Colorado Nurse - February 2022
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The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
Volume 122 • No. 1 • <strong>February</strong> <strong>2022</strong><br />
Quarterly publication distributed to approximately 42,200 RNs and LPNs in <strong>Colorado</strong><br />
NURSE<br />
From the Desk of<br />
the CNF President<br />
Dear <strong>Colorado</strong> <strong>Nurse</strong>s,<br />
My Name is Margaret Mulhall, and I am the<br />
incoming <strong>Colorado</strong> <strong>Nurse</strong>s Foundation President. First,<br />
let me assure you that Dr. Sara<br />
Jarrett has just stepped down<br />
from the President role, but<br />
will continue to be actively<br />
involved in the Foundation<br />
as the Vice President. Her<br />
mentorship as I transition into<br />
this role will be a valued and<br />
treasured asset. I wish you all<br />
a Happy New Year. But after<br />
saying that, I also confess that<br />
I have a heavy heart as we<br />
enter into this new year. The<br />
fires in Boulder County required that the nurses and<br />
staff at Avista Adventist Hospital evacuate the facility.<br />
Truly a herculean action when many were probably<br />
unsure of the status of their own homes. <strong>Nurse</strong>s<br />
throughout the state are tired and the seemingly<br />
endless pandemic offers no time for rejuvenation.<br />
Although words cannot improve the situation on a<br />
global basis, this post that was found on social media<br />
expressed my thoughts, concerns, and feelings better<br />
than anything I’ve seen in a long time. Reprinted with<br />
Ms. Warren’s permission.<br />
MASKED WARRIORS~<br />
Margaret Mulhall<br />
<strong>Colorado</strong> <strong>Nurse</strong>s<br />
Association President...<br />
Membership Matters<br />
In this time of political unrest and continued global<br />
healthcare crisis, many nurses are searching for the<br />
answers to their personal questions. Do I want to do this<br />
anymore? What makes me continue to go to work? Why<br />
am I a nurse? Does what I do really matter? Am I valued?<br />
Am I safe? Many nurses enter the profession because<br />
of their willingness to sacrifice self for others. Some<br />
believe it is a calling. Few believe they became a nurse<br />
to offer suboptimal care for their patients. None believe<br />
they should be exposed to families and patients that<br />
commit mental or physical abuse. The <strong>Colorado</strong> <strong>Nurse</strong>s<br />
Association acknowledges the difficulties that nurses<br />
face every shift. CNA represents the voice of every nurse<br />
in <strong>Colorado</strong>. We want to hear from you. We want to<br />
give you the opportunity to engage at any level you feel<br />
comfortable. Now is the time that nurses deserve to be<br />
heard. Your membership dues fund our continued effort<br />
to participate at the highest levels of <strong>Colorado</strong> legislature.<br />
What you do matters. Others need to know it matters.<br />
Your stories and experiences provide context into the<br />
It’s Not Too Late!<br />
human conflict that is lived by<br />
<strong>Colorado</strong> nurses every day.<br />
CNA is working hard at all<br />
levels to encourage legislation<br />
for safe practice, now more<br />
than ever. Your hard-earned<br />
money pays for our amazing<br />
lobbyists, Gil, Ryan, and Alec<br />
Romero at Capitol Success<br />
Group. I have personally seen<br />
the passion and dedication<br />
that this group provides to the Laura Rosenthal<br />
nurses of <strong>Colorado</strong>. Although<br />
CNA cannot answer many of the personal questions you<br />
ponder every day, CNA is at the table. CNA believes in<br />
the value of the care that you provide every single day.<br />
We are here for you so that you can be here for patients.<br />
Consider joining us in the fight for safe nursing practice.<br />
We want your voice, your representation, your love for the<br />
profession. Join CNA today.<br />
To All Medical Professionals, Staff and Caregivers:<br />
Long before the sun displays its brilliant array of<br />
stunning colors from a palette that only God could<br />
have created, you are already dressed and ready in<br />
your battle gear. Through your trembling fear of<br />
this unseen enemy, your heart pumps strong with a<br />
formidable force. You are ready for what every day<br />
may bring even if what some days bring is death.<br />
CNF President continued on page 2<br />
current resident or<br />
Non-Profit Org.<br />
U.S. Postage Paid<br />
Princeton, MN<br />
Permit No. 14<br />
See page 3 for more information<br />
From the Desk of CNA Director of<br />
Practice and Government Affairs ...............3<br />
District and Special Interest Group Reports .........4<br />
Peer Assistance ...............................5<br />
Government Affairs &<br />
Public Policy Committee ......................5<br />
In Memory ...................................6<br />
News from American Association<br />
<strong>Nurse</strong> Practitioners (AANP) ....................7<br />
Board of Nursing Update ........................7<br />
INSIDE<br />
Childhood Shaped His Perspective ................8<br />
Updates CNA Nursing Continuing<br />
Professional Development Program .............8<br />
CU <strong>Nurse</strong>-Midwifery Student Dodges Boulders,<br />
Finds Route for Reaching Her Peak ..............9<br />
HIPAA, COVID-19 Vaccination,<br />
and the Workplace .......................10-12<br />
Overcoming Nursing Barriers to<br />
Caring for Patients with Serious Mental Illness ...13<br />
Managing Moral Distress .................... 14-15
2 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
COLORADO NURSE (ISSN-8750-846X) is published 4 times annually, <strong>February</strong>,<br />
May, August, and November, by the Arthur L. Davis Publishing Agency, Inc. for the<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014;<br />
Mailing: P.O. Box 3406, Englewood, CO 80155-3406.<br />
For advertising rates and information, please contact Arthur L. Davis Publishing<br />
Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@<br />
aldpub.com. CNF and the Arthur L. Davis Publishing Agency, Inc. reserve the<br />
right to reject any advertisement. Responsibility for errors in advertising is<br />
limited to corrections in the next issue or refund of price of advertisement.<br />
Acceptance of advertising does not imply endorsement or approval by the<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Foundation of products advertised, the advertisers, or the<br />
claims made. Rejection of an advertisement does not imply a product offered<br />
for advertising is without merit, or that the manufacturer lacks integrity, or<br />
that this association disapproves of the product or its use. CNF and the Arthur<br />
L. Davis Publishing Agency, Inc. shall not be held liable for any consequences<br />
resulting from purchase or use of an advertiser’s product. Articles appearing<br />
in this publication express the opinions of the authors; they do not necessarily<br />
reflect views of the staff, board, or membership of CNF or those of the<br />
national or local associations.<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Foundation wants to hear from you and welcomes letter to<br />
the editors. Correspondence may be sent to <strong>Colorado</strong> <strong>Nurse</strong>s Foundation,<br />
2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406,<br />
Englewood, CO 80155-3406; email, info@coloradonursesfoundation.com.<br />
To submit an article for publication, consider the following guidelines.<br />
1. Topic is current and relevant to RN practice.<br />
2. 500 word limit<br />
3. Individuals may submit articles for consideration by emailing<br />
carolomeara@aol.com.<br />
<strong>Colorado</strong> <strong>Nurse</strong> Publication Article Submission<br />
• March 15 for May Issue<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Association in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation seeks your<br />
regular reports and any content you feel would be informative for <strong>Colorado</strong> <strong>Nurse</strong>s.<br />
Submit to: https://civicamanagement.wufoo.com/forms/m10eei4p1ds8okp/<br />
Material is copyrighted by the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation and may not be<br />
reprinted without written permission from CNF.<br />
Co-Editors: M. Colleen Casper, RN, MS, DNP (16)<br />
Eve Hoygaard, MS, RN, WHNP (30)<br />
Carol O’Meara, MS, RN, WHNP (20/30)<br />
Sonja Hix<br />
COLORADO NURSES FOUNDATION<br />
EXECUTIVE COMMITTEE<br />
President: Sara Jarrett<br />
Vice President: Margaret Mulhall<br />
Secretary: Carol O’Meara<br />
Treasurer: Eve Hoygaard<br />
CNF President continued from page 1<br />
Even as you begin each day tired from the day<br />
before, a miraculous strength from somewhere<br />
deep within you eases you into motion. Once you<br />
reach your workspace, the day is filled with the<br />
saving of lives, the comforting of the sick, the<br />
communicating with family, the holding back of<br />
tears, swallowing the lumps in your throat that<br />
threaten asphyxiation, the sudden hush when<br />
a patient transitions. Although each and every<br />
transition drains some small hint of persistence<br />
from you, it cannot deter you from your mission.<br />
The quiet whisper of life ebbing listlessly from<br />
lonely souls filled with pain and terror is the life<br />
force which drives you forward as if building<br />
a new ransom for lives left untaken. The soft<br />
cries echoing down scrubbed hallways pull at<br />
the muscles of your heart, but you keep moving<br />
forward to save those who will survive and<br />
comfort those who will not.<br />
You are special, having been chosen by your<br />
Creator to perform a job that most of us would<br />
shy away from. You are unique in every way. The<br />
barely perceptible wings on your backs show that<br />
you are God’s servants and messengers of Hope.<br />
Join a committed team caring for the Pikes Peak<br />
Region and surrounding areas<br />
Peak Vista Community Health Centers<br />
is hiring Care Team <strong>Nurse</strong>s<br />
Join a network of 28 health centers providing nationally recognized,<br />
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Enjoy amazing benefits, coupled with a great work<br />
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More info:<br />
Careers at Peak Vista - <strong>Colorado</strong> Springs, CO<br />
peakvista.org/resources/careers<br />
The compassion with which you treat your<br />
patients knows no boundaries. You work through<br />
fatigue, anxiety, stress, and burnout. Your war<br />
wounds, the tired red eyes, the tracks of miles<br />
of tears, the aching in your heart, are all there<br />
to remind you that you, too, are human and that<br />
you must take care of yourself.<br />
My father used to tell me, “We are related<br />
to our birth family by coincidence, but we can<br />
choose our earth family from those who share<br />
our goals, objectives and visions.” You’ve stood<br />
in for the families and friends who could not be<br />
there for their loved ones. You’ve grieved for<br />
them and shared with them. Please know that<br />
you are so very appreciated. Know that you are<br />
honored. Know that you are loved. Know that<br />
we support you and deeply respect you as we<br />
sit in awe of your magnanimous courage and<br />
determination. Know that the survivors owe their<br />
lives to you and will never forget you. Lastly,<br />
know that those who lost their fight will rest in<br />
eternal peace for the last thing they saw before<br />
passing was your face...the face of courage,<br />
bravery and love, the face of someone who<br />
sacrificed everything to help them through a<br />
storm until it blew over.<br />
I pray for each and every one of you, that<br />
you will take a moment to look at a sunrise<br />
or a sunset and absorb all the beauty and<br />
magnificence on display as God’s artwork calms<br />
and soothes you and strengthens you for the<br />
next battle ahead.<br />
From your white or blue caps, uniforms, scrubs,<br />
clogs, stethoscopes, needles, buckets, brooms,<br />
mops, etc., to your professionally engineered<br />
and/or home designed face masks, I am eternally<br />
grateful for the honor of knowing of you and<br />
pray God’s blessings for your selfless daily<br />
offerings of service.<br />
Stay safe, stay healthy, stay prayed up.<br />
(Audrey) E Layne Warren<br />
May the spirit of Florence Nightingale strengthen<br />
each of you.<br />
Margaret Mulhall RN, MSN<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Foundation President<br />
BOARD MEMBERS<br />
Jeanne Burnkrant, Terry Buxton, Colleen Casper,<br />
Lola Fehr, Linda Stroup, Betsy Woolf, Lisa Zenoni<br />
COLORADO NURSES ASSOCIATION<br />
Region 1 Director:<br />
Mavis Mesi<br />
Region 2 Director<br />
(DNA 3, 12, 16, 20, 23):<br />
Amanda Cobb<br />
Region 3 Director (DNA 4):<br />
Mary Satre<br />
Region 4 Director (DNA 6):<br />
Glenda Jackson<br />
DNA #6: Charlotte LeDonne<br />
Alamosa, CO<br />
DNA #7: Nora Flucke<br />
DNA #9: Brenda Tousley<br />
EXECUTIVE COMMITTEE<br />
President: Laura Rosenthal<br />
Past President: Linda Stroup<br />
Vice President: Angela Petkoff<br />
Secretary: Nan Morgan<br />
Treasurer: Carol OMeara<br />
BOARD OF DIRECTORS<br />
Region 5 Director (DNA 7):<br />
Nora Flucke<br />
Region 6 Director (DNA 5):<br />
Deb Bailey<br />
Director At Large (SIGs):<br />
Patricia Abbott<br />
Director At Large (SIGs):<br />
V. Sean Mitchell (SIG 30)<br />
Director at Large (Recent Graduate)<br />
Jeanna Brewer<br />
DNA PRESIDENTS<br />
DNA #3: Anne Zobec DNA #12: Amanda Chappell<br />
<strong>Colorado</strong> Springs<br />
DNA #16: Rebecca Sposato<br />
DNA #4: Kathryn Carpenter<br />
DNA #20: Jean Schroeder<br />
Model, CO<br />
DNA #23: Colleen Casper<br />
DNA #5:<br />
SIG #30: Meghan Abrams,<br />
DNP, NP-C<br />
SIG #31: Ruby Martinez,<br />
PhD, RXN, CNS, PMHCNS-BC<br />
Director of Practice<br />
and Government Affairs: Colleen Casper, RN, MS, DNP<br />
Chief Administrative Officer:<br />
Sonja Hix<br />
To contact any person listed above, please use the<br />
CNA/CNF office numbers/address/email address.<br />
CNA Contact Information:<br />
Ph: 720-457-1194 • Fax: 303-200-7099<br />
Email: info@coloradonurses.org<br />
CNF Contact Information: Ph: 720-457-1004<br />
Email: info@coloradonursesfoundation.com<br />
www.coloradonurses.org
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 3<br />
From the Desk of CNA Director of<br />
Practice and Government Affairs<br />
Investing in a Nursing Workforce<br />
Colleen Casper, DNP, RN, MS<br />
Director of Practice and Government Affairs<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
“Never let a good crisis go to waste.”<br />
Winston Churchill<br />
Florence Nightingale was a pioneer in public health nursing<br />
