nurses at Risk of Leaving Their Organization.”<br />
Becker’s Hospital Review, 30 Sep. 2021. https://www.beckershospitalreview.com/nursing/<br />
analysis-shows-nearly-30-of-nurses-at-risk-of-leaving-profession.html.<br />
You have been honored by Rachel Spalding through the <strong>Indiana</strong> Nurses<br />
Foundation Honor a Nurse Program. As an honoree deserving recognition, we would<br />
like to recognize you for the support and professionalism you have shown unto<br />
others:<br />
“It is my great pleasure to honor Heidi Hinkle, Director of Professional Practice<br />
at Good Samaritan in Vincennes, IN. Heidi has been instrumental by organizing<br />
and maintaining our “Buddy Program” that has supplemented staffing needs<br />
throughout the pandemic. She has been innovative and creative in promoting and<br />
operationalizing our buddies to provide needed support throughout the organization.<br />
Heidi also has led our Magnet 4 Europe initiative in collaboration with Dr. Linda<br />
Aiken and the UPenn Center for Health outcomes and Policy Research. Heidi gave<br />
an international presentation in September 2021 describing her collaboration with<br />
Good Samaritan’s European partner to have staff who have cared for Covid patients<br />
along with Good Samaritan staff, to share their experiences virtually with a chaplain<br />
as facilitator. It was very healing for staff from both hospitals and had a significant<br />
impact on many other hospitals in the same program. During Covid, Heidi has<br />
accomplished so much for the good of the nursing profession and has committed<br />
herself tirelessly to serve. It is evident that she has a servant’s heart.”<br />
The Foundation’s Honor a Nurse Program recognizes nursing professionals who<br />
have made a difference as a friend, mentor, caregiver, or teacher. Contributions<br />
made through donations support the Foundation’s mission in giving back to <strong>Indiana</strong><br />
nurses. A donation has been made in your name in support of the “Nurses in<br />
Need” program.<br />
The <strong>Indiana</strong> Nurses Foundation, and <strong>Indiana</strong> State Nurses Association, salutes<br />
you as a significant contributor to the nursing profession.<br />
Sincerely,<br />
Sincerely,<br />
Jo May<br />
Jo May<br />
President, <strong>Indiana</strong> Nurses Foundation
18<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
MESSAGE from the INF PRESIDENT<br />
INF Board Extends Term as We Strategize for a Stronger <strong>2022</strong> and Beyond<br />
Jo May, DNP, RN, RN-BC<br />
President <strong>Indiana</strong> Nurses Foundation<br />
As we look back on 2021, the <strong>Indiana</strong> Nurses<br />
Foundation appreciates your generosity and your<br />
compassion. Donations made to the INF bring hope to<br />
nurses through certification achievement, professional<br />
development, and grants to improve health for Hoosiers. A<br />
big change in 2021 included the addition of contribution<br />
designation. In response to the COVID-19 pandemic, and<br />
with your request, the INF has responded by launching<br />
the Nurses in Need Fund. We are grateful for our generous<br />
donors’ support, serving fellow colleagues financially but<br />
most importantly hope at a time when we all need it the<br />
most. Here is a break down of 2021 Program Designation:<br />
the INF Bylaws would end in <strong>February</strong> after 24 months of service, however we<br />
did not conclude our strategic planning for future work of the INF. We are still<br />
in process of planning to be stronger and positioned to give back even more in<br />
<strong>2022</strong>. Have you thought about your board seat on the Foundation board? Please<br />
follow us through the ISNA social media channels to learn of upcoming board<br />
opportunities.<br />
If every member of ISNA contributed just $22 in <strong>2022</strong> to help build the<br />
legacy of <strong>Indiana</strong> Nursing through the <strong>Indiana</strong> Nurse Foundation we could give<br />
approximately $54,000 in the future! Donate today through our Text to Donate –<br />
Text ‘Nurses” to 74121, Honor a Nurse by recognizing a nurse in the next <strong>Bulletin</strong><br />
with a donation made in their name, or share a general donation through our<br />
<strong>Indiana</strong>Nurses.NursingNetwork.com website.<br />
We look forward to sharing more INF highlights, recognition, and successes this<br />
year!<br />
A Quick 2021 Total Contribution Snapshot:<br />
In case you missed us, the INF was<br />
