New Hampshire - March 2022

Quarterly publication direct mailed to approximately 1,250 Registered Nurses and LPNs and delivered electronically via email to 16,500 Registered Nurses and LPNs in New Hampshire.
New Hampshire
Nursing News
Official Newsletter of New Hampshire Nurses Association
www.NHNurses.org
March 2022 | Vol. 46 No. 2
Hello!
PRESIDENT’S MESSAGE
This message is my first as
President of the NHNA. I
want to thank Carlene Ferrier
for all of the hard work and
dedication she has put forth
in her time as President.
Carlene has facilitated an
update to the NHNA bylaws
as well as the NHNA strategic
plan. This work is to help
the NHNA achieve the goal
of being the first accredited
Constituent State Nursing Holly McCormack
Association of the ANA. I look
forward to continuing this work with Carlene.
As we move forward in 2022, it is essential to note that
many of the challenges we faced in 2021 are still lingering.
Issues around the workforce continue to challenge our
healthcare system, and the staffing issues are reaching crisis
proportions.
As I reflect in these early
months of 2022, I am hoping
this is a transformative year.
“Transformative” is defined as
causing a marked change in
someone or something. This
issue of NH Nursing News is
our annual advocacy issue,
reporting on NHNAs legislative
priorities for 2022. It is always
a hopeful time when legislation
is introduced with hopes that
something transformative will
Pamela P. DiNapoli
result. Hopes for a bill that may
have the same impact as the Affordable Care Act signed
by President Obama did in 2010. The ACA reduced the
uninsured rates, increased the rate of individuals qualifying
for Medicaid, and helped to increase access to care leading
to early diagnosis of chronic health conditions like cancer.
current resident or
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371
Hospitals
have to cap beds and
close entire units. The capping and
closures can mean delays or even transfers to other
facilities, often hundreds of miles from home. As leaders
and officials around the state contemplate these issues,
NHNA must contribute to the conversation. The Vision
statement for NHNA is to inspire New Hampshire nurses
as leaders to expand the impact of the nursing profession
to improve the health of the people of New Hampshire.
This issue will require innovation and collaboration to effect
a change. As these attributes are among the core values, I
believe the NHNA is up to the challenge.
In closing, I would like to encourage you to be active
within NHNA. There are many opportunities for volunteers
within the association. With your help, we can continue to
have a voice in health advocacy within the State of New
Hampshire.
REFLECTIONS FROM THE ED
Key issues at the forefront of this federal legislative session
are the transformation and modernization of systems.
As we consider these issues, essential to the profession
of nursing is the need to modernize and transform our
education system to foster workforce development.
Beginning last May with the release of the Nurse of the
Future 2020-2030, Mary Wakefield PhD, RN, FAAN has
said:
“Policymakers and health system leaders must seize this
moment to strengthen nurse education and training,
integrate health equity into nursing practice, and protect
nurses’ physical, emotional and mental well-being so they
can provide the best care possible.”
The COVID-19 pandemic has left nurses feeling burnt out
and vulnerable as a result of experiences in the workplace.
The time is right to examine recent transformations in
the workplace and more importantly examine future
modernizations and transformations to impact the work of
future nurses.
The most obvious transformation experienced in the
workplace has been the nursing shortage. As a result of
the ongoing shortage, made more acute by the pandemic,
nurses now have less time, pay less attention to detail, have
more stress and take more shortcuts. In turn, those hospital
systems that have recently focused on quality
metrics, nursing sensitive quality indicators, now
face a lack in continuity of care, medication errors,
fewer safety protocols resulting in hospital acquired
infections and overall comprised quality of care.
Having fewer nurses to share the workload adds to
layers of stress already associated with providing
direct care impacting the physical and emotional
wellbeing of the workforce.
The US will need approximately 1.2 million nurses
to meet patient demand. As a result of current
nursing shortages, organizations have increasingly
turned to the use of travel nurses. (See related
article.) Is this a sustainable model? Not likely. A
Please be sure to notify us with address
changes/corrections. We have a very large list
to keep updated. If the nurse listed no longer
lives at this address – please notify us to
discontinue delivery. Thank you!
Index
Please call 603-225-3783 or
email to office@nhnurses.org with
Nursing News in the subject line.
President's Message ..............page 1
Reflections from the ED ..........page 1
Editorial .........................page 3
Legislative Update ............ pages 4-5
Nurses Night at Fenway is BACK! .. page 7
Nurses On Boards. . . . . . . . . . . . . . . . . page 8
Pappas Letter ..................... page 8
A Personal Reflection of the AWHONN
National Convention 2021 ......... page 9
The trauma of traveling nurses . pages 10-11
One Nurses Opinion ..............page 12
We See You .......................page 12
Climate Action and Health ........page 13
Welcome New and Returning
NHNA Members! .................page 13
ANA Policy Proposal .......... pages 14-19
In memory of our colleagues .. pages 22-23
sustainable transformation must be the healthcare industry
putting more value on what nurses do and the critical care
they provide. Many health care experts and advocates
lament that the current health care system under-develops,
under-utilizes and under-appreciates nurses. We need to
make this our ACA moment.
It is time to unleash the potential of nurses to revolutionize
and modernize the health care delivery system. The work
of NHNA this year will be to help nurses to transform
education by advocating for ways to move new graduates
into clinical practice in a way that they can immediately
contribute in the workplace. For example, nurse
apprenticeship models. We will advocate for tools that
increase efficiency and improve access to care such as
lobbying for parity in payment for the use of telehealth.
And finally, we will consider how we reimburse for nursing
care. Advocating for innovative care models that reimburse
nurses directly based on the lower cost, increased
accessibility, and improved outcomes of that care. We can
make 2022 a transformative year.

Page 2 • New Hampshire Nursing News March, April, May 2022
Guidelines for Submissions to NH Nursing News
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NHNA.
Vol. 46 No.2
Official publication of the New Hampshire
Nurses’ Association (NHNA), a constituent
member of the American Nurses Association.
Published quarterly every March, June,
September and December. Library subscription
rate is $30. ISSN 0029-6538
Editorial Offices
New Hampshire Nurses Association, 25 Hall St.,
Unit 1E, Concord, NH 03301. Ph (603) 225-3783,
E-mail office@NHNurses.org
Editor: Jessica Reeves, MSN, MPH, APRN
NHNA Staff
Pamela P. DiNapoli, PhD, RN, CNL,
Nurse Executive Director
NURSING NEWS is indexed in the Cumulative
Nursing Index to Nursing and Allied Health
Literature (CINAHL) and International Nursing
Index.
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Responsibility for errors in advertising is limited
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publication express the opinions of the authors;
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board, or membership of NHNA or those of the
national or local associations.
VISION STATEMENT
Inspire New Hampshire nurses as leaders to expand
the power of the nursing profession to improve the
health of the people of New Hampshire.
MISSION STATEMENT
Promote nursing practice and the wellbeing of
New Hampshire nurses by providing professional
development, fostering nurse innovation and
leading in health advocacy to enhance the health
of the people in New Hampshire.
Adopted 11-10-2021.
CORE VALUES
Caring • Integrity • Excellence
Diversity/Inclusion/Belonging

March, April, May 2022 New Hampshire Nursing News • Page 3
Jessica Reeves, MSN, MPH, APRN
As I was putting together this issue of the New Hampshire
Nursing News, I was struck by a term in Anne Frechette’s
piece – nurse mode. She mentions it in the context of the
beginning of the COVID pandemic, when supplies and
information were scarce, yet there was a job to do – and
nurses went into nurse mode.
“Regardless of your specialty,
all nurses know what nurse mode is.”
EDITORIAL
Nurse Mode
in all areas of healthcare, at all levels of licensure. I want to talk with student nurses,
new nurses, seasoned nurses, those who came to nursing later in life or as a second
career – all nurses are welcome. Tell me more about you, the setting in which you
work, what you love about nursing, what you wish could be different about nursing,
or anything else on your mind. To be a part of the conversation, drop me an email at
NewHampshireNursingNews@gmail.com.
Let’s start talking about what nurse mode is, what it could be, and how we can get
there – together.
I am glad to be here, and I am glad that you are, too.
And here we are, two years later – with nurse mode in
full effect, day in and day out. We may have overcome
that initial shortage of PPE or lack of understanding of
Jessica Reeves
COVID and how to treat it, but still we find ourselves in
our day-to-day professional lives with so many things that require nurse mode. Staffing
shortages, severe testing of the limits of our resiliency, staffing ratios, burnout, The
Great Resignation, the list goes on. Simply being there for each other as nurses and
colleagues is an element of nurse mode, though this has become more challenging as
we continue to ride the waves of COVID and its surges, and as we pick up the pieces
that each of these surges leave in its wake.
I am new in this position as editor for the New Hampshire Nursing News, and I want
to know more about who is reading, why they are reading, and how we can best go
into nurse mode for each other. In future editions, I want to spotlight nurses working
Challenges in the Nursing
Workforce, Graduate Nursing
Education, and Future of Nursing
Take care,
Jessica
New Editor
March 2022 marks the first edition of the New Hampshire Nursing News with
Jessica Reeves, MSN, MPH, APRN in the editor role. She takes the reins from Sue
Fetzer, RN, PhD, who was editor of the New Hampshire Nursing News for the
previous 15 years. “While these are big shoes to fill, I am pleased to have the
opportunity to serve and support my fellow nurses in this way,” says Reeves.
Jessica earned her Masters degree in Nursing at Simmons College, and Masters
degree in Public Health at Dartmouth College. She is a Family Nurse Practitioner
with a background in reproductive health, family health, and behavioral health.
Her professional interests are centered on the health of her fellow nurses as
much as that of her patients; in service to that, she also coaches nurses and
has published her first book, Secrets From The World’s Most Productive Nurse
Practitioner, in spring 2021. “One of my favorite things about nursing is the
variety,” she says. “There is always something new to learn, a new role to take on.
There are so many things that it can mean to say, ‘I am a nurse.’”
Georgianna Thomas, D.Ed., MSN, RN
Somi Nagaraj, DNP, MSN, RN, CSSGB, CONTL
Reprinted with permission from Illinois The Nursing Voice September 2021 issue
The healthcare sector is an intricate, albeit fundamental, part of ancient and modern
societies. It comprises a long list of agents, from the individual seeking healthcare services
to the medical staff and nurses, all operating within a legal framework involving providers,
consumers, insurance companies, government, medical schools, nursing schools, and
regulatory institutions (Amorim Lopes et al., 2015).
The healthcare market is always composed of both suppliers of health services and patients
demanding their services. On the one side is the workforce of physicians, nurses, and
remaining clinical staff educated according to standards and criteria, ready to assist those
in need. On the other side stand the forces that drive the demand for medical services,
strongly related to demographic, socioeconomic, and epidemiological factors. Analyzing
these two market forces is a critical step in assessing whether the available health care
human resources are enough in quantity and skills to meet the current and future demand
in due time and may lay solid foundations for further research, considering perhaps changes
to the existing health policy framework (Amorim Lopes et al., 2015).
A high degree and extent of uncertainty affect supply and demand: asymmetric information
between physicians, nurses, and patients, restrictions on competition, an aging workforce
in all areas, strong government interference, and supply-induced demand are some of the
most glaring differences that can be pinpointed. These may be relevant when assessing
the impact of any policy involving Healthcare Human Resource [HHR] planning (Amorim
Lopes et al., 2015).
Supply
Supplying human capital with the appropriate expertise to enable workers to perform
and satisfy the demand for health care is no simple task. The time and effort required to
equip HHR, especially physicians and advanced nurse practitioners, exceeds most other
professions. In some particular healthcare professions, the set of necessary skills to qualify
for medical practice is acquired through extensive academic learning, which involves
enrollment in long courses that may take up decades to complete due to a strict licensing
process. The analysis of the medical and nurse education process is relevant but may be
insufficient, as several other factors may affect the efficiency and effectiveness of the care
services delivered (Amorim Lopes et al., 2015).
Despite the limitations, some measures to overcome imbalances in the quantity (number)
of physicians and nurses have already been identified in the health policy literature (Chopra
et al., 2008), namely the following: increasing the number of domestic- and foreigntrained
medical graduates or increasing the number of medical and nursing schools and
classroom sizes; increasing the enrollment limits; reducing the requirements for entry to
medical and nursing schools; raising the wages of the medical and nursing staff, as well
as the perspectives for their future career path; or reducing the costs of attending medical
and nursing school, which may encourage potential students to enroll. These proposals
Challenges in the Nursing Workforce continued on page 21