and dramatically improved the health care planning and<br />
delivery of services to the British soldiers in the Crimean war.<br />
Nightingale led widespread changes by tracking data specific<br />
to incidences and frequency of the horrific conditions that<br />
were leading to the death of British soldiers in the military<br />
hospitals. Practices that Nightingale studied and implemented<br />
continue to be relied upon today, in both hospital care delivery<br />
and the education and preparation of public health providers.<br />
Nightingale’s work highlights the importance of data<br />
to drive health care systems improvement. Current data is<br />
significantly lacking in terms of hospital specific conditions Colleen Casper<br />
that are contributing to the “great resignation” of front<br />
line nurses and other essential healthcare providers, including pharmacists, respiratory<br />
therapists, physicians, certified nurses assistants, environmental health services and food<br />
and nutritional services staff. Investing in and assuring an essential health care<br />
workforce is going to require significant operational and cultural changes in<br />
today’s clinical care environments, from public health, to primary care, acute<br />
care, emergency care, and long term care, be it in long term living facilities or at<br />
home.<br />
Attempting to describe a path forward, it is our premise that we need to create a more<br />
significant and shared awareness of the real factors contributing to workforce resignations.<br />
I will focus on the nursing workforce with the understanding that most health care<br />
providers share similar characteristics. Those characteristics include:<br />
• Nursing is a relationship and knowledge based profession that requires time to<br />
develop competencies and to provide adequate care;<br />
• Nursing practice standards are developed nationally (ANA National Scope &<br />
Standards of Care) and are governed at the state level by the <strong>Colorado</strong> <strong>Nurse</strong><br />
Practice Act;<br />
• Inability to provide safe care, whether due to worker safety through things such as<br />
personal protective equipment, adequate sick time, and sufficient workforce, puts<br />
patients at significantly greater risk of complications;<br />
• RN and LPN licensees and Certified <strong>Nurse</strong>s Assistants are all subject to disciplinary<br />
actions by the <strong>Colorado</strong> State Board of Nursing based on complaints against licensee<br />
related to inability to provide adequate care;<br />
• Moral distress occurs when individual providers are unable to provide the care in<br />
accordance with known standards due to factors beyond their control;<br />
• Prolonged moral distress leads to burnout, helplessness, and resignation; and,<br />
• <strong>Colorado</strong> frontline nurses have repeatedly been silenced by their employers and<br />
subject to threats and retaliation.<br />
<strong>Colorado</strong>ans, that assures minimum standards of care are met for all patients,<br />
residents, and consumers. CDPHE must more closely monitor the performance<br />
of facilities and track essential data points as a means of understanding trends in<br />
the incidences and frequency of bad outcomes related to patients and workforce.<br />
CDPHE must hold employers accountable and not solely the licensed professionals<br />
who are working in sub-optimal work environments.<br />
2. The <strong>Colorado</strong> Department of Health Care Finance and Policy can take a stronger<br />
stance in public reporting of percentages of employer profits that support<br />
the nursing workforce. What actual and percentages of costs are afforded<br />
“administrative budgets” as compared to direct, front line clinical care? Do these<br />
costs reflect the time required for professionals to deliver adequate care?<br />
3. Human resource policies and practices must be adapted to reflect the diverse<br />
needs of the front line workers. There is evidence to suggest that twelve-hour<br />
shifts are less than safe, let alone greater than three twelve-hour shifts per week.<br />
Traveler (temporary contracted) nurses are currently signing contracts for upwards<br />
of $330.00 per hour if they agree to work 20 hours of overtime per week, equally<br />
more than $15,000.00 per week per nurse. Employers want the federal and state<br />
governments to “backfill” this expense. What if we invested $10,000.00 per week<br />
to retain experienced staff and assure sane, safe workloads with career pathway<br />
development to remain at the bedside?<br />
Without aggressive, responsible, and accountable leadership that includes real<br />
investment in workforce and work environments, <strong>Colorado</strong> nurses will not have a choice<br />
but to legislate nurse staffing – on behalf of patients. What’s your choice?<br />
LIFE-CHANGING<br />
CAREERS<br />
Now Hiring <strong>Nurse</strong><br />
Instructors in Denver!<br />
Full-time and part-time opportunities available!<br />
For over 30 years, Concorde Career Colleges has prepared thousands of people for rewarding<br />
careers in the healthcare industry. Our goal is to prepare students for the most in-demand jobs in<br />
healthcare. Nursing instructors will be responsible for delivering academic instruction for clinical and/<br />
or theory components of the Practical Nursing or Associate’s Degree in Nursing Program.<br />
Qualifications we’re looking for include:<br />
Current <strong>Colorado</strong> RN license or willing to obtain, MSN, 3 years of clinical experience,<br />
self-starter, excellent communication skills, sense of urgency and results oriented<br />
To learn more and apply visit https://careers.concorde.edu<br />
Apply with Concorde today! Train our future skilled <strong>Nurse</strong>s.<br />
EOE/M/F/D/V<br />
This is what “investment” does not look like!<br />
Moving forward, there are options.<br />
1. The <strong>Colorado</strong> Department of Public Health and Environment (CDPHE) licenses each<br />
and every care facility (employer) in the State of <strong>Colorado</strong>, including hospitals, a<br />
long term care, surgical centers, urgent care centers, home care and hospice care<br />
facilities, and probably more. That license is a contract with the State and it’s people,<br />
Eden Milestone 2 Community<br />
Come join our team & love where you work.<br />
<strong>2022</strong> CNA Annual Conference<br />
We are seeking <strong>Nurse</strong>s and <strong>Nurse</strong> Leaders to promote<br />
the Eden Alternative.<br />
Plan now to join us for a conference focused<br />
on thriving through all things COVID.<br />
AGENDA<br />
Facing Addiction in America: Evidence Based Practice Tips for Everyday<br />
<strong>Nurse</strong>s Role in Equality, Equity, Justice & Human Dignity<br />
Virtual Health: Reimagining Healthcare and Nursing Practice<br />
Uncertainty and Fear Link to Mental Health Among<br />
<strong>Nurse</strong>s Lived Experience with COVID-19<br />
<strong>Nurse</strong>s in Space: Breaking the Resistance Barrier<br />
Beyond Burnout: Insights on <strong>Colorado</strong> <strong>Nurse</strong>s<br />
Survey on Trauma and Moral Distress<br />
REGISTER HERE<br />
The goal of the Eden Alternative is Elder-directed care. Aging can<br />
be a time of growth rather than decline. This is accomplished<br />
by creating a human habitat through community design, care<br />
partner training, and organizational redesign. We are home!<br />
Excellent benefits including Health & Dental, Vision,<br />
401(k) with match, Education Reimbursement and more.<br />
To apply, submit your resume/application at<br />
HTTPS://SHALOMPARK.VIKUS.NET<br />
IF YOU ARE AN EDEN ASSOCIATE OR DESIRE TO<br />
BECOME ONE, this is the place for you!
4 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
District and Special Interest Group Reports<br />
DNA 16<br />
Rebecca Sposato, President<br />
Members of DNA 16 met on November 9 for dinner<br />
in downtown Denver followed by going to see healthcare<br />
themed comedian <strong>Nurse</strong> Blake at the Paramount Theater.<br />
On December 14, members gathered at the home of<br />
Carol and Alan Brautigan for our holiday party. Each<br />
member brought a donation for children staying at<br />
Samaritan House, a place to help people experiencing<br />
homelessness in Denver. Attendees discussed potential<br />
events for <strong>2022</strong>, including volunteering at a covid vaccine<br />
clinic and touring the Justina Ford Museum in <strong>February</strong> for<br />
Black History Month.<br />
Over the last several months, the SIG 30 board<br />
members have been assessing and collating member<br />
feedback and working on ways to the improve the<br />
ease of use and communication through the SIG 30<br />
website. Important changes for ease of usability and a<br />
seamless interface have been identified and revisions<br />
to the website are hopefully underway. It is anticipated<br />
that the changes will be completed and the “new<br />
SIG 30” website will go live in the New Year. SIG 30<br />
is also working on finalizing educational offerings for<br />
members to potentially begin in late winter/early spring<br />
<strong>2022</strong>. Topics include Neurology in primary care; health<br />
and wellness holistic interventions; the nuts and bolts<br />
of precepting; expanding your career into academia<br />
as a <strong>Nurse</strong> Educator and supplement use in practice. If<br />
SIG 30<br />
The Path to Change for <strong>2022</strong><br />
you have a member idea about an educational need or<br />
opportunity that you feel would be of interest to the<br />
SIG 30 community, please reach out to a SIG 30 board<br />
member via the “Contact Us” feature on our website.<br />
Furthermore, we would like to extend a warm<br />
welcome to Monica Garbiso, NP, who is the new<br />
SIG 30 GAPP Committee Chair Member. Monica is<br />
an Acute-Care <strong>Nurse</strong> Practitioner by training with<br />
experience in acute care, aesthetics, management, and<br />
pharmaceuticals. Welcome to the SIG 30 team, Monica!<br />
To help SIG 30 ring in the new year, our January<br />
meeting featured an update from Dr. Colleen Casper,<br />
CNA Director of Practice and Government Affairs,<br />
regarding important <strong>Colorado</strong> APRN political agendas<br />
and legislation.<br />
DNA 20 – West Metro Area<br />
Join other post-acute care nurses and healthcare<br />
professionals to share best practices, expand your<br />
knowledge, and make lasting connections.<br />
Register now at AAPACN.org<br />
<strong>Nurse</strong> Family Partnership<br />
We are seeking nurses to join our <strong>Nurse</strong> Family Partnership<br />
team. Responsibilities include case management and<br />
care coordination through home visitation for low-income,<br />
first time pregnant women and their families from early<br />
pregnancy up to the child's second birthday. Full time<br />
position in Grand County and part-time position in Summit/<br />
Clear Creek/Gilpin Counties. Excellent benefit package and<br />
a sign-on bonus program available!<br />
Please see program website:<br />
https://www.nursefamilypartnership.org/<br />
MINIMUM QUALIFICATIONS:<br />
• BSN required<br />
• Current RN license (in good standing) required in the state<br />
of <strong>Colorado</strong> or an active RN license with a compact state.<br />
• Current CPR required<br />
• Two years recent experience in maternal/child health,<br />
public health, home visiting or mental/behavioral<br />
nursing preferred.<br />
• Home visiting experience preferred<br />
• Excellent written and verbal communication skills.<br />
• Basic computer skills.<br />
• Valid driver’s license and insured automobile required.<br />
To see the full job postings, qualifications and<br />
to apply, please visit<br />
www.summitcountyco.gov/jobs<br />
For more information call 970-668-9711<br />
Equal Opportunity Employer<br />
Norma Tubman MScN, RN<br />
Despite COVID, DNA 20 remains active. Many members<br />
volunteered at Vuela For Health Fall 2021 Flu/COVID<br />
Vaccination Clinics doing their part to decrease COVID’s<br />
spread.<br />
Two virtual presentations in October and November to<br />
50 nursing students at Front Range Community College<br />
were well received. In October, the <strong>Colorado</strong> Center for<br />
Nursing Excellence Project Director, Carmen Luttrell, MSN,<br />
RN presented on “Innovative Strategies to Support Rural<br />
Health Care Workforce” and Assistant Project Director,<br />
Tondeleyo Gonzalez MA, BSN, RN, CCMC, presented<br />
on the “Workforce Innovative Nursing Network Project<br />
(WINN).” Feedback from students was that they were<br />
encouraged to hear positive things about opportunities<br />
and support for nurses in <strong>Colorado</strong>. Feedback was equally<br />
positive for Kathy Crisler’s presentation in November<br />
on “The Benefits of Belonging to Your Professional<br />
Association.”<br />
On Saturday, December 11, seven members joined<br />
Norma Tubman at her home for morning coffee. This<br />
was the first in-person meeting of members since<br />
<strong>February</strong> 2020. DNA 20 member Irene Drabek gave<br />
a brief overview of two Denver based non-profits.<br />
The first was Project Angel Heart, a non-profit which<br />
provides medically tailored meals seven days a week<br />
to homes of clients with severe illnesses. The second<br />
was on Judi’s House which offers community-based<br />
bereavement help for children and families. Members<br />
brought food, toys, men’s clothing, and diapers to<br />
the meeting to be donated to The Action Center. The<br />
Center serves those experiencing hardship by offering<br />
the resources needed to stabilize lives and promote<br />
pathways to lasting change.<br />
January saw us return to a virtual meeting with an<br />
update on Ralston House Child Advocacy Center from<br />
its Executive Director, Don Mosely. Ralston House<br />
is a non-profit agency that provides a safe place for<br />
child and teen survivors of abuse to tell their stories.<br />
Founded in 1990, Ralston House receives referrals<br />
from law enforcement, social services and the district<br />
attorney’s office and works in conjunction with these<br />
entities to provide forensic interviews and medical<br />
examination.<br />
Congratulations to Emily Valencia who is the recipient<br />
of the 2021 DNA 20 $1500 Scholarship. Emily lives in Frisco<br />
and is a second-year student at <strong>Colorado</strong> Mountain College<br />
in Breckenridge. She works as a CNA at Saint Anthony<br />
Summit Hospital in Frisco and plans to enroll in a BSN<br />
Program in Fall <strong>2022</strong>. Thank you to Norma Tubman who<br />
represented DNA 20 on the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation<br />
Scholarship Selection Committee.<br />
Annette Cannon, DNA 20 Board Member at Large,<br />
announced at our October Meeting that she is running<br />
