June 2022 • Volume 31 • Number 3
2 Executive Director’s Message
3 What is Non-compliance?
3 Reflections on Year of Nurse
5 Resources for your Patient with
8 District 1: News & Updates
8 Precepting Nurse Practitioner
9 Gala Speciality Organizations
Across the State - PNANV
11 Courage in Everyday Nursing
12 Nevada Nursing Student
13 The Nurses Honor Guard
17 Getting Clear on Bullying Versus
18 Rest, Relax, Laugh: Spending Time
4 Research & EBP Corner
6 NNA Environmental Health
10 Antimicrobial Stewardship –
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 1,000 RNs and LPNs and
delivered electronically via email to 40,000 RNs and LPNs in Nevada
The President’s Message
Mary D. Bondmass,
Ph.D., RN, CNE
Sometimes a message
can be delivered best in a
brief story with memorable
quotes; that is my intent for
this edition’s communication.
This story is not directly about
Lawrence Peter Berra (1925 -
2015) but some of his famous
quotes. You may have heard of Lawrence Berra by his
best-known nickname of ‘Yogi.’ He was a cultural icon
in New York baseball and well known for his many
witticisms, known as Yogi-isms. Baseball fan or not,
Yogi was and still is, known and loved for his Yogiisms.
I want to share two of my favorite Yogi-isms and
apply them to an issue relative to nursing in Nevada:
the nursing licensure compact (NLC). I’ll start with my
second favorite quote and leave the first to the end of
My second favorite Yogi quote is ‘It’s Deja Vu All
Over Again,’ and yes, colleagues, it may be déjà vu all
over again for the NLC if we do not act and act now.
With the 2023 Legislative session fast approaching, it’s
not too early to talk about the NLC! We need to let
voting Nevadans know that the NLC is good for Nevada
nurses and Nevada consumers of healthcare. So don’t
let it be ‘deja vu all over again’ for the NLC in Nevada.
According to the National State Boards of Nursing,
the NLC is a modern licensure solution for the 21st
century for those who may not know. Leaders in public
protection, i.e., the State Boards of Nursing, developed
and adopted the Nurse Licensure Compact in 2015 as
a general public protection measure. The NLC allows
for nurses to have one multistate license with the
ability to practice in all compact states. Currently, the
NLC is enacted in 39 U.S. jurisdictions (see graphic), but
Nevada is not one of those jurisdictions (NSBON, 2022).
The Nevada Nurses Association, the Nevada State
Board of Nursing, and the Nevada Hospital Association
are proponents of the NLC. Moreover, past surveys in
Nevada have demonstrated that most rank-and-file
nurses also favor the NLC. So what’s the problem?
Perhaps our legislators do not know that nurses vote
too, and most of us prefer the NLC. Maybe we need to
let them know.
At the last formal legislative session in Carson City
from February to June 2021, the NLC did not even
make it to the ‘bill-draft’ stage of the legislative process
because there was no legislator who would sponsor
the bill. So is it déjà vu all over again, or can we make
it different at the 2023 legislative session? I say the
latter; if we stick together and make our collective
voice heard, we may be able to make strides with the
passage of the NLC.
President’s Message continued on page 3
14 Nevada Nurses Foundation
18 Healthy Nurses
current resident or
Mark Your Calendars
• October 8th, 2022 – 7th Annual Shining Stars
of Nursing Awards Gala Nugget Hotel Casino & Spa – Sparks, NV
• November 5th, 2022 – NNA Annual Membership Meeting
(newly elected officers will be installed)
2 6 5 $
L S - P A L S - A C L S
Page 2 • Nevada RNformation June, July, August 2022
NNA Mission Statement
The Nevada Nurses Association promotes professional nursing practice through
continuing education, community service, nursing leadership, and legislative
activities to advocate for improved health and high quality health care for citizens of
NNA State Board of Directors
Mary D. Bondmass, PhD, RN, CNE Mary.firstname.lastname@example.org ..............President
Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC email@example.com .......Vice President
Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE firstname.lastname@example.org .........Treasurer
Veloma Wolfe, RN .............................................. Secretary
Arvin Operario, MBA, BSN, RN ..............................Director at Large
Michelle L. Bookout, RN, BSN, MSN, DNP .....................Director at Large
Norman Wright, RN, BSN, MS email@example.com ...................Director at Large
Bernadette Longo, PhD, RN, FAAN .........................President, District 1
Margaret Covelli, DPN, RN Margaret.firstname.lastname@example.org ..........President, District 3
Starla Gallagher, email@example.com .............Executive Director
Executive Director’s Message
Nevada Nurses Association is excited to announce that it is time for our Annual
Call to Serve. Every year we ask NNA members to make nominations for the
Nevada Nurses Association State and District Boards for any and all open positions.
To nominate someone or yourself, you must be a current NNA member, and the
individual being nominated must be as well. (Some positions require that you are a
member of ANA and NNA.) This year will bring a great deal of change for our NNA
State Board, and we would like to invite you to participate in choosing the future
leadership of NNA.
Please place your nominations via our NNA website at nvnurses.org, simply
log into your member profile and complete the appropriate form. If you are not
currently a member but you would like to become a member and participate, you
can do that by visiting our membership information page at nvnurses.org/Members/.
Thank you for considering the NNA Call to Serve.
Managing Editor, Linda Bowman, RN, RNFormation@nvnurses.org
Mary D. Bondmass, PhD, RN, CNE
Tracey Long PhD, APRN-BC
Bernadette Longo, PhD, RN, FAAN
Lisa Pacheco, MSN, RN
Vicki Walker DNP, BS RN
Are you interested in submitting an article for publication in RNFormation?
Please send it in a Word document to us at RNFormation@nvnurses.org. Our
Editorial Board will review the article and notify you whether it has been
accepted for publication.
If you wish to contact the author of an article published in RNFormation,
please email us and we will be happy to forward your comments.
The following positions are open for candidates for the 2022 Election:
State Level: seeking candidates for the positions of:
o President (2-yr term)
o Vice President (2-yr term)
o Treasurer (2-yr term)
o Director At Large (two positions, all 2-yr terms)
Northern Nevada & Rurals - District 1: seeking candidates for the
o President-Elect (1-year term and then becomes President)
o Treasurer (2-yr term)
o Secretary (2-yr term)
o Directors (three positions, all 2-yr terms)
Southern Nevada - District 3: seeking candidates for the positions of:
o Treasurer (2-yr term)
o Secretary (2-yr term)
ANA Membership Assembly in Washington DC: seeking candidates for one
Representative & two alternates (1-yr terms). This position only serves in the summer
for the Assembly; expenses are covered. (You must be a member of ANA and NNA.)
Nominations Committee: three members (1-yr terms) - You must be a member
of ANA and NNA.
Please consider joining the NNA leadership team – you can make a difference.
Arthur L. Davis
Publishing Agency, Inc.
can point you right to that perfect
Free to Nurses
Easy to Use
E-mailed Job Leads
June, July, August 2022 Nevada RNformation • Page 3
Robert J. Vadovic, RN, DNP,
If you are an APRN, when
was the last time you received a
report on a patient that started
with 'this is a non-compliant
patient'? The chances are that
this is a daily occurrence, if not
several times a week! But what
is non-compliance? Have you
ever considered what it means to call someone noncompliant?
According to the dictionary, non-compliance is the
failure to act in accordance with a wish or command.
In healthcare, non-compliance is so common that it
carries its own NANDA nursing diagnosis; although
NANDA removed the 'non' and now only uses the
word compliance, the meaning is the same i.e., the
patient's failure to act in accordance with a wish or
command. Yet is a patient ever really non-compliant?
As nurses and healthcare providers, our goal is
to improve health and wellness. We do this based
on our knowledge from research, experience, and
standards of care. When we develop a treatment
plan, we are always taught to be patient-centered and
individualized, but do we ever ask the patient what
Consider this scenario. You are treating a 75-yearold
female who just had a stroke. You know the patient
should be on a statin, an aspirin, and likely medications
to control blood pressure or other chronic diseases.
This regimen is a time-honored treatment plan, backed
by study after study and known as the best course of
action. You go through the plan with the patient, and
despite everything you tell them about the science and
the necessity for the drug, the patient refuses to take
Two weeks after discharge, the patient is seen in the
office by their primary care provider, and a medication
reconciliation indicates that the patient is not taking the
statin. You inquire why the patient is not taking it, and
they state that they heard bad things about statins and
do not want to take it; no matter how much you say,
you can't get them to change their mind. Is this patient
non-compliant? How many of us would call this patient
Remember the earlier definition of noncompliance,
failure to act in accordance with a wish or command.
When we developed the treatment plan for our
hypothetical patient, was there a discussion to see
what the patient wanted? As providers in this case, we
failed the patient by not considering what they wanted.
As a result, we failed to make the plan individualized
to the patient, based on the needs and wants of the
Prescribing the statin is the right thing to do;
encouraging the patient to take it and explaining why
they need it are also the right things to do. However,
is it the patient who is non-compliant because they
are not taking the drug, or have we failed to develop a
treatment plan that works for both the patient and us?
As healthcare providers, perhaps we should give the
patient the information we have, explain the risks and
benefits of treatments or the lack of treatment, and
then develop a treatment plan that works for both the
patient and us.
Moving forward in our practice, perhaps we should
not think of non-compliance as a patient’s failing but
rather as an opportunity for us to discuss our patient’s
wants and needs when we prescribe their medications.
Be the advocate that nurses are supposed to be and
support a patient's right to choose. Understand that
we may be the experts in nursing and medicine, but
we are not the experts in the lives and choices of our
Reflections on Year of Nurse Educator
Rochelle Walsh, DNP, RN,
I talked to someone I
consider a friend recently, but
before she was a friend, she
was a mentor (informal) at
first, and then later formal –
as she became my chair and
shepherded me through my
thesis. She reminded me that it
was the year of the nurse educator and asked if I had
any reflections. I had received an email from someone,
but I hadn't reflected on what Nursing Education is
to me. One of Dr. Longo's statements, "teachers give
back to others," became the topic of my reflection for
Education is a big part of what nurses do. We teach
patients about their disease and teach them skills
like how to bathe their first baby and deal with the
complications of the disease. To be a nurse educator is
an extension of that role. Instead of teaching patients,
we now teach students how to become nurses, work
in hospitals to onboard nurses, and introduce new
procedures, policies, and technologies in the agency
setting to nurses who range from novice to expert. We
are not just giving them new knowledge but trying to
integrate it with current practice.