Page 4 • New Hampshire Nursing News March, April, May 2022
LEGISLATIVE UPDATE
Legislative Advocacy and The Annual Town Hall Update
The second year of the biennial New Hampshire Legislative process began in
earnest in the fall of 2021 with the submission of over 2000 pieces of legislation
submitted for House and Senate consideration. The work of the Commission
on Government Affairs initially reviewed and prioritized over 800 pieces of
legislation with our lobbyist Shaun Thomas of the Demers and Prasol Firm.
With this preparation, the Commission on Government Affairs (CGA) held
their annual Legislative Advocacy Training to lay the groundwork for the 2022
legislative hearings. The Legislative Advocacy Committees (LACs) played a key
role in planning the Annual Town Hall and advocacy and education efforts. The
four LAC’s (see related article) culled the bills initially prioritized to just over 50
pieces of legislation for review. As expected, the majority of the bills reviewed
were related to vaccination, specifically COVID-19 mandates. During their first
work session, over 57 CGA and LAC members contributed to narrowing the
number of bills to 21 for presentation at the January 18, 2022, NHNA Legislative
Town Forum (Table 1). Each piece of legislation was thoroughly vetted, scanning
for scientific evidence to develop NHNAs position always keeping in mind the
mission and vision of NHNA in protecting the public’s health.
Facilitated by Pamela DiNapoli, NHNA Executive Director and Marcy Doyle,
Chair of the Commission on Government Affairs, the Annual Legislative Town
Hall was held virtually on January 18th from 5:30-8:00 with 120 participants in
attendance. NHNA recognizes that attendance was lower than previous years
owing to the demands on the nursing workforce. Another reason for lower
attendance was fewer student attendees whose semester had not yet started.
There is a Zoom recording of the forum available on the NHNA website for
those interested.
The session opened with a brief review for attendees of the legislative process
given by Shaun Thomas and Dr. Doyle. A review of the American Nurses
Association’s (ANA) federal legislative priorities was provided by Mary
Benke, and Marsha Davidson. Ms. Benke and Ms. Davidson were NHNA’s
representatives to ANA’s 2021 Advocacy Institute. The two highlighted the
Future Advancement of Academic Nursing (FAAN) Act (S.246/H.R. 851), and
the important Lorna Breen Health Care Protection Act (S.610/H.R.1667). The
first piece of legislation would invest $1 billion into nursing schools, including
schools in medically underserved communities, health professional shortage
areas, and minority serving institutions. Ms. Davidson highlighted the need for
such investment noting that the “Bureau of Labor Statistics projects the need
for RNs to increase 7% and for APRNs to increase 45% by 2029.” Ms. Benke
presented the second piece that will promote mental and behavioral health
among nurses and other health care professionals specifically this ACT will:
• identify and disseminate best practices to reduce and prevent mental and
behavioral health conditions, suicide, and burnout
• increase access to evidence-based treatment for nurses and other health care
professionals
• encourage health care workers to seek assistance when needed
As we are entering the third year of the Covid-19 pandemic, it is no surprise
that the NH Legislature has filed many bills that address aspects of our public
health system. The Public Health LAC, with co-leads Katie Lajoie and Polly
Campion, was challenged with sorting through the more than 30 vaccine related
bills, as well as many others addressing potential requirements regarding invasive
testing, hospital visitation, remote access to meetings of public bodies and a
dental benefit for Medicaid beneficiaries. Each presentation aimed to share
the substance of each bill, or set of bills, in a manner that balanced the goal
of protecting human health and lives of individuals, families, communities and
populations with the potentially conflicting right to personal autonomy. The
other LACs had fewer but no less important bills to present impacting maternal
and child health, licensure, and behavioral health. Table 1 represents a list of all
the bills presented. At the conclusion of the forum attendees were asked to rank
in order of importance (1=least – 10=most) to guide CGA and LAC efforts going
forward on behalf of the membership.
TABLE 1: Legislative Town Hall Forum Bill Rankings
Bill TITLE LAC
HB1017/2013
HB1633/2049
HB1224/2361
HB1233/2426
HB1351/2631
establishing criminal penalties for
harming or threatening to harm an
essential worker.
relative to requiring COVID-19
vaccination for school attendance.
prohibiting state and local governments
from adopting certain mandates in
response to COVID-19; and prohibiting
employers and places of public
accommodation from discriminating on
the basis of vaccination status.
prohibiting higher education institutions
receiving state funds from requiring face
masks and COVID-19 vaccinations for
attendance.
prohibiting certain employers from
requiring a COVID-19 vaccination as a
condition of employment.
Mental Health/
Behavioral Health
Maternal and
Child
NHNA
Position
Support 8.36
Support 7.03
Public Health Oppose 6.92
Public Health Oppose 6.89
Public Health Oppose 6.77
Ranking
(most important
to least)
HB255
HB 1210
HB1604/2142
SB 422/HB 103
HB1332/2458
HB1014/2054
SB277/2939
HB1659
HB1030/2372
HB1260/2141
HB1379/2527
HB1358/2789
SB222/2896
HB1606/2150
HB1035/2182
relative to prohibiting vaccine mandates
by New Hampshire employers. -
RETAINED
relative to exemptions from vaccine
mandates.
including state medical facilities in the
statute providing medical freedom in
immunizations.
an act establishing an adult dental
benefit under the state Medicaid
program.
excepting public universities and
colleges from requirements under
medical freedom in immunizations.
allowing public meetings to be
conducted virtually.
relative to emergency or temporary
health care licenses.
relative to criminal history background
checks for certain health care workers.
relative to licensure by alternate
experience for licensed nursing assistant.
making immunization status a protected
class.
relative to the department of health and
human services' rulemaking authority
regarding immunization requirements.
requiring public and private employers
to establish procedures and exceptions
for the use of mandatory intrusive testing
as a condition of new or continued
employment.
permitting licensing boards to conduct
remote meetings.
making the state vaccine registry an optin
program.
relative to exemptions from school
vaccine mandates.
Public Health Oppose 6.69
Public Health Oppose 6.62
Public Health Oppose 6.57
Public Health Support 6.52
Public Health Support 6.47
Public Health Support 6.42
Practice Support 6.31
Practice Support 6.2
Practice Support 6.19
Public Health Oppose 6.18
Public Health Oppose 6.1
Public Health Oppose 6.05
Public Health Support 6
Maternal and
Child
Maternal and
Child
Oppose 5.83
Oppose 5.74
HB1439/2492 relative to hospital visitation policies. Public Health Support 4.69
Following a report on current bills, the participants were asked to opine on two issues
that NHNA has not historically advocated legislating. While NHNA has published
statements regarding these issues to inform individual member decision making, we
have not offered testimony or advocated for support or opposition. These two issues
are Cannabis and Reproductive Rights.
Reproductive Rights
Historically, right to abortion in NH has had bipartisan support. Gov. Sununu ran on a
pro-choice platform. New abortion law was signed and tied with state budget for 2022
which allowed for abortion to be ruled a felony after 24 weeks with no exception
made for rape or incest or fetal abnormalities. Further it mandates that an ultrasound
be performed to verify gestational age prior to abortion. As a result, NH Executive
Council defunded Planned Parenthood and family planning centers, which includes
sexually transmitted infection screening, contraceptive care, and cancer screening for
men and women. These current laws and actions disproportionally affect vulnerable
women, women of low socioeconomic status, Medicaid recipients, and women
of minority population. Seventy five percent of women obtaining an abortion are at
or below the federal poverty level yet NH Medicaid will not cover services for an
abortion, the ultrasound, or procedure.
Two relevant pieces of legislation have been introduced including:
• CACR18
• This is a constitutional amendment that the right to make reproductive
medical decisions is inviolate and prohibits the state and its political
subdivisions from infringing upon or unduly inconveniencing this right.
AND
• SB399
• This senate bill repeals the fetal health protection act (prohibits a health care
provider from performing an abortion after 24 weeks except in the case of a
medical emergency.) Further the bill removes felony offense which will save
the state time, money, and resources in legal and judicial fees. This reverts to
the legal status of abortions in 2021.
NHNA has not taken a formal position; however, NHNA supports legislation that is
congruent with the ANA code of ethics.
ANA statement for reproductive health issues, “Healthcare clients have the right
to privacy and the right to make decisions about personal health care based on full
information and without coercion.”
The ANA Code of Ethics provision three states that “nurses promote, advocates for, and
protects the rights, health and safety of the patient.” Provision eight and nine further state
nurses must “promote human rights, health diplomacy” and “social justice.”

March, April, May 2022 New Hampshire Nursing News • Page 5
LEGISLATIVE UPDATE
Cannabis Legislation
In March of 2019 NHNA published a position paper consistent with other professional
associations which essentially said:
“NHNA believes that it is imprudent to legalize recreational marijuana. Legalization
of recreational marijuana does not promote the health and wellbeing of New
Hampshire residents.”
This year despite the number of cannabis bills in the legislative process (see Table 2)
NHNA has again not taken a position. We recognize that our border states, Maine,
Vermont, Massachusetts, New York, and Connecticut all make cannabis legal. This is
likely to influence the way the legislators vote on the pending bills.
Below Table 2 summarizes the number of studies presented this year relative to
Cannabis:
BILL POSSESS USE GROW SELL COMMENTS
CACR 20 x x Applies to adults
CACR 34 x x x x
CACR 35 x x x
HB 1306 x x
HB 1348 x x x
HB 1468 x x
HB 1598 x x x x
The state shall make no law prohibiting
the use, sale, or cultivation of cannabis for
persons over 18 years of age.
Applies to adults
Requires legislative regulation
Applies to persons > 21
Allows 1 ounce cannabis, 5 grams hashish
Applies to adults
Allows 1 ounce cannabis, 5 grams hashish
Allows home cultivation
Applies to persons > 18
Deletes cannabis from Controlled Drug
Schedule
Applies to persons > 21
Calls for regulation similar to alcohol
Allows registered cultivation facility
Prohibits personal cultivation without
legal authorization
NHNA will continue to work with coalition partners to advocate with written
testimony and remote sign on, but will not likely present oral testimony on the bills in
Table 3 and others that may be submitted during the session.
Table 3: Watch Bills
SB 288
SB 384
SB 300
SB 382
SB 390
SB 228
SB 335
SB 313
HB 1536
HB 1578
SB 407/3089
HB1444/2506
r/t prohibiting schools and childcare centers from vaccine mandate
requiring notification of hands-free law
r/t commission on human rights
r/t licensure requirements for telehealth services
prohibiting discrimination against victims of domestic violence
r/t regulation and practice of physician assistants
r/t regulation of bottled drinking water
relative to the authority of the office of professional licensure and certification to
establish fees
r/t expanding Medicaid to postpartum services
r/t Medicaid and children’s health program
r/t expanding Medicaid to postpartum services
r/t registration of med spas
Thank you to the Board of Directors and Dr. Dinapoli for her guidance and support.
Finally, a special thank you to all of the CGA and LAC members that planned for the
Town Hall event. Their ongoing commitment to the welfare of NH as evidenced
by learning, mentoring, testifying, and writing all while working (one or more jobs),
coming out of retirement to work and volunteer is inspiring. I am honored to be a part
of this profession and NHNA.
Respectfully Submitted,
Marcy Doyle on behalf of the Commission on Government Affairs

Page 6 • New Hampshire Nursing News March, April, May 2022
Members of the Commission on Government
Affairs and Legislative Advisory Council Members
Commission on Government
Affairs
Legislative Advisory Council:
Maternal/Child Health
Legislative Advisory Council:
Public Health
Legislative Advisory Council:
Licensure
Legislative Advisory Council:
Mental Health/Behavioral Health
CHAIR: Marcy Doyle, DNP,
MHS, RN, CNL
Clinical & Quality Improv.
Director, UNH
Lead: Carla Smith, MSN, RN,
NCSN, GCPH
Assistant Professor of Nursing,
MCPHS University
Lead: Katie Lajoie, BSN, BA, RN
Retired RN & Volunteer
Lead: Judith Odom, MSN,
RN, CCRN
Concord Ambulatory Care
Marsha Davidson, BSN, RN
RN DHMC
Carla Smith, MSN, RN,
NCSN, GCPH
Assistant Professor of Nursing,
MCPHS
April Phelps
Clinical Assistant Professor of
Nursing, UNH
Co-Lead: Polly Campion,
MS, RN
Retired State Rep.
Linda Compton, MS, RN
School Nurse
Julie Gilston, RN
Portsmouth Hospital
Barbara Cormier, MSN, RN
Nursing Professor, MCC
Melanie Tidd
Marcelo Casteo
MBA, BSN, RN, RRT-NPS,
NEA-BC
Patricia Lazarre, RN
Retired
Bonnie Lee Fecowicz
Marsha Davidson, BSN, RN
Staff Nurse, DHMC
Nicole Tadlock Ellen Rearick, Ph.D., RN, CCM Allison Davidson, MSN, RN Nicole Ineson
Polly Campion, MS, RN
Retired State Rep.
Dawn Guilbeault
Candace McWhirter Davis,
MSN, FNP-BC, CCRN
Director, Nurse Practitioner
Residency Program
Karen Perry, BSN, RN, PCCN
Portsmouth Regional Hospital
Katie Lajoie, BSN, BA, RN
Retired RN & Volunteer
Mary Garces
Angela Braswell, MS, RN,
CWOCN, CNL
Debra Hastings
Judith Odom, MSN, RN, CCRN
Staff Nurse, Concord
Ambulatory Care
Karen Perry, BSN, RN, PCCN
Portsmouth Regional Hospital
Mary F Behnke, BSN, RN
NH Professionals Health Program
Susan Smith, BSN, MHA, NEBC
Carol A. Townsend, BSN, RN
Director of Nursing
Emese Nemeth Amanda Hodges Carol Townsend BSN, RN
Bonnie Crumley Aybar, MSN,
CPAN, FRE
VA Medical Center
Sandra Pascucci
Elizabeth Martell
Amanda Fay
Lisa Kennedy-Sheldon
Rachel Hough