for a second four-year term as Jefferson County Coroner.<br />
We wish her the best. Kudos to Jean Schroeder, DNA 20<br />
President, who has been appointed to the PIMA Medical<br />
Institute Nursing Advisory Board.<br />
Information on DNA 20 meetings and speakers can<br />
be found on the CNA website or by contacting DNA 20<br />
President Jean Schroeder at nursingstrategies@gmail.com.<br />
Juniper Village at the Spearly Center<br />
We are hiring<br />
RNs<br />
LPNs CNAs<br />
At Juniper, we are taking a proactive, timely, and<br />
innovative approach and we are hiring during<br />
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Come join our amazing team!<br />
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We are certified as<br />
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Please visit us and apply at<br />
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2205 W. 29th Ave. Denver, CO 80211 • 303-458-1112
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 5<br />
Peer Assistance<br />
We are writing this as the two-year anniversary of the COVID-19 Pandemic<br />
approaches. For 91 weeks we have been tracking public health orders and<br />
relentlessly following our own office policies. As we follow threats of new variants<br />
and breakthrough cases - trying to stay safe and healthy as a staff—and as a team—<br />
challenges us all. When you read this in <strong>February</strong> we hope for improved data and a safer<br />
environment.<br />
Reflecting on FY 20/21, we are reminded that the continued demand for services<br />
demonstrated that our screening, brief intervention and peer health assistance programs<br />
are vital to communities statewide. We have relied on the talents and energy of our<br />
team; we relied on their dedication to our mission and to each other. Here are a few<br />
highlights:<br />
Training: Screening, Brief Intervention, Referral to Treatment<br />
The SBIRT team exceeded expectations, providing 58 live virtual trainings to 700<br />
professionals in 44 sites that included hospitals, primary care clinics, and school-based<br />
health centers. These trainings augment the professional development of <strong>Colorado</strong>’s<br />
health and mental health workforce. Implementation support was provided to 23 clinics<br />
throughout northeast and southeast <strong>Colorado</strong>. We submitted proposals to three of<br />
<strong>Colorado</strong>’s four Managed Services Organizations as part of the funding made available<br />
by HB20-1411 – COVID Cares Act to provide SBIRT training and technical assistance,<br />
training-of trainer sessions, measurement-based care implementation support, and<br />
enhanced online training available 24/7. We expanded the team’s skill for training with<br />
integrated suicide prevention by leveraging the SBIRT model, or universal screening, to<br />
identify the risks associated with substance use and mental health concerns.<br />
Health Professionals; Peer Health Assistance Programs<br />
The Peer Health Team provided services to over 1100 health and mental health<br />
professionals. The increasing number of those with Rehabilitation Contracts<br />
demonstrates the continuing need for programming for individuals with substance use,<br />
mental health, physical health, and related concerns. Safety to practice is supported<br />
through constructive case management and monitoring.<br />
The closure of many businesses, including drug testing sites, has presented unique<br />
challenges for PAS clients. Alternative drug testing options were implemented, allowing<br />
clients to maintain compliance with monitoring requirements. The tremendous need<br />
for health and mental health professionals in the workforce resulted in increased<br />
employment opportunities for health and mental health professionals working with<br />
PAS, though employment in a pandemic has caused amplified stressors, due to long and<br />
demanding work hours, increased exposure risk, and isolation due to disease exposure.<br />
The Nursing Peer Health Assistance Program provided these services throughout<br />
the Pandemic:<br />
- 823 RN’s, and LPN’s accessed services including evaluation, case management,<br />
short-term problem resolution, or referral to treatment.<br />
- 267 RN’s and LPN’s received a comprehensive biopsychosocial evaluation.<br />
- The average number of nurses receiving case management, monitoring, and<br />
support is 363 – majority of whom are employed using their license.<br />
- Program awareness information was distributed regarding the availability of<br />
24/7 services.<br />
- Virtual presentations were provided to nurses in hospitals, schools, and clinics to<br />
address substance use and mental health concerns exacerbated by COVID-19.<br />
- Outreach to thousands of <strong>Colorado</strong> nurses through numerous avenues<br />
including The <strong>Colorado</strong> <strong>Nurse</strong><br />
Government Affairs &<br />
Public Policy Committee<br />
Mary Satre, MSN, MBA, RN<br />
CNA Board Member Region 3, Co-Chair of GAPP Committee<br />
The first <strong>2022</strong> meeting of the <strong>Colorado</strong> <strong>Nurse</strong>s Association (CNA) Government Affairs<br />
and Public Policy Committee (GAPP) coincided with the start of the Second Regular<br />
Session of the Seventy-third General Assembly of the <strong>Colorado</strong> State Legislature on<br />
January 12, <strong>2022</strong>. These meetings, resuming their semi-monthly schedule during the<br />
legislative session on the second and fourth Wednesdays of the month from 6:15 to<br />
8:00 pm, will continue in virtual format via Zoom for the foreseeable future, allowing<br />
participation of membership across <strong>Colorado</strong>. CNA’s Director of Practice and Government<br />
Affairs, Colleen Casper, DNP, RN, MS, is the spokesperson for this Committee and<br />
represents CNA as required in matters relating to policy and legislation. Contract Lobbyist<br />
Gil Romero and his team cover the action in the State Legislature and update the GAPP<br />
members on committee activity as well as budget allocation. With three billion federal<br />
dollars available to <strong>Colorado</strong> this year and many health care measures on the table, GAPP<br />
will be monitoring activity closely.<br />
The presentation of the Governor’s FY <strong>2022</strong>-2023 budget in early December gave a<br />
preview of the issues that will be under consideration as the legislative session proceeds.<br />
Our lobbyist team anticipates a very busy season, and the agenda for GAPP meetings<br />
will be full as health care related bills are presented and discussed. Member experts,<br />
some with decades of experience in their specialty areas of practice, contribute substance<br />
to the discussions as they debate the pros and cons of each bill, ultimately making<br />
recommendations to support or oppose a bill or remain neutral. A number of state<br />
legislators have worked diligently with Dr. Casper and the team to advance supported<br />
bills through the House and Senate. As such, the recent redistricting in <strong>Colorado</strong> and its<br />
ultimate effect on representation has been on the GAPP Committee’s radar.<br />
In a year where the nurse staffing shortage has been declared a crisis at the national<br />
level by the American <strong>Nurse</strong>s Association, and as the COVID-19 pandemic continues to<br />
highlight this shortage, the collective voice of nurses raised in defense of safe practices<br />
and indeed their own safety is paramount. GAPP meetings are open to all CNA members<br />
and students are encouraged to visit the website (https://www.coloradonurses.org/gov-taffairs-public-policy-gapp-)<br />
to register to attend as guests.<br />
GAPP encourages all nurses as health care professionals to cultivate connections with<br />
their respective state legislators to enable efficient delivery of relevant messaging. GAPP<br />
stands ready to support this process.<br />
We are grateful to provide this column in The <strong>Colorado</strong> <strong>Nurse</strong> which helps us<br />
with important outreach. PAS provides the statewide Nursing Peer Health Assistance<br />
Program through a contract with the <strong>Colorado</strong> State Board of Nursing, Department<br />
of Regulatory Agencies. www.peerassistanceservices.org<br />
For more information contact Annie Klein, Communications and Program<br />
Outreach Manager, aklein@peerassistanceservices.org; 303-369-0039 x224.<br />
Office locations:<br />
2170 South Parker Road, Suite 229 200 Grand Avenue, Suite 270<br />
Denver, CO 80231 Grand Junction, CO 81501<br />
303-369-0039 970-986-4360<br />
Weld County Public Health<br />
(Greeley, CO)<br />
invite applicants to apply:<br />
Public Health <strong>Nurse</strong> I or II<br />
(<strong>Nurse</strong>-Family Partnership)<br />
To view the complete job<br />
announcements and apply online:<br />
https://www.governmentjobs.com/<br />
careers/weld
6 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
In Memory<br />
Eve Cook Hoygaard, MS,RN, WHNP<br />
If you are a nurse who has read previous issues<br />
of the <strong>Colorado</strong> <strong>Nurse</strong>, you have probably read this<br />
column about nurses who have passed away that you<br />
have worked with or otherwise known at some time<br />
in your career. Did you wonder how we knew about<br />
these losses? We depend upon receiving from families<br />
and friends of these departed nurses. We depend on<br />
other people... like you!<br />
Our criteria for information to be included requires<br />
it being about a RN or an LPN who has been educated<br />
in, lived in and/or worked in <strong>Colorado</strong> plus the date<br />
and, if available, of where they lived at the time they<br />
passed away. We appreciate provision of additional<br />
information as to where and when they received their<br />
nursing education, degree(s), age, where they were<br />
employed, special awards (such as being a Nightingale<br />
Award or nominee) are examples we consider<br />
including. For women, the issue of including their birth<br />
name sometimes is included if known... if desired we<br />
would not include this information.<br />
We Remember<br />
OConnell, Jeanne, RN (67) passed away in<br />
October 2021. She graduated from Nursing School in<br />
Evanston Illinois in 1974. She moved to Denver over<br />
30 years ago. She worked in Labor and Delivery for<br />
many years. She spent 25 hears as Hospice <strong>Nurse</strong> at<br />
the Denver Hospice and Halycon Hospice.<br />
Oatis, Helen Dorothy (Benz) RN, (96) passed<br />
away in December 2021. She attended Denver<br />
University, then received her nursing training and<br />
became as a registered nurse. She worked at both St.<br />
Anthony’s and Lutheran Hospitals in Denver.<br />
Rusk, Elizabeth S., RN (91) passed away in<br />
October 2021 in Highland Ranch, CO. She served as a<br />
Major in the Army <strong>Nurse</strong> Corps.<br />
Vanderveen, Mary Ann, (Hoke), RN passed away<br />
in her early 80’s. She was also a nurse practitioner.<br />
Wiley, Mabel Ahlean (Roush) RN (95) passed<br />
away in December 2021. She attended the Denver<br />
University nursing program at Children’s Hospital.<br />
After graduation she worked as a pediatric nurse<br />
at Childrens’s Hospital, Denver and later worked as<br />
a pediatric nurse in Honolulu, HI. Later, she was a<br />
volunteer with The Friends of Nursing in Denver.<br />
Williams, Maureen Kellogg, RN (81) passed away<br />
in July 2021. She was a 1966 graduate of St. Luke’s<br />
Hospital School of Nursing in Denver. After graduation,<br />
she began her career at St. Luke’s. Later, she worked for<br />
CAN and Cigna insurance companies.<br />
We reserve the right to edit material submitter<br />
and endeavor to verify all information included in this<br />
column. If you notice an error, please advise us and a<br />
correction will be published in the next available issue.<br />
Your assistance in providing this column is greatly<br />
appreciated. To submit information, please contact Eve<br />
Hoygaard at hoygaard@msn.com. Thank you.<br />
2021 American Academy of Nursing<br />
<strong>Colorado</strong> Fellows Announced<br />
Kathleen Flarity Ingrid Johnson Caren Misky<br />
The American Academy of Nursing (Academy) announced the 2021 Class of<br />
Fellows. From the Academy President Eileen Sullivan-Marx, PhD, RN, FAAN, “I am<br />
thrilled to welcome another exceptional class of Fellows to the American Academy<br />
of Nursing during a momentous time of change and progress in our collective<br />
efforts to fulfill the organization’s vision for healthy lives for all people.”<br />
The newest Fellows to the Academy from <strong>Colorado</strong> include:<br />
– Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN, FAAN (UC Health/Center for<br />
Combat Research)<br />
– Ingrid Johnson, DNP, MPP, RN, FAAN (<strong>Colorado</strong> Center for Nursing Excellence)<br />
– Caren Misky, MSN, RN, FNP-BC, FAAN(Dispatch Health)<br />
On behalf of <strong>Colorado</strong> <strong>Nurse</strong>s Association congratulations on this honor and<br />
thank you for your leadership.<br />
CAREER ADVANCEMENT | HIGHLY AFFORDABLE<br />
Online<br />
RN-BSN<br />
- Dual Enrollment<br />
New Curriculum in Fall 2021<br />
30 Nursing credit hours<br />
Contact us at nursingadvising@msudenver.edu<br />
www.msudenver.edu/online/rn-to-bs/
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 7<br />
News from American<br />
Association <strong>Nurse</strong><br />
Practitioners (AANP)<br />
Constance McMenamin,<br />
AANP State Representative<br />
Each year, the AANP State Award for Excellence<br />
acknowledges two outstanding individuals from<br />
each state for their clinical excellence as a nurse<br />
practitioner (NP) or advocacy efforts on behalf of NPs<br />
and patients. This year’s recipients will be honored<br />
during the <strong>2022</strong> AANP National Conference June 21-<br />
26. In addition to an awards ceremony, the honorees<br />
are given conference admission and a one-year AANP<br />
membership with all the membership benefits (or an<br />
extension of their existing membership).<br />
Congratulations to Sarah Schaeffer, NP, who<br />
was awarded AANP’s <strong>Colorado</strong> NP State Award for<br />
Excellence for demonstrating excellence in clinical<br />
practice. Schaeffer is an NP specializing in neurology<br />
with a subspecialty of multiple sclerosis. She practices<br />
at UC Health in Fort Collins, <strong>Colorado</strong>. Schaeffer speaks<br />
publicly in her community and nationally on neurology<br />
topics and is a board member and speaker for Brain<br />
Health Center of the Rockies.<br />
Kudos to Colleen Casper, RN, MS, DNP, who is the<br />
Director of Practice and Government Affairs of the<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Association and who received AANP’s<br />
