Georgia Nursing - July 2022

“Nurses shaping
the future of
professional nursing
for a healthier Georgia.”
Since 1907
The Official Publication of the Georgia Nurses Foundation (GNF).
Quarterly publication distributed to approximately 58,000 RNs in Georgia.
Visit us online at www.georgianurses.org
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Volume 82 • Number 3 • July, August, September 2022
Georgia Nursing
GNA PRESIDENT’S MESSAGE
CEO’S MESSAGE
Dina M. Hewett, Ph.D., RN, J.M., NEA-BC
President@GeorgiaNurses.org
Happy Nurses Week!
As I write this article for Georgia Nursing, I am
reflecting on the events and activities surrounding
Nurses Week, May 6-12, 2022. Nursing has been in the
spotlight more than ever over the last two years, from
the pandemic to the criminal charges brought against a
former Tennessee nurse, RaDonda Vaught for criminally
negligent homicide and abuse of an impaired adult after
a medication error. The GNA joined the American Nurses
Association in stating: “Health care is highly complex
and ever-changing, resulting in a high risk and error-prone system. Organizational
processes and structures must support a ‘just culture’, which recognizes that health
care professionals can make mistakes and systems may fail. All nurses and other
health care professionals must be treated fairly when errors occur. ANA supports
a full and confidential peer review process in which errors can be examined and
system improvements and corrective action plans can be established. Swift and
appropriate action should and must always be taken as the situation warrants.”
On Friday, May 13, Vaught received a sentence of three-year-probation and no
jail time. (Timms, M. 2022, Ex-nurse in Tennessee will serve no jail time in death
of patient after medication error, judge rules. USA Today, retrieved: https://www.
usatoday.com/story/news/nation/2022/05/13/radonda-vaught-gets-no-jail-timemedication-error-led-death-patient/9761895002/).
Vaught, whose license has been revoked by the Tennessee Board of Nursing,
stated after the verdict, "This sentencing is bound to have an effect on how they
(nurses) proceed both in reporting medical errors, medication errors, raising
concerns if they see something they feel needs to be brought to someone's
attention," Vaught said. "I worry this is going to have a deep impact on patient
safety." (Timms, M., 2022).
As the nursing profession faces a continuing nursing shortage, burnout and mental
health related issues in the nursing profession must be addressed. Employers should
provide time for nurses to focus on self-care during the course of a shift instead of
pushing on and working with less support. The May issue of the American Nurse has
a good article on ways to provide yourself with self-care during a shift. “Burnout is
defined as a work-related condition, which means that events in the workplace
contribute to exhaustion, cynicism about work, and reduced job performance. These
Recharge, Reconnect and Relax at
GNA’s 2022 Conference
Matt Caseman, GNA CEO
Please join us at the 2022 GNA Conference “Nurses
Challenge Healthcare to Change” on September 30th
– Oct 2nd at the Hotel at Avalon in Alpharetta, GA. This
is an ideal environment to recharge, reconnect and relax
with your fellow nurses from a variety of backgrounds,
including CNOs, deans and directors, APRNs, nurse faculty,
school nurses, emergency room nurses, bedside nurses,
and much more. GNA members are innovative healthcare
practitioners who are team champions within their
respective specialties.
Our keynote speakers this year include Dr. Debbie
Hatmaker, American Nurses Association chief nursing officer; Andy Miller, founder
and chief editor of the paramount publication devoted solely to the healthcare
profession, Georgia Health News; and Dr. Jean Sumner, dean of Mercer University
School of Medicine, all of which are nationally known and accomplished subject
matter experts.
Difficult Conversations in the Workplace, How to Protect your License, Preventing
Burnout, Nurses Speaking with the Media, and the Nursing Shortage 2022 and
beyond, are only some of the topics of our robust agenda. 15 contact hours will be
available for attendees.
GNA President’s Message continued on page 3
CEO’s Message continued on page 3
current resident or
Non-Profit Org.
