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The New Mexico Nurse - July 2022

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The Official

Publication of

VOLUME 67 • NUMBER 3 JULY 2022

Inside

Advocating for Nursing Practice

Since 1921

Quarterly publication sent to more than 25,850 Registered Nurses in New Mexico.

Provided to New Mexico’s Nursing Community by the New Mexico Nurses Association

A Constituent of the American Nurses Association • (505) 471-3324 • http://www.nmna.org/

The Backbone of Dignity is Mattering”

New Mexico Native American Indian

Nurses Association Leaders Recognized

at the Nurse Excellence Award Ceremony

Page 3

ANA Public Health Service Award

Page 5

Nurse License Protection Case Study:

Administering medication without an order

Page 12

Colleen Casper, DNP, RN, MS

CNA Director of Practice & Government Affairs

Congratulations on National Nurses Month to all of the

incredibly wise, attentive, and caring nurse professionals

who find yourselves reading this column today.

Nurse’s Month was such a great time to remind

us of the 2022 results of the Gallup survey that rates

nurses as the highest for honesty and ethics for

the 20th consecutive year. Read that again, 20th

consecutive year!!!

Of course, we as nurses say, that is who we are.

The question is, do we matter? Are nurses valued?

Given the results of the recent legal proceedings of our

nurse colleague at Vanderbilt being charged criminally

with negligence and abuse, I suggest we are not

valued. Given the lack of healthcare leaders courage

and integrity to honestly confront and address the

severe nursing shortage, I am again confident that we

are not valued.

I have been a professional student of healthy work

environments since the beginning of my management

career, in the 1980’s. In 2004 (20 years later), when

the Quality Chasm was published, I thought for

sure nursing’s value was about to be more widely

recognized in the way we provide 24-hour surveillance

of and interventions for patient needs and potential

harm, whether in a hospital, a school, a home, long

term care, etc.

Today, as your professional association’s interface

with legislative and governmental agencies, I can claim

that we have had moments of value, though we have

some distance to go.

The title for this column comes from our recent

conference presenter, Dr. Katie Boston-Leary, PhD,

MBA, MHA, RN, NEA-BC, CCTP. We were fortunate

to hear her message of the historical roots of nursing

as a political movement and our ongoing challenges

to address nurses’ tendency towards powerlessness.

I can’t help but think of the incredible numbers of

nurses, nurse’s assistants, and LPNs I have spoken with

in the last two years, too afraid to tell their story to

their own supervisors, let alone the agencies designed

to regulate and assure public safety in Colorado.

In exploring the concept of “dignity and mattering,”

I’ll quote now from Isaac Prilleltensky, author and

scholar who writes, “To feel worthy, we have to feel

that we are equal to others, and that we deserve to be

treated with respect. We have to experience fairness

in relationships, at work, and in society. Moreover, we

have to be fair to ourselves. We cannot experience

dignity without fairness.”

Exclusion in decision making is one significant

example I offer to describe workforce devaluing, which

is contributing to nursing workforce resignation. The

power of a travel nurse position, shifts the power

differential so that decisions about me, cannot be

made without me. Exclusionary behaviors such as being

left out of staffing decisions, quite naturally triggers

anger and hostility and helplessness. What are our

options?

First, remember, we are recognized as the most

honest and trusted profession because we advocate for

patients and families when they are most vulnerable.

Remember, who you are and what you do every day

has value and impacts individual lives.

Explore strategies to strengthen your own personal

confidence and competencies in having difficult

conversations with those who may be in positions of

power over you. Be constructive, respectful and firm.

Be clear about your intent and your goal. I’ll borrow

from Phyllis Beck-Kritek, PhD, RN, FAAN, who reminds

us that when we are negotiating at an “uneven

table,” sometimes “drawing a kind line in the sand

and walking away” is best for you, your soul and your

work.

May you find dignity in all that you do!

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Page 2 • The New Mexico Nurse July, August, September 2022

The New Mexico Nurse is published quarterly every January,

April, July and October by the Arthur L. Davis Publishing

Agency, Inc. for the New Mexico Nurses Association, a

constituent member of the American Nurses Association.

For advertising rates and information, please contact

Arthur L. Davis Publishing Agency, Inc., PO Box 216,

Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.

com. NMNA 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 New Mexico Nurses Association

of products advertised, the advertisers, or the claims

made. Rejection of an advertisement does not imply a

product offered for advertising is without merit, or that

the manufacturer lacks integrity, or that this association

disapproves of the product or its use. NMNA and the

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

liable for any consequences resulting from purchase or

use of an advertiser’s product. Articles appearing in this

publication express the opinions of the authors; they do not

necessarily reflect views of the staff, board, or membership

of NMNA or those of the national or local associations.

New Mexico Nurse is a juried nursing publication for

nurses licensed in New Mexico. The Editorial Board

reviews articles submitted for publication and articles for

consideration should be submitted to dwalker@nmna.org.

NMNA Board, Committee Chairs and Staff

President: Michael Shannon MSN, BSN

Vice President Rachel Frija DNP, RN-BC

Treasurer: Barbara Salas C-NP

Secretary Lisa Leding DNP, MSN, RN

Directors:

Suzanne Canfield MBA, BSN, RN, NPD-BC

Mitch Irwin MSN, RN

Siri GuruNam Khalsa MSN, RN

I finally found a

nursing career that is

great for me and my

family!

Judy Liesveld PhD, MS, BSN

Cynthia Nuttal PhD, RN

Lisa Marie Turk MSN, RN

Mario Valencia MBA, MSN, RN

Committees:

Government Relations Committee Co-Chairs

Christine De Lucas , DNP, MPH, RN

Gloria Doherty PhD, MSN, Adult

Health Nurse Specialist, ACNP-BC

Guest Editor Deborah Walker, MSN, RN

NMNA Website: www.nmna.org

Office Mailing Address: P.O. Box 418, Santa Fe, NM 87504

Office Phone: 505-471-3324

Be a nurse who helps create a healthier New Mexico!

Apply today!

Public Health:

Heather Black, 505-470-0462, heather.black@state.nm.us

In-Patient Facilities:

Heather Black, 505-470-0462, heather.black@state.nm.us

Developmental Disabilities Division:

Elizabeth Finley, 505-841-2907

Division of Health Improvement:

Kevin Keith, 505-670-5982

Epidemiology and Response Division:

Liana Lujan, 505-476-8220

We offer a

competitive salary

and benefits

package, and one

of the best public

retirement plans in

the nation.

An Accredited Health

Department by the

Public Health

Accreditation Board

since 2015

For more information go to: http://www.spo.state.nm.us/

Executive Director: Deborah Walker, MSN, RN

PO Box 418 Santa Fe, NM 87504

Office: 505-471-3324 Cell: 505-660-3890

Accredited Approver Program Director:

Suzanne Canfield, MBA, BSN, RN, NPD-BC

ceapps@mnna.org 505-690-6975

Peer Reviewers:

Cynthia Nuttall, PhD, RN, NE-BC

Claudia Phillips, MSN-Ed, RN

Kelli Desmond, MSN, CNP

Ann Buttner, DNP, RN

Kristi Erikson, MSN, NCEcl

Leigh Raymond, PhD, MSN, RN

www.nmna.org

Published by:

Arthur L. Davis

Publishing Agency, Inc.


July, August, September 2022 The New Mexico Nurse • Page 3

New Mexico Native American

Indian Nurses Association

Leaders Recognized at the

Nurse Excellence Award

Ceremony

NMNAI nurse leaders, Erma Marbut MSN, RN and Dee Billops PhD, RN,

were recognized at the recent Nurse Excellence awards ceremony for their

contributions to nursing and healthcare in New Mexico. Erma Marbut MSN, RN

received recognition as a Nursing Legend and Dee Billops was the recipient of the

Community Service Award. Erma Marbut currently serves as the President of the

NMNAI and Dee Billops serves as Treasurer.

