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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 />

high quality care for more than 94,000 patients<br />

Collaborates with a diverse, talented, compassionate team in a<br />

mission-driven environment where your career matters<br />

Enjoy amazing benefits, coupled with a great work<br />

life balance (no nights, no call)<br />

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 />

the COVID-19 challenge.<br />

Come join our amazing team!<br />

Great<br />

Benefits!<br />

We are certified as<br />

A Great Place To Work from Forbes.<br />

Please visit us and apply at<br />

junipercommunities.com/find-juniper-communities-jobs/<br />

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 />

right to that perfect NURSING JOB!<br />

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E-mailed Job Leads<br />

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 />

Help us to EDUCATE the profession<br />

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employer has been very supportive; I couldn’t have<br />

stayed clean and sober without the program.<br />

START BELIEVING.<br />

303.369.0039<br />

For confidential information: info@peerassist.org<br />

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 />

Disclaimer: The information offered within this article reflects general principles only and does not<br />

constitute legal advice by <strong>Nurse</strong>s Service Organization (NSO) or establish appropriate or acceptable<br />

standards of professional conduct. Readers should consult with an attorney if they have specific<br />

concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this<br />

information is applied in practice or for the accuracy of this information.<br />

This risk management information was provided by <strong>Nurse</strong>s Service Organization (NSO), the nation’s<br />

largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since<br />

1976. The individual professional liability insurance policy administered through NSO is underwritten<br />

by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without<br />

permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call<br />

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