March, April, May 2022 New Hampshire Nursing News • Page 7
New Hampshire Nurses Association COVID-19,
Nursing Ethics, and the Core Tenets of Public
Health Nursing
During this legislative session lawmakers introduced
fourteen vaccine bills, with only HB 1332 1 seeking to grant
more authority to mitigate COVID-19's transmission. The
remaining thirteen bills, under the guise of bodily autonomy
and personal freedom, are anti-mandate mandates that
are also anti-science. These developments underscore the
need for nurses to refocus on the Nursing Code of Ethics 2
and on public health nursing 3 with its emphasis on primary
prevention and on achieving “the greatest good for the
greatest number of people or the entire population.” In
other words, COVID-19 is about “us,” not “me.”
THE NURSING CODE OF ETHICS:
COUNTERACTING MISINFORMATION
The National Council of State Boards of Nursing has
released a Policy Statement 4 that addresses a nurse’s ethical
obligation to counteract misinformation about Covid-19.
Nurses are expected to:
1. Be prepared to practice from an evidence base;
2. Promote safe, quality patient care;
3. Use clinical/critical reasoning to address simple to
complex situations; and
4. Assume accountability for one’s own and delegated
nursing care.
According to the statement, dissemination of misinformation
“jeopardizes the health and well-being of the public” and
may put a nurse’s “license and career in jeopardy as well.”
The Covid-19 pandemic has nurtured hostility toward
health care professionals and their desire and obligation
to provide science-based care. This hostility can lead
to distress among nurses who have rightfully enjoyed
high praise and support from the public. As one New
Hampshire ICU nurse stated: “Historically, one of the most
trusted professions. To feel like we’ve lost the trust of the
public is very disheartening for our staff.” 5
During these difficult times, nurses must support each other
and must challenge threats to our professional practice.
NHNA recommends that all nurses revisit the ethical and
science-based principles that are the foundation of the care
we provide daily to the citizens of New Hampshire.
For more information: 6
Getting on Board with Vaccinations
The Future of Nursing 2020-2030: Valuing Community and
Public Health Nursing
How ICU Nurses Are Surviving COVID-19-related Moral
Distress
ENDNOTES
1. New Hampshire House Bill 1332. (2022 Session). An
act excepting public universities and colleges from
requirements under medical freedom in immunizations.
http://www.gencourt.state.nh.us/bill_Status/pdf.
aspx?id=27828&q=billVersion
2. American Nurses Association. Code of ethics for
nurses. https://nursing.rutgers.edu/wp-content/
uploads/2019/06/ANA-Code-of-Ethics-for-Nurses.pdf
Source: American Nurses Association. (2015). Code of ethics
with interpretive statements. Silver Spring, MD: Author.
https://www.nursingworld.org/coe-view-only
3. American Public Health Association. (2020, October). What
is public health nursing. https://ncpublichealthnursing.org/
wp-content/uploads/2020/10/PHN-Manual-What-is-PH-
Nursing-10012020-Final.pdf
4. National Council of State Boards of Nursing. (2021,
December 2). Dissemination of non-scientific and misleading
COVID-19 information by nurses [Policy statement]. https://
www.ncsbn.org/PolicyBriefDisseminationofCOVID19Info.
pdf
5. Sullivan, A. (2021, December 29). Nurses stressed, frustrated
as COVID patients continue to fill hospitals. WCAX3. https://
www.wcax.com/2021/12/29/nurses-stressed-frustratedcovid-patients-continue-fill-hospitals/
6. Kennedy M. S. (2021, October). Getting on board with
vaccinations. The American journal of nursing, 121(10), 7.
https://doi.org/10.1097/01.NAJ.0000794188.04965.a8
National Academy of Medicine. (2021, May). The future of
nursing 2020-2030: Valuing community and public health
nursing [Report Brief]. https://www.phnurse.org/assets/docs/
FON%20Valuing%20Community%20and%20Public%20
Health%20Nursing.pdf
Wood, D. (2021, June 9). How ICU nurses are surviving
COVID-19 -related moral distress. Nursing News. https://
www.americanmobile.com/nursezone/nursing-news/howicu-nurses-are-surviving-covid-19-related-moral-distress/
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Page 8 • New Hampshire Nursing News March, April, May 2022
Nurses On Boards
Pappas Letter
NHNA member Rachel M. Hough MSN, CAGS, APRN,
FNP-BC has been elected to serve on the Nursing
Advisory Board for Sureset, a division of MedicaMetrix.
Rachel has been selected as one of the founding
members of the SureSet Nurse Advisory board. As part
of her role, Rachel is providing medical, professional,
and marketing feedback for the company’s line of
SureSet Devices. SureSet is creating a line of IV and
catheter securement devices using their “Safe-Track
Strain Relief Technology” with plans to begin national
and international distribution in early-2022. “We felt that
Rachel’s experience as a nurse would benefit our board
immensely,” said Perry Borch, SureSet’s Director of Sales
and Business Development, “and her experience in both
home care and oncology have been a huge resource for us.”
Rachel M. Hough
Rachel Hough has nearly eight years of experience caring for patients in areas
such as oncology, home infusion therapy, school nursing, long-term care, skilled
nursing care, and nursing education. She works full time as a Nurse Practitioner
in a SNF in addition to being a part time Clinical Associate at Vermont Technical
College.
Hough states the reason why she volunteered for the Nurses on Boards Coalition is
because she has always “been passionate about giving back.” She says her service
goal is to “impart a passion for nursing in such a way that it contributes to the
entire community.” Currently, she volunteers on the NHNA Legislative Advocacy
Council in addition to her Nurse Advisory Board position at Sureset.
Hough holds a BA in Biology from Wright State University, an ASN from St. Joseph
School of Nursing, a Master’s in Nursing Education as well as a post-Master’s
certificate from Rivier University as a Family Nurse Practitioner. She continues to
pursue her education at Rivier where she is currently enrolled in their Doctorate of
Nursing Practice program.
As a single mom of two young boys, an outdoor enthusiast and a nurse
practitioner in a variety of settings, Hough juggles her family life, profession and
volunteer work for one good reason —“I have had incredible mentors throughout
my career and I believe it is part of my professional responsibility to pay it
forward.”
About the Nurses on Boards Coalition
The Nurses on Boards Coalition was created in response to the 2010 Institute of
Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health,
that recommended increasing the number of nurse leaders in pivotal decisionmaking
roles on boards and commissions that work to improve the health of
everyone in America.
The Coalition’s goals are to help ensure that at least 10,000 nurses are on boards
by 2020 (achieved), as well as raise awareness that all boards would benefit from
the unique perspective of nurses to achieve the goals of improved health, and
efficient and effective health care systems at the local, state, and national levels.
Nurses that are currently serving on a board, or who would like to be considered
for a board seat, are encouraged to visit nursesonboardscoalition.org to learn
more.
For more information about Sureset please visit www.SureSetSecure.com
Mr. Jeffrey Zients
COVID-19 Response Team Coordinator
The White House
1600 Pennsylvania Ave., NW
Washington, D.C. 20500
Dear Mr. Zients:
The current surge in COVID-19 cases fueled by the Omicron variant continues
to put incredible strain on our health care system, particularly the supply of
desperately needed hospital staff, including nursing staff. The situation has
affected every state and every corner of the nation, challenging hospitals’
ability to care for their patients due to these dire workforce concerns. The
persistent strain of the pandemic has required many hospitals to rely on nursestaffing
agencies to supply urgently needed staff to care for the increasing
number of patients.
We are writing because of our concerns that certain nurse-staffing agencies
are taking advantage of these difficult circumstances to increase their profits
at the expense of patients and the hospitals that treat them. We urge you to
enlist one or more of the federal agencies with competition and consumer
protection authority to investigate this conduct to determine if it is the product
of anticompetitive activity and/or violates consumer protection laws.
The situation is urgent and the reliance on temporary workers has caused
normal staffing costs to balloon in all areas of the country. We have received
reports that the nurse staffing agencies are vastly inflating price, by two,
three or more times pre-pandemic rates, and then taking 40% or more of
the amount being charged to the hospitals for themselves in profits. We have
heard the amounts charged to hospitals rose precipitously as the newest wave
of the COVID-19 crisis swept the nation and the agencies seemingly seized
the opportunity to increase their bottom line. But this is not the first time the
agencies have engaged in this sort of conduct. As the first wave of COVID-19
swept the nation in 2020, they similarly inflated their prices to hospitals.
Hospitals have no choice but to pay these exorbitant rates because of the dire
workforce needs facing hospitals around the country.
Thank you for your attention to the matter, these costs are simply
unsustainable for many health systems across the country. We urge you to
ensure that this issue gets the attention from the federal government it merits
to protect patients in dire need of life-saving health care treatment and prevent
conduct that is exacerbating the shortage of nurses and straining the health
care system. We look forward to your response.
HUMOR ME
Regularly exercising our sense of humor improves resiliency, positivity and
balances anti-negativity. Laughter may not solve problems but can change
your chemistry allowing you to face them anew. Submissions are welcome.

March, April, May 2022 New Hampshire Nursing News • Page 9
A Personal Reflection of the AWHONN National Convention 2021
Anne Frechette MSN, RNC-MNN
This was the first national convention I attended
completely online. I definitely was able to connect
and engage with other nurses across the country
using the chat feature in rooms during the convention
hours. They had challenges to keep people engaged
and there were definite benefits to online: decreased
registration fees, convenience of not having to travel or
keep up appearances. That being said, I have attended
several live conventions and I love to travel, so felt it
was a missed opportunity for lived experiences for me
personally. However, as we have learned over the past
almost two years… we can do things differently and we
can be okay with it.
The presentation I got the most out of from the entire
convention was the first opening general session
presentation titled Managing Chaos, Cultivating Calm by
Ginny Beeson. I have seen her speak before on other
topics, and always find her presentations fruitful. This
presentation was really reflective of my life as a clinical
nurse manager since the pandemic began. Chaos has
been present since the toilet paper shortage. It was the
first time I can recall that the unknown was present in all
aspects of my life and it was hard to escape. There were
so many unknowns at work and at home. It became a
very scary time. How do you unplug when there was so
much unknown?
tools of resiliency to deal with a worldwide pandemic
and all it has thrown at us. On a personal note, I
began to really incorporate some resiliency tools into
my daily practice a few months before COVID hit,
and I am forever grateful I did, as I truly believe that is
what made the difference for me. I practice resiliency
on a daily basis and have hardwired many different
techniques into my daily life that have definitely helped
me to be more resilient and allowed me to not only
remain a nurse during such time, but also helped
me to remain grounded, have gratitude, and fully
appreciate how lucky I am to be part of a profession
that has provided care and support to women during
life changing events in very scary times. In obstetrics,
we didn’t get to shut down and stay home when the
world was on pause trying to figure out next steps. We
had to go on with business as usual, and figure out how
to navigate our new normal, all while providing even
more emotional support to our labor and postpartum
patients who were sometimes limited to having no
personal or family supports during and immediately
following childbirth. It didn’t matter if we were out of
supplies (things we never had to deal with as a nurse
on such a level as we saw during COVID), babies still
came in to the world, and for the hospital I work at, at
a rate that was going up, not down.
Ginny’s presentation really highlighted stories of some
amazing nurses and about being flexible and relying
on nurse mode. Regardless of your specialty, all nurses
know what nurse mode is. It is how all nurses can fully
relate to each other. It reminded me of why the world
viewed nurses as heroes and I have never been more
proud to be part of a profession.
In the presentation Ginny referred to five ways that
leaders and nurses can manage the chaos and cultivate
the calm. Her presentation hit home for me. The five
ways included teamwork, passion, shared leadership,
resiliency, and courage. While those terms weren’t new
information or terminology for me, I learned how great
things can be when they are all put together. Ginny’s
presentation reminded me of my “why.” Sometimes we
need a little shake up to remind us of our why. It can be
so powerful and rejuvenating when we can reflect back
on our why. To reignite that passion for nursing was so
helpful. I was not like some nurses who knew from a
young age they were born to be a nurse. Being a nurse
was never something I intended to be, yet nursing found
me, and I always say that being a nurse is what I was
meant to be all along, I just didn’t know it. It is more
than a career, it is a passion and reflecting back on my
why reminded me of that.
The other piece of the presentation that really hit home
for me was resiliency. I had attended a resiliency
workshop in early Fall of 2019… a few short months
before the world was introduced to COVID-19. It was
during that workshop I learned what resiliency was,
and how important it can be in combating burnout.
Little did I know just how much I would need those
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Page 10 • New Hampshire Nursing News March, April, May 2022
The trauma of traveling nurses —
a tug between supply and demand
Roberta Baker, The Laconia Daily Sun
Jan 17, 2022 | Updated Jan 17, 2022
LACONIA — Gerie Pingol, 53, was trained as
mechanical engineer in the Philippines, his native
country. But when his degree and experience didn’t
translate to a career in the U.S, he tapped an inner talent
and an abiding interest: his love of people — especially
elders in need of care, empathy and patience.
“As a Filipino, it’s normal for us to take care of
older people, and normal for us to take care of our
grandparents,” said Pingol, a green card holder who did
an about-face from manufacturing.
For the last six years, Pingol has worked as a licensed
practical nurse, or LPN, on staff at Belknap County
Nursing Home — a job he never envisioned, but
has discovered fulfillment in — including during the
turbulence of COVID-19.
“At Belknap County Nursing Home, the residents are
very nice so it was easy to change my career,” he said.
“Working at the nursing home is like my second home.”
To the patients, Pingol is a blessing. To BCNH, he
is a godsend — a dependable staff caregiver during
unprecedented times: the pandemic never actually
passes, but ebbs temporarily, only to return around the
corridor with vigor or a variant.
Skills and heart aren’t the only value Pignol and stalwart
nurses bring in these times. As the pandemic wears
on, burnout and disillusionment run high, along with
temptations to travel or work elsewhere for higher pay.
Health care facilities in New Hampshire and nationwide
are grappling with ways to attract and retain nurses at
all levels. Solutions range from boosting wages to workstudy
agreements, subsidizing education, and improving
benefits.
In the simmering emergency that COVID-19 spawned,
coupled with an exodus of retiring nurses and others
lured by easier jobs or less stress in related careers,
traveling nurses have emerged as a lifesaver and last
resort for facilities plagued by chronic staff shortages.
But the use of exorbitantly paid transients is a doubleedged
sword, according to health care administrators
and staff.
“We love traveling nurses,” said Mike DellaVecchia,
now a staff nurse in emergency room at Huggins
Hospital in Wolfeboro. Without them, over-worked
nurses would endure longer shifts and weeks without
a break, he said. But “paying rental doctors and rental
nurses is not sustainable. The traveling nurses aren’t
making all the money. It’s the big agencies,” said
DellaVecchia, who worked as traveling nurse between
Florida and New England for 18 years. He said he
makes more money now, especially with overtime,
because travelers have periods without pay between
assignments.
It's a thorny issue. Traveling nurses enable facilities to
keep beds open, and occasionally admit new patients.
But they can cost two to three times what a staff nurse
is paid, and their contracts usually expire after 90 to
180 days, requiring replacements, or an extension of
their contract. When staff nurses leave, some return
to their original employers for temporary assignments
that pay double what they previously earned. Hourly
rates become a matter of supply and demand, and they
fluctuate. Staffing agencies collect hefty fees and one
of the first questions they ask health care administrators
whose backs are against the wall: How much are you
willing to pay?
The pandemic ushered in bidding wars, not unlike
those in real estate – and a whole new level of financial
precariousness.
“The cost of travelers is enormous,” said Pam DiNapoli,
executive director of the New Hampshire Nurses
Association. “And they don’t have to come from out of
state. They can come from Catholic Medical Center,
going to Elliot Hospital” in Manchester. “We need to
incentivize people to stay at their home organizations.”
Traveling LNAs, LPNs and RNs from staffing agencies
have always cost much more to hire, but COVID-19
dissolved any invisible, fragile ceiling that may have
existed before. The cost of traveling nurses has vaulted
120% since the pandemic started, said DiNapoli. That
translates to one traveling nurse for the price of two
to three staff nurses — sometimes four. This is bad
economics especially for nursing homes that depend
on the state’s Medicaid reimbursements, which don’t
come close to covering the actual costs of caring for
chronically ill and elderly patients, most of whom have
run through their life savings. At county-owned nursing
homes, the percentage of patients on Medicaid is 75.9%
— 80 to 85% at BCNH, when the facility is full.
Hospitals are also hard hit, and strapped to compete
with the rates of travelers.
Price gouging in a free market that is not free
DiNapoli said the rationale is, "If I’m going to work this
hard, I want to be compensated." Some traveling nurses
make $125 an hour compared to staff members who
have stayed and are making $50 or less plus benefits,
with more experience at the job.
One large out-of-state staffing agency, which books
traveling nurses nationally through its website, allows
facilities to press a button to automatically outbid what
another facility is offering elsewhere in the country.
Nurses who travel are typically not grounded by family
commitments, or bound to a facility by health insurance,
retirement benefits or workplace culture, or by loyalty
to patients or co-workers. Some have their housing and
travel expenses paid through tax-free vouchers.
When they arrive on a new turf, sometimes with less
training and experience, their presence can dampen
morale among loyal staff. They require on-site training,
just like any newbie.
Most staff members are happy to do some mentoring,
but over the long haul, it can be demoralizing to train
someone who is making a lot more money and is less
prepared to hit the ground running.
“It can cause a lot of friction where you work,” said Di
Napoli. “It’s become a national issue. We have a lot of
conversations about what this is doing for quality of care.
You have inexperienced nurses coming into a setting
they don’t know, taking care of the sickest of the sick.”
Then there’s staff attrition. Some nurses are lured away
by what amounts to a gold-rush size paycheck for
temporary commitments in the high-stress, high-risk
work environment of the pandemic.
Agencies are taking advantage of a free market that is not
actually free, but tied to fixed rates of reimbursement,
health care experts say.
Ethics vs. economics
“Some people are calling to say it’s an ethical issue
because people are charging so much,” said DiNapoli.
“It’s a form of price gouging. They’re taking advantage of
the times.”
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Brendan Williams, president of the New Hampshire
Health Care Association, which represents 58 nursing
homes, nine assisted living facilities and five continuing
care retirement communities, said traveling nurses have
become the solution du jour where there a few if any
alternatives. In long term care, “It’s absolutely essential
because we don’t have other options. Even though
facilities have raised wages, none of that matters if you
can’t find licensed professionals in your community. In
order to cover your shift, you have to go with staffing
agencies. It’s predatory pricing. They play a lot of
games,” he said.
County nursing homes in the southern tier of the state
were quoted $50 an hour for a traveling nurse assistant,
or LNA, whose rate in New Hampshire typically varies
between $14 and $18 an hour. “You tack on $20 if you
have COVID in the facility,” said Williams.
Some agencies book nurses with more than one
provider, which prompts a last-minute price war with
hospitals and nursing homes bidding against each other,
said Williams. "It’s really a marketplace of desperation at
this point. And it’s unsustainable.”
“Staff leave and return to your building as a traveler for
an out of state staffing agency. It’s like we’re swirling
down the drain and there’s no end in sight. Medicaid
doesn’t cover normal nursing costs, let alone traveling
nurses,” said Williams. “You have no choice other than
utilizing pirates. You’ve got to cover your shifts.”