recently featured in the <strong>Indiana</strong>polis<br />
Business Journal’s <strong>2022</strong> Giving Guide<br />
which highlights philanthropic opportunities<br />
through <strong>Indiana</strong>. You can find a copy at<br />
https://issues.ibj.com/ibj/supplements/<br />
giving-guide/<strong>2022</strong>/ . You’ll find us on page<br />
48. The best part of being included in<br />
this publication, shared with over 40,000<br />
readers, is the fact that we get to highlight<br />
some of our previous and distinguished<br />
recipients. We want to share double the<br />
amount of photos in <strong>2022</strong>! Which headshot<br />
will you be sending in?<br />
As we plan ahead for <strong>2022</strong>, the INF<br />
board has voted to extend the current<br />
2020-<strong>2022</strong> term for an additional three<br />
months. The current term as written in
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 19<br />
Linda Webb, MBA, BSN,<br />
RN, NEA-BC, Chief Nursing<br />
Officer, Pulaski Memorial<br />
Hospital Recognized as a<br />
“Community Star” on the<br />
11th Annual National<br />
Rural Health Day<br />
Linda Webb, Chief Nursing<br />
Officer (CNO) and ISNA<br />
Member has been named<br />
<strong>Indiana</strong>’s 2021 Community<br />
Star, the National Organization<br />
of State Offices of Rural Health<br />
(NOSORH) recently announced.<br />
Linda, an ISNA and ANA<br />
dual member since 2012,<br />
has served as the CNO of<br />
Pulaski Memorial Health for<br />
26 years. Webb has been a<br />
past board member of the<br />
<strong>Indiana</strong> Organization of Nursing<br />
Executive, serving in various seats including President.<br />
She currently serves as chairman of the West Central<br />
Patient Safety Coalition in <strong>Indiana</strong>, President of the<br />
Four County Counseling Center board, and is an active<br />
member of Pulaski County Drug-Free Council and St.<br />
Peter’s Catholic Church. Linda supports several initiatives<br />
to address tobacco prevention and cessation, human<br />
trafficking, mental health, social determinants of health,<br />
reducing patient harm, and improving maternal health<br />
and reducing infant mortality.<br />
On the third Thursday of November every year,<br />
NOSORH, the member association for each of the<br />
50 State Offices of Rural Health, leads National<br />
Rural Health Day (NRHD). NRHD is an annual day of<br />
celebration that shines a light on those who serve the<br />
vital health needs of the estimated 57 million people<br />
living in rural America. On November 18, the 11th annual<br />
NRHD, NOSORH honored and celebrated Linda Webb’s<br />
incredible contributions to rural health by sharing their<br />
story in the official book of Community Stars.<br />
Beginning in 2015, NOSORH made a nationwide call<br />
for Community Star nominations, seeking individuals,<br />
organizations, and coalitions making a positive impact<br />
in rural communities. This year, nominations cover<br />
every state, making this the first time in the recognition<br />
program’s history for sharing 50 inspiring stories,<br />
including Webb’s.<br />
The 2021 Community Stars eBook will be published<br />
on the official NRHD website, powerofrural.org, on<br />
November 18, 2021.<br />
Please help ISNA in congratulating and thanking<br />
Linda for her dedication to improving Hoosier healthcare.<br />
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20<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Think like an expert witness to avoid falls liability<br />
Georgia Reiner, MS, CPHRM<br />
An 88-year-old patient slips on the floor, falling and<br />
breaking his hip. Your immediate concern is getting him<br />
the help he needs, but you also wonder if you could<br />
be legally liable for what happened. By thinking like an<br />
expert witness, you can help determine if this concern<br />
is valid and whether you could have taken steps to avoid<br />
the situation in the first place. But first, you need to<br />
understand some background information.<br />
Falls facts<br />
From 2007 to 2016, the fall death rate for older<br />
adults in the United States increased by 30%, according<br />
to data from the CDC. Each year, 3 million older adults<br />
are treated in emergency departments (EDs) for fall<br />
injuries, and more than 800,000 people are hospitalized<br />
each year because of injuries related to a fall. These falls<br />
extract a high price—more than $50 billion for medical<br />
costs in a single year.<br />
Nurse professional liability claims involving falls are<br />
