Virginia Nurses Today - May 2022

The Official Publication of the Virginia Nurses Foundation 

May 2022 Quarterly publication distributed to approximately 111,000 Registered Nurses 

Volume 30 • No. 2 

We are pleased to provide every registered nurse in Virginia with a copy of Virginia Nurses Today. 

For more information on the benefits of membership in of the Virginia Nurses Association, 

please visit www.virginianurses.com! 

New Workplace Violence 

Toolkit Available 

Page 4 

Nurses Month: Nurses Make a 

Difference (Wow, do you ever!) 

Page 7 

Join Our Nurse Leadership 

Academy in 2023! 

Page 10 

Providing Competent Care for 

People Who Are Transgender 

Page 16 

Moving forward after the 

RaDonda Vaught Verdict 

By VNF Vice President Dipti Ramnarain, Esq. 

The case and subsequent verdict of former Vanderbilt Hospital nurse 

RaDonda Vaught has caused great concern for nurses across the nation. In our 

continued support for Virginia’s nursing community, VNA is taking steps to stay 

abreast of the changing legal landscape and related implications for nurses. We 

will be providing updates and webinars regarding information from this case 

and associated news. Our goal is to be a reliable source of information and a 

platform for Virginia nurses to communicate their concerns. 

With many nurses wondering what action they can or should take now, VNA 

presents the following for steps for your consideration: 

1. Be Informed! Many inaccurate statements about the case are circulating, 

especially on social media. Remember to be wary of rumors and 

inflammatory information. To ensure nurses have access to accurate 

information, VNA has developed a repository of documents, articles, and 

other information sources that has been reviewed for accuracy. Visit 

https://tinyurl.com/sk9ydjrp. 

2. Be Aware! The jury’s verdict in this case has made clear that there is a 

large difference between the general public’s understanding of nursing 

practice and the understanding within the nursing community, where 

there is almost universal dismay at her guilty verdict. VNA is identifying 

opportunities to communicate with both the public and policymakers to 

advocate for nurses and promote understanding. Stay tuned for more ways 

you can get further involved with VNA to help advocate for your profession! 

3. Be Vocal! Nurses face unique stressors, and the COVID-19 pandemic has 

further amplified an already thinly stretched workforce. This case is a 

good reminder to focus on even the most routine aspects of patient care. 

If you have concerns about your work environment or best practices that 

could be implemented, be sure to speak out. 

4. Be Wary! Many auxiliary businesses are taking advantage of the 

uncertainty nurses may feel to market products specifically referencing 

the RaDonda Vaught case. While some products may be useful generally, 

we encourage nurses to not fall into a false sense of security that there 

is a “magic bullet” or product that addresses all of the concerns that this 

case has brought up. For example, while personal professional liability 

insurance is important, it would be a mistake to think that it would 

protect you from the criminal negligence claims seen in the RaDonda 

Vaught case. 

Moving forward after the...continued on page 2 

Legislative Update 

Big Legislative Wins, with More 

Work to be Done 

Thank you to everyone who contacted their legislator in support of our 

legislation this session! Thanks to our combined efforts, the Virginia Nurses 

Association (VNA) was highly successful in working with our partners and 

gaining support for the majority of nursing’s 2022 Public Policy Platform (https:// 

virginianurses.com/page/2022GeneralAssemblySession). We were able to push 

for $6.4 million in funding to be added to various nursing program funds and 

much more! A bipartisan group of legislators introduced our initiatives and helped 

to get them across the finish line. Check out these advances for nursing! 

1. Continuing funding for the APRN preceptor incentive program (budget), 

2. Providing significant new funding for nursing student scholarships and 

loan repayment programs (budget), 

3. Extending the COVID-19 workers’ compensation presumption for 

healthcare workers (HB932, Robinson), 

4. Clarifying the law to ensure a CNS without prescriptive authority does not 

need a practice agreement (HB285, Adams), and 

5. Supporting various other initiatives to create and sustain conditions that 

support the health and well-being of all Virginia communities. 

While, as of this writing, budget negotiators are continuing to work on a final 

budget for the full House and Senate to consider, many items to support nursing 

are included in one if not both versions approved by the respective chambers. 

We continue to support the inclusion of these items in the final budget 

agreement: 

• $1 million for the APRN Virginia Preceptor Incentive Program 

• $1 million to fund nursing scholarship programs at VDH 

• $2.4 million for the State Loan Repayment Program for Healthcare Workers 

• $2 million to capitalize a Virginia Health Workforce Development Fund 

pursuant to the provisions of HB191, and funding to create an Advisor to 

the Governor for Healthcare Workforce 

• Increased reimbursement rates for medicaid providers 

• Increased tuition assistance grants for graduate level students seeking 

degrees in healthcare 

• A study by the State Council of Higher Education for Virginia to review 

nursing needs and barriers to nursing education to address workforce 

shortages. 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

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Permit No. 14 

While the work is not yet completed, VNA was successful in advancing a 

number of important legislative and budget initiatives during the 2022 General 

Assembly Session. As we have for the past few years, VNA convened the Virginia 

Legislative Nursing Alliance to bring together nursing leaders from a multitude 

of special nursing organizations throughout Virginia to jointly craft a policy 

agenda during the fall of 2021. A record number of organizations participated in 

this work and our collective thoughts and ideas led to a Public Policy Platform 

with six main priorities: 

1. Continue funding for the Virginia Preceptor Incentive Program, and to 

support other nursing scholarships and loan forgiveness programs. 

2. Extend the COVID-19 Workers’ Compensation Presumption for Healthcare 

Workers 

Legislative Update continued on page 6

Page 2 | May, June, July 2022 

Virginia Nurses Today | www.VirginiaNurses.com 

is the official publication of the Virginia Nurses 

Foundation: 2819 N. Parham Road, Suite 230, 

Richmond, Virginia 23294, VNF’s affiliate, the 

Virginia Nurses Association, is a constituent of 

the American Nurses Association. 

www.VirginiaNurses.com 

admin@virginianurses.com 

Phone: 804-282-1808 

The opinions contained herein are those of the 

individual authors and do not necessarily 

reflect the views of the Foundation. 

Virginia Nurses Today reserves the 

right to edit all materials to its style 

and space requirements and to 

clarify presentations. 

THE TIME FOR CHANGE IS NOW! 

The Virginia Nurses Association invites you to 

join us IN-PERSON for our 2022 Fall Conference, 

The Time for Change is NOW! This program will be 

held September 9-10, 2022 at the Westfields Marriott 

in Chantilly, Virginia. We hope you’ll join us for 

what will be our first IN-PERSON event since prepandemic!! 

Nursing is at a precipice. The pandemic has 

debilitated an already failing and antiquated 

structure. We continue to struggle with appropriate 

staffing, unhealthy work environments, and 

developing the workforce we need for the future. 

All of this leaves the nurses disengaged and our 

patients disadvantaged. How can we change this? 

The Time for Change is NOW! During this 

conference, we will address how nurses can and 

must lead the next evolution of healthcare through 

innovation and collaboration. Dr. Oriana Beaudet, 

Moving forward after the...continued from page 1 

For more information on the reason nurses 

may be sued and the types of liability 

insurance available, we encourage you to read 

this article published in ANA’s American Nurse 

Journal, myamericannurse.com/individualnurse-liability-insurance. 

5. Do Not Panic! We recognize that many in the 

healthcare community have found the outcome 

of this case disheartening, if not alarming, 

and now have increased concerns for their own 

Vice President of Innovations at the American 

Nurses Association Enterprise, will help us explore 

how every nurse can contribute to transforming 

nursing so that we can better serve the people 

behind our purpose. We will hear from innovators 

in nursing and healthcare that are taking chances, 

trying new approaches, and transforming the work 

we do. After we learn from change makers, Dr. 

Oriana Beaudet will lead conference participants 

through a Design Challenge where we will develop 

big solutions to address nurse staffing and 

unhealthy work environments. Let’s work together to 

change the future of nursing! 

The Time for Change is Now! 

More information, including registration rates and 

the program agenda, will be available soon at www. 

virginianurses.com. 

professional practice and licensure. Be assured 

that VNA will continue to update you on 

developments regarding the issues surrounding 

this case, as well as steps you can take to 

advocate and protect your practice. 

Your input and perspectives will be invaluable 

in helping us shape our policy work, educational 

programming, and community outreach. 

Please complete our brief survey (https://www. 

surveymonkey.com/r/SZ9H5WK) to let us know what 

specific concerns and questions the case raises for 

you and what related issues you would like covered 

via webinars and other forums. 

The RaDonda Vaught case has affected many 

aspects of the nursing profession and is a dynamic 

situation. Stay connected to receive verified 

information from VNA, as well as educational 

opportunities and advocacy forums regarding this 

case! 

VNF Mission Statement 

VNF is committed to improving the health 

of Virginia’s communities by developing an 

educated and diverse nursing workforce 

through leadership development, research, 

and innovation. 

VNT Staff 

Janet Wall, CEO 

Elle Buck, Managing Editor 

Virginia Nurses Today is published quarterly 

every February, May, August and November by 

the Arthur L. Davis Publishing Agency, Inc. 

Copyright © 2020, ISSN #1084-4740 

Subscriber rates are available, 804-282-1808. 

For advertising rates and information, please 

contact Arthur L. Davis Publishing Agency, 

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(800) 626-4081, sales@aldpub.com. 

VNF 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 Virginia 

Nurses Foundation of the products advertised, 

the advertisers or the claims made. Rejection 

of an advertisement does not imply that 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. VNF and the Arthur 

L. Davis Publishing Agency, Inc. shall not be 

held liable for any consequences resulting 

from purchase or use of advertisers’ products. 

Articles appearing in this publication express 

the opinions of the authors; they do not 

necessarily reflect views of the staff, board, or 

membership of VNF, or those of the national 

or local chapters. 

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Your always-on resource for nursing jobs, research, and events.

www.VirginiaNurses.com | Virginia Nurses Today May, June, July 2022 | Page 3 

VNA President's Message 

The complexities of nurse staffing 

Nurse staffing is a highly complex issue. 