A lot of the role is instinctual and guided by our
initial nursing education, but to be that person who
can help nursing students change roles, to manage the
bridge from student to nurse, or help a knowledgeable
nurse obtain and keep their competency on lifesaving
technologies is guided by more than instinct. It takes
knowledge about how people learn, how to build
effective programs for various learners, someone
who can evaluate the program for success and
opportunities, and then reflect on the process. Nurse
educators don't limit their knowledge to nursing but
are also education experts.
President’s Message continued from page 1
Nurses have done so much for health and healthcare
in Nevada, especially in the last few pandemic-laden
years; indeed, many think of us as heroes. It’s now
time for Nevada to do something for nurses and pass
the NLC. While we didn’t get our desired outcome in
2021, I remain a steadfast fan of Yogi-isms with my
first favorite quote from Lawrence Peter Berra: “It Ain’t
Over, Till It’s Over.” Thanks, Yogi!
Mary D. Bondmass, Ph.D. RN, CNE
President, Nevada Nurses Association
NSBON, 2022. NLC: About, Stay Informed, Take Action.
Be informed about the NLC; read more and decide
for yourself at https://www.ncsbn.org/nurse-licensurecompact.htm.
We are hiring Registered Nurses!
Healthcare facilities bordering the Navajo Nation
Gallup Indian Medical Center (Gallup, NM)
Tohatchi Health Care Center (Tohatchi, NM)
Med/Surg, OB/L&D, ICU, Ambulatory Care, ER, Peds,
Periop & other specialty positions available.
Loan Repayment Site Eligible
Kudos to those in the trenches, working
with nursing students and our nursing force in
the community as they engage with the public,
interprofessional peers, and each other encouraging
them to look and respond to those teachable
moments. I will amend Dr. Longo's statement to
"Nurse educators give back to others."
Navajo Area Indian Health Service
Gallup Service Unit
Deanna Mataya – Nurse Recruiter
505.409.9926 | firstname.lastname@example.org
I.H.S. is required by law to give absolute preference to qualified Indian applicants. Equal Opportunity Employer.
Page 4 • Nevada RNformation June, July, August 2022
Research & EBP Corner
Evaluation of an Advance Care Planning Workshop to
Improve the Self-Efficacy of Health Care Providers
Mary Bondmass, Ph.D., RN, CNE
This RNF feature presents abstracts of research and
evidence-based practice (EBP) projects completed or
spear-headed by nurses or student nurses in Nevada.
The focus is on new evidence (i.e., research) or on the
translation of evidence (i.e., EBP) in Practice, Education,
or Research. Submissions are welcome and will be
reviewed by the RNF editorial board for publication;
send your abstract submission in a similar format used
below to email@example.com
Joy Patrick, DNP, APRN,
CCNS-AG, CCRN, graduated
with honors from UNLV in
May of 2022 with a Doctor of
Nursing Practice (DNP) degree.
She is currently a lecturer at
Nevada State College’s School
of Nursing. As a Clinical Nurse
Specialist, Joy has experience in
“system level change” projects
such as staffing models,
palliative care programs, and
improving healthy work environments. Dr. Patrick’s
research interests are critical care, nursing education,
APRN practice, and palliative medicine. Her most
recent scholarly work, presented as a poster at the
2022 Western Institute of Nursing (WIN) conference,
was related to improving the self-efficacy of health
care providers in facilitating advance care planning.
Joy also conducted several change projects such as
reducing barriers such as fear in nurses providing pain
management at the end of life. The project, “Pain
Management at the End of Life,” utilized Bandura’s
Self-Efficacy theory to improve nurses’ clinical practice
caring for palliative care patients within an oncology
unit. In addition, she has collaborated on several
research and project initiatives and has experience
disseminating findings at national conferences.
Additionally, Joy has experience in academia, nursing
administration, and staff development.
Evaluation of an Advance Care Planning Workshop to
Improve the Self-Efficacy of Health Care Providers
Background: Advance care planning (ACP) consists
of a discussion between an individual, their care
providers, and those close to them about future care.
Continually the barriers to advance care planning
are multifocal such as provider apprehension, lack
of time, and fear. Available evidence demonstrates
a broad range strategies to improve provider selfefficacy.
Interventions such as the use of role-playing,
simulation, trained persons, and even the use of
mnemonics have shown feasibility to utilize for my
phenomenon of interest.
Purpose: The purpose of this Doctor of Nursing
Practice (DNP) was to develop, implement, and evaluate
an online module related to improving healthcare
providers' knowledge and self-efficacy in ACP.
Methods: The project included a pre-and postsurvey
utilizing the Advance Care Planning Engagement
Survey (ACP-SE) and an asynchronous online education
introducing the PERSON mnemonic to aid in ACP
conversations. Inclusion criteria included being one
of the following: RN, APRN, Physician, PA, medical
students, or nursing student. A total of 83 participants
(N = 83) out of 114 respondents completed all surveys
and online education and were included in the project’s
Results: The overall results demonstrated positive
gains in perceived self-efficacy, knowledge gain, and
positive evaluations of the online education training.
The ACP-SE pre-training M=49.7 as compared to posttraining,
M=60.5 (p=0.001). The pre-intervention
knowledge scores were M=50.8 as compared to postintervention,
M=57.2 (p=0.035). The participant’s postevaluation
of the training was positive, 70% rated the
training favorably (agree/strongly agree).
Implications: The implications of this DNP project
showed there remains a need to educate and build
health care workers' self-efficacy as it relates to
advance care planning and goals of care discussions.
Addressing the barriers such as fear in facilitating ACP
and GOCD, supports patient-centered care through
improving communication between the healthcare
provider and their patients.
Keywords: advance care planning, providers, goals
of care, education, survey, end-of-life
June, July, August 2022 Nevada RNformation • Page 5
By Bernadette M. Longo,
PhD, RN, CNL, PHNA, FAAN
An estimated 9.4% of adults in Nevada report
current asthma (CDC, 2019 prevalence data). Nationally,
8.4% of children receive the diagnosis (Dharmage
et al., 2019). Today in Nevada, climate change is
impacting asthma maintenance with environmental
triggers that can prompt an acute exacerbation. Hotter
temperatures are leading to the formation of more
ground-level ozone and extending pollen seasons.
Intense rainfall events are causing flooding that can
prompt mold growth in homes. Drought conditions in
the West are contributing to a longer wildfire season
that produces toxic smoke and more days of poor air
quality. Therefore, the challenge is upon us as nurses to
best care for our patients with asthma.
Nurses across Nevada can provide some new
resources to their patients. By engaging in shared
decision making and personalized care, nurses can
support each patient’s asthma journey towards
improved health outcomes and quality of life.
National Heart Lung and Blood Institute -
Resources for your Patient with Asthma
Check out the updated “Digital Toolkit” for
- Tools and Resources for Professionals
NEW: 2020 Focused Updates to the Asthma
Use these resources to help guide treatment
decisions for your patients:
• Clinician's Guide
• At-a-glance Guide
• Professional Education Opportunities
• Clinical Decision Support Resources
- Fact Sheets
Use these to help your patients understand different
treatment options and asthma management:
• Asthma Management Guidelines and Your Care
• The Changing Role of Inhaled Corticosteroids in
• Long-Acting Muscarinic Antagonists (LAMAs)
• Reducing Allergens in Your Home
- Asthma Action Plan
Use this updated worksheet with your patient to
personalize their plan to monitor their asthma and treat
changing symptoms or attacks:
• 2020 Asthma Action Plan
- Traditional and Social Media Resources
• Sample posts and graphics
- Learn More Breathe Better® Program
• Asthma Motion Graphics/GIFs
• Asthma Videos for patient education
The National Institute of Environmental Health
Sciences – Research
NIEHS conducts and supports asthma research from
basic laboratory studies to human clinical trials. This
research focuses on the complex relationships among
the environment and people’s genetics and immune
system. Projects include:
• Development of sensors that measure personal
environmental triggers of asthma.
• Clinical trials that examine if reduced indoor air
pollution can improve asthma symptoms.
• Data science methods that combine
environmental data gathered across the United
NIEHS-funded Study Examples:
- The Natural History of Asthma with Longitudinal
Environmental Sampling (NHALES) study is
helping to understand how bacteria and other
factors in the environment affect people who
have moderate to severe asthma.
- Asthma triggers in schools – A study of innercity
students linked airborne mouse allergens
in schools to increased asthma symptoms and
decreased lung function in children. The study
suggests schools can take steps to improve air
quality and help children who have asthma.
- Indoor air pollution makes asthma worse
– Obese inner-city children living in homes
with high levels of indoor air pollution may
have worse asthma symptoms if they are also
deficient in vitamin D.
- Outside triggers of asthma – Babies who
breathe high levels of traffic-related air pollution
were more likely to have persistent wheezing
during childhood, and children exposed to high
levels of traffic-related air pollution through age
7 were more likely to develop asthma.
- The genetics of asthma – Asthma patients
with a specific genetic makeup who live close
to a highway are more likely to have intense
The Allergy Asthma Network
As an innovator in encouraging family participation
in treatment plans, the A & A Network (founded
in 1985) specializes in making accurate medical
information relevant and understandable to all while
promoting evidence-based standards of care.
Resources for healthcare professionals:
- Educational webinars for professionals and
- Digital educational content on asthma, allergy,
atopic dermatitis and related conditions
• Atopic Dermatitis
• Related conditions
- Downloadable digital and print patient
- Shared Decision-Making resources
- Resources for healthcare professionals and for
your office, including our popular posters
- Annual Asthma Summit for healthcare
- Annual Allergy and Asthma Day on Capitol Hill
Living Well with Asthma Virtual Event Series
for Patients – started in 2021
• A whole-body approach to managing asthma
and lung health
• Stress Relief and Meditation for Better Breathing
• The Best Yoga Poses for Better Breathing
Centers for Disease Control and Prevention (2019). Most
Recent Asthma State or Territory Data. https://www.
Dharmage, S. C., Perret, J. L., & Custovic, A. (2019).
Epidemiology of asthma in children and adults.
Frontiers in Pediatrics, 7, 246.
Page 6 • Nevada RNformation June, July, August 2022
NNA Environmental Health Committee
Wildfire Smoke: Resources for Nurses and their Patients
The “smoke season” is lengthening as forest fires across the Western United
States are more frequent, last longer and have higher intensities. Wildfire smoke
is produced by the combustion of vegetation, or biomass. It is composed of
multiple pollutants that include CO2, CO, water vapor, particulate matter (PM),
hydrocarbons, together with thousands of other organic chemical compounds such
as acrolein, benzenes and aldehydes. If buildings or homes are consumed by the fire,
more toxic pollutants are added to the smoke.
The link between fine PM air pollution and cardiorespiratory effects in
populations has become clearer. Research has found associations between wildfire
smoke events and clinical presentations for dyspnea, cough, wheezing, SOB, chest
pain and eye irritation. Hospital admissions correlate with PM levels for respiratory
diseases (asthma with acute exacerbation, acute bronchitis, COPD exacerbation,
pneumonia, upper respiratory infections), as well as cardiovascular diseases (ischemic
heart disease, cardiac dysrhythmias, congestive heart failure, cerebrovascular
disease, and stroke).
Everyone is affected at some level, but some of our patients are at higher risk to
adverse health effects from exposure to the smoke. These patients may be children,
pregnant women, outdoor workers, elderly, or have obesity, a cardiorespiratory
disease, or have low socio-economic status without resources to reduce smoke
exposure in their residence and seek health care. Therefore, as nurses we need to
reach out and provide education and free tools for all our patients. These actions
can help reduce disparities and the inequities experienced from environmental
A New Dashboard of Resources
Nevada Nurses Association has created a user-friendly Wildfire Smoke
Information Dashboard that is available on NNA’s website. This dashboard
provides links to resources and tools for you and your patients. For example, there
are alert notifications that you and your patient can sign up for that send texts or
emails when air quality is poor in the area. Also, there are links to free continuing
education courses for nurses and APRNs offered by the EPA and the Centers for
Disease Control and Prevention.
We are proud to help recognize
and support the accomplishments
of Nevada’s shining stars – nurses.
Your strength, compassion,
courage and composure
are woven into the fabric of
your organizations and your
Join Our Team!
Looking for a change of pace?
Carson Valley Medical Center is undergoing
a multi-million dollar expansion. We’re
recruiting for a variety of positions including
management level, clinical, ancillary and
support staff. In addition to competitive pay
and benefits, we offer a Clinical Ladder
Program and scholarship opportunities through
our designation as a HRSA/Nurse Corps site
Visit our Career Page to view our generous sign-on/
retention bonus listing and apply today!
Figure 1. NNA’s new Wildfire Smoke Information Dashboard
What interventions should I offer my Patients?
1. Guidance on Knowing the Air Quality: Knowledge of air quality will help
your patients make the best decisions for their health.
Have your patients
a. Use the Air Quality Index (AQI) developed by the EPA. The AQI is a tool
that uses color-coded categories about real-time air quality in the area,
advising which groups of people may be affected, and steps to take to
reduce exposure to air pollution. There are also “AQI forecasts” that can
help a patient plan ahead for the day.
b. Make AirNow for their residence as a “favorite” on their computer and
get the AirNow App on their iPhone or Android (Fig. 2).
c. Sign up for AQI text alerts: go to EnviroFlash (it’s easy to set this up for
one or more locations like home and work)
d. Personal Exposure Monitoring: There are new small, low-cost, highly
portable air quality sensors that patients can wear while doing their
normal activities. This may be appropriate for patients with means who
live in highly polluted urban areas – not just for wildfire smoke events.
Most measure PM and ozone levels. (Information in EPA’s Air Sensor
2. Use the AirNow’s Fire and Smoke Map: The Map available on the web
shows levels of fine particle pollution (PM2.5) from permanent monitors
(EPA), temporary monitors deployed for smoke events, and low-cost sensors
made by PurpleAir. The map shows air monitors in colors that reflect the
air quality (e.g., green is good), along with large fire incidents as fire icons,
satellite fire detections as small glowing points, and smoke plume locations as
3. Behavioral Actions: There are handouts/fact sheets that you can give to
your patients on actions while indoors and outdoors. Advise your patients
on behavioral actions based on their individual health status. For example, a
patient with asthma in Nevada should have wildfire smoke events as part of
their Asthma Action Plan.
Interventions may include:
• Taking it easy during smoky times to reduce their smoke exposure. If
it looks or smells smoky outside, they should limit time outdoors and
certainly avoid strenuous activities such as mowing the lawn or going for
a run or bike ride.
• Wearing NIOSH N95 or P100 respirators when going outdoors.
Demonstrate how to use these masks properly. Offer a supply if possible.
Do not rely on dust masks, surgical masks, or bandanas.
• Reducing smoke in your vehicle by closing the windows and vents and
running the air conditioner in recirculate mode. Slow down when you
drive in smoky conditions.
• Staying inside with the doors and windows closed. Whether your
patient has a central air conditioning system or a room unit, they should
use high efficiency filters to capture
• Seeking shelter elsewhere if they
do not have an air conditioner and
it is too warm to stay inside with the
• Not adding to indoor air pollution.
They should not burn candles or use
gas, propane, wood-burning stoves,
fireplaces, or aerosol sprays. Do not
fry or broil meat, smoke tobacco
products, or vacuum.
• Using a portable air cleaner to
reduce indoor air pollution. Make sure
it is sized for the room and that it does
not make ozone, which is a harmful
air pollutant. Portable air cleaners can
be used along with central air systems
to maximize the reduction of indoor
• Creating a “clean room” in their
home. Choose a room with no
fireplace and as few windows and
doors as possible, such as a bedroom.
Use a portable air cleaner in the room.
Figure 2. AirNow App on
June, July, August 2022 Nevada RNformation • Page 7
NNA Environmental Health Committee
• Refreshing the air in the home. Long-term smoke events usually
have periods when the air is better. When air quality improves, even
temporarily, air out the home to reduce indoor air pollution
• Having enough food and medication on hand to last several days
so you don’t have to go out for supplies. If you must go out, avoid the
smokiest times of day. Check the AQI and the Fire and Smoke Map!
• Having a family plan in case of evacuation. Patients should know
how to get alerts and health warnings, public service announcements
(PSAs). Public advisories can provide important information such as
changing smoke conditions and evacuation notices. They should know
the evacuation routes, organize important items ahead of time, and know
where to go in case they must evacuate.
• Keeping pets safe. Resources from the CDC are available for small pets
4. Monitoring their Health Status: Encourage your patients to check their
health status and seek medical care as needed. They may take their blood
pressure more often. Remind them to carry any rescue medications (check
that they have a working inhaler – have them show it to you). Emphasize
the importance of taking their heart and BP medicines as prescribed. Keep
communication open with your outpatient clinic’s team (RNs, doctor, or nurse
Examples of Resources on the Dashboard
• Fact Sheets: (CDC https://www.cdc.gov/disasters/wildfires/pdf/wildfiresfacts.
pdf and AirNow https://www.airnow.gov/wildfire-guide-factsheets/ )
• Web Cams: sites across Nevada and Northern
• Videos: How to Make Your Home and
Property Fire-Safe https://www.youtube.com/
• Websites: Living with Fire (University of Nevada Reno,
• Evidence: current peer-reviewed research publications
Bernadette Longo, Ph.D., RN, PHNA-BC, CNL, FAAN
Chair, NNA’s Environmental Health Committee
Figure 3. An enormous blanket of smoke across Nevada from the Dixie fire
and many others on August 6, 2021. Credit: GOES-17 satellite, NASA.
Job Openings Available at:
850 Elm Street
Elko, NV 89801
Page 8 • Nevada RNformation June, July, August 2022
District 1: News & Updates
Year of the Nurse Educator - 2022
Nurse educators and their programs across District 1
have the primary responsibility for preparing nursing’s
future workforce. These educators are tasked with teaching
the translation of ever advancing scientific knowledge
into evidence-based practice. Some educators are faculty
in schools of nursing, some teach clinical or simulation,
and some are frontline educators to practicing clinicians
in facilities. As leaders, they role model and represent
excellence in the role. As scholars, they continue the
development of nursing as a unique discipline and applied science. As colleagues,
they inspire each other to be the best team for the students.
Behind every Great Nurse is a Great Nurse Educator!
District 1 wishes to recognize and say “thank you” to each of those dedicated
nurses who choose to be teachers! Below are listed the teaching teams from schools
of nursing in the north. We also honor the many clinical nurse educators in facilities
across our district.
- Great Basin College’s Nursing Program
Skyler Basanez, Julie Bracken, Dorothy Callander, Stacy Crouch, Brian
Dankowski, Madonna Doke, Amber Donnelli, Peggy Drussel, Jessica Dullum,
Diane Elmore, Melissa Gerber, Dawn Horton, Michelle Husbands, Gina
Johnson, Heidi Johnston, Jessica Lynch, Malia Keep, Tamara Mette, Rhonda
Miner, Suzanne Rowan, Staci Warnert
- Truckee Meadows Community College’s Maxine S. Jacobs Nursing Program
Jody Covert, Tamera Allred, Connie Croysdill, Heidi Julius, Jacqueline
McDonald, Rachel Wooley, Itzel Woolpert
- Unitek College’s Nursing Program
Victoria Squier, Paula Anderson, J’Amy Babb, Russell Esmenda, Aaron Fischer,
Dawn Johnson, Shana Kennon, Brian Lee, Elizabeth Melton, Cheryl Reed,
Vanessa Rojas, Freida Schoech, Lyndsy Walker, Michael Yazinka
- University of Nevada Reno’s Orvis School of Nursing
Debera Thomas, Alma Yanez, Amy Khan, Amy Millsaps, Anna Smith, Aubree
Carlson, Bernadette Longo, Brandi French, Cameron Duncan, Carina Funk,
Carrie Hintz, Cassandra Padgett, Catherine Gonzalez, Cheryl Reed, Christina
Alsop, David Morgan, Deborah Arnow, Deborah Shindell, Denise Stahlbusch,
Elaine Cudnik, Emily McClure, Erin Tuttle, Ezra Holston, Fnu Alfandy, George
Rodway, Glenn Hagerstrom, Haley McNeil, Jacqueline Ferdowsali, Jasen
Brooks, Jeanette Smith, Josh Hamilton, Julie Sawyer, Karen Meskimen, Kim
Baxter, Kimberly Buell, Kimberly Marcus, Kris Gregor, Kristin Combs, Lisa
Thomas, Lisa Woodall, Lorraine Bonaldi, Maureen Barnes, Megan Pratt,
Michael Marinaccio, Molly Kokenge, Patricia Ozuna, Preston Peterson, Robyn
Chiasson, Rochelle Walsh, Roger Green, Salli Vannucci, Sally Miller, Sandy
Olguin, Sarah Murray, Setare Taabodi, Shannon Burleson, Shannon Richard,
Stacy Demitropoulos, Stephanie Deboor, Suchawadee Yimmee, Susan Ervin,
Teresa Serratt, Theresa Watts, Tiffany Broce, Val Wedler, Vania Carter-Strauss,
- Carrington College’s Nursing Program
Susan Drossulis, Christine Ballew, Jay Brownson, Katie Callahan, Patricia
Crepps, Sara DuBois, Shile Eguen, Peg Farrar, Stacie Ferrante, Elisa Giglio-
Siudzinski, Sherry Hynes, Angel Jackson, Vicky Lang-Catlin, Melody
Leiva, Julie Madden, Renee Mattovich, Laura Oki, Lori Porter, Katie Powell,
Geraldene Ralleca-Llaguno “Nica”, Heidi Sabol, Nancy Smith, Karla Spesert,
Rosalyne Reynolds, Michelle Rudman, Amy Whalen, Alixandra White, Jayme
Yocom, Chelsea Zielinski
- Western Nevada College’s Nursing Program
Debi Ingraffia-Strong, Stefanie Bischoff, Liz Carrasco, Robert Ciminski,
Kathryn Cocking, Lisa Dunkelberg, Edda Gibson, Sarina Gould, Kim Griffin,
Erika Holliday, Gay Lutz, Natalie Matley-Keeney, Chassity Mills, Kimbirli
Macchiaverna, Heather Reardon, Kendall Valdez
Precepting Nurse Practitioner Students
Susan S. VanBeuge,
DNP, APRN, FNP-BC,
Precepting is a term well
known in nursing. It is defined
as a teacher or tutor (Merriam-
Webster, 2022). From our
through nurse practitioner
training, many professionals
served as preceptors to teach, guide, and mentor to
assist nurses in achieving their next level of education.
