Nebraska Nurse - May 2022

Nebraska 

Nurse 

Sent to all Nebraska Nurses courtesy of the 

Nebraska Nurses Foundation in partnership 

with the Nebraska Nurses Association 

Quarterly circulation approximately 36,000 to all 

RNs, LPNs, and Student Nurses in Nebraska. 

Volume 55 • No. 2 

May, June, July 2022 

The Impact of Nursing 

Education on Sepsis 

Screening and Identification 

Pages 6-7 

Nebraska Nurse 

Practitioners Update 

Page 12 

Nurses Day at 

the Legislature 

Pages 8-9 

In This Issue 

Inside the NNA 

President’s Column ............................1 

NNA MIG Reports ............................3 

NNA State Director ............................3 

Nebraska Nurses Foundation 

NNF 2023 Project Grants – Applicants Needed! .......1 

Show Your Pride as a Nebraska Nurse! ..............4 

Feature Articles 

Project Firstline ....................................2 

$5 Million Dollars of Nebraska ARPA Funding 

Appropriated to Nursing Scholarships .................5 

The Impact of Nursing Education on 

Sepsis Screening and Identification .................. 6-7 

Nurses Day at the Legislature ........................8-9 

Think like an expert witness to avoid falls liability ....... 10-11 

Embracing Our Differences: DEI Webinar Series ...........11 

Affiliate Organizations 

Nebraska School Nurses Association ...................9 

Nebraska Nurse Practitioners Update .................12 

What is the Success Pays Program? ....................14 

Call for Submissions ................................14 

Membership Activation Form .........................15 

President’s Column 

Kari Wade, RN 

Nebraska Nurses Association President 

Happy Nurses Week 2022! 

This past month, the Nebraska 

Nurses Association has been 

deep into planning the 2022 

NNA Annual Convention details. 

As planning got underway, we 

reflected on the past two years 

of convention topics. In 2020, 

the NNA convention focused on 

population health, a prominent 

topic based on the events 

which occurred that year, most 

Kari Wade 

notably the beginning of the pandemic. In 2021, the NNA 

convention focused on Nurse’s self-care. After a year of 

mental, emotional, and physical strain, speakers provided 

tools and resources to enhance well-being and resilience 

for Nebraska nurses. So, we thought, what should be the 

focus for 2022? 

The decision - Coming Together. 

Nurses have already come together in 2022 with 

notable impact. During the spring legislative session, 

nurses from across the state collaborated to advocate 

for important legislation to address the nursing 

workforce. The experience was a powerful coming 

together of nurses having their voices heard. 

This summer, NNA is hosting the webinar series 

Embracing our Differences: Diversity, Equity, and 

Inclusion. As health professionals, we will come 

together to enhance DEI understanding and to improve 

our profession and the health for all people. 

And finally, in 2022 we are coming together for 

the first time since 2019 in-person for the NNA 

Annual Convention. Nursing organizations and 

associations from across the state will be coming 

together with NNA, including speakers from the 

Emergency Nurses Association, Nebraska Nurse 

Practitioners, Nebraska School Nurses, and many 

more. After two long years of being virtual, the 2022 

conference will be as much about coming together 

in-person again with our nurse colleagues across 

the state as it is about professional development 

and celebration. Mark your calendars for October 7 

& 8 and we hope to see you at the Lincoln Marriot 

Cornhusker hotel for two dynamic days of nurses 

coming together! 

NNF 2023 Project Grants – 

Applicants Needed! 

The NNF is once again able to accept applications for our project grants. The grants are 

designed to provide funding to NNA members for evidence-based practice, quality improvement or 

innovation projects conducted within clinical nursing or education settings. With all the pandemic 

surges we believe that ideas to enhance the nursing work environment or practice experience 

should be considered innovations. So gather your team and see what ideas come to mind! 

Materials have been updated and as facilities emerge from the latest pandemic surges, 

we are hoping that NNA members will consider applying. Maybe your unit has an idea for a 

‘rejuvenation space’ or something to enhance the work environment. Maybe a new refrigerator 

in the break room? Blanket warmer for patients? Ice machine? Anything that will benefit 25 or 

more persons and costs less than $1000 could be eligible. Sometimes the little things make a big 

difference during or after a long shift. 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

The acceptance deadline for applications to fund 2023 calendar year grants is December 1, 2022. 

Visit https://nebraskanursesfoundation.org/practice-clinical-grant-program/ for application materials 

and contact Teresa@tlandersonconsulting.com with questions or for more information.

Page 2 • Nebraska Nurse May, June, July 2022 

FEATURE ARTICLE 

PROJECT FIRSTLINE 

Nurses are the nation’s first line of defense against infectious diseases such as COVID-19. That’s why ANA has 

partnered with the CDC to present Project Firstline, an interactive series of free online tools that give you the training 

and information you need about infection prevention and control (IPC). Comprehensive education includes best practices 

addressing COVID-19 and other pathogens, as well as evidence-based strategies to improve outcomes. 

Project Firstline resources are designed to help you understand and confidently apply IPC principles regardless of 

previous training or background. New courses will be added as information advances so you can stay prepared with the 

latest knowledge. Together, we can stop the spread. 

Featured topics this month include: 

How COVID-19 Spreads 

• Episode 4: What’s a Respiratory Droplet? Why Does It Matter? 

• Episode 6: How Do Viruses Spread from Surfaces to People? 

• Episode 24: How Can COVID-19 Spread When You Don’t Feel Sick? 

• Episode 19: What Do New COVID Strains Mean for Infection Control? 

• Episode 7: How does COVID-19 spread? A Review 

Visit NNA’s Project Firstline Website for more! https://nebraskanurses.org/firstline 

NNA’s Mission: 

The mission of the Nebraska Nurses Association is advancing 

our profession to improve health for all. The vision of the 

Nebraska Nurses Association is to be a proactive voice for 

nurses and an advocate for improved health for all. 

NNA’s Core Priorities 

C – Collaboration 

A – Advocacy 

R – Recognition 

E – Education 

NNA’s Official Publication: 

The Nebraska Nurse is the official publication of the 

Nebraska Nurses Association (NNA) (a constituent member 

of the American Nurses Association), published quarterly 

every February, May, August, and November. The NNA 

provides education, networking opportunities, publications 

and other products and services to its members and 

extends its mission to all nurses in Nebraska. 