Consideration must be given to matching the 

right nurse with the needs of the specific patient, 

workflows, access to resources and organizational 

culture. In the context of the COVID-19 pandemic 

and the post surge environment, staffing concerns 

continue to grow as demand has been met by a 

diminishing supply of nurses, capacity for care, 

and the necessary improvements to provide the 

highest level of quality care and experience to 

patients and those who care for them. This supply 

and demand equation has been based on multiple 

factors including expanded job opportunities for 

nurses outside of traditional settings creating 

a shift in the workforce, availability of nursing 

faculty, aging populations of nurses and patients, 

generational and societal factors, and workplace 

conditions as well as those choosing to leave the 

profession. 

The solutions to these issues are multifaceted, 

making decisions regarding how to approach 

each neither quick or easy. Ratios, which focus on 

numbers of patients and nurses do not take into 

consideration the acuity of the patient, experience 

of the staff, skill mix availability, patient turnover, 

managerial issues, and other elements. Studies 

on an international level have shown that ratios 

do show a reduction in cost and improvement in 

quality as it relates to length of stay, readmissions, 

and mortality. Correspondingly, acuity models 

have shown similar outcomes, while improving 

nursing satisfaction. 

The Virginia Nurses Association continues to 

work as a convener to create meaningful strategies 

to address staffing. In a recent Nurse Staffing 

Deep Dive meeting, led by Dr. Pam Cipriano, 

Teresa Haller, Janet Wall, CEO VNA/VNF and 

myself, with representation from the areas of 

academia, public health, long term care and other 

nursing entities, we examined both short-term and 

long-term strategies to address nurse staffing. 

Short-Term Strategies Currently being 

Addressed 

Legislation & Policy 

Loan Forgiveness: Pursue loan forgiveness 

for nurses and adequate funding of existing 

commonwealth scholarships for nurses. 

VNA advocated for the following proposed 

budget amendments: 

• $800,000 for SCHEV to enable nursing 

students eligible to receive the two-year 

college transfer grant to receive an additional 

$1000 supplement 

• $7.6 million to award full TAG grant for 

graduate students pursuing advanced 

degrees in nursing, mental health counseling, 

pharmacy, and other medical fields, with the 

goal of preparing new workers for careers in 

areas facing workforce shortages in Virginia. 

• $1 million each year to capitalize four 

existing nursing scholarship programs at 

VDH that have been unfunded since 2015 

• Expand eligibility for the G3 program to 

include high school students 

* G3 is the acronym for Get Skilled, Get a 

Job, & Get Ahead.” It is a tuition assistance 

program for any Virginia resident who 

qualifies for in-state tuition and whose 

family income falls below an identified 

threshold. Students pay little to no tuition. 

Tangentially, we also advocated for: 

• $100,000 for SCHEV to conduct a study to 

evaluate the growing needs of schools of 

nursing so they may more comprehensively 

and effectively address the extensive nursing 

shortages in VA. 

Mandatory Regulations: Explore with the Dept. 

of Health Professions (DHP) Mandatory Reporting 

regulations to ensure they don't serve as a barrier 

to nurses seeking help for the mental health &/or 

substance abuse. 

• DPH Director Dr. David Brown is currently 

addressing this for physicians, nurses, and 

others. 

Staffing Committees: 

Advocate for staffing committees intended to 

support nurses' meaningful engagement in shared 

governance and staffing discussions. 

• VNA’s Nursing Practice Commission will 

develop a best practice model we can advance 

that includes collection and utilization of 

meaningful data 

Work Environment: 

Joint statement from VNA and Virginia Hospital 

& Healthcare Association (VHHA) about standards 

required to create a healthy work environment for 

nursing. 

• The Workplace Violence Workgroup discussed 

the potential and timing of a joint statement 

with the VHHA. 

• Establish an online repository for best 

practices of short-term staffing relief 

strategies in collaboration with the Virginia 

Organization of Nurse Executives and 

Leaders (VONEL). Once completed, the 

repository will live on the VNA’s website and 

other organizations will be encouraged to 

include links from their websites. 

Partnerships 

Ensure capacity building through inclusion 

of organizations representing underrepresented 

nurses. 

* LGBTQ+, nurses of color, etc. 

• Collaborations and partnerships have long 

been at the core of who VNA is and how we 

operate. A growing number of niche nursing 

organizations engage in the VNA-spearheaded 

Virginia Legislative Nursing Alliance (VLNA) 

and are eager to work with us to address 

the nurse staffing crisis. Nurse leaders 

representing diverse organizations also 

participate on the joint VNA & VNF Diversity, 

Equity, & Inclusion (DEI) Council, and VNA 

and VNF have great working relationships 

with many other organizations, including 

state administration and the VHHA. 

Long-Term Strategies: 

The following long-term strategies generated 

from the meeting include three primary bodies 

of work: Improved work environment, innovative 

staffing models while optimizing scope of 

practice, and advocating at the federal level for 

reimbursement for nursing services. 

Improved work environment 

• Address onboarding and retention strategies 

• Innovate to create/discover flexible staffing 

and scheduling models 

• Promote and innovate in job sharing 

initiatives 

• Promote Mentorship Programs for new team 

members – engaging with new team members 

prior to their first day. 

• Focus on workplace violence 

• Harness best practices regarding safety of 

staff 

• Promote resources inclusion within 

organizational systems to cultivate a culture 

of wellness through the prioritization of 

psychological needs of nurses and other 

healthcare workers to address and mitigate 

factors that contribute to moral distress, 

moral residue, and moral injury 

• Investigate salary 

compensation models 

for nurses. While 

we can’t control 

Linda M. Shepherd, 

what employers pay 

MBA, BSN, RN, 

nurses, conducting 

NEA-BC 

this research will be 

crucial as we further strengthen & broaden 

our sphere of influence. 

• Ensure a diverse workforce with 

consideration to equality in order to ensure 

nurses represent their service population 

• Elevate awareness and respect for disabilities 

and equity throughout nursing practice 

Create Innovative Staffing Models while 

Optimizing Scope of Practice 

• Integrate other levels of nursing professionals 

(unlicensed assistive personnel, LPNs, APRNs 

and interprofessional partners to collaborate 

on responsibilities. 

Incorporate mindfulness of nursing scope 

of practice, supervision, and insurance of 

positive patient outcomes as supported by 

evidence 

• Promotion and push for acute care nurses 

working to the top of their license 

• Provide education related to scope of practice 

for each role so that all remain in their scope 

of practice 

• Explore opportunities for tele/remote/ 

virtual health options as part of nursing care 

delivery. 

Advocate at the Federal Level for 

Reimbursement for Nursing Services 

• Support ANA and the national work being 

done around this issue. 

The Nurse Staffing Deep Dive group will 

continue to meet and further develop tactics 

associated with the above strategies. In a recent 

call with Senator Kaine’s aid, discussions around 

the challenges within academia which contribute 

to nursing shortages were discussed as a means 

of educating our legislative representatives on the 

issues and how they can help. 

As we move forward, we will continue to work to 

assist in building a better tomorrow for the nurses 

within the commonwealth and the populations 

they serve. 

Under investigation 

by the Virginia 

Board of Nursing? 

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Save the date for VNA’s 2022 

Legislative Summit 


VNA Encourages Utilization of 

New Workplace 

Violence Toolkit 

By VNA Commissioner on Nursing Practice Erin 

Keister, MSN, CPPS, CPHQ 

VNA’s annual Legislative Summit will give you the best legislative tools 

and insights to become a powerful advocate for nursing and for the health 

of all Virginians. Plus, we’ll examine the critical issues facing nursing and 

healthcare and discuss the statewide impact of the results of the November 

election. You’ll get a detailed look into upcoming nursing legislation and 

nursing’s 2023 legislative. We’ll be talking about legislative solutions for our 

nurse staffing shortage, school nurses, APRN issues, and more! Be sure to 

check our website regularly for agenda updates at www.virginianurses.com. 

Today more than ever, the health of our healthcare 

workforce across the Commonwealth of Virginia is a 

top priority. Daily, workers in the healthcare industry 

experience workforce violence through a variety of 

different avenues including intimidation, threats, 

physical or verbal abuse, and disruptive behaviors just 

to name a few. Violence can involve employees, patients, 

co-workers, clients, families and visitors. These acts of 

violence, intentional or not intentional can leave long 

lasting psychological, emotional or physical harm to Erin Keister 

staff that are involved. 

In recognition of National Workplace Violence Awareness Month in April, the 

Virginia Hospital & Healthcare Association (VHHA) released a Workplace Violence 

Toolkit aimed at providing hospitals, healthcare providers and staff new tools to 

protect themselves from violence. This toolkit is a comprehensive document that 

supplies employers with a strategic plan to increase the safety of the workplace, 

minimize workplace violence events, and respond appropriately and supportively 

if a workplace violence event occurs. During a time when healthcare workers are 

weary, the release of this toolkit could not be more appropriate or more important. 

The toolkit also aims to educate the general public on violence against healthcare 

workers and the struggles they endure every day. It promotes a respectful 

collaboration between healthcare workers and the patients they serve. 

VNA’s Commission on Nursing Practice has taken an active role of support 

and collaboration with VHHA to encourage all healthcare workplaces to adopt 

the best practices laid out in the Workplace Violence Toolkit. The toolkit is clear, 

concise and designed for easy adoption. It provides the necessary information 

and tools to educate employees while creating a zero-tolerance culture towards 

workplace violence. Violence against healthcare workers is a crime in Virginia. 

All healthcare workers should be working in a safe environment, free from 

violence, allowing them to deliver the best possible care they can. Those 

interested can access the toolkit on VNA’s Workforce Issues webpage at https:// 

virginianurses.com/page/WorkforceIssues. VHHA’s press release for the toolkit 

can be read here: https://tinyurl.com/5n863w9x.



Legislative Update continued from page 1 

3. Reduce unnecessary practice restrictions, especially those related to 

autonomous practice for Nurse Practitioners 

4. Supporting Registered Nurses in Public Schools 

5. Clarifying the Prescriptive Authority Law for Clinical Nurse Specialists, and 

6. Advance legislative solutions that create and sustain conditions that support 

the health and well-being of all Virginia communities 

Give the Gift of Nursing Pride 

for 2022 Nurses Week! 

The Virginia Nurses Foundation’s license plate honoring and supporting 

the important work of nurses in our commonwealth makes the perfect gift for 

the nurse in your life (or for you!). More than 4,300 of the license plates are 

currently on Virginia’s roads! Even more exciting, the $15 VNF receives from 

each plate fee supports our scholarships and nursing education initiatives. 