March, April, May 2022 New Hampshire Nursing News • Page 11
The cost of travelers leaves little or no money to expand total nursing staff, which would
enable long term care facilities to admit new residents. Occupancy at New Hampshire’s
13 county nursing homes hovers at roughly 75% – about 65% in Belknap County.
“There’s enough beds,” said Williams. “There’s just not enough staff.” That
reverberates for hospitals, which cannot release eligible patients to long term care.
“Hospitals get jammed up,” said Williams. To health care facilities squeezed at both
ends, “It feels like an extinction event.”
Traveling nurses have been hired for public health assignments, too, manning
COVID vaccination sites and working as members of strike teams to provide
emergency health care coverage around the state.
Is intervention required to staunch the climbing costs?
Regulating costs in a free market
The state of Massachusetts currently regulates what health care staffing agencies can
charge, much like utilities. Texas also has controls that limit what traveling nurses
can be paid. Minnesota is currently looking at price ceilings. In the meantime, the
American Healthcare Association has filed a complaint with the Federal Trade
Commission. Williams said he hopes the New Hampshire’s consumer protection
laws will enable the NH Attorney General’s office to take up the cause also.
In terms of changing the landscape, the pandemic has functioned as a rapidly
moving glacier, the stuff of science fiction, exaggerating and accelerating staffing
and cost problems that had been brewing long before. In some cases, hospitals can
pass along costs to consumers in the form of larger bills, but that’s not possible for
nursing homes. Medicare and private-pay consumers already help subsidize the cost
of caring for otherwise uninsured Medicaid patients, many of whom are indigent.
“We’ve all become vulnerable during this pandemic,” said Williams. “And then the
vultures descended. And now we can’t shoo them away.” New Hampshire is one of
the best states in the country in terms of vaccination rates for nursing home staff and
residents, he said. “The staffing crisis is the second wave of the pandemic. We just can’t
find people. It’s like eBay. Instead of bidding on an object, you’re bidding on a person.”
Ground zero at nursing homes
It’s difficult to estimate how many traveling nurses are working in New Hampshire –
or even their uppermost rate of pay. Or what percentage of health care facility staff
they comprise at the present time.
The Belknap County Nursing Home currently employs four traveling nurses.
Administrator Shelley Richardson said talking freely about how much they cost only
serves to discourage loyal full-time workers.
“In order to keep the building viable, we have to hire from outside agencies,” said
Richardson. “We’ve always had traveling nurses. We have four travel nurses now or we
would have to close.” The nursing home licensed for 98 beds is hovering at two-thirds
full, unable to accept more.
Richardson hopes the county delegation will approve a jump in funding that will
enable BCNH to bring wages in line with competitors, including other county homes.
American Rescue Plan funds boosted pay with short-term stipends. Starting wages for
LNAs are now $15 an hour, up from just shy of $13. Pay for LPNS begins at $24 an
hour. “If we didn’t do something, we’d have a mass exodus,” Richardson said. She
hopes a compensation study will pinpoint a sweet spot for wages that are realistic —
and doable.
“When you call agencies now they ask, ‘What are you willing to pay?’ Unless you’ve got
someone in your building and they like it,” the sky’s the limit. “I have (agencies) every
day trying to recruit our staff,” Richardson said.
A Connecticut agency is currently charging $154 an hour for a transient RN, while a
Nebraska agency wants $178 for a registered nurse. RNs at BCNH currently earn $32 an
hour — $50 if they’re mandated to stay because someone calls in sick. It’s not unusual
for nursing homes to pay double or triple for a traveler with an identical license. With
the ongoing stress of the pandemic, some staff leave for three- to six-month contracts
without benefits, a retirement plan or health insurance.
Williams hopes the bubble will burst and rates will drop back down to realistic levels —
without a recession to cool things down.
“I believe in the free market,” said Williams. “But there are limitations. It’s not supposed
to rise to such excess. Health care is not really part of the free market when you have
government payers.”
“We need to pay people so we can open up our building more, take more staff and
make more money,” said Richardson.
“We are very affected by the lack of nurses,” said Pingol, who, like others on BCNH’s
staff, stays late when a replacement doesn’t show. “We are concerned about the safety
of residents.” RNs and LPNs have many of the same responsibilities, he said, including
dispensing medications.
“Still, we are so happy to have traveling nurses work for us. They help lessen the stress if
someone is out,” said Pingol, who hopes someday to become an RN.
When traveling nurses haven’t worked at BCNH before, “you need to train them first and
some are arrogant and disrespectful to staff. If you are going to a new facility, you need
to be more respectful,” he said. “From the first day, you need to be part of the flow.”

Page 12 • New Hampshire Nursing News March, April, May 2022
One Nurses Opinion:
Where Have All the
Nurses Gone?
Rita J. Morin, DNP, RN, NEA-BC
There has been a lot of attention to the nursing shortage. It has been a topic
for many years, but it has reached critical levels during the Covid-19 pandemic.
This article reflects the opinion of one nurse related to several issues affecting
licensed registered nurse staffing.
Supply and Demand
According to the 2017 report by the U.S. Department of Health and Human
Services Health Resources and Services Administration: Supply and Demand
Projections of the Nursing Workforce: 2014-2030, New Hampshire was
projected to have a supply of 21,300 Registered Nurses and a Demand of only
20,200. The total number of licensed registered nurses in New Hampshire
listed in the 2021 7th Annual Report from the Office of Professional Licensure
and Certification was 22,891 or 7.2% over the 2023 projection, and this was
after removing the 2104 RNs practicing with emergency licenses issued in
2021. Do we have more nurses in N.H. than we need? In fact, it is not about
the numbers.
The discrepancy between the supply and demand, based on the 2017 data,
must be viewed in the context of the ongoing pandemic, which has required
patients to receive more specialized care and has resulted in higher patient
volumes in our hospitals. This certainly could not have been predicted. As the
pandemic wages on, the capacities of our acute care hospitals continue to be
strained by the ebb and flow of patient demand. The exodus of licensed nurses
from the workforce has hit N.H. hard; in a recent Union Leader article, it was
estimated that there are currently 8,000 licensed nurses who are not working
in the state or who have left healthcare entirely. That certainly changes the
number of available nurses and the real effect is not captured by available
data. Even more elusive is data related to the number of nurses who are
traveling across state lines to work.
Nursing Salary
The mean salary for a registered nurse in N.H. is $73,800 annually or $35 per
hour. Compared to $93,160 annually or $44.78 per hour in Massachusetts.
There has been some recent level setting; however, N.H. does continue to
lag. Many nurses living in the southern part of the state trade the quality of
life afforded by working closer to home for the hourly commute necessary for
higher salaries paid by hospitals across our southern border.
Travel Nursing
Travel Nursing, especially during the pandemic, has become very lucrative. In
a recent conversation with a “travel nurse”, she revealed that she could work
3-12 hour shifts as a travel nurse for premium pay at a hospital less than 20
miles away from her home while continuing to work her scheduled 3-12 hour
shifts at her “usual” hospital. Some agencies offer guaranteed overtime and
salaries of $4000 or more a week and charge premium rates to organizations
that are struggling to fill staff vacancies. This does not seem to be a sustainable
option. Unfortunately, as nurses continue taking travel assignments, the supply
of nurses in N.H. and other states will continue to fluctuate, and the market
will not be able to stabilize. Another unsustainable solution.
Continued Threats
Work overload and burnout remain significant threats to our nursing workforce
in N.H., as throughout the country, which has increased due to the Covid-19
pandemic. Ongoing limitations in workforce development due to insufficient
numbers of nursing faculty continue to constrain the nursing supply. The
retirement of experienced nurse faculty and the low salaries in academia for
qualified nurses, who can earn more providing direct care, is a significant
concern. Without a supply of new qualified nurse educators to replace those
that have left leaves many schools throughout the U.S. in a situation with more
applicants than nursing program capacity.
I want all of the healthcare workers, volunteers, and communities to know, we see
you! We see you stepping up when you don’t know where the next step is. We see
you holding your heads high despite the pile of rubble heaped atop of you. We see
you giving every last bit of energy when you don’t feel you have any left to give. We
see you continuing to fight this treacherous COVID war despite the never-ending
battles. It is a challenging world to be a part of and every single person is feeling the
effects.
As a nurse practitioner (NP) by training, mother by blessing, and health care leader
by privilege, I want to recognize the nation’s 290,000 NPs working across all health
care settings who continue to step up, lead by example, and volunteer their time
and energy into taking care of others in a time of desperation. This act of selflessness
comes with a known consequence of taking time away from one’s personal life,
family, and self-care.
I cannot adequately urge each and every one of you to check-in with yourself
regularly. Make sure you are working to learn new healthy coping skills, as we
continue to realize some of our prior coping skills may no longer be viable options.
Please take time to check in with a friend, colleague or stranger. Always offer kindness.
Nurse practitioners continue to be critical in educating, vaccinating, and caring for
patient populations across New Hampshire and our country. The New Hampshire
Nurse Practitioner Association continues to stand with NPs and all health care
providers through this pandemic.
NHNPA is excited to offer a variety of opportunities for NPs to: recognize one another,
learn together and advocate for our profession and the patients that we serve. Please
visit nhnpa.org to learn more.
NHNPA Annual Awards Program
Nominate a colleague today for one of NHNPA's annual awards. Annually, NHNPA
recognizes outstanding NP's and supporters who have gone above and beyond
to support our profession. New this year, we will also be recognizing a student and
preceptor of the year. Recipients are honored at the Northern New England Nurse
Practitioner Conference. Nominations will be accepted for the 2022 awards until
March 11, 2022.
NHNPA Legislative Affairs
We See You
With hundreds of bills before the NH legislature this session, you may be wondering
how our NHNPA leadership decides when and how to engage in the state's legislative
process. Our staff, consultants, and members have decades of experience navigating
the NH State Government including the legislative and executive branches. Our
team includes recognized leaders in both the state and Nation's capitol. Under the
leadership of our committee chair Siobhan Benham, we are engaged in: legislation,
rulemaking, administrative hearings, and licensure and regulatory matters. NHNPA is
also represented on a wide-rage of legislative commissions through appointed seats.
Northern New England Nurse Practitioner Conference
The conference planning committee, led by Evie Stacy, has been working diligently
to plan this key event. With the combination of: a destination location and extensive
agenda we are confident that this is an event that you do not want to miss! We look
forward to seeing you on April 7-8, 2022 at the Mount Washington Hotel - Bretton
Woods, NH. Pre-conference workshops will be offered on April 6. The event features
three Keynote addresses, 40+ esteemed faculty, 30+ concurrent sessions, several
poster sessions, 50+ exhibitors, 20 CEs, one Leadership in Healthcare Reception with
live music, endless opportunities for networking, learning, and fun!
Advocacy
There are no easy answers. We need to encourage our government leaders to
prioritize the over 4 million nurses in the U.S. by continuing to address issues
facing the profession such as the nursing shortage, workplace violence, and
ensuring adequate PPE, to name a few. You can act by signing on to a letter
to your legislator to help end the nursing shortage crisis: Nurses Don’t Need
Platitudes. Congress must help end the nursing shortage crisis
https://p2a.co/lx0lkjt?p2asource=STAFFINGFCSNACALL292022
Editors Note: This opinion was submitted in part in response to an editorial
published recently by Linda Aiken and Claire Fagan “Medicare Can Help Fix
the Nursing Shortage.” https://www.statnews.com/2022/02/08/medicare-canhelp-fix-the-nurse-shortage-in-hospitals/