The nomination for Erma Marbut as Legend noted: “Erma’s journey into

professional nursing started with LPN licensure by attending the Indian School of

Practical Nursing in the era of Bureau Indian Affairs and its Indian Determination

Program.” Upon completion of the LPN program Ms. Marbut was relocated to

Staten Island, New York. Her interest in the betterment of the life of all Indian

people, and her desire to obtain advanced education in the nursing profession only

grew and was put into action. During a career spanning fifty-six years in nursing

she worked to address the healthcare disparities, racism, poor living conditions of

Natives living in the urban setting and the ongoing lack of understanding of Native

culture, and their arts and crafts. She served as a chief nurse within the Indian

Health Service at Crownpoint making many inroads and only recently finalized her

direct care.

Dee Billops has been committed to nursing education in New Mexico and

recently persevered to achieve her PhD. She continues to serve in academia. Her

recognition stems from her unending volunteer work during the pandemic. She

worked with others in the NM Nurses Association to package and deliver PPE

(including face shields) and hand sanitizer to twenty-two clinics, hospitals and longterm

care facilities in northern and central NM. She regularly volunteered three times

a week to serve in the vaccine clinic at the Pitt.

It should be noted that Erma Marbut and Dee Billops co-founded and

incorporated the only non-profit native American nursing professional association

incorporated in year 1980 as the New Mexico Native American Indian Nurses

Association.

Most recently, under their leadership, NMNAI has successfully applied for grants

from the NM BON Nursing Excellence funds to increase the percentage of Native

American nurses to implement a scholarship program for native nursing students.

Erma Marbut has written grants and Dee has facilitated the awards and written on

the outcomes. Several grants have been awarded up to the present. Unlike most

scholarships, the scholarship grant is issued to the student to use for unforeseen

and/or extraneous costs for education and includes a strong, unique mentoring

component. Under the Leadership of Erma and Dee this NMNAINA Mentorship

Program was established and the mentorship curriculum was chosen because it is

based in traditional value systems of American Indian people. One purpose of this

workshop is to train Native and non-Native nurses to become mentors for American

Indian nursing students from rural areas who are accepted and attending various

nursing programs. At present there are now 35 mentors trained around the state

of New Mexico. The main aim of the scholarship and mentorship workshop is to

increase the percentage of Native American nurses providing care in New Mexico to

equal, in the future, the percentage of Native people in the state (11%).

CONGRATULATIONS TO

APPROVED PROVIDERS

who received NMNA re-approval for three years!

Approved Providers go through a rigorous review process to achieve New

Mexico Nurses Association approval to award contact hours to nurse learners

and others in the organization and community. This includes a Self-study in

which the applicant assesses its own performance regarding structural capacity,

education design processes and quality outcomes. NMNA Nurse Peer Reviewers

evaluate the Self-study for alignment with the American Nurses Credentialing

Center criteria to award approval.

ORGANIZATIONS

Shannon Medical Center

San Angelo, TX

University Medical Center El Paso

El Paso, TX

PRIMARY NURSE PLANNERS

Cameron Wilson, MSN, RN, NPD-BC

Celia Gonzalez-Najera, BSN, RN

Dee Billops PhD, RN Community Service Award Recipient and

Erma Marbut MSN, RN Nursing Legend


Page 4 • The New Mexico Nurse July, August, September 2022

NMNA members represented New Mexico Nurses during

ANA Hill Day and Membership Assembly

NMNA Delegates to Membership Assembly and award winning

nursing practice


July, August, September 2022 The New Mexico Nurse • Page 5

ANA Public Health Service Award

Lisa E. Patch, MSN, RN, NCSN

Executive Director of Health Services

Alamogordo Public Schools

The American Nurses Association (ANA) Board of

Directors has selected Lisa Patch, MSN, RN, NCSN to

receive the ANA Public Health Service Award, which

recognizes the exceptional leadership and outstanding

professional contributions of a public health nurse in

shaping the role and advancing the practice of public

health nursing. Ms. Patch is the Executive Director

of Health Services for Alamogordo Public Schools.

She was recognized at a reception on the evening of

Thursday, June 9, 2022 immediately preceding the

2022 ANA Membership Assembly, which was held at

the Grand Hyatt Washington hotel in Washington, DC.

Recipients of ANA national awards have always

represented the best of the best and NMNA was

pleased to be there when she was presented with the

honor.

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Page 6 • The New Mexico Nurse July, August, September 2022

Meeting the nurse staffing challenge, part one: Recruitment tips

Georgia Reiner, MS, CPHRM,

Risk Specialist, NSO

NMNA felt all parties will benefit from this

article provided by NSO: Meeting the nurse

staffing challenge, part one: Recruitment tips.

The COVID-19 pandemic has reinforced the need for

healthcare and nursing leaders to shift their approach

to nurse recruitment and retention, as the exodus of

nurses takes its toll on remaining staff and, in some

cases, quality of care. 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.

The link for this article on the NSO webpage

is: https://www.nso.com/Learning/Artifacts/Articles/

Recruitment-Tips-for-Meeting-the-Nurse-Staffing-

Challenge

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 two-part 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 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.


July, August, September 2022 The New Mexico Nurse • Page 7

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/organizationalprograms/magnet/about-magnet/why-becomemagnet/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-to-know/year-one-covid-19-impactassessment-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-andpatient-safety

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/

expert-insights/ten-recruiting-strategies-to-attractnurses

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.

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Page 8 • The New Mexico Nurse July, August, September 2022

ANA Professional Policy Committee - Policy Proposal

The Impact of Climate Change on Health

NMNA Delegates to the ANA Membership

Assembly held June 10, 11, 2022 in Washington

DC will be participating in this dialogue forum.

NMNA wants members to be aware of the

proposal and this process for policy updates and

change at ANA.

Reprinted with permission, New Hampshire Nursing

News March 2022

Topic: The Impact of Climate Change on Health

Strategic Goal: Evolve the Practice of Nursing to

Transform Health and Healthcare

Describe how this proposal relates

to the above strategic goal?

This proposal requests that American Nurses

Association (ANA) update its position statement on

Climate Change and Health, which has not been

revised since 2008 (ANA HOD, 2008) and to host a

Dialogue Forum to inform that process. In August of

this year, the World Health Organization stated that

climate change is now “the single biggest health threat

facing humanity.” (WHO, 2021) A recent editorial

published in 200 leading medical journals, including

The Lancet, The New England Journal of Medicine

and the British Medical Journal, argued that the world

cannot “wait for the COVID-19 pandemic to pass

before addressing climate change.” (Sommer, 2021)

(Gaines, 2021) The WHO (2021) recognizes nurse as

effective and trusted messengers of public health

information, and once again, the Gallop poll has

ranked nurses as the most trusted profession. (Gaines,

2021) As the leading nursing organization, ANA needs

to take a strong leadership position in addressing the

impacts of climate change on human and population

health, and help prepare nurses to engage patients

in conversations about climate change and its health

impacts.

Further, the health impacts of climate change

disproportionately impacts the most vulnerable

populations. A recent EPA analysis demonstrated that

underserved communities disproportionally suffer the

most severe harms resulting from climate change and

are the least able to prepare for and recover from

the impacts of climate change. (EPA, 2021) The EPA

analysis further noted that “racial and ethnic minority

communities are particularly vulnerable to the greatest

impacts of climate change.” (EPA, 2021).

In a 2018 policy statement, the American Academy

of Nursing noted that nurses play essential roles in

public health and emergency services and through

this work they can respond to and reduce health

consequences of climate change. (Leffers & Butterfield,

2018) The International Council of Nurses Position

Statement on Nurses, Climate Change and Health, as

ANA Professional Policy Committee - Policy Proposal

The Impact of Climate Change on Health revised in

2018, calls on national nurses’ associations, to “raise

awareness of the health implications of climate change

and how to assess and address climate change risks

to health by developing policy documents on the

subject,” (ICN, 2018).