Plates are on sale now at the DMV’s website! $25 for regular plates or $35 

for personalized plates. 

Can my family and friends purchase a nursing car license plate if they are 

not a nurse? YES! You do not need to be a nurse to purchase the license plate. 

Plates can be purchased at this link: https://tinyurl.com/yb2wsd7e 

Learn more! 

Unfortunately, we and our partners were not successful in reducing the 

transition to practice for APRNs. While the House passed legislation continuing 

the two year transition period for a nurse practitioner to practice autonomously, 

the Senate refused to do so and instead preserved the five year transition period 

that was established in 2018. We will continue to support legislation removing 

this barrier to practice and support full practice authority for all nurses. The 

legislature also failed to make progress on the important issue of providing for 

a registered nurse in all public schools. The importance of having a nurse in 

schools has never been more important than it is now as we work to emerge from 

the COVID-19 pandemic, and we will continue to work on this important issue. 

During this year’s 60-day session, which began back on January 12, the 

legislature ultimately considered more than 2,100 bills. Of those, more than 

800 bills passed the General Assembly and went to Governor Youngkin for 

his consideration. He has signed 701 bills so far, vetoed 26, and proposed 

amendments to the rest. The legislature will reconvene to vote on the governor’s 

proposed amendments and vetoes as scheduled on Wednesday, April 27. If the 

legislature adopts the governor’s amendments to bills by a majority vote in both 

chambers, the bill becomes law. If they are rejected, the legislation returns to 

the governor for his signature, or he may veto the bill. To override a veto, both 

chambers must pass the bill notwithstanding the governor’s veto with 2/3 

support in both the House and Senate. 

Aside from the reconvened session, the legislature is technically in a special 

session at the moment. Because the General Assembly had not completed 

negotiations on a final budget bill by the scheduled March 12 adjournment, they 

adjourned the regular session and agreed to come back in a special session to 

complete the budget and another 46 pieces of legislation that were still being 

finalized. As of this writing, there is still no agreement on the budget and so the 

date for completion of the special session is still undetermined. Technically, the 

current budget remains in place through June 30, so there is no hard deadline 

until that point. However, local governments must plan their own budgets based 

on state resources and so the pressure will continue to rise on budget conferees to 

complete their work in the coming days. 

VNA will continue to advocate for nurses throughout the reconvened and 

special sessions and then continue to educate lawmakers on our issues as we 

look ahead to the 2023 session of the Virginia General Assembly. We appreciate 

your interest and participation in this work, whether through our policy 

committees, town hall meetings, lobby days, or even writing or calling your 

legislator on these important issues. 

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Nurses Month: Nurses Make a Difference (Wow, do you ever!) 

For all you do, for all you are… Thank You! While 

Nurses’ Week and Nurses Month are a great time 

to celebrate you and your peers, your expertise and 

knowledge, the length to which you go to advocate 

for your patients and clients, your professionalism, 

and your compassion are invaluable and appreciated 

beyond measure every day. Take time to celebrate 

your profession and remember the lessons learned 

from nursing pioneer Florence Nightingale, born on 

May 12, and other nurse leaders, past and present, 

who have fought to advance nursing throughout the 

decades. 

2022 Nurses Month Theme - Nurses Make a 

Difference 

Whether it is a national health emergency or 

routine daily care, nurses’ vital contributions impact 

the health and well-being of our communities, which 

is why the American Nurses Association selected 

the theme for May as Nurses Make a Difference. To 

honor nurses and support the nursing profession, 

VNA and ANA are promoting weekly themes and 

activities. While continued physical distancing may 

limit face-to-face activities, we encourage everyone to 

think of creative ways to engage! 

Week 1: Self-care (May 1–7) 

• This week is dedicated to cultivating and 

maintaining optimal mental health and 

physical well-being. 

Week 2: Recognition (May 8–14) 

• Honor the work of nurses who lead, excel, and 

innovate, not only in our health care systems, 

but also in our communities which makes 

them vital to transforming the future of health 

care. 

Week 3: Professional Development (May 15–21) 

• Access resources and insights to guide you in 

your professional development. Focus on how 

you can excel and lead in your nursing career 

or inspire and help others in their professional 

nursing journey. 

Week 4: Community Engagement (May 22–31) 

• Focus on Engaging with your community this 

week, whether virtually or in-person. Educate 

members of your community on what nurses do 

beyond the bedside — advocacy, shaping public 

policy, or serving as organizational board 

members, among other duties. Encourage them 

to support current and future nurses. 

If you or your facility had or has planned an 

exciting Nurses Week event, please share your 

celebrations with us! 

We’d love to know more about your: 

• Florence Nightingale's birthday anniversary 

celebrations 

• Nurses Month celebrations 

• Nurses in action 

• Donations and gifts from the community for 

nurses 

You can share the photos on Facebook, and tag us 

@Virginia Nurses Association, or on our Instagram, 

@virginianurses. You can also send photos of your 

celebrations and events to VNA Communications 

Manager Elle Buck, at ebuck@virginianurses.com. 

Make sure to frequently check our website, www. 

virginianurses.com, for updates, resources, and 

nurse specific discounts! 

If there is a nurse (or nurses!) you’d like to 

publicly honor during Nurses Week, you can fill out 

the Virginia Nurses Foundation’s Honor a Nurse form 

at https://tinyurl.com/u76zro6. This is the perfect 

opportunity to celebrate a nurse friend, colleague, or 

family member or to say thank you to a nurse that 

has made a difference. We will publish the names 

of honored nurses on our website on the Honor a 

Nurse Tribute Wall and in our quarterly publication, 

Virginia Nurses Today. Additionally, all honorees 

will receive an email letting them know you wanted 

to say thank you. Your donation of $10 or more 

will support the launch of the Nurse Leadership 

Academy. For check donations, go to https://tinyurl. 

com/y9bvcuy2 to download the form to be mailed 

with your check. 

To learn more about the history behind National 

Nurses Week, visit ANA’s webpage at https://www. 

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Meeting the nurse staffing challenge, part one: Recruitment tips 

Georgia Reiner, MS, CPHRM, 

Risk Specialist, NSO 

The COVID-19 pandemic has prompted nurses 

to rethink their careers and reinforced the need for 

healthcare and nursing leaders to shift their approach 

to nurse recruitment and retention. A 2021 survey 

by the American Nurses Foundation found that 18 

percent of 22,316 respondents planned to leave their 

current position in the next six months. When the 

data are sorted by nurses working in hospitals (8,524), 

that percentage rises to 21 percent. These pandemicrelated 

staffing problems are intensified by factors 

that existed before COVID-19 and that still plague 

leaders. For example, hospitals in rural areas continue 

to struggle more with nurse staffing than those in 

urban locations. Generational differences also exist, 

with Generation Zers and Millennials more likely to 

leave positions compared to Generation Xers and Baby 

Boomers. The exodus of bedside nurses takes its toll 

on remaining staff and, in some cases, quality of care. 

Too often, organizations have viewed nurses 

primarily as an expense, failing to understand that 

investing in this workforce yields financial rewards. 

High-quality nursing care helps to reduce the 

likelihood of patient safety events and costly medical 

malpractice lawsuits related to missed errors. Savvy 

leaders know that ensuring appropriate staffing levels 

is key to the financial health of the organization, 

which means engaging in effective recruitment and 

retention strategies. This article, the first in a twopart 

series on nursing recruitment and retention, will 

address recruitment strategies that leaders can utilize 

to help attract new nurses to their organization. 

Recruitment 

Nursing and other organizational leaders need to 

work closely with human resources staff to ensure 

recruitment processes are efficient and effective: 

Craft ads that work. First impressions count. 

Everyone is your competitor for a limited pool of 

nursing talent, so do what you can to make your 

organization stand out as an attractive place to 

work. Be sure images in recruitment ads reflect 

the organization, particularly when it comes 

Southeastern Virginia Training Center 

We are a 75 bed intermediate care 

facility for individuals with intellectual 

and developmental disabilities in Chesapeake, VA. We are state 

operated through the Department of Behavioral Health and 

Developmental Services. 

We are looking for RN's (FT and PT) 

* $5,000 sign on bonus or student loan repayment for full-time 

RNs w/1 year agreement 

* state employee benefits for FT positions 

To apply online, go to: 

https: //virginiajobs.peopleadmin.com 

(and select Agency 723) 

to diversity. Many organizations feature their 

own nurses in ads, which has the additional 

benefit of employee recognition. Try to make your 

messaging as personalized as possible, emphasizing 

your organization’s culture and authentically 

communicating why nurses should want to be a part 

of your organization. 

Reach out early. Ask staff who work with students 

completing clinical rotations to identify those who 

might make good employees when they graduate. 

Then get to know the students and encourage them 

to apply when the time comes. If you lead a specialty 

unit, invite students to attend meetings (onsite or 

virtual) of local chapters of the national specialty 

nursing association so they can learn more about the 

role. You also may want to partner with local schools 

to teach a class or workshop so you can connect with 

students. 

Promote digital efforts. Organizations’ websites 

often miss the opportunity to feature nurses. Your 

facility’s website should have a special section 

highlighting nursing, including stories that feature 

individual nurses. You can ask staff to record 

video testimonials that highlight what they enjoy 

about working for your organization. In addition, 

your organization’s job portal and job application 

process should not be so cumbersome that potential 

employees give up in frustration. 

Individualize benefits. Avoid a “one size fits 

all” approach to benefits. Instead, offer a menu 

that nurses can choose from. For example, a latecareer 

nurse may be more interested in retirementmatching 

funds, but a newer-to-practice nurse may be 

attracted to a flexible schedule, tuition or student loan 

assistance, or child-care benefits. 

Obtain Magnet® status. Becoming a Magnet®designated 

facility can be expensive, but many nurses 

prefer organizations with this designation, so it can be 

well worth the investment. Magnet® status also may 

help reduce turnover and decrease patient morbidity 

and mortality. 

Provide optimal onboarding. This is often 

discussed as a retention tool, but it also falls under 

the recruitment category, as potential employees want 

to know how supported they will be in their new role. 