March, April, May 2022 New Hampshire Nursing News • Page 13
NHNA Begins Critical New Commission –
Climate Action and Health
In 2021 the World Health Organization (WHO)
declared that “climate change is the single biggest
health threat facing humanity” (WHO, 2021). NHNA
is committed to bringing attention to this link between
climate change and health. Reflecting that commitment,
the Board of Directors and Co-Chairs Kaitlynn Liset,
MS, RN, CNL, and Judy Joy, PhD, RN, are pleased to
announce the January 26th, 2022 inaugural meeting of
the NHNA Commission on Climate Change Action and
Health (CCCAH). Members of the Commission include
Angela Diorio, APRN, Brooke Hall, student nurse,
Jacob McGinnis, student nurse, Raelene Shippee-
Rice, PhD, RN and Sharon Tweedie, BSN, RNBC.
The Commission is open to additional membership or
short-term volunteers. If you are interested in making
a difference in climate and health contact office@
nhnurses.org
The Commission’s first agenda included drafting
preliminary goals and objectives (included below)
and establishing Commission protocols. Because of
a fortuitous release of the finalized document, the
Commission was also able to recommend that the
NHNA Board of Directors support a proposal to the
American Nurses Association (ANA) Membership
Assembly related to climate and health (see related
article). The proposal calls for the ANA to revise and
strengthen its position on climate and health last
revised in 2008. The proposal was developed by
a national collaboration including NHNA’s former
Executive Director Joan Widmer (now ANA’s treasurer)
and Judy Joy. Others in support of the proposal include
neighboring ANA Vermont and the national Alliance
of Nurses for Healthy Environments (ANHE) a leading
national nurse organization in climate advocacy.
At present, draft goals for the Commission are as follows:
• To provide the nurses of New Hampshire with
the knowledge and skills to address the impact
of climate on the health of citizens and nurses
themselves
• The objectives drafted to achieve this goal
o Raise awareness and visibility of nurses working
to address climate health
o Advocate for public policy to improve climate
health
o Collaborate with partners to achieve mutual goals
o Engage member and nonmembers to improve
climate health
o Educate the NH community about the impact of
climate on health
o Develop the role of ambassador to utilize expertise
among members with a focus on clinical areas -
e.g. pediatric health, mental health
The Commission will refine these objectives and
establish action steps with milestones in coming
meetings. As both the NHNA Executive Director,
Pamela DiNapoli, PhD, and Co-Chair Joy are members
of the Board of Directors of New Hampshire Healthcare
Workers for Climate Action (NHHWCA), and with
Co-Chair Kaitlynn Liset are members of ANHE, the
Commission will be collaborating closely with and
leveraging the resources of both organizations.
Nurses are encouraged to visit NHHWCA s site at https://
www.nhclimatehealth.org/ to sign the petition on climate
and health. Virtual events, resources and more are also
offered courtesy of NHHWCA via their website and
ANHE at https://envirn.org/.
Commission members discussed their perception that
many in the community, including some in health
care, are not fully aware of the profound impact of
climate on all aspects of health. Although the direct
impacts are often understood (e.g. heat stroke,
asthma) the indirect issues may not be which can
range from increased vector borne disease (ticks) to
injury and systems strain from severe weather events.
Part of the Commission’s role will be to increase
awareness of not only the implications of climate for
health but the actions nurses may take to address
those impacts.
World Health Organization. (2021, October 30). Climate
change and health. https://www.who.int/news-room/factsheets/detail/climate-change-and-health).
WELCOME NEW and RETURNING NHNA MEMBERS!
NHNA welcomes these new and returning members. Thank you!!! What do these 37 nurses and over 1,100 NHNA members know that you don’t?
If you are not a member ask your neighbor on this list why they joined! Go to nhnurses.org where joining is easy and one of the best
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Danielle Kendall
Exeter
Abrah Canfield
Madison
Debra Temm
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Tina Williamson
Barrington
Heather Phelan
Kathy Boyd
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Jennifer Johnson
Briston
Karen Maloney
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Brooke Lawler
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Sharon Milan-Snow
Colebrook
Monica White
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Chari Szepanski
Theresa Peace
Ryan Terry
Derry
Maria Checket
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Page 14 • New Hampshire Nursing News March, April, May 2022
ANA Professional Policy Committee - Policy Proposal
The Impact of Climate Change on Health
Topic: The Impact of Climate Change on Health
Strategic Goal: Evolve the Practice of Nursing to
Transform Health and Healthcare
Describe how this proposal relates
to the above strategic goal?
This proposal requests that American Nurses Association
(ANA) update its position statement on Climate Change
and Health, which has not been revised since 2008
(ANA HOD, 2008) and to host a Dialogue Forum to
inform that process. In August of this year, the World
Health Organization stated that climate change is now
“the single biggest health threat facing humanity.”
(WHO, 2021) A recent editorial published in 200
leading medical journals, including The Lancet, The
New England Journal of Medicine and the British
Medical Journal, argued that the world cannot “wait
for the COVID-19 pandemic to pass before addressing
climate change.” (Sommer, 2021) (Gaines, 2021) The
WHO (2021) recognizes nurse as effective and trusted
messengers of public health information, and once
again, the Gallop poll has ranked nurses as the most
trusted profession. (Gaines, 2021) As the leading nursing
organization, ANA needs to take a strong leadership
position in addressing the impacts of climate change on
human and population health, and help prepare nurses
to engage patients in conversations about climate change
and its health impacts.
Further, the health impacts of climate change
disproportionately impacts the most vulnerable
populations. A recent EPA analysis demonstrated that
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underserved communities disproportionally suffer
the most severe harms resulting from climate change
and are the least able to prepare for and recover from
the impacts of climate change. (EPA, 2021) The EPA
analysis further noted that “racial and ethnic minority
communities are particularly vulnerable to the greatest
impacts of climate change.” (EPA, 2021).
In a 2018 policy statement, the American Academy of
Nursing noted that nurses play essential roles in public
health and emergency services and through this work
they can respond to and reduce health consequences
of climate change. (Leffers & Butterfield, 2018) The
International Council of Nurses Position Statement on
Nurses, Climate Change and Health, as
ANA Professional Policy Committee - Policy Proposal
The Impact of Climate Change on Health revised in
2018, calls on national nurses’ associations, to “raise
awareness of the health implications of climate change
and how to assess and address climate change risks to
health by developing policy documents on the subject,”
(ICN, 2018).
Updating and revising position statements falls directly
within ANA’s strategic goal to evolve the practice
of nursing to transform health and healthcare, and
specifically within strategic objective 3.2 to evolve
nursing programs and practice priorities. ANA’s Nursing
Scope and Standards of Practice, 4th Edition, Standard
18 calls on registered nurses to practice so as to advance
environmental safety and health, and specifically to
advance environmental concerns through advocacy and
to promote “sustainable global environmental health
policies.” (ANA, 2021) What better way to promote
environmental health and safety for all patients than to
educate nurses on the links between climate change
and health and provide tools and resources so they can
incorporate climate change into their nursing practice
(many resources and tools already exist which ANA can
share through it nursing network)?
Climate change has helped drive a fivefold increase
in the number of weather-related disasters in the
last 50 years. (Pruitt-Young, 2021) Secretary-General
of the World Meteorological Organization, Peterri
Taalas, recently stated that the warming of oceans has
increased the frequency and geographic region of the
most intense tropical storms. (McDaniel, 2021) Charles
(2021) notes that rising heat is amplifying hurricanes and
torrential rain, which in turn trigger flooding, as well
as increasing the number of wildfires and the length
of the wildfire season in areas with diminished rainfall.
Nurses need to be prepared to help address natural
disasters, e.g. tornadoes, hurricanes, flooding, extreme
heat, and wildfires, when they occur. This emergency
preparedness planning needs to occur before the climate
change induced disasters occur and must incorporate
public health and safety concerns including mitigation
strategies and response and recovery plans, taking into
special consideration populations most vulnerable
to significant negative impacts from these disasters.
Providing nurses with the requisite knowledge and
training to better prepare for climate-related disasters
exactly correlates with ANA’s strategic objective 3.1, to
enhance nurses’ disaster preparedness capabilities.
Does the proposal have national relevance? Yes
Identify if the proposal is being submitted by leaders
of an entity (e.g., C/SNA, Individual Member Division
(ANA-IMD), ANA Board of Directors or Organizational
Affiliate) or by an individual ANA member (e.g.,
ANA-C/SNA or ANA-Only).
Introduced By: Joan C. Widmer, MS, MSBA, RN, CEN,
Treasurer, ANA Board of Directors
Supported by: New Hampshire Nurses Association
(Judith Joy), ANA-Vermont (Meredith Roberts), ANA-
Michigan (Tobi Lyon and MaryLee Pakieser), Minnesota
Organization of Registered Nurses (Kathi Koehn),
Washington State Nurses Association (David Keepnews),
Montana Nurses Association (Vicki Byrd), Delaware
Nurses Association (Chris Otto), ANA-California
(Marketa Houskova), ANA-Massachusetts (Cammie
Townsend), Colorado Nurses Association (Colleen
Casper), New Mexico Nurses Association (Deborah
Walker), Alliance of Nurses for Healthy Environments
(Katie Huffling)
Prepared by: Joan C Widmer, MS, MSBA, RN, CEN,
(ANA-BOD/NHNA), Judith A. Joy, PhD, RN, (New
Hampshire Nurses Association), MaryLee Pakieser,
MSN, RN, FNP-BC, (ANA-Michigan), Meredith Roberts,
PhD, RN (ANA-Vermont), Kathi Koehn, MA, RN, FAAN
(Minnesota Organization of Registered Nurses), Lisa Del
Buono, MD, (Michigan Clinicians for Climate Action)
and Katie Huffling, DNP, RN, CNM, FAAN (Alliance of
Nurses for Healthy Environments).
Primary Contact Person (or Designee):
This individual needs to be available to respond to
questions or requests from the Professional Policy
Committee or Membership Assembly Representatives
if the proposal is accepted.
Policy Proposal continued on page 16
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Page 16 • New Hampshire Nursing News March, April, May 2022
Policy Proposal continued from page 14
Name: Ms. Joan C. Widmer
Credentials: MS, MSBA, RN, CEN
Phone Number: 603-620-1531
Email Address: joan.widmer@ana.org
Second Contact Person (or Designee)
Name: Dr. Judith A. Joy
Credentials: PhD, RN
Phone Number: 603-477-4895
Email Address: judyajoy1@gmail.com
1. Provide reason for submitting the proposal:
Because the single biggest health threat facing humanity is climate change (WHO, 2021),
the strategic goal of evolving of the practice of nursing to transform health and healthcare
will not be possible without addressing this topic. As the leading nursing organization,
ANA needs to take a strong leadership position in addressing the impacts of climate
change on human and population health and help prepare nurses to engage patients in
conversations about climate change and its health impacts.
The top two listings under a Google search of the key words “ANA and climate change
and health” are the 2008 HOD Position Statement on Climate Change and Health and a
Letter from ANA President, Rebecca Patton (term 2006-2010). Our knowledge of climate
change and health has expanded significantly in the ensuing 12 years, yet ANA has shared
little new information with nurses. Is this the sort of message ANA wishes to send to
nurses, especially younger nurses who are passionate about this issue?
Section 2 of this document will identify the numerous reasons why this issue is of national
relevance, not the least of which is that the World Health Organization has declared that
climate change is now the single biggest health threat facing humanity. Further, climate
change is increasing the number and severity of weather related disasters and nurses need
to be better prepared to address the health impacts of these disasters.
Possible Questions to Ask:
• What role can and should nurses play in increasing the awareness of the impacts of
climate change on health?
• What are the best ways in which nurses can advocate for climate actions to reduce
the impact of climate on human and population health?
• What can individual nurses do to help reduce their personal impact on climate
change?
2. Explain how the topic/issue is of national relevance.
In Florence Nightingale's Environmental Theory, she identified five (5) environmental
factors: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct
sunlight. Her observations are still relevant in today’s world as evidenced by this quote
“According to the Standard 18 of the Standards of Professional Nursing Practice found in
Nursing: Scope and Standards of Practice, 4th Edition,” the registered nurses practices in
an environmentally safe and healthy manner. “ (ANA, 2021)
We have seen an approximate 1.0 °C rise in average global temperature to date, and if
greenhouse gas emissions continue unabated, the average global temperature is on a
trajectory to reach between 3-4 °C increase by the end of the century. (WHO, 2021 and
Climate Interactive, n.d.)
Last fall, in advance of the COP26 in Glasgow, editors from over 200 health journals,
including the prestigious New England Journal of Medicine warned that a global
temperature increase of “1.5° C above the pre-industrial average . . . risk(s) catastrophic
harm to health that will be impossible to reverse.” (Dewan, 2021 and Atwoli, et al,
2021) Conversely, if efforts to keep the temperature rise below 1.5 °C are successful,
significant public health gains will be realized, such as half the number people globally
will experience water scarcity; similarly, instead of 37% of the world’s population being
regularly exposed to severe heatwaves, this will be cut by more than half to 14%. (IPCC,
2019)
As demonstrated by the CDC wheel below, the climate crisis impacts many areas of health
care:
Section 3 of this document will identify the reasons why this issue is important to the ANA,
the nursing profession and the public. Most importantly, as nurses are considered the most
trusted and ethical profession, nurses need to be messengers of the impacts of climate
change on human and population health; and ANA needs to take a leadership position in
being the voice of nurses.
The purpose of the proposed dialogue forum is first and foremost to inform nurses of the
relevance and importance of this issue. It will also help to identify the most important role
which nurses can play, what actions we can take as a profession, to address this issue.
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March, April, May 2022 New Hampshire Nursing News • Page 17
The climate crisis may impact health directly, or by acting as a “threat multiplier;” that
is, taking a common, treatable health care condition and catapulting it into a health
emergency. For example:
• An elderly patient with COPD easily maintained on home oxygen presents to the ER
because his home has lost power in an extreme weather event, or
• A patient with renal insufficiency suddenly requires dialysis because of an extreme
heat event.
• The mentally ill homeless person whose medications lose their effectiveness in
extreme heat, or
• Individuals displaced from their homes because of flooding at the onset of the
COVID-19 pandemic, prior to vaccines being readily available.
The good news is that “climate solutions ARE health solutions,” since many of the actions
addressing greenhouse gas emissions reductions also improve indoor and outdoor air
quality, increase activity levels, and improved diet. For example:
• Transitioning to clean, renewable energy sources improves outdoor air quality.
• Electrification of our transportation system improves outdoor air quality.
• Electrification of our building sector improves indoor air quality.
• Eating less meat is better for cardiovascular health.
• Active transport is also better for cardiovascular health.
And, as beautifully stated by Kailey Kanaziz BSN, RN, currently enrolled at University of
Michigan School of Nursing graduate program:
"With the climate crisis being an incessant and dire threat to human health,
influential organizations like the ANA can help by taking a health-centric
approach to discussing and acting on the matter. Young nurses, like myself, seek
out organizational membership to stay current, and we look to established leaders
and organizations for guidance on what emerging topics we should be paying
attention to that are impacting our patients and practices. While climate change is
far from being a new circumstance, the limited extent to which it is discussed is
not proportional to the vast burden it is imposing on our health and communities.
It is my hope that the ANA can serve as both a role model and trusted resource
for climate stewardship in the context of healthcare. By updating their climate
statement and integrating climate change awareness into every facet of the
organization, the ANA will send a clear message to young nurses that our profession
is committed to staying current, aware, and adaptable."
Fortunately, the Alliance of Nurses for Healthy Environments, the Medical Society
Consortium on Climate and Health and other groups (see below) have many wellestablished
resources to empower registered nurses to educate themselves, their patients,
and their community. Locating all resources in an easy to use site on nursingworld.org will
reduce the need to reinvent the wheel.
• Alliance of Nurse for Healthy Environments and Health Care Without Harm’s Nurses
Climate Challenge
• Climate - Smart Health Care
• Medical Society Consortium on Climate and Health
• MiAir/MiHealth (and other similar state groups)
3. Describe the impact of this topic/issue on the association,
profession and/or the public.
According to the World Health Organization (WHO, 2021), “climate change is the single
biggest health threat facing humanity.” In its summary report of the COP26 Conference
2021,
WHO recounted the many extremes that have occurred in our climate with
unprecedented frequency in recent years including those that directly and indirectly
impact health: heat, wildfires (air quality) hurricanes, droughts, and floods. They
conclude that “The climate crisis is upon us .... The consequences for our health
are real and often devastating.” (WHO, 2021) Likewise, the Union of Concerned
Scientists has declared that human sponsored changes in our climate have created
“one of the most devastating problems that humanity has ever faced.” (Union of
Concerned Scientists, 2021)
In 2018 the International Council of Nurses issued a strongly worded climate health
position statement in an update to their previous statement. Its leading sentence states
that public health advances over the past five decades are at risk due to climate changes.
(International Council of Nurses, 2018) The Canadian Nurses Association (CNA) updated
their 2009 position on Climate Change and Health in 2017. They conclude state that
nurses, across the practice, research, leadership, education and social policy spectrum,
must play a part in “adaptation and mitigation” in response to global climate change.
Just last year, a poll by an independent polling organization (Pew Research, 2021) states
that two thirds of Americans feel there is a need for greater focus on climate issues.
With this overwhelming expression of concern by internationally respected health care
organizations, credentialed scientists, the public, and the foremost international nurse
organization it is incumbent upon nurses in the United States to address climate in practice.
The foundational documents of the American Nurses Association also cite the profession’s
obligation to address climate change.
The Code of Ethics for Nurses concludes with the ethical obligation for the profession of
nursing, collectively though its professional organizations to address social justice issues
through nursing and health policy. Specifically, 9.4 Social Justice in Nursing and Health
Policy states:
“Social justice extends beyond human health and well-being to the health and wellbeing
of the natural world. Human life and health are profoundly affected by the
state of the natural world that surrounds us. Consistent with Florence Nightingale’s
historic concerns for environmental influences on health, and with the metaparadigm
of nursing, the profession’s advocacy for social justice extends to eco-justice.
Environmental degradation, aridification, earth resources exploitation, ecosystem
destruction, waste and other environmental assaults disproportionately affect the health
of the poor and ultimately affect the health of all humanity. Nursing must also advocate
for policies, programs, and practice within the healthcare environment that maintain,
sustain, and repair the natural world. As nursing seeks to promote and restore health,
prevent illness and injury, and alleviate pain and suffering, it does so within the holistic
context of healing the world.”
The newly revised Nursing Scope and Standards of Practice, 4th Edition, refers specifically
to the issue of environmental health, stating that the registered nurse practices in a manner
that advances environmental safety and health. Among the competencies identified for all
registered nurses are:
• “Analyzes the impacts of social, political, and economic influences on the human
health experience and global environment.
• Advances environmental concerns and complaints through advocacy and
appropriate reporting mechanisms.
• Promotes sustainable global environmental health policies and conditions that focus
on prevention of hazards to people and the natural environment.”
Additional competencies for the graduate-level prepared registered nurse, including the
advance practice registered nurse include:
• “Designs research addressing the connections between the environment, its
conditions, and health status.
• Uses community assessment data and plans to develop policies, recommendations,
and programs addressing threats as well as prevention of hazards to both the people
and the natural environment.”
Policy Proposal continued on page 18