Updating and revising position statements falls

directly within ANA’s strategic goal to evolve the

practice of nursing to transform health and healthcare,

and specifically within strategic objective 3.2 to

evolve nursing programs and practice priorities. ANA’s

Nursing Scope and Standards of Practice, 4th Edition,

Standard 18 calls on registered nurses to practice

so as to advance environmental safety and health,

and specifically to advance environmental concerns

through advocacy and to promote “sustainable global

environmental health policies.” (ANA, 2021) What

better way to promote environmental health and safety

for all patients than to educate nurses on the links

between climate change and health and provide tools

and resources so they can incorporate climate change

into their nursing practice (many resources and tools

already exist which ANA can share through it nursing

network)?

Climate change has helped drive a fivefold increase

in the number of weather-related disasters in the

last 50 years. (Pruitt-Young, 2021) Secretary-General

of the World Meteorological Organization, Peterri

Taalas, recently stated that the warming of oceans

has increased the frequency and geographic region

of the most intense tropical storms. (McDaniel, 2021)

Charles (2021) notes that rising heat is amplifying

hurricanes and torrential rain, which in turn trigger

flooding, as well as increasing the number of wildfires

and the length of the wildfire season in areas with

diminished rainfall. Nurses need to be prepared to help

address natural disasters, e.g. tornadoes, hurricanes,

flooding, extreme heat, and wildfires, when they

occur. This emergency preparedness planning needs

to occur before the climate change induced disasters

occur and must incorporate public health and safety

concerns including mitigation strategies and response

and recovery plans, taking into special consideration

populations most vulnerable to significant negative

impacts from these disasters. Providing nurses with the

requisite knowledge and training to better prepare for

climate-related disasters exactly correlates with ANA’s

strategic objective 3.1, to enhance nurses’ disaster

preparedness capabilities.

Does the proposal have national relevance? Yes

Identify if the proposal is being submitted

by leaders of an entity (e.g., C/SNA, Individual

Member Division (ANA-IMD), ANA Board of

Directors or Organizational Affiliate) or by an

individual ANA member (e.g., ANA-C/SNA or

ANA-Only).

Introduced By: Joan C. Widmer, MS, MSBA, RN,

CEN, Treasurer, ANA Board of Directors

Supported by: New Hampshire Nurses Association

(Judith Joy), ANA-Vermont (Meredith Roberts),

ANA-Michigan (Tobi Lyon and MaryLee Pakieser),

Minnesota Organization of Registered Nurses (Kathi

Koehn), Washington State Nurses Association (David

Keepnews), Montana Nurses Association (Vicki Byrd),

Delaware Nurses Association (Chris Otto), ANA-

California (Marketa Houskova), ANA-Massachusetts

(Cammie Townsend), Colorado Nurses Association

(Colleen Casper), New Mexico Nurses Association

(Deborah Walker), Alliance of Nurses for Healthy

Environments (Katie Huffling)

Prepared by: Joan C Widmer, MS, MSBA, RN,

CEN, (ANA-BOD/NHNA), Judith A. Joy, PhD, RN, (New

Hampshire Nurses Association), MaryLee Pakieser,

MSN, RN, FNP-BC, (ANA-Michigan), Meredith Roberts,

PhD, RN (ANA-Vermont), Kathi Koehn, MA, RN, FAAN

(Minnesota Organization of Registered Nurses), Lisa Del

Buono, MD, (Michigan Clinicians for Climate Action)

and Katie Huffling, DNP, RN, CNM, FAAN (Alliance of

Nurses for Healthy Environments).

Primary Contact Person (or Designee):

This individual needs to be available to

respond to questions or requests from the

Professional Policy Committee or Membership

Assembly Representatives if the proposal is

accepted.

Name: Ms. Joan C. Widmer

Credentials: MS, MSBA, RN, CEN

Phone Number: 603-620-1531

Email Address: joan.widmer@ana.org

Second Contact Person (or Designee)

Name: Dr. Judith A. Joy

Credentials: PhD, RN

Phone Number: 603-477-4895

Email Address: judyajoy1@gmail.com

1. Provide reason for submitting the proposal:

Because the single biggest health threat facing humanity

is climate change (WHO, 2021), the strategic goal of

evolving of the practice of nursing to transform health

and healthcare will not be possible without addressing this

topic. As the leading nursing organization, ANA needs to

take a strong leadership position in addressing the impacts

of climate change on human and population health and

help prepare nurses to engage patients in conversations

about climate change and its health impacts.

The top two listings under a Google search of the key

words “ANA and climate change and health” are the 2008

HOD Position Statement on Climate Change and Health

and a Letter from ANA President, Rebecca Patton (term

2006-2010). Our knowledge of climate change and health

has expanded significantly in the ensuing 12 years, yet ANA

has shared little new information with nurses. Is this the

sort of message ANA wishes to send to nurses, especially

younger nurses who are passionate about this issue?

Section 2 of this document will identify the numerous

reasons why this issue is of national relevance, not the

least of which is that the World Health Organization has

declared that climate change is now the single biggest

health threat facing humanity. Further, climate change

is increasing the number and severity of weather related

disasters and nurses need to be better prepared to address

the health impacts of these disasters.

Section 3 of this document will identify the reasons why

this issue is important to the ANA, the nursing profession

and the public. Most importantly, as nurses are considered

the most trusted and ethical profession, nurses need to be

messengers of the impacts of climate change on human

and population health; and ANA needs to take a leadership

position in being the voice of nurses.

The purpose of the proposed dialogue forum is first and

foremost to inform nurses of the relevance and importance

of this issue. It will also help to identify the most important

role which nurses can play, what actions we can take as a

profession, to address this issue.

Possible Questions to Ask:

• What role can and should nurses play in

increasing the awareness of the impacts of

climate change on health?

• What are the best ways in which nurses can

advocate for climate actions to reduce the impact

of climate on human and population health?

• What can individual nurses do to help reduce

their personal impact on climate change?

2. Explain how the topic/issue is of national

relevance.

In Florence Nightingale's Environmental Theory, she

identified five (5) environmental factors: fresh air, pure

water, efficient drainage, cleanliness or sanitation,

and light or direct sunlight. Her observations are still

relevant in today’s world as evidenced by this quote

“According to the Standard 18 of the Standards of

Professional Nursing Practice found in Nursing: Scope

and Standards of Practice, 4th Edition,” the registered

nurses practices in an environmentally safe and healthy

manner. “ (ANA, 2021)

We have seen an approximate 1.0 °C rise in average

global temperature to date, and if greenhouse gas

emissions continue unabated, the average global

temperature is on a trajectory to reach between 3-4

°C increase by the end of the century. (WHO, 2021 and

Climate Interactive, n.d.)

Last fall, in advance of the COP26 in Glasgow,

editors from over 200 health journals, including the

prestigious New England Journal of Medicine warned

that a global temperature increase of “1.5° C above

the pre-industrial average . . . risk(s) catastrophic harm

to health that will be impossible to reverse.” (Dewan,

2021 and Atwoli, et al, 2021) Conversely, if efforts to

keep the temperature rise below 1.5 °C are successful,

significant public health gains will be realized, such

as half the number people globally will experience

water scarcity; similarly, instead of 37% of the

world’s population being regularly exposed to severe

heatwaves, this will be cut by more than half to 14%.

(IPCC, 2019)

As demonstrated by the CDC wheel below, the

climate crisis impacts many areas of health care:


July, August, September 2022 The New Mexico Nurse • Page 9

• Transitioning to clean, renewable energy sources improves outdoor air quality.

• Electrification of our transportation system improves outdoor air quality.

• Electrification of our building sector improves indoor air quality.

• Eating less meat is better for cardiovascular health.

• Active transport is also better for cardiovascular health.