This is particularly true of new graduate nurses, 

who have seen their recently graduated colleagues 

rushed into practice as a result of the pandemic. Many 

organizations are being shortsighted in cutting back 

on nurse residency programs, which not only attract 

staff, but also promote a smoother transition into 

practice, thus increasing retention. 

Preceptors should be chosen based not only on 

their level of expertise, but their effectiveness as 

educators. Orientees (and preceptors) should know 

that they can speak up if the match isn’t working. 

Be sure staff feel warmly welcomed. For example, 

some organizations send a signed welcome card to the 

employee’s home before their start date. Others post 

the employee’s name and photo in a visible location on 

the unit. 

Check in regularly with new staff to see how they 

are adjusting, such as weekly for a month, then every 

other month or so, and then after 6 months. 

Meeting the challenge 

Finding creative solutions to recruit nurses is 

more important than ever. However, it is only the 

first piece of the puzzle to building a robust nursing 

team. Creating a safe, supportive work environment 

that recognizes nurses’ meaningful contributions is 

essential to encourage nurses to want to keep working 

for your organization. Part two will discuss retention 

strategies that healthcare and nursing leaders can 

employ to help increase the likelihood that they retain 

current nursing staff. 

References 

American Nurses Credentialing Center. Magnet benefits. n.d. 

https://www.nursingworld.org/organizational-programs/ 

magnet/about-magnet/why-become-magnet/benefits/ 

American Nurses Foundation. COVID-19 impact assessment 

survey – the first year. 2021. https://www.nursingworld. 

org/practice-policy/work-environment/health-safety/ 

disaster-preparedness/coronavirus/what-you-need-toknow/year-one-covid-19-impact-assessment-survey/ 

CNA & NSO. Nurse Professional Liability Exposure Claim 

Report: 4th Edition: Minimizing Risk, Achieving 

Excellence. 2020. https://www.nso.com/Learning/ 

Artifacts/Claim-Reports/Minimizing-Risk-Achieving- 

Excellence 

Malliaris AP, Phillips J, Bakerjian, D. Nursing and Patient 

Safety. Agency for Healthcare Research and Quality. 

2021. https://psnet.ahrq.gov/primer/nursing-and-patientsafety 

Pink D. When: The Scientific Secrets of Perfect Timing. 

Riverhead Books; 2019. 

Reitz O, Anderson M, Hill PD. Job embeddedness and nurse 

retention. Nurs Admin Q. 2010;34(3):190-200. 

Sherman RO. The Nuts and Bolts of Nursing Leadership: 

Your Toolkit for Success. Rose. O. Sherman; 2021. 

Wolters Kluwer. Ten recruiting strategies to attract nurses. 

2019. https://www.wolterskluwer.com/en/expertinsights/ten-recruiting-strategies-to-attract-nurses 

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.


Virginia Nurses Association Achieves ANCC Reaccreditation as 

an Approver for Nursing Continuing Professional Development 

• Increasing demand to offer continuing 

professional development contact hours that 

are essential to building professional portfolios, 

and maintaining certification and accreditation 

from ANCC and other licensing boards and 

regulatory bodies 

The ANCC Accreditation Model is based on 

the original Donabedian framework of structure, 

process, and outcome measures to evaluate quality. 

The ANCC standards provide organizations with 

a structured, evidence-based framework to design 

and implement NCPD activities. The development 

of quality outcomes ensures that accredited 

organizations are continuously evaluating processes 

and their impact on the professional development of 

nurses. www.nursingworld.org/ncpd 

If your organization is interested 

in planning continuing education 

activities and awarding nursing contact 

hours, you can learn more about how 

you can be approved as an individual 

activity applicant or approved provider 

organization through the Virginia Nurses 

Association at 

https://virginianurses.com/page/Education. 

The Virginia Nurses Association was granted 

reaccreditation as an Approver for nursing 

continuing professional development (NCPD) 

in February 2022 from the American Nurses 

Credentialing Center (ANCC). This reaccreditation 

demonstrates our commitment to using evidencebased 

criteria when approving other organizations 

to provide educational activities. This ensures highquality 

educational activities are provided that 

promote the professional growth of nurses. 

With this reaccreditation, the Virginia Nurses 

Association continues to be part of an influential 

global community of practice of accredited 

organizations. The reaccreditation allows VNA to 

approve both individual activity applicants and 

approved provider organizations. 

Achieving reaccreditation as an Approver of 

Nursing Continuing Professional Development 

supports VNA in its mission to promote advocacy 

and education for registered nurses to advance 

professional practice and influence the delivery 

of quality care. The Accredited Approval Unit 

expands access to nursing continuing professional 

development activities across the commonwealth and 

our country. 

NCPD accreditation from ANCC elevates 

educational offerings that benefit our nurses, and 

the patients and communities we serve, by: 

• Promoting the highest professional standards 

to sustain effective strategies that improve 

professional nursing practice 

• Improving curricula for nurses to provide 

evidence-based education that strengthen 

professional development programs 

• Increasing credibility to adhere to evidencebased, 

global standards that deliver quality 

professional education 

• Expanding visibility to be included among other 

accredited organizations that are listed in a 

nationwide, searchable directory 

Bachelor of Science 

in Nursing (RN to BSN) 

[6 

For practicing RNs who 

wish to obtain their BSN 

Finish in 5 semesters 

part-time 

Financial aid available 

for those who qualify 

Clinical Nurse 

Leader (MSN) 

For RNs with their BSN who wish 

to become advanced practitioners 

✓ 

Two starts per year 

(Jan., Aug.) 

Online format with 

two clinical courses 

Now Hiring: 

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To Apply: 

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school-health-public-health-nurse-ii?department[0]=Health%20 

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The Fairfax County Health Department is a progressive public 

health leader serving 1.2 million residents from diverse ethnic, 

cultural and economic backgrounds. With more than 100 years of 

leadership in the field, we are committed to promoting population 

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residents’ equitable access to health services and information. 

Among the state's 

most economically 

priced programs 

Accreditations & Certifications: 

Part-time curriculum 

for busy RNs 

Certified by SCH EV to operate in Virginia, 

accredited by ABHES & approved by NC-SARA. 

The School Public Health Nurse works in the school health program 

assigned to school sites. Provides a variety of community services 

using a multi-disciplinary approach serving diverse populations in 

the school community. Services and interventions include outreach 

which include home/school visits, community assessment, health 

promotion, education, case finding, care coordination and disease 

prevention for students, families and communities. Must have 

strong working knowledge of computers (Microsoft Office Suite 

and other software applications). Must participate in the training, 

supervision and evaluation of unlicensed assistive personnel. 

This position includes a signing bonus of 

$2,000 for new hires.



Join Our Nurse Leadership Academy in 2023! 

Lindsey Cardwell, MSN, RN, NPD-BC, Director of 

Professional Development 

As you read in Janet Wall’s CEO Report in the 

February edition of Virginia Nurses Today, the Nurse 

Leadership Academy kicked off its inaugural year in 

January of 2022 with some fabulous presenters and 

content! 

“Most training offered by 

my organization is aimed at 

discussing tools or strategies 

for specific programs. The NLA 

reaches us on a personal level to 

develop our professional skills!” 

The Academy’s flagship year has continued 

flawlessly with four additional virtual sessions 

to develop the 39 nurse fellows. This content has 

been presented by healthcare leaders with amazing 

expertise and knowledge! Our fellows have examined 

their personal leadership and communication styles 

through a DiSC Leadership Profile assessment and 

explored topics such as providing and receiving 

effective feedback, authentic leadership in 

healthy work environments, leading with cultural 

humility, facilitating a high reliability environment 

through patient safety, a spirit of inquiry, and 

process improvement, and the influencer role in 

change management. Fellows will participate in 

a final virtual session in June focused around 

examining the finances of healthcare. Following 

this session, the 39 fellows will embark on their 

individual applied leadership projects within their 

organizations under the guidance of their chosen 

mentor. In December 2022, all nurse fellows will 

share their leadership projects and the outcomes 

they have achieved and we plan to have an 

opportunity for the Academy fellows to disseminate 

their work to you! 

Nurse Leadership Academy fellows have shared 

that the Academy goes well beyond the development 

provided by their organizations and “reaches us on a 

personal level to develop our professional skills!”. The 

feedback underscores that the program has been 

meeting and exceeding professional development 

needs and that all nurse leaders should attend the 

Academy! 

“I am really enjoying reflecting 

on myself and seeing my 

opportunities to grow and lead 

my team in a positive, effective 

manner!” 

If you are a new or emerging nurse leader, we 

encourage you to learn more about the Nurse 

Leadership Academy at https://virginianurses.com/ 

mpage/VNFNLA! This program was meticulously 

designed by experienced nurse leaders of varying 

backgrounds across the commonwealth to meet 

the professional development needs of nurses 

transitioning into leadership roles across ALL 

healthcare practice environments. The first six 

months of this year-long program are dedicated to 

live virtual didactic sessions focused on the following 

core topics: 

• Fundamentals of effective leadership 

• Organizational culture 

• Facilitating a high reliability environment 

• Influencing change: Driving outcomes through 

strategic action 

• No margin no mission- Examining the finances 

of healthcare. 

“I am absolutely enjoying every 

single session and find myself 

looking forward to the next.” 

The second six months are focused on applying 

the concepts learned in an applied leadership project 

in the fellow’s organization under the direction 

of their mentor. The goal of this program is to 

prepare emerging and new nurse leaders with the 

foundational leadership skills needed to lead change 

and teams in their organizations. 

VNF’s Nurse Leadership Academy inaugural 

launch was kicked off with ANA Enterprise CEO 

and past VNA President Dr. Loressa Cole, with her 

compelling story of her leadership path from her 

childhood in the Appalachians of West Virginia to 

her present-day success. 

Next Rose Markey, senior learning and 

development consultant at the University of Virginia, 

discussed the four skill sets of courage during her 

“Introduction to Courageous Leadership.” Rose 

is also a member of the global team of Certified 

Dare to Lead Facilitators based on the work of 

researcher and New York Times best-selling author 

Dr. Brené Brown, and the learning and dialogue 

was fascinating! We discussed “Armored vs. Daring 

Leadership,” how to practice our values, not just 

profess them, and why “vulnerability” has gotten a 

bad rap! Rose also examined how to master difficult 

conversations; a discussion the Academy’s Nurse 

Fellows examined in greater depth during the 

February program. 