U.S. Postage Paid
Princeton, MN
Permit No. 14
Letter to the Editor . ................2
2022 GNA Conference ...............3
2022 Legislative Session Wrap Up. ......4
Nursing: A Profession of Care and
Compassion .....................5
How nurses can counter health
misinformation ..................6
Nurse License Protection Case Study:
Administering medication without an order .. 8
Human-Centered Leader in Action:
One Turtle at a Time. .................9
Advancing Health Equity in Georgia:
A Call for Health Policy Action ......... 10
Membership
Index
GNA Membership Application. ........23

Page 2 • Georgia Nursing July, August, September 2022
May 22, 2022
Dear Editor:
We were pleased to see an article about increasing
gender diversity in nursing in the latest issue of Georgia
Nursing (“Why Men Should Pursue Nursing as a
Profession” by Patricia Sarmiento). As proud nurses,
we agree that nursing is a fulfilling career that more
people should consider, especially as we strive to
build a nursing workforce that reflects the population.
However, in this time of enhanced dedication to
equity and inclusion in health care, we also believe it
is important to point out unhelpful stereotypes where
they arise.
While Ms. Sarmiento rightly acknowledges that
all nurses are “equipped to work in any specialty of
their choosing,” she goes on to list three “prominent
options” for men. The options she gives are emergency
room, ICU, and critical care. Setting aside that “ICU”
and “critical care” are synonymous terms (https://
NursingALD.com
can point you right to that perfect
NURSING JOB!
Letter to the Editor
NursingALD.com
Free to Nurses
Privacy Assured
Easy to Use
E-mailed Job Leads
medlineplus.gov/criticalcare.html), the assumption here
is that male gender predicts a preference for higheracuity
settings and a chance to work with complex
medical equipment. A related assumption is apparent
in the author’s earlier comment, “Men prefer to work
in challenging environments that provide them a high
sense of fulfillment,” a generalization for which no
evidence is given (and suggests that other people
prefer unchallenging jobs that leave them unfulfilled).
One of us (BTM) is a former emergency nurse
who chose to work in the ER of a safety-net hospital
because of empathy with medically marginalized
patients, not because he is an adrenaline junkie
who likes machines. The other of us (TJF), a certified
pediatric nurse practitioner, embraces the relational
aspects of caring for children and their families. He
finds that caring for diverse patients with unrelenting
understanding and compassion is highly challenging
and satisfying. We are just two examples of the
wide range of interests and skills in the “male nurse”
population. The profession will benefit as diverse
individuals are exposed to the vast range of what is
possible in nursing. That exposure is not just for their
own fulfillment, but also for the benefit of patients
who deserve care from the best talent for the job
regardless of gender.
On that point, the author mentions that male
patients may be uncomfortable being vulnerable
with non-male (“opposite gender”) nurses. While
it is important that our profession look more like
the population it serves, we should not slide into
promoting scenarios where patients always expect
to receive care from someone of the same gender.
This type of logic has real consequences, including for
equal opportunity in education. For example, male
nurse practitioner and midwifery students sometimes
encounter gender-specific barriers to finding clinical
hours in women’s health practices.
We appreciate Ms. Sarmiento and Georgia Nursing
for supporting the laudable goal of a more diverse
nursing workforce, and we hope we can work in
solidarity to that end.
With kind regards,
Blake T. McGee, PhD, RN
Tommy J. Flynn, PhD(c), RN, CPNP-AC
(Opinions are our own and do not necessarily
represent those of our employers or any other
organization.)