And, as beautifully stated by Kailey Kanaziz BSN, RN, currently enrolled at

University of Michigan School of Nursing graduate program:

"With the climate crisis being an incessant and dire threat to human health,

influential organizations like the ANA can help by taking a health-centric approach

to discussing and acting on the matter. Young nurses, like myself, seek out

organizational membership to stay current, and we look to established leaders

and organizations for guidance on what emerging topics we should be paying

attention to that are impacting our patients and practices. While climate change is

far from being a new circumstance, the limited extent to which it is discussed is

not proportional to the vast burden it is imposing on our health and communities.

It is my hope that the ANA can serve as both a role model and trusted resource

for climate stewardship in the context of healthcare. By updating their climate

statement and integrating climate change awareness into every facet of the

organization, the ANA will send a clear message to young nurses that our profession

is committed to staying current, aware, and adaptable."

(CDC, 2021)

The climate crisis may impact health directly, or by acting as a “threat multiplier;”

that is, taking a common, treatable health care condition and catapulting it into a

health emergency. For example:

• An elderly patient with COPD easily maintained on home oxygen presents to

the ER because his home has lost power in an extreme weather event, or

• A patient with renal insufficiency suddenly requires dialysis because of an

extreme heat event.

The mentally ill homeless person whose medications lose their effectiveness in

extreme heat, or

• Individuals displaced from their homes because of flooding at the onset of the

COVID-19 pandemic, prior to vaccines being readily available.

The good news is that “climate solutions ARE health solutions,” since many of

the actions addressing greenhouse gas emissions reductions also improve indoor

and outdoor air quality, increase activity levels, and improved diet. For example:

Fortunately, the Alliance of Nurses for Healthy Environments, the Medical Society

Consortium on Climate and Health and other groups (see below) have many wellestablished

resources to empower registered nurses to educate themselves, their

patients, and their community. Locating all resources in an easy to use site on

nursingworld.org will reduce the need to reinvent the wheel.

• Alliance of Nurse for Healthy Environments and Health Care Without Harm’s

Nurses Climate Challenge

• Climate - Smart Health Care

• Medical Society Consortium on Climate and Health

• MiAir/MiHealth (and other similar state groups)

3. Describe the impact of this topic/issue on the association,

profession and/or the public.

According to the World Health Organization (WHO, 2021), “climate change is the single

biggest health threat facing humanity.” In its summary report of the COP26 Conference

2021,

ANA Professional Policy Committee...continued on page 10


Page 10 • The New Mexico Nurse July, August, September 2022

ANA Professional Policy Committee...continued from page 9

WHO recounted the many extremes that have

occurred in our climate with unprecedented frequency

in recent years including those that directly and

indirectly impact health: heat, wildfires (air quality)

hurricanes, droughts, and floods. They conclude that

The climate crisis is upon us .... The consequences

for our health are real and often devastating.” (WHO,

2021) Likewise, the Union of Concerned Scientists has

declared that human sponsored changes in our climate

have created “one of the most devastating problems

that humanity has ever faced.” (Union of Concerned

Scientists, 2021)

In 2018 the International Council of Nurses issued a

strongly worded climate health position statement in an

update to their previous statement. Its leading sentence

states that public health advances over the past five

decades are at risk due to climate changes. (International

Council of Nurses, 2018) The Canadian Nurses Association

(CNA) updated their 2009 position on Climate Change and

Health in 2017. They conclude state that nurses, across the

practice, research, leadership, education and social policy

spectrum, must play a part in “adaptation and mitigation”

in response to global climate change.

Just last year, a poll by an independent polling

organization (Pew Research, 2021) states that two thirds of

Americans feel there is a need for greater focus on climate

issues.

With this overwhelming expression of concern by

internationally respected health care organizations,

credentialed scientists, the public, and the foremost

international nurse organization it is incumbent upon

nurses in the United States to address climate in practice.

The foundational documents of the American Nurses

Association also cite the profession’s obligation to address

climate change.

The Code of Ethics for Nurses concludes with the ethical

obligation for the profession of nursing, collectively though

its professional organizations to address social justice issues

through nursing and health policy. Specifically, 9.4 Social

Justice in Nursing and Health Policy states:

“Social justice extends beyond human health and

well-being to the health and well-being of the natural

world. Human life and health are profoundly affected

by the state of the natural world that surrounds us.

Consistent with Florence Nightingale’s historic concerns

for environmental influences on health, and with the

metaparadigm of nursing, the profession’s advocacy

for social justice extends to eco-justice. Environmental

degradation, aridification, earth resources exploitation,

ecosystem destruction, waste and other environmental

assaults disproportionately affect the health of the poor

and ultimately affect the health of all humanity. Nursing

must also advocate for policies, programs, and practice

within the healthcare environment that maintain,

sustain, and repair the natural world. As nursing seeks

to promote and restore health, prevent illness and injury,

and alleviate pain and suffering, it does so within the

holistic context of healing the world.”

The newly revised Nursing Scope and Standards of

Practice, 4th Edition, refers specifically to the issue of

environmental health, stating that the registered nurse

practices in a manner that advances environmental

safety and health. Among the competencies identified

for all registered nurses are:

• “Analyzes the impacts of social, political, and

economic influences on the human health

experience and global environment.

• Advances environmental concerns and complaints

through advocacy and appropriate reporting

mechanisms.

• Promotes sustainable global environmental

health policies and conditions that focus on

prevention of hazards to people and the natural

environment.”

Additional competencies for the graduate-level

prepared registered nurse, including the advance

practice registered nurse include:

• “Designs research addressing the connections

between the environment, its conditions, and

health status.

• Uses community assessment data and plans

to develop policies, recommendations, and

programs addressing threats as well as prevention

of hazards to both the people and the natural

environment.”

As identified in ANA’s foundational documents,

advocacy directed towards the climate crisis, with

its multiple direct and indirect impacts on health, is a

professional imperative and should be an essential

component of ANA’s issues of concern platform.

In recognition of the serious health impacts and

health inequities related to climate change, the

Department of Health and Human Services established

the Office of Climate Change and Health Equity

(OCCHE), and the National Academy of Medicine (NAM)

launched the Action Collaborative on Decarbonizing

the U.S. Health Sector in 2021. Now is the time for

strong nurse leadership on this issue and work with our

healthcare colleagues on climate solutions.

Additional Considerations:

• Current and future younger nurses are more

aware of environmental impacts on human

health.

• Nursing practice is going to be defined by health

impacts of climate change which is being felt

today with only one degree global temperature

increase, and is projected to increase significantly

higher within their lifetime.

• Our responsibility is to prepare the next

generation of nurses for these challenges and

demonstrate collaborative practice with other

healthcare professionals

• We need to be respectful of the upcoming

nurses’ fund of knowledge on these issues.

Nurses are the largest part of healthcare delivery

system

Nurses have the ability to impact change at the

micro level

• Collaboration is part of the nursing curriculum -

understand the power

• Connecting the dots between patient care and

environmental impacts

• Empower nurses to advocate and educate

- through personal education, give them

confidence to take leadership roles and

encourage them to go beyond the hospital/health

care system into their local communities

• Help to develop the toolkit that has resources

from collaborative climate/health care

organizations

• Healthy Nurse/Healthy Nation similar to

Nurses Climate Challenge: Change self/change

community.

Nurses know what they know and what they

don’t know and are willing to ask for help

and they know where to get more credible

information.

4. Identify the underlying issue(s) to be

addressed during the Dialogue Forum.

Climate change is a global problem that starts with

individual actions but is ultimately impacted by the

actions of individuals, corporations, and countries

around the world. It’s multifactorial and appears to

be a task beyond any individual’s ability to address.

Because the need to start somewhere is so critical,

nurses should start at the junction they know and

understand: the impacts on human and population

health. So the first question we can ask is: what role

can and should nurses play in increasing the awareness

of the impacts of climate change on health? Exploring

this question is support by Standard 18 of the

Nursing Scope and Standards of Practice, 4th Edition.