“It’s hitting all the topics I need 

in my leadership role.” 

The ever-popular Dr. Eileen O’Grady closed the 

day for us with a focus on how Nurse Leadership 

Hinges on Well-being. Dr. O’Grady is a certified Adult 

Nurse Practitioner and ICF-Certified Wellness Coach. 

She is Founder of The School of Wellness, and holds 

a master’s degree in public health from The George 

Washington University, as well as a master’s degree 

in nursing and a PhD in nursing from George Mason 

University. 

Dr. O’Grady is also author and editor of six 

books, most recently, Advanced Practice Nursing: 

An Integrative Approach and Intentional Therapeutic 

Relationships: Advancing Caring in Health Care, a 

how-to book on placing relationships at the center 

of health care. Her most recent book is her most 

personal, Choosing Wellness: Unconventional Wisdom 

for the Overwhelmed, the Discouraged, the Addicted, 

the Fearful or the Stuck, (2021). 

“I feel that every leader should 

take this course!” 

Registration Now Open! 

If this has piqued your curiosity, or you think a 

colleague might be interested, learn more on our 

Academy web page, https://virginianurses.com/ 

mpage/VNFNLA. 

Register today for the 2023 virtual Nurse 

Leadership Academy! 

Questions? Contact our Director of Professional 

Development Lindsey Cardwell who, along with 

the Steering Committee, was instrumental in 

creating this highly dynamic program! lcardwell@ 

virginianurses.com.

School of Nursing – MSN – PMHNP 

Psychiatric Mental Health 

Nurse Practitioner 

Psychiatric Mental Health Nurse Practitioner is an advanced practice nursing role. Graduate 

education prepares the Psychiatric Mental Health Nurse Practitioner (PMHNP) to become a 

licensed independent health care provider with prescriptive authority. The PMHNP provides 

mental health care throughout the lifespan. This program provides the knowledge, skills, values 

and experience to assume the role of PMHNP in a variety of settings. Preparation includes 

content necessary to provide psychotherapy and medication to individuals, families and groups 

within hospitals and community settings. This role incorporates skills to: 

• Assess, diagnose and treat individuals and families with mental health challenges or 

psychiatric illnesses 

• Identify risk factors for psychiatric illness 

• Contribute to policy development, quality improvement, practice evaluation and 

healthcare reform 

Completion of a graduate nursing program allows for certification by the 

American Nurses Credentialing Center (AACN) to obtain a PMHNP 

certification which is required to obtain a state license to practice. 

Learn More 

https://odu.edu/nursing/graduate/msn/nurse-practitioner 

MSN – Family Nurse Practitioner 

Innovative 

Healthcare 

Providers 

Enhance your expertise in theory, research, and advanced nursing 

practice through academic courses and clinical experiences that take a 

holistic approach to health and nursing care. You will be taught by ODU 

faculty who bring innovative solutions to improve healthcare in rural 

and underserved communities through telehealth and interprofessional 

education. The program bridges to the Doctor of Nursing Practice (DNP) 

program. Full-time and part-time options. 

Learn More 

https://odu.edu/nursing/graduate/msn/nurse-practitioner/fnp


VNF President's Message 

Good Brain Health Improves Our Mental Wellness 

Phyllis Whitehead, 

PhD, APRN/CNS, ACHPN, FNAP, FAAN 

As we enter into spring, it is a great opportunity to start healthy lifestyle 

changes. At our latest Mental Health Roundtable meeting on February 17, we had 

NOW HIRING!! 

• Registered Nurses (Night Shift) with a 

$7,500 sign-on bonus 

• Certified Nursing Assistant (Evening or 

Night Shift) Full Time 

• Certified Nursing Assistant 

Part-Time/PRN 

• Licensed Practical Nurse Full Time and 

Part Time positions available 

• Personal Care Attendants Full- and Part-Time 

Currently offering $3,000 sign-on 

bonus for full time CNAs and LPNs 

For more information, call 804-524-7600. 

To learn more and apply, please visit 

https://virginiajobs.peopleadmin.com/ 

HIRAM W. DAVIS MEDICAL CENTER 

26317 WEST WASHINGTON STREET 

PETERSBURG, VA 23803 


a special focus on Brain Health. We are fortunate to have 

among our many resources, a colleague who has been 

advocating for good brain health for many years. 

David DeBiasi, BSN, RN is Associate State Director at 

AARP Virginia and in this role has been a Virginia Action 

Coalition (VAC) co-lead since 2012. David launched 

AARP’s brain health program in Virginia in 2015, and it 

has since spread nationwide. 

At the meeting, David discussed the connection 

Phyllis Whitehead, 

PhD, APRN/CNS, 

ACHPN, PMGT-BC, 

FNAP 

between brain health and nursing. There is much we can do to take charge of our 

brain health and improve our quality of life. Nurses have unique opportunities 

to foster improved brain health by becoming brain health presenters within our 

communities. 

Dr. Rebekah Dailey, DNP, RN, CEN, CPE, AARP Virginia Community 

Ambassador, continued this dialogue by presenting the Six Pillars of Brain Health: 

https://www.aarp.org/health/brain-health/ 

These pillars follow guidance from the Global Council on Brain Health 

(https://www.aarp.org/health/brain-health/global-council-on-brain-health/), 

independent group of researchers affiliated with AARP. 

The six pillars include: 

1. Engage Your Brain 

2. Stay Socially Engaged 

3. Manage Stress 

4. Exercise 

5. Get Restorative Sleep 

6. Eat Right 

Mental Health Roundtable participants had the exciting opportunity to schedule 

a presentation of the Six Pillars of Brain Health in their community or become an 

AARP Virginia brain health presenter. This is just one of the many ways nurses 

are serving our communities while improving the mental and brain health of the 

citizens of the commonwealth. 

Dr. Kathy Baker, RN, PhD, NE-BC, VAC Co-Lead, ended the day with a 

discussion of how Virginia nurses are leaders in well-being and health equity. If 

you are interested in learning more about these initiatives, please contact VNA 

Administrative Coordinator India Woolfolk at Iwoolfolk@virginianurses.com. 

With the beauty of spring among us, remember to be good “Self-Stewards” and 

engage your brain and improve your overall well-being. We (VNF & VNA) are here 

with excellent resources to support you. 

an


CEO Reflections 


We Hear You! 

Highlights of VNA’s Current Member Insights & Needs Assessment 

Every few years, VNA asks members to complete a comprehensive survey 

to reflect on their membership, and to share what they value most in their 

membership, as well as what direction they would like us to take as nursing’s 

premier professional association in Virginia. 

The timing of the survey was quite intentional. The bulk of our survey 

results will have been received prior to our board’s May/June joint (VNA and 

the Virginia Nurses Foundation) Strategic Planning Retreat, and will serve as 

the foundation for much of the conversations that take place that day. While 

we can’t set the table for all 5,000 members to be in attendance at our retreat, 

know that you will be very much present. Your survey responses, considered 

in aggregate, are incredibly important to our work and will be central to our 

discussions throughout the day. 

So, a little about the VNA members who completed the survey … 

Nursing positions held by respondents 

• The largest segment of respondents was direct 

patient care/clinical nurses (31%), followed Janet Wall, MS 

by management (20%), Advanced Practice 

(14%), Faculty (9%) and executives (8%). Others work in professional 

development, case management, and quality improvement. 

• Not surprisingly, nearly 51% of respondents work in a hospital setting, 

while more than 14% work at a college or institution of higher learning. 

Another 7% work in public health, 6% in ambulatory care, and 5% in 

long-term care. Home/health hospice nurses, k-12 school nurses, and 

nurse entrepreneurs make up another 8% of our membership. Retired 

nurses, an invaluable resource, make up another 16% of licensed 

nurses responding to our survey, while another 4% are currently 

unemployed. * 

* We are concurrently conducting another survey of all nurses in the 

commonwealth whose licenses are either inactive or have expired in 

the past four years to understand what it would take – if anything 

– to appeal to them to return to the workforce. This information will 

also be shared with VNA and VNF board members during our joint 

strategic planning retreat and in ongoing Nurse Staffing Deep Dive 

meetings spearheaded by VNA. We will let you know what we learn. 

• Seventy percent have been working on the frontlines of the pandemic. 

Sadly, but anticipated, 38% of responding members said the pandemic 

has prevented them from participating in our virtual conferences, 

webinars, legislative advocacy efforts, and chapter events.


Do you envision yourself continuing to work as a nurse in your current or a 

similar practice setting… 

Continuing Education/Professional Development. Creating Community trailed at 

50.3%, which we believe is due in great part to the limitations of the pandemic. 

Survey respondents ranked their needs of the chapters, with professional 

development dominating the responses (65%), and government relations (25%), 

networking (16%), student nurse mentoring (15%), and social events (8%) 

following. We’re working on re-energizing our chapters post-pandemic and 

welcome MJ Gearles to the role of Membership Manager, in which capacity she 

will focus much of her time on chapter engagement. 

• Eighty-eight percent are confident they will be working in their current or 

a similar position one year from now, while that confidence drops to 50.5% 

in five years. 25.5% of respondents do not believe they will be working as a 

nurse in their current or a similar practice setting, while another 24% are 

unsure. 

• The highest degree earned by responding nurses: 41% have an MSN/MS, 

30% earned a BSN, 14.4% earned their DNP and another 5% their PhD, 

7.8% have an associate degree, and 1% earned their diploma in nursing. 

Survey highlights 

People generally join their professional association for one of four reasons: 

1. Advocacy, 2. Networking/Community, 3. Education and 4. News and 

Information. What can change from year to year – and the reason why this 

survey is frequently illuminating – is the way in which members prioritize these 

areas. As an organization that hangs its hat on representing the interests of this 

state’s approximately 115,000 RNs, it’s exciting to see that 96% of our members 

rank advocacy as extremely or very important (and that more than 90% agree 

that VNA is the Voice of Nursing in Virginia), while 87% rated Updates on 

Nursing Issues as extremely or very important, and 78% gave the same high 

level of importance to Continuing Education & Professional Development, 

followed at 77% by Creating Community (chapters, networking, online groups…). 