identified in the Nurse Professional Liability Exposure<br />
Claim Report: 4th Edition. The report notes that many<br />
of the closed claims analyzed in the report dataset<br />
which involved falls occurred because the nurse failed<br />
to follow fall-prevention policies and procedures. Further,<br />
the report states that falls most frequently occurred in<br />
inpatient hospital, surgical services, and aging services<br />
settings, as well as in patients’ homes.<br />
Given the statistics and the many places falls can<br />
occur, a fall is not an uncommon occurrence in a nurse’s<br />
career. A fall does not automatically mean the nurse is<br />
liable; for that to happen, key elements of malpractice<br />
need to be present.<br />
Elements of malpractice<br />
To be successful in a malpractice lawsuit, plaintiffs<br />
must prove four elements:<br />
1. Duty. A duty existed between the patient and the<br />
nurse: The nurse had a responsibility to care for the<br />
patient.<br />
2. Breach. The duty to care was breached; in other<br />
words, the nurse may have been negligent. To<br />
determine if negligence occurred, the expert<br />
witness would consider whether the nurse met the<br />
standard of care, which refers to what a reasonable<br />
clinician with similar training and experience would<br />
do in a particular situation.<br />
3. Injury. The patient suffered an injury. Even if a duty<br />
existed and it was breached, if no injury occurred,<br />
it’s unlikely the lawsuit would be successful. Keep<br />
in mind, however, that injury can be defined as not<br />
only physical injury, but also psychological injury or<br />
economic loss.<br />
4. Causation. The breach of duty caused the injury—<br />
the injury must be linked to what the nurse did<br />
or failed to do. This can be summed up in one<br />
question: Did the act or omission cause the<br />
negative outcome?<br />
Expert witnesses will consider these four elements as<br />
they review the case, and they’ll ask multiple questions<br />
(see Was there liability?). The questions primarily address<br />
prevention and what was done after the fall occurred.<br />
Prevention<br />
The following steps can help prevent falls and,<br />
if documented correctly, prove that the nurse took<br />
reasonable steps to protect the patient from injury:<br />
Take a team approach. Registered nurses, licensed<br />
practical/vocational nurses, and certified nursing<br />
assistants are ideal members for a team dedicated to<br />
creating a falls reduction plan for each patient.<br />
Assess the risk. Whether in the hospital, rehabilitation<br />
facility, clinic, or home, a comprehensive assessment is<br />
essential to identify—and then mitigate—falls hazards.<br />
This starts with assessing the patient for risk factors<br />
such as history of a previous fall; gait instability and<br />
lower-limb weakness; incontinence/urinary frequency;<br />
agitation, confusion, or impaired judgment; medications;<br />
and comorbid conditions such as postural hypotension<br />
and visual impairment. It’s also important to consider<br />
the environment, particularly in the home setting. For<br />
example, throw rugs are a known falls hazard.<br />
An excellent resource for assessing communitydwelling<br />
adults age 65 and older is the CDC’s STEADI<br />
(Stopping Elderly Accidents, Deaths & Injuries) initiative,<br />
which is an approach to implementing the American and<br />
British Geriatrics Societies’ clinical practice guideline for<br />
fall prevention. The initiative provides multiple resources<br />
for clinicians, such as a fall risk factors checklist with<br />
the categories of falls history; medical conditions;<br />
medications; gait, strength, and balance (including quick<br />
tests for assessing); vision; and postural hypotension.<br />
Keep in mind that assessment should be ongoing during<br />
the patient’s care because conditions may change.<br />
Develop a plan. Once the assessment is complete, the<br />
patient care team, including the patient and their family,<br />
can develop a falls-reduction plan based on the patient’s<br />
individual risk factors. The plan should address locations<br />
that are at greatest risk, such as bedside, bathrooms, and<br />
hallways, and detail action steps. Sample action steps<br />
include giving patients nonslip footwear, making sure<br />
call lights are within reach, removing throw rugs from the<br />
home, and providing exercises to improve balance.<br />
Communicate. It’s not enough to create a plan;<br />