This Standard calls on registered nurses to advance

environmental safety and health through their practice.

Similarly, Standard 18 also calls on registered nurses

to advance environmental concerns through advocacy

and to promote sustainable global environmental

health policies, supporting an exploration of the

question: what are the best ways in which nurses can

advocate for climate actions to reduce the impact of

climate on human and population health?

Finally, the Code of Ethics for Nurses holds that

nurses have a duty to self-care. Many climate healthy

solutions lead to improved human health. Nurses will

be better informed as to steps they can take that will

improve their health while improving the health of the

planet.

5. Recommended actions.

The participants in the Dialogue Forum should

determine the most appropriate actions. The team

drafting this proposal identified several suggestions that

might be considered.

• Urge ANA to update/revise 2008 House of

Delegates Statement on Global Climate Change

and Human Health.

• Develop and deploy a survey to determine nurse

knowledge of the links between health and

climate change, and their understanding of

possible climate actions that can help to mitigate

climate change.

• Urge ANA to share information/educational

resources/tool kits to educate nurses on the

impact of climate change on human health and

provide guidance for nurses to educate the

public on these impacts. Many of these resources

are already available and can be provided to

registered nurses through partnerships/affiliations

with organizations such as Alliance of Nurses for

Healthy Environments.

• Include the climate crisis and its consequential

impact on human and population health as an

essential component of ANA’s issues of concern

platform.

• Urge/continue to urge American Association

of Colleges of Nursing (AACN) and Health

Resources and Services Administration (HRSA) to

develop curricula and professional development

opportunities to increase the knowledge and

skills of the health-care workforce to effectively

address health impacts of climate change.

• Develop Healthy Nurses Healthy Nation

challenges that also recognized that many climate

healthy solutions lead to improved human health,

such as reducing the amount of meat in your diet,

walking/biking to work when possible to reduce

use of fuel powered vehicles, etc.

• Urge nurses through ANA’s Nurse Innovation

program to consider developing products/

technologies that are climate friendly.

• ANA could consider hosting a Climate Summit

in 2023. The Climate Summit would be the

opportunity to create an inter-professional

arena where health and climate experts from all

disciplines can discuss solutions from a variety

of points of view and find common ground for

meaningful action and reduce redundancy of

actions and silo thinking. Nurses are uniquely

trusted messengers, and ANA’s robust grassroots

membership is ideal for implementation. By

consolidating already established resources under

the ANA Enterprise (ANA, ANCC, ANF) and easily

accessed on the ANA website, nurses at all levels

can easily mobilize for real change.

Opportunities available in Bernalillo, Deming,

Las Vegas and Taos!

Start your career in correctional healthcare today!

New graduates encouraged to apply.

References-Partial:

• World Health Organization. (2021, October 30).

Climate change and health. https://www.who.int/

news-room/fact-sheets/detail/climate-change-andhealth).


July, August, September 2022 The New Mexico Nurse • Page 11

• Gaines, K. (2022, Jan) Nursing ranked as the most

trusted profession for 20th year in a row. https://nurse.

org/articles/nursing-ranked-most-honest-profession/.

• Sommer, L. (2021, September 7). Climate change

is the greatest threat to public health, top

medical journals warn. NPR. https://www.npr.

org/2021/09/07/1034670549/climate-change-is-thegreatest-threat-to-public-health-top-medical-journalswarn

• World Health Organization. (2021, August 4). A social

media toolkit for healthcare practitioners, desktop.

https://www.who.int/publications/m/item/a-socialmedia-

toolkit-for-healthcare-practitioners---desktop).

• EPA. (2021, September 2). EPA Report Shows

Disproportionate Impacts of Climate Change on

Socially Vulnerable Populations in the United States

https://www.epa.gov/newsreleases/epa-report-showsdisproportionate-impacts-

climate-change-sociallyvulnerable).

• Leffers, J. & Butterfield, P. (2018). Nurses play essential

roles in reducing health problems due to climate

change, American Academy of Nursing on Policy, Nurse

Outlook. 66. 210-213.

• International Council of Nurses. (2018). Position

Statement: Nurses, climate change and health, Revised

2018. https://www.icn.ch/sites/default/files/inlinefiles/ICN%20PS%20Nurses%252c%20climate%20

change%20and%20health%20FINAL%2 0.pdf).

• American Nurses Association. (2021, May 14). Nursing

Scope and Standards of Practice, 4th Edition. American

Nurses Association.

• Pruitt-Young, S. (2021, September 11). Climate

change is making natural disasters worse, along

with our mental health. NPR. https://www.npr.

org/2021/09/11/1035241392/climate-change-disastersmental-

health-anxiety-eco-grief

• McDaniel, E. (2021, September 7). Weather

disasters have become 5 times as common, thanks

in part to climate change. NPR. https://www.npr.

org/2021/09/07/1034607602/weather-disasters-havebecome-five-times-as-common-thanks-in-part-toclimate-cha

• Charles, D. (2021, September 2). Our future on

a hotter planet means more climate disasters

happening simultaneously. NPR. https://www.npr.

org/2021/09/02/1033054816/our-future-on-a-hotterplanet-means-more-climate-disasters-happeningsimultaneou

• World Meteorological Organization. (2021, October).

State of Climate in 2021: Extreme events and major

impacts. https://public.wmo.int/en/media/press-release/

state-of- climate-2021-extreme-events-and-majorimpacts

• Climate Interactive. (n.d.). Climate scoreboard. https://

www.climateinteractive.org/ci-topics/climate-energy/

scoreboard/

• Dewan, A. (2021, September 5). More than 230

journals warn 1.5°C of global warming could be

'catastrophic' for health. CNN Health. https://www.

cnn.com/2021/09/05/health/climate-health-journalswarning-

intl/index.html

• Atwoli, L. Baqui, A. Benfield, T. Bosurgi, R. Godlee, F.

Hancocks, S. Horton, R. et al. (2021, September 16).

Call for emergency action to limit global temperature

increases, restore biodiversity, and protect health, The

New England Journal of Medicine. https://www.nejm.

org/doi/full/10.1056/NEJMe2113200

• IPCC, 2018: Global Warming of 1.5°C. An IPCC

Special Report on the impacts of global warming of

1.5°C above pre-industrial levels and related global

greenhouse gas emission pathways, in the context

of strengthening the global response to the threat of

climate change, sustainable development, and efforts

to eradicate poverty [Masson-Delmotte, V., P. Zhai, H.-

O. Pörtner, D. Roberts, J. Skea, P.R. Shukla, A. Pirani,

W. Moufouma-Okia, C. Péan, R. Pidcock, S. Connors,

J.B.R. Matthews, Y. Chen, X. Zhou, M.I. Gomis, E.

Lonnoy, T. Maycock, M. Tignor, and T. Waterfield

(eds.)]. https://www.ipcc.ch/sr15/

• CDC (2021, March 2). Climate effects on health, Impact

of climate change on human health. https://www.cdc.

gov/climateandhealth/effects/default.htm

• World Health Organization (2021). COP26 special

report on climate change and health: the health

argument for climate action. Geneva: World Health

Organization

• Union of Concerned Scientists (2021). https://www.

ucsusa.org/climate. Cambridge, MA: Union of

Concerned Scientists.

• Pew Research (2021) https://www.pewresearch.org/

fact-tank/2021/10/14/67-of-americans-perceive-arise-in-extreme-weather-but-partisans-differ-overgovernment-efforts-to-address-it/

October 14

• International Council of Nurses (2018). International

Council of Nurses calls for increased nursing leadership

to combat effects of climate change on health; https://

www.icn.ch/news/international-council-nurses-callsincreased-nursing-leadership-combat-effects-climatechange;

September 27, 2018, Geneva, Switzerland

• American Nurses Association. (2015). Code of Ethics

for Nurses with Interpretive

Statements.