<strong>Colorado</strong> Advocate State Award for Excellence. The<br />
advocacy award acknowledges an individual who<br />
advanced the goals of NPs. The advocacy award does<br />
not have to be an NP and is often awarded to state<br />
legislators. This year, it goes to both a registered nurse<br />
and advocate! Over the past several years, Casper has<br />
advocated for NPs as we have continued to lift barriers<br />
to care through the reduction of mandatory hours<br />
for prescriptive authority as well as the recent sunset<br />
review. Casper’s precise attention to detail throughout<br />
the legislative process, along with her work with the<br />
CNA Government Affairs and Public Policy (GAPP)<br />
Committee and CNA’s contracted lobbyist group,<br />
Capital Success, makes her a great recipient for this<br />
advocacy award.<br />
I encourage my NP colleagues to think about<br />
nominations for the 2023 awards. You must be an<br />
AANP member to nominate someone, but the nominee<br />
does not need to be an AANP member. Announcements<br />
for nominations go out in August and the deadline is<br />
the first week in September. We all have extraordinary<br />
colleagues, and this is an opportunity to highlight them.<br />
For more information on AANP activities in <strong>Colorado</strong> or<br />
how you can get involved with the association, please<br />
reach out to constance.mcmenamin.np@gmail.com.<br />
Board of Nursing Update<br />
Emergency rules were adopted in November<br />
2021 by the Division of Professions and Occupations<br />
regarding temporary licensure and/or scope expansion,<br />
including delegation and vaccination administration,<br />
pursuant to the Governor’s Executive Orders on<br />
COVID-19 pandemic measures.<br />
Here’s what these rules mean for the profession:<br />
PROFESSIONAL AND PRACTICAL NURSES<br />
• Temporary licenses issued to professional and<br />
practical nursing applicants from non-compact<br />
states under the Governor’s Executive Orders on<br />
or after November 2, 2021 will be effective from<br />
the date of issuance through May 31, <strong>2022</strong>. On<br />
June 1, <strong>2022</strong>, if a full license to practice nursing<br />
in <strong>Colorado</strong> has not been issued, the temporary<br />
licensee must cease practice immediately until<br />
such time as full licensure to practice nursing in<br />
the state has been granted.<br />
• Professional and practical nursing applicants issued<br />
a temporary license from non-compact states<br />
between April 6, 2021 and Nov. 1, 2021 must have<br />
ceased practice on Jan. 1, 2021 if a full license to<br />
practice nursing had not been issued or a second<br />
temporary license obtained. Those applicants<br />
issued a temporary license between April 6, 2021<br />
and November 1, 2021 may apply here for a<br />
second temporary license to be effective from the<br />
date of issuance through May 31, <strong>2022</strong>.<br />
CERTIFIED NURSE AIDES<br />
The <strong>Colorado</strong> Board of Nursing may issue a<br />
temporary certification to an applicant that is a new<br />
graduate of an approved nurse aide training program<br />
meeting all qualifications for certification except<br />
the successful completion of the required exams as<br />
set forth in Section 12-255-205, <strong>Colorado</strong> Revised<br />
Statutes. <strong>Nurse</strong> aide graduates wishing to apply for the<br />
temporary certification may apply here.<br />
Temporary certificate holders must have ceased<br />
practice as a nurse aide in <strong>Colorado</strong> on Jan. 1, <strong>2022</strong> if<br />
another temporary certificate has not been issued, until<br />
such time as full certification has been granted. Skills<br />
examinations may be scheduled through Credentia.<br />
The Board may issue a temporary emergency<br />
certification valid through May 31, <strong>2022</strong> to a new<br />
reinstatement applicant who meets all qualifications<br />
for certification with the exception of successful<br />
completion of the required skills examinations OR<br />
issue a second temporary certificate for those issued a<br />
temporary emergency certificate between April 5, 2021<br />
and Nov. 1, 2021, under terms set forth in emergency<br />
rules.<br />
The information above is the latest currently<br />
available, and is subject to change based on any<br />
extensions or changes to the Disaster Recovery<br />
Executive Order. Please make sure to check additional<br />
communications from DPO, including its website,<br />
alerting the public to any such revisions.<br />
RN, LPN and CNA Education Requirements<br />
Clinical requirements for students in nurse education<br />
and training programs have changed. The suspension<br />
of these requirements temporarily allows programs to<br />
provide alternative means for students to obtain clinical<br />
hours to demonstrate competency. These changes,<br />
pending further action, are in effect for no longer than<br />
120 days from their Nov. 2, 2021 activation.<br />
Questions regarding temporary licensure, temporary<br />
certification, or changes to educational requirements<br />
may be directed to dora_nursingboard@state.co.us.<br />
Full information also is available on the emergency rules<br />
webpage.<br />
Events Calendar:<br />
www.watsoncaringscience.org/home/events-calendar/<br />
Connect with WCSI:<br />
www.watsoncaringscience.org/contact-wcsi/<br />
Featured Course – Caritas Coach<br />
Education Program<br />
www.watsoncaringscience.org/events/caritas-coach-educationprogram-ccep-april-<strong>2022</strong>/
8 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
Updates <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
Nursing Continuing Professional<br />
Development Program<br />
Connie Pardee, PhD, RN<br />
Sayonara 2021 and Welcome <strong>2022</strong><br />
As we approach the end of<br />
almost two years living with<br />
a pandemic, I want to take a<br />
few moments to offer thanks<br />
and gratitude for all nursing<br />
and healthcare colleagues. My<br />
heart is with you even if my<br />
body is not. You have all given<br />
one hundred and ten percent<br />
and continue to provide<br />
outstanding professional quality<br />
care even though you are Connie Pardee<br />
exhausted. I applaud you and<br />
hope you are able to provide some self-care to ease your<br />
stress in these challenging times. Here’s to a healthy less<br />
stressful <strong>2022</strong>.<br />
AMAZING<br />
REMARKABLE<br />
AWESOME<br />
American Renal Associates<br />
Our Staff Make the Difference!<br />
Opportunities for dialysis nurses in the<br />
Denver Metro Area in <strong>Colorado</strong>.<br />
Please apply at americanrenal.com.<br />
RN: CAM1' NURSE<br />
GENEVA GLEN CAMP in INDIAN HILLS, <strong>Colorado</strong>, will hire two<br />
RN’s for the <strong>2022</strong> Summer season: May 27 th –August 6 th . GENEVA<br />
GLEN has an excellent reputation and rich heritage. ACA accredited.<br />
Compensation includes $7,750 salary, travel allowance up to $350,<br />
insurance, room and board, beautiful, modern health center facility,<br />
participation in camp life including horseback riding, swimming,<br />
hiking – ideal <strong>Colorado</strong> climate, healthful working environment<br />
(Indian Hills is near Red Rocks). RN graduates welcome!<br />
Contact: Reid McKnight,<br />
P.O.Box 248, Indian Hills, CO 80454, (303) 697-4621 x 14<br />
Email: reid@genevaglen.org. Apply online at: www.genevaglen.org/nurse<br />
NursingALD.com can point you<br />
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Changes in <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
(CNA) Accredited Approver Unit<br />
Please join me in welcoming Nan Morgan BSN,<br />
MS (Nursing Leadership & Education), RN, who will<br />
assume the Accredited Approver Program Director<br />
role on January 1, <strong>2022</strong>. Connie Pardee PhD, RN,<br />
who has served in the role for almost five years, will<br />
be retiring. Nan brings extensive nursing education<br />
experience to the role, including Nursing Clinical<br />
Scholar, Clinical <strong>Nurse</strong> Education at Swedish Hospital<br />
for a decade and as a Quality specialist. She loves<br />
networking with nurses and is a long-time active<br />
member of <strong>Colorado</strong> <strong>Nurse</strong>s Association, serving<br />
a third term as Secretary of the Association. She<br />
was honored with a Nightingale award in 2011<br />
for starting the No One Dies Alone Program at<br />
Swedish Medical Center. She is the proud mother<br />
of a Women’s Health <strong>Nurse</strong> Practitioner, one of two<br />
children and five grandchildren. In her spare time,<br />
she enjoys family, travel, fabric crafts and reading<br />
non-fiction. Nan will assume all responsibilities of<br />
the role on January 1, <strong>2022</strong> and can be reached at<br />
programdirector@coloradonurses.org or via phone<br />
303-905-9906. Please welcome her and call her with<br />
any nursing continuing professional development<br />
needs.<br />
Thank you Connie Pardee, PhD, RN<br />
<strong>Colorado</strong> <strong>Nurse</strong>s Association Board of Directors,<br />
members and staff offer our sincerest gratitude<br />
for Dr. Pardee’s leadership over the past five<br />
plus years. Connie, as we know and appreciate<br />
her, came to the role of program director of CNA<br />
accredited approver unit at a time when we had to<br />
rebuild our strong history and tradition of quality<br />
services. Dr. Pardee did that and more. Pardee<br />
led the reaccreditation process by the American<br />
<strong>Nurse</strong>s Credentialing Center and re-established<br />
CNA’s role in assuring quality continuing education<br />
and ongoing nursing professional development for<br />
educational providers through-out <strong>Colorado</strong> and<br />
regionally. Thank you is not enough and yet, we<br />
are so grateful for her wisdom, good humor and<br />
competencies when we needed them most. We all<br />
look forward to working with Nan Morgan in this<br />
role in the new year!<br />
NOW HIRING<br />
CNAs, LPNs, and a DON<br />
for our nursing home<br />
RN Night positions available at our<br />
Critical Access Hospital<br />
$1,000 Sign on Bonus.<br />
Applications can be submitted on our<br />
website at www.schealth.org<br />
Nursing opportunities in<br />
hospital and clinic settings,<br />
surgery, rehab, long term<br />
care, homecare, hospice<br />
and dialysis.<br />
To view our openings and apply please<br />
visit our website at www.ubh.org<br />
435.722.6188 | Roosevelt, Utah<br />
Childhood Shaped<br />
His Perspective<br />
Dana Brandorff<br />
Director of Marketing and Communication,<br />
University of <strong>Colorado</strong> College of Nursing<br />
Whether it’s learning to<br />
drive, graduating high school,<br />
or moving out, there’s a<br />
lot of freedom that comes<br />
with young adulthood.<br />
For Christopher Battelli, a<br />
2021 graduate University<br />
of <strong>Colorado</strong> College of<br />
Nursing, the transition from<br />
child to young adult meant<br />
the ability to make his own<br />
medical decisions. “For Christopher Battelli<br />
my entire childhood, I was<br />
unvaccinated and part of the ‘exempt’ crowd.” Against<br />
his mother’s wishes, he chose to get vaccinated when<br />
he was 18. “I did a lot of soul searching and research<br />
and decided the science was too overwhelming not to<br />
get vaccinated. My mother was not happy.<br />
Battelli says his parents, especially his mother,<br />
have always been skeptical of vaccines and<br />
distrustful of the health care system. “I can’t fault<br />
them as their distrust was rooted in personal<br />
experience and a fear that any health issue could<br />
destroy their life savings. ”Lack of insurance, fear<br />
of the cost of health care, and not being listened<br />
to by providers when they did have appointments,<br />
compounded the negative impression they had<br />
of the system. “I grew up in a very generous<br />
household. My mother believes strongly in helping<br />
others and taking care of them and that it’s the right<br />
thing to do. She is fiercely independent and did not<br />
trust health care or vaccinations.”<br />
When Battelli’s sister was young, she was<br />
diagnosed with Lyme disease. “Early on my mother<br />
even suggested Lyme disease to the providers, which<br />
was ignored.” But after months of misdiagnoses,<br />
tests, and bills, the diagnosis came back. Recalling<br />
the incident, Battelli says, “Being disregarded and<br />
not heard is extremely frustrating and causes feelings<br />
of being marginalized.”<br />
Another encounter that shaped his family’s<br />
perceptions was when his father died during his<br />
senior year at <strong>Colorado</strong> State University. “I absolutely<br />
think our system failed him. It was baffling to see the<br />
number of times he went in and out of the hospital<br />
with untreated mental health issues.” According<br />
to Battelli, the nursing staff made it less painful.<br />
“I can remember the nurses’ names. I don’t recall<br />
a single doctor.” That was the seminal event that<br />
changed his outlook and pushed him into a nursing<br />
career through the University of <strong>Colorado</strong> College of<br />
Nursing Accelerated pathway (UCAN).<br />
After graduating from CSU with a degree in<br />
Anthropology, he worked in public health consulting<br />
for a few years. “My undergraduate degree helped<br />
me look through a different lens. I use it every<br />
day,” says Battelli. His childhood, life experiences,<br />
and education have shaped how he views people,<br />
patients, and situations. It helps him understand that<br />
we may have different values and don’t always have<br />
to agree. “Arguing with people who disagree with<br />
you, belittling them, and not understanding where<br />
they come from is not effective,” says Battelli. He<br />
suggests listening and trying to understand how they<br />
have come to their viewpoints. “Things aren’t always<br />
black and white. But there’s been this polarization<br />
when it comes to COVID and vaccinations.”<br />
For Battelli, the difference of opinion has become<br />
a lesson in acceptance and a roadmap for how he<br />
might handle similar situations in the future. He and<br />
his sister were even able to convince their mother<br />
into getting the Johnson & Johnson COVID-19<br />
vaccine by appealing to her travel bug. “She was<br />
resistant, but her strong desire to travel outweighed<br />
her reticence to get the vaccine,” says Battelli.<br />
Sometimes knowing your patient, empathizing with<br />
them, and providing them with data are the best<br />
ways to handle differences of opinions. Intending to<br />
grow his skills and technical expertise, Battelli has<br />
his eyes on working at a progressive care unit of a<br />
hospital post-graduation.