Page 18 • New Hampshire Nursing News March, April, May 2022
Policy Proposal continued from page 17
As identified in ANA’s foundational documents, advocacy
directed towards the climate crisis, with its multiple direct
and indirect impacts on health, is a professional imperative
and should be an essential component of ANA’s issues of
concern platform.
In recognition of the serious health impacts and health
inequities related to climate change, the Department of
Health and Human Services established the Office of
Climate Change and Health Equity (OCCHE), and the
National Academy of Medicine (NAM) launched the Action
Collaborative on Decarbonizing the U.S. Health Sector in
2021. Now is the time for strong nurse leadership on this
issue and work with our healthcare colleagues on climate
solutions.
Additional Considerations:
• Current and future younger nurses are more aware of
environmental impacts on human health.
• Nursing practice is going to be defined by health
impacts of climate change which is being felt today
with only one degree global temperature increase,
and is projected to increase significantly higher within
their lifetime.
• Our responsibility is to prepare the next generation
of nurses for these challenges and demonstrate
collaborative practice with other healthcare
professionals
• We need to be respectful of the upcoming nurses’
fund of knowledge on these issues.
• Nurses are the largest part of healthcare delivery
system
• Nurses have the ability to impact change at the micro
level
• Collaboration is part of the nursing curriculum -
understand the power
• Connecting the dots between patient care and
environmental impacts
• Empower nurses to advocate and educate - through
personal education, give them confidence to take
leadership roles and encourage them to go beyond
the hospital/health care system into their local
communities
• Help to develop the toolkit that has resources from
collaborative climate/health care organizations
• Healthy Nurse/Healthy Nation similar to Nurses
Climate Challenge: Change self/change community.
• Nurses know what they know and what they don’t
know and are willing to ask for help and they know
where to get more credible information.
4. Identify the underlying issue(s) to be addressed during
the Dialogue Forum.
Climate change is a global problem that starts with
individual actions but is ultimately impacted by the actions
of individuals, corporations, and countries around the
world. It’s multifactorial and appears to be a task beyond
any individual’s ability to address. Because the need to start
somewhere is so critical, nurses should start at the junction
they know and understand: the impacts on human and
population health. So the first question we can ask is: what
role can and should nurses play in increasing the awareness
of the impacts of climate change on health? Exploring this
question is support by Standard 18 of the Nursing Scope
and Standards of Practice, 4th Edition. This Standard calls
on registered nurses to advance environmental safety and
health through their practice.
Similarly, Standard 18 also calls on registered nurses to
advance environmental concerns through advocacy and to
promote sustainable global environmental health policies,
supporting an exploration of the question: what are the best
ways in which nurses can advocate for climate actions to
reduce the impact of climate on human and population
health?
Finally, the Code of Ethics for Nurses holds that nurses have
a duty to self-care. Many climate healthy solutions lead to
improved human health. Nurses will be better informed as
to steps they can take that will improve their health while
improving the health of the planet.
5. Recommended actions.
The participants in the Dialogue Forum should determine
the most appropriate actions. The team drafting this proposal
identified several suggestions that might be considered.
• Urge ANA to update/revise 2008 House of Delegates
Statement on Global Climate Change and Human
Health.
• Develop and deploy a survey to determine nurse
knowledge of the links between health and climate
change, and their understanding of possible climate
actions that can help to mitigate climate change.
• Urge ANA to share information/educational
resources/tool kits to educate nurses on the impact
of climate change on human health and provide
guidance for nurses to educate the public on these
impacts. Many of these resources are already
available and can be provided to registered nurses
through partnerships/affiliations with organizations
such as Alliance of Nurses for Healthy Environments.
• Include the climate crisis and its consequential impact
on human and population health as an essential
component of ANA’s issues of concern platform.
• Urge/continue to urge American Association of
Colleges of Nursing (AACN) and Health Resources
and Services Administration (HRSA) to develop
curricula and professional development opportunities
to increase the knowledge and skills of the healthcare
workforce to effectively address health impacts
of climate change.
• Develop Healthy Nurses Healthy Nation challenges
that also recognized that many climate healthy
solutions lead to improved human health, such as
reducing the amount of meat in your diet, walking/
biking to work when possible to reduce use of fuel
powered vehicles, etc.
• Urge nurses through ANA’s Nurse Innovation
program to consider developing products/
technologies that are climate friendly.
• ANA could consider hosting a Climate Summit in
2023. The Climate Summit would be the opportunity
to create an inter-professional arena where health
and climate experts from all disciplines can discuss
solutions from a variety of points of view and find
common ground for meaningful action and reduce
redundancy of actions and silo thinking. Nurses
are uniquely trusted messengers, and ANA’s robust
grassroots membership is ideal for implementation.
By consolidating already established resources under
the ANA Enterprise (ANA, ANCC, ANF) and easily

March, April, May 2022 New Hampshire Nursing News • Page 19
accessed on the ANA website, nurses at all levels can
easily mobilize for real change.
References-Partial:
• World Health Organization. (2021, October 30). Climate
change and health. https://www.who.int/news-room/factsheets/detail/climate-change-and-health).
• Gaines, K. (2022, Jan) Nursing ranked as the most trusted
profession for 20th year in a row. https://nurse.org/articles/
nursing-ranked-most-honest-profession/.
• Sommer, L. (2021, September 7). Climate change is the
greatest threat to public health, top medical journals
warn. NPR. https://www.npr.org/2021/09/07/1034670549/
climate-change-is-the-greatest-threat-to-public-health-topmedical-journals-warn
• World Health Organization. (2021, August 4). A social
media toolkit for healthcare practitioners, desktop. https://
www.who.int/publications/m/item/a-social-media- toolkitfor-healthcare-practitioners---desktop).
• EPA. (2021, September 2). EPA Report Shows
Disproportionate Impacts of Climate Change on Socially
Vulnerable Populations in the United States https://www.
epa.gov/newsreleases/epa-report-shows-disproportionateimpacts-
climate-change-socially-vulnerable).
• Leffers, J. & Butterfield, P. (2018). Nurses play essential
roles in reducing health problems due to climate change,
American Academy of Nursing on Policy, Nurse Outlook.
66. 210-213.
• International Council of Nurses. (2018). Position Statement:
Nurses, climate change and health, Revised 2018. https://
www.icn.ch/sites/default/files/inline- files/ICN%20PS%20
Nurses%252c%20climate%20change%20and%20
health%20FINAL%2 0.pdf).
• American Nurses Association. (2021, May 14). Nursing
Scope and Standards of Practice, 4th Edition. American
Nurses Association.
• Pruitt-Young, S. (2021, September 11). Climate change is
making natural disasters worse, along with our mental
health. NPR. https://www.npr.org/2021/09/11/1035241392/
climate-change-disasters-mental- health-anxiety-eco-grief
• McDaniel, E. (2021, September 7). Weather
disasters have become 5 times as common, thanks
in part to climate change. NPR. https://www.npr.
org/2021/09/07/1034607602/weather-disasters-havebecome-five-times-as-common-thanks-in-part-to-climatecha
• Charles, D. (2021, September 2). Our future on
a hotter planet means more climate disasters
happening simultaneously. NPR. https://www.npr.
org/2021/09/02/1033054816/our-future-on-a-hotter-planetmeans-more-climate-disasters-happening-simultaneou
• World Meteorological Organization. (2021, October). State
of Climate in 2021: Extreme events and major impacts.
https://public.wmo.int/en/media/press-release/state-ofclimate-2021-extreme-events-and-major-impacts
• Climate Interactive. (n.d.). Climate scoreboard. https://www.
climateinteractive.org/ci-topics/climate-energy/scoreboard/
• Dewan, A. (2021, September 5). More than 230 journals
warn 1.5°C of global warming could be 'catastrophic' for
health. CNN Health. https://www.cnn.com/2021/09/05/
health/climate-health-journals-warning- intl/index.html
• Atwoli, L. Baqui, A. Benfield, T. Bosurgi, R. Godlee, F.
Hancocks, S. Horton, R. et al. (2021, September 16). Call
for emergency action to limit global temperature increases,
restore biodiversity, and protect health, The New England
Journal of Medicine. https://www.nejm.org/doi/full/10.1056/
NEJMe2113200
• IPCC, 2018: Global Warming of 1.5°C. An IPCC Special
Report on the impacts of global warming of 1.5°C above
pre-industrial levels and related global greenhouse gas
emission pathways, in the context of strengthening the
global response to the threat of climate change, sustainable
development, and efforts to eradicate poverty [Masson-
Delmotte, V., P. Zhai, H.-O. Pörtner, D. Roberts, J. Skea, P.R.
Shukla, A. Pirani, W. Moufouma-Okia, C. Péan, R. Pidcock,
S. Connors, J.B.R. Matthews, Y. Chen, X. Zhou, M.I. Gomis,
E. Lonnoy, T. Maycock, M. Tignor, and T. Waterfield (eds.)].
https://www.ipcc.ch/sr15/
• CDC (2021, March 2). Climate effects on health, Impact of
climate change on human health. https://www.cdc.gov/
climateandhealth/effects/default.htm
• World Health Organization (2021). COP26 special report on
climate change and health: the health argument for climate
action. Geneva: World Health Organization
• Union of Concerned Scientists (2021). https://www.ucsusa.
org/climate. Cambridge, MA: Union of Concerned Scientists.
• Pew Research (2021) https://www.pewresearch.org/facttank/2021/10/14/67-of-americans-perceive-a-rise-in-extremeweather-but-partisans-differ-over-government-efforts-toaddress-it/
October 14
• International Council of Nurses (2018). International Council
of Nurses calls for increased nursing leadership to combat
effects of climate change on health; https://www.icn.ch/
news/international-council-nurses-calls-increased-nursingleadership-combat-effects-climate-change;
September 27,
2018, Geneva, Switzerland
• American Nurses Association. (2015). Code of Ethics for
Nurses with Interpretive
Statements.
• World Health Organization (2021) Climate change - the
biggest health threat facing humanity. https://www.who.int/
news-room/fact-sheets/detail/climate-change-and-health
• Canadian Nurses Association (2017). Position Statement:
Climate Change and Health. https://hl-prod-ca-oc-
download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-
4a40- 45ca-863c- 5ebf0a138d5e/UploadedImages/
documents/Climate_change_and_health_position_stat
ement.pdf
Additional Resources:
• Planetary Health and the Role of Nursing: A Call to Action
• Nurses See the Big Picture: Addressing Climate Change as a
Social Determinant of Health
• ANHE's Nurses Climate Challenge
• Key findings: How Americans’ attitudes about climate
change differ by generation, party and other factors
• Nurses Drawdown
• CHANT: Climate, Health, and Nursing Tool
• NSNA: In Support of Increasing Awareness of the Effects of
Climate Change on Mental Health, 2019, p.44.
• NSNA: Increased Nursing Student Action on and Awareness
of the Effects of Climate Change on Health, 2017, p. 36.
• Nursing Collaborative on Climate Change and Health
Happy
Nurses Week
2022!

Page 20 • New Hampshire Nursing News March, April, May 2022
ANA’s proposed policy solutions to address
the nurse staffing shortage crisis
Reprinted with permission from the Indiana Bulletin
February 2022 Issue
HHS Must Convene Stakeholders to
Identify Short- and Long-Term Solutions
to Staffing Challenges.
ANA urges HHS to convene all stakeholders for a robust
discussion of staffing challenges and potential solutions.
These challenges are not solely contained within the
nursing profession, especially as the health care delivery
system continues to evolve towards a more integrated
system. As such, it is crucial that the agency convenes, in
addition to nurses, hospitals, physicians, other health care
personnel, state and federal government officials, and key
stakeholders to examine, identify, and then implement
real solutions to the nursing shortage. The focus of these
discussions must be to identify the current challenges
and both short- and long-term solutions. Short-term
solutions will allow us to adequately face the demand of
the COVID-19 pandemic response. Long-term solutions
will ensure the nation’s health care delivery system is best
equipped to provide quality care for patients and stands
ready for the future challenges. ANA implores HHS to have
these critical conversations and stands ready to work with
the agency to facilitate them.
HHS must work with CMS to take steps
to appropriately acknowledge nurses in
reimbursement methodologies, ensuring payment
equity for nursing services provided to patients.
The COVID-19 pandemic response has made clear that
APRNs and RNs are indispensable to providing the care
that patients need now and in the future. For instance,
APRNs are a significant source of primary care, especially
in rural and underserved areas. Further, RNs are responsible
for a wide array of direct care and care coordination
services in community settings as well as hospitals and
long-term care facilities. These health care services are key
in ensuring access to care, a critical aspect of addressing
health inequity. However, there must be parity in how these
vital services are reimbursed.
Recognition through appropriate payment for nursing
services is critical in ensuring a resilient nursing workforce
ready and able to meet future needs. It is long overdue for
nursing services to be separated from “room and board,”
as currently considered by the Medicare program. Nurses
provide vital services to patients across the care continuum
and the health care delivery system must recognize their
critical role through appropriate reimbursement. ANA
Opportunity Awaits
REGISTERED NURSES
Emergency Department
IPCU
Specialty Clinic
Psychiatric Inpatient
Adult Day Program
To view all current job
opportunities, and to apply
please go to:
https://
springfieldhospital.org/
careers/
Equal Opportunity Employer
urges HHS to work with CMS to consider methodologies
and approaches that will ensure payment equity for nursing
services.
In light of the rise of Coronavirus variants
and increased COVID-19 contraction, HHS
must provide additional resources including
recruitment and retention incentives and support
to bolster the nursing workforce to meet current
demands for critical health care services.
Hospitals are quickly reaching capacity limits due to
the surge of COVID-19 cases and the nursing shortages
across the country. It is imperative that HHS continue its
thoughtful pandemic leadership and utilize all available
authorities to address this issue. Nurses are still in need of
resources to combat the pandemic and ANA continues
to call on the Administration to act in response. Standing
on the front lines, our nation’s nurses are becoming
increasingly burned out as the pandemic continues to
weigh heavily on them. We are seeing large numbers of
nurses leaving the profession as a result. This only results in
further strain on the nursing workforce, which was already
in a supply crisis before the pandemic.
ANA appreciates the Administration’s thoughtful pandemic
response to date through issuance of waivers and other
resources to bolster nurses’ ability to provide vital health
care services amid the challenges faced by the health care
system.
ANA urges HHS to remove unnecessary
regulatory barriers to APRN practice
In various ways, certain Medicare payment rules restrict
APRN practice above and beyond their state scope-ofpractice
rules. Examples include unnecessary supervision
requirements, as well as payment restrictions for certain
Medicare services provided by APRNs. Such restrictions
limit access to care and beneficiaries’ choice of qualified
provider. Several of these federal practice restrictions
have been waived during the COVID-19 public health
emergency (PHE). As experiences resulting from these
waivers demonstrate, allowing APRNs to practice to the
full extent of their state license translates to needed system
capacity and expanded access for patients. We continue to
call on CMS to grant permanent regulatory relief for APRN
practice, so that access is not constricted when the PHE
ends.
HHS must continue to educate the nation on
the importance of the COVID-19 vaccine and
provide support and resources for widespread
administration of the vaccine and any subsequent
boosters.
Vaccines are critical to the control and prevention of
infectious disease transmission. Nurses play a critical role
in educating the public and fellow health care colleagues,
as well as in the administration of COVID-19 vaccines.
Currently, the nation faces significant vaccine hesitancy
while cases of the Delta variant increase rapidly, straining
an already strained nursing workforce. HHS must continue
to provide resources and support efforts to educate the
public on the importance of getting the COVID-19 vaccine.
NEW HAMPSHIRE DEPARTMENT OF
CORRECTIONS IS LOOKING FOR:
REGISTERED NURSES
Northern NH Correctional Facility in Berlin, Secure
Psychiatric Unit in Concord, NH State Prison for Men in
Concord, NH Correctional Facility for Women in Concord
RN I: $51,438.40-$71,884.80
RN II: $55,827.20-$78,353.60
RN III: $60,569.60-$85,425.60
PLUS 15%
INCREASE ON TOP
OF BASE SALARY
(Salary does not reflect Hazard Duty, applicable Shift differential, and/or Weekend pay)
Provides general nursing care and treatment in an adult ambulatory setting, inpatient
infirmary unit, and/or in an inpatient psychiatric forensic unit under the direction of the
nurse coordinator. Correctional nursing requires ongoing close and immediate contact
with prisoners and/or civilly committed residents while maintaining safety and security.
Locations are secure facilities managed by the NH Department of Corrections.
Please apply on line at www.nh.gov. Click on the job opportunities icon
and follow the instructions to Register; create a complete profile and save.
Log In and apply. Questions may be directed to Linda McDonald at
603-271-5645 or via e-mail at Linda.J.McDonald@doc.nh.gov.
In addition, it was recently announced that boosters
for the already vaccinated will be available. HHS must
provide the necessary resources to states and localities
for successful distribution and administration of the
booster vaccine doses. The agency must also educate
the public on the importance of receiving the booster
doses, when appropriate. The vaccine is an important
component of COVID-19 mitigation efforts—
especially in an effort to keep patients out of hospitals
facing capacity challenges. ANA urges HHS to provide
support and resources for continued education and
ongoing distribution and administration of the vaccine
across the country.
HHS must ensure a resilient nursing
workforce that meets current and future
staffing demands and ensures access to care
for patients.
Prior to the COVID-19 pandemic, nurses already
experienced tremendous levels of stress in their dayto-
day work. The pandemic has further intensified
the feelings of exhaustion, anxiety and being
overwhelmed especially with respect to patients
that are dying and having to inform and comfort
their surviving family members. It is vital the nation
prioritizes the mental health of nurses and other
health professionals who are caring for our most
vulnerable patients. ANA actively advocates to reduce
stigma around seeking help for mental health and
substance use disorders for health professionals as
well as their patients.
Moreover, nurses also must be treated and
compensated appropriately as they provide care
under extraordinary circumstances, so that the next
generation is encouraged to enter the field and ensure
the nation’s readiness for public health emergencies.
Appropriate compensation ensures that the health
care delivery system retains the nurses needed to
provide care to patients. We are seeing examples
throughout the country of nurses leaving their
communities for the higher compensation offered
by travel nurse agencies. This only serves to further
local staffing strains, often in the most underserved
communities.
However, a resilient workforce is achieved not only by
adequate pay, as the working environment must also
allow nurses to flourish in their profession. Nurses are
professionals providing critical health care services
to patients—they should not have to fight for allotted
breaks and other challenges created by antiquated
views of the profession. All too often, we hear of
staffing plans not being enforced, resulting in long
shifts and strains on nurses providing care. Nurses
know best the provisions that they and their team
need, from patient complexity to layout of the nursing
unit. This is just another instance where health care
delivery and outcomes would be improved by greater
nurse involvement. It is crucial for nurses to take on
leadership roles, in all settings, to meet the demands
of our ever-changing health care system, including
being permitted to practice to the full extent of their
education, training and licensure.
Lastly, the introduction of electronic health records
(EHR) has proved to be burdensome, detracting
from patient-centered care. Documentation and
required recording of various questions is time
consuming, which leaves less time for nurses to
connect with patients. HHS should reevaluate
current and future requirements and ensure the right
balance is struck between the positive impact of EHR
in comprehensive, coordinated care and provider
burden.
To ensure a future workforce that meets all the needs
and demands of patient care, it is crucial that we not
only attract students to the nursing profession but
retain skilled nurses throughout their careers. Effective
workforce planning and policymaking require
better data collection and an improved information
infrastructure. ANA encourages HHS to work with
nurses to identify approaches to bolstering a resilient
nursing workforce ready to meet the demands of
today and tomorrow’s health care delivery system.

March, April, May 2022 New Hampshire Nursing News • Page 21
Challenges in the Nursing Workforce continued from page 3
are short-term measures to alleviate the immediate stress
put on the healthcare system triggered by an undersupply
of personnel and may not be suitable for tackling long-term
imbalances due to huge shortages or surpluses of medical
and nursing staff (Amorim Lopes et al., 2015).
Demand
Demand for health care is a derived demand (Grossman,
1972), which means that people do not seek health
care services as a final good for consumption but as an
intermediate service allowing them to be healthy and to
improve their stock of health capital (well-being). They want
to improve their health, and to do so; they seek healthcare
services (Amorim Lopes et al., 2015).
The concept of needs in health care is not consensual in
the health literature, with a semantic confusion arising from
its use in health economics (Hall & Mejia, 2009). While
the economic or effective demand translates the actual,
observed demand, usually measured in terms of service
utilization ratios such as bed occupancy rates, number of
inpatients, the needs component tries to fully encompass
the epidemiological conditions that characterize a given
population, measured through morbidity and mortality
rates or by the opinion of a panel of experts, and how that
may translate into a given quantity of required healthcare
services. Therefore, we see that the classical concept of
economic demand may not reflect the biological needs of
the population, as it may leave out the necessities of the
population regardless of their ability to pay (Amorim Lopes
et al., 2015).
An integrated approach uses a dynamic, system-level
perspective covering key drivers of supply and demand that
includes manpower planning and workforce development
is critical to overcoming such challenges (Stordeur et al.,
2010). The importance of paying attention to needs is also
continuously stressed, as changes in the health patterns
of the populations take place (Tomblin et al., 2009). The
impact of microeconomic and organizational changes in
productivity and the skill mix, of the evolution of demand
for healthcare services, and also of the evolution of health
diseases and its potential impact on the health system.
The given quantity of workers may provide more or less
healthcare services depending on their productivity and
skill mix, influencing the conversion from headcounts to
full-time equivalents (FTEs). Such conversion is critical to
properly assess the healthcare workforce, as a significant
number of physicians and nurses work part-time only. For
this reason, FTE is a more accurate measure as it normalizes
headcounts. On the demand side, economic (effective)
demand can be initially measured by analyzing utilization
indicators. How this demand will evolve in the future
will then be subject to typical economic factors such as
demography and the growth of the income/GDP (Amorim
Lopes et al., 2015).
In parallel, potential needs can be assessed by incorporating
the incidence and prevalence of diseases and then mapping
a given disease to an estimate of FTE requirements.
Whether future supply forecasts should tackle all of the
estimated needs is a decision left to the consideration of the
policymaker, as the analysis does not incorporate financial
constraints. Despite the abundance of approaches and
techniques to determine supply and need for professionals,
none of the methodologies has ultimately proved to be
superior (Ricketts, 2011).
Recent studies testing current forecasting models show
that there is still plenty of room for improvement given the
gap between projected and actual results (Greuningen et
al., 2013). It becomes even clearer that workforce planning
should be accurate and performed in due time, given
the attritions and the delays in enacting policies in the
healthcare sector. Adapting medical and nursing schools,
altering legislation, and changing roles is an effort that may
take years to bring forth. Therefore, planning has to target a
long enough time horizon to be useful and applicable and
has to be done pre-emptively (Amorim Lopes et al., 2015).
Accurate HHR planning requires an approach that is both
integrated and flexible, featuring supply and demand
(potential and effective) and incorporating less tangible
factors, such as skill mix and productivity (Amorim Lopes et.
al., 2015).
Academia
Looking at the area of academia, there are many issues at
hand that present challenges for nursing education at the
doctoral level. Having enough faculty to provide quality
education to those interested in pursuing a doctoral degree
in nursing relies on competent individuals. Presently there
are two types of doctoral degrees one can earn, both
are terminal degrees, and both allow nurses to continue
to practice in the clinical field. The Doctor of Nursing
Practice (DNP) has a clinical focus that allows the nurse
to possess expert knowledge to influence healthcare
outcomes across direct patient care, advocating for
healthcare policy implementation, and collaborating with
organizational leadership (Leveck, 2020, Chism 2010).
The Doctor of Philosophy (PhD) focuses on research in
advancing the nursing profession and change the quality
of patient care and outcomes in the field. PhD nurses also
teach and mentor nurses at the college and university
level, growing the next cohorts of professional nurses.
There is a difference between these two degrees in their
primary foci and length of education (registerednursing.
com). However, the DNP degree has become the more
sought-after degree, and individuals who have earned it
are considered equal at many institutions in academia in
relation to tenure attainment and administrative positions.
It was more common to see the individual with a PhD in
the academic setting. However, individuals seeking this
degree are decreasing in number, and some individuals
are having difficulty completing their dissertation. This adds
to the faculty shortage we continue to experience in the
profession. There is a distinction between the two degrees
and needs to be recognized and valued in advancing new
nurses, however, the DNP graduate is more prepared for the
clinical arena.
According to Drs. Di Fang and Karen Kesten, one-third
of the current nursing faculty workforce in all levels of
education are expected to retire by 2025 (ANA Fact Sheet,
2020). This will certainly have an effect on the numbers of
students who will be accepted when they apply for nursing
education overall.
Continuous changes in the nursing and medical fields have
been rapidly evolving because of technology and studies
such as the genome project. Graduate student feedback to
courses and discussions with clinical affiliates to the college/
university are two ways that information can be ascertained
in relation to curricular issues for content. Accreditation
standard revisions and the recently adopted Essentials with
emphasis on outcomes and competencies in learning have
also added to many of the changes schools are making to
revise overall curriculums (AACN, 2021). Learning theories
are used to expose students to various learning experiences.
Online teaching, simulation, inter-professional learning,
case studies, and other teaching formats take much time to
prepare and grade and may not all be familiar for present
faculty to fulfill.
Interdisciplinary education (IPE) among the various
healthcare providers is expected to be utilized in schools.
This type of education provides shared experiences that
allow for better understanding, improved engagement, and
clearer insight into cooperation in the work environment
and quality patient care. This activity in schools with major
medical affiliations has an edge in providing this type
of learning while many smaller colleges and universities
struggle to gain this opportunity. Many IPE opportunities
that do exist are noted through simulation-enhanced activity
(Fawaz, 2018). Although simulation is helpful, real-time
situations may affect the learner differently when exposed.
Technology has become more influential in our lives,
especially after the past year and a half of pandemic
experiences. However, online education is not a new
concept in education. Use of learning platforms, Zoom
meetings, Wiki’s, Google docs, social media, Electronic
Health Records, and so on have not been mastered by all
in education, faculty, or student. Many students like the
idea behind online learning in that they can study at their
own pace often or at a time that is most convenient for
them. This strategy for education allows for flexibility to
view course material in both an asynchronous and, at
times, synchronous format. Faculty find this learning takes
more time in their schedule for preparation and grading
than when classes met traditionally. Class size is not always
capped. Lack of support staff with course development
and difficulty managing technological changes have been
identified as barriers to distance education (Iwasiw et al.,
2020). This becomes frustrating to both teacher and student
in that the partnership that develops in learning is not fully
developed.
Future of Nursing
The Future of Nursing 2020-2030: Charting a Path to
Achieve Health Equity, study sponsored by Robert Wood
Johnson Foundation identified, that a nation cannot thrive
fully until everyone can live their healthiest possible life,
and helping people live their healthiest life is and has
always been the essential role of nurses. The ultimate goal
is to achieve health equity in the United States built on
strengthened nursing capacity and expertise (National
Academies of Sciences, Engineering, and Medicine, 2021).
The committee developed a framework identifying the key
areas for strengthening the nursing profession to meet the
challenges of the decade ahead. These areas include the
nursing workforce, leadership, nursing education, nurse
well-being, and emergency preparedness and response, as
well as responsibilities of nursing with respect to structural
and individual determinants of health (National Academies
of Sciences, Engineering, and Medicine, 2021).
In 1998 the Pew Health Professions Commission, a
group of healthcare leaders charged with assisting health
policymakers and educators teaching health professionals to
meet the changing needs of healthcare systems, completed
a report listing competencies healthcare providers of the
future would need. The competencies are listed in the
Fourth Report of the Pew Health Professions Commission
(O’Neal & Pew Health Professions Commission, 1998).
The book To Err Is Human: Building a Safer Health System
(Kohn, Corrigan, & Donaldson, 1999) brought national
attention to the issue of patient safety by discussing the
number of people who die each year from medical errors.
This, in turn, sharpened the focus of patient safety in nursing
education (Scheckel, 2008).
Despite the practice setting in which students learn
nursing care, it will include using various technologies and
knowledge of informatics to assist with patient care. These
technologies can include but are not limited to medical
devices patients will use to provide self-care, as well as
information retrieval, clinical information management, and
documentation technologies (Scheckel, 2008). Students’ use
of these devices has important implications for improving
their clinical judgment (Newman & Howse, 2007). Nurses
are also being exposed to the use of variety of clinical
management systems, like patient surveillance systems many
of which have implications for ensuring quality and safety.
A significant movement that accompanied the curriculum
revolution involved using pedagogies to ensure students
could think critically in clinical practice. Traditionally,
students who learned the nursing process were thought to
be learning critical thinking. During the past few decades,
the nursing process has been challenged as the best
approach to developing students’ critical thinking (Scheckel,
2008). However, current research in nursing education
suggests that students also need to engage in thinking
processes that promote reflective thinking, where they build
practical knowledge, embodied thinking, where they learn
the importance of intuition and pluralistic thinking, where
they consider a clinical situation using many perspectives
(Scheckel & Ironside, 2006).
Innovations
As nurses assume increasing responsibility for patient care
in primary care settings, the combination of increased
clinical and systems knowledge, as well as the capability
to apply and evaluate evidence to practice innovations,
can only have a positive impact. The presence of DNPprepared
APRNs in primary care will expand educational
opportunities. In the short term, the DNP-prepared APRNs
can mentor the MSN-prepared APRNs within the system.
Equally important is the opportunity for enhanced preceptor
education for nursing students in primary care (Dunbar-
Jacob et al., 2013).
Indeed, the preparation of the DNP will influence the
perception of health care systems regarding the added value
of DNP education. If graduates of such programs bring an
increased depth of knowledge and skill to the clinical arena,
the DNP will likely flourish. If graduates bring little more
than what is offered by master’s-level education, the DNP
will not be an attractive addition to the clinical arena. Thus,
the quality of the preparation of the DNP will influence
the adoption of the DNP practitioner and administrator by
health care systems (Dunbar-Jacob et al., 2013).
Conclusion
Challenges in building DNP programs include the
identification of qualified faculty for each specialty, qualified
capstone advisors, and qualified clinical preceptors. A
further challenge is the simultaneous education of master’s
cohorts and DNP cohorts. The challenges by requiring
faculty to obtain a doctoral degree, developing critical
academic–service partnerships in mentoring students for
practicum and capstone projects, and discontinuing MSN
advanced practice specialty programs while focusing on
the BSN-to-DNP and MSN-to-DNP programs. High-quality
DNP academics and DNP clinicians are crucial to help meet
these challenges. Each educational program must assess its
challenges and strategies for addressing those challenges.
How we proceed will determine the impact of our
programs on the future of the health care system (Dunbar-
Jacob, Nativio, & Khalil, 2013).
In academia, both the PhD and DNP prepared nurses
can work together to ensure quality education for our
nursing students. Both need an educational foundation to
be learned to be successful educators. The distinction of
the PhD concentrating on teaching theory and research
to assist nursing to maintain its scientific foundation and
the DNP concentrating on the clinical skills and acting as
preceptor/clinical educator at any level of nursing appear to
be the ideal partnership to develop. Both nurses can assist
academia and the clinical arena in staying current and
developing innovative care measures to provide quality
care to clients. When looking at the definitions noted at the
beginning of this work, this collaboration in teaching nurses
fits what was noted.