Phone: (888) 885–7025 

You can leave a message at any time! 

Email: Director@NebraskaNurses.org 

Web site: www.NebraskaNurses.org 

Mail: c/o Midwest Multistate Division 

3340 American Avenue, Suite F 

Jefferson City, MO 65109 

Nebraska HIV Update & PrEP Institute Part 3 

Thursday, June 9, 2022 | 7:45 am – 5:00 pm CST 

INTENDED 

AUDIENCE 

LEARNING 

OBJECTIVES 

CEUs 

Healthcare providers, HIV care and prevention staff, and managers who 

work with PrEP and ART from health departments, clinics, and CBOs 

• Identify what is new in HIV care 2022 

• Discuss common and evolving co-morbidity management in HIV care 

• Define optimal strategies for the engagement of multidisciplinary team 

members in the care of patients with HIV 

• Describe patient perspectives on desiring and receiving long-acting 

antiretroviral therapy 

• Discuss best practices in the implementation of PrEP usage for ages 14-18 

• Extend awareness of PrEP usage within the Native American Community 

• Identify best practices to rebrand PrEP in social media 

Continuing education will be provided for: Physicians, Nurses, and Pharmacists 

Certificates of attendance will be available for any attendee 

Completion of evaluation required to receive Continuing Education Certificate 

Registration for the IN PERSON format is limited, and will close on May 30, 2022: 

https://matec.caspio.com/dp/BA50700090280c9da9194a3daf9c?ER_ID=38121 

Registration for the VIRTUAL format will remain open until June 8, 2022 at: 

https://matec.caspio.com/dp/BA50700090280c9da9194a3daf9c?ER_ID=38605 

Please send any questions to Daemon Donigan: 

Daemon.Donigan@nebraska.gov 

Questions about your nursing license? 

Contact the Nebraska Board of Nursing at: 

(402) 471–4376. The NBON is part of the Nebraska Health 

and Human Services System Regulation and Licensure. 

Questions about stories in the Nebraska Nurse? 

Contact: NNA. 

This newsletter is a service of the Nebraska Nurses 

Association and your receipt of it does not mean 

you are automatically a member. Your membership 

in support of this work is encouraged; please visit 

www.nebraskanurses.org. 

Writer’s Guidelines: 

• Any topic related to nursing will be considered for 

publication in the Nebraska Nurse. 

• Authors are not required to be members of the NNA; 

however, when space is limited, preference will be given 

to NNA members. 

• Photos are welcome, digital is preferred. NNA does not 

assumes responsibility for lost or damaged photos. 

• Use current APA formatting for any article requiring 

citation. 

• Provide a brief author biography indicating the author’s 

nursing experience and/or expertise with the paper’s 

content. 

o Limit the author’s biography to 4-sentences. 

• Submitted material is due by the 2nd of the month in 

January, April, July, and October of each year. 

• The peer-review is blinded; submit the title page 

separately from the article 

• Submit the title page and article as Word documents to 

npdc@nebraskanurses.org 

For advertising rates and information, please contact Arthur 

L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa 

50613, (800) 626–4081, sales@aldpub.com. NNA and the 

Arthur L. Davis Publishing Agency, Inc. reserve the right to 

reject any advertisement. Responsibility for errors in advertising 

is limited to corrections in the next issue or refund of price of 

advertisement. 

Acceptance of advertising does not imply endorsement 

or approval by the Nebraska Nurses Association of products 

advertised, the advertisers, or the claims made. Rejection of an 

advertisement does not imply a product offered for advertising 

is without merit, or that the manufacturer lacks integrity, or that 

this association disapproves of the product or its use. NNA and 

the Arthur L. Davis Publishing Agency, Inc. shall not be held 

liable for any consequences resulting from purchase or use of 

an advertiser’s product. Articles appearing in this publication 

express the opinions of the authors; they do not necessarily 

reflect views of the staff, board, or membership of NNA or 

those of the national or local associations.

May, June, July 2022 Nebraska Nurse • Page 3 

NNA MIG Reports 

Omaha Metro Area MIG Update 

Anna Mackevicius, BSN RN PMP 

Chair, Omaha Metro Area Mutual Interest Group 

Here’s an update regarding events planned by the Omaha Metro Area Mutual Interest 

Group this year. Remember, all area nurses are welcome at any of our events; you do not 

need to be a NNA member but, of course, we hope you consider becoming one. 

Student Leaders Recognition 

This virtual event, organized by Omaha MIG member Beth Flott, was held on March 

26; the event was attended by local colleges and universities of nursing in Region 4. 

The purpose of the event is to recognize local student nurses who are leaders of their 

campus’ Student Nurses Association. Congratulations to all 15 future nursing leaders 

who were recognized! See the article in this edition with more details of this event. 

The Positive Image of Nursing Awards 

Recognition of the Positive Image of Nursing continues. No in-person event again this 

year. We are accepting nominations until April 19. The portal can be found at https:// 

nebraskanurses.org/2022-nna-pin-award-nominations/?eType=EmailBlastContent&eId=e 

b232f1f-a0dd-4b49-85ed-2a4c90085a6e. We’d love to have a photo of your nominee, 

too! The presentation will be posted to the NNA website by April 30. As you catch your 

breath at work, nominate a peer! Certificates for each honoree will be sent to their 

facility or to the honoree and nominator (if nominated individually). Look for the list of 

honorees in the next Nebraska Nurse issue. Feel free to contact me with any questions. 

Email address is at the end of this article. 

Nurses Political Reception 

A legislative reception is planned for August 23, 2022 at the Thompson Alumni 

Center on UNO’s campus. The planning group will reach out to elected officials 

and candidates to attend after the primary elections are held. The Omaha MIG will 

be seeking corporate and individual sponsors for this year’s event. Please consider 

contributing this to worthwhile event. More information will be available soon. Check 

your inbox and/or the NNA website for more details in June. 

Omaha Metro Area Mutual 

Interest Group Recognizes Local 

Student Nurse Leaders 

Members of the NNA Omaha Metro Area Mutual Interest Group (MIG) and 

current faculty recognized 15 student nurse leaders on Saturday, March 26. 

The event was held at Nebraska Methodist College. Participating colleges and 

universities included College of Saint Mary, Nebraska Methodist College, and the 

University of Nebraska - College of Nursing. 