communication is essential for optimal execution. All care<br />
team members, including patients and their families,<br />
need to be aware of the patient’s fall risk and the falls<br />
reduction plan.<br />
Communication also includes education. The STEADI<br />
initiative has falls prevention brochures for patients<br />
and family caregivers at www.cdc.gov/steadi/patient.<br />
html. Families often are underutilized as a resource for<br />
helping to prevent falls. They may know the best way<br />
to approach patients who are reluctant to follow fallsreduction<br />
recommendations and can take the lead to<br />
reduce home-related risks. The falls risk reduction plan,<br />
communication with others, and education provided<br />
should all be documented in the patient’s health record.<br />
If a fall occurs<br />
Despite nurses’ best efforts, a patient may fall. An<br />
expert witness will scrutinize how the nurse responded to<br />
the event. The following steps will help to reduce the risk<br />
of a lawsuit or the chances that a lawsuit is successful:<br />
Assess the patient. Examine the patient for any<br />
obvious physical or mental injuries. For example, check<br />
vital signs; look for bleeding, scrapes, or signs of broken<br />
bones; ask the patient about pain; and check mental<br />
status. Do not move the patient if a spinal injury is<br />
suspected until a full evaluation can be made. Be<br />
particularly alert for possible bleeding if the patient is<br />
taking anticoagulants. When appropriate, ask patients<br />
why they think they fell and continue monitoring at<br />
regular intervals.<br />
Communicate assessment results. Notify the patient’s<br />
provider of the fall and results of the assessment.<br />
The provider may order X-rays for further evaluation.<br />
Remember to mention if the patient is taking<br />
anticoagulants, particularly in the case of a potential<br />
head injury, so the appropriate scans can be ordered.<br />
Revise the plan. As soon as possible after the fall,<br />
work with the team to reassess risk factors, revisit the<br />
falls reduction plan, and revise the plan as needed. For<br />
example, footwear may need to be changed, the amount<br />
of sedatives the patient is receiving may need to be<br />
reduced, or more lighting may need to be added to a<br />
hallway. It’s important that actions are taken to prevent<br />
future falls.<br />
Document. Each step should be documented in the<br />
patient’s health record, especially all assessment results<br />
and provider notifications. The expert witness can then<br />
see that the nurse followed a logical progression, with<br />
thorough evaluation and follow-up. Never alter a patient’s<br />
health record entry for any reason, or add anything to a<br />
record that could be seen as self-serving, after a fall or<br />
other patient incident. If the entry is necessary for the<br />
patient’s care, be sure to accurately label the late entry<br />
according to your employer’s policies and procedures.<br />
Reducing risk<br />
Unfortunately, patient falls are not completely<br />
avoidable. However, developing a well-conceived<br />
prevention plan can help reduce the risk, and taking<br />
appropriate actions after a fall can help mitigate further<br />
injury. Both prevention and post-fall follow up not only<br />
benefits patients, but also reduces the risk that the nurse<br />
will be on the losing side of a lawsuit.<br />
Article by: Georgia Reiner, MS, CPHRM, Senior Risk<br />
Specialist, Nurses Service Organization (NSO)<br />
RESOURCES<br />
Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice.<br />
StatPearls. 2020. www.ncbi.nlm.nih.gov/books/<br />
NBK470573.<br />
Centers for Disease Control and Prevention. Important facts<br />
about falls. www.cdc.gov/homeandrecreationalsafety/falls/<br />
adultfalls.html.<br />
Centers for Disease Control and Prevention. STEADI: Materials<br />
for healthcare providers. 2020. www.cdc.gov/steadi/<br />
materials.html.<br />
Was there liability?<br />
If a patient falls, an expert witness will likely<br />
want to know the answers to the following<br />
questions (developed by Patricia Iyers) when<br />
deciding if liability may exist:<br />
Before the fall:<br />
• Was the patient identified as being at risk<br />
for falls? How was that risk communicated to<br />
others?<br />
– What medications did the patient receive?<br />
Do they have side effects that may<br />
increase the risk of a fall?<br />
– Were there specific conditions present that<br />
could increase the risk of a fall?<br />