This role of the preceptor has many rewards.
Teaching others is a wonderful experience that
both fulfills and challenges simultaneously. As nurse
practitioners, this is part of our role in professional
development and obligation. Having been recipients
of those who shared their talent, time, expertise, and
patience with us as we trained obligates us to do the
same as we progress in our career along the way.
Some of the benefits of precepting students
are that we get a chance to help mold the next
generation of providers. This vital role of modeling
and teaching allows the passing of a baton to learners
on many levels. For example, as a preceptor, you can
demonstrate clinical knowledge, application of clinical
practice guidelines, evidence-based practice, and
practice management. These basics are second nature
to a seasoned provider and may seem daunting to a
newer nurse practitioner student just wondering how
they will develop a differential diagnosis!
In a study by Roberts et al. (2017), they reported
additional benefits or incentives to collaborate with
other faculty and preceptors. This collaboration builds
the network of different providers and professionals
whom a preceptor may work with in the future to
build up their scholarship. In addition, preceptors may
utilize the hours towards certification. In this study,
28% of respondents used this as a renewal method for
Taking on the role of the preceptor is an opportunity
to expand your practice and knowledge as an
educator. There are some considerations to starting the
experience with a student in preparation for the role.
First, it is crucial to establish the role and expectations
with the academic institution where the student is
enrolled. The expectations may require orientation and
training sessions, completing onboarding paperwork,
and evaluating the student. An evaluation may
include written forms, online or face-to-face meetings
with faculty members, and other means to measure
student progress. As a preceptor, it is essential to have
explicit knowledge of your role so no ambiguity exists
and reduces the burden in your role as the teacher
The National Organization of Nurse Practitioner
Faculties (NONPF) has created a faculty and preceptor
checklist tool to help bridge the gap between faculty
and preceptors. This checklist, developed by leaders
in nurse practitioner practice and education, provides
a basic list for faculty and preceptors. In addition, the
website titled "Preceptor Portal Main" is a valuable
resource, including the checklist, resources, preceptor
manual, and videos for training in various situations
As nurse practitioners and clinicians, it is essential
to our profession and role-development of students
to provide a strong foundation for practice. Modeling
practice standards, clinical skills, and management skills
will be part of the foundation to ensure the quality
of nurse practitioner education; if you are currently
precepting, bravo/brava! But, if you consider this vital
role in our professional development, go for it! The
rewards are rich, and the impact is significant in our
Merriam-Webster. (n.d.). Preceptor. In Merriam-Webster.
com dictionary. Retrieved May 17, 2022, from https://
Perryman, Ka’Shiris W. DNP, APRN, FNP-BC, CNE, LNC1
Nurse practitioner preceptor education to increase role
preparedness, Journal of the American Association of
Nurse Practitioners: May 2022 - Volume 34 - Issue 5 - p
763-768 doi: 10.1097/JXX.0000000000000702
Preceptor Portal Main (2022). Downloaded from The
National Organization of Nurse Practitioner Faculties
Roberts, Mary Ellen DNP, RN, ANP-C, FAANP, FNAP, FAAN;
(Assistant Professor)*,1; Wheeler, Kathy J. PhD, RN,
APRN, FNP-C, FNAP, FAANP; (Assistant Professor)2;
Tyler, Diane O. PhD, RN, FNP-C, FNP-BC, FAAN, FAANP,
CAE; (Director)3; Padden, Diane L. PhD, RN, CRNP,
FAANP; (Vice President)4 Precepting nurse practitioner
students, Journal of the American Association of Nurse
Practitioners: August 2017 - Volume 29 - Issue 8 - p
484-491 doi: 10.1002/2327-6924.12482
June, July, August 2022 Nevada RNformation • Page 9
Gala Speciality Organizations Across the State - PNANV
The Philippine Nurses Association of Nevada celebrated their 30th anniversary
and held a Fundraising and Gala event on May 7, 2022 from 6:00-11:00 pm at the
Orleans Hotel and Casino in Las Vegas. Hundreds were in attendance and a good
time was had by all. Letters of support and congratulations were sent from the
Governor, the Mayor, our Senator, and the Board of Nursing. You can read the
event’s souvenir journal at
30TH ANNIVERSARY GALA SOUVENIR JOURNAL | Pnanv
Watch more about the Gala on YouTube
TFC News Nevada, USA | PH nurses’ group in Nevada marks 30th anniversary
PNANV’s President (2021-2023), Elizabeth de Leon-Gamboa, MSN Ed., RN,
CPHQ, CCM, CMCN, notes that to augment the fundraising at the Gala, the Filipino-
American Nurses here in Nevada through the Philippine Nurses Association of
Nevada's are having a fundraising campaign. The campaign was held throughout
May, but you can contribute anytime throughout the year. Your contributions help
support and promote diversity, equality, and inclusion among nursing students and
nursing professionals to achieve positive outcomes for all the patients in Nevada,
especially bridging the gaps in health care for the AAPI community. Go to https://
www.giveinmay.org/story/Qlm65f or Home | Pnanv and help support this 501c3
professional non-profit AAPI organization's mission to foster excellence in areas
of nursing practice, leadership through education of its constituents, to promote
professional growth and to help address the growing health care needs of the
Entertainment and special dancing was part of the celebration
at the Pearls of Wisdom Gala
Page 10 • Nevada RNformation June, July, August 2022
Antimicrobial Stewardship – Infection Prevention
The Greatest Medical Experiment Ever Done – Part 4
Vaccinations, Disinformation, and Pandemic Fatigue
By Norman Wright, RN, BSN, MS -
It is the middle of May 2022, and the official United
States death toll from COVID-19 now totals over one
million. We are more than two years into the pandemic.
Anyone over 16 could have been vaccinated for more
than a year. Treatments like Ritonavir-Boosted Nirmatrelvir
(Paxlovid) appear effective, while others like Ivermectin and
Hydroxychloroquine are not so, yet some continue to tout
Most medical experiments use only one variable, but our Sars-Cov-2 experiment
is more complicated and involves numerous variables. The primary question remains:
Do Vaccines Prevent Infection, hospitalization, and Death?
The answer is - yes!
Doing simple subtraction, in Nevada, 14.5% received just one dose, compared
with 8.2% in Oregon, 7.8% in Utah, and 11.5% in Arizona. Nevada's hospitalization
and death statistics for those who were boosted are not readily available. - It is my
hope this changes soon.
Moving on from vaccine efficacy, another variable, Deaths Per Million population
(DPM), compares Nevada’s DPM, which was 3,514 on May 18, 2022, with Oregon’s,
which was 1,794. This means Nevada’s DPM almost doubles that of Oregon’s and
more than doubles Utah’s DPM of 1,485.
This table from the Arizona DHS shows that during the month of March 2022 -
a fully vaccinated person was 7.4% less likely to be hospitalized and 13 times less
likely to die than someone who is not fully vaccinated. The boosted results are more
dramatic. A boosted person is 13 times less likely to be hospitalized and 19 times
less likely to die.
Another bordering state, Oregon, gives the actual numbers displayed in this
chart, documenting that, since the vaccines became available, 3,979 people who
were not fully vaccinated died compared with just 195 who were fully vaccinated
and boosted. When you divide 3,979 by 195, an unvaccinated person in Oregon
was over 20 times more likely to die than someone who was fully vaccinated
The term “not fully vaccinated” is emphasized because someone who has
received only one dose of Moderna or Pfizer, the two mRNA vaccines, is classified as
being unvaccinated even though they may have received some immunity from the
initial shot. Just one more variable to explore in the future, and questions regarding
the effectiveness of the J&J vaccine are another.
This chart, accurate to May 15, 2022, establishes three cohorts. It documents 1)
the percentages of people who received only one dose, (2) the fully vaccinated, and
(3) the boosted.
Column 3 of this abridged Worldometer chart from May 18, 2022, lists states in
descending order of the total number of cases. Due to space limitations, active and
recovered cases, number of tests per million, etc., have been removed. Nevada is
35th, just behind Oregon’s number of cases, which totals 745,723.
Arizona is not shown in this chart because Arizona has over 2 million cases and is
number 13. Please note Arizona’s DPM was 4,157 - or 661 more than Nevada’s, and
Arizona had the second-highest number of DPM in the US, just behind Mississippi,
which was number one.
Why this dramatic disparity?
Differing vaccination and boosting rates are factors, and there are numerous
other variables impacting DPM:
Does one state have a younger population? What are the ethnic disparities?
Does the quality of health care differ? Did the majority of deaths occur early in the
pandemic when there were no vaccines or treatments? Are there geographical
considerations? What restrictive infection prevention interventions were followed,
e.g., social distancing, masking, school closures, lockdowns, etc.?
The list goes on, but an April 12, 2022 editorial in the Las Vegas Review Journal
headlined with: "Utah offers lessons on restrictive virus response" cherry-picks data
and uses only one variable, "restrictive virus response," as the reason. Yes, Utah’s
DPM was half of Nevada’s, but the editorial page of the Review-Journal skews
statistics, and the truth is politicized and distorted, causing confusion and death.