Kari Wade Ed.D., MSN, RN, CNE, President of Nebraska Nurses Association, 

discussed the many opportunities NNA provides and how they advocate for 

nurses. The group was also addressed by Jodi Hayes, MSN, RN, SANE-A discussed 

her role as a sexual assault nurse examiner (SANE) and the programs offered in 

Nebraska. 

Small group discussions were utilized to facilitate networking and idea-sharing 

by students from the different schools including discussing ideas for future group 

events. Each student was provided a certificate recognizing their leadership 

contributions. The MIG plans to hold this event in 2023 and encourages all local 

colleges and universities to participate. Congratulations to the following Student 

Nurse Leaders of today and our future Nursing Leaders! 

College of Saint Mary 

Allyson Smith 

Nicole Knight 

Atalia Kemp 

Anna Hough 

Ashlyn Echrich 

Serena Moore 

UNMC 

Carey Kyes 

Isabelle Vanderneck 

Nebraska Methodist College 

Emma Kuker 

Jaclyn Schnakenberg 

Jessica Dang 

Allie Enderle 

Katie Kruger 

Hannah Guild 

Kaylyn Biery 

Annual Dinner and Charitable Drive 

The MIG is considering options for a dinner or luncheon for 2022. Looking into a 

possible outdoor venue early summer that we could combine with chartable drive. We 

would love to hear your ideas for a fun and safe gathering. More to come on this event. 

Finally, Happy Nurses Week to everyone! I am honored to be a member of our 

respected and trusted profession. Feel free to contact me at annamackevicius@gmail.com 

if you have any questions about the Omaha Metro MIG events or membership to NNA. 

NNA State Director 

Kim Houtwed, MBA, BSN, RN 

NNA State Director 

As I look back on previous articles and my indoctrination to 

the Nebraska Nurses Association almost three years ago as the 

State Director, I am continually amazed at the knowledge and 

dedication this association is fortunate to have with your NNA 

elected leaders. They spend countless hours reviewing bills, 

discussing our position on the bill, writing, and giving testimony. 

During this short Legislative session, over five hundred 

bills were read, eleven letters of support or opposition sent, 

and eleven times nurses provided testimony to the Legislative 

Committees. This all would not be possible without the expert 

guidance from our Lobbyist, Don Wesely from O’Hara-Lindsay in 

Lincoln. I encourage you to review our Bill Tracker that is located Kim Houtwed 

on our web page at www.nebraskanurses.org, Testimony and 

letters are found under the Members Only section of the website. 

Nurses are the backbone of our health care system as we protect, promote, and 

optimize health and abilities, prevent illness and injury, alleviate suffering through 

diagnosis and treatment of human response and advocate in the care of individuals, 

families, communities, and populations. All too often our nurse voices are not heard in the 

legislative process. Nurses Day at the Legislature introduces legislative advocacy as a way 

for nurses and nursing students to advocate for their patients and positively impact health 

care policy. Legislators do want to hear from us! Advocacy, on the part of all registered 

nurses is essential if we are to have the resources, voice, and practice authority to provide 

safe, effective care to patients. 

Membership and participation in the Nebraska Nurses Association and American 

Nurses Association is a fantastic way to learn about how to be a voice for nursing. 

Advocacy is not necessarily political. Advocacy can take place at the bedside, unit 

leadership councils, the boardroom, or at the levels of local, state, and national 

governments. 

From all of us at NNA, we thank you for your continued support of the important 

advocacy work that represents every nurse in Nebraska.


Show Your Pride 

In extraordinary times, Nebraskans 

can rely on exceptional professionals 

NEBRASKA CENTER FOR NURSING honors nurses for their 

compassion, courage, dedication and expertise in caring for their 

patients and communities. 

Nebraska Nurse! 

Now is a perfect time to wear or display 

your pride as a nurse in Nebraska. The 

Nebraska Nurses Foundation seeks to build 

camaraderie and pride among nurses in our 

state, by continuing to offer “Proud to Be a 

Nebraska Nurse” pins to all interested nurses 

for a donation of $15 (includes shipping and 

handling to send the pin directly to your 

door). The gold-toned metal pin, shaped 

in the image of the State of Nebraska will 

stand out on your lapel, jacket, lanyard, 

purse, or hat. 

Visit the link below to access the order 

form today. 

Purchase your Nurses Care specialty plate 

center4nursing.nebraska.gov 

Promoting the value of nurses 

and nursing careers 

Building, maintaining and expanding 

the state’s nursing work force 

Improving access to care. 

https://nna.salsalabs.org/ 

nnfpridepinorderform/index.html 

The Nebraska Masonic Home is a continuing care 

retirement community that provides independent 

living, assisted living, long-term nursing care, and 

Alzheimer’s/dementia care located in Plattsmouth, 

NE, just 20 minutes south of Omaha. 

We are hiring for full-time and part-time 

RNs, LPNs, and CNAs. 

We offer an excellent benefits package and a 

superior working environment. 

To apply please visit: thenebraskamasonichome.org 

or call: 402-296-7300



$5 Million Dollars of Nebraska ARPA Funding 

Appropriated to Nursing Scholarships 

Kari Wade, NNA President 

The Nebraska Nurses Association (NNA) was 

fully engaged with the 2022 Nebraska legislature 

as NNA provided testimony for 16 legislative bills 

(LB) during the short session. One bill, LB 1091 

introduced by Senator Dorn, was significantly 

impacted by the work of NNA and the Nebraska 

Center for Nursing. The bill recommended using $5 

million dollars of American Rescue Plan Act (ARPA) 

funds to invest in the future Nebraska nursing 

workforce through nursing school scholarships. The 

bill required a two-year time limit for distribution 

as per ARPA distribution guidelines. While the 

original bill did not include registered nurses or 

accelerated bachelor’s degree in nursing programs, 

amendments were eventually made to include both 

on the bill through work by NNA and the Center 

for Nursing. LB 1091 advanced from the Health and 

Human Services Committee to the Appropriations 

Committee for ARPA funds consideration (LB 

1014), but the bill did not make the Appropriation 

Committee’s list for ARPA funding. 