• Were measures implemented to prevent falls?<br />
– Was the patient capable of using the<br />
call light and was it used to call for<br />
assistance?<br />
– Was the bed in the lowest position?<br />
– Were the lights on in the room or under<br />
the bed to help light the area at night?<br />
– Was the patient given antiskid slippers?<br />
Immediately after the fall:<br />
• How soon was the individual found after he<br />
had sustained a fall (it’s not always possible<br />
to establish an exact time)?<br />
• What was done at the time of the fall?<br />
• Was the patient appropriately monitored after<br />
the fall to detect injuries?<br />
• What did the assessment (including vital<br />
signs) reveal?<br />
• Did the nurse communicate the findings to<br />
the patient’s provider?<br />
• Were X-rays ordered and performed?<br />
• Was there an injury? If so, how soon was it<br />
treated?<br />
• If the patient hit their head, was the chart<br />
reviewed to determine if mediations included<br />
an anticoagulant? If on anticoagulant, was<br />
this information communicated to the<br />
provider so head scans could be performed to<br />
check for cranial bleeding?<br />
Following up after a fall:<br />
• Was there a change in mental status after the<br />
fall?<br />
• Were additional assessments and monitoring<br />
done as follow up?<br />
• Was the patient’s risk for falls reassessed<br />
after the fall and the plan of care revised to<br />
minimize the risk of future falls?<br />
CNA, NSO. Nurse Professional Liability Exposure<br />
Claim Report: 4th Edition. 2020. www.nso.com/<br />
nurseclaimreport.<br />
Dykes PC, Adelman J, Adkison L, et al. Preventing falls<br />
in hospitalized patients. Am Nurs Today. 2018;13(9):8-<br />
13. https://www.myamericannurse.com/preventingfalls-hospitalized-patients.<br />
Iyer P. Legal aspects of documentation. In: KG Ferrell,<br />
ed. Nurse’s Legal Handbook. 6th ed. Wolters Kluwer;<br />
2015.<br />
Van Voast Moncada L, Mire GL. Preventing falls in older<br />
persons. Am Fam Physician. 2017;96(4):240-247.<br />
https://www.aafp.org/afp/2017/0815/p240.html.<br />
Disclaimer: The information offered within this article<br />
reflects general principles only and does not constitute<br />
legal advice by Nurses Service Organization (NSO)<br />
or establish appropriate or acceptable standards of<br />
professional conduct. Readers should consult with an<br />
attorney if they have specific concerns. Neither Affinity<br />
Insurance Services, Inc. nor NSO assumes any liability<br />
for how this information is applied in practice or for the<br />
accuracy of this information.<br />
This risk management information was provided by<br />
Nurses Service Organization (NSO), the nation’s<br />
largest provider of nurses’ professional liability<br />
insurance coverage for over 550,000 nurses since<br />
1976. The individual professional liability insurance<br />
policy administered through NSO is underwritten by<br />
American Casualty Company of Reading, Pennsylvania,<br />
a CNA company. Reproduction without permission of the<br />
publisher is prohibited. For questions, send an e-mail to<br />
service@nso.com or call 1-800-247-1500. www.nso.com.
<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 21<br />
Drink Less, Live More<br />
Rachel Pritz, RN, MSN<br />
Certified Coach, Certified Enneagram Coach<br />
I was driving to my job as a<br />
nurse manager one day and I<br />
started day dreaming. What if<br />
I got into a car accident, just<br />
a small one of course, but<br />
one that would require other<br />
people to take care of me for a<br />
change. I pulled into work and<br />
woke up from my day dream<br />
in horror. This wasn’t normal<br />
and how did I even get to this<br />
place in life anyway? I was<br />
drinking a bottle of wine most<br />
nights to “get through life”<br />
and this had become problematic. As I got unstuck<br />
from over-drinking, I started talking to about it on<br />
stages and with the teams I coached. At first, it was<br />
vulnerable and scary. Then, people started coming to<br />
me and messaging me after saying “me too.” While<br />
there is comfort in knowing you aren’t alone, it was<br />
also a little frightening to know how many of us in<br />
healthcare were out there. It’s a lot and more than I’d<br />
ever imagined.<br />
What drew you to this read?<br />
I am lucky to have a very close friend that is also<br />
a practicing clinical psychologist. She recently shared<br />
insights and takeaways from the authors on her practice<br />
