Alabama Nurse- February 2022

alabamanurses.org
A publication of
The Alabama State
Nurses Association
February, March, April 2022 • Volume 49 • Issue 1
A quarterly publication distributed to more than 72,000 RNs and LPNs in Alabama
SAVE THE DATE
April 19, 2022
(Virtual)
A message from your
ASNA President
Dr. Lindsey Harris, DNP, FNP-BC
Elizabeth A. Morris Clinical
Education Sessions - FACES '22
September 19 – 21, 2022 –
Grand Hotel, Point Clear, AL
Inside
ED's Notes. .................................. 3
LPN Corner. .................................. 4
Membership Corner .......................... 4-5
Introducing Five Alabama Notable Nurses: ......... 6-9
Meet Your ASNA 2021-22 Board. .................. 9
Managing Moral Distress ..................... 11-13
What ASNA's Career Coach Can Do For You!......... 14
Why am I not getting job interviews?............... 14
Crowne Healthcare receives
Nurse Legion of Honor Medal.................. 15
Teresa Marcus, Recipient of the
ASNA Legion of Honor Award. ................. 15
Chronic Kidney Disease in the Elderly. ...........16-19
BROUGHT TO YOU BY:
current resident or
Non-Profit Org.
U.S. Postage Paid
Princeton, MN
Permit No. 14
Karass, a term coined by Kurt Vonnegut Jr. is
a network or group of people that are somehow
affiliated or linked. This term eloquently crafts
a sense of unity for the nursing community. As a
nurse, we all have taken the Nightingale Pledge
(1935) which brings us together towards one
mission, the devoted service for human welfare.
Nightingale Pledge (1935)
I solemnly pledge myself before God and in
the presence of this assembly to pass my life in
purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and
mischievous and will not take or knowingly
administer any harmful drug.
I will do all in my power to maintain and
elevate the standard of my profession and will hold
in confidence all personal matters committed to
my keeping and all family affairs coming to my
knowledge in the practice of my calling.
With loyalty will I aid the physician in his work,
and as a missioner of health, I will dedicate myself
to devoted service for human welfare.
Congratulations
ASNA on receiving the Citizen
of the Year Award from the
Alabama State Broadcasters
Association. SNA was selected
to receive the award on behalf
of ALL nurses in the state for
their extraordinary service
and sacrifices during the twoyear
pandemic.
My karass is each of you! Our Nightingale Pledge
(1935) unites nursing together creating one mission
devoting ourselves to service for human welfare and
elevating the standard of nursing. The Alabama State
Nurses Association, the VOICE of all Alabama nurses, is
a united body that creates the opportunity to truly uphold
this mission. We must join together creating safe practices,
better working environments, increased pay, access to
care, and grow our next generation of educators.
As we (ASNA) lobby for increased pay, improved
staffing, and adequate breaks, we must have one voice.
The voice of all 100,000+ nurses in the state of Alabama
must be united. In this new year, lets change the direction
of nursing! Let’s create a space where the voices of
Alabama’s nurses resound, where the patient remains at
the center of our care, and we grow stronger together. I
place a challenge before each member in 2022 to recruit
and retain two members. Together we must strengthen our
foundation. We are the largest profession in healthcare.
Together, with one voice, we can make a difference!
Visit https://www.youtube.com/
watch?v=MQAwrj7wNnA to view
the ABA Award Presentation.

Page 2 • Alabama Nurse February, March, April 2022
HOT JOBS!
The Alabama State Nurses Association is proud
to announce a fresh UNIQUE opportunity for job
seekers and employers. Our new Career Center, HOT
JOBS marries two services that have great benefits
for job seekers and employers. The HOT JOBS site,
alabamanurses.org/hotjobs, helps the prospective employee
(nurse) enhance their chances in the application / interview
process with FREE consultation from ASNA’s professional
career coach, Bridget Stevens. Bridget has over 25 years
Author Submission Guidelines
for Alabama Nurse
Manuscript Format – Submit in APA style as
double spaced word document using 12 –point font.
Include article’s title and author(s) name, credentials,
organization/employer, contact information and current
email address. Authors must address any potential
conflict of interest, whether financial or other, and
identify any applicable commercial affiliation.
Photographs – Photographs of high resolution (300
dpi preferred) may be submitted digitally as a separate
file in .jpg or .tiff format. Photos taken for ASNA
related purposes may be used in ASNA publications/
social media unless other requested by the subject.
Supply a caption or photo credit for each photo. All
material submitted become the property of ASNA.
Advertising – Product, program, promotional, or service
announcements are considered advertisement, please contact
our publisher, Arthur L. Davis Publishing Agency, Inc. at
sales@ALDpub.com or phone 800-626-4081.
UPDATE MY
INFORMATION:
https://form.jotform.com/50155902976965
experience as a recruiter in the medical field and is widely
respected by major employers in the state. You can ask for
her help at the email provided below.
Employers will love using HOT JOBS to prioritize
high demand positions in their posts. Bridget can help
employers get set up on HOT JOBS and refer qualified
candidates with no recruiting fee! If you are a job seeker
or HR staff, give Bridget a call or email and find out how
ASNA’s HOT JOBS can help you.
ASNA would like to extend our sympathy to
The family of Katie Drake-Speer, longtime ASNA
District 5 member and ASNA’s former Continuing
Education Coordinator, January 2, 2022.
Dr. Lindsey Harris, ASNA President on the loss
of her grandmother, Eula Mae Harris of Rossville,
Georgia on January 5, 2022.
Dr. Erica Elkins-Little, ASNA District 4 on the loss of
her aunt, Vera Theresa Barlow, December 22, 2021.
Dr. Frankie Wallis, ASNA Treasurer on the loss of
his daughter-in-law’s mother.
Dr. D’Ann Somerall, ASNA District 3 on the loss
of her mother, Frances Merriam Lowe of Fayette,
Alabama on December 22, 2021.
Jeanette Atkinson, ASNA District 1 on the loss
of her mother, Bridget Dubroca of Somerville,
Alabama on December 6, 2021
Dr. Laura Hart, ASNA District 3 Member on the
passing of her husband John.
ASNA Board of Directors
President Lindsey Harris, DNP, FNP-BC
President-elect James Hardin, MSc, BSN, RN, NE-BC
Vice President Jennifer Humphries, DNP, CRNP, NNP-BC
Secretary Lisa Gurley, PhD, RN, CNE, COAT
Treasurer Frankie Wallis, DNP, FNP, NEA-BC, COI
District 1 Kindra Swauger, BSN, RN, CRC
District 2 Abby Horton, EdD, RN, CHC, CLC
District 3 Adrienne Curry, DNP, RN
District 4 Brenda Woodmansee, DNP, RN
District 5 Katilya Ware, PhD, RN
Commission on Professional Issues: Jo Ann Otts, DNP,
RN, NEA-BC
Parlimentarian: Philip Cohn, RN
Recent Grad Liaison: Kristina Gentle,
BSN, RN
ASNA Staff
Interim Executive Director, D'Ann Somerall, DNP,
MA Ed, CRNP, FNP-BC, FAANP
Director Leadership Services,
Charlene Roberson, MEd, NPD-BC, RN-BC
ASNA Attorney, VACANT
Programs & Structural Unit Coordinator,
April Bishop, MPA, BS, ASIT
Continuing Education Coordinator,
Amy Morris, MSN, RN
Our Mission
ASNA is committed to promoting excellence in nursing.
Our Vision
ASNA is the professional voice of all
registered nurses in Alabama.
Our Values
• Modeling professional nursing practices to other
nurses
• Adhering to the Code of Ethics for Nurses
• Becoming more recognizably influential as an
association
• Unifying nurses
• Advocating for nurses
• Promoting cultural diversity
• Promoting health parity
• Advancing professional competence
• Promoting the ethical care and the human dignity of
every person
• Maintaining integrity in all nursing careers
Advertising
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls,
Iowa 50613, (800) 626-4081, sales@aldpub.com. ASNA and
the Arthur L. Davis Publishing Agency, Inc. reserve the
right to reject any advertisement. Responsibility for errors in
advertising is limited to corrections in the next issue or refund
of price of advertisement.
Acceptance of advertising does not imply endorsement
or approval by the Alabama State Nurses Association
of products advertised, the advertisers, or the claims
made. Rejection of an advertisement does not imply a
product offered for advertising is without merit, or that
the manufacturer lacks integrity, or that this association
disapproves of the product or its use. ASNA and the Arthur
L. Davis Publishing Agency, Inc. shall not be held liable
for any consequences resulting from purchase or use of an
advertiser’s product. Articles appearing in this publication
express the opinions of the authors; they do not necessarily
reflect views of the staff, board, or membership of ASNA or
those of the national or local associations.
The Alabama Nurse is published quarterly every February,
May, August and November for the Alabama State Nurses
Association, 360 North Hull Street, Montgomery, AL 36104
© Copyright by the Alabama State Nurses Association.
Alabama State Nurses Association is a constituent
member of the American Nurses Association.

February, March, April 2022 Alabama Nurse • Page 3
ED’s Notes
Florence Nightingale, one of
the first advocates for nurses,
insisted on the importance of
building trusting relationships
with patients. Nightingale
believed that nurses’ presence
with a patient was a keystone
for providing professional
communication between the
nurse and patient. As the
interim Executive Director
for the Alabama State Nurses
Association (ASNA), I promise that my primary
goal in the next few months is to live Nightingale’s
pledge. Rather than building trusting relationships
with patients, however, I pledge that the ASNA will
work to build a trusting relationship with the nurses
of Alabama. I firmly believe that ASNA’s presence
with YOU, the nurses of Alabama, is a keystone for
creating, maintaining, and expanding professional
communication that is essential to our role as the state
association that represents Alabama’s nurses.
The current by-laws state that the Board of
Directors (BOD) shall delegate to the executive
director, as the chief executive officer, the authority
to manage the association according to policies
established by the ASNA House of Delegates and the
Board of Directors (BOD). The executive director
shall be accountable to the BOD. The ASNA is
a member driven, member led organization. The
Executive Director supports the roles and mission
of the organization and its members. As directed by
the BOD, I am reviewing the financial health of the
organization so that ASNA can move into an improved
position to provide the best resources for our members.