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 9<br />
CU <strong>Nurse</strong>-Midwifery Student Dodges Boulders, Finds Route for Reaching Her Peak<br />
Debra Melani<br />
Science Writer, University of <strong>Colorado</strong> Anschutz<br />
Medical Campus<br />
For Chantal Dengah, her<br />
master’s degree specializing<br />
in <strong>Nurse</strong>-Midwifery came<br />
with some “Indiana Jones<br />
moments.” Unexpected<br />
stressors arose for the<br />
University of <strong>Colorado</strong> College<br />
of Nursing student and single<br />
mother of three, especially<br />
as COVID crashed her entire<br />
graduate school experience, at<br />
times, turning her into “a ball<br />
of stress.” Yet as she accepts<br />
Chantal Dengah<br />
her MS degree during the Fall 2021 graduation ceremonies,<br />
marking the place she has always wanted to be, the<br />
standout student leader with a contagious laugh will reflect<br />
on the good things the past two years delivered and the<br />
possibilities her future holds. “My goal was always to be a<br />
midwife,” said Dengah, whose kids excitedly helped keep<br />
count of her 50 deliveries during the graduate program. “It<br />
has always been to get to this point.”<br />
Partly due to pandemic stressors, Dengah,<br />
whose undergraduate years at CU Nursing were loaded<br />
with volunteering and extracurricular activities, decided to<br />
ease up on the side work during her pandemic-cloaked<br />
graduate education. “There were definitely those Indiana<br />
Jones moments, where you are running, and the boulder<br />
is coming, and you are like (lets out a squeal), and you<br />
are trying to roll under the door coming down,” Dengah<br />
said, describing her time in the rigorous, nationally<br />
ranked midwifery program, that she called “well-paced”<br />
and “immersive.” Support from “amazing” faculty and<br />
preceptors guided her under that door every time, she<br />
said. “They are so wonderful and knowledgeable that,<br />
even with those moments, I really felt encouraged and<br />
supported,” Dengah said. She has also put PhD plans on<br />
hold to enjoy practicing midwifery and time with her family.<br />
But a reduced pace for Dengah would feel like warp speed<br />
for many people.<br />
During graduate school, Dengah volunteered with the<br />
American College of <strong>Nurse</strong>-Midwifery and the CU College<br />
of Nursing Alumni Association, mentoring students for the<br />
alumni association’s Student Success Committee. She also<br />
served as a teaching assistant in an undergraduate OB/<br />
GYN course for two semesters. “It was really great,” she<br />
said of teaching new nursing students, noting that the<br />
benefits were reciprocal. “I think when you teach, you<br />
learn. Students helped me see some things from different<br />
perspectives,” Dengah said. “I also really find value in giving<br />
back to my community. When you are building up a robust<br />
community around you, you are building in this beautiful<br />
network of support for yourself and for others.”<br />
Of course, the pinnacle of her midwife training was<br />
her first delivery. “That birth was just really beautiful. It<br />
was like a way post, right? It marked a transition into<br />
now practicing the theories that I’ve been learning and<br />
been wanting to practice for the past decade.” Dengah’s<br />
post-graduation plans begin with passing the American<br />
Midwifery Certification Board exam, which she said,<br />
holding up crossed fingers, she hopes to take in December.<br />
“I’m feeling really good and prepared. We (CU’s midwifery<br />
program) have a very high pass rate.” (The certification rate<br />
within one year of graduation is 97%.)<br />
Once those MS/CNM letters become official behind<br />
her name, Dengah plans to launch her own birthing<br />
brand, starting with the publication of a cookbook she<br />
worked on during graduate school. “I’d been noticing<br />
that a lot of my patients had been coming in and saying:<br />
What should I eat? Or: I’ve been throwing up; is my baby<br />
OK?” So she conceived the cookbook idea to answer<br />
those questions and more. The book will look at dietary<br />
needs for each trimester, from calories to recommended<br />
percentage of nutrients, such as protein and fat. And it<br />
will offer “really accessible, easy recipes” that fulfill those<br />
needs, said Dengah, who hopes to publish this spring.<br />
Next up, Dengah wants to write a birthing book on the<br />
mind/body aspect of birthing and become an Instagram<br />
presence that educates the public about her profession,<br />
she said. “When you are called to midwifery, I feel like<br />
it’s, at least for me, a responsibility to leave the profession<br />
better than you found it.”<br />
Dengah’s active personal life also outpaces many<br />
people’s, with singing backup for local musicians,<br />
hosting a TV adventure show, rock-climbing for sport<br />
and working as a ring girl for the national MMA (Mixed<br />
Martial Arts) all on her résumé. Some of her stressrelieving<br />
outside gigs were taken away by pandemic<br />
shutdowns, including the MMA job, inspiring her to<br />
“hang up my bikini,” she said with a laugh.On a sad<br />
note, Dengah also lost her longtime climbing partner<br />
to a non-climbing tragic accident two years ago,<br />
stealing her main form of meditation during graduate<br />
school. “It’s been really hard during COVID to find any<br />
partners,” she said, adding that surviving without her<br />
meditative sport was not easy.“ I was pretty much a ball<br />
of stress. It was a big eye-opener for me, like: I do need<br />
this in my life. This is my big stress-reliever, and I wasn’t<br />
replenishing my cup. It was an important cautionary tale:<br />
Make sure you don’t neglect the things that make you<br />
feel centered and make you feel you.” She intends to<br />
get back to climbing and, eventually, pursue her PhD so<br />
that she can contribute to what she calls much-needed<br />
research in her chosen field.<br />
But for now, she’s ready for her next adventure –<br />
being the midwife she was called to be. That calling<br />
was cemented, she said, when a midwife controlled a<br />
dire situation – severe hemorrhaging during the birth<br />
of Dengah’s first child. Now, with four of Dengah’s 50<br />
deliveries during graduate school involving significant blood<br />
loss, she’s come full-circle. “They all did fine,” she said of<br />
the four mothers and babies. “I always wanted to be that<br />
bad-ass midwife who knows what to do, and now I am. It’s<br />
really cool.”
10 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
HIPAA, COVID-19 Vaccination, and the Workplace<br />
As <strong>Nurse</strong>s work diligently to provide care and<br />
educate our patients and communities during the<br />
pandemic, it is challenging and disheartening to hear<br />
misinformation regarding the provisions of HIPAA and<br />
Covid vaccinations. On September 30, 2021, the US<br />
Department of Health and Human Services, Office of<br />
Civil Rights, issued guidance to clarify the statutes and<br />
counter the misinformation.<br />
FAQs:<br />
1. Does the HIPAA Privacy Rule prohibit businesses<br />
or individuals from asking whether their customers<br />
or clients have received a COVID-19 vaccine?<br />
No. The Privacy Rule 2 does not prohibit any person<br />
(e.g., an individual or an entity such as a business),<br />
including HIPAA covered entities and business<br />
associates, from asking whether an individual has<br />
received a particular vaccine, including COVID-19<br />
vaccines.<br />
First, the Privacy Rule 3 applies only to covered<br />
entities 4 (health plans, health care clearinghouses, and<br />
health care providers that conduct standard electronic<br />
transactions) and, to some extent, their business<br />
associates. 5<br />
Second, the Privacy Rule does not regulate the<br />
ability of covered entities and business associates<br />
to request information from patients or visitors.<br />
Rather, the Privacy Rule regulates how and when<br />
covered entities and business associates are permitted<br />
to use 6 and disclose 7 protected health information 8<br />
(PHI) (e.g., PHI about whether an individual has received<br />
a COVID-19 vaccine) that covered entities and business<br />
associates create, receive, maintain, or transmit. Thus,<br />
the Privacy Rule does not prohibit a covered entity<br />
(e.g., a covered doctor, hospital, or health plan) or<br />
business associate from asking whether an individual<br />
(e.g., a patient or visitor) has received a particular<br />
vaccine, including COVID-19 vaccines, although it does<br />
regulate how and when a covered entity or its business<br />
associate may use or disclose information about an<br />
individual’s vaccination status.<br />
Additional examples. The Privacy Rule does not<br />
apply when an individual:<br />
– Is asked about their vaccination status<br />
by a school, 9 employer, store, restaurant,<br />
entertainment venue, or another individual.<br />
– Asks another individual, their doctor, or a service<br />
provider whether they are vaccinated.<br />
– Asks a company, such as a home health agency,<br />
whether its workforce members are vaccinated.<br />
Other state or federal laws address whether<br />
individuals are required to disclose whether they have<br />
received a vaccine under certain circumstances.<br />
2. Does the HIPAA Privacy Rule prevent customers<br />
or clients of a business from disclosing whether<br />
they have received a COVID-19 vaccine?<br />
No. The Privacy Rule does not prevent any individual<br />
from disclosing whether that individual has been<br />
vaccinated against COVID-19 or any other disease. The<br />
Privacy Rule does not apply to individuals’ disclosures<br />
about their own health information. It applies only to<br />
covered entities 10 and, to some extent their business<br />
associates. 11 Therefore, the Privacy Rule does not<br />
apply when an individual tells another person, such<br />
as a colleague or business owner, about their own<br />
vaccination status.<br />
3. Does the HIPAA Privacy Rule prohibit an<br />
employer from requiring a workforce member to<br />
disclose whether they have received a COVID-19<br />
vaccine to the employer, clients, or other parties?<br />
No. The Privacy Rule does not apply to employment<br />
records, including employment records held by<br />
covered entities 12 or business associates 13 in their<br />
capacity as employers. 14 Generally, the Privacy<br />
Rule does not regulate what information can be<br />
requested from employees as part of the terms and<br />
conditions of employment that an employer may<br />
impose on its workforce. 15 However, other federal<br />
or state laws do address terms and conditions of<br />
employment. 16 For example, federal anti-discrimination<br />
laws do not prevent an employer from choosing<br />
to require that all employees physically entering<br />
the workplace be vaccinated against COVID-19<br />
and provide documentation or other confirmation<br />
that they have met this requirement, subject to<br />
reasonable accommodation provisions and other<br />
equal employment opportunity considerations. 17<br />
Documentation or other confirmation of vaccination,<br />
however, must be kept confidential and stored<br />
separately from the employee’s personnel files under<br />
Title I of the Americans with Disabilities Act (ADA). 18<br />
4. Does the HIPAA Privacy Rule prohibit a covered<br />
entity or business associate from requiring its<br />
workforce members to disclose to their employers<br />
or other parties whether the workforce members<br />
have received a COVID-19 vaccine?<br />
No. The Privacy Rule does not apply to employment<br />
records, including employment records held by<br />
covered entities 19 and business associates 20 acting in<br />
their capacity as employers. 21 Thus, the Privacy Rule<br />
generally does not regulate what information can be<br />
requested from employees as part of the terms and<br />
conditions of employment that a covered entity or<br />
business associate may impose on its workforce, 22<br />
such as the ability of a covered entity or business<br />
associate 23 to require its workforce members to provide<br />
documentation of their vaccination against COVID-19<br />
or to disclose whether they have been vaccinated to<br />
their employer, other workforce members, patients, or<br />
members of the public. For example:<br />
1. The Privacy Rule does not prohibit a covered<br />
entity or business associate from requiring or<br />
requesting each workforce member to:<br />
2. Provide documentation of their COVID-19 or<br />
flu vaccination to their current or prospective<br />
employer.<br />
3. Sign a HIPAA authorization for a covered<br />
health care provider to disclose the<br />
workforce member’s COVID-19 or varicella<br />
vaccination record to their employer. 24<br />
4. Wear a mask–while in the employer’s facility,<br />
on the employer’s property, or in the normal<br />
course of performing their duties at another<br />
location.<br />
5. Disclose whether they have received a<br />
COVID-19 vaccine in response to queries from<br />
current or prospective patients.<br />
Other federal or state laws address whether an<br />
employer may require a workforce member to obtain<br />
any vaccinations as a condition of employment and<br />
provide documentation or other confirmation of<br />
vaccination. These laws also address how employers<br />
must treat medical information that they obtain from<br />
employees. For example, documentation or other<br />
confirmation of vaccination must be kept confidential<br />
and stored separately from the employee’s personnel<br />
files under Title I of the Americans with Disabilities Act<br />
(ADA).<br />
5. Does the HIPAA Privacy Rule prohibit a doctor’s<br />
office from disclosing an individual’s protected<br />
health information (PHI), including whether<br />
they have received a COVID-19 vaccine, to the<br />
individual’s employer or other parties?<br />
Generally, yes. The Privacy Rule prohibits covered<br />
entities 25 and their business associates 26 from using or<br />
disclosing an individual’s PHI 27 (e.g., information about<br />
whether the individual has received a vaccine, such as<br />
a COVID-19 vaccine; the individual’s medical history or<br />
demographic information) except with the individual’s<br />
authorization or as otherwise expressly permitted or<br />
required by the Privacy Rule.<br />
Generally, where a covered entity or business<br />
associate is permitted to disclose PHI, it is limited<br />
to disclosing the PHI that is reasonably necessary to<br />
accomplish the stated purpose for the disclosure. 28<br />
If consistent with other law and applicable ethical<br />
standards, under the Privacy Rule:<br />
• A covered healthcare provider is permitted to<br />
disclose PHI relating to an individual’s vaccination<br />
to the individual’s health plan as necessary to<br />
obtain payment for the administration of a<br />
COVID-19 vaccine. 29<br />
• A covered pharmacy is permitted to disclose<br />