The facts are that when the DPM of Utah and Oregon, one a "red" and the other
a "blue" state, are compared, they both are in the bottom 10%, while Arizona, a
“red” state, had the second-highest DPM in the nation.
The Review-Journal editorial states, “The key takeaway is that more restrictive
government policies . . . did not result in noticeably better health outcomes and
often imposed devastating costs,” which in part may be true. But blurring statistics
by neglecting the impact of the other variables does a disservice.
China has a “zero COVID policy” that recently resulted in truly draconian
lockdown restrictions that go way beyond what is necessary to control the spread.
In my opinion, a balance must be achieved, and this will only occur when we
work together to find a common source of facts. Fake News and editorials with a
political agenda that skew statistics do not serve us well.
The Genie is out of the bottle.
Two years ago, I would never have imagined that we would still be fighting this
virus, but it keeps attacking and morphing. Two years ago, I thought Sars-Cov-2
would have gone the way of Zica and Ebola, but Sars-Cov-2 is different.
We have experienced Alpha, Delta, and recently various Omicron strains that
are evolving beyond BA-2. Strains BA-3, 4, and 5 are here, strains that are more
contagious. Currently, breakthrough infections are increasing in Nevada and the
USA as a whole. If you are fully vaccinated, getting boosted is essential, and if you
are not yet fully vaccinated, get vaccinated. Yes, we are all tired of Sars-Cov-2, but,
unfortunately, the virus is not tired or done with us.
Two years ago, Dr. Deborah Brix was standing beside former President Trump
when he talked about drinking bleach and inserting ultra-violet lights into our
bodies as being a cure for COVID-19. In April 2022, Dr. Birx published a book, Silent
Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing
the Next Pandemic Before it’s Too Late.
June, July, August 2022 Nevada RNformation • Page 11
Antimicrobial Stewardship – Infection Prevention
I have not had an opportunity to fully review
Silent Invasion yet, but microbes are all around us.
COVID-19 continues, and the next pandemic will occur
sooner or later. In my opinion, we, as nurses, must
work together to find and promote truth regarding
infection prevention before we can defeat the
Please do your own independent research and send
me any additional data, sources of information, or
opposing opinions that you may have. The only way we
will win the war against microbes is to have an open
and honest discussion. We are all still in this together,
something that has been forgotten in the last two
This link takes you to a video, COVID Vaccines,
Ethical Considerations for Nurses, which presents the
ANA’s position on the vaccines. Please review it.
Author's note, by the time you read this, Mary
Bondmass and I will have returned from Washington
DC, where we are representing the NNA at the annual
ANA convention. More to come.
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
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
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
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
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
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
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
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.
I hope you choose to practice courageously, doing
the right things for the right reasons. As Theodore
“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.”
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.
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
Page 12 • Nevada RNformation June, July, August 2022
Janelle Willis, MSN, RN, FNP-C, CNE
Senior lecturer – UNLV School of Nursing and CEO for NVNSA
The Nevada Nursing Student Association (NVNSA) held it Annual Convention,
May 22, 2022. At this convention the new slate of officers were installed and the
organization’s Reason for Being’ was re-affirmed*. The following students began
their responsibilities as the 2022-2023 NVNSA Board of Directors.
• President – Nikole Taylor
• VP – Michelle Moriarty
• Treasurer – Alessandra Baldono
• Secretary – Marielle Cuenca
• Communications Director – Kate Katigbak
• Community Outreach – Lidia Gebersiassie
Nevada Nursing Student Association
Nurse Bliss Jazmyn Duncan MSN RN
Visit our website for more NVNSA information
Nevada Nursing Student Association (nvnsa.org)
June, July, August 2022 Nevada RNformation • Page 13
The Nurses Honor Guard
Tracey Long PhD, APRN-BC, CDCES, CCRN
Nursing is a life calling, a way of life, and it's a team
sport. Nurses need each other to work synergistically in
teamwork from lifting patients to crying on the shoulder of
another nurse who truly understands sorrow and pain. We
understand each other, in life, and in death. In life nurses
honor each other as we help with each other’s patients
and in death through a very special tribute service known
as the Nurses Honor Guard. The Nurses Honor Guard is a
national nonprofit organization that nurses in many states
have created to pay tribute to nurses at the time of their
death. Similar to a military tribute, a Nurses Honor Guard
recognizes the men and women who have dedicated their
lives to the nursing profession and healing service of others. Their charge is to stand
guard in the traditional nursing white uniform at the nurse’s casket, urn, or picture
and be a presence at the memorial service. A Nightingale light is lit in the nurse’s
honor. The nurse’s name is called with a request to report to duty with the sound of
a bell. When the nurse doesn’t respond after three times ringing the bell, the lamp’s
flame is extinguished, and the nurse is released from their nursing duty.
Some states request a nominal fee to help pay for the items that are gifted at the
funeral service including a white rose that is placed on the casket, a glass nurses’ oil
lamp and the framed poem. The Nightingale Tribute is a formal poem to honor the
deceased nurse and read by the volunteer nurses. Beginning a Nurses Honor Guard
is not difficult or expensive but does require a group of dedicated volunteers to have
a few meetings on how to organize themselves, notify funeral directors of their
availability and offer their service to families of a nurse. Each nurse is responsible
to purchase their own white uniform and shoes and have a traditional blue nursing
cape made to match the group.
“This has been such a rewarding group to be a part of” said Luisa Echeverria
of the Utah Nightingales. The Utah group’s Facebook page lists opportunities for
the group’s volunteers so whoever can attend comes to help with the tribute. “The
services we have already done are some of the most rewarding things we have ever
done in our careers,” said Joan Anderson from the Minnesota’s Honor Guard. “The
families are so appreciative, and it’s very moving for them and each of us.” The
Honor Guard is open to nurses of all ages. “It means a lot that we can comfort the
families in some way and make them feel that their loved one did something very
honorable for their whole life,” added Anita Hanson from the Twin Cities Nurses
“Name”, we honor you this day and
give you a white rose to symbolize our
honor and appreciation for being our
“Name” (ring triangle) “Name” (ring
triangle) “Name” (ring triangle) We
officially release you of your nursing
duties. (extinguish lamp and give to family
member with quiet condolences)
The state of Nevada currently does not
have a Nurses Honor Guard.
To learn more about how to start
a Nurses Honor Guard in Nevada
contact the Nurse Honor Guard at:
NursesHonorGuard.aspx or Julie Murray at
Photo by Paige Keiffer Sun Post
From left, Sally Schilling, Lori Winchell, Sharon Ellis, Nancy Labish, Dianne
Roth, Anita Hanson, Norma Stueland, Rae Ann Schmidt, Joan Anderson,
and Jeannette Belland of Twin Cities Nurses Honor Guard.
The Nightingale Tribute
Nursing is a calling, a lifestyle, a way of living. Nurses here today honor “Name”
and his/her life as a nurse.
“Name of the deceased” is not remembered by his/her years as a nurse, but by
the difference he/she made during those years by stepping into people’s lives…. by
“Name” Was There
When a calming, quiet presence was all that was needed,
“Name”- was there. (spoken in unison)
In the excitement and miracle of birth or in the mystery and loss of life,
“Name”- was there. (spoken in unison)
When a silent glance could uplift a patient, family member or friend,
“Name” -was there. (spoken in unison)
At those times when the unexplainable needed to be explained,
“Name” -was there. (spoken in unison)
When the situation demanded a swift foot and sharp mind,
“Name” -was there. (spoken in unison)
When a gentle touch, a firm push, or an encouraging word was needed,
“Name” -was there. (spoken in unison)
In choosing the best one from a family’s “Thank You” box of chocolates,
“Name” - was there. (spoken in unison)
To witness humanity---its beauty, in good times and bad, without judgment,
“Name” - was there. (spoken in unison)
To embrace the woes of the world, willingly, and offer hope,
“Name” - was there. (spoken in unison)
And now, that it is time to be at the Greater One’s side,
“Name”- IS there. (spoken in unison)
© Duane Jaeger, RN, MSN
Come join our team! Opportunities
available in our Winslow and Dilkon
locations. Our Winslow location is
just 45 minutes east of Flagstaff and
a few hours north of Phoenix. You
can go from Standing in the Corner
of Winslow, Arizona to hiking scenic
and majestic landscapes. Our new
Dilkon facility will be opening in
January 2023 and is 43 miles north
of Winslow, on the Navajo Nation.
To view our
visit us here:
WINSLOW INDIAN HEALTH CARE CENTER
Nursing opportunities and breathtaking
allure of Navajoland await committed
and highly motivated nurses.
• Great benefits
• Great incentives
• Nurse Residency Program
New graduate nurses are encouraged
to apply for Clinical Nurse positions in
Urgent Care and Ambulatory Care.
500 North Indiana Avenue
Winslow, Arizona 86047
Page 14 • Nevada RNformation June, July, August 2022
Nevada Nurses Foundation EST 2014
Nicki Aaker & Brad Aaker
The Nevada Nurses Foundation (NNF), a federally recognized non-profit
organization since 2014 and the charitable and philanthropic arm of the Nevada
Nurses Association, hosted its 8th annual Big Hat “Kentucky Derby” High Tea on
Saturday, April 2, 2022 at the Nevada Governor’s Mansion.
The 2022 Tea was sold out, again! Thank you to all our distinguished guests for
attending and creating such an uplifting afternoon!
Thank you, First Lady Kathy Sisolak, Sheriff Kenny Furlong, and Carson City
Mayor Lori Bagwell for attending and supporting the NNF. Previously, the Tea was
attended by Senator Bernice Mathews, Former Attorney General Adam Laxalt,
Carson City Mayor Bob Crowell. Thank you, Sheriff Kenny Furlong, for attending
every year since 2015!
BreAnna Connelly, First Lady Kathy Sisolak, & Alexx Echevarria
Guests enjoyed a delicious
raspberry tea, lunch, desserts,
and multiple fundraising
activities. The beautiful
created by Dr. Caren Jaggers,
were an extraordinary
compliment to the “Kentucky
Thank you, David Gamble,
esq., a local attorney,
comedian, and former
Nevada Nurses Foundation
Advisory Board member, for
entertaining us with your quick
wit and gregarious personality
while serving as the 2022 Big
Hat “Kentucky Derby” Master
Landen Flournoy, RN, is a
Michelle Garthe, LPN
gifted pianist with an amazing
ability to transform an upright piano into a Steinway! Mr. Flournoy has been
performing for the Nevada Nurses Foundation since winning Nurses Have Talent in
2017. The String Beans delighted guests with their whimsical notes dancing off the
reverberation of their strings.
Michelle Garthe, LPN, has been performing on stage since childhood. When she
sings, she lights up the room. Congratulations, Ms. Garthe, for continuing your
education and pursuing a RN.
We appreciate and value our very talented entertainers.
Thank you to our generous sponsors:
• Carson Tahoe Health
• Chamberlain College
• Nightingale College
• Northern Nevada Medical Center & Sierra Medical Center
• Unitek College
• University of Nevada, Las Vegas
• University of Nevada, Reno
David Gamble, Esq
June, July, August 2022 Nevada RNformation • Page 15
Nevada Nurses Foundation EST 2014
Congratulations to the 2022
Spring scholarship recipients! Thank
you for applying! On August 1,
2022, the scholarship application
reopens. The NNF awards eight NNF
funded scholarships twice a year. The
following scholarships are available in
the Spring and Fall each year.
2. CNA to RN
4. LPN to RN
5. Pre-licensure RN
6. RN to BSN
Carson Tahoe Health Team
Captured in this photo is First Lady
Kathy Sisolak with Cassidy Jost. Ms. Jost,
the 2016 Nevada Nurses Foundation
Jessie J. Valentine scholarship recipient,
accepted the plaque on behalf of Carson
Tahoe Health. Since 2016, Carson Tahoe
Health has been a loyal sponsor of the
Jessie J. Valentine scholarship. The legacy
scholarship is named after an extraordinary
CTH nurse who although is gone from
sight, lives in the hearts of those she
Congratulations to Elizabeth “Beth”
Melton, for winning the Dr. John
and Debra Scott endowed nursing
Thank you to our very kind and
generous silent auction donors:
Advanced Wellness Partners of Nevada,
Olivia Amos, Dr. Louis A. Bonaldi, Burger
Me, Carson City Health and Human
Services, Cantina Los Tres Hombres,
Carson Tahoe Health, Chick-fil-A,
Bree Creation by BreAnna Connelly,
Crumbl Cookie, Donut Shop, Du Barry
Fashions, Enchanted Cate Café, Farley
Photography, Dawn Heath, Forrest Hill,
Fortune Star, Huntsman Brewing, Dr.
Caren Jaggers, Sandy Kinser, Keith and
Vicky Lang Catlin, Lavish Lash & Skin
Studio, Alex Leader, Mario Portofino,
NDO Wellness, Nothing Bundt Cake,
Nothing To It, Nugget Casino, Denise
Ogletree McGuinn, Olguin Family,
Outback Steakhouse, Renew MD, Reno Ice Raiders, Roseman University, RevitaLife,
Ruby River Steakhouse, Sierra Donor Services, Larry Sickles, Squeeze In, Vania
Carter Strauss, Carol Swanson, Sweat Reno, Sweets Handmade Chocolates, Target,
Dee Tison, Two Chicks, Julie Wagner, and Val Wedler. We appreciate you and your
NNF continued on page 16
Because of the charitable
contributions from individuals
and organizations who create
legacy endowments and
scholarships, the NNF gets to
award additional scholarships.
Thank you to our scholarship
• Eric Christopherson
Family & Friends
• Margaret & Ian Curley
• Lauren Delameter Family
• Elizabeth de Leon
• Greg Peistrup Family & Friends
• Dr. John & Debra Scott
Page 16 • Nevada RNformation June, July, August 2022
Nevada Nurses Foundation EST 2014
NNF continued from page 15
Thank you to our wonderful
planning team & volunteers,
Nicki Aaker, Brad Aaker, Dr. Mary
Bondmass, Michael Cleaver,
BreAnna Connelly, Elizabeth de
Leon Gamboa, Alexx Echevarria,
Kristene Enloe, Kelly Farley, Dr.
Caren Jaggers, Cryssa Jaggers,
Emma Jaggers, Dr. Delos Jones,
Emily Koestner, Dr. Glenn
Hagerstrom, Dr. Vicky Lang Catlin,
Dr. Sherri Lindsey, Chris Lyons,
Rev. Dr. Denise Ogletree McGuinn,
Alyx Olguin, Bruce Olguin, Lyle
Pritchett, Larry Sickles, Dee Tison,
Sydney Treppiccione, and Julie
Wagner. You are the life force of
Please join us
next year, Spring
2023 for a Big
Hat “Mardi Gras”
High Tea @ the
Margaret Curley Rural & Frontier Nursing
Great Basin College & Virtual
*Friday, August 26, 2022, 5:00 PM - 8:00 PM
*Saturday, August 27, 2022, 8:00 AM - 12:30 PM
THE CAPACITY TO LEARN IS A GIFT; THE ABILITY TO
LEARN IS A SKILL; THE WILLINGNESS TO LEARN IS A
CHOICE. ~BRIAN HERBERT
Join us on August 26th and 27th at the Great Basin College in Elko,
Nevada in-person or virtually for a two-day symposium with seven nursing
continuing education units. Nevada Nurses Association members only pay
$35.00; non-members, $70.00; and nursing students, $15.00.
The wonderful speakers include:
• Brian Dankowski (NNF scholarship & grant recipient)
• Norah Lusk (NNF grant recipient)
• Jessica Lynch (NNF scholarship recipient)
• Dr. Joy Patrick (NNF grant recipient)
• Sherri Stofko (NNF scholarship recipient)
• Dr. Dawn Taylor (NNF scholarship & grant recipient)
• Dr. Wei-Chen Tung (NNF grant recipient)
• Dr. Evette M. Wilson
*This event helps fund the NNF Rural & Frontier Nursing Scholarship.
Scholarship applications are open in February & August each year and
awarded in April & October. The grant application is open from October to
February and awarded in the Spring.
For more information call 775-560-1118.
Defending Professional Licenses in Administrative Proceedings.
Offering legal services for all Nursing Board related matters, including
disciplinary defense and licensing issues.
KNOW YOUR RIGHTS!
Free Initial Consultation
Experienced • Tenacious • Diligent
• 2021 Leaders in Law • 2020 Top Lawyers Administrative Agency Practice
• 2019 Top Administrative Law Attorneys • 2018 and 2017 Top Attorneys in Rising Star
• 2016 Best of the Bar, Administrative License Defense
• 2015 Top Attorney, Municipal and Government
• 2014 Best of the Bar, Administrative Law and Personal Injury
619.684.5073 (Phone) | 619.363.8091 (Fax)
June, July, August 2022 Nevada RNformation • Page 17
Nevada Nurses Foundation EST 2014
As the Baby Boomers age and health care needs
increase, the nursing shortage intensifies. Nursing
schools continue to feel the pressure to increase
enrollment despite experiencing a severe nursing
faculty shortage. We are also seeing a retention
problem with high turnover rates, retirement, and
nurses permanently leaving the profession.
The important work of growing and retaining nurses
has become the focus of many Nevada organizations.
To celebrate the nurses and student nurses who are
modeling advocacy, leadership, and community, and
are increasing access to quality healthcare in Nevada,
the Nevada Nurses Foundation will be holding its 7th
Annual Shining Stars of Nursing Awards Gala.
The Gala will be held October 8, 2022 at the
Celebrity Showroom inside the Nugget Casino and
Resort in Sparks, Nevada. The Gala will have a private
VIP reception starting at 5 p.m. with a one-hour
hosted cocktail party with live entertainment. General
admission reception begins at 6 p.m., dinner is served
at 6:30 p.m., and the program begins at 6:45 p.m.
Tickets are $100 for general admission, $150 for VIP
admission. Tickets may be purchased online at www.
nvnursesfoundation.org. Please call 775-560-1118 for
more information. Reserve your tickets today as there is
limited seating inside the Showroom.
Proceeds from the Shining Stars of Nursing in
Nevada Awards Gala will benefit the mission of the
Nevada Nurses Foundation, which is dedicated to
supporting the professional development of nurses and
increasing access to quality health care for Nevadans.
We are excited to celebrate exemplary nurses,
student nurses, and partnering organizations at this
fun statewide nursing awards gala. We appreciate the
generosity of individuals and organizations. We cannot
do what we do without our wonderful volunteers who
share their time, resources, and talent, make charitable
contributions, participate in fundraising, and promote
The event features many prestigious awards.
Distinguished Nurse Leader with Lifetime
Achievement Award – This award is based on lifetime
achievement and service. The previous winners,
selected judges who live outside of Nevada, and Ian
Curley, on behalf of 2018's recipient Margaret Curley,
will evaluate the nominations. Please complete an
online nomination by July 1, 2022. Nominee
Acceptance Letters due August 1st, 2022.
People's Choice Chief Nursing Officer/Director of
Nursing/Dean of Nursing (CNO/DON/DON) of the
Year Award – Nominations are open online and public
voting ends on September 15, 2022. Visit our
Website form to nominate or vote for your favorite
CNO and DON.
Nevada Rising Stars: Student Nurse Leader
Awards – These student nurses are selected by their
respective schools, institutions, and organizations
based on their involvement in the nursing profession,
demonstration of leadership skills, effective
communication, and promoting quality care in their
community. Institutions will submit names to the
Stars@NVNursesFoundation.org by August 1,
2022, for inclusion in the program.
"50 Under and 50” Awards – Join us in recognizing
fifty nurses (RN/LPN/APRN) under 50 who have
demonstrated excellence in practice, advocacy, and
leadership. Nominations are accepted online until
July 1, 2022. Acceptance letters must be received
by August 1st, 2022.
Shooting Stars: Professional Progression Awards
– All nurses who have completed advanced degrees
and specialty certifications in 2021 and 2022 will be
honored. Submissions will be accepted through
August 1, 2022.
Nurses on Boards – All nurses who served
on governing or advisory boards representing the
nursing occupation or healthcare issues and concerns
during 2021 and 2022 will be honored. If you know
of a colleague who should be recognized for his/
her representation of or leadership in nursing, please
submit their name for consideration. Submissions are
accepted through August 1, 2022.
Forever Stars – All nursing stars who have recently
departed within the last year will be recognized in
memoriam in the souvenir program and slide show.
Please submit names of the nurse or nursing student
with a 100-word bio and picture by September 1,
2022, to Stars@NVNursesFoundation.org.
Recognition of Scholarship Recipients &
Sponsors – We honor individual and corporate donors
who have set aside funds from their charitable giving to
create a legacy scholarship. Sponsors may name their
scholarship and set the criteria.