blog and mentioned them to me the last time she came to<br />
visit. I knew right away it was something I wanted to better<br />
understand and possibly share with nurses.<br />
This book is available on Audible which is a win for me<br />
so that I can multitask. I had a road trip planned and it<br />
was the perfect length to accompany me on my ride. You<br />
know it is going to be good if Brene Brown calls it a “total<br />
game changer.”<br />
The audio version comes with a printable PDF for<br />
working through stressful decisions (cost/benefit analysis)<br />
and additional supportive worksheets. I liked the idea<br />
of exercises in addition to the content so that I could<br />
hopefully apply the methodology to my own life events.<br />
What have you learned from this author?<br />
One of my key takeaways, early in my listening was that<br />
we are all on a journey. Wellness is not an end destination<br />
but is an ongoing process that requires attention and<br />
purposeful action. The authors focus on how to respond,<br />
moving fluidly, through life and the stress response cycle.<br />
Why, if so, do you recommend this book to other nurses?<br />
I recommend this book to nurses, really to any female.<br />
I do not recommend the book to readers that identify as<br />
male as it is written specifically for females, or individuals<br />
that identify as female. I appreciate that the authors clearly<br />
state this in the beginning. I think many of the actions<br />
and processes can be applied to males, however Nagoski<br />
and Nagoski take into consideration that male brains (or<br />
individuals that identify as) can function differently than<br />
females, hence some of these items may not come into<br />
play or be as useful.<br />
A favorite section includes the authors referring to<br />
our own “mad woman in the attic”, the importance of<br />
connecting with your inner voice, and how to build the<br />
relationship in our favor. If you have an inner voice that<br />
consumes you, this may be just the book for you.<br />
I recommend this book as we are all spread thin and<br />
overwhelmed. Stress and stressors are compounding and<br />
occurring non-stop, even more so today that last year and<br />
the year before. Nagoski and Nagoski guide the reader to<br />
move fluidly through stress and stressful circumstances<br />
by preventing us from being stuck in a negative state. We<br />
can process suffering if we know why we are responding<br />
in this way. Meaning is good for us. “People with greater<br />
sense of meaning and purpose in life experience better<br />
health and are more likely to access preventive health<br />
care services to protect that health… A meta-analysis of<br />
the relationship between purpose in life and health found<br />
It makes sense. You have a hard day, or night, at<br />
work and come home exhausted. You just want to<br />
turn off your brain and relax. A global pandemic and<br />
all that has come with it both professionally and<br />
personally, hasn’t made this easier. Not only do you<br />
have all the to-do’s and the emotional toll of being a<br />
healthcare professional, but you also have so many<br />
responsibilities outside of work. Kids, aging parents,<br />
family drama, relationship struggles, etc. We’ve<br />
normalized drinking as a way to cope with all the<br />
stressors that are thrown our way. But, what if you got<br />
curious about the deeper why behind the drinking?<br />
Is this behavior working for you or is it causing you<br />
harm? What are the emotions and thoughts behind the<br />
drinking?<br />
Healthcare professionals everywhere have been<br />
told to practice more self-care as the answer to their<br />
burnout and exhaustion. I remember being told this<br />
too. But what if society sold us a bag of lies about<br />
what self-care really is? It’s so much deeper than<br />
bubble baths and chardonnay. In fact, when I was<br />
swimming in chardonnay that was the exact opposite<br />
of self-care. Here are some of the strategies I used to<br />
help dig me out of the pit of despair. I call it radical<br />
self care. Nothing radical about it, but it does take<br />
time and daily intention. If you truly want to get to the<br />
ISNA’s Bookshelf<br />
Burnout: The Secret to Unlocking the Stress Cycle<br />
by Emily Nagoski, PhD and Amelia Nagoski, DMA<br />
that greater sense of purpose is<br />
associated with 17% lower risk<br />
of all-cause mortality.” (Nagoski<br />
& Nagoski, 2019, Chapter 3,<br />
08:19).<br />
This book is truthful, easy to<br />