• World Health Organization (2021) Climate change

- the biggest health threat facing humanity.

https://www.who.int/news-room/fact-sheets/

detail/climate-change-and-health

• Canadian Nurses Association (2017). Position

Statement: Climate Change and Health. https://

hl-prod-ca-oc-download.s3-ca-central-1.

amazonaws.com/CNA/2f975e7e-4a40-

45ca-863c-5ebf0a138d5e/UploadedImages/

documents/Climate_change_and_health_

position_stat ement.pdf

Additional Resources:

• Planetary Health and the Role of Nursing: A Call

to Action

Nurses See the Big Picture: Addressing Climate

Change as a Social Determinant of Health

• ANHE's Nurses Climate Challenge

• Key findings: How Americans’ attitudes about

climate change differ by generation, party and

other factors

Nurses Drawdown

• CHANT: Climate, Health, and Nursing Tool

• NSNA: In Support of Increasing Awareness of

the Effects of Climate Change on Mental Health,

2019, p.44.

• NSNA: Increased Nursing Student Action on and

Awareness of the Effects of Climate Change on

Health, 2017, p. 36.

• Nursing Collaborative on Climate Change and

Health


Page 12 • The New Mexico Nurse July, August, September 2022

Nurse License Protection Case Study:

Administering medication without an order

Nurses and License Protection Case Study with Risk Management Strategies,

Presented by NSO

A State Board of Nursing (SBON) complaint may be filed against a nurse by

a patient, colleague, employer, and/or other regulatory agency, such as the

Department of Health. Complaints are subsequently investigated by the SBON

in order to ensure that licensed nurses are practicing safely, professionally, and

ethically. SBON investigations can lead to outcomes ranging from no action against

the nurse to revocation of the nurse’s license to practice. This case study involves

a registered nurse (RN) who was working as the clinical director of a small, rural

emergency care center.

Summary

The insured RN was employed as the clinical director of a small, rural emergency

care center when they responded to a Code Blue, arriving just as the patient was

being intubated. The patient was fighting the intubation, so a physician gave a

verbal order for propofol. The RN asked the pharmacy technician to withdraw a 100-

cc bottle of propofol from the medication dispensing machine and asked another

nurse to administer the medication to the patient. Shortly after the other nurse

began administering the propofol, the patient’s blood pressure dropped, so the

nurse was ordered to stop the propofol infusion.

The patient continued to decompensate and suffered respiratory collapse/arrest.

Following some delay, the patient was eventually intubated, then emergently

transferred to a higher acuity hospital for further treatment. The patient ultimately

suffered anoxic encephalopathy while he was in respiratory arrest.

A recorder was present documenting the Code, and, afterwards, another nurse

transcribed the recorder’s notes into the patient’s healthcare information record. The

recorder noted that it was the insured RN who advised the pharmacy technician to

remove propofol from the medication dispensing machine and instructed a nurse to

administer the medication. However, the recorder failed to note that the physician

gave a verbal order for the propofol. The insured RN failed to review the notes that

the recorder and nurse entered into the patient’s healthcare information record and

failed to note this error. The physician who was present during the Code also failed

to catch this error in the record.

Approximately six months later, the patient’s family filed a lawsuit against

the emergency care center. During a review of the Code record in response to

the lawsuit, it was noted that, during the Code, the RN instructed another nurse

to administer propofol. However, there wasn’t any indication in the record that a

physician had ordered the medication. The emergency care center dismissed the

RN from employment and reported the incident to the SBON. The SBON opened its

own investigation into the RN’s conduct.

Resolution

While the insured RN denied ordering another nurse to administer propofol

without a verbal order from the physician, the RN could not deny failing to ensure

that the propofol administration was documented in the patient's healthcare

information record.

The RN entered into a stipulation agreement with the SBON, under which:

• the RN’s multi-state licensure privileges were revoked;

• the RN was required to complete coursework on nursing jurisprudence

and ethics, medication administration, documentation, and professional

accountability; and

• the RN was required to work under direct supervision for one year and submit

quarterly nursing performance evaluations to the SBON.

The total incurred expenses to defend the insured RN in this case exceeded

$16,600.

Risk Control Recommendations

• Know the parameters of your state’s nursing scope of practice act, and

your facility’s policies and procedures, related to medication administration.

• Only accept verbal drug orders from practitioners during emergencies

or sterile procedures. Before carrying out a verbal order, repeat it back to

the prescriber. During a Code Blue, be sure to communicate all procedures,

medications, treatments to the recorder.

• Review Code Blue records for completeness and process of care after

each Code. Report any concerns and provide feedback through proper

channels to ensure that any errors in the record or areas of improvement are

identified and addressed.

• Document simultaneously with medication administration, whenever

possible, in order to prevent critical gaps or oversights.

Disclaimers

These are illustrations of actual claims that were managed by the CNA insurance

companies. However, every claim arises out of its own unique set of facts which

must be considered within the context of applicable state and federal laws and

regulations, as well as the specific terms, conditions and exclusions of each

insurance policy, their forms, and optional coverages. The information contained

herein is not intended to establish any standard of care, serve as professional

advice or address the circumstances of any specific entity. These statements

do not constitute a risk management directive from CNA. No organization or

individual should act upon this information without appropriate professional

advice, including advice of legal counsel, given after a thorough examination of the

individual situation, encompassing a review of relevant facts, laws and regulations.

CNA assumes no responsibility for the consequences of the use or nonuse of this

information.

This publication is intended to inform Affinity Insurance Services, Inc., customers

of potential liability in their practice. This information is provided for general

informational purposes only and is not intended to provide individualized guidance.

All descriptions, summaries or highlights of coverage are for general informational

purposes only and do not amend, alter or modify the actual terms or conditions of

any insurance policy. Coverage is governed only by the terms and conditions of the

relevant policy. Any references to non-Aon, AIS, NSO, NSO websites are provided

solely for convenience, and Aon, AIS, NSO and NSO disclaims any responsibility with

respect to such websites. This information is not intended to offer legal advice or

to establish appropriate or acceptable standards of professional conduct. Readers

should consult with a lawyer if they have specific concerns. Neither Affinity

Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information

is applied in practice or for the accuracy of this information.

Nurses Service Organization is a registered trade name of Affinity Insurance

Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA,

MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance

Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct

Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity

Insurance Agency.


July, August, September 2022 The New Mexico Nurse • Page 13

New Mexico Nurses Association and the NM Board of Nursing:

What’s the Difference?

NEW MEXICO NURSES ASSOCIATION (NMNA)

Mailing Address: PO Box 418, Santa Fe, NM 87508

Phone: (505) 471-3374

Cell: (505) 660-3890

Emails: dwalker@nmna.org

ceapps@nmna.org

Website: www.nmna.org

PURPOSE:

The purposes of NMNA shall be to advance

the nursing profession by promoting professional

development, fostering high standards of nursing

practice, promoting the safety and well-being of

nursing in the workplace, and advocating on issues

impacting nurses.

The functions of NMNA include the following:

To promote standards of nursing practice, nursing

education and nursing services as defined by ANA;

To promote adherence to the Code of Ethics

established by ANA;

To promote legislation and to speak for nurses in

regard to legislative and regulatory action;

To promote and protect the economic and general

welfare of nurses;

To represent nurses and serve as their state

spokesman with allied professionals, community and

governmental groups and with the public;

To provide for representation in the ANA

Membership Assembly;

To promote professional and leadership

development;

To maintain communication with and provide

services to members;

To advocate for nursing practices that foster safe

patient care and support the profession;

To stimulate and to promote nursing research,

disseminate findings and encourage the utilization of

the results as a basis for nursing practice.