Prior to the floor debate for LB 1014 however, 

NNA was made aware an amendment would 

be introduced by Senator Murman to request 

LB 1091 funding once again be included into LB 

1014. NNA and Center for Nursing quickly got to 

work and provided needed support information 

to the Senators. During the floor debate, Senators 

Murman, Dorn, Arch, and Day all spoke strongly 

in support of the importance of investing in the 

nursing workforce of Nebraska and quoted data 

provided by the Center for Nursing as justification. 

Ultimately, the amendment was adopted with 

a vote of 37-1, and $5 million dollars was 

appropriated for nursing scholarships in Nebraska. 

A tremendous amount of time and work 

went on behind the scenes for this initiative by 

nurse volunteers to be introduced, supported, 

introduced again, and passed. A special thank 

you to NNA/Center for Nursing members Ann 

Oertwich and Christi Glesmann; NNA lobbyist 

Don Wesely; NNA Legislative Advocacy and 

Representation Committee; and the Nebraska 

Hospital Association; for their collaborative work 

with this initiative. Also, thank you to the nurses of 

Nebraska who contacted their Senators in support 

of the bill. The success of this legislation was an 

incredible team effort! 

Nebraska Nursing 

Students and NNA 

Members: 

The Nebraska Nurses Association has several awards 

and scholarship opportunities available this year and 

are now open for application submission. The following 

scholarships are open for application submissions: 

• NNA Member Scholarship – one $1000 

scholarship per NNA membership liaison region 

to an NNA member seeking higher education 

• Arthur L. Davis –two $500 scholarships for prelicensure 

nursing students 

• Gail Graham Memorial – one $500 scholarship 

for nurses furthering their education. 

More information on the awards and scholarship 

applications can be found at http://www. 

nebraskanurses.org/awards-scholarships/. The deadline 

for all applications is AUGUST 26, 2022. Submit your 

applications today! 

STATE OF IOWA NOW HIRING 

Glenwood Resource Center (GRC) is seeking 

applicants for RNs and LPNs caring for those with 

Intellectual Disabilities and Physical Disabilities. 

RN hourly rates starting at: $26.53 - $41.17* 

LPN hourly rates starting at: $22.48 - $34.14* 

1 

2 

RNs & LPNs 

Apply online: https://das.iowa.gov 

Click on Human Resources 

Click on State employment 

*based on 

experience



The Impact of Nursing Education on Sepsis 

Screening and Identification 

Linda Moody, Robert Elledge, & Carol Bett 

Sepsis involves a multifaceted development of infectioninduced 

pathophysiologic derangements which can 

advance to life-threatening organ dysfunction (Singer et al., 

2016). The rates of diagnoses of sepsis are rising in tandem 

with increasing lifespan, concomitant chronic disease 

states, increased screening efforts and knowledge of sepsis 

pathophysiology, and accentuation on outcomes which may 

govern reimbursement. This condition occurs worldwide 

and affects men and women in all racial, geographic, and 

socio-economic strata. Sepsis remains a leading cause 

of significant morbidity and mortality and accounts for 

considerable health care costs (Maclay & Rephann, 2017). 

Pathophysiology of Sepsis and Septic Shock 

Sepsis accounts for approximately 10% of all Intensive 

Care Unit (ICU) admissions and can arise from either 

community acquired infection or developed within a 

health care setting. Sepsis frequently occurs secondary 

to pneumonia, urinary tract infections, intra-abdominal 

infections, cellulitis, complex wounds or osteomyelitis, and 

catheter associated infections related to central venous 

catheters or arterial catheters placed during hospitalization 

(Brashers, 2017; McCulloh & Opal, 2016). The virulence of 

the causative organism, source of infection and baseline 

health status of the patient are all factors which significantly 

affect an individual’s prognosis. 

Sepsis begins with an initial infection which progresses to 

bacteremia. Bacteria and their production of toxic substances 

induce an overproduction of proinflammatory cytokines 

such as tumor necrosis factor alpha (TNF-α), interleukin-1 

(IL-1), and interleukin-6 (IL-6) which produce an exaggerated 

inflammatory host response, otherwise known as an 

inflammatory cascade (Brashers, 2017). Endotoxins secondary 

to gram-negative sepsis are strong activators of both the 

clotting and complement systems which can increase 

capillary permeability leading to high-volume plasma loss into 

interstitial space. This excessive plasma depletion often results 

in hypotension and can progress to cardiovascular shock, in 

this case termed septic shock (Schwartz et al., 2017). Septic 

shock secondary to gram-negative sepsis has been associated 

with up to 50% mortality. Stimulation of the coagulation 

cascade can also result in the syndrome of disseminated 

intravascular coagulation (DIC). 

Clinical Manifestations of Sepsis 

Signs and symptoms of sepsis include tachycardia 

defined as heart rate greater than 90 beats per minute, 

tachypnea with more than 20 breathes per minute, 

temperature less than 36 degrees or more than 38 degrees 

Celsius denoting hypothermia or fever, and less than 4,000 

or more than 12,000 white blood cells or greater than or 

equal to 10% of banded neutrophils otherwise known as 

leukocytosis, leukopenia, and bandemia respectively (Marik 

& Taeb, 2017). Hematologic results may include either 

leukocytosis, leukopenia, or increased number of immature 

leukocytes, elevated procalcitonin level, elevated C- reactive 

protein level, and increased lactic acid level. Compromise of 

vital organs secondary to sepsis can be identified by altered 

mental status, hypotension, hypoxemia, acute decrease 

in urine output and increase in serum creatinine related 

to renal dysfunction, and hepatic alterations including 

thrombocytopenia, hyperbilirubinemia, and coagulation 

abnormalities (McCulloh & Opal, 2016). 

Current Screening and Diagnostic Methods 

Various methods exist for attempting to rapidly and 

accurately identify individuals with sepsis. Tools utilized 

for sepsis screening include the signs and symptoms 

previous listed, Sequential Organ Failure Assessment



(SOFA) scoring, and Quick Sequential Organ Failure 

Assessment (qSOFA) scoring (Marik & Taeb, 2017). These 

instruments include measurement of vital signs, lab 

values such as serum lactate and creatinine, suspicion of 

infection, and alterations in mental status from perceived 

patient baseline. Septic shock was further delineated by 

the presence of marked hypotension requiring vasoactive 

medications despite adequate fluid resuscitation in 

patients meeting sepsis criteria. 