read/listen to, and helpful as we<br />
process our current environment<br />
and everyday stress. The book<br />
barely mentions happiness, but<br />
realistically focuses on how to<br />
cultivate joy by working through<br />
your stress, because we all have<br />
it. Most importantly we all have<br />
the power to persevere.<br />
How will you apply what you have learned?<br />
• Nagoski and Nagoski have helped me put labels on<br />
and define stress. They have also shed light on how to<br />
separate stressors from my response to stress. This is<br />
foundational material in monitoring my stress cycles.<br />
• Thinking through the concept of stressors and<br />
response to stress as components of a cycle will<br />
help remind me to close the gap and to work through<br />
either or both cause and the outcome of stressors in<br />
which are in and out of my control.<br />
• A reminder to not be hard on myself while on this<br />
journey and to not use obtaining wellness as a check<br />
off or end game.<br />
• This was a great reminder that I am in control of how<br />
I let stress affect me. Stress is inevitable but how I<br />
manage it is in my control.<br />
• The authors reminded me that adversity or<br />
overcoming difficulties and stressful circumstances<br />
can help me define my own meaning in life, moving<br />
me through coping onto thriving. Post traumatic<br />
growth builds strength and supports handling<br />
additional difficulties that will come my way if I am<br />
completing my stress cycles.<br />
• We make our own meaning to life, which requires<br />
focus and intention. It’s what sustains us. Just like<br />
wellness, it is an ongoing journey.<br />
What is your next book or reading material in your queue?<br />
I’d like to hear or read more from Kristin Neff about<br />
Compassion. She has a Ted Talk that gets referenced<br />
frequently and authored two books, Self-Compassion: The<br />
Proven Power of Being Kind to Yourself, and Fierce Self-<br />
Compassion. I’ve also recently started Moral Resilience,<br />
written by Cynda Hylton Rushton, which I am enjoying and<br />
moving through quickly.<br />
Interested in sharing a recent book, podcast, article, or<br />
show? Email me katie@indiananurses.org<br />
root cause of any harmful numbing behavior, here are<br />
some ways to do it:<br />
• Therapy/Coaches<br />
• Podcasts/Audiobooks<br />
• Self-awareness work (I used the Enneagram)<br />
• Exercise<br />
• Healthy eating<br />
• Spirituality<br />
• Meditation (I use a guided version)<br />
• Deep connections with other humans<br />
• Belonging, not just fitting in<br />
• Healthy boundaries<br />
• Understanding thoughts and emotions and making<br />
space to process them<br />
• Asking for (and at times hiring) help<br />
Ultimately, I decided to stop blaming everyone else<br />
around me and to take accountability for the life I’d<br />
created. No one was stopping me from doing all of the<br />
above, but me. Not my work, my boss, my partner, my<br />
kids, my parents. No one else was responsible but me.<br />
My favorite definition of self-care is creating a life you<br />
don’t have to regularly escape from. Think about what you<br />
are escaping and where you might need help. This is a<br />
personal journey and my guidance might not match what<br />
you need. But the good news here is you already know<br />
what you need if you can just quiet the noise around you.<br />
Here’s what I’ve learned after going from drinking a<br />
bottle of wine per night, to only drinking when I really<br />
want to, which is rare.<br />
• I sleep better - yes, alcohol can get you to sleep,<br />
but you don’t get quality sleep.<br />
• I have much less anxiety. Hangxiety is a real (and<br />
chemical thing).<br />
• My mood is better.<br />
• Alcohol numbed the more negatively perceived<br />
emotions. But it also numbed all the good stuff.<br />
• Alcohol added no value in my life.<br />
• I’ve lost weight. Calories aren’t the only biological<br />
reason for this.<br />
• Shaming yourself doesn’t work. Self-love does.<br />
I thought my journey out of over-drinking would<br />
only impact my drinking. Turns out, this healing and<br />
empowering journey fixed a whole lot of problems in<br />
my life. When we get to the root cause, that’s when the<br />
magic happens.<br />
Rachel Pritz, RN, MSN<br />
www.rachelpritz.com<br />
Instagram: @indyenneagram<br />
Facebook: Rachel Pritz Life Coaching<br />
LinkedIn: Rachel Pritz<br />
Disclaimer: If you believe you are an addict or<br />
alcoholic I encourage you to seek help.