When asked how well we are meeting members’ expectations in the above 

areas, and recognizing that there is always room for improvement, respondents 

gave us generous marks (“excellent” and “very well”) in Updates on Nursing 

Issues, which ranked first, followed by Legislative & Regulatory Advocacy, and 

Top Issues Members Want VNA to Address 

While we haven’t yet sifted through all of the results (and more surveys 

continue to be completed), staffing is clearly the front runner. Responses 

mentioned frontline nursing support, adequate/safe staffing, staffing ideas 

for semi-retired nurses, and ratios. One respondent wrote, “I know this is 

VERY difficult to legislate, yet I look at what is happening around Virginia 

and elsewhere and wonder what it will take (i.e., another sentinel event) before 

hospital and LTC systems realize they cannot work nurses to death.” 

Staffing concerns also extended to the faculty shortage and the “need to 

better quantify nursing faculty workload with comparable [competitive] pay.” 

Retention and the “stabilization of manpower” also ranked high. 

A myriad of workplace issues arose; most significantly the need to ensure 

a safe workplace for nurses and other healthcare professionals, and to finally 

bring an end to the bullying and incivility that has plagued the profession for 

far too long. 

Top Continuing Education Requested 

While staff needs to take more time to thoughtfully review all of the 

responses, I wanted to share that Leadership (Development, Resilience, 

Mentoring) was a recurring theme in response to professional development 

needs. For those of you who may not be aware, the Virginia Nurses Foundation, 

in partnership with VNA, recently launched the first cohort of our Nurse 

Leadership Academy, with a class of nearly 40 fellows. This year-long program, 

which includes six months of virtual didactic learning and six months spent 

developing a leadership project with mentor and coaching support, is geared 

toward new and emerging nurse leaders. The Academy’s next class will begin 

January 2023. Look for more information at VirginiaNursesFoundation.org and 

in upcoming issues of VNA News Brief. Registration will open shortly. While this 

will not be the only avenue for leadership development programming, you may 

find that becoming an Academy fellow is “just what the nurse ordered.” 

I’m so thankful for everyone’s input in this survey process, as is our board, 

and believe you will be excited to read more in the next issue of Virginia Nurses 

Today about how we’re going to respond in order to better meet – and exceed – 

your expectations via our new strategic imperatives. Until then, please consider 

helping us grow our voice further by joining VNA/ANA if you haven’t already 

done so. The larger our numbers, the greater our impact, and at $174/year for 

the combined membership, we believe it’s a great value! To learn more, click the 

“Join VNA” button at the top of our website, www.virginianurses.com.



Providing Competent, Supportive Care for People 

Who are Transgender 

F. Patrick Robinson, PhD, RN, ACRN, CNE, FAAN 

Sherry L Roper, PhD, RN 

Reprinted with permission from 

Illinois The Nursing Voice, June 2021 issue 

The idea that gender is binary (male or female) and determined at birth 

predominates Western cultures. However, research evidence and lived 

experiences suggest that gender exists on a spectrum with many options. 

Some people identify as a gender different from their gender determined at 

birth (Deutsch, 2016). Our traditional understanding of gender, based on 

chromosomes and primary (genitalia) and secondary sex characteristics, is 

often called biological sex or gender (or sex) assigned at birth. Gender identity, 

on the other hand, is the innermost concept of self as male, female, a blend of 

both, or neither (Lambda Legal, 2016.). 

The majority of people are cisgender, which occurs when gender assigned 

at birth and gender identity are the same. However, the best available data 

suggest that approximately 1.4 million adults do not self-identify with their 

gender assignments (e.g., someone assigned female at birth but identifies as 

male) (Flores et al., 2016). Transgender is an umbrella term for this population. 

A visibly growing segment of the U.S. population does not identify with the 

binary notion of gender. Nonbinary is a collective term for this population, but 

individuals may use terms such as genderqueer, gender fluid, or gender nonconforming. 

There is no standard or correct way to be (or be seen as) transgender. 

Some people who are transgender choose gender-affirming hormone therapy 

to achieve masculinizing or feminizing effects; others do not. Surgery that 

revises genitals to conform to gender identity is a critical part of the transition 

for many people who are transgender (Deutsch et al., 2019). Others do not 

feel that genital surgery is a necessary part of transition but may opt for 

non-genital surgeries to produce desired characteristics, including breast 

augmentation or removal and body contouring procedures. In other words, 

the importance of therapy related to the quality of life varies by individual. 

Also, some people who are transgender may want these services but do not 

have access to them because they are (a) unavailable in the community; (b) not 

covered by insurance (even if the individual has insurance, and many do not), 

and (c) too expensive. 

Remember: there is no one way to "be" transgender or cisgender. People 

choose to express their gender identities in personally satisfying ways, which 

may or may not match social expectations of what it means to look and behave 

Choose from four concentrations: 

– Advanced Practice 

– Nurse Executive 

– Psych-Mental Health Nurse Practitioner 

– Post-master's Nurse Anesthesia 

as a male or female. Some transgender women choose not to wear makeup or 

dresses, and some cisgender men choose to wear their hair long and earrings. 

Health Disparities in People Who are Transgender 

Negative attitudes and discrimination toward the transgender community 

create inequalities that prevent the delivery of competent healthcare and 

elevate the risk for various health problems (Grant et al., 2011). In comparison 

to their cisgender counterparts, people who are transgender experience higher 

incidences of cancer, mental health challenges, and other health problems 

(Department of Health & Human Services, n.d.). For instance, transgender 

women, compared to all other populations, are at the highest risk of injury 

from violence and death by homicide. People who are transgender are also 

more likely to smoke, drink alcohol, use drugs, and engage in risk behaviors 

(Institute of Medicine, 2011). 

Furthermore, discrimination and social stigma increase poverty and 

homelessness in people who are transgender (Safer et al., 2017). The 

inability to afford basic living needs may lead to employment in underground 

economies, such as survival sex work or the illegal drug trade, which place the 

person who is transgender at an even higher risk for violence, drug use, and 

sexually transmitted infections (Deutsch, 2016). 

People who are transgender are more likely to rely on public health 

insurance or be uninsured than the general population. Even those insured 

report coverage gaps caused by low-cost coverage that does not include 

standard services for preventative, behavioral health, or gender-affirming 

therapies, including hormones (Deutsch et al., 2019). Lack of access to 

comprehensive health care leads some people who are transgender to seek 

hormones from the community and social networks without clinical support 

and monitoring, putting them at additional risk for adverse reactions and 

complications. 

Researchers suggest that healthcare providers' inability to deliver 

supportive and competent care serves as a powerful mechanism underlying 

health disparities (Fenway Institute, 2016). The experiences of people who 

are transgender are often not included in healthcare provider diversity and 

inclusiveness training. While transgender-related content in health professions 

basic education programs would effectively improve provider knowledge, 

skills, and attitudes, transgender health has not been prioritized in nursing 

education. The result is a nursing workforce inadequately prepared to care for 

people who are transgender (McDowell & Bower, 2016). 

Nursing Care of People Who Are Transgender 

Competent, supportive transgender care requires nurses to recognize 

potential biases and understand gender that may differ from their current 

beliefs and social norms. Honest reflection on these feelings is an essential 

step in providing competent transgender care. Using a lens of cultural 

humility, where cisgender nurses acknowledge that they do not adequately 

know about being transgender while also being open to learning, is helpful. In 

this spirit, open, transparent inquiry on the part of nurses when they do not 

know something (When I speak to your children, what name should I use to 

refer to you?) or how to proceed with care (I need to place a catheter into your 

bladder, and I know you have had gender-affirming surgery. Do you want to 

give me any special instructions?) can build trust. 

While gender-affirming care such as hormones, androgen-blocking agents, 

and surgeries require specialist care management, nurses will encounter 

transgender patients in all healthcare areas. Assessing the history and 

current status of gender-affirming therapies is critical to inform safe care. 

For example, hormone-induced changes in muscle and bone mass, along 

with menstruation or amenorrhea, can alter gender-defined reference ranges 

for laboratory tests such as hemoglobin/hematocrit, alkaline phosphatase, 

and creatinine (Deutsch, 2016). Nurses should consider the gender assigned 

at birth (especially if it is the only gender information to which the lab has 

access) and gender-affirming therapy-induced physiological changes to make 

valid inferences about lab values. Nurses should also ensure that a complete 

history of the use of hormones and androgen blockers (including those 

obtained from non-licensed providers) is taken. Nurses should work with other 

providers to ensure that hormone therapy does not stop with hospitalization 

unless contraindicated by current pathology or prescribed medications. Abrupt 

cessation of hormone therapy can have a significant and negative impact on 

emotional and physiological health. 

Systems-Level Policies, Processes, and Advocacy 

Professional nurses can play a crucial role by advocating for policies and 

processes that promote safe, effective, and supportive care for people who are 

transgender. Misgendering a patient (making an incorrect assumption about 

gender identity) can cause emotional distress and erode patient-provider trust. 

Unfortunately, electronic health records (EHR) often do not support competent 

care for people who are transgender. For instance, healthcare providers should 

use a 2-step gender identification process (Deutsch, 2016). However, many do 

not, and EHR systems rarely provide prompts for the processor space for easy 

documentation and access to information derived from the process. Asking 

about a patient's current gender identity can result in several responses. The 

EHR should make checkboxes for a reasonable number of those responses, 

including male, female, transgender male, transgender female, and nonbinary. 

A fill-in-the-blank is needed for other identifies. The gender assigned at 

birth also requires options beyond male or female; people born with external 

genitalia, gonads, or both that do not conform to what is typically male or 

female (intersex) may have been identified incorrectly at birth. The EHR should 

provide an intersex option to this question. Some people who are transgender 

are uncomfortable revealing gender assigned at birth, so decline-to-state 

should be another option. Note that this process should be the standard for all 

patients, not just those assumed to be transgender. 

People who are transgender may use names other than their legal names 

(Lambda Legal, 2016). Navigating a legal name change is complicated and


costly. Some people who are transgender do not 

have the resources for a legal name change; for 

others, it may not be safe, given current social or 

legal circumstances. Using a patient's chosen 

name and pronouns is critical to patient-centered 

care. The EHR should prominently document 

the patient's chosen name and pronouns, which 

should also be used outside the EHR, including 

for appointments and prescriptions. Patients 

should only have to provide the information once, 

decreasing the need to correct providers and 

improving patient-provider relationships. EHRs 

should also contain an organ inventory, perhaps 

as part of surgical history, as providers will 

need to know about the presence or absence of 

reproductive and gonadal organs to inform clinical 

decision-making. This information must be clear, 

unambiguous, and easily accessible in the EHR 

to inform care and prevent medical and surgical 

errors. 