GEORGIA
NURSING
Volume 82 • Number 3
Communications Director: Charlotte Báez-Díaz
GEORGIA NURSES FOUNDATION BOARD OF TRUSTEES
Wanda Jones, BSN, RN, MSN, FNP-BC, President
Orlin Marquez, DNP, MBA, APRN, FNP-BC, Vice President
Katelyn Little, RN, BSN, Secretary
Shawn Little, CNE, DNP, RN, Treasurer
Catherine Futch, RN, MN, NEA-BC, CHC, FACHE,
Immediate Past President
Evelyn M. Olenick, DNP, RN, NEA-BC, Member
Sherry Sims, RN, Member
Mary Gullatte, PhD, RN, ANP-BC, AOCN, FAAN, Member
Natalie Jones, MSN, RN, NPD-BC, Member
Gerald Hobbs, RN, Member
Brenda B. Rowe, RN, MN, JD, Member
Dina Hewett, PhD, RN, NEA-BC, Member
Felicia P. Chatman, MSN, BSN, RN, Member
Matt Caseman, Ex-Officio, Member
GEORGIA NURSES ASSOCIATION BOARD OF DIRECTORS
President - Dina Hewett, PhD, RN, NEA-BC
President-Elect & ANA Delegate-At-Large
Erica Mills, PhD, RN, NPD-BC
Secretary & ANA Delegate-At-Large
Barbara Austin, MN, RN
Treasurer & 1st Alternate ANA Delegate-At-Large
Rachel E. Myers, PhD, RN, CDCES
Director of Leadership Development & 2nd ANA
Delegate-At-Large
Linda Morrow, DPN, MSN, MBA, NE-BC, CPHQ
Director Legislation/Public Policy
Elizabeth K. Bolton-Harris, DNP, ACNP-BC, CHFN
Director Nursing Practice & Advocacy
Joy L. King-Mark, DNP, MBA, APRN, NP-C
Director Advanced Practice Registered Nurse
Victoria Gordon, MSN, RN, CNM
Director Staff Nurse
Natasha Laibhen-Parkes, PhD, RN, CPN
Director Membership Development
Bree Becker, MSN, FNP-C, RNC-MNN
Director New Graduate
Emily Kathryn Lewis, BSN, RN
GNF President
Wanda Jones, BSN, RN, MSN, FNP-BC
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July, August, September 2022 Georgia Nursing • Page 3
GNA President’s Message continued from page 1
factors, as defined by the World Health Organization,
ultimately cause harm to patients, nurses, and other
healthcare professionals.” (Cunningham, T. 2022, Selfcare
during a single shift, American Nurse Journal, 17:5,
p. 20). A couple of take aways from the article:
1. Pause at the Pump – from a frontline nurse at
Emory Healthcare. Take a few minutes during
hand hygiene (pump sanitizing gel) and silently
recite a prayer or mantra or mediate on your
health and wellbeing.
2. Go outside – the Japanese practice of Shinrin
Yoku aligns with the practice of being in nature
and the reduction of stress hormones in the body.
Partner with your teammates to cover while each
of you takes a few minutes to step outside and
get some fresh air.
Finally, I am excited about the upcoming GNA
Conference on September 30 to October 2, 2022.
This event will be held at The Hotel at Avalon and the
theme is “Nurses Challenge Healthcare to Change.”
Mark your calendars for this event and plan to take
time to reconnect with colleagues from throughout the
state!
Yours in service,
Dr. Dina Hewett
GNA President
CEO’s Message continued from page 1
The Fall is the perfect time to experience a
conference hosted at a modern and sophisticated
hotel setting such as the Avalon. Countless dining and
shopping options are only a stone’s throw from the
front door, making this not only an excellent venue
for attendees to stay, learn and network but also to
unwind and build lifelong memories with nursing
colleagues.
With over 30 years of working, one of my greatest
inspirations has been connecting with those who are in
the profession, but outside of where I work. To me it is
always a breath of fresh air hearing what others were
experiencing compared to my own challenges. There
is a sense of comfort being around those in the same
boat and learning specific techniques and methods for
bettering our careers.
The 2022 GNA Conference is an opportunity for
Georgia’s nurses to unite in what is sure to be a
great couple days of seeing old friends, building new
relationships, learning, and having a good time!
That said, we could not be more excited, and hope
you will join us for the best nurse gathering in the state
of Georgia!
Don’t delay, take advantage of the Early Bird Rate
which ends Aug 31st, and sign up today.
To learn more and register go to www.
georgianurses.org.
Thank you for choosing the number one trusted
profession, nursing!

Page 4 • Georgia Nursing July, August, September 2022
2022 Legislative Session Wrap Up
By Tim Davis, GNA Sr. Director of Membership &
Government Affairs
The 2022 Legislative Session adjourned sine die on
Monday April 4, 2022. Several bills passed this session
that impact not only nursing, but also Georgia citizens’
access to care overall, including the expansion of access
to and coverage of mental health services, an expanded
period for post-partum Medicaid coverage, and an
increased incentive to open primary care facilities in
areas with a shortage of providers.
The FY23 State Budget included $150,000 for the
Georgia Nurses Association Peer Assistance Program
(GNA-PAP). These resources will allow us to grow the
scope and depth of our program which supports nurses
living with the disease of substance use disorder. We
are grateful to the members of both chambers who
are responsible for the work of appropriations, for their
support of this vitally important program.