The ASNA Executive Director also serves as the
bridge with the Alabama Legislature to advocate for
registered nurses throughout out state. Most recently,
the ASNA BOD wrote a letter of support for HB 268
clarifying the working relationship that certified
registered nurse practitioners (CRNPs) and physicians
have in providing care. CRNAs are highly qualified
professionals who have, for years, practiced to provide
essential services for the patients of Alabama. The
COVID-19 pandemic highlighted the importance for
the need of word smithing to recognize that there was
a need to change “direction” to “coordination” of care.
CRNAs rose to the occasion to aid a struggling health
care team by assisting patients who were in need of
ventilator support, running codes, or whatever was
needed by this highly trained group of professionals.
This one word change appears minor, but it will aid
tremendously in the everchanging world of healthcare.
As the ASNA ED there is a need to provide
presentations for graduating students. It is important
for nursing graduates to understand the roles of the
ASNA and the Alabama Board of Nursing (ABON).
The primary role of the ABON is to advocate for
patient safety which PROTECTS THE PUBLIC. As a
regulatory body, the ABON cannot and does not lobby
for nursing. The ASNA is YOUR organization that
ADVOCATES FOR ALL NURSES in Alabama. We
are fortunate that our ABON is supportive of measures
that promote practice safety for nurses, but the ASNA
is YOUR advocate who lobbies for ALL NURSES and
for practice improvement to move nursing ahead.
The ASNA is fortunate to have a strong, forwardthinking
board of directors who are working to
support ALL Alabama nurses. I am excited to work
with the board and district presidents to move nursing
forward in Alabama. Please encourage your fellow
nurses to join the ASAN. Our voice needs to be clear.
Our strength is in our number.
D’Ann Somerall, DNP, MAEd, CRNP, FNP-BC,
FAANP
Interim Executive Director
Alabama State Nurses Association
ADVANCED FORENSIC NURSING CARE EDUCATION FOR
SEXUAL ASSAULT NURSE EXAMINER (ANE/SANE)
ANE/SANE EDUCATION
The purpose of the ANE/SANE funding is to increase the number of
Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs)
and Forensic Nurses trained and certified as sexual assault nurse examiners
(SANEs) in communities on a local, state or regional level.
USA offers two online didactic
pathways to SANE education:
1. Community and
2. Academic (sub-specialty) Advanced Forensic Nursing.
Simulated patient clinical skills training, certification preparation,
continuing education and networking opportunities are available.
Contact us: www.southalabama.edu/con/SANE or (251) 517-5171
anesanegrant@southalabama.edu.
“This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services
(HHS) as part of an award totaling approximately $1.1 million with zero percentage financed with nongovernmental sources. The contents are those
of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.”

Page 4 • Alabama Nurse February, March, April 2022
LPN Corner
How To Make
A New Start
Gregory Howard
LPN
Acknowledge the genius
within you. It is said we are all
born geniuses. Some people
develop their gift, others
sadly use it / file it away until
circumstances activate it again.
First you must know what
you want and know what you
can do best. Second, find
yourself. Do not hide behind inferiority, resentment
or self doubt. Third, get motivated. Have a sense of
purpose. Do your best, by creating a positive image.
Seek opportunities with an open mind and develop
your personality. A magnetic personality exudes
vitality, enthusiasm and vision. Forget the past,
forgive yourself and others, live for today.
Most of all, do not limit yourself, get outside
yourself and believe in miracles.
DECEMBER 16, 2021 NEWS RELEASE
Membership Corner
ALABAMA NURSE/HEALTH CARE
EXECUTIVE RECEIVED UNIVERSITY’S
ALUMNI HIGHEST AWARD
The American Nurses Association promoted 2020 and 2021 as The Year of the Nurse. It is fitting that a nurse, Mrs. Lula
Whigham-Marable, RN, MA, Chief Nurse Executive and Health Care Executive was selected for the 2021 Alumni Merit
Award by her alma mater, Tuskegee University in October 2021. Mrs. Lula Whigham-Marable was presented the 2021
Alumni Merit Award by Tuskegee University during the homecoming weekend convocation on October 24, 2021. Due to the
ongoing corona virus pandemic, the Coordinator of Alumni Affairs and Reunion Activities, Mrs. Kimberly Holland, and the
president of Tuskegee University, Dr. Charlotte P. Morris, presented the award virtually.
The Alumni Merit Award is the highest award presented to an alumnus by Tuskegee University. Mrs. Holland stated:
“I have the distinct pleasure of announcing the 2021 Alumni Merit Award recipient, Mrs. Lula Whigham-Marable. Mrs.
Whigham-Marable received her B.S. Degree in Nursing from Tuskegee Institute (now Tuskegee University) in 1960,
and her Master of Arts Degree from New York University in Psychiatric-mental Nursing and Curriculum Development
in 1971. Mrs. Whigham-Marable has achieved a commendable level of excellence as a health care executive. She has
worked tirelessly in the Tuskegee University Alumni Association for many years, and has established an endowed nursing
scholarship in her name for the school of nursing. She often mentors nursing students. She is a member of the Tuskegee
University Founder’s Circle of the (Presidential) Eminent Associates, the highest giving category, and the 1881
Society for those who have given $100,000.00 or more to alma mater.”
In making the presentation to Mrs. Whigham-Marable,” Mrs. Holland stated, “the award is given in recognition of your
service as a distinguished alumnus, dedicated nurse, and loyal supporter. Your professional devotion in the field
of nursing and academia, and your many years of altruism and community service, truly epitomizes the spirit of
tuskegee and the art of giving.”
Mrs. Whigham-Marable has received many awards. Her stellar career in healthcare, community service and support to alma
mater, have been recognized at the local, state and national levels.
Mrs. Whigham-Marable served as a faculty and faculty advisor at four different universities in Alabama and Ohio. She
held leadership positions at four different Department of Veterans Affairs (V.A.) Medical Centers, in New York, Ohio
and Alabama. Her positions ranged from Staff Nurse to the executive level of Associate Director of Primary Care
and Tertiary Care. She received V.A. Medical Center Director’s highest award, the Director’s Commendation from four
different V.A. officials for her leadership role in improving healthcare for veterans, team building, and staff development. She
received the V.A. Healthcare System of Ohio, Network Director’s Commendation for her “diligence, initiative, and
creativity in implementing the advanced clinic access initiative to reduce waiting times for veterans to get healthcare
appointments.”
Mrs. Whigham-Marable retains active membership in the Alabama State Nurses Association (ASNA), the American Nurses
Association, the Tuskegee University National Alumni Association, and the Tuskegee University National Nursing Alumni
Association. She was the first nurse elected to a national office of the American Nurses Association (ANA), the ANA
Cabinet on Human Rights in 1984. She served as Vice President and helped to write healthcare policy. She received
the ASNA highest award, the Lillian B. Smith Award for her leadership role in promoting human rights and cultural diversity
in the nursing organizations and educational institutions. She served on the Licensure Advisory Board of the Alabama State
Board of Health from 1983 to 1989.
Mrs. Whigham-Marable is a charter member inductee of the Tuskegee University School of Nursing Hall of Fame
- (2014). Her endowed School of Nursing scholarship, set up in 2004 has provided financial assistance to more than
30 junior and senior nursing students. One student wrote, “You have lightened my financial burden, which allows me
to focus more on the important aspect of school: learning. Your generosity has inspired me to help others and give back to
the community.” (May 2019). Another student wrote, “It is a great honor to be the recipient of the Lula Whigham-Marable
Scholarship. I plan to uphold the standard of previous recipients of this scholarship. Thank you for helping me further my
education by helping my financial needs.” (May 2019).
In accepting the Tuskegee University Alumni Merit Award, Mrs. Whigham-Marable said, “I am deeply humbled and very
appreciative to receive this award. I hope that others will be inspired to give to Tuskegee University, my alma mater.”
Mrs. Whigham-Marable is a native of Eufaula Alabama. She and her late husband Clarence Marable lived in Auburn
Alabama for many years. She attended post graduate school at Auburn University. When time permits, she enjoys
entertaining family and friends, reading, writing, attending sporting events, dining out, and composing poetry and prose for
close family and friends. She is a member of Greater Peace Missionary Baptist Church in Opelika Alabama.
Submitted from the office of Lula Whigham-Marable for
Lula Whigham-Marable
NursingALD.com
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February, March, April 2022 Alabama Nurse • Page 5
Membership Corner
We Couldn’t Do It
Without You!
Renewing and Rejoining ASNA members
(October – December, 2021)
DISTRICT 1
Kelly Berrong
Linore Bouska
Terri Charland
Susan Copeland
Kim Driggers
Jeremy Gaertner
Kim James
Rosita Karigan
Ann Lane
Sarah Logan
Kathleen McCoy
Tracy Norton
Shea Polancich
Lorri Pugh
Cynthia Raines
Pamela Smith
Rachel Speakman
Kindra Swauger
DISTRICT 2
Kimberly Armstrong
Ramona Bonner
Norma Cuellar
Carl Henderson Jr.
Jill Hobbs
Latonia Mitchell
Virginia Nash
Teresa Potter
Suzanne Prevost
Sharon Titus
Paula Worthington
DISTRICT 3
Whitney Bailey
Rebecca Bertalan
Jeannie Brown
Heather Cowart
Mary Crow
Rachel Davidson
Martha Dawson
Laura Earley
Martha Eason
Julie Facklam
Karen Handley
Lattie Hardy
Arlene Hayne
Maria Huffman
Carthenia Jefferson
Marilyn Johnson
Bette Jolly
Adam Kinsaul
Wendy Landier
Lori Loan
Susan McMullan
Jacqueline Moss
Patricia Patrician
Lionel Player Jr.