Page 22 • New Hampshire Nursing News March, April, May 2022
IN MEMORY OF OUR COLLEAGUES
The New Hampshire Nurses Association honors the
memory of and acknowledges the practice of deceased
nurses who have graduated from New Hampshire
nursing schools or who have actively practiced in New
Hampshire during their career. Sharing their names and
information about their career is one way we honor
their contribution to the profession. Brief submissions
are welcome.
Nurse Leader
Margaret (Gately) Comiskey, 98, died
on November 2, 2021. A Massachusetts
native she joined the Nurse Cadet Corps
in 1943, serving in Boston during World
War II. She attended and graduated from Simmons
College School of Nursing. Later she pursued graduate
studies in nursing and education at Boston College,
Boston University, Saint Anselm College and the
University of New Hampshire. She taught in both
hospital and collegiate schools of nursing in
Massachusetts and New Hampshire for many years.
Comiskey served as the President of the New
Hampshire League for Nursing. In this role she was
actively involved with the committees that established
the nursing program at UNH and the health careers
programs at the state technical colleges. During this
time, she also served on the first Advisory Council on
Health Careers for the State of New Hampshire.
Sacred Heart Grad
Angela "Cookie" (Kuk) Macek, 95,
passed on November 6, 2021. Cookie
was a lifelong resident of Manchester
and earned her Bachelor's of Science in
Nursing from Mount Saint Mary's
College. She practiced as a pediatric nurse at Sacred
Heart Hospital.
Notre Dame Grad
Mary (Van Lier) Lamy, 87, died
November 11, 2021. She earned her
degree in nursing from Notre Dame
Hospital and practiced nursing for 40
years at Catholic Medical Center.
Career Mobility
Joan A. (Betterly) McAndrews, 82, passed
away on November 15, 2021, after a
lengthy battle with breast cancer. She
practiced as a registered nurse at a variety
of healthcare organizations including
Greenbriar, Nashua Memorial Hospital,
Matthew Thornton, and Dartmouth-
Hitchcock where she retired in 2004.
Wentworth Hospital Grad
Shirley Ann (Renaud) Casella, 90,
passed away November 17, 2021. She
earned her nursing diploma from
Wentworth Hospital School of Nursing
in 1951. She had a 40-year career as a
maternity nurse at Portsmouth Hospital.
Nursing Instructor
Maureen Louise Welch, 72, passed away
November 17, 2021. A lifelong resident
of Manchester, she graduated from the
Sacred Heart Hospital School of
Nursing. She practiced as a staff nurse
and then returned to become a freshman instructor at
the CMC School of Nursing until its closure in 1981.
She was employed at Catholic Medical Center for over
45 years until her retirement in 2019.
Mary Hitchcock Grad
Marjorie E. (Bastow) Glidden, 94, died
on November 20, 2021. Following the
career path of her mother, she enrolled
as a nurse cadet at the Mary Hitchcock
Memorial Hospital School of Nursing,
graduating in 1946. She practiced in
Massachusetts and later at Speare
Memorial Hospital in Plymouth.
ARNP
Susan Elizabeth (Wolfe) Gust, 65,
passed on November 20, 2021 after a
short battle with cancer. She obtained
her BSN in Nebraska in 1986 and
received her Master’s degree from Rivier
College in in 2006 as a nurse
practitioner.
Palliative Care Nurse
Mary Lou Perin 78, passed away on
November 23, 2021, in Sharpsburg, MD.
A New York City native, she obtained
her nursing diploma from John Hopkins
SON in 1964 and practiced at
Dartmouth Hitchcock Medical Center
for many years in Psychiatry and
Oncology. She then obtained a Bachelor
of Science from UNH and a Master’s in Education from
UVM. At 50 she obtained an advanced nursing degree
at the University of Pennsylvania where she graduated
Summa Cum Laude to start a new career in Palliative
Care.
Concord Hospital Nurse
Joan (McAllister) Nolin, 89, passed
away on November 24, 2021. A Concord
native, she received her nursing degree
from Sacred Heart School of Nursing in
Manchester in 1952. Joan served as a
U.S. Navy Nurse from 1953 to 1955 and
then practiced in the maternity ward at
Concord Hospital for over 40 years.
Second Career
Dolouris ‘Dee’ Irene (Moeller) Ziter, 94,
died on November 27, 2021. Born in
Indiana she moved to Littleton, NH as a
homemaker. At 48 years old she
obtained her GED, took college prep
classes, and was accepted at NHTI. She
graduated with her AS degree with
Honors in nursing in 1977. She practiced
critical care nursing at Concord Hospital for 20 years
before retiring.
Veterans Nurse
Kathryn Lee (Mitchell) Colby, 65, passed
away unexpectedly on November 28,
2021. Born in Ruislip, England, she
obtained her associates at NHTI and her
BSN at UNH. She practiced at the
Veterans Administration Hospital in
Manchester, NH for many years. After a
motorcycle accident in October of 2000,
she became a Tele-Nurse with Health Dialogue which
required her to hold nursing certifications in all 50
states. She was employed there from 2001 until her
retirement in 2017.
Mary Hitchcock Grad
Jayne K. Trench, 65, passed away after a
long illness on November 30, 2021. Her
40-year nursing career started when she
graduated from the Mary Hitchcock
Memorial Hospital School of Nursing in
1978. She practiced at Mary Hitchcock
Memorial Hospital, then moved to
Boston, and then returned to DHMC.
She was awarded the 2013 DHMC Service Ace Award
and the 2015 Arete Award for recognition of caring and
service excellence to patients and colleagues.
NHNA President
The Rev. Marilyn Elaine Bushnell, 91,
died on December 5, 2021. Marilyn was
a diploma graduate of the Elliot
Community Hospital School of Nursing
in Keene, where she later taught. She
received a bachelor’s degree from
Simmons College and Master's Degrees
from Andover Newton Theological School, Boston
University School of Nursing and Harvard Divinity
School. In her nursing career she practiced in
psychiatric facilities including the NH State Hospital.
She was ordained in 1959 and served as the full-time
minister of the East Congregational Church in Concord.
Marilyn was active in the New Hampshire Nurses
Association, serving as president and a member of the
History Committee and Newsletter Committee.
Gero Nurse
Phyllis Joanne (Whitney) Phillips, 89,
passed away on December 8, 2021.
After obtaining her nursing diploma in
1953 in Massachusetts she practiced in
California. She relocated to New London
in 1972 and practiced at New London
Hospital, Seminole Point Hospital in
Sunapee NH, the VNA, and Woodcrest
Village. She also volunteered for the Council on Aging.
Oncology Nurse
Ursula G. (Flannery) Scribner, 77,
passed away on December 12, 2021,
after a valiant battle with Covid. She
obtained her nursing diploma in 1965
and moved to NH in 1978. She
practiced at the Monadnock Community
Hospital in several departments until the
Oncology Clinic opened and she found
her calling. She held certification in oncology as an
OCN. She loved the spirit and courage of cancer
patients.
NH Hospital Grad
Jean (Hayes) Gray, 84, passed away on
December 14, 2021. She obtained her
nursing diploma from the NH Hospital
School of Nursing. She practiced at the
Nephrology Associates of Concord, NH,
until her retirement.
NH Hospital Grad
Joan Catherine (Jackson) Cimikoski, 92,
passed away on December 19, 2021.
Born in Halifax, NS, Canada she was a
1950 graduate of the NH Hospital
School of Nursing in Concord. She
received her BA from New England
College in 1974. Joan practiced at NH
Hospital, rising to the position of
Assistant Director of Nursing, and retired in 1989.
Concord Hospital Nurse
Alexandra (Puntin) Pilsbury, 26, passed
away after a brave battle with cancer on
December 23, 2021. She obtained her
BSN from Western Carolina University
and was employed by Concord Hospital.
She practiced on the medical oncology
floor, she was dedicated to supporting
her patients and providing the care they
needed during their most difficult times. Alex had
started serving as a Resource Person on the unit when
she became ill.
Nurse Legislator
Alice Ziegra (Tisdale) Calvert, 94,
passed away on December 24th, 2021.
Born in Boston, she graduated from
Skidmore College in 1949 with a degree
in nursing. She practiced in New
Hampshire with the VNA in Alton and
was politically active in town and state
government. She served five terms (1989
to 1997) in the NH House of Representatives.
Public Health Nurse
D. Lynn (Barker) Heinzman, 65, passed
away on December 24, 2021, after a
very brief resurgence of cancer. After
obtaining a bachelor’s degree in Health
Education in Pennsylvania, she
continued her education throughout her
life attending the practical nurse
program at St. Joseph School of Nursing
in Nashua. She then obtained an associates degree in
nursing in Massachusetts. She practiced for the State of
New Hampshire as a Public Health Nurse Coordinator
during the late 1990's and early 2000's. She was also
summer Camp Nurse. She retired in November 2021.

March, April, May 2022 New Hampshire Nursing News • Page 23
IN MEMORY OF OUR COLLEAGUES
Nursing Faculty
Carolyn (Redden) Lorandeau, 87, died
on December 25, 2021. She was a
graduate of the Mary Hitchcock
School of Nursing. She practiced for
over 40 years including at the Keene
Pediatrics Clinic. She obtained a
bachelors degree from Keene State
College, and became a nursing faculty
member at NH Technical College in Claremont,
director of the LPN and Medical Assistant programs,
and coordinator of cancer screening programs.
Long Term Care Nurse
Patricia Ann ‘Trish’ (Wall) McGee,
76, died on December 29, 2021. She
obtained her LPN in 1978 and an
associates in nursing in 1989. She
practiced for many years as the
charge nurse at the Rockingham
County Nursing Home until her
retirement in 2001.
Valley Regional Nurse
Susan D. (Collins) Clark, 64, died after a
15-year struggle with breast cancer, on
January 20, 2022. She was a graduate of the
New Hampshire Vocational Technical
School in Claremont, earning an AS in
Nursing in 1988. She practiced at Valley
Regional Hospital in Claremont, NH, as a
Visiting Nurse in Bellows Falls, Vt, as a Med
/ Surg / ICU nurse at Monadnock Community Hospital, and
finally as the Friday Telemonitoring Nurse at Home
Healthcare Hospice and Community Services in Keene.
WDH Nurse
Karen Lee (Whelan) Mullaney, 76, died
January 23, 2022. She attended the
University of Massachusetts Amherst,
where she was part of the College of
Nursing's first graduating class. A long
career in pediatric nursing followed, which
included 42 years at Wentworth-Douglass
Hospital in Dover. She retired in 2012.
Mary Hitchcock Grad
Erica Moor Brinton, 73, died on
January 27, 2022. She earned a B.S. in
nursing at Russell Sage College. Erica's
longest-term employer was the Mary
Hitchcock Memorial Hospital,
particularly in orthopedics. When the Hospital
became the Dartmouth-Hitchcock Medical Center in
Lebanon, Erica moved with it. She retired from
DHMC after 2010.
Concord Hospital Grad
Sandra Rae (Palmer) Rhodes, 83,
passed away on January 29, 2022. She
was a 1960 graduate of the Concord
Hospital School of Nursing. She
practiced as a pediatric nurse at
Concord Hospital then at the NH State
Hospital. She also held positions as a
school nurse, a private nurse and
visiting nurse. Prior to her retirement she practiced at
Concord Urology.
WDH Nurse
Maureen Ann (St. Laurent) Foss, 80,
passed away on December 29, 2021.
She graduated from Sacred Heart
Nursing School in Manchester, NH in
1962. She started her career working
at Wentworth Douglass Hospital in
Dover.
Rivier Grad
Lisa (Michaud) Deware, 53, died on
December 30, 2021 as a result of
injuries she sustained in a motor
vehicle accident. A Nashua native,
she graduated from Rivier College
with an Associate Degree in Nursing.
Childbirth Educator
Jaime Elizabeth (Largent) Hunt, 43,
passed away suddenly on January 4,
2022. She practiced as a childbirth
educator at Lakes Region General
Hospital. She was also employed by
Franklin Hospital and the Veteran's
Home in Tilton during her twenty-year
career in nursing.
Laconia Grad
Anita (Simoneau) Edmands, 96,
passed away on January 13, 2022, in
Arizona. A Laconia native she
obtained her nursing diploma from
the Laconia Hospital School of Nursing and was a
member of the Cadet Nurse Corps prior to the end
of WWII. She practiced at the Laconia Clinic for
many years as well as an industrial nurse at Sanders
Associates in Nashua, from which she retired in
1996.
NHTI Grad
Sally Elizabeth (Beane) Lester, 75,
passed away January 18, 2022. She
was a 1989 graduate of the NHTI
nursing program.
Nursing Faculty
Rhoda E. Bergeron, 87,
passed away January 19,
2022. Part of her 40 year
career in nursing included
20 years as a nursing
instructor at the NHTI in
Concord. She was a
member of NHNA and the
American Nurses Association.