DESCRIPTION

• Founded in 1921

• 501 (c) 6 nonprofit professional association for all

nurses in NM

• Engages in advocacy for practice of nurses in NM

• Is a constituent member of the American Nurses

Association

• Membership association funded by dues revenue;

$20.34 a month for combined NMNA/ANA

• Promotes the continuing professional

development of all NM Nurses using the ANCC

process and in concert with the NM Nurse

Practice Act

• Promotes the Scope and Standards of Nursing

Practice and Nursing Code of Ethics

BOARD OF DIRECTORS

Elected by members of the Association by electronic

ballot

Executive Committee:

President: Michael Shannon MSN, RN

Vice President: Rachel Frija DNP, RN

Secretary: Lisa Leiding DNP, RN

Treasurer: Barbara Salas Women’s Health NP

NMNA STAFF

Executive Director: Deborah Walker MSN, RN

dwalker@nmna.org

(505) 660-3890

Lobbyist: Linda Siegle, JD

SPECIALTY NURSING PROFESSIONAL ASSOCIATIONS

WHO REGULARLY AFFILIATE WITH NMNA

NM NURSE PRACTITIONER COUNCIL

(505)948-4115

https://www.nmnpc.org

PURPOSE:

To unite NM nurse practitioners in an organization

dedicated to promoting excellence in practice and

optimal patient care

DESCRIPTION

Is a 501 ©(6)

Strives to be informed and effective in efforts to

protect and promote nurse practitioners’ professional

interests and to provide strong patient advocacy

BOARD OF DIRECTORS

Elected by members

President: Michelle Peacock MNS, FNP-BC

STAFF: Rachel Bevan BSN, RN Executive Director

Linda Siegle, JD Lobbyist

NM NATIVE AMERICAN INDIAN NURSES ASSOCIATION

PO Box 26674

Albuquerque, NM 87125

Website: http://www.nmmaina.org

GOALS

Advocate for the healthcare needs of the American

Indian People

Act as a liaison within the profession through the

development of nursing education activities

Inform the public about the health needs of

American Indian people

Recommend nursing care strategies to meet the

health needs of American Indian people

Support American Indian students pursuing health

careers

DESCRIPTION:

Was incorporated in 1986

Membership is open to Registered Nurses and

Licensed Practical Nurses

BOARD OF DIRECTORS

President: Erma Marbut MSN, RN

Vice President: Lucretia Jones MSN/Ed

Treasurer: Dee Billops PhD, RN

NM AFFILIATE OF THE AMERICAN COLLEGE OF

NURSE MIDWIVES

Newmexico.midwife.org

PURPOSE: Dedicated to serving both the needs

of the membership and the public toward advancing

personal and community health

To promote the health and well-being of women

throughout their lifespan

To promote the health and well-being of newborns

and families within the context of their cultural

experience

To achieve legislation, public policy, and regulation

that is reflective of the best practice of midwifery

To establish mechanisms for cooperation and

collaboration with other groups and organizations in

promoting the health and well-being of NM families

To support excellence in the education of midwives

within NM

Co-chairs:

Catherine Lukes MSN, CNM

Chelsea Martinez MSN, CNM

Secretary: Catherine Hewlett-Masser MSN, CNM

Treasurer: Heather Veltch MSN, CNM

NEW MEXICO BOARD OF NURSING

Address: 6301 Indian School NE Suite 710

Albuquerque, NM 87110

Phone: (505) 841-8340

Website: https://nmbon.sks.com

PURPOSE: Protect the public safety through

effective regulation of nursing care

DESCRIPTION

NM Governmental regulatory agency established in 1923

Board meets at least once every three months

Adopts rules as necessary to carry out provisions of

the Nursing Practice Act;

Including rules for RNs, LPNs, APRNs hemodialysis

technicians, lactation, medication aides

Responsible for licensure of registered nurses,

licensed practical nurses and certification of hemodialysis

technicians, medication aides and lactation care providers

Prescribes standards and approves curricula for prelicensure

programs of nursing

Reports directly to the NM Governor

Pursuant to the NM Nurse Practice Act Chapter

61, Article 3 Section 1-31 NMSA-1978 compiles and

submits an annual report to the NM Governor

Disciplines licensees in response to violations of the

Nurse Practice Act

Serves in the administrative role of the Nursing

Compact with NCSBN

BOARD OF DIRECTORS

63-3-8 A. creates a seven member “board of

nursing” consisting of four licensed nurses and three

members representing the public

Members are appointed by the NM Governor

Current Chair: Jacqueline Kaiser MSA, BSN, APN, CRNA

STAFF

Sheena Ferguson DNP, RN, Interim Executive Director

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NM SCHOOL NURSES ASSOCIATION

https: //nmsna.nursingnetwork.com

PURPOSE: to promote and advance quality school

health services and health education throughout the

State of NM

President: Lisa Crawford

Lobbyist: Linda Siegle, JD

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Page 14 • The New Mexico Nurse July, August, September 2022

How nurses can counter health misinformation

The wealth of health information available online

can be beneficial for patients, but only if that

information is accurate. Although recent issues on

misinformation have centered on the COVID-19

pandemic, misinformation has been a problem in many

other areas related to wellness and healthcare, such

as dieting, exercise, and vitamins and supplements.

Although misinformation isn’t new, the internet and

social media have supercharged the ability for it to

spread.

Nurses and nurse practitioners have the power

to counteract misinformation, but first, they need to

understand the nature of the problem and why people

may be inclined to believe information that is not

grounded in science.

Misinformation overview

Two definitions help better understand this issue.

Misinformation refers to claims that conflict with

the best available scientific evidence. Disinformation

refers to a coordinated or deliberate effort to spread

misinformation for personal benefit, such as to

gain money, power, or influence. An example of

misinformation is the false claim that sugar causes

hyperactivity in children. An example of disinformation

is a company that makes false scientific claims about

the efficacy of their product to boost sales. This article

focuses on misinformation.

People increasingly seek health information online

through sources such as search engines, health-related

websites, YouTube videos, and apps. Unfortunately,

misinformation can occur at all these points, as well as

via blogs, social media platforms, and user comments

on articles or posts. Even when not actively seeking

health information, people can be exposed to it

through media outlets such as print, TV, and streaming

networks.

Why do people believe misinformation?

Several factors can lead to people accepting

misinformation:

Health literacy. Health literacy refers not only to

the ability to read and understand health information,

but the appraisal and application of knowledge. People

with lower levels of health literacy may be less able

to critically assess the quality of online information,

leading to flawed decision-making. One particular

problem is that content is frequently written at a level

that is too high for most consumers.

Distrust in institutions. Past experiences with the

healthcare system can influence a person’s willingness

to trust the information provided. This includes not

only experiences as an individual but also experiences

of those in groups people affiliate with. Many people

of color and those with disabilities, for example, have

had experiences with healthcare providers where

they did not feel heard or received substandard care,

eroding trust. In some cases, healthcare providers have

lied, as was the case with the Tuskegee syphilis study

of Black men; the men were not told they had the

disease or offered treatment. In addition, some people

have an inherent distrust of government, leading them

to turn to alternative sources of information that state

government-provided facts are not correct.

Emotions. Emotions can play a role in both the

spread and acceptance of misinformation. For example,

false information tends to spread faster than true

information, possibly because of the emotions it elicits.

And Chou and colleagues note that during a crisis

when emotions are high, people feel more secure and

in control when they have information—even when

that information is incorrect.

Cognitive bias. This refers to the tendency to

seek out evidence that supports a person’s own point

of view while ignoring evidence that does not. If the

misinformation supports their view, they might accept

it even when it’s incorrect.

How to combat misinformation

Recommending resources, teaching consumers how

to evaluate resources, and communicating effectively

can help reduce the negative effects of misinformation.

Recommendations. In many cases, patients and

families feel they have a trusting relationship with

their healthcare providers. Nurses can leverage that

trust by recommending credible sources of health

information. Villarruel and James note that before

making a recommendation, nurses should consider the

appropriateness of the source. For example, a source

may be credible, but the vocabulary used may be at

too high a level for the patient to understand. And

someone who prefers visual learning will not appreciate

a website that is dense with text. Kington and

colleagues suggest using these foundational principles

when evaluating sources:

• Science-based: The source provides information

consistent with the best scientific evidence

available and meets standards for creation,

review, and presentation of scientific content.