PHI relating to an individual’s vaccination status<br />
(e.g., that an individual has received a COVID-19<br />
vaccination, the date of vaccination, the vaccine<br />
manufacturer) to a public health authority, such<br />
as a state or local public health agency. 30<br />
• In such situations, the covered pharmacy may<br />
rely, if such reliance is reasonable under the<br />
circumstances, on a representation by the public<br />
health authority that the information requested<br />
constitutes the minimum necessary for the stated<br />
purpose(s) of the disclosure (e.g., to track and<br />
compare the effectiveness of different COVID-19<br />
vaccines). 31<br />
• A health plan is permitted to disclose an<br />
individual’s vaccination status where required<br />
to do so by law. 32<br />
• A covered nurse practitioner is permitted to<br />
provide PHI relating to an individual’s COVID-19<br />
vaccination status to the individual. 33<br />
• A covered clinician who is an investigator in a<br />
COVID-19 vaccine clinical trial is permitted to<br />
use or disclose PHI to the vaccine manufacturer<br />
and FDA about clinical trial participants for the<br />
purpose of activities related to the quality, safety,<br />
or effectiveness of the COVID-19 vaccine. 34 Such<br />
purposes include:
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 11<br />
• To collect or report adverse events, product defects or problems (including<br />
problems with the use or labeling of a product), or biological product<br />
deviations.<br />
• To track FDA-regulation products, including COVID-19 vaccines.<br />
• To enable product recalls, repairs, replacement, or lookback (including locating<br />
and notifying individuals who have received products that have been recalled,<br />
withdrawn, or are the subject of lookback).<br />
• To conduct post-marketing surveillance.<br />
• A covered hospital is permitted to disclose PHI relating to an individual’s<br />
vaccination status to the individual’s employer so that the employer may<br />
conduct an evaluation relating to medical surveillance of the workplace (e.g.,<br />
surveillance of the spread of COVID-19 within the workforce) or to evaluate<br />
whether the individual has a work-related illness, 35,36 and all of the following<br />
conditions are met:<br />
• The covered hospital is providing the health care service to the individual at the<br />
request of the individual’s employer or as a member of the employer’s workforce. 37<br />
• The PHI that is disclosed consists of findings concerning work-related illness or<br />
workplace-related medical surveillance.<br />
• The employer needs the findings in order to comply with its obligations under<br />
the legal authorities of the Occupational Safety and Health Administration<br />
(OSHA), the Mine Safety and Health Administration (MSHA), or state laws<br />
having a similar purpose (e.g., under OSHA’s recordkeeping requirements,<br />
worker side effects from vaccination constitute a “recordable illness,” and<br />
thus, employers are responsible for recording such side effects in certain<br />
circumstances). 38,39,40<br />
• The covered health care provider provides written notice to the individual that<br />
the PHI related to the medical surveillance of the workplace and work-related<br />
illnesses will be disclosed to the employer. (This can be accomplished by<br />
providing the individual with a copy of the notice at the time the health care is<br />
provided, or by posting the notice in a prominent place at the location where<br />
the health care is provided if the health care is being provided on the work site<br />
of the employer.) 4<br />
In other circumstances, the Privacy Rule generally requires a covered entity to<br />
obtain an individual’s written authorization before disclosing the individual’s<br />
PHI, 42 such as disclosure of whether the individual has received a vaccine, to,<br />
for example:<br />
• A sports arena or entertainment purveyor.<br />
• A hotel, resort, or cruise ship.<br />
• An airline or car rental agency.<br />
NOTE: The Privacy Rule does not prohibit an individual from choosing to provide any<br />
of these individuals or entities with information regarding their vaccination status.<br />
Footnotes<br />
1. The HHS Office for Civil Rights (OCR) is issuing these FAQs to address questions about when<br />
and how the HIPAA Rules apply to uses and disclosures of COVID-19 vaccination-related<br />
information. However, the information in the FAQs concerning the HIPAA Rules is applicable<br />
to all vaccinations, regardless of the disease or condition being addressed or whether the<br />
vaccine has been fully approved or authorized via an emergency use authorization (EUA).<br />
2. The “Privacy Rule” refers to the privacy regulations under the Health Insurance Portability<br />
and Accountability Act of 1996 (HIPAA), 45 CFR part 160 and subparts A and E of part 164.<br />
OCR administers the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules<br />
(collectively known as the HIPAA Rules), 45 CFR parts 160 and 164. This guidance focuses on<br />
the Privacy Rule, which regulates uses and disclosures of protected health information (PHI).<br />
3. The HIPAA Privacy, Security, and Breach Notification Rules, 45 CFR Parts 160 and 164.<br />
4. See 45 CFR 160.103 (definition of “Covered entity”). See also https://www.hhs.gov/hipaa/forprofessionals/covered-entities/index.html.<br />
5. See 45 CFR 160.103 (definition of “Business associate”). See also Direct Liability of Business<br />
Associates Fact Sheet at https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/<br />
business-associates/factsheet/index.html. Examples of business associates include health care<br />
claims processing services, medical transcriptionists, and accounting firms that have access to<br />
protected health information.<br />
6. See 45 CFR 160.103 (definition of “Use”).<br />
7. See 45 CFR 160.103 (definition of “Disclosure”).<br />
8. See 45 CFR 160.103 (definition of “Protected health information”).<br />
9. While the Privacy Rule does not regulate whether schools can ask individuals whether they<br />
have received a vaccine, the HIPAA Rules may regulate how the information is handled once<br />
it is in the possession of a school when that school is subject to the HIPAA Rules (i.e., when<br />
the school is a covered entity) and the health information does not meet the definition of<br />
“education records” covered by the Family Educational Rights and Privacy Act (FERPA). See<br />
45 CFR 160.103 excluding individually identifiable health information in education records<br />
covered under FERPA from the definition of “protected health information.” See also Joint<br />
Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And<br />
the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to Student Health<br />
Records, US Department of Health and Human Services and US Department of Education<br />
(December 2019), available at https://www.hhs.gov/sites/default/files/2019-hipaa-ferpajoint-guidance.pdf<br />
- PDF, describing what types of institutions FERPA applies to and what<br />
information is included in “education records.”<br />
10. See 45 CFR 160.103 (definition of “Covered entity”).<br />
11. See 45 CFR 160.103 (definition of “Business associate”).<br />
12. See 45 CFR 160.103 (definition of “Covered entity”).<br />
13. See 45 CFR 160.103 (definition of “Business associate”).<br />
14. See 45 CFR 160.103 (definition of “Protected health information). HHS addressed<br />
questions regarding the application of the HIPAA Privacy Rule to employers in the<br />
preambles to the 2000 Privacy Rule and the 2002 Modifications to the HIPAA Privacy<br />
Rule. “With regard to employers, we do not have statutory authority to regulate<br />
them. Therefore, it is beyond the scope of this regulation to prohibit employers from<br />
HIPAA, COVID-19 Vaccination, and the Workplace continued on page 12<br />
For additional information on the Privacy Rule and its application, visit https: //<br />
www.hhs.gov/hipaa/for-individuals/index.html.<br />
Resources<br />
The CDC issued “Updated Healthcare Infection Prevention and Control Recommendations<br />
in Response to COVID-19 Vaccination,” available at https://www.cdc.gov/<br />
coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html.<br />
OSHA, at the U.S. Department of Labor, published “Protecting Workers: Guidance on<br />
Mitigating and Preventing the Spread of COVID-19 in the Workplace”, available at<br />
https://www.osha.gov/coronavirus/safework. Additional guidance and resources on<br />
COVID-19 and the workplace, are available at https://www.osha.gov/coronavirus.<br />
The U.S. Equal Employment Opportunity Commission issued guidance entitled, “What You<br />
Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO<br />
Laws,” available at https://www.eeoc.gov/wysk/what-you-should-know-about-covid-<br />
19-and-ada-rehabilitation-act-and-other-eeo-laws.
12 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
<strong>Colorado</strong> <strong>Nurse</strong>s<br />
Association Leadership<br />
Announcement<br />
<strong>Colorado</strong> <strong>Nurse</strong>s<br />
Association (CNA)<br />
President Laura Rosenthal,<br />
DNP, ACNP, FAANP,<br />
announces that Colleen<br />
Casper, DNP, RN, MS will<br />
remain with <strong>Colorado</strong><br />
<strong>Nurse</strong>s Association in the<br />
role of Director of Practice<br />
and Government Affairs.<br />
To complement her<br />
work, Sonja Hix, of Civica Sonja Hix<br />
Associations Conferences<br />
and Exhibitions will expand her role with CNA to<br />
include Chief Administrative Officer to support the<br />
governing board, strategic planning, programmatic<br />
improvements, and membership services. Dr.<br />
Casper will work closely with Civica and the<br />
Governing Board in the transition of these roles and<br />
responsibilities while focusing primarily on advocacy<br />
for nursing practice in the regulatory, legislative and<br />
work environment related initiatives. Casper will<br />
also continue to liaison with the American <strong>Nurse</strong>s<br />
Association and the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
Continuing Education and Nursing Professional<br />
Development in partnership with Civica.<br />
CNA is fully engaged in the planning and<br />
prioritization of the <strong>2022</strong> Legislative agenda. We are<br />
confident this new arrangement with Civica will serve<br />
to strengthen the services available to members and<br />
the opportunities for CNA to advance nursing and<br />
health care access for all Coloradans.<br />
HIPAA, COVID-19 Vaccination, and the Workplace continued from page 11<br />
requesting or obtaining protected health information.”<br />
65 FR 82426, 82592 (December 28, 2000). “[T]he<br />
Department must remain within the boundaries set by<br />
the statute, which does not include employers per se as<br />
covered entities. Thus, we cannot regulate employers,<br />
even when it is a covered entity acting as an employer.”<br />
67 FR 53182, 53192 (August 14, 2002).<br />
15. See 45 CFR 160.103 (definition of “Workforce”).<br />
16. See EEOC, What You Should Know about COVID-19 and<br />
the ADA, the Rehabilitation Act, and Other EEO Laws,<br />
§ K (June 28, 2021), available at https://www.eeoc.gov/<br />
wysk/what-you-should-know-about-covid-19-and-adarehabilitation-act-and-other-eeo-laws.<br />
See generally<br />
Shen, Wen W. (2019). “Legal Sidebar: An Overview<br />
of State and Federal Authority to Impose Vaccination<br />
Requirements” (CRS Report No. LSB10300), available<br />
at https://crsreports.congress.gov/product/pdf/LSB/<br />
LSB10300. See also information about state vaccination<br />
laws on the websites of the Centers for Disease Control<br />
and Prevention (CDC) and the National Conference of<br />
State Legislators exit disclaimer icon (NCSL).<br />
17. See EEOC, What You Should Know, at § K.<br />
18. See id., § K.4.<br />
19. See 45 CFR 160.103 (definition of “Covered entity”).<br />
20. See 45 CFR 160.103 (definition of “Business associate”).<br />
21. See 45 CFR 160.103 (definition of “Protected health<br />
information”).<br />
22. See 45 CFR 160.103 (definition of “Workforce”). For<br />
additional information, see FAQ 301, https://www.hhs.<br />
gov/hipaa/for-professionals/faq/301/does-the-hipaapublic-health-provision-permit-health-care-providers-todisclose-information-from-pre-employment-physicals/<br />
index.html.<br />
23. See 45 CFR 160.103 (definitions of “Business associate”<br />
and “Covered entity”). See also https://www.hhs.gov/<br />
hipaa/for-professionals/covered-entities/index.html.<br />
24. See 45 CFR 164.508(b)(4)(iii).<br />
25. See 45 CFR 160.103 (definition of “Covered entity”).<br />
26 See 45 CFR 160.103 (definition of “Business associate”).<br />
27. See 45 CFR 160.103 (definition of “Protected health<br />
information”).<br />
28. See 45 CFR 164.514(d)(3).<br />
29. See 45 CFR 164.506(c)(1).<br />
30. See 45 CFR 164.512(b)(1)(i).<br />
31. See 45 CFR 164.514(d)(3)(iii)(A).<br />
32. See 45 CFR 164.512(a).<br />
33. See 45 CFR 164.502(a)(1)(i) (permitting a covered entity<br />
to use or disclose an individual’s PHI to the individual).<br />
Note, when an individual, or their personal representative,<br />
requests access to the individual’s PHI, in addition to the<br />
disclosure being permissible, it is also required under an<br />
individual’s right of access. See 45 CFR 164.524 (providing<br />
individuals with the right of access to inspect and obtain a<br />
copy of PHI about the individual in a designated record set).<br />
34. See 45 CFR 164.512(b)(1)(iii).<br />
35. See 29 CFR 1904.5 (definition of “Work-related illness”).<br />
See also OSHA’s website for guidance on the application<br />
of OSHA requirements to COVID-19.<br />
36. See 45 CFR 164.512(b)(1)(v). See also FAQ 301, https://<br />
www.hhs.gov/hipaa/for-professionals/faq/301/doesthe-hipaa-public-health-provision-permit-healthcare-providers-to-disclose-information-from-preemployment-physicals/index.html.<br />
37. See 45 CFR 164.512(b)(1)(v)(A).<br />
38. See OSHA, Protecting Workers: Guidance on Mitigating<br />
and Preventing the Spread of COVID-19 in the<br />
Workplace, at § 9 (June 10, 2021), available at https://<br />
www.osha.gov/coronavirus/safework (describing<br />
recording and reporting requirements related to<br />
COVID-19 infections and deaths and the current<br />
exception to requirements to record worker side effects<br />
from COVID-19 vaccination through May <strong>2022</strong>).<br />
39. See 45 CFR 164.512(b)(1)(v)(C).<br />
40. Covered entities must implement policies and procedures<br />
with respect to PHI that are designed to comply with the<br />
requirements of the Privacy Rule, which would include, if<br />
applicable to the covered entity, a policy and procedure<br />
to ensure that disclosures to an employer under 45 CFR<br />
164.512(b)(1)(v) meet the conditions specified in that<br />
paragraph. See 45 CFR 164.530(i)(1).<br />
41. See 45 CFR 164.512(b)(1)(v)(D).<br />
42. Subject to the permissions for disclosures required by law<br />
and those necessary to lessen or prevent a serious and<br />
imminent threat. See 45 CFR 164.512(a) and 164.512(j).
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 13<br />
Overcoming Nursing Barriers to Caring for Patients<br />
with Serious Mental Illness<br />
Mary Bondmass, Ph.D., RN, CNE<br />
Reprinted with permission from Nevada RNformation,<br />
September 2021 Issue<br />
This RNF feature presents abstracts of research and<br />
evidence-based practice (EBP) projects completed or<br />
spear-headed by nurses or student nurses in Nevada.<br />
The focus is on new evidence (i.e., research) or the<br />
translation of evidence (i.e., EBP) in Practice, Education,<br />
or Research. Submissions are welcome and will be<br />
reviewed by the RNF editorial board for publication;<br />
send your abstract submission in a similar format used<br />
below to mary.bondmass@unlv.edu<br />
Erin A. Pate, RN, MSN,<br />
CCRN, received a BSN at<br />
California State University,<br />
Stanislaus, an MSN in<br />
Leadership and Administration<br />
from Ball State University.<br />
She is expected to complete<br />
her DNP at the University of<br />
Nevada, Reno, in December of<br />
2021. Erin started her career<br />
as a critical care nurse in 2012.<br />
She is a veteran and continues<br />
to serve in the United States Air Force; her current<br />
position is Chief, Extended Care Mental Health Nursing<br />
Service at the VA Sierra Nevada Healthcare Systems, in<br />
Reno, NV. In addition to her distinguished career, Erin is<br />
a wife and a mom of two beautiful daughters.<br />
Erin’s DNP project is described in the abstract below.<br />
Erin A. Pate, RN, MSN, CCRN<br />
Background: Mental illness will likely impact most<br />
individuals, with 20% of all people experiencing<br />
some form of mental illness in their lifetime and 4%<br />
being diagnosed with serious mental illness (SMI).<br />
With the prevalence of mental illness, nurses need to<br />
feel comfortable and competent in providing care to<br />
this population. Unfortunately, research reflects that<br />
nursing attitudes are in line with societies, such that<br />
many nurses agree there should be social restrictions<br />
and distance requirements (i.e., marriage, work, living<br />
location, etc.) on individuals with mental illness.<br />
Many nurses carry bias into the patient-care<br />
provider relationship when a psychiatric diagnosis<br />
is involved. When a patient has a mental health<br />
diagnosis, their medical conditions are up to 20% less<br />
likely to be correctly identified by nursing staff. The<br />
bias affects the identification of needs and where and<br />
how this population should be cared for, with 67% of<br />
non-psychiatric nurses believing patients with mental<br />
illness should be separated from those without mental<br />
illness.<br />
Previous research has identified many barriers<br />
to non-bias care of patients with SMI by nonpsychiatric<br />
nurses. For example, nurses identified a<br />
lack of knowledge related to mental health as one<br />
of the most significant barriers to effectively caring<br />
for patients requiring intervention for behavioral<br />
concerns.<br />
Purpose/Methods: This project aimed to explore<br />
barriers that mental health and non-mental nurses<br />
identify in providing care for patients with SMI<br />
diagnosis in acute and subacute settings. To this<br />
end, the following questions were addressed in this<br />
project.<br />
1. What are the barriers for a nurse in providing<br />
care for patients with an SMI diagnosis in the<br />
acute and subacute setting?<br />
2. Do Psychiatric and Non-Psychiatric <strong>Nurse</strong>s<br />
experience different barriers to providing care<br />
for SMI patients?<br />
3. What interventions can be implemented to<br />
overcome the barriers to caring for a patient<br />
with an SMI diagnosis?<br />
4. How does an organization operationalize these<br />
interventions in a usable and cost-effective<br />
manner?<br />
A pre-post interventional design was utilized<br />
for this project. Three theoretical frameworks<br />
underpinned the project, including Leininger’s<br />
Cultural Care Theory, Spradley’s Change Model, and<br />
Benner’s Novice to Expert. The target population and<br />
setting respectively, included nurses with and without<br />
psychiatric training working in multiple practice areas<br />
at a major medical center. A previously validated<br />
instrument, the Behavioral Health Care Competency<br />
(BHCC), was used to collect data on the barriers to<br />
care. Based on an identified knowledge gap in the<br />
pre-interventional BHCC surveys, an intervention of an<br />
educational toolkit was developed and implemented.<br />
After that, a post-intervention BHCC survey was<br />
conducted and data were analyzed to assess for<br />
change.<br />
Results: Post-intervention, the respondents<br />
showed an increased perception of their ability to<br />
provide care for patients with SMI in all practice<br />
areas. Statistically significant increases (p = < 0.05)<br />
were seen in four questions on the BHCC, and<br />
improvement, although not statically significant, was<br />
demonstrated across all other competency categories<br />
on the BHCC. Not surprisingly, those who selfidentified<br />
specifically as mental healthcare unit (MHU)<br />
nurses scored higher on the BHCC pre-intervention<br />
survey.<br />
Conclusion: Based on the pre-post change<br />
demonstrated in this project, it was concluded that the<br />
developed tool kit improved this sample’s knowledge<br />
and perception in their abilities to assess patients for<br />
potential psychiatric problems, effectively manage<br />
conflicts triggered by patients who have a mental illness,<br />
effectively intervene with a hallucinating patient, and use<br />
de-escalation techniques and crisis communication to<br />
avert aggressive behaviors.<br />
The small sample size limited this project, and future<br />
work to validate similar findings is recommended to<br />
determine if results may be generalized to other staff<br />
and facilities.<br />
Abbreviated References:<br />
Bird, P. (2018). Generalist nurses caring for patients with<br />
mental illness in a non-psychiatric setting. [Doctoral<br />
Dissertation, The University of North Carolina at<br />
Chapel Hill]. https://doi.org/10.17615/5daq-dc80<br />
Burson, R., & Moran, K. (2020). Creating and developing<br />
the project plan. In K. Moran, R. Burson, & D. Conrad<br />
(Eds.), The doctor of nursing practice project: A<br />
framework of success (pp. 223-252). Burlington, MA:<br />
Jones & Bartlett Learning.<br />
Cecil-Riddle, K. (2014). <strong>Nurse</strong>s’ Knowledge and<br />
Perceptions of Rapid Response Teams in a<br />
Psychiatric Facility (Doctoral dissertation, Walden<br />
University). https://search-ebscohost-com.unr.<br />
idm.oclc.org/login.aspx?direct=true&db=ccm&AN<br />
=109774669&site=ehost-live&scope=site<br />
Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A.<br />
(2017). Empowering education: A new model for inservice<br />
training of nursing staff. Journal of Advances in<br />
Medical Education & Professionalism, 5(1), 26-32.<br />
de Jacq, K., Norful, A. A. & Larson, E. (2016). The<br />
variability of nursing attitudes toward mental<br />
illness: An integrative review. Archives of Psychiatric<br />
Nursing, 30(6), 788-796. https://doi.org/10.1016/j.<br />
apnu.2016.07.004<br />
Department of Veteran Affairs. (2019). VA research on<br />
mental health. Office of Research and Development.<br />
https://www.research.va.gov/topics/mental_health.cfm<br />
Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L.<br />
A., Milliken, C. S., & Wilk, J. E. (2014). PTSD treatment<br />
for soldiers after combat deployment: Low utilization of<br />
mental health care and reasons for dropout. Psychiatric<br />
Services, 65(8), 997-1004. https://doi.org/10.1176/appi.<br />
ps.201300307<br />
Horntvedt, M. E., Nordsteien, A., Fermann, T., & Severinsson,<br />
E. (2018). Strategies for teaching evidence-based<br />
practice in nursing education: A thematic literature<br />
review. BMC Medical Education, 18. https://doi.<br />
org/10.1186/s12909-018-1278-z<br />
King, B. M., Linette, D., Donohue-Smith, M., & Wolf, Z. R.<br />
(2019). Relationship between perceived nurse caring and<br />
patient satisfaction in patients in a psychiatric acute care<br />
setting. Journal of Psychological Nursing and Mental<br />
Health Services, 57(7), 29-38. https://doi-org.unr.idm.<br />
oclc.org/10.3928/02793695-20190225-01<br />
McDonald, D. D., Frakes, M., Apostolidis, B., Armstrong,<br />
B., Goldblatt, S., & Bernardo, D. (2003). Effect of a<br />
psychiatric diagnosis on nursing care for non-psychiatric<br />
problems. Research in Nursing & Health, 26, 225-232.<br />
doi: https://doi.org/10.1002/nur.10080<br />
National Alliance on Mental Illness. (2020). Understanding<br />
your diagnosis. National Alliance on Mental Illness.<br />
https://www.nami.org/Your-Journey/Individuals-with-<br />
Mental-Illness/Understanding-Your-Diagnosis<br />
National Association of State Mental Health Program<br />
Directors. (2017). Trend in psychiatric inpatient capacity,<br />
United States and each state, 1970-2014. National<br />
Association of State Mental Health Program Directors.<br />
https://www.nri-inc.org/media/1319/tac-paper-10-<br />
psychiatric-inpatient-capacity-final-09-05-2017.pdf<br />
Nursing Theory. (2011). From Novice to Expert. Current<br />
Nursing. http://currentnursing.com/nursing_theory/<br />
Patricia_Benner_From_Novice_to_Expert.html<br />
Nursing Theory. (2016). Cultural Care Theory. Nursing<br />
Theory. https://nursing-theory.org/theories-and-models/<br />
leininger-culture-care-theory.php<br />
Parant, R. L., Pingitore, F. R. B., & LaRose, J. A. (2014).<br />
An educational program to promote competency in<br />
pediatric psychiatric mental health nursing. The Journal<br />
of Continuing Education in Nursing, 45(7), 321-326.<br />
doi:10.3928/00220124-20140620-01<br />
Occupational Safety and Health Administration. (2018).<br />
Workplace violence in healthcare: Understanding the<br />
challenge. United States Department of Labor. https://<br />
www.osha.gov/Publications/OSHA3826.pdf<br />
Rutledge, D. N., Wickman, M., Drake, D., Winokur, E., &<br />
Loucks, J. (2012). Instrument validation: Hospital nurse<br />
perceptions of their behavioral health care competency.<br />
Journal of Advanced Nursing, 68(12), 2756-2765. doi:<br />
10.1111/j.1365-2648.2012.06025.x<br />
Rutledge, D. N., Wickman, M., Cacciata, M., Winokur, E.<br />
J., Loucks, J., & Drake, D. (2013). Hospital staff nurse<br />
perceptions of competency to care for patients with<br />
psychiatric or behavioral health concerns. Journal for<br />
<strong>Nurse</strong>s in Professional Development, 29(5), 255-262.<br />
doi: 10.1097/01.NND.0000433150.18384.1c<br />
Spradley, B. W. (1980). Managing change creatively. Journal<br />
of Nursing Administration, 10, 32-37. https://oce-ovidcom.unr.idm.oclc.org/searchResults?q=0002-0443.<br />
is%20and%20%2210%22.vo%20and%20%225%22.<br />
ip%20and%20%2232%22.pg&req=HTML<br />
Weare, R., Green, C., Olasoji, M., & Plummer, V. (2019). ICU<br />
nurses feel unprepared to care for patients with mental<br />
illness: A survey of nurses’ attitudes, knowledge, and<br />
skills. Intensive and Critical Care Nursing, 53, 37-42.<br />
https:// doi.org/10.1016/j.iccn.2019.03.001
14 • <strong>Colorado</strong> <strong>Nurse</strong> | <strong>February</strong> <strong>2022</strong><br />
Cynthia Saver, MS, RN<br />
The COVID-19 pandemic has added to the burden of<br />
nurses’ daily work in many areas, including forcing them<br />
into situations where they feel moral distress. Failure to<br />
manage this distress appropriately can affect nurses’<br />
wellbeing and cause them to leave the profession. But<br />
applying strategies to help prevent moral destress or<br />
resolving moral distress in a positive way can benefit both<br />
nurses and organizations by promoting optimal patient care<br />
and reducing staff turnover and the risk of litigation from<br />
clinical errors.<br />
Moral distress strategy:<br />
The 4 Rs<br />
Cynda Hylton Rushton and Kathleen Turner<br />
created a tool nurses can use to sort through<br />
situations that can cause moral distress—the 4Rs.<br />
• Recognize. The first step is to recognize<br />
the situation for what it is. To do so, be<br />
aware of the complexities related to the<br />
patient, the patient’s family, and the care<br />
team, including what each party wants to<br />
happen and emotions that may affect their<br />
perspectives.<br />
• Release. Consider what you can change<br />
and what you can’t. Let go of past<br />
experiences that aren’t helpful in the<br />
current situation.<br />
• Reconsider. You may need to reframe an<br />
issue or view it in a new way. Be open to<br />
fresh approaches and ensure everyone<br />
understands each other’s perspectives.<br />
• Restart. At this point, you may find you<br />
are asking new questions or have new<br />
ideas about how the situation can be<br />
moved forward in a positive way.<br />
Sources: Hilton L. 4Rs strategy offers a fresh perspective<br />
to confront ethical challenges. <strong>Nurse</strong>.com. 2020. www.<br />
nurse.com/blog/2020/09/15/4-rs-strategy-offers-a-freshperspective-to-confront-ethical-challenges;<br />
Rushton CH,<br />
Turner K. Suspending our agenda: considering what will<br />
serve when confronting ethical challenges. AACN Adv<br />
Crit Care. 2020;31(1):98-105.<br />
“<br />
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association<br />
Managing Moral Distress<br />
NURSING<br />
Peer Health Assistance Program<br />
RNs and LPNs<br />
Peer Assistance Services, Inc.<br />
Encourage nurses to SEEK HELP EARLY<br />
What is moral distress?<br />
According to the American Association of Critical-<br />
Care <strong>Nurse</strong>s (AACN) tool “Recognize & Address Moral<br />
Distress”, moral distress occurs when someone “knows<br />
the right thing to do, but constraints, conflicts, dilemmas,<br />
or uncertainty make it nearly impossible to pursue the right<br />
course of action.” Moral distress differs from burnout,<br />
which refers to physical, mental, and emotional exhaustion<br />
caused by workplace stress, and it differs from compassion<br />
fatigue, which is physical, mental, and emotional weariness<br />
related to caring for those in significant pain or emotional<br />
distress.<br />
Causes of moral distress<br />
Various situations, usually related to values conflicts,<br />
trigger moral distress. Examples of these situations include<br />
continuing what the nurse feels is unnecessary treatment<br />
for a patient or witnessing inadequate pain relief because a<br />
provider fails to order adequate medication.<br />
Many external factors can constrain or stop nurses from<br />
acting in the way they wish, thus contributing to moral<br />
distress. According to the AACN tool, unit-level factors<br />
include inadequate staffing, ineffective communication,<br />
working with incompetent colleague(s), bullying, and<br />
lack of a healthy work environment. Organization factors<br />
include inadequate staffing, lack of resources, pressures<br />
to decrease costs, hospital policies, hierarchy of power,<br />
ineffective communication, and financial limitations. If not<br />
addressed, these factors can lead to the disturbing effects<br />
of moral distress.<br />
Effects of moral distress<br />
Moral distress affects both individuals and<br />
organizations. In individuals, it can produce symptoms<br />
that are emotional (frustration, anger, anxiety, guilt,<br />
sadness powerlessness, withdrawal), physical (muscle<br />
aches, headaches, heart palpitations, neck pain, diarrhea,<br />
vomiting), and psychological (depression, emotional<br />
exhaustion, loss of self-worth, nightmares, reduced job<br />
satisfaction, depersonalization of patients) in nature.<br />
Repeated episodes of moral distress that aren’t resolved<br />
can accumulate as “moral residue,” with nurses ultimately<br />
experiencing burnout and leaving their jobs—or even their<br />
careers.<br />
Job attrition causes organizations to incur turnover<br />
costs. More importantly, unresolved moral distress can<br />
negatively impact the quality of patient care, potentially<br />
leading to adverse patient events. This not only affects an<br />
SAVE LIVES… both practitioners and patients<br />
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www.PeerAssistanceServices.org<br />
Moral resilience<br />
Developing resilience can help nurses cope with<br />
moral distress more effectively. Strategies include:<br />
• Developing self-awareness (for example,<br />
examine positive and negative assumptions<br />
that may be guiding your behavior to see if<br />
they are accurate).<br />
• Learning to self-regulate to disrupt negative<br />
patterns of thinking and behaving. Methods<br />
to help with this include mindfulness-based<br />
stress reduction, meditation, and movement<br />
practices such as yoga and tai chi.<br />
• Wisely discerning ethical challenges and<br />
principled actions. This requires you to<br />
understand your values and analyze ethical<br />
dilemmas.<br />
• Nurturing the willingness to take courageous<br />
action. Keep in mind that when speaking up,<br />
state your concerns clearly and calmly.<br />
• Discovering meaning amid adversity. It may<br />
help to keep a journal and to reaffirm your<br />
values.<br />
• Preserving one’s integrity, as well as the<br />
integrity of the team, and others. Remember<br />
that you can seek support from others, for<br />
instance, by talking with trusted colleagues<br />
or leaders.<br />
Source: Rushton CH. Moral resilience: a capacity for<br />
navigating moral distress in critical care. AACN Adv Crit<br />
Care 2016;27(1):111-119; Rushton CH. Building moral<br />
resilience to neutralize moral distress. Am <strong>Nurse</strong> Today.<br />
2016;11(10).<br />
organization’s reputation in the community, but it could<br />
result in greater liability exposure from errors.<br />
Taking action<br />
What should you do if you are experiencing moral<br />
distress?<br />
Identify the source. The source may be a patient<br />
care issue, a policy problem (such as how family member<br />
meetings related to end-of-life issues are held), a lack of<br />
collaboration among team members, or something else.<br />
Conduct a self-assessment. Self-assessment begins<br />
with determining the severity of the distress. The Moral<br />
Distress Thermometer, developed by Wocial and Weaver, is<br />
used for research, but also can be helpful for clinicians. The<br />
thermometer asks you to rate your distress on a scale from<br />
1 to 10 and includes descriptions (mild, uncomfortable,<br />
distressing, intense, and worst possible) to help with the<br />
process. The results will give you a sense of how urgently<br />
you need to act, and you can use the tool to track changes<br />
in your distress over time.<br />
The second component of self-assessment is<br />
determining your readiness to act. The “4A’s to Rise Above<br />
Moral Distress,” published by AACN, suggests asking<br />
yourself these questions:<br />
• How important is it to you to try to change the<br />
situation?<br />
• How important would it be to your colleagues/unit to<br />
have the situation changed?<br />
• How important would a change be to the patients/<br />
families on your unit?<br />
• How strongly do you feel about trying to change the<br />
situation?<br />
• How confident are you in your ability to make<br />
changes occur?<br />
• How determined are you to work toward making this<br />
change?<br />
The AACN publication contains a rating scale, but you<br />
also can simply reflect on whether you feel you are ready<br />
to act. Listing the risks and benefits of taking action may be<br />
helpful in making your decision.<br />
Keep in mind that in some cases the law will compel<br />
you to take action. For example, your state likely has laws<br />
requiring you to report child or elder abuse. Failure to do<br />
so leaves you open to legal liability. You’ll also need to<br />
consider if the standard of care is being violated. In these<br />
cases, failure to speak up can make you the target of a<br />
state licensing board complaint, or a target in any a lawsuit<br />
related to patient harm that occurs as a result.
The Official Publication of the <strong>Colorado</strong> <strong>Nurse</strong>s Foundation in partnership with the <strong>Colorado</strong> <strong>Nurse</strong>s Association <strong>February</strong> <strong>2022</strong> | <strong>Colorado</strong> <strong>Nurse</strong> • 15<br />
Develop a plan. Once you decide to take action, consider when you<br />
will act, who will be involved, and what resources are available to you. For<br />
example, you may want to gather facts and share your concerns with a trusted<br />
colleague to ensure you have a sound plan. Your plan should include self-care,<br />
as this will be a stressful time. Resources to help you in assessing the situation<br />
and developing a plan include the ANA Code of Ethics with Interpretive<br />
Statements, your state board of nursing (when a practice issue is involved), the<br />
ethics consulting service in your hospital, and your organization’s employee<br />
assistance program.<br />
Make the case. Share your concerns with the appropriate person(s). Present<br />
the facts in a calm, respectful way. Consider timing and location—unless the<br />
situation is urgent, you’ll want to bring up the issue privately. Following the chain<br />
of command is important, particularly if your concerns aren’t being acknowledged.<br />
For example, if a physician isn’t listening to your concerns about lack of sufficient<br />
pain medication, you’ll want to involve your immediate supervisor. If your supervisor<br />
does not take action, move up to the next level. In the case of non-clinical issues<br />
related to an individual team member, you may need to speak to a human resources<br />
representative.<br />
Document. Document your conversations, including whom you spoke with, the<br />
information conveyed, and the response. If related to a patient situation, record the<br />
information in the patient’s health record. If you are dealing with a problem with a<br />
team member or organizational policy, you should keep a personal record, so you<br />
can trace the steps you took.<br />
Prevention<br />
<strong>Nurse</strong>s, units, and organizations play a role in preventing moral distress and<br />
addressing it effectively should it occur. <strong>Nurse</strong>s can enhance their moral resilience<br />
(see Moral distress strategy: The 4 Rs) and participate in professional development<br />
activities such as continuing education programs on ethics.<br />
The AACN tool identifies strategies for units and organizations. Units can identify<br />
ethics champions for peer support, create a committee to address common areas<br />
that cause distress, and establish a mentoring program for new staff.<br />
Organizations can provide resources to support staff (for example, an ethics<br />
consulting service), provide education on topics such as debriefing, adopt zerotolerance<br />
policies for all forms of violence, and offer programs that improve staff<br />
well-being. Ultimately, the goal should be to create a healthy work environment.<br />
AACN has identified six standards for a healthy work environment: skilled<br />
communication, true collaboration, effective decision-making, meaningful recognition,<br />
appropriate staffing, and authentic leadership. A healthy work environment improves<br />
nurses’ psychological health, job satisfaction, and job retention; it also results in<br />
reduced patient errors and patient mortality.<br />
A partnership<br />
Ideally, nurses and leaders should work together to establish a health work<br />
environment that supports nurses in many ways, including providing adequate staffing<br />
and a mechanism for dealing with ethical dilemmas, so moral distress is reduced. <strong>Nurse</strong>s<br />
and leaders should also partner to ensure that those experiencing moral distress have the<br />
resources needed to address the situation.<br />
RESOURCES<br />
AACN. Recognize and address moral distress. 2020. www.aacn.org/clinical-resources/moraldistress.<br />
American Association of Critical-Care <strong>Nurse</strong>s Ethics Work Group. The 4 A’s to Rise Above Moral<br />
Distress. Aliso Viejo, CA: American Association of Critical-Care <strong>Nurse</strong>s; 2004.<br />
American <strong>Nurse</strong>s Association. Code of Ethics with Interpretive Statements. 2015. www.<br />
nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coeview-only.<br />
Hilton L. 4Rs strategy offers a fresh perspective to confront ethical challenges. <strong>Nurse</strong>.com. 2020.<br />
www.nurse.com/blog/2020/09/15/4-rs-strategy-offers-a-fresh-perspective-to-confrontethical-challenges.<br />
Rushton CH. Cultivating moral resilience. Am J Nurs. 2017;117(2 Suppl 1):S11-S15.<br />
Rushton CH. Moral resilience: a capacity for navigating moral distress in critical care. AACN Adv<br />
Crit Care. 2016;27(1):111-119.<br />
Rushton CH. Building moral resilience to neutralize moral distress. Am <strong>Nurse</strong> Today. 2016;11(10).<br />
Rushton CH, Turner K. Suspending our agenda: considering what will serve when confronting<br />
ethical challenges. AACN Adv Crit Care. 2020;31(1):98-105.<br />
Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical care nurse work<br />
environments 2018: findings and implications. Crit Care <strong>Nurse</strong>. 2019;39(2):67-84.<br />
University of Kentucky Moral Distress Project. 2020. http://moraldistressproject.med.uky.edu.<br />
Wocial LD, Weaver MT. Development and psychometric testing of a new tool for detecting moral<br />
distress: the Moral Distress Thermometer. J Adv Nurs. 2013;69(1):167-74.<br />
Cynthia Saver is president of CLS Development, Inc., in Columbia, Md.<br />
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