Partnering Professional Nursing Organizations'
Stellar Nurses – We offer an opportunity for
Professional Organizations to select one stellar nurse
to be recognized at the Awards Gala. All stellar
nurses will be celebrated on stage and in the souvenir
program. The criteria and selection of the stellar
nurse are determined by each professional nursing
organization. We request organizations to submit
the following documentation by August 1, 2022: 1.
the name of the professional nursing organization, 2.
name of the nurse, 3. their credentials, 4. role within
the organization, 5. a professional photo, and 6. their
contact information to Stars@NVNursesFoundation.
Nominate and vote for individuals at https://
On September 15th visit our website and register
for the silent auction. As we accumulate gifts, we will
continue to post them in the online silent auction at
would like to donate a gift, advertise, attend, or be a
sponsor, please contact us at 775-560-1118 or Stars@
In 2022, Dr. Delos Jones, Assistant Dean at Roseman
University is dialing in on his role as the Shining Stars
of Nursing auctioneer for the LIVE auction held on
Saturday, October 8th!
All proceeds support the NNF mission to increase
access to quality health care for Nevada citizens by
promoting professional development of nursing
through recognition, grants, and scholarships.
Thank you and have great days,
Sandy Olguin, DNP, MSN, RN
Nevada Nurses Foundation
Getting Clear on Bullying Versus Incivility
Renee Thompson, DNP, RN, CSP
Reprinted with permission from
The Florida Nurse February 2022 issue
Numerous studies show the
prevalence and devastating
impact disruptive behaviors
have on nurse retention and
satisfaction, patient safety
and the financial health of
an organization. Today, more
than ever, the unpredictable,
life-and-death nature of the
pandemic has created an
environment that is ripe for
an increase in workplace
bullying and incivility. Research
at the Healthy Workforce
Institute shows an uptick in
bad behavior and nurses are
experiencing greater workplace incivility now more
than ever before. Additional studies show:
• 45.7% of nurses said they witnessed more
incivility than before the pandemic (El Ghaziri et
• 14.3% of surgery patients had higher
complications with surgeons who had one
to three reports of unprofessional behaviors
compared to those surgeons who had no
reports of disruptive behaviors (Cooper et al.,
• 94% of individuals have worked with a toxic
person in the last five years; 51% of the targets
stated they are likely to quit as a result (Kusy,
Developing successful, targeted interventions to
reduce bullying and incivility among nurses will require
that leaders develop awareness and understanding of
nurses’ unique experiences with disruptive behavior.
One of the biggest areas of confusion that makes
it difficult to address and eliminate bad behavior is
a misunderstanding about the differences between
bullying and incivility.
An important first step to educating yourself and
your employees is to get clear on those differences.
This will help you raise awareness, set expectations,
and develop appropriate strategies to eliminate each
type of disruptive behavior. Bullying should be a
NEVER event, but not everything is bullying and when
we call everything bullying, we lessen our chances of
identifying and addressing true bullying behavior.
For a behavior to be considered bullying, it must
include three things:
A Target-This target can be a single person or group
of people. Group targets can include the opposite
shift, new nurses, or nurses who have a particular
Harmful-The behavior must be harmful in some way.
This harm can be to the target or harmful to a patient.
Repeated-The most important element of bullying.
The behavior can’t be just a one-time event, it must be
repeated over time.
Incivility is different from bullying but tends to be
much more pervasive. While the behaviors can be
similar, they tend to be lower level. Incivility shows
up as your typical rude, unprofessional, inconsiderate
behaviors: eye-rolling, condescension, favoritism,
alienation, gossiping, mocking, cursing. Make no
mistake about it, incivility is a healthy and professional
workplace killer, and needs to be addressed.
The Bottom Line
Bullying and incivility can destroy work environments
and impact patients in a negative way. The key is to
get very clear on the behavior – is it bullying (target,
harmful, repeated) or incivility (low level, rude, and
unprofessional). We are hemorrhaging nurses due to
bad behavior and it’s time we get educated on how to
recognize and address bullying and incivility so that we
can cultivate a more respectful and professional work
Cooper, W., Spain, D., Guillamondegui, O., et al. (2019,
June). Association of Coworker Reports About
Unprofessional Behavior by Surgeons with Surgical
Complications in Their Patients. JAMA Surgery, 154(9),
El Ghaziri, M., Johnson, S., Purpora, C., Simons, S. and
Taylor, R. (2021, July). Registered Nurses’ Experiences
with Incivility During the Early Phase of COVID-19
Pandemic: Results of a Multi-State Survey. Workplace
Health & Safety. doi:10.1177/21650799211024867
Kusy, M. (2017). Why I don’t work here anymore: A leader’s
guide to offset the financial and emotional cost of toxic
employees. Boca Raton, FL: CRC Press
As an international speaker and consultant, Dr.
Renee Thompson tackles the challenges facing
healthcare leaders today. With 30 years as a nurse,
Renee is an expert on creating healthy workforces by
eradicating bullying & incivility. She is in demand as a
keynote speaker and has authored several books on
Page 18 • Nevada RNformation June, July, August 2022
Is Healthcare Making You Sick?
Tracey Long PhD, MS, MSN,
RN, APRN-BC, CCRN, CNE
In the past two years during
the worldwide COVID-19
pandemic, nurses have not
only been in the spotlight
as healthcare heroes but
also in the dim light of their
own faltering mental health.
During the pandemic, nurses
have worked with more critically ill patients, with less
supplies including personal protective equipment,
shorter breaks between shifts, confusion of changing
protocols to fight the virus, and fear of exposing
themselves and their families to the mysterious and
often fatal virus with each patient interaction. Hospital
protocols changed often daily and as elective surgeries
were postponed during the height of COVID-19, OR
nurses were transferred to other units they were not
familiar with. The shift to using only surgical masks,
and often repeated use, contributed to nurses feeling
their own health and safety was not a priority to their
administration fostering a sense of mistrust. Nurses
acted as proxy for family at end-of-life moments as
family visitation privileges were suspended increasing
the emotional burden of nurses at the bedside. “When
the nurse walks into the hallway away from the
bedside, only tear-filled eyes of colleagues are there for
comfort” (Owens, 2020).
Shear physical and emotional exhaustion have
created another pandemic unique to nurses known as
compassion fatigue. And nurses are leaving nursing.
Thirty-two percent of surveyed registered nurses said
they are considering leaving bedside nursing since
the pandemic according to research conducted in
2021 (McKinsey and Company, 2022). The death of a
nurse by suicide has brought attention to the nursing
profession’s mental health. Michael Odell, a travel
nurse at UCSF left mid-shift and was in crisis himself
(Chaterjee, 2022). He had a previous suicide attempt
and was waiting for a medication refill pending his
insurance. He cared deeply for his patient and shared
with his colleagues the heavy burden of watching so
many of his patients dying from COVID. In the days
while he was missing, his friends created a Facebook
page to help find him and found instead an outpouring
of empathy from fellow nurses who experienced
similar breakdowns, panic attacks, depression, and
suicidal ideation. Nurses are finally voicing requests for
employers to create less stressful environments, more
shift support, and resources for mental health. A study
revealed that more than 70% of health care workers
in the United States admitted to symptoms of anxiety
and depression, 38% have symptoms of post-traumatic
stress disorder, and 15% have had recent thoughts of
suicide or self-harm (Hendrickson, et al).
Nurses are recognizing they must create a safe
environment to express that they are not ok themselves
before they can safely care for others, and that requires
a change in our culture. “There's a feeling among
doctors and nurses that they are the ones who heal
others, not the ones who need to ask for help,” says
nurse Paredes, a friend of nurse Michael Odell. Another
nurse, Warren, read of Odell’s death and proactively
began a partnership to create more awareness of
mental health among nurses. The healthcare industry
already established a physician suicide hotline, but one
was not created specifically for nurses yet. Together
they have created a website, and colleague-supported
hot-line called “Don’t Clock Out” inspired by the fact
that Odell left his shift under stress and never returned.
The team wants nurses to know they are not alone.
Help is available by the very caregivers who really
understand you. They have received legal help to create
the organization and even guidance by a veteran’s
group who believes frontline nurses and veterans are
similar in experiencing post-traumatic syndrome. Their
campaign includes proposals for more mental health
awareness and resources. Just as long-COVID has
become a real chronic condition, so too is the fragility
of mental health among nurses and healthcare workers
who are exhausted. Nursing friends of Odell recognize
his struggle with mental health must have been long
until he could no longer cope during a nursing shift.
The quest for improved support of mental health for
nurses will also be long. The campaign for stronger
mental health among nurses begins with each nurse
being aware of the behaviors and emotional coping
of each other and self-awareness of their own coping
Reach out to each other, use or volunteer for hotlines,
and take time for yourself to rejuvenate the joy
Photo by https://www.shutterstock.com/imagephoto/depressed-crying-doctor-mask-havingmental-1709102854
of life. For more strategies about protecting your own
mental health go to: https://www.myamericannurse.
Chaterjee, R. (2022). A nurse’s death raises the alarm
about the profession’s mental health. Shots,
March 2022. https://www.npr.org/sections/healthshots/2022/03/31/1088672446/a-nurses-death-raisesthe-alarm-about-the-professions-mental-health-crisis
Hendrickson, R.C., Slevin, R.A., Hoerster, K.D. et al. The
Impact of the COVID-19 Pandemic on Mental Health,
Occupational Functioning, and Professional Retention
Among Health Care Workers and First Responders.
J GEN INTERN MED 37, 397–408 (2022). https://doi.
McKinsey and Company (2022). Nurses and other
healthcare professionals shed light on why they are
considering leaving, as well as what might make
them stay. https://www.mckinsey.com/industries/
Owens, India T. MSN, RN, CEN, NE-BC, FAEN Supporting
nurses' mental health during the pandemic, Nursing:
October 2020 - Volume 50 - Issue 10 - p 54-57 doi:
Rest, Relax, Laugh: Spending Time with Yourself
Dr. Phyllis Lawrence, DNP, RN, NEA-BC
Reprinted with permission from Tennessee Nurse
February 2022 issue
Rest and Relax
How many times have you been told that you need
to get plenty of sleep for good physical health? Sleep
is also instrumental in maintaining sound mental and
emotional health. Rest is not only the act of sleeping,
but you can rest your body, mind, and tap into your
spirit simply by feeling renewed. Waking up and feeling
that you have run a marathon is a sign of significant
activity during your rest period. Either the mind
continues to cycle, or you may be suffering from a
sleep disorder. In either case, you are not at rest.