Heather Rankin
Deon Scott
Cynthia Selleck
Victoria Smith
Yvette Spencer
Heather Wallace
Judy Washington
Connie White Williams
Kelly Williamson
DISTRICT 4
Kim Cooper
Heather Hall
Stephanie Hedden
Bobbie Holt-Ragler
Barbara Johnson
Kristen Rush
Demetra Sexton
Ruth Wagner
Brenda Woodmansee
DISTRICT 5
Barbara Britton
LaKessia Dixon Herbert
Robin Gosdin Farrell
Kelly Heath
Lauretta Huff
Hayley Kennedy
Elizabeth Morris
Sarah Pounds
Wendy Reeves
Janice Seip
Angela Smith
Shellye Vardaman
Barbara Wilder
Darlene Wilson
DISTRICT 1
Nancy Barnette
Stephanie Beaver
Shala Coots
Wale Dorsey
Harriet Edmondson
Elli Ehrhard
Lydia Fassett
Heather Fritts
Kirsten Gage
Jacob Gwaltney
Stacy Jensen
Julie Johnson
Cassandra Lynum
Kristen Manthey
Phyllis McLean
Bianca Norris
Kay Ousby
Kathy Roe
Heather Statum
Stephanie Tate
Melisa Taylor
Chasen Uptain
Elizabeth Wasylow
Connie White
Evangeline Young
Welcome New ASNA Members
(October 16, 2021 – January 15 2022)
DISTRICT 2
Shenevalyn Cousette
Kimberly Muller
Andrea Patterson
Herlecia Rhodes
Dr. Anthony Roberson
Ellen Singleton
DISTRICT 3
Parker Anderson
Ashley Aranmolate
Michael Bailey
Sheila Barnes
Toni Beam
Betty Beneke
Elizabeth Coleman
Ramona Collins
Lauren Coursey
Cameron Davis
Marta Dolzyk
Crystal Gilliland
Shannon Hall
Chiquita Harris
Natosha Harris
Darlene Huffman
Jenna Hull
Pamela Jackson
Melanie Jenkins
Alexis Long
Alexis Mahaffey
Sonjala Miller
Nicholas Owens
Shewana Pickett
Charlotte Pitts
Parker Pitts
Deborah Pullen
Erika Redmond
Nancy Rudner
Amanda Sandlin
Octavia Scott
Amber Starr
Michele Talley
Sarah Veal
Angela Walker
Candy Washington
Bailee Woodis
DISTRICT 4
Tara Childers
Julie Colvin
Sharon Curtis
Michael Falco
Heather Harvey
Rachel Hughes
Rebekah Jones
Bertha Kennedy
Ashley Kern
Benita Law Love
Tessa Lowery
Robert Reed
Victoria Reno
Brian Sheldt
Sherri Wall
DISTRICT 5
Yolanda Beverly
Ashley Brooks
Janice Durr
Sheilah Futral
Jessica James
Amanda Manker
Lois Meadows
Ashlee Palmer
Sheila Sharp
Josephine Tion
Susan Tompkins
Joy Whatley
William Wood
Katrina Wright
ASNA/ANA membership only $15 a month!
Join your colleagues at alabamanurses.org!
District 77
Find Your Voice
Improve Your Speaking
& Communication
Skills
Contact Kevin • 228-223-3203
d77kevinpoe@protonmail.com

Page 6 • Alabama Nurse February, March, April 2022
Introducing Five Alabama Notable Nurses:
Favorite People, Favorite Place
Summer Camp Nurses
Camp Chateaugay, located in the Adironack
Mountains of northern New York, seeks resident
Nurses for summer of 2022.
Private Co-ed camp provides room, board, and good
salary. Must be an RN with school, ER, pediatric,
or family medicine experience.
Contact: Hal Lyons at 800-431-1184 or Hal@chateaugay.com
www.chateaugay.com 800-431-1184
Join us for a summer of memories that will last a lifetime!
Ida V. Moffett, RN, Jefferson County
Ida V. Moffett was one of the most beloved and
influential Alabamians in health care. As a nurse for 65
years, she was a gifted healer whose touch could change
a patient’s health. She spent most of that time at the
executive level of the Baptist Hospital system based in
Birmingham. There she held three key positions in nursing
for 29 years. She was director of nursing at the two units of
the Birmingham Baptist Medical Centers, and she directed
the largest school of nursing in Alabama. A nursing
leader in the state and the nation, she was admired for
her high ideals and deep values about patient care. Under
her leadership, in 1946 she attended the first nationwide
conference of nursing organizations, convened in Atlantic
City, New Jersey, where she became committed to the
concept that nurses should be educated in a university
setting. That same year, Gov. Chauncey Sparks appointed
Moffett to the Alabama State Board of Nurses' Examiners
and Registration, and she was elected chair at her first
meeting. Moffett next helped gain state accreditation for
Alabama's first four-year collegiate nursing program,
which was located at Tuskegee University, and worked
to foster equal treatment in the profession for African
American nurses. Throughout her 65 years as a nurse,
she constantly communicated her concern for patients,
students, those in the health care professions, and finally
for the institutions she helped build.
In 1955, the Ida V. Moffett School of Nursing was the
first program in the state of Alabama to be accredited
by the National League for Nursing. She also initiated
a plan in cooperation with Dean Hixson to provide
opportunities for diploma-prepared RNs to complete
their baccalaureate degrees in nursing. Well-respected
by her nursing colleagues, she was active in the Alabama
State Nurses’ Association where she held top offices and
contributed articles to its publications. An inspiration
for her students, her nursing staff, and all nurses, she
committed her life to providing quality patient care and
creating quality standardized nursing education. http://
encyclopediaofalabama.org/article/h-1193 https://nursing.
ua.edu/?page_id=3543
Dr. Lillian Holland Harvey, RN,
Macon County
In 1948 Lillian Holland Harvey received her master’s
degree from Teachers College at Columbia University
and initiated the first baccalaureate degree in nursing
program in the state of Alabama at Tuskegee Institute.
This program brought national attention to the School
of Nursing. The School of Nursing flourished under the
leadership of Dean Lillian Harvey. Nursing students not
only received education and practical nursing experience
at the Andrew Memorial Hospital and the Veterans
Notable Nurses continued on page 7

February, March, April 2022 Alabama Nurse • Page 7
Administration Hospital in Tuskegee, but they were
also assigned to other major medical facilities from
Massachusetts to Florida. Her graduates would forever
credit Dr. Harvey with having a powerful influence on
their lives through encouraging them to advance their
education, be involved in their communities, and balance
work with family. In 1957, the Nursing School received
full accreditation for its baccalaureate degree program
from the National League for Nursing. A believer in
education, Dean Harvey completed her own Doctor of
Education degree from Teachers College at Columbia
University in 1966. She then completed a construction
grant application to the U.S. Department of Health,
Education, and Welfare that resulted in a new building
for the School of Nursing. In 1978, she was the first
person named Dean Emeritus by Tuskegee University.
At the national level, she served on the President’s
Commission on the Status of Women, the American Red
Cross Advisory Committee on Nursing Service, and the
Nursing Advisory Committee of the Kellogg Foundation.
She was a member of the Expert Advisory Committee
for Professional Traineeships of the U.S. Public Health
Service. She served on the Board of Directors of the
National League for Nursing and the American Journal
of Nursing. In almost three decades as a nursing dean,
Dr. Harvey made enduring and exceptional contributions
to nursing education and healthcare. she ushered in an
unimaginable event by initiating the first baccalaureate
nursing program in the state of Alabama. Dr. Harvey
stands as heroine of equal rights for minorities by defying
the times of unprecedented injustice during the 1940s,
1950s and 1960s and beyond for people of color in the
State of Alabama. Dr. Harvey led her own Underground
Railroad for unrestricted professional recognition for
African American nurses across the state of Alabama and
the Nation. She singlehandedly worked to desegregate
the Alabama State Nurses Association. Dr. Harvey
used her expertise and talents working through many
professional organizations. She was awarded the Mary
Mahoney Award by the American Nurses Association
for going above and beyond when it comes to integration
and equal opportunities for minorities in nursing. In
1992, the Tuskegee University Board of Trustees, by
recommendation of the President, renamed the Nurses'
Home the Lillian H. Harvey Hall. In 1969, Dr. Harvey
was inducted into the Alabama Healthcare Hall of fame
for rendering exemplary service in the State of Alabama.
In 2001, she was a member of the inaugural class inducted
into the Alabama Nursing Hall of Fame. Dr. Harvey's
distinguished contributions to teaching, scholarly, activity,
and service supports this timely and fitting induction into
the Tuskegee University Nursing Hall of Fame. https://
nursing.ua.edu/?page_id=3535
Dr. Florence A. Hixson, RN,
Tuscaloosa & Jefferson County
Dr. Florence A. Hixson had established an excellent
reputation as a teacher and administrator in nursing
schools in New York, Pennsylvania, and Michigan when
she came to The University of Alabama as its first nursing
dean in 1950. Known for having high expectations for her
students, she expected high achievement, high morals,
and ethical behavior. In addition to being dean at the
University of Alabama School of Nursing, she was the
school’s only faculty member for its first year and a half
of operation. In spite of having no faculty, by the time the
new School of Nursing opened in fall of 1950, it had not
only an undergraduate program, but a second program
for RNs to earn their baccalaureate degrees. At the
request of the diploma school directors, she also helped
set up a centralized program for teaching biological and
social sciences to diploma school students through the
University’s extension centers. In 1955, she established
the school’s master of science in nursing program in
administration of nursing education. Despite continuous
faculty shortages, she established a major in teaching of
maternal and child health nursing and sweeping statewide
programs for both tuberculosis nursing education and
psychiatric nursing education that served not only School
of Nursing students, but also diploma school students from
around the state. In 1967, she shepherded the School of
Nursing through its move to Birmingham. After leading
the University of Alabama School of Nursing through
its first 20 years, Dr. Florence A. Hixson retired June
30, 1970. Dr. Linda Olivet, former student and faculty
member, remembers, “As students we just revered her.
Here was this diminutive, quiet person for whom we had
a huge amount of respect. She had come and established
that program almost single-handedly, and we knew that.”
https://nursing.ua.edu/?page_id=3539
Historical Note: Florence Alberta Hixson was born in
Bingen, Pennsylvania, on October 18, 1899, the youngest
of eleven children. Hixson enrolled at the Hospital
School of Nursing at the University of Pennsylvania
in Philadelphia and received her diploma in 1924. She
received a bachelor's degree in nursing education from
Columbia in 1931 and a master's degree in education
from the University of Pennsylvania in 1939. In the 1940s
she began work in a doctoral program in education at
Columbia University, she would be awarded the degree
in 1952. From 1924 until 1949, while continuing her
education, Hixson taught in several hospital nursing
schools in New York, Michigan and Pennsylvania. In 1949
the Alabama State legislature authorized the creation of a
four-year baccalaureate nursing program at the Tuscaloosa
campus of The University of Alabama. Hixson was hired
as the school's first dean and moved to the campus in
1950. That fall, the school opened with 17 students and
one faculty member, Dean Hixson. Throughout the 1950s
and early 1960s, the nursing program continued to grow
and prosper on the Tuscaloosa campus. In 1966, however,
University President Frank Rose appointed a committee
which he charged with making recommendations for the
future of the school. The committee recommended that
the School be moved from Tuscaloosa to the University's
Medical Center in Birmingham where faculty and staff
Notable Nurses continued on page 8

Page 8 • Alabama Nurse February, March, April 2022
Notable Nurses continued from page 7
had been present since 1953. President Rose accepted the
recommendation and the School was moved during August
of 1967. Hixson remained at the new location for the next
three years, and again worked to "refound" the School of
Nursing at the newly autonomous University of Alabama
in Birmingham (UAB). After serving as dean for twenty
years, Dr. Florence A. Hixson retired effective June 30,
1970, and was named Professor Emerita by the Board of
Trustees. In honor of her contributions to nursing and to
UAB, the nursing student residence on the UAB campus
was rededicated Florence A. Hixson Hall in 1985. Dr.
Hixson returned from her home in Pennsylvania for the
rededication of the building. Florence Alberta Hixson,
founding dean of The University of Alabama School of
Nursing, died in Pennsylvania in 1989.
Picture of Dr. Hixon courtesy of the UAB archives,
https://library.uab.edu/locations/archives/collections/
manuscripts/numerical/collection-mc49
Dr. Roberta O. Watts, RN, Etowah County
The first African American to serve as nursing dean
at a major public university in the State of Alabama, Dr.
Watts served as Dean of Jacksonville State University’s
Lurleen B. Wallace College of Nursing for over 20
years. Nationally known for her work in the evaluation
and advancement of nursing education programs, Dr.
Watts served two terms on the Board of Review of the
National League for Nursing. Gubernatorial appointments
have included Chair, Alabama Foster Care Advisory
Committee; Vice Chair, Alabama State Board of Human
Resources; and most recently, Commissioner, Alabama
Commission on Higher Education. Dr. Watts had a vision
resulting in implementation of the first nursing clinic in
an Alabama collegiate school of nursing and established
community health centers focused on eliminating health
disparities in North Alabama. The Roberta O. Watts
Medical Center in Gadsden, Alabama was named in her
honor in recognition of her commitment to improving
the quality of life for the residents of her community.
Her service on the Gadsden City Board of Education
stimulated support for improving inner city schools.
During her tenure as President of the Alabama League
for Nursing, Dr. Watts established the Lamp Lighter
Award to recognize significant professional contributions
by Alabama nurses. Dr. Watts continues to serve her
community through her business, Enrestoration, Inc., a
community based program offering support to individuals
with intellectual disabilities, as President and CEO of the
Bethesda Life Center, and as Chancellor and Founder of
the Excel Institute for pre-kindergarten through twelfth
grade. Dr. Roberta Watts continues her journey, believing
there is more that can be done and she is called to do it.
https://nursing.ua.edu/?page_id=3464
In 2021, Quality of Life Health Services, Inc. began
its forty-fourth year of People caring about People. What
began as the dream of one individual, Dr. Roberta O.
Watts, has grown into a 24-center comprehensive primary
health care network, something that has exceeded the
expectations of the founding Board of Directors. Since
its inception, Quality of Life has grown to serve more
than a hundred thousand people in both rural and urban
communities throughout Northeast Alabama. Roberta
Watts founded Etowah Quality of Life Council in 1977
as a Community Health Center designed to address the
medical and health needs of medically underserved
patients in Gadsden. In early 1981 the Gadsden
Neighborhood Health Center's name was changed to the
Roberta O. Watts Neighborhood Health Clinic as a way
of recognizing the efforts of the founding Board Member.
Roberta Watts is the essence of a legend; she has worked
relentlessly promoting the welfare of Gadsden's residents.
Her promotion of excellence in education and health care
for all has definitely made her a "legend in our time."
Accomplishments: *Dean Emeritus The first black
named Professor/Dean Emeritus at a historically white
college/university (HWCU) *The first black to serve as
Dean of Nursing at a HWCU *The first black to serve
in an acting capacity as Vice-President of Academic
Affairs at Jacksonville State University *The first black
female to serve on Gadsden City Board of Education *The
first black to serve as Vice-Chair of the Department of
Human Resources Board (Governor is Chair) *The first
black female to serve as Chair of the Academic Affairs
Committee of the Alabama Commission of Higher
Education Dr. Roberta Watts discovered her passion for
helping others early in life when at age five she helped her
mother with a dental emergency. Her belief that service to
others was her divine destiny stayed with her through her
time as a staff nurse, educator, leader, public servant, and
entrepreneur.
Elizabeth “Liz” Morris Barker, RN,
Montgomery County
Elizabeth “Liz” Morris Barker is a nursing legend
in Alabama. After earning her Bachelor of Science in
Nursing at The Ohio State University, she moved to
Alabama and worked at Jackson Hospital as a private
duty nurse. She also served on the faculty of St.
Margaret’s Hospital School of Nursing in Montgomery.
In 1973, Liz was named the Executive Director of
the Alabama State Nurses Association. During her
tenure she earned a Master’s Degree in Education from
Troy State University. Leading the Alabama State
Nurses Association for 25 years, Liz was an incredibly
influential and effective voice for nursing in state

February, March, April 2022 Alabama Nurse • Page 9
government. Always the quiet voice of reason and
sensibility, she received extraordinary results working
with various regulatory agencies such as The Alabama
Board of Nursing and the Alabama Department of
Public Health. Examples of Liz’s ability and success
abound. In 1978 she was instrumental in the passage
of a bill establishing graduate scholarships for nurses,
greatly expanding educational possibilities for nurses
around the state. In the 1980s, Liz successfully
championed the establishment of a law allowing
Certified Nurse Midwives to practice in Alabama.
She succeeded in expanding practice rights for
Nurse Practitioners to include prescriptive authority.
A strong advocate for school nurses, she worked
tirelessly with the legislature to require nurses in
public schools. “Behind the scenes,” Liz continuously
monitored the political climate and never hesitated
to advocate her position if nurses’ rights or the wellbeing
of the profession were under attack. Her intimate
knowledge of the political process, her ongoing efforts
to maintain positive relationships with the political
players, and her unrelenting drive to produce what was
best for nursing and for patient care are earmarks of
her career. Liz Morris was, without question, the very
public face of nursing in the Alabama Legislature for
25 years and, quite possibly, the most influential voice
in the public policy arena for Alabama nurses in the
last century. https://nursing.ua.edu/?page_id=3448
Special acknowledgement to the Capstone
College of Nursing at the University of Alabama
for allowing us access and use of biographical
information from the Alabama Nursing Hall of
Fame.
**** Send inquires to www.alnotablenurse@gmail.
com
Alabama Notable Nurses Project Team
& Commemorative Logo
Constance S. Hendricks, PhD, RN, FAAN; Ola Fox,
DNS, RN; Valarie Thomas, RN, DNP; Annitta Love,
RN, MSN; Gwendolyn Lipscomb, RN, MSN; Vera
Smith, RN, MSN; Etta Felton, RN, MSN; Patricia
Wilson, RN, BSN; Mary Dorsey, RN, BSN; Elcedo
Bradley, RN, EdD; Patricia Gullette, RN, BSN; Ellen
Buckner, RN, PhD; Denisha Hendricks, EdD
http://careers.kindredathome.com

February, March, April 2022 Alabama Nurse • Page 11
Managing Moral Distress
By Cynthia Saver, MS, RN
Reprinted with Permission from ANA-New York Nurse, July 2021 Issue
The COVID-19 pandemic has added to the burden of nurses’ daily work in many
areas, including forcing them into situations where they feel moral distress. Failure
to manage this distress appropriately can affect nurses’ wellbeing and cause them
to leave the profession. But applying strategies to help prevent moral destress or
resolving moral distress in a positive way can benefit both nurses and organizations
by promoting optimal patient care and reducing staff turnover and the risk of
litigation from clinical errors.
What is moral distress?
According to the American Association of Critical-Care Nurses (AACN) tool
“Recognize & Address Moral Distress”, moral distress occurs when someone
“knows the right thing to do, but constraints, conflicts, dilemmas, or uncertainty
make it nearly impossible to pursue the right course of action.” Moral distress
differs from burnout, which refers to physical, mental, and emotional exhaustion
caused by workplace stress, and it differs from compassion fatigue, which is
physical, mental, and emotional weariness related to caring for those in significant
pain or emotional distress.
Causes of moral distress
Various situations, usually related to values conflicts, trigger moral distress.
Examples of these situations include continuing what the nurse feels is unnecessary
treatment for a patient or witnessing inadequate pain relief because a provider fails
to order adequate medication.
Many external factors can constrain or stop nurses from acting in the way they
wish, thus contributing to moral distress. According to the AACN tool, unitlevel
factors include inadequate staffing, ineffective communication, working
with incompetent colleague(s), bullying, and lack of a healthy work environment.
Organization factors include inadequate staffing, lack of resources, pressures to
decrease costs, hospital policies, hierarchy of power, ineffective communication,
and financial limitations. If not addressed, these factors can lead to the disturbing
effects of moral distress.
Effects of moral distress
Moral distress affects both individuals and organizations. In individuals, it
can produce symptoms that are emotional (frustration, anger, anxiety, guilt,
sadness powerlessness, withdrawal), physical (muscle aches, headaches, heart
palpitations, neck pain, diarrhea, vomiting), and psychological (depression,
emotional exhaustion, loss of self-worth, nightmares, reduced job satisfaction,
depersonalization of patients) in nature. Repeated episodes of moral distress
that aren’t resolved can accumulate as “moral residue,” with nurses ultimately
experiencing burnout and leaving their jobs—or even their careers.
Job attrition causes organizations to incur turnover costs. More importantly,
unresolved moral distress can negatively impact the quality of patient care,
potentially leading to adverse patient events. This not only affects an organization’s
reputation in the community, but it could result in greater liability exposure from
errors.
Taking action
What should you do if you are experiencing moral distress?
Identify the source. The source may be a patient care issue, a policy problem
(such as how family member meetings related to end-of-life issues are held), a lack
of collaboration among team members, or something else.