Nurses should work within governance 

processes to ensure that all institutional policies 

support transgender patients, staff, and visitors. 

Nondiscrimination statements should include 

gender identity. Policies about restrooms and staff 

changing rooms (usually labeled in gender-binary 

terms) should state that a person's gender identity 

rightly determines the room to be used and that 

that right should not require any proof (e.g., health 

provider confirmation) related to gender or gender 

identity. Finally, clear guidelines concerning nonprivate 

room assignments should include assigning 

roommates based on gender identity rather than 

gender assigned at birth. 

Deutsch, M.B, Bowers, M.L., Radix, A., & Carmel, T.C. 

(2019). Transgender medical care in the United States: 

A historical perspective. In J.S. Schneider, V.M.B. 

Silenzio, & Erikson-Schroth, L. (Eds.). The GLMA 

Handbook on LGBT Health (1, 83-131). Santa Barbara, 

CA: Praeger. 

Fenway Institute, National LGBT Health Education 

Center. (2016). Providing inclusive services and care for 

LGBT people. https://www.lgbtqiahealtheducation.org/ 

publication/learning-guide/ 

Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. 

(2016). How many adults identify as transgender in the 

United States? UCLA School of Law, William Institute. 

https://williamsinstitute.law.ucla.edu/publications/ 

trans-adults-united-states/ 

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., 

Herman, J. L., & Keisling, M. (2011). Injustice at 

every turn: A report of the National Transgender 

Discrimination Survey. https://www.transequality.org/ 

sites/default/files/docs/resources/NTDS_Report.pdf 

Institute of Medicine. (2011). The health of lesbian, 

gay, bisexual, and transgender people: Building a 

foundation for better understanding. http://www. 

Western State Hospital 

nationalacademies.org/hmd/Reports/2011/The- 

Health-of-Lesbian-Gay-Bisexual-and- 

Lambda Legal. (2016). Transgender rights toolkit. https:// 

www.lambdalegal.org/issues/transgender-rights 

McDowell, A. & Bower, K. (2016). Transgender health care 

for nurses: An innovative approach to diversifying 

nursing curricula to address health inequalities. 

Journal of Nursing Education, 55(8), 476-479. DOI 

10.3928/01484834-20160715-11 

Safer, J. D., Coleman, E., Feldman, J., Garofal, R., 

Hembree, W., Radix, A., & Sevelius, S. (2017). Barriers 

to health care for transgender individuals. Current 

Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 

168-171. DOI: 10.1097/MED.0000000000000227 

Singh, S., & Durso, L. E. (2017). Widespread 

discrimination continues to shape LGBT people's 

lives in both subtle and significant ways. Center for 

American Progress. https://www.americanprogress. 

org/issues/lgbt/news/2017/05/02/429529/ 

widespread-discrimination-continues-shape-lgbtpeoples-lives-subtle-significant-ways/ 

Power to Make a Difference 

The ANA Code of Ethics obligates nurses to 

practice "compassion and respect for the inherent 

dignity, worth, and unique attributes of every 

person" (ANA, 2015, para 1). While some nurses 

may intentionally discriminate against people 

who are transgender, it is more likely that a lack 

of knowledge and experience leads to nursing 

actions that result in suboptimal care. Nurses play 

critical roles in transgender care by (a) providing 

supportive, affirming care, (b) creating an inclusive 

environment, and (c) leading interprofessional 

teams toward gender-affirming care. Education 

and a commitment to understanding the lived 

experiences of people who are transgender is, 

therefore, essential for all nurses. 

References 

American Nurses Association. (2015). What is the nursing 

code of ethics? https://nurse.org/education/nursingcode-of-ethics/ 

Department of Health and Human Services, Office 

of Disease Prevention and Health Promotion. 

(n.d.). Healthy people. Lesbian, gay, bisexual, and 

transgender health. https://www.healthypeople. 

gov/2020/topics-objectives/topic/lesbian-gay-bisexualand-transgender-health 

Deutsch, M.B. (2016). Guidelines for the primary and 

gender-affirming care of transgender and gender 

nonbinary people (2nd ed.). Center of Excellence for 

Transgender Health, University of California at San 

Francisco. https://transcare.ucsf.edu/sites/transcare. 

ucsf.edu/files/Transgender-PGACG-6-17-16.pdf 

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Case Study in Innovation: 

Pioneers’ Program Addresses Staffing Shortage 

By Eileen L. Dohmann, MBA, BSN, RN, NEA-BC SVP, CNO Mary 

Washington Healthcare Fredericksburg, VA 

& 

Patti Lisk, DACCE, MS, BSN, RN Dean Germanna Community College, 

Nursing and Health Technologies Fredericksburg, VA 

In November 2022, at the beginning of “The Great Resignation,” Mary 

Washington Healthcare (MWHC) was experiencing an increase in RN and 

CNA vacancies. The plea from RNs was for more CNAs, at the bedside. The 

MWHC CNO was searching for workforce resources to answer this plea. 

At the time, nursing students were not allowed to be in hospitals for 

clinical rotations due to PPE shortages and COVID concerns. The MWHC 

CNO contacted the Dean of the Germanna Community College’s (GCC) 

Nursing & Health Technologies with a plea, “Can I hire your nursing 

students to assist us at the bedside?” The rationale was twofold: 

1. An immediate relief/source for bedside patient care 

2. An opportunity for nursing students to be in the clinical setting and 

to increase their “comfort and confidence” in the clinical environment 

(long standing feedback on what new Grad RNs were lacking (“They 

need more hospital clinical experience to increase their comfort and 

confidence which will support development of critical thinking skills.”) 

Within three weeks of the “plea,” MWHC had announced, interviewed, 

competency validated, hired and started 30 GCC nursing students as 

Nursing Assistants (in Staffing Office prn role). This was the shortest “time 

to file” turnaround ever experienced by MWHC HR Recruiters! 

Onboarding had to be considered as the shortage of CNAs challenged the 

usual onboarding process with CNA Preceptors. MWHC Nurse Educators 

utilized the traditional “faculty:student” approach (one nursing students 

were already comfortable with) of having 1 Nurse Educator: 6 Nursing 

Assistants who took them on the units to onboard them to the role which 

included “shadowing” a CNA. Onboarding occurred over the first two weeks 

of the nursing students Winter Holiday school break. By January 1, 2021, 

MWHC had 30 Nursing Assistants available on the units. Nurse feedback 

included “You (CNO) said help was coming. Today, help arrived and it’s called 

a Nursing Assistant. We LOVE them. Please send more!” 

Nursing Assistants work a minimum of 10 hours/week and a maximum 

of 20 hours/week while in school. When school is not in session, they can 

work as much as needed. MWHC has been flexible in lowering/eliminating 

the minimum hours if students need it. During the early months of 2021, 

the success of the Nursing Assistant role was clearly evident. MWHC has 

continued to hire Nursing Assistant cohorts three times/year in May, June, 

and December. In spring 2021, MWHC brought on a cohort during students’ 

spring break. This was successful but was more challenging as it was only 

one week and students were in the midst of semester work. The CNO again 

approached the GCC Dean, “How can these Nursing Assistant students’ get 

clinical academic credit for the NA role?” 

The GCC Dean shared a passion for nursing students to be paid for 

hospital clinical rotation hours. A team of MWHC Nurse educators and 

GCC faculty came together and created a clinical rotation pilot for the first 

cohort of NAs. In fall 2021, these NAs were in their 3rd semester at GCC. 

They were required to do 64 hours of med surg clinical rotation. The pilot 

took 36 of those hours and scheduled each NA student with a hospital RN, 

as an RN Mentor, to work (3) 12-hour shifts with the RN Mentor. The RN 

Mentors, selected by the Nurse Manager and Nurse Educator on unit, were 

trained in the students' learning and clinical competencies (unfortunately, 

new information for our RN Mentors). The NA students were scheduled on a 

Monday or Tuesday, which are the busiest days of the week in the hospital 

unit. The GCC faculty rounded continuously on the Nursing Assistant 

Student and RN Mentor partners. The feedback was astounding. RN Mentors 

enjoyed their focused teaching (“I never knew what students were supposed 

to learn with me so I just taught them what I thought they needed to learn”) 

and the help of “their own NA” for the shift. NA Students learned more in a 

12-hour shift (“I’ve done more clinically in this shift than in all of my other 

clinicals”). The most astounding and gratifying observation was to watch and 

hear the student nurse evolve from “I helped the nurse” to “My RN Mentor 

expected me to answer “If you were the RN…what would you do? I knew the 

answer. I was the RN!” 

In December, these Nursing Assistant Students (our PIONEERS) and 

RN Mentors completed their 3rd semester with a celebration at MWHC. All 

recognized the RN Mentors with a GCC/MWHC lab jacket. The Nursing 

Assistant/Student RN were given a “golden ticket”…a written job offer for 

the MWHC New Grad RN Residency cohort in July 2022, on the unit of their 

choice! Of the 16 job offers, 14 have been accepted! 

For the PIONEERS 4th semester, they again will do a 36-hour pilot with (3) 

12-hour shifts with the RN Mentor on night shift (the most likely shift they 

will work as a New Grad RN) on the unit where they will be a New Grad RN, 

starting July 2022. 

We are excited to measure the transition to RN practice (time and 

intensity) for these 14 PIONEERS. 

The hiring of NAs continues with the 5th cohort starting in May 2022. 

Mary Washington Hospital hopes to hire 50+. 

The clinical rotation pilots also continue with new 3rd semester NA/ 

Students doing (3) 12-hour shifts with RN Mentor in spring 2022. 

The “secret to success”…a strong academic/clinical partnership with a 

team that understands the “rules” and is willing to try new approaches to 

creating excellent nurses.



VNA & VNF’s spring conference reaches record numbers 

• Bon Secours 

• Carilion Clinic 

• Centra Health 

• Inova Health System 

• Mary Washington Healthcare 

• Riverside Health System 

• UVA Health 

• VCU Health. 

VNA and VNF’s spring conference, Calling All Disruptors for the Future 

of Nursing, was a smash hit! We couldn’t be more thrilled to report that eight 

health systems and four schools of nursing across Virginia took advantage of 

our group registration to provide ALL of their nurses access to integral topics 

related to positive disruption and the future of the nursing profession! If you are 

employed at one of the following health systems, please contact your employer 

for access to this important content: 

Participant feedback included, “Overall an excellent conference with 

great speakers and important content. All issues were well presented in a 

comprehensive way with practical suggestions for improving practice.” 

Calling All Disruptors for the Future of Nursing featured an impressive lineup 

of expert speakers in the nursing industry such as: Dr. Susan Hassmiller, Dr. 

Katie Boston-Leary, Dr. Peter Buerhaus, and Dr. Tener Goodwin Veenema. 

Conference speakers challenged participants to become positive disruptors in 

their work environments by highlighting both best practice and ‘fail forwards.’ 

The conference concluded with a robust discussion of the challenges that the 

nursing workforce, organizational leaders, nursing educators, and policymakers 

need to overcome so that the future nursing workforce will be prepared to 

address the health needs of society. 

One participant wrote of what they learned from Calling All Disruptors for the 

Future of Nursing saying, “What we would have considered traditional issues 

for the nursing profession, even five years ago, has expanded. We must not shy 

away from confronting issues affecting our patients and the communities in 

which they live, work and learn. That includes social determinants of health, 

racism, implicit bias and resulting health inequities.” 

VNA and VNF’s ultimate goal was to have nurses attending be able to walk 

away with strategies, tools, and resources to support their nursing practice as 

they move to a greater understanding of the power of positive disruptors in the 

nursing field. 

Participants noted, “This conference was one of the best conferences I have 

attended with VNA. All of the speakers were excellent, information and content 

was relevant and had takeaways that could be put into action. It served as a 

launch of gaining momentum to get the nursing profession on the move as one.” 

Intrigued? There’s still time to view the conference and access 8.75 hours of 

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check your email for the link to access the content on demand. If you missed the 

registration window, you can still sign up at https://virginianurses.com/store/ 

default.aspx and access your CE until 11:59pm July 31, 2022.

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Courage in Everyday Nursing Practice 


Carol Dobos PhD, RN-BC, NEA-BC 

Reprinted with permission from 

Arizona Nurse, July 2021 issue 

Courage is an important attribute in life and in 

your nursing practice. As Helen Keller said, 

“Security is mostly a superstition. It does not exist 

in nature nor do the children of men as a whole 

experience it. Avoiding danger is no safer in the long 

run than outright exposure. Life is either a daring 

adventure, or nothing.” 

Nursing is a noble profession that is not for the 

faint of heart. Opportunities to choose courageous 

acts present themselves on a regular basis because 

risk is everywhere. You can attempt to minimize the 

risks by playing it safe. However, there are risks to 

yourself, your colleagues, your profession, and those 

you serve when you don’t take risks in showing up, 

speaking up, or practicing according to the highest 

standards of evidence-based practice. 

Choosing to practice courageously, consistent 

with your personal and professional values, will 

cause some discomfort, bumps, and bruises to you 

and your career. It will also bring professional and 

personal fulfillment, strengthen the profession, and 

improve patient outcomes. You will know that you 

are making a difference in your daily practice and 

throughout your nursing career. 

One way to cultivate courageous behavior is 

through personal risk-taking (PRT), but first you 

need to understand the nature of risk and its related 

concept, positive deviance. 

What is Risk? 

Risk is defined as the possibility of losing 

something of value, which could be physical, 

psychological, or economic. Common risks include 

falling out of favor with others in authority, losing 

support, or damaging essential relationships. Any of 

these events could lead to losing status or influence 

at work, or even losing one’s position or employment. 

A related concept called “positive deviance” refers 

to an intentional act of breaking the rules to serve 

the greater good. Positive deviance is intentional and 

honorable behavior that departs or differs from an 

established norm. It contains elements of innovation, 

creativity, adaptability, or a combination thereof; and 

it involves risk for the nurse. 

For most nurses, whether a particular action 

is right or wrong will often be judged by others in 

charge of rules enforcement. The decision to engage 

in positive deviance, however, lies entirely with the 

nurse. 

Personal Risk-Taking 

PRT is behavior that is consciously and freely 

chosen among available alternatives, some of which 

are known to incur less risk than the chosen action. 

It is supported by the strength and belief of personal 

convictions. Courageous action upholds principles. 

Calculated inaction due to fear leaves one powerless, 

with values compromised. 

Nurses promote courageous action by sharing 

courageous behavior, also called hero stories. This 

can be done formally and informally, verbally and 

in writing, one on one or in groups, during staff 

meetings, during change of shift report, or rounds. 

We create a culture based on what we talk about, 

what we value, and what we support and reward. 

Sometimes we stand alone, and sometimes we 

influence others to follow our lead and take their 

own personal risks. In one study, risk taking was 

found to be one of the key elements in attaining 

expert nursing practice, which supports effective 

and quality-based healthcare outcomes. Risk taking 

also was found to enhance clinical and professional 

development. 

Rather than sitting on the sidelines and hurling 

judgment or advice at others (for example, “Someone 

needs to do something about this.”), we must dare to 

show up and let ourselves be seen, which can result 

in change. (See Success story.) 

We pay a price when we shut down and disengage, 

failing to take action. I have heard nurses talk about 

“staying under the radar.” In doing so they pay a 

dear price. Their talents, wisdom, knowledge, and 

values are not being shared to positively influence 

care and support the development of new nurse 

graduates and other colleagues through courageous 

role modeling. Vulnerability occurs in sharing an 

unpopular opinion, standing up for oneself or others 

such as a colleague who is being bullied, being 

accountable, asking for help, trying something new, 

admitting uncertainty, and asking for forgiveness. 

When courage and fear meet, it often feels awkward 

and scary; however, “being all in” is to be alive. To 

act in alignment with your values is key to personal 

and professional happiness. 

Success story 

When residents were not interacting appropriately 

with pediatric patients, risking psychological harm, 

I discussed this with the chief and arranged 

education. I advised our team that in identifying 

this issue, relationships might become strained, 

but we had an obligation to our patients to address 

this problem. I often used the mantra “I am doing 

the right thing for the right reason” stating it over 

and over in my head to help me stay the course 

and follow through with my convictions. As feared, 

the residents and even an attending physician 

demonstrated passive aggressive behavior towards 

us. The care of the children did improve, however, 

and we knew we had made the right call. 

PRT and Promoting Patient Safety 

Failing to take risks and practice courageously 

can lead to threats to patient safety. Focusing on 

my obligation to “First do no harm,” I made the 

decision not to deploy a transport team until all 

the team members demonstrated competency. I 

was transparent in discussing my concern and 

contingency plan to send another team with my 

medical and administrative colleagues. I was told 

that this was a “career-limiting move.” I simply 

stated, “I have to be able to sleep at night.” 

In another organization, I disagreed with a 

plan to move critically ill patients multiple times 

to accommodate unit renovation. I identified an 

alternative that required only one move. Although 

my plan was successfully implemented, my action 

caused me to fall out of favor with the administrator 

and eventually resulted in my having to move on to 

another position. In both instances, I had to put my 

patients first because when I became a member of 

the nursing profession, I made a promise to protect 

them. 

Why We May Not Take Personal Risks 

Understanding scarcity is key to understanding 

why nurses may not take justified risks. The three 

components of scarcity are shame, comparison, and 

disengagement. 

Shame is the fear of ridicule and belittling 

often used to control people and to keep them in 

line. Shame-based cultures are very unhealthy 

for nurses and patients. The killer of innovation 

is shame. In these cultures, covert or sometimes 

overt messages are common, such as to dare not, 

you’re not good enough, who do you think you are, 

don’t you dare get too big for your britches.” Shame 

becomes fear, fear leads to risk aversion, and risk 

aversion kills innovation and can lead to unsafe 

patient care. Shame is the intensely painful feeling 

or experience of believing that we are flawed and 

therefore unworthy of belonging. Shame makes us 

feel unworthy of connection. Resilience to shame 

occurs when recognizing and speaking openly about 

shame, practicing critical awareness, and reaching 

out to others. 

Healthy competition can be beneficial, but 

constant overt or covert comparing and ranking 

suffocates creativity and risk taking. If nurses are 

held to one narrow standard, they may not question 

the relevance of a course of action to a specific 

situation and embrace evidence- based practice. 

Disengagement occurs when people are afraid to 

take risks and try new things. Too often it is easier 

to stay quiet than to share stories, experiences, and 

ideas. It is important to do what is right, not what 

is easy. The best way through a difficult situation is 

to address the situation directly with honesty and 

integrity, sharing your story and asking for what you 

need. An excellent resource for nurses is the book 

Crucial Conversations. Often what we fear does not 

happen, but even if it does, we have retained our 

self-respect and commitment to professional values. 

Courageous Practice 

I hope you choose to practice courageously, doing 

the right things for the right reasons. As Theodore 

Roosevelt said,


“Far better it is to dare mighty things, to win glorious 

triumphs, even though checkered by failure, than to 

take rank with those poor spirits who neither enjoy 

much nor suffer much, because they live in the gray 

twilight that knows not victory nor defeat.” 

Selected references 

Dobos C. Defining risk from the perspective of nurses in 

clinical roles. J Adv Nur. 1992;17:1303-9. 

Dobos C. Understanding personal risk taking among staff 

nurses: critical information for nurse executives. J Nurs 

Adm. 1997;27(1):1-2. 

Gary JC, Exploring the concept and use of positive 

deviance in nursing. Am J Nurs. 2013;113(8):26- 

34. Haag-Heitman B. The development of expert 

performance in nursing. J Nurses Staff Dev. 

2008;24(5):203-11. 

Brown B. Daring Greatly: How the Courage to be 

Vulnerable Transforms the Way We Live, Love, Parent, 

and Lead. Gotham Books; 2012. 

Patterson K, Grenny J, McMillan R, et al. Crucial 

Conversations: Tools for Talking When Stakes are High, 

2nd ed. New York, NY: McGraw-Hill; 2011. 

Carol Dobos lives in Phoenix Arizona and is the 

past-president of the Arizona Association for Nursing 

Professional Development, a state affiliate of the 

Association for Nursing Professional Development. 

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Virginia Nurses Today - Print and Digital - 

Leadership roles are available at both the local and 

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