Method 

A retrospective chart review at a Midwestern acute care 

medical center was used to collect and analyze data on 

sepsis screening measures and provider alerts pertaining to 

adult patients diagnosed with sepsis. Data were examined 

prior to, and following, implementation of targeted nursing 

education on sepsis screening using Pearson’s chi-squared 

test with a significance threshold of p-value < .05 using 

two-tailed probability. 

Results 

Consistent nursing screening is determined to be present 

if a patient is screened for sepsis at least every twelve hours 

by the nursing staff. In reviewing nurses’ documentation 

before and after the nursing education, the findings 

showed that consistent nursing screenings were performed 

for 26% of patients prior to nursing sepsis education and 

42% of patients were consistently screened following 

the nursing sepsis education. The targeted nursing sepsis 

education did have an impact on consistent nursing 

screening practices for sepsis. 

Conclusion 

Sepsis remains an ambiguous and life-threatening 

clinical syndrome which is variable in presentation and 

difficult to diagnose. Early identification and treatment of 

this disease process has been associated with improved 

patient outcomes while delays to diagnosis demonstrates 

exponential risk in patient morbidity and mortality. Nursing 

education on sepsis pathophysiology and the importance 

of consistent screening practices has been associated 

with enhanced sepsis surveillance and decreased time 

to diagnosis. Nurses play a vital role in the identification, 

diagnosis, and treatment for this life-threatening condition. 

References 

Brashers, V. L. (2017). Alterations of cardiovascular function. In S. 

E. Huether, K. L. McCance, V. L. Brashers, & N. S. Rote (Eds.), 

Understanding pathophysiology (6th ed.), pp. 1915-1922. 

Elsevier Health Sciences. 

Maclay, T., & Rephann, A. (2017). The impact of early 

identification and a critical care–based sepsis response 

team on sepsis outcomes. Critical Care Nurse, 37(6), 88- 

91. doi:10.4037/ccn2017183 

Marik, P. E., & Taeb, A. M. (2017). SIRS, qSOFA and new 

sepsis definition. Journal of Thoracic Disease, 9(4), 943- 

945. doi:10.21037/jtd.2017.03.125 

McCulloh, R. J., & Opal, S. M. (2016). Bacteremia and 

sepsis. In I. J. Benjamin, R. C. Griggs, E. J. Wing, & J. G. 

Fitz (Eds.), Andreoli and Carpenter’s cecil essentials of 

medicine (9th ed., pp. 846-851). Elsevier Saunders. 

Schwartz, A., McCance, K. L., & Rote, N. S. (2017). 

Alterations of hematologic function. In S. E. Huether, 

K. L. McCance, V. L. Brashers, & N. S. Rote (Eds.), 

Understanding pathophysiology (6th ed., pp. 1623). 

Elsevier Health Sciences. 

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar- 

Hari, M, Annane, D, M., Bauer, M., Bellomo, R., Bernard, 

G. R., Chiche, J-D., Coopersmith, C. M., Hotchkiss, R. 

S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, 

S. M., Rubenfeld, G. D., van der Poll, T. Vincent, J-L., & 

Angus, D.C. (2016). The third international consensus 

definitions for sepsis and septic shock (sepsis-3). Journal 

of the American Medical Association, 315(8), 801-810. 

doi:10.1001/jama.2016.0287



Nurses Day at the Legislature 

- Suzanne L. Nuss, MBA, PhD, RN, CENP 

Chief Nursing Officer, Nebraska Medicine 

- Tina Pate, MSN, RN, CEN 

Chief Nursing Officer, Great Plains Health 

- Tim Plante, RN MSN MHA 

Division Vice President of Nursing, CHI Health 

- Nicole Thorell, RN, MSN 

Chief Nursing Officer, Lexington Regional Health 

Center 

- Lisa Vail, RN, DNP, NEA-BC 

Vice President Patient Care Services and Chief 

Nursing Officer, Bryan Health 

Anna Mackevicius, Chair, Planning Committee 

More than 450 nurses and nursing students 

participated in the 2022 Nurses Day at the Legislature. 

The On-Demand presentations opened on February 

24 and were available for viewing until March 31. 

Participants included 105 Registered Nurses, 21 

Advanced Practice Registered Nurses, and 326 nursing 

students. Students represented nearly each school/ 

college of nursing in Nebraska with robust registration 

from Bryan College, Central Community College, 

Northeast Community College, Nebraska Methodist 

College, and the University of Nebraska Medical Center. 

The presentations this year addressed highly relevant 

topics to the practice of nursing in Nebraska, as well as an 

update on legislative bills in the Nebraska Unicameral that 

are important to Nursing. The presentations included: 

• Genius is Taking Something Complex and 

Making It Simple: Team-Based Nursing Care 

- Kathy Hoebelheinrich, MSN, APRN-NP, ANP-BC 

DHHS Nurse Consultant, Nebraska Department 

of Health and Human Services 

• Models of Patient Care – Panel Presentation 

- Teri Bruening, MSN, RN-C, CNE 

Vice President for Patient Care Services and 

Chief Nursing Officer, Methodist Hospital and 

Women’s Hospital 

• Nebraska Legislative Update: At the Table 

Where It Happens 

- Don Wesley, BA 

Lobbyist/NNA Legislative Liaison, O’Hara Lindsay 

Government Relations 

- Rita Weber, MSN, RN 

Co-Chair, Nebraska Nurses Association Legislation, 

Advocacy, and Representation Committee (LARC) 

• Call to Action 

- Kari Wade, Ed.D., MSN, RN, CNE 

President, Nebraska Nurses Association 

The event also included several “rooms” for video 

calls with State Senators. The Senators were provided 

a list of questions so they may prepare responses for 

the 20 minute session. The Q&A session was attended 

by 193 participants and 10 State Senators.



AFFILIATE ORGANIZATIONS 

The NNA thanks all of the Sponsors for this event, 

whose generous contribution makes this event possible. 

Video Sponsor 

Nebraska Methodist Health System 

Banner Sponsors 

Bellevue University 

Bryan Health 

Clarkson College 

Creighton University College of Nursing 

Nebraska Wesleyan University 

Purdue University Global 

University of Nebraska Medical Center College of 

Nursing 

Virtual Listing Sponsors 

Nebraska Nurse Practitioners 

Southeast Nebraska Oncology Nursing Society 

Individual Sponsors 

Brenda Bergman-Evans 

Melissa Florell 

Heidi Gubanyi 

Douglass Haas 

Linda Hardy 

Kathy Hoebelheinrich 

Michelle L. Johnson 

Alice Kindschuh 

Carole Lainof 

Linda Lazure 

Anna Mackevicius 

Rachel Mann 

Jodi Nelson 

Marilyn Valerio 

Kari Wade 

Carol Wahl 

Rita Weber 

Nebraska 

School Nurses 

Association 

The Nebraska School Nurses Association, the official 

affiliate of the National Association of School Nurses, in 

collaboration with the Central Nebraska School Nurses 

Association, is hosting the 38th Annual School Nurse 

Conference in person on June 6 and June 7, 2022 in 

Kearney, Nebraska. 

The Keynote speaker is Dr. Maria Cantu Hines, a 

Health Educator for DHHS Office of Health Disparities 

and Health Equity. She will be presenting on Culturally 

and Linguistically Appropriate Services Standards. Other 

presenters will cover topics such as Type 1 Diabetes, 

Common pediatric GI disorders, and seizure safe schools. 

If you are interested in attending the conference, please 

contact catherine.heck@ops.org for more information. 

Additionally, the Nebraska School Nurses Association 

will hold the annual all members meeting and install newly 

elected NSNA board of director positions. 

Register Today! 

MATEC-KS/NE Regional Program: 

HIV Prevention & Treatment Challenges in 

Rural America 

Speaker: Donna Sweet, MD, MACP, AAHIVS 

Tuesday, June 21, 2022 • 8:30 - 9:45am CST 

Learning Objectives: 

1. Discuss who should be offered HIV PrEP 

2. Identify current options in HIV Treatment 

3. Recognize HIV care issues for people with HIV in rural areas 

Zoom link will be sent upon registration 

Click here to register 

No fee for participants but registration is required 

Disclaimer: “This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part 

of an award totaling $3,994,961 with 0% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official 

views of, nor an endorsement, by HRSA, HHS or the U.S. Government.” 

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Think like an expert witness to avoid falls liability 

Georgia Reiner, MS, CPHRM 

An 88-year-old patient slips on the floor, falling and 

breaking his hip. Your immediate concern is getting 

him the help he needs, but you also wonder if you 

could be legally liable for what happened. By thinking 

like an expert witness, you can help determine if 

this concern is valid and whether you could have 

taken steps to avoid the situation in the first place. 

But first, you need to understand some background 

information. 

Falls facts 

From 2007 to 2016, the fall death rate for older 

adults in the United States increased by 30%, 

according to data from the CDC. Each year, three 

million older adults are treated in emergency 

departments (EDs) for fall injuries, and more than 

800,000 people are hospitalized each year because 

of injuries related to a fall. These falls extract a high 

price—more than $50 billion for medical costs in a 

single year. 

Nurse professional liability claims involving falls are 

identified in the Nurse Professional Liability Exposure 

Claim Report: 4th Edition. The report notes that 

many of the closed claims analyzed in the report 

dataset which involved falls occurred because the 

nurse failed to follow fall-prevention policies and 

procedures. Further, the report states that falls most 

frequently occurred in inpatient hospital, surgical 

services, and aging services settings, as well as in 

patients’ homes. 

Given the statistics and the many places falls can 

occur, a fall is not an uncommon occurrence in a 

nurse’s career. A fall does not automatically mean the 

nurse is liable; for that to happen, key elements of 

malpractice need to be present. 

Elements of malpractice 

To be successful in a malpractice lawsuit, plaintiffs 

must prove four elements: 

1. Duty. A duty existed between the patient and 

the nurse: The nurse had a responsibility to care 

for the patient. 

2. Breach. The duty to care was breached; in other 

words, the nurse may have been negligent. To 

determine if negligence occurred, the expert 

witness would consider whether the nurse met 

the standard of care, which refers to what a 

reasonable clinician with similar training and 

experience would do in a particular situation. 

3. Injury. The patient suffered an injury. Even if 

a duty existed and it was breached, if no injury 

occurred, it’s unlikely the lawsuit would be 

successful. Keep in mind, however, that injury 

can be defined as not only physical injury, but 

also psychological injury or economic loss. 

4. Causation. The breach of duty caused the 

injury—the injury must be linked to what the 

nurse did or failed to do. This can be summed 

up in one question: Did the act or omission 

cause the negative outcome? 

Expert witnesses will consider these four elements 

as they review the case, and they’ll ask multiple 

questions (see Was there liability?). The questions 

primarily address prevention and what was done after 

the fall occurred. 

Prevention 

The following steps can help prevent falls and, 

if documented correctly, prove that the nurse took 

reasonable steps to protect the patient from injury: 

Take a team approach. Registered nurses, licensed 

practical/vocational nurses, and certified nursing 

assistants are ideal members for a team dedicated to 

creating a falls reduction plan for each patient. 

Assess the risk. Whether in the hospital, 

rehabilitation facility, clinic, or home, a comprehensive 

assessment is essential to identify—and then 

mitigate—falls hazards. This starts with assessing 

the patient for risk factors such as history of a 

previous fall; gait instability and lower-limb weakness; 

incontinence/urinary frequency; agitation, confusion, 

or impaired judgment; medications; and comorbid 

conditions such as postural hypotension and visual 

impairment. It’s also important to consider the 

environment, particularly in the home setting. For 

example, throw rugs are a known falls hazard. 

An excellent resource for assessing communitydwelling 

adults age 65 and older is the CDC’s STEADI 

(Stopping Elderly Accidents, Deaths & Injuries) 

initiative, which is an approach to implementing the 

American and British Geriatrics Societies’ clinical 

practice guideline for fall prevention. The initiative 

provides multiple resources for clinicians, such as 

a fall risk factors checklist with the categories of 

falls history; medical conditions; medications; gait, 

strength, and balance (including quick tests for 

assessing); vision; and postural hypotension. Keep in 

mind that assessment should be ongoing during the 

patient’s care because conditions may change. 

Was there liability? 

If a patient falls, an expert witness will likely want 

to know the answers to the following questions 

(developed by Patricia Iyers) when deciding if liability 

may exist: 

Before the fall: 

▪ Was the patient identified as being at risk for falls? 

How was that risk communicated to others? 

– What medications did the patient receive? Do 

they have side effects that may increase the 

risk of a fall? 

– Were there specific conditions present that 

could increase the risk of a fall? 

▪ Were measures implemented to prevent falls? 

– Was the patient capable of using the call light 

and was it used to call for assistance? 

– Was the bed in the lowest position? 

– Were the lights on in the room or under the 

bed to help light the area at night? 

– Was the patient given antiskid slippers? 

Immediately after the fall: 

▪ How soon was the individual found after he had 

sustained a fall (it’s not always possible to establish 

an exact time)? 

▪ What was done at the time of the fall? 

▪ Was the patient appropriately monitored after the 

fall to detect injuries? 

▪ What did the assessment (including vital signs) 

reveal? 

▪ Did the nurse communicate the findings to the 

patient’s provider? 

▪ Were X-rays ordered and performed? 

▪ Was there an injury? If so, how soon was it 

treated? 

▪ If the patient hit their head, was the chart 

reviewed to determine if mediations included 

an anticoagulant? If on anticoagulant, was this 

information communicated to the provider so 

head scans could be performed to check for 

cranial bleeding? 

Following up after a fall: 

▪ Was there a change in mental status after the fall? 

▪ Were additional assessments and monitoring 

done as follow up? 

▪ Was the patient’s risk for falls reassessed after the 

fall and the plan of care revised to minimize the 

risk of future falls? 

Pain Management Guidance 

The Nebraska Department of Health and Human Services (DHHS) continues to take action to help 

prevent drug overdoses in Nebraska. This document was developed by DHHS in collaboration with an 

expert advisory task force, actively practicing providers, and senior state officials. Written for clinicians 

who are helping people live better lives. 

Although opioids can be a useful option for pain management, inappropriate use can result in significant harms. This guidance 

document will assist in making clinical decisions easier and provide effective options to treat pain while ensuring patient safety. 

This document was created with the assistance of the Pain Management Guidance Task Force and in partnership with the Nebraska 

Medical Association. 

“...read the Art of the Difficult 

Conversation. It is worth its 

weight in gold.” 

“These are a quick reference 

that could benefit providers.” 

Art of Difficult 

Conversations 

Guidance on having those 

challenging discussions 

with patients 

Treating 

Acute Pain 

Guidance on opioid and 

non-opioid options 

Tools 

Overview of tools for 

evaluating and managing 

your chronic pain patients 

Learn more: DHHS.NE.GOV/PDMP



Develop a plan. Once the assessment is complete, the patient care team, 

including the patient and their family, can develop a falls-reduction plan based on 

the patient’s individual risk factors. The plan should address locations that are at 

greatest risk, such as bedside, bathrooms, and hallways, and detail action steps. 

Sample action steps include giving patients nonslip footwear, making sure call lights 

are within reach, removing throw rugs from the home, and providing exercises to 

improve balance. 

Communicate. It’s not enough to create a plan; communication is essential for 

optimal execution. All care team members, including patients and their families, 

need to be aware of the patient’s fall risk and the falls reduction plan. 

Communication also includes education. The STEADI initiative has falls 

prevention brochures for patients and family caregivers at www.cdc.gov/steadi/ 

patient.html. Families often are underutilized as a resource for helping to prevent 

falls. They may know the best way to approach patients who are reluctant to 

follow falls-reduction recommendations and can take the lead to reduce homerelated 

risks. The falls risk reduction plan, communication with others, and 

education provided should all be documented in the patient’s health record. 

If a fall occurs 

Despite nurses’ best efforts, a patient may fall. An expert witness will scrutinize 

how the nurse responded to the event. The following steps will help to reduce the 

risk of a lawsuit or the chances that a lawsuit is successful: 

Assess the patient. Examine the patient for any obvious physical or mental 

injuries. For example, check vital signs; look for bleeding, scrapes, or signs of 

broken bones; ask the patient about pain; and check mental status. Do not move 

the patient if a spinal injury is suspected until a full evaluation can be made. Be 

particularly alert for possible bleeding if the patient is taking anticoagulants. When 

appropriate, ask patients why they think they fell and continue monitoring at 

regular intervals. 

Communicate assessment results. Notify the patient’s provider of the 

fall and results of the assessment. The provider may order X-rays for further 

evaluation. Remember to mention if the patient is taking anticoagulants, 

particularly in the case of a potential head injury, so the appropriate scans can be 

ordered. 

Revise the plan. As soon as possible after the fall, work with the team 

to reassess risk factors, revisit the falls reduction plan, and revise the plan 

as needed. For example, footwear may need to be changed, the amount of 

sedatives the patient is receiving may need to be reduced, or more lighting may 

need to be added to a hallway. It’s important that actions are taken to prevent 

future falls. 

Document. Each step should be documented in the patient’s health record, 

especially all assessment results and provider notifications. The expert witness can 

then see that the nurse followed a logical progression, with thorough evaluation 

and follow-up. Never alter a patient’s health record entry for any reason, or add 

anything to a record that could be seen as self-serving, after a fall or other patient 

incident. If the entry is necessary for the patient’s care, be sure to accurately label 

the late entry according to your employer’s policies and procedures. 

Reducing risk 

Unfortunately, patient falls are not completely avoidable. However, developing 

a well-conceived prevention plan can help reduce the risk, and taking appropriate 

actions after a fall can help mitigate further injury. Both prevention and post-fall 

follow up not only benefits patients, but also reduces the risk that the nurse will 

be on the losing side of a lawsuit. 

Three-part webinar series for Health 

Professionals to enhance DEI understanding 

and improve the health for all people 

Sessions are NO COST to NNA members 

$45.00 all others (One fee includes all three sessions) 

3.0 non-peer-reviewed continuing education credits provided by NNA 

(1.0 non-peer-reviewed CE credit per session attended - LIVE SESSIONS ONLY) 

PRESENTATIONS: 

• June 15, 2022, 7:00-8:00 p.m. CST 

DEI and Cultural Competence: A Look into Implementation, 

Sustainability, and Best Practices 

Dr. Archana Vatwani, PT, DPT, MBA, CLWT, CDP, CLSSBB, PMP 


Understanding African Americans in Healthcare Settings 

Minister Crystall Williams, M. MIN. 


Social Determinants and Diminishing Disparities in Healthcare 

Dr. Hilary Applequist, DNP, APRN-NP, ACHPN 

REGISTER ONLINE: 

https://nna.salsalabs.org/dei-series 

Pre-registration is required for access to the Live, Virtual sessions. 

REGISTRATION CLOSES JUNE 10, 2022 

Sessions will also be recorded and available on-demand in the members-only page 

of the NNA website. On-demand viewing is available to NNA members only and will be 

available on July 1, 2022. 

Article by: Georgia Reiner, MS, CPHRM, Senior Risk Specialist, Nurses Service 

Organization (NSO) 

RESOURCES 

Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice. StatPearls. 2020. www.ncbi.nlm. 

nih.gov/books/NBK470573. 

Centers for Disease Control and Prevention. Important facts about falls. www.cdc.gov/ 

homeandrecreationalsafety/falls/adultfalls.html. 

Centers for Disease Control and Prevention. STEADI: Materials for healthcare providers. 

2020. www.cdc.gov/steadi/materials.html. 

CNA, NSO. Nurse Professional Liability Exposure Claim Report: 4th Edition. 2020. www.nso. 

com/nurseclaimreport. 

Dykes PC, Adelman J, Adkison L, et al. Preventing falls in hospitalized patients. Am Nurs 

Today. 2018;13(9):8-13. https://www.myamericannurse.com/preventing-falls-hospitalizedpatients. 

Iyer P. Legal aspects of documentation. In: KG Ferrell, ed. Nurse’s Legal Handbook. 6th ed. 

Wolters Kluwer; 2015. 

Van Voast Moncada L, Mire GL. Preventing falls in older persons. Am Fam Physician. 

2017;96(4):240-247. https://www.aafp.org/afp/2017/0815/p240.html. 

Disclaimer: The information offered within this article reflects general principles only 

and does not constitute legal advice by Nurses Service Organization (NSO) or establish 

appropriate or acceptable standards of professional conduct. Readers should consult with 

an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO 

assumes any liability for how this information is applied in practice or for the accuracy of 

this information. 

This risk management information was provided by Nurses Service Organization (NSO), 

the nation’s largest provider of nurses’ professional liability insurance coverage for 

over 550,000 nurses since 1976. The individual professional liability insurance policy 

administered through NSO is underwritten by American Casualty Company of Reading, 

Pennsylvania, a CNA company. Reproduction without permission of the publisher is 

prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. 

www.nso.com.


AFFILIATE ORGANIZATIONS 

Nebraska Nurse 

Practitioners 

Update 

2022-2024 

STRATEGIC PLAN 

NEBRASKA 

L 

Leadership 

E 

Education 

Active leader in statewide 

communities to collaborate 

and engage within, and 

outside, the NP profession. 

Promote high standards of 

clinical practice through 

excellent continuing 

education offerings and 

empowering evidencebased 

practice. 

Nebraska Nurse Practitioners have updated the 

mission and goals of the organization with strategic 

planning. Please see our graphic for further information. 

More specific information regarding events and listening 

sessions will be forthcoming over the next year. 

NURSE 

PRACTITIONER 

Empowering all Nebraska Nurse Practitioners to 

advance the profession through exceptional patient 

care, innovation and engagement. 

A 

Advocacy 

D 

Diversity 

Decrease barriers to 

clinical practice and 

improve the access to 

healthcare for 

Nebraskans through 

legislative advocacy. 

Represent the ideas 

and needs of ALL NPs 

and NP students in 

Nebraska by 

encouraging an open 

and inviting forum and 

ensuring statewide 

representation. 

N E B R A S K A N U R S E P R A C T I T I O N E R 

2022-2024 GOALS 

L 

Increase membership. 

Increase NNP Brand recognition. 

E 

Increase participation in educational activities. 

Explore alternative tracks/offerings. 

Increase student awareness/engagement. 

A 

Decrease barriers to practice. 

Improve access to healthcare. 

Leverage NP reputation. 

D 

Representation of ALL communities within NNP. 

Relevant to all NP specialties. 

Increase diversity on NNP board.


What is the Success Pays Program? 

NNA partners with the American Nurses Credentialing Center (ANCC) using the Success Pays Program 

to support professional development of nurses, increase the number of certified nurses in the workforce, 

decrease test-taking anxiety and reduce financial burden for our members. 

NNA members can apply to take the exam up to two times and pay the reduced rate of $260 only if they 

pass the exam. This saves time, money and anxiety. Certifications with ANCC can also be renewed through 

NNA at a reduced price of $250. 

How it works: 

• If the nurse passes the exam, the nurse is charged for the exam fees 

• If the nurse is unsuccessful, they can take the exam an additional time before the contract expiration date 

• If the nurse passes the second time around, then the nurse is charged the exam fee 

• If the nurse does not pass, no one pays if within the contract date 

Benefits of the program: 

• Reduced test stress for nurses: Fear of failure is eased (FailSafe) and confidence increases 

• Better care: Certified nurses provide the best nursing care to patients and families 

Information concerning registering for the exam: 

Applying for the ANCC Success Pays Program does not register you for the exam. To be eligible to take a 

certification exam, you must meet all eligibility criteria at the time of the application. 

• For more information concerning the exam and criteria, please visit the NNA Success Pays webpage. 

https://nebraskanurses.org/success-pays/ 

Full-Time Day and Night RN positions available 

Competitive Salary • Sign-on Bonus 

Tuition Reimbursement 

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Apply online at cozadhealthcare.com or send 

resume to hbrennan@cozadhealthcare.com 

WE NEED YOU! 

Are you an experienced APRN 

looking for a new challenge? 

Do you want to help shape 

the future of APRN practice in 

Nebraska? 

The State of Nebraska, 

Department of Health and 

Human Services is a seeking 

a full-time DHHS Nurse 

Consultant to the Board of 

Nursing for the Division of 

Public Health. 

For more information and to apply, please visit 

dhhs.ne.gov/careers or contact Nichole Newland at 531-207-5418. 

EEO/VET


To access electronic copies of the 

Nebraska Nurse, please visit 

http://www.NursingALD.com/publications 

Warm & Welcoming! 

That’s who we are! 

We care like family… Join us! 

Megan Becklun, 

402-887-4151, hr@amhne.org, 

102 W 9th St, Neligh NE 68756 

402-887-6397 (Fax) 

• 

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Nebraska Nurse - May 2022

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