Conduct a self-assessment. Self-assessment begins with determining the severity
of the distress. The Moral Distress Thermometer, developed by Wocial and Weaver,
is used for research, but also can be helpful for clinicians. The thermometer asks
you to rate your distress on a scale from 1 to 10 and includes descriptions (mild,
Managing Moral Distress continued on page 12
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This position offers competitive compensation with excellent benefits,
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For more information and to apply please go to:
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Page 12 • Alabama Nurse February, March, April 2022
Managing Moral Distress continued from page 11
uncomfortable, distressing, intense, and worst possible) to help with the process.
The results will give you a sense of how urgently you need to act, and you can use
the tool to track changes in your distress over time.
The second component of self-assessment is determining your readiness to act.
The “4A’s to Rise Above Moral Distress,” published by AACN, suggests asking
yourself these questions:
• How important is it to you to try to change the situation?
• How important would it be to your colleagues/unit to have the situation
changed?
• How important would a change be to the patients/families on your unit?
• How strongly do you feel about trying to change the situation?
• How confident are you in your ability to make changes occur?
• How determined are you to work toward making this change?
The AACN publication contains a rating scale, but you also can simply reflect
on whether you feel you are ready to act. Listing the risks and benefits of taking
action may be helpful in making your decision.
Keep in mind that in some cases the law will compel you to take action. For
example, your state likely has laws requiring you to report child or elder abuse.
Failure to do so leaves you open to legal liability. You’ll also need to consider if the
standard of care is being violated. In these cases, failure to speak up can make you
the target of a state licensing board complaint, or a target in any a lawsuit related
to patient harm that occurs as a result.
Develop a plan. Once you decide to take action, consider when you will act, who
will be involved, and what resources are available to you. For example, you may
want to gather facts and share your concerns with a trusted colleague to ensure you
have a sound plan. Your plan should include self-care, as this will be a stressful
time. Resources to help you in assessing the situation and developing a plan include
the ANA Code of Ethics with Interpretive Statements, your state board of nursing
(when a practice issue is involved), the ethics consulting service in your hospital,
and your organization’s employee assistance program.
Make the case. Share your concerns with the appropriate person(s). Present
the facts in a calm, respectful way. Consider timing and location—unless the
situation is urgent, you’ll want to bring up the issue privately. Following the chain
of command is important, particularly if your concerns aren’t being acknowledged.
For example, if a physician isn’t listening to your concerns about lack of sufficient
pain medication, you’ll want to involve your immediate supervisor. If your
supervisor does not take action, move up to the next level. In the case of nonclinical
issues related to an individual team member, you may need to speak to a
human resources representative.
Document. Document your conversations, including whom you spoke with, the
information conveyed, and the response. If related to a patient situation, record the
information in the patient’s health record. If you are dealing with a problem with a
team member or organizational policy, you should keep a personal record, so you
can trace the steps you took.
Prevention
Nurses, units, and organizations play a role in preventing moral distress and
addressing it effectively should it occur. Nurses can enhance their moral resilience
(see Moral distress strategy: The 4 Rs) and participate in professional development
activities such as continuing education programs on ethics.
The AACN tool identifies strategies for units and organizations. Units can
identify ethics champions for peer support, create a committee to address common
areas that cause distress, and establish a mentoring program for new staff.
Organizations can provide resources to support staff (for example, an ethics
consulting service), provide education on topics such as debriefing, adopt zerotolerance
policies for all forms of violence, and offer programs that improve staff
well-being. Ultimately, the goal should be to create a healthy work environment.
AACN has identified six standards for a healthy work environment: skilled
communication, true collaboration, effective decision-making, meaningful
recognition, appropriate staffing, and authentic leadership. A healthy work
environment improves nurses’ psychological health, job satisfaction, and job
retention; it also results in reduced patient errors and patient mortality.
A partnership
Ideally, nurses and leaders should work together to establish a health work
environment that supports nurses in many ways, including providing adequate
staffing and a mechanism for dealing with ethical dilemmas, so moral distress is
reduced. Nurses and leaders should also partner to ensure that those experiencing
moral distress have the resources needed to address the situation.
Moral distress strategy: The 4 Rs
Cynda Hylton Rushton and Kathleen Turner created a tool nurses can use to sort
through situations that can cause moral distress—the 4Rs.
Managing Moral Distress continued on page 13
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February, March, April 2022 Alabama Nurse • Page 13
Managing Moral Distress continued from page 12
• Recognize. The first step is to recognize the
situation for what it is. To do so, be aware of the
complexities related to the patient, the patient’s
family, and the care team, including what each
party wants to happen and emotions that may
affect their perspectives.
• Release. Consider what you can change and
what you can’t. Let go of past experiences that
aren’t helpful in the current situation.
• Reconsider. You may need to reframe an
issue or view it in a new way. Be open to fresh
approaches and ensure everyone understands
each other’s perspectives.
• Restart. At this point, you may find you are
asking new questions or have new ideas about
how the situation can be moved forward in a
positive way.
Sources: Hilton L. 4Rs strategy offers a fresh
perspective to confront ethical challenges. Nurse.com.
2020. www.nurse.com/blog/2020/09/15/4-rs-strategyoffers-a-fresh-perspective-to-confront-ethicalchallenges;
Rushton CH, Turner K. Suspending
our agenda: considering what will serve when
confronting ethical challenges. AACN Adv Crit Care.
2020;31(1):98-105.
Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical
care nurse work environments 2018: findings and
implications. Crit Care Nurse. 2019;39(2):67-84.
University of Kentucky Moral Distress Project. 2020.
http://moraldistressproject.med.uky.edu.
Wocial LD, Weaver MT. Development and psychometric
testing of a new tool for detecting moral distress:
the Moral Distress Thermometer. J Adv Nurs.
2013;69(1):167-74.
Cynthia Saver is president of CLS Development, Inc.,
in Columbia, Md.
Disclaimer: The information offered within this
article reflects general principles only and does not
constitute legal advice by Nurses Service Organization
(NSO) or establish appropriate or acceptable standards
of professional conduct. Readers should consult with
an attorney if they have specific concerns. Neither
Affinity Insurance Services, Inc. nor NSO assumes
any liability for how this information is applied in
practice or for the accuracy of this information.
This risk management information was provided
by Nurses Service Organization (NSO), the nation's
largest provider of nurses’ professional liability
insurance coverage for over 550,000 nurses since
1976. The individual professional liability insurance
policy administered through NSO is underwritten
by American Casualty Company of Reading,
Pennsylvania, a CNA company. Reproduction
without permission of the publisher is prohibited. For
questions, send an e-mail to service@nso.com or call
1-800-247-1500. www.nso.com.
1-
Moral resilience
Developing resilience can help nurses cope with
moral distress more effectively. Strategies include:
• Developing self-awareness (for example,
examine positive and negative assumptions that
may be guiding your behavior to see if they are
accurate).
• Learning to self-regulate to disrupt negative
patterns of thinking and behaving. Methods to
help with this include mindfulness-based stress
reduction, meditation, and movement practices
such as yoga and tai chi.
• Wisely discerning ethical challenges and
principled actions. This requires you to
understand your values and analyze ethical
dilemmas.
• Nurturing the willingness to take courageous
action. Keep in mind that when speaking up,
state your concerns clearly and calmly.
• Discovering meaning amid adversity. It may help
to keep a journal and to reaffirm your values.
• Preserving one’s integrity, as well as the
integrity of the team, and others. Remember that
you can seek support from others, for instance,
by talking with trusted colleagues or leaders.
Source: Rushton CH. Moral resilience: a capacity
for navigating moral distress in critical care. AACN
Adv Crit Care 2016;27(1):111-119; Rushton CH.
Building moral resilience to neutralize moral distress.
Am Nurse Today. 2016;11(10).
JI
THE
FIRST CHOICE
FOR HEALTHCARE.
RESOURCES
AACN. Recognize and address moral distress. 2020.
www.aacn.org/clinical-resources/moral-distress.
American Association of Critical-Care Nurses Ethics
Work Group. The 4 A’s to Rise Above Moral
Distress. Aliso Viejo, CA: American Association
of Critical-Care Nurses; 2004.
American Nurses Association. Code of Ethics with
Interpretive Statements. 2015. www.nursingworld.
org/practice-policy/nursing-excellence/ethics/
code-of-ethics-for-nurses/coe-view-only.
Hilton L. 4Rs strategy offers a fresh perspective to
confront ethical challenges. Nurse.com. 2020.
www.nurse.com/blog/2020/09/15/4-rs-strategyoffers-a-fresh-perspective-to-confront-ethicalchallenges.
Rushton CH. Cultivating moral resilience. Am J Nurs.
2017;117(2 Suppl 1):S11-S15.
Rushton CH. Moral resilience: a capacity for navigating
moral distress in critical care. AACN Adv Crit
Care. 2016;27(1):111-119.
Rushton CH. Building moral resilience to neutralize
moral distress. Am Nurse Today. 2016;11(10).
Rushton CH, Turner K. Suspending our agenda:
considering what will serve when confronting
ethical challenges. AACN Adv Crit Care.
2020;31(1):98-105.

Nursing
National
Career Fair
Virtual
Thursday, April 28 | 5–8pm ET
Page 14 • Alabama Nurse February, March, April 2022
WHAT ASNA'S CAREER COACH
CAN DO FOR YOU!
As a FREE service, AL State Nurses Association offers
career coaching. What are the avenues of help and for
whom?
Bridget Stevens assists student nurses to 20 plus
year veterans with any degree and specialty. With over
25 years working in healthcare and recruiting, Bridget
uses that expertise to make your resume shine, get a
jump on the competition by using inroad networking,
and interview tips with practice. Different facilities use
different interview tactics and with inside knowledge
and preparation of what will be asked, you will ace the
interview! For example, any question on your hardest
challenge in the past and how you overcame be sure to
concentrate on the solution, NOT the problem! Get ready
for your 60 second “Tell us about yourself” and behavioral
questions. We will be coaching you the whole way!
Southeast Health in Dothan, AL is looking to add CRNA's
to their well-established, hospital-employed group.
Dothan offers a short 90-minute drive to the Gulf Coast
beaches of FL and is home to Season 16 Top Chef
winner, Kelsey Barnard Clark.