22<br />
The <strong>Bulletin</strong> <strong>February</strong>, March, April <strong>2022</strong><br />
Policy Primer continued from page 3<br />
SB 239: Provider disclosure of license<br />
Requires any advertising by a healthcare<br />
provider to include the license type of the provider.<br />
Advertising is broadly defined to include any<br />
communication that promotes services to the<br />
general public. Also requires direct health care<br />
providers to wear a badge displaying their name<br />
and license type. Adds additional titles to the list<br />
reserved for physicians.<br />
SB 250: Terrible for APRNs<br />
Removes APRN signature authority related to<br />
handicap parking placards and death certificates.<br />
Requires APRNs with prescriptive authority to<br />
practice within 75 miles of their collaborator.<br />
Requires an APRN with prescriptive authority to<br />
meet quarterly with their collaborator, either inperson<br />
or via electronic communication. Changes<br />
APRN prescriptive authority from collaboration<br />
to supervision by a physician. Require APRN<br />
prescriptions to include the name, contact<br />
information, and DEA number of their collaborator.<br />
Requires providers to wear badges displaying their<br />
name and license type.<br />
HB 1113: Provider disclosure of license<br />
Requires any advertising by a healthcare<br />
provider to include the license type of the provider.<br />
Advertising is broadly defined to include any<br />
communication that promotes services to the<br />
general public. Also requires direct health care<br />
providers to wear a badge displaying their name<br />
and license type. Adds additional titles to the list<br />
reserved for physicians.<br />
HB 1158: APRN signature and other health matters<br />
Allows APRNs to sign certain individualized<br />
family service plans. Modifies the regulation of<br />
pharmacies and updates <strong>Indiana</strong> Code sections<br />
related to HIV.<br />
HB 1167: APRN signature for diabetic drivers<br />
Provides APRN signature authority for intrastate<br />
motor carrier drivers who are insulin dependent<br />
diabetics<br />
COVID-19 & Immunizations<br />
SB 3 Agency public health powers<br />
Allows state agencies to continue to obtain<br />
federal emergency funds and to issue standing<br />
orders for vaccines to individuals at least five<br />
years old after <strong>Indiana</strong>’s declared public health<br />
emergency ends. Extends temporary health<br />
licenses through 3/31/<strong>2022</strong>.<br />
SB 30: Workplace immunizations<br />
Prohibits employers from requiring an<br />
employee to receive any immunization that poses<br />
a significant risk to the employee’s health or is<br />
against the employee’s religious beliefs. No criteria<br />
is provided for what constitutes a significant risk.<br />
Also prohibits incentive programs that reward<br />
employees for getting vaccinated, unless employees<br />
that opt out due to health risk or religious belief<br />
also receive the reward.<br />
SB 31: Workplace COVID immunizations<br />
Exact same provisions as SB 30, except only<br />
applies to vaccines against COVID-19.<br />
SB 114: Vaccine status<br />
Prohibits vaccine status from being used to<br />
provide a benefit or withhold a good or service.<br />
Applies to all vaccines.<br />
HB 1001: COVID relief funding and vaccine<br />
mandates<br />
Provide state agencies the authority to continue<br />
to seek federal funds they have been receiving<br />
through the public health emergency. Restrict the<br />
ability of employers to require employees to have a<br />
COVID vaccine.<br />
HB 1408: Prohibit COVID vaccine mandates<br />
Employers and government entities cannot have<br />
COVID-19 immunization mandates.<br />
Forensic nurses<br />
HB 1091: Delay forensic medical exams and<br />
human trafficking hotline notices<br />
Prohibits commencement of a forensic medical<br />
examination until after the provider has contacted<br />
the rape crisis center and asking the patient if<br />
they would like the victim advocate present for<br />
the examination once the victim advocate arrives.<br />
Requires all emergency rooms, urgent care centers,<br />
bars, and other establishments to post a notice<br />
for the human trafficking hotline in every restroom<br />
and near the entrance or a conspicuous location in<br />
clear view.<br />
HERE<br />
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both your profession<br />
and your career.<br />
Make nursing stronger by<br />
adding your voice to ours.<br />
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Department of Health<br />
SB 84: Suicide and overdose fatality reporting<br />
Requires the Department of Health to prepare an<br />
annual report containing: (1) the number of suicides<br />
and overdose fatalities that occurred in each county;<br />
(2) the number of fatalities that occurred during<br />
each month; (3) the age and sexual orientation of<br />
each fatality victim; and (4) the method of suicide or<br />
overdose, including the type of weapon used.<br />
HB 1169: Health Department matters<br />
Requires the Health Department to employ a chief<br />
medical officer and requires the chief medical officer<br />
to be a physician. Updates terminology and adds<br />
services for the health department.<br />
HB 1254: Newborn screenings<br />
Allows an expert advisory committee under the<br />
Health Department to make additions to the list<br />
of required newborn screenings, so that additional<br />
screenings do not require going through the<br />
legislature.<br />
Professional Licensing Agency<br />
SB 260: Organ donor<br />
Anyone applying for or renewing a license with PLA<br />
may become an organ donor as part of the license<br />
process.<br />
HB 1065: Cultural awareness training<br />
Requires licensed health professionals to obtain<br />
two hours of cultural awareness and competency<br />
training every two years.<br />
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<strong>February</strong>, March, April <strong>2022</strong> The <strong>Bulletin</strong> 23<br />
ISNA WELCOMES our NEW and REINSTATED MEMBERS<br />
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