• Objective: The source takes steps to reduce the

influence of financial and other forms of conflict

of interest or bias that could compromise or

be perceived to compromise the quality of the

information provided.

• Transparent and accountable: The source discloses

limitations of the provided information, conflicts

of interest, content errors, or procedural missteps.

• Each principle has specific attributes, which

are listed in the article available for download

at https://www.ncbi.nlm.nih.gov/pmc/articles/

PMC8486420/.

Another tool for evaluating sources of health

information is the CRAAP test (Currency, Relevance,

Authority, Accuracy, and Purpose), which focuses

on evaluating the accuracy of research. It consists

of multiple questions in each category (see https://

researchguides.ben.edu/source-evaluation). For a

more concise tool, nurses can turn to the algorithm,

developed by Kington and colleagues, for assessing the

credibility of online health information.

Although the tendency is to recommend

government sources such as the Centers for Disease

Control and Prevention and National Institutes of

Health, as noted earlier, some people do not trust the

government. In this case, sources such as MedlinePlus,

World Health Organization, and condition-specific

nonprofit organizations (e.g., the American Heart

Association, American Cancer Society, Alzheimer’s

Association) might be preferred.

Education. The sheer scope of the information

found online can make it difficult for even the most

astute consumer to determine what is accurate.

Nurses can help patients by providing tools they

can use to evaluate what they read. The website

Stronger suggests a four-step process for checking for

misinformation (https://stronger.org/resources/how-tospot-misinformation).

• Check the source. Is the website or person known

for conflating facts and opinions?

• Check the date. Is it implied that the information

is recent even though it’s not? Is there more

current information available elsewhere?

• Check the data and motive. What is the original

source of the information? Are they just looking

for anything that supports their own worldview?

• If still unsure, use a reputable, fact-checking site

such as Snopes.com or FactCheck.org.

UCSF Health (https://www.ucsfhealth.org/education/

evaluating-health-information) provides a useful short

overview for patients on how to evaluate the credibility

(e.g., authors’ credentials) and accuracy (e.g., whether

other sources support the information) of health

information and red flags to watch for (e.g., outdated

information, no evidence cites, poor grammar).

Communication. Communication is the best way

to correct misinformation and stop its spread. This

starts with the nurse clearly explaining the evidence

for recommended interventions. From the start, the

nurse should establish the principle of shared decisionmaking,

which encourages open discussion.

A toolkit from the U.S. Surgeon General on

misinformation (https://www.hhs.gov/sites/default/files/

health-misinformation-toolkit-english.pdf) recommends

that nurses take time to understand each person’s

knowledge, beliefs, and values and to listen with

empathy. It’s best to take a proactive approach and

create an environment that encourages patients and

families to share their thoughts and concerns (see “A

A proactive approach

Villarruel and James provide the following

suggestions for talking with patients about

misinformation:

• Acknowledge the barrage of health

information that is available online and

through other sources and the difficulty

of “knowing who and what to trust.” (“I

know there’s a great deal of information

about COVID-19 and not all of it is the

same. Sometimes, it’s hard to sort it out

and know what to trust.”)

• Assess where patients and families obtain

their health information and what sources

they trust. Keep in mind that even when a

source is credible, a person may not trust

it, and a person may trust a site that is not

credible. (“Where do you get most of your

information about COVID-19? What makes

that a trusted source for you?”)

• Provide alternative and accurate sources

of information. (“I’m not familiar with

that website, but I’ll look at it and let you

know what I think. In the meantime, here’s

where I get information and why I trust

it.”)

• When correcting misinformation be

nonjudgmental. (“I’ve heard similar

information about not getting vaccinated.

Here’s what I’ve learned from the science

and why I believe getting vaccinated is

important and safe.”)

Source: Villarruel AM, James R. Preventing

the spread of misinformation. Am

Nurs J. 2022;17(2):22-26. https://www.

myamericannurse.com/preventing-the-spreadof-misinformation/

proactive approach”). Nurses should remain calm,

unemotional, and nonjudgmental.

Nurses also can prepare for conversations where

they know misinformation may occur such as

vaccination. For example, the CDC has a page on its

website that addresses infant vaccination (https://www.

cdc.gov/vaccines/hcp/conversations/conv-materials.

html). It includes resources such as responses to

possible questions.

Listening and providing information may not be

enough. In some cases, a patient may not want to

hear what the nurse is saying. When patients become

angry or frustrated, the nurse should remain calm. It

can be helpful to acknowledge the frustration (“I can

see that you are upset.”) Depending on the situation, it

may be possible to briefly summarize key points before

reinforcing the desire to provide information to support

the patient and then move on to another topic. The

goal is to maintain a positive nurse-patient relationship,

which leaves the door open to further conversation.

Documentation

As with any patient education, it’s important to

document discussions related to misinformation in

the patient’s health record. Nurses should objectively

record what occurred and include any education

material they provided. Should the patient experience

harm as a result of following misinformation instead of

the recommended treatment plan, this documentation

would demonstrate the nurse’s efforts and could help

avoid legal action.

A positive connection

Nurses can serve as a counterbalance to the

misinformation that is widely available online. Providing

useful resources, educating consumers, and engaging

in open dialogue will promote the ability of patients

to receive accurate information so they can make

informed decisions about their care.

By Georgia Reiner, MS, CPHRM, Risk Analyst, Nurses

Service Organization (NSO)


July, August, September 2022 The New Mexico Nurse • Page 15

References

CDC. How to address COVID-19 vaccine misinformation.

2021. https://www.cdc.gov/vaccines/covid-19/healthdepartments/addressing-vaccine-misinformation.html

CDC. Talking with parents about vaccines for infants.

2021. https://www.cdc.gov/vaccines/hcp/conversations/

conv-materials.html

CDC. The U.S. public health service syphilis study at

Tuskegee. 2021. https://www.cdc.gov/tuskegee/index.

html

Chou W-YS, Gaysynsky A, Vanderpool RC. The COVID-19

misinfodemic: Moving beyond fact-checking. Health

Educ Behav. 2020;1090198120980675:1-5.

Kington RS, Arnesen S, Chou W-YS, Curry SJ, Lazer D, and

Villarruel AM. Identifying credible sources of health

information in social media: Principles and attributes.

NAM Perspect. 2021:10.31478/202107a. https://www.

ncbi.nlm.nih.gov/pmc/articles/PMC8486420/

Kurpiel S. Evaluating Sources: The CRAAP Test.

Benedictine University. 2022. https://researchguides.

ben.edu/source-evaluation

Office of the Surgeon General. A Community Toolkit for

Addressing Health Misinformation. US Department of

Health and Human Services. 2021. https://www.hhs.

gov/sites/default/files/health-misinformation-toolkitenglish.pdf

Stronger. How to spot misinformation. n.d. https://

stronger.org/resources/how-to-spot-misinformation

Schulz PJ, Nakamoto K. The perils of misinformation:

When health literacy goes awry. Nat Rev Nephrol.

2022. https://www.nature.com/articles/s41581-021-

00534-z

Swire-Thompson B, Lazer D. Public health and online

misinformation: Challenges and recommendations.

Annu Rev Public Health. 2020;41:433-451.

UCSF Health. Evaluating health information. n.d. https://

www.ucsfhealth.org/education/evaluating-healthinformation

Villarruel AM, James R. Preventing the spread of

misinformation. Am Nurs J. 2022;17(2):22-26. https://

www.myamericannurse.com/preventing-the-spread-ofmisinformation/

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. Please note

that Internet hyperlinks cited herein are active as of the

date of publication but may be subject to change or

discontinuation.

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.

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