• Flexible Scheduling
• 12 Free CEU’s/yr
• Additional call pay
• No travel required
• Competitive Compensation & Benefits Package
• Educational Stipends & Sign-on bonus available
For more information, please contact:
Emily Grimes, Director, Physician Recruitment
(334) 793-8145, x3321
elgrimes@southeasthealth.org
Some comments of nurses previously coached:
"Being out of the Nursing Industry for over 15 years,
I did not know where to start and the skills I needed
to add. ASNA's free career coach helped me every
step of the way! Invaluable advice to the new way of
presenting my experience, interviewing, and getting my
dream job! Thank you ASNA! "
“Wow! Thanks so much for your heartfelt response!
I certainly appreciate you, your prayers, and your
willingness to help. It means so very much.”
“I took four years off from Nursing to take care of
my children. Your help getting my resume right and
direction has been invaluable!”
“I didn’t know how important networking was and how
to do it. Helped me get noticed and finally get the job.
Thank you!”
Why am I not getting
job interviews?
Have you heard of getting your resume “ATS
ready” so your resume is considered? What is
ATS? Why is it important?
There are an average of 250 applicants per
job posting. An Applicant Tracking System
(ATS) is a human resources software that
allows employers to organize large numbers
of applicant resumes. Recruiters and hiring
managers can search their ATS by keyword
to discover well-matched applicants. You can
improve your chances of grabbing a recruiter’s
attention by optimizing your resume keywords.
Approach resume building with an ATS
(Application Tracking System) strategy. It’s
important to remember that many resumes are
screened with an ATS, which uses an algorithm
to scan resumes for relevant keywords and
information. That’s why up to 75% of resumes
are rejected before they ever reach the hiring
manager.
Accurately predicting which words the
recruiter will type into the search bar is one of
the best ways to get noticed in an ATS. Print out
a job description and hilite key words to make
sure your resume includes them. Recruiters are
likely to search for:
• Job titles, like Nursing Supervisor, Case
Manager, or Director
• Hard skills, like Behavioral Medicine,
EMR software, Microsoft Excel
The best indicator of which words they’ll
search is the job description. Also, include the
job title in your resume headline if possible.
Then notice which hard skills—learned skills
based on experience and training—appear early
or multiple times in the job description. Add
those to the appropriate areas on your resume.
** Do not use fancy formatting on your
resume. Avoid tables, columns, headers,
and footers. Uploading a resume with heavy
formatting may shift important fields and then
will be voided on the employer’s system.
An optimized ATS resume keeps your
application in play longer and increases your
chance to get that interview! Customize your
resume per the job you are seeking.
If you have any questions please reach
out to your AL State Nurses Association’s
Career Coach. Bridget Stevens: BStevens@
AlabamaNurses.Org
REGISTER NOW!
Scan QR Code to Register

February, March, April 2022 Alabama Nurse • Page 15
Crowne Healthcare receives
Nurse Legion of Honor Medal
The medal was presented by District 1 member Dawn Thomas.
Reprinted with permission from Steven Stiefel, Times-Journal
On Dec. 9, Crowne Healthcare of Fort Payne hosted the presentation of the Alabama
State Nursing Association’s highest honor, the Nurse Legion of Honor Medal, to the
family of nurse Judy Ann Locklear Stephens, LPN, presented by Nurse Dawn Thomas,
RN. This medal represents the highest measure of courage and valor in dangerous
circumstances. Stephens died of COVID-19 as a direct result of contracting the illness
from providing nursing care for patients. She became ill at the end of her shift and
tested positive on July 27, 2020. She lost her battle with COVID on August 28, 2020,
at Centennial Hospital in Nashville, Tenn. Her service and sacrifice for her residents
and co-workers were covered by The Times Journal in a stark reminder of the working
circumstances frontline workers have endured valiantly during the pandemic. The Nurse
Legion of Honor Medal serves as a way for the Alabama State Nursing Association to
remind loved ones left behind that Stephens’ sacrifice is not forgotten and is historically
recognized as the medical recipient of honor. Present for award of the medal and
certificate were Crowne Healthcare’s administrator, Jim Turnipseed, Director of Nursing
Carol Hawkins, RN, Stephens’ co-workers and immediate family. Pictured from left are
Jeremy Glassco, RN, Cassidy Bray, Susan Glassco, RN, Trent Stephens, Haley and Jacob
Rodriguez, Mildred Locklear and Zach Wofford.
Teresa Marcus, Recipient of the
ASNA Legion of Honor Award
Julie Savage Jones
The Nurse Legion of Honor Medal is the highest award
presented by the Alabama State Nurses Association in its
109 year history. The criteria mirrors that of the Medal of
Honor for the military. Nurses who preform acts of courage
with risks beyond those normally associated with the
profession are nominated and carefully screened by their
peers to qualify for the Medal.
In September of 2020, a loving wife, mother,
grandmother, and community R.N., Teresa Marcus, passed
away. She practiced as a Registered Nurse with Chilton
Medical Associates in Clanton, AL. Early in the pandemic,
she helped care for a client with the virus, contracted it
herself, and passed away as a result.
Nurse Marcus did not let the deadly virus deter her from going about her normal
duties of caring for her community members. She represents many brave nurses that
gave their lives in the line of duty during the pandemic.
Caring for those in need was not limited to the office where she practiced as a
R.N. For ten years prior to the pandemic, Teresa traveled on medical missions trips to
Guatemala with a group from Clanton. She was also an active member of the volunteer
fire department in her community and served in youth ministry at her church. Her
giving did not stop there. Teresa provided many community members with free CPR
classes over the years.
Teresa Marcus was a deserving
recipient of the ASNA Legion
of Honor Award. Her medal was
presented on November 29th
to her husband, Rex Marcus.
The presentation was at Chilton
Medical Associates with Dr.
Funderburk, her son Anthony
and family, as well as office staff
present.

Page 16 • Alabama Nurse February, March, April 2022
Research Corner
Chronic Kidney Disease in the Elderly
Annotated Bibliography
Madison Nowell, BSN
MSN Student at Troy University
mnowell102181@troy.edu
Aucella, F., Corsonello, A., Leosco, D., Brunori, G.,
Gesualdo, L., & Antonelli-Incalzi, R. (2019). Beyond
chronic kidney disease: The diagnosis of renal disease
in the elderly as an unmet need. A position paper
endorsed by Italian Society of Nephrology (SIN) and
Italian Society of Geriatrics and Gerontology (SIGG).
Journal of Nephrology, 32(2), 165-176. https:/ /doi
.org/10.1007/s40620-019-00584-4
This study was aimed at summarizing evidence
regarding differences between physiologic aging of
the kidney and progressive kidney disease, as well as
challenges in diagnosing kidney disease among elderly
patients. Description of the CKD process which includes
patient referral, clinical assessment and use of imaging
and renal biopsy, in an effort to aid in promotion of strict
collaboration between nephrologist and geriatricians in
the clinical management of elderly patients. Diagnosing
CKD in the elderly can be challenging due to the agerelated
changes in structures and functions of the kidney,
which may be difficult to distinguish between CKD and
multi-morbidity. In this regard, this article recommends
that symptoms, clinical findings, and abnormalities in
labs should be considered as a potential clue to help
differentiate and diagnose CKD. Correct patient referral
is very important: patients with CKD stages 4-5 as well
as the patients with progressive nephropathy or worsening
proteinuria should receive a referral to nephrologist.
Performance of a renal biopsy can be a key diagnostic
exam and should not be excluded from option solely due to
basis of age. Recognition of renal disease and its causes,
as well as developing a tailored treatment plan requires
and in depth knowledge of patient, which commonly is
out of reach within the realms of nephrologic approach.
Collaboration and involvement of primary care physicians
also provides an opportunity to obtain early identification
and appropriate referral of elderly patients diagnosed
with CKD. A strict cooperation between nephrologist
and geriatricians is recommended in order to select the
best tools for comprehensive geriatric assessment and to
provide practical therapeutic treatment plans.
Betz, M., Steenes, A., Peterson, L., & Saunders, M. (2021).
Knowledge of renal diet restrictions in patients with
non-dialysis dependent chronic kidney disease stages
3-5. Renal Society of Australasia Journal, 17(1 ).
https://doi.org/10.33235/rsaj.17 .1
The focus of this study was to describe what patients
with non-dialysis dependent CKD stages 3-5 understood
about the need for certain food restrictions such as sodium,
potassium and phosphorus, as well as their knowledge
of food sources of those nutrient foods. A cross sectional
survey was conducted and patients were recruited from an
outpatient nephrology clinic. Inclusion criteria included
a CKD diagnosis, no current requirement of dialysis,
GFR of 45mL/min or less, English speaking and no
documentation of cognitive impairment or dementia.
All 266 participants completed the Chronic Kidney
Disease & Nutrition Questionnaire which was developed
with a reading grade level of 5.3. The questionnaire was
administered verbally to everyone. 95.8% of patients were
aware of the importance to limit sodium, 39.9% reported
the need for phosphorus limitation, and 69.8% reported
the need for potassium restriction despite the history
ofhyperkalemia. In regard to food sources, patients were
most familiar with food sources of sodium (76.53%),
followed by potassium (41.67%), and phosphorus (16.76%).
A recommended strategy to improve education related to
renal diet is to focus on food patterns rather than specific
nutrients. Increase its referrals to registered dietitians for
patients with NDD CKD is another opportunity to help
increase patient knowledge and confidence in appropriate
food choices.
Davison, S. N., Tupala, B., Wasylynuk, B. A., Siu, V.,
Sinnarajah, A., & Triscott, J. (2019). Recommendations
for the care of patients receiving conservative kidney
management. Clinical Journal of the American Society
of Nephrology, 14(4), 626-634. https://doi.org/10.2215/
cjn. l 0510917
This article aimed to describe the development
of conservative kidney management specific
recommendations for both CKD management as well as
symptom control. The recommendations presented in the
article were developed by using both existing evidence
and expert nephrology opinion, geriatric medicine
and palliative care. The two primary objectives of the
recommendations were: (1) to make them more appropriate
for patients undergoing conservative kidney management
and (2) to make them more accessible to health care
professionals caring for these patients outside of
nephrology. Conservative management recommendations
included the following symptoms: blood pressure,
dyslipidemia, calcium and phosphorus metabolism, uremic
pruritus, restless leg syndrome, and nausea vomiting. It
was found that BP control is not likely to be a beneficial
focus of patients undergoing conservative kidney
management. Rather, the aim of BP management should be
targeted for optimization of quality of life (QOL), preserve
physical and cognitive function, and minimize the risk
of orthostatic hypotension and falls. Relaxing BP targets
is recommended in these patients receiving conservative
management due to the QOL and safety concerns. In
patients taking statins for dyslipidemia, it was found in
previous studies that cessation of statin therapy was not
only safe but that it also improved QOL. In calcium and
phosphorus metabolism, the focus should be on adequate
nutrition, avoiding malnutrition and inflammation and
liberalizing the diet. Low-dose gabapentin or pregabalin
to be most effective in uremic pruritus and RLS. Nausea
and vomiting symptoms should be treated first line with
Reglan due to its limited risk of side effects. Neuropathic
pain should be treated with gabapentin, nociceptive pain
should be treated with low opioids as a last resort. This
article provides explanation of and rationales of each
symptom and appropriate treatment so that providers can
be more understanding and patients can become more
involved as active participants in their care.
Grill, A., & Brimble, S. (2018). Approach to the detection
and management of chronic kidney disease. Canadian
Family Physician, 64(10), 728-735. https://pubmed.ncbi.
nlm.nih.gov/30315015/
The purpose of the article was to provide a step-by-step
approach to assist primary care providers in detection,
identification, diagnosing and management of CKD, as
well as the how to determine when a referral to nephrology
is needed. This stepwise approach includes four steps
to aid primary care providers in their practice. The first
step is to identify and evaluate patients who are at risk for
CKD which include patients with the following: CAD,
CHF, stroke, and PYO). Step two involves detection of
CKD. Once the elevated risk or possible suspicion of
CKD, there are two tests that should be ordered: an eGFR
and urine ACR test. Step three involves management of
CKD. Management in primary care requires implementing
Research Corner continued on page 17
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February, March, April 2022 Alabama Nurse • Page 17
Research Corner
Research Corner continued from page 16
measures that reduce cardiovascular risk, minimizing
further kidney damage and slowing the rate of CKD
advancement. Step four included information regarding the
appropriate criteria that warrant a referral to nephrology.
The recommendation for criteria warranting nephrology
referral includes an eGFR of less than 30 mL/min, rapid
deterioration in kidney function, an ACR greater than
60mg/mold or 5-year Kidney Failure Risk Equation
greater than or equal to five percent. Most patients with
CKD can be managed within the primary care setting.
Close follow-up is important to identify patients who could
potentially be high risk of progression to advanced stages
of CKD. Collaboration between providers is a key element
in improving the lives of those living with CKD.
Ji, A., Pan, C., Wang, H., Jin, Z., Lee, J. H., Wu, Q.,
Jiang, Q., & Cui, L. (2019). Prevalence and associated
risk factors of chronic kidney disease in an elderly
population from eastern China. International Journal
of Environmental Research and Public Health, 16(22),
4383. https://doi.org/10.3390/ijerph 16224383
Chronic kidney disease has been a major problem
amongst healthcare around the world. The main objective
of this study was to research and identify the prevalence
and associated risk factors related to chronic kidney
disease (CKD). This was a cross-sectional study that
used a stratified sampling method to select participants.
Participants were required to meet the following criteria:
(1) 60 years or greater, (2) has been a resident to the
area for five years or more, (3) without mental disorder
or malignant tumor. Participants were to complete a
questionnaire that included their demographics (age
and sex), past medical history and family history,
and lifestyle behaviors such as exercise. A spot urine
specimen was collected for analysis of albumin and
creatinine. Patients with an ACR greater than 30mg/g
were defined as having albuminuria. Definition of
reduced renal function was defined as eGFR 90 or any use of antihypertensives in the past
two weeks. Diabetes was defined with participants who
had HgbA 1 C greater than 7mmol/L. It was found that
chronic non-communicable diseases including diabetes,
hypertension, hyperhomocysteinemia, hyperuricemia,
hypertriglyceridemia, and obesity strongly correlated
with greater prevalence of CKD. Due to the prominent
effects on advancement of CKD, these diseases should
be followed closely as a strategy to help prevent the
progression of CKD in the elderly.
Kim, K.-S., Park, S. W., Cho, Y.-W., & Kim, S.-K. (2018).
Higher prevalence and progression rate of chronic
kidney disease in elderly patients with type 2 diabetes
mellitus. Diabetes & Metabolism Journal, 42(3), 224.
https://doi.org/10.4093/dmj.2017.0065
The objective of this study was to identify and
evaluate the prevalence of chronic kidney disease and
rate of progression in elderly patient diagnosed with type
2 diabetes mellitus. Medical records of one-hundred
and ninety elderly patients sixty-five and older were
investigated in six month increments over six years;
specifically, in patients with type two diabetes. Exclusions
included patients with Type I Diabetes, acute diseases,
known inherited kidney disease, cancer, or acute renal
failure caused by certain circumstances. Staging of CKD
was done according to the Kidney Disease Outcomes
Quality Initiative guidelines and were defined as the
following: Stage 1 (eGFR>90ml/min), stage 2 (eGFR
60-89ml/min), stage 3 (eGFR 30-59ml/min), stage 4
(eGFR 15-29ml/min) and stage 5 (eGFR

Page 18 • Alabama Nurse February, March, April 2022
Research Corner
Research Corner continued from page 17
redefining of management in certain aspects of care
such as pharmacists adjusting medications, or nurses
adding diagnosis into patients record. Decision support
involves evidence-based guidelines which encourage
continuing education, embedding guidelines into standards
of proactive, and sharing the guidelines with patients.
Clinical information systems focus on organization and
involves timely feedback, and reminders for providers
and patients, identifying relevant sub-populations, within
the organization to facilitate patient care planning that is
individualized, sharing of information with patient through
coordinated care, and monitoring of quality performance
among practice team and healthcare system. This review
identified the benefit of sharing specialized knowledge
amongst staff in primary care settings for both providers
and patients who have not yet been seen in the nephrology
clinics.
Pereira, R., Batista, M.A., Meira, A. S., Oliveira, M. P., &
Kusumota, L. (2017). Quality of life of elderly people
with chronic kidney disease in conservative treatment.
Revista brasileira de enfermagem, 70(4), 851-859.
https://doi.org/10.1590/0034-7167-2017-0103
The purpose of this study was to describe the quality
of life among the elderly population diagnosed with
chronic kidney disease who are undergoing conservative
treatment. For the data collection, interviews that
lasted 40 minutes on average were conducted,
while patients waited for their appointments. The
instrument used for the patients' sociodemographic
and clinical characterization was developed based on
Kusumota, which addresses personal data, economic,
sociodemographic and clinical conditions. QOL was
assessed using the WHOQOL-Bref and WHOQOL-
Old scales. For the cognitive evaluation, the Mini-
Mental State Examination (MMSE) was used. Among
most chronic diseases, CKD stands out as one of the
number one causes of inabilities and mortality across
the nation. CKD is characterized as an irreversible and
rapid progressing disease which damages the renal
system and ultimately ends in renal failure. Treatment
in the pre-dialysis stage of CKD involves drug therapy,
diet recommendations which frequently involve fluid
restriction and specific behaviors which in concurrent
use decelerate CKD advancement. In this study, it
was found that the main results on quality of life in
patients with CKD allowed them to state that patients
in the final stage of the disease have a worse QOL
when comparing to the general elderly population. The
treatment for patients diagnosed with CKD should be
focused on not only longevity, but also the strengthening
and overall improvement of QOL. Results obtained
in this study revealed the highest mean score for
"Social Relationships" domain and the lowest mean
score for "Psychological Domain." It was also found
that the prevalence of complications on this disease
increase while the renal function is declining. With the
psychological aspect scoring as the lowest, it is necessary
to include in the healthcare of these patient's strategies
aimed at maximizing the strength in the psychological
domain of care.
Rosansky, S. J., Schell, J., Shega, J., Scherer, J., Jacobs,
L., Couchoud, C., Crews, D., & McNabney, M. (2017).
Treatment decisions for older adults with advanced
chronic kidney disease. BMC Nephrology. https://doi.
org/1 O. l 186/s12882-0l 7-0617-3
Older adults with CKD in advanced stages typically
lose renal function slowly over time, and often suffer
with other comorbidities and in turn have a high risk
of death before requiring dialysis. Current guidelines
recommend nephrology in the following instances:
glomerular filtration rate less than 30mL/min, albumin
to creatinine ratio greater than 300 >mg/gm or a vast
advancement of renal failure defined by sustained decline
in renal function of less than 5ml/min/year. This current
systematic review provides a pragmatic framework to aid
providers in the shared decision making process when
treating elderly patients with advanced CKD. It has been
determined that older adults in the advanced stages of
CKD are at a higher risk of death from non-renal failure
related conditions before they are faced with the decision
regarding dialysis. Interdisciplinary efforts by providers
should consist of early and consistent discussions with
patients and their family members regarding patient's
preferences and goals in regards to potential risk
and benefits of initiation of dialysis therapy. In some
instances, conservative therapy may be an appropriate
choice for patients whose primary goal is to maintain
independence and avoid discomforts and potential
complications related to dialysis.
Totoli, C., Carvalho, A. B., Ammirati, A. L., Draibe,
S. A., & Canziani, M. E. (2019). Associated factors
related to chronic kidney disease progression in
elderly patients. PLOS ONE, 14(7). https://doi.
org/10.1371/joumal.pone.0219956
In this single center retrospective observational study,
the focus was aimed to describe associated factors and
the behavior of CKD progression in a cohort of elderly
patients. Laboratory studies were collected from patients
which included urea, Hgb, sodium, potassium, ionized
calcium, phosphorus, intact PTH, bicarbonate, glucose,
glycated Hgb, uric acid, LDL & HDL cholesterol and
triglycerides. Spot urine samples were collected to detect
presence of proteinuria which was classified as absent,
mild, moderate, or severe. After data collection and
analysis, diabetic neuropathy and hypertension were
found to be the main cause of CKD.
Almost 60% of participants showed a decrease in
kidney function over an average of two years or followup.
Advancement of CKD was found to be related
to younger age, diabetic nephropathy, higher serum
phosphorus and proteinuria. The presence of proteinuria
is a major marker of kidney damage and has been found
to be the best-known risk factor of CKD progression.
In recent studies, it was determined that the presence
of proteinuria was related to a rapid rate of decline in
kidney function and achievement of ESRD. Advancement
of CKD was observed in the majority of the CKD
patients who were elderly and proteinuria was the most
significant factor associated with decline in kidney
function among this population.