To rest the mind, you must relax. Relaxation is
defined as the state of being free from tension and
anxiety (Google dictionary, 2022). The Cambridge
Dictionary defines relaxation as a pleasant activity
that makes you become calm and less worried. This
definition supports the concept of complementary
and alternative interventions and modalities.
Relaxation can really be a state of mind. One of
the most effective holistic modalities that promotes
relaxation is meditation. Meditation is reflected in
many forms, including guided imaginary, mindfulness,
Zen meditation, Mantra meditation, Transcendental
meditation, and Yoga meditation, just to name a
few. Mindfulness has become popular over the last
few years. Being mindful is the basic human ability
to be fully present in the moment, aware of your
surroundings, feelings, and emotions. Try it, sit still in
a quiet place. Place your hands in your lap. Now close
your eyes. What do you hear? What do you smell?
Breathe slow and steady while maintaining the rhythm.
Continue this practice for approximately 10-15 minutes.
Notice the change in your stress level or anxiety. This
simple exercise can alleviate stress and anxiety, and if
engaged in regularly, lead to an optimistic outlook.
Laugh for a Healthier You
Have you noticed that when you laugh, you feel
better? It is harder to cry while you are laughing.
Research has found that laughing triggers the release
of endorphins (nature’s feel-good chemicals). It has also
been reported that laughter decreases stress hormones
and increases immune cells. We have a natural
response to infection, which helps produce antibodies,
improving our resistance to disease and promoting
our overall well-being. What makes you laugh? Is it a
funny commercial, your loved one(s), maybe your coworkers?
Laughter is the best medicine. In an article
by Robinson, Smith, & Segal (July 2021), learn to create
opportunities to laugh, watch a funny movie, TV show,
or YouTube video, check out a comedy club, read the
funny pages, check out the humor section in your
bookstore, play with a pet, better yet host a game
night with friends.
I would like to share with you some of the things
that make me laugh. Watching my favorite comedy
movies, even though I know the punch line, dancing
to my favorite 80’s jam on YouTube, and serving
with a grateful heart. When I see someone smile, I
smile! During hard times, laughter has been a saving
grace for many. Whitman (2017) A new study reveals
how laughter affects the brain, which may be an
explanation why giggles play an important role in social
When you take time for yourself, you validate your
worthiness and value. Make it a point to celebrate
your life. Buy that neat sweater, go to the movies with
your spouse, family, or friends. Do something that
you enjoy, and that makes you feel good. How about
butter pecan ice cream? Take care of yourself so that
you can take care of others. The first step to self-care
is accepting that you are worthy of that care. The care
you require may need to come from a professional
source, and that’s okay. There are services available
through most healthcare facilities and organizations.
Sometimes you just might need to talk. It may be a
good time to phone a friend.
Take a moment and plan to rest, relax, and laugh.
Try to include at least one activity to cover each one of
the components. Start with resting and relaxing, then
let the laughter begin. Remember, you are worthy,
valuable, and appreciated. Self-worth can only be
measured by you. So make every moment count, and
be mindful of your value. I can sum it up in one word,
L. Robinson, M. Smith & J. Segal (2021). Laughter is the Best
Mindful: healthy mind, healthy life (2022). https://www.
Whiteman, H. (2017). Laughter releases ‘feel good
hormones’ to promote social bonding. https://www.
June, July, August 2022 Nevada RNformation • Page 19
by Tracey Long
PhD, MS, MSN, APRN-BC
Health is defined as more
than the absence of disease.
Healthy nurses are not only
physically vibrant and able to
perform duties with energy, but
they are also mentally clear and
refreshed. Ideally. The reality
is that many nurses, especially
after COVID-19, are emotionally and physically
exhausted and have even begun to question continuing
in the nursing profession. Before giving up on the
nursing profession it may be time to rethink activities
you do outside of nursing. One category that can
bring a welcome change to your emotional and mental
energy is exploring a side hustle. A side hustle can
bring in extra income and often restore your energy
and enjoyment for life as you monetize an interest or
Side Hustle for Nurses
• Making money on the side can be helpful for
• Nurses have many skills and abilities apart from
patient care that can be profitable.
• Many resources and possibilities exist for nurses
to earn extra money in addition to their full-time
What Is a Side Hustle and Why Would You Want
A side hustle is a part-time job or an income
producing activity that is done aside from a full-time
professional job. It’s a job you control that brings in
extra income. Despite competitive wages for nurses,
extra money is always welcome. Many nurses are still
paying off debts from nursing or graduate school and
have more month than money at the end of their
budget. According to a national survey by the Penny
Hoarder, over 55% of those surveyed admitted they
don’t keep a budget. Less than 30% of the adult
American population has a long-term financial savings
plan. It’s no surprise why many people wonder why
their income doesn’t match their expenses. 56% of
survey respondents admitted they don’t know how
much they spent last month. Unfortunately, nurses
are no different than the general population in money
management and need more greenbacks. You can
either make more money or decrease your expenses.
Having a side hustle is another way to earn extra
Advantages of a Side Hustle
There are many advantages to having a side hustle
and being a nurse entrepreneur. The most obvious
advantage is the ability to bring in more income
aside from a nursing job, which can help with budget
restraints. Earning extra money can help you save for a
special event such as a vacation or a large purchase like
a new car.
In addition to the added income, some nurses
like to create a side hustle to explore other interests
or hobbies and make money while doing it such
as teaching a yoga class or selling homemade art
and crafts. Optimizing a hobby into income can be
A side hustle doesn’t have to be worked every
day, which allows more flexibility for you to be your
own boss. You can work the schedule you want
while fulfilling your full-time nursing job. It may mean
working in the mornings, evenings, or off-work days.
It may even become something that evolves into a fulltime
job by replacing your usual nursing income. An
example is a nurse who works on the side as a personal
health coach who begins to acquire so many clients
that creates such enjoyment the nurse trades bedside
nursing for full-time coaching and then works prn at
the hospital instead, making the hospital job the side
Disadvantages of a Side Hustle
Before you hang up your scrubs, you need to
consider some realities and possible disadvantages of
being your own boss. Being a nurse entrepreneur has
the attraction of creating your own schedule and being
your own boss, however, unless you are self-motivated
and self-disciplined you may not get anything done
in your side job. There is risk involved if your side job
requires an investment of money eating up some of
your savings before you see any profit. It is estimated
that over half of all new businesses fail in the first year.
Financial freedom also means you are responsible for
filing your own taxable income without an employer
to perform those accounting duties. You will need to
budget, record your expenses and income and plan for
financial matters in your own business. If you create
a material object then you must inventory it, ship it,
manage it and sometimes store it.
Like any new job, success takes time, initiative, and
discipline. Those are the same qualities that helped
you earned your nursing degree so they can be used
towards the success of your own independent business.
You are only as successful as the level of the problem
you solve. You have unique skills and knowledge that
can benefit others and be monetized.
Side Hustle Ideas for Nurses
There are many side hustle ideas for the average
person such as house sitting, pet care, selling art
At McKenzie-Willamette Medical Center,
we take caring for people very personally.
Join our MWMC family today in the
beautiful Pacific NW!
We have RN positions available in our
Operating Room and Cath Lab.
on Esty or Pintrest, babysitting, mystery shopping,
becoming a notary, buying a small franchise such as
selling essential oils or products, being an Uber driver,
or a freelance photographer.
There are also many side hustles especially for nurses
that use your unique skills in different ways.
Here are a dozen ideas to jump-start your own
thinking if you’re interested in earning extra cash in
exchange for your skills and knowledge unique to
being a nurse.
• Paid medical market research surveys
• Immunization worker
• Freelance health writer
• Telehealth nurse
• Online tutor
• Work as a standardized patient
• Work as adjunct nursing instructor
• Private duty nursing
• Teach BLS
• Sell your scrubs or extra gear
• Create an online course with your expert
• Create a new product of design (wound care
• Become a medical transcriber in your own home
• Become a nurse health coach
• Moonlight as a per diem nurse
How to Begin Your Side Hustle
Deciding what you want to do is the first step.
Study what the market needs, brainstorm your ideas,
determine what action steps are needed, and then act.
S: Study the market for needs you can fill
I: Idea brainstorm to see what matches your
interests and talents
D: Determine action steps needed to make it
E: Execute your plan
Marketing yourself includes letting people see you
on social media sites by making your profile public. Take
a professional profile picture, update your summary,
add your skills and certifications, and begin to network
with others by asking questions within online groups.
Create your business plan and budget and then begin to
advertise yourself through free resources first.
If you’re not confident in selling your skills yet,
boost your knowledge by learning more through
online courses or even YouTube to learn about
marketing, finance, budgeting and even how to be an
entrepreneur. Having a side hustle can even help reenergize
you in your regular job as you have fun doing
something you love and begin to lessen the burden of
heavy finances. Doing something new and exciting to
you can even help reduce burn-out.
NAMI Nevada’s mission is to
“The improvement of the quality of life for persons who are affected by
mental illnesses, by providing education, support, and advocacy. The
state organization supports and develops local affiliates and addresses
the needs of the membership.”
Our main goal is to provide services and referrals for people
and their families living with a mental health condition. We
provide the overall service to help our members, affiliates,
and the citizens of this state to better understand how to
navigate the system in this state as well as understand what
sometimes seems to be the lack of a system in this state.
The goal for individuals and families is to reach recovery
and become self-sufficient. The goals of NAMI NV are to
advocate, educate and support people living with mental
health conditions and the families that love them.
The Cath, Hybrid, EP, and Operating Rooms are more than just
procedural areas at MWMC. While collaboratively working
to promote operational efficiency, fiscal responsibility, and
purposeful change, we strive to empower each individual with the
tools necessary to foster learning and growth while enhancing
patient, staff, and physician satisfaction.
Sign-on bonuses up to $20,000 available!
2022 ANNUAL EDUCATION CONFERENCE
In-person & Virtual EVENT
October 17th thru 20th, 2022
Change Nevada, Change the World
Explore our Nursing Opportunities:
https://mckwebcareers.com/ 100 Arlington Avenue, Suite 360 | Reno, NV, 89501
Office: 775-470-5600 | Robin@naminevada.org
Seeking Cardiovascular RNs
Here is why you want to come work for us:
• Sign-on Bonus
• Tuition Reimbursement
• Career Growth Opportunities
• Great Benefits
• Also hiring Med/Surg, ER, BH, and OR
Jobs Hotline: 702-657-5551
Career Site: www.northvistahospital.com/careers
Scan to find your dream job: