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
Nurses Day at
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
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
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
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
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
NNF 2023 Project Grants –
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
U.S. Postage Paid
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
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
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!
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
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
• 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:
Registration for the VIRTUAL format will remain open until June 8, 2022 at:
Please send any questions to Daemon Donigan:
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?
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
• 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
• Provide a brief author biography indicating the author’s
nursing experience and/or expertise with the paper’s
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
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626–4081, email@example.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
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://
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
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
Nebraska Methodist College
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 firstname.lastname@example.org
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
From all of us at NNA, we thank you for your continued support of the important
advocacy work that represents every nurse in Nebraska.
Page 4 • Nebraska Nurse May, June, July 2022
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.
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
Purchase your Nurses Care specialty plate
Promoting the value of nurses
and nursing careers
Building, maintaining and expanding
the state’s nursing work force
Improving access to care.
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
May, June, July 2022 Nebraska Nurse • Page 5
$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!
Students and NNA
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
• 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
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*
RNs & LPNs
Apply online: https://das.iowa.gov
Click on Human Resources
Click on State employment
Page 6 • Nebraska Nurse May, June, July 2022
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
May, June, July 2022 Nebraska Nurse • Page 7
(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.
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
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.
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.
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-
Marik, P. E., & Taeb, A. M. (2017). SIRS, qSOFA and new
sepsis definition. Journal of Thoracic Disease, 9(4), 943-
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.
Page 8 • Nebraska Nurse May, June, July 2022
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
- 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
• Nebraska Legislative Update: At the Table
Where It Happens
- Don Wesley, BA
Lobbyist/NNA Legislative Liaison, O’Hara Lindsay
- 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.
May, June, July 2022 Nebraska Nurse • Page 9
The NNA thanks all of the Sponsors for this event,
whose generous contribution makes this event possible.
Nebraska Methodist Health System
Creighton University College of Nursing
Nebraska Wesleyan University
Purdue University Global
University of Nebraska Medical Center College of
Virtual Listing Sponsors
Nebraska Nurse Practitioners
Southeast Nebraska Oncology Nursing Society
Michelle L. Johnson
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
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 email@example.com 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.
MATEC-KS/NE Regional Program:
HIV Prevention & Treatment Challenges in
Speaker: Donna Sweet, MD, MACP, AAHIVS
Tuesday, June 21, 2022 • 8:30 - 9:45am CST
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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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Page 10 • Nebraska Nurse May, June, July 2022
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
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
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
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.
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
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)
▪ Did the nurse communicate the findings to the
▪ Were X-rays ordered and performed?
▪ Was there an injury? If so, how soon was it
▪ 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
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
“...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
Guidance on having those
Guidance on opioid and
Overview of tools for
evaluating and managing
your chronic pain patients
Learn more: DHHS.NE.GOV/PDMP
May, June, July 2022 Nebraska Nurse • Page 11
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
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
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
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
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.
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)
• 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
• June 22, 2022, 7:00-8:00 p.m. CST
Understanding African Americans in Healthcare Settings
Minister Crystall Williams, M. MIN.
• June 29, 2022, 7:00-8:00 p.m. CST
Social Determinants and Diminishing Disparities in Healthcare
Dr. Hilary Applequist, DNP, APRN-NP, ACHPN
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
Bono MJ, Wermuth HR, Hipskind JE. Medical malpractice. StatPearls. 2020. www.ncbi.nlm.
Centers for Disease Control and Prevention. Important facts about falls. www.cdc.gov/
Centers for Disease Control and Prevention. STEADI: Materials for healthcare providers.
CNA, NSO. Nurse Professional Liability Exposure Claim Report: 4th Edition. 2020. www.nso.
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.
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 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 firstname.lastname@example.org or call 1-800-247-1500.
Page 12 • Nebraska Nurse May, June, July 2022
Active leader in statewide
communities to collaborate
and engage within, and
outside, the NP profession.
Promote high standards of
clinical practice through
education offerings and
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.
Empowering all Nebraska Nurse Practitioners to
advance the profession through exceptional patient
care, innovation and engagement.
Decrease barriers to
clinical practice and
improve the access to
Represent the ideas
and needs of ALL NPs
and NP students in
encouraging an open
and inviting forum and
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
Increase NNP Brand recognition.
Increase participation in educational activities.
Explore alternative tracks/offerings.
Increase student awareness/engagement.
Decrease barriers to practice.
Improve access to healthcare.
Leverage NP reputation.
Representation of ALL communities within NNP.
Relevant to all NP specialties.
Increase diversity on NNP board.
Page 14 • Nebraska Nurse May, June, July 2022
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.
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May, June, July 2022 Nebraska Nurse • Page 15
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Nebraska Nurse, please visit
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