Vincent A. Van Gelder, Nynke D. Scherpbier-De
Haan, Wim J.C. De Grauw, Gerald M.M. Vervoort,
Chris Van Weel, Marion C.J. Biem1ans, Joze C.C.
Braspenning & Jack F.M. Wetzels (2016) Quality
of chronic kidney disease management in primary
care: A retrospective study, Scandinavian Journal of
Primary Health Care, 34: 1, 73- 80, DOI: 10.3109/028
I 3432.2015.1132885
The purpose of this study was to analyze quality
of care in general practice for all stages of CKD
regarding patient and practice characteristics. Indicators
were derived from the interdisciplinary guideline for
primary care. Process indicators included monitoring
of disease progression (assessment of creatinine,
eGFR, albuminuria, blood pressure and glucose),
monitoring of metabolic parameters (assessment of Hgb,
calcium, phosphate, PTH, albumin, and potassium),
and recognition of CKD in patients with an eGFR less
than 60ml/min. The fourth indicator was achieving
blood pressure targets. Adequate monitoring of disease
advancement was observed in 42% of metabolic
parameters in 2%, correct identification of impaired renal
function was 31%, and obtaining blood pressure targets in
43% of CKD patients. High quality of care was strongly
associated with the presence of diabetes and to a lesser
extent in males with hypertension. After completion of the
study, it was found that room for improvement was needed
in all aspects of CKD management. Due to quality of care
being higher in patients diagnosed with diabetes, future
CKD management may be improved with development of
strategies similar to caring of patients with diabetes.
Yang, C., Meng, Q., Wang, H., Wang, Y., Su, Z., Liu,
L., Liu, W., Kong, G., Zhang, L., Zhao, Y., & Zhao,
M.-H. (2020). Anemia and kidney function decline
among the middle-aged and elderly in China: A
population-based National Longitudinal Study.
BioMed Research International, 2020, 1-7. https://doi.
org/10.1155/2020/2303541
The purpose of this study was aimed to investigate
the longitudinal association between kidney function and
anemia among the elderly in China. The longitudinal
survey for households included individuals forty-five
years and older. A four-stage, stratified, cluster sampling
method was utilized to obtain a sample from eligible
participants. Venous samples were taken from participants
and C-reactive protein, total cholesterol, high density
lipoprotein, low-density lipoprotein, triglycerides, fasting
glucose, creatinine, and uric acid were tested. Anemia
was defined as a hemoglobin level less than 13 g/dL in
men and 12 g/dL in women. Association between anemia
(Hgb levels) and progressive decline in kidney function
was analyzed by multivariate logistic regression, with
adjustment for age, sex, residence, education, medical
insurance, personal consumption expenditure, smoking,
drinking, BMI, central obesity, CRP, CVD, hypertension,
diabetes, hyperuricaemia, and baseline eGFR. The results
of this study indicate that anemia in fact is an independent
risk factor for the advancement of decline in kidney
function among middle-aged and elderly population. In
previous clinical studies, it has been found that anemia
could also contribute to decline in kidney function,
mainly by hypoxia or increased oxidative stress. A triad
of worsening anemia, CKD progression, and worsening
heart failure creates a vicious cycle for the development
of cardiorenal anemia syndrome. In pre -dialysis patients,
anemia often goes undetected and untreated despite
the potential severe consequences. In clinical settings,
attentive management and interventions specifically
targeting anemia could be effective to reduce the risk of
kidney failure and improve the overall prognosis of the
general population.
References
Aucella, F., Corsonello, A., Leosco, D., Brunori, G., Gesualdo,
L., & Antonelli-Incalzi, R. (2019). Beyond chronic
kidney disease: the diagnosis of Renal Disease in the
Elderly as an unmet need. A position paper endorsed
by Italian Society of Nephrology (SIN) and Italian
Society of Geriatrics and Gerontology (SIGG). Journal
of nephrology, 32(2), 165- 176. https://doi.org/10.1007/
s40620-019-00584-4
Betz, M., Steenes, A., Peterson, L., & Saunders, M. (2021).
Knowledge of renal diet restrictions in patients with
non-dialysis dependent chronic kidney disease stages 3-5.
Renal Society of Australasia Journal, 17(1). https://doi.
org/10.33235/rsaj.17 .1.24-33
Davison, S. N., Tupala, B., Wasylynuk, B. A., Siu, V., Sinnarajah,
A., & Triscott, J. (2019). Recommendations for the care
of patients receiving conservative kidney management.
Clinical Journal of the American Society of Nephrology,
14(4), 626-634. https://doi.org/10.2215/cjn.10510917
Grill, A., & Brimble, S. (2018). Approach to the detection and
management of chronic kidney disease. Canadian Family
Physician, 64(10), 728-735. https://pubmed.ncbi.nlm.nih.
gov/30315015/
Ji, A., Pan, C., Wang, H., Jin, Z., Lee, J. H., Wu, Q., Jiang, Q.,
& Cui, L. (2019). Prevalence and associated risk factors
of chronic kidney disease in an elderly population from
eastern China. International Journal of Environmental
Research and Public Health, 16(22), 4383. https://doi.
org/10.3390/ijerphl 6224383
Kim, K.-S., Park, S. W., Cho, Y.-W., & Kim, S.-K. (2018).
Higher prevalence and progression rate of chronic kidney
disease in elderly patients with type 2 diabetes mellitus.
Diabetes & Metabolism Journal, 42(3), 224. https://doi.
org/10.4093/dmj.2017.0065
Llewellyn S. (2019). The chronic care model, kidney disease, and
primary care: A Scoping Review. Nephrology nursing
journal: journal of the American Nephrology Nurses'
Association, 46(3), 301-328. https://pubmed.ncbi.nlm.nih.
gov/31199097/
Pereira, R., Batista, M.A., Meira, A. S., Oliveira, M. P., &
Kusumota, L. (2017). Quality of life of elderly people
with chronic kidney disease in conservative treatment.
Revista brasileira de enfermagem, 70(4), 851-859. https://
doi.org/1 O. l 590/0034-7167-2017-0103
Rosansky, S. J., Schell, J., Shega, J., Scherer, J., Jacobs, L.,
Couchoud, C., Crews, D., & McNabney, M. (2017).
Treatment decisions for older adults with advanced
chronic kidney disease. BMC Nephrology. https://doi.
org/10.1186/s 12882-017-0617-3
Totoli, C., Carvalho, A. B., Ammirati, A. L., Draibe, S. A., &
Canziani, M. E. (2019). Associated factors related to
chronic kidney disease progression in elderly patients.
PLOS ONE, 14(7). https://doi.org/10.1371/joumal.
pone.0219956
Vincent A. Van Gelder, Nyn.ke D. Scherpbier-De Haan, Wim
J.C. De Grauw, Gerald M.M. Vervoort, Chris Van Weel,
Marion C.J. Biermans, Joze C.C. Braspenning & Jack
F.M. Wetzels (2016) Quality of chronic kidney disease
management in primary care: a retrospective study,
Scandinavian Journal of Primary Health Care, 34: 1,
73-80, DOI: 10.3109/02813432.2015.l 132885
Yang, C., Meng, Q., Wang, H., Wang, Y., Su, Z., Liu, L., Liu, W.,
Kong, G., Zhang, L., Zhao, Y., & Zhao, M.-H. (2020).
Anemia and kidney function decline among the middleaged
and elderly in China: A population-based National
Longitudinal Study. BioMed Research International,
2020, 1-7. https://doi.org/10.l 155/2020/2303541

February, March, April 2022 Alabama Nurse • Page 19
The Alabama State Nurses Association District 3
recently held a call for scholarships. The scholarship
committee had an overwhelming response with 32
applications from an excellent representation of the
nursing programs in District 3. We are pleased to
announce the recipients of a $500 scholarship that
can be used for books, tuition, and the extra expenses
found in nursing school. The two recipients are Alexis
Erskine and Jiwon Min. The scholarship committee
members recently interviewed the recipients.
ASNA District 3
Call for Scholarships
members, we clean, we give meds, we do discharge
planning, we transport patients. We just don’t take
orders and give meds…..we have so many roles. I
never knew there were so many things that we do.
What is your five year plan? It’s amazing! After
graduating I would like to work for two years as a RN
and then return to school to earn my Psych NP and
down the line I hope to open my own practice. I want
to be a part of a community.
What is the one thing that has amazed you from
nursing school? Nursing is amazing. My first day of
clinical was filled with so many opportunities to learn
and experience.
What is your five year plan? I will Graduate in the
summer and then would like to work for two years as a
RN and then travel as a nurse for a few years. I plan to
enroll in grad school to become a NP. I would like to
be a Women’s Health NP.
Alexis Erskine, fourth semester
student at the Moffit and Sanders
School of Nursing at Samford
University in Birmingham, AL.
What lead you to choose nursing as a career?
Always been interested in medical field. Loved
watching medical shows, but it was when my
Grandmother became sick that I knew that I wanted
to be able to help take care of her. Now I know how to
assist with her meds to control her diabetes and I can
help to answer questions when she has questions.
What school are you attending? Samford
University.
Why did you choose Samford for your nursing
program? I looked at the NCLEX passing rates and
knew that I would receive an education that would
educate me as an excellent nurse, but also prepare me
to pass the NCLEX.
What is the one thing that has amazed you from
nursing school? That nurses do a lot! We take care
of patients, but we comfort patients and their family
Jiwon Min is a fourth semester
student at the University of Alabama
at Birmingham School of Nursing in
Birmingham, AL.
What lead you to choose nursing as a career?
Middle school year I went to the Philippines on a
mission trip. I saw that people were suffering illness
that could be cured with antibiotics that would not
have been available if our team was not there. I saw
the good and this sealed it for me to want to help
people and the way for me to do that was to enter the
profession of nursing.
What school are you attending? The University of
Alabama at Birmingham School of Nursing.
Why did you choose UAB for your education?
UAB has a great reputation as a great school. The
opportunities for clinical rotations was also appealing.
The UAB sites would provide me lots of experience
with common conditions, but because of its high
reputation I would see things that I would not see in
other hospital settings.
The members of District 3, led by President Dr.
Adrienne Curry, congratulate Alexis and Jiwon
on their scholarships and look forward to working
alongside you as Registered Nurses.