Additionally, lawmakers included funds for a 5.4%
salary increase for Georgia’s school nurses, $126,086
in funding to provide an analyst to coordinate the
collection and reporting of nursing and hospital data,
$3M for one-time funding of equipment and operating
grants for nursing programs with wait lists and
additional student capacity, and a $1.2M transfer funds
from the Teaching program to fund the first year of a
five-year plan to expand capacity for nursing students
across the university system.
On another note, a top GNA priority has been to
ensure the safety of practice environments for nurses
within our state. Sponsored by Senator Matt Brass,
SB573 constitutes a step in the right direction towards
ensuring that harmful and dangerous surgical smoke
produced in surgery and ambulatory settings is properly
evacuated by requiring that hospitals and ambulatory
centers have a policy for evacuation of surgical smoke.
As far as another GNA priority is concerned,
however, two bills that would have created a
commission aimed at exploring ways to address
the nursing workforce shortage failed to receive
final passage. But we have a silver lining. Last week
Governor Kemp signed an executive order establishing
the “Georgia Healthcare Workforce Commission.”
GNA is working to ensure that nursing is represented
on the commission and will certainly provide valued
feedback and insights to the commission as they work
to produce their recommendations and report, which
are due to the Governor by the end of 2022.
The 2022 session was the second in Georgia’s
Biennial Legislative Session, which means that all bills
which failed to receive final passage will need to be reintroduced
in the 2023 legislative session, thereby restarting
their process for passage.
The Georgia Nurses Association worked to advance
the priorities highlighted within our 2022 Legislative
Platform.
2022 Sine Die Bill Tracking Report
• SB573 – Surgical Smoke Bill – Passed
o Requires that each hospital and ambulatory
surgical center adopt policies for the reduction
of human exposure to surgical smoke
• SB338 – Postpartum Medicaid Coverage - Passed
o Extends Medicaid coverage for lactation care
and postpartum care for mothers from six
months to one year following the date the
pregnancy ends.
• HB1371 – Rural Health Advancement Commission
– Did Not Pass
o Created the Rural Health Advancement
Commission to develop private-sector solutions
to address short-term and long-term health
care and long-term care workforce shortages,
with an emphasis on rural areas. This bill
crossed over from the house but failed to
receive favorable consideration in the Senate.
• HB1520 – Ga Council on Addressing Healthcare
Workforce Challenges – Did Not Pass
o Created the Georgia Council on Addressing
Healthcare Workforce Challenges for the
purpose of providing strategic thought
leadership and recommendations on the future
of the healthcare workforce in Georgia. The
council will work with various experts and
stakeholders to explore workforce challenges,
identify future trends, raise awareness of
workforce issues. This bill crossed over from
the house but failed to receive favorable
consideration in the Senate.
• HB1042 – One Ga Authority Act – Passed
o Creates a grant program that will enable
local development authorities in areas with a
shortage or primary care providers to partner
with one or more provider and offset the cost
of establishing and operating a primary care
facility in the area.
• HB1013 – Mental Health Parity Act – Passed
o Increase access to mental health & substance
use services in Georgia
• HB 369 - APRNs and PAs to prescribe schedule II’s
– Did Not Pass
o Authorized advanced practice registered nurses
and physician assistants to execute affidavits
certifying an individual is disabled for purposes
of obtaining special vehicle decals for persons
with disabilities, authorized physicians to
delegate the authority to physician assistants
and advanced practice registered nurses to
prescribe Schedule II controlled substances
under certain conditions. This bill crossed over
from the house but failed to receive favorable
consideration in the Senate.
• HB430 – APRN Licensure – Did Not Pass
o Created a separate license to practice for
Advance Practice Registered Nurses. This bill
crossed over from the house but failed to
receive favorable consideration in the Senate
• HB937 – Mammograms for Women over 40 –
Passed
o Every insurer shall provide notification to each
female insured upon such female attaining the
age of 40 of her coverage for mammograms
and continuing annually thereafter, for as long
as mammogram screening is recommended for
such female insured based on her individual
health status, as determined by her physician.
• HB 1609 – GNA Safe Nurse Staffing Bill – Did Not
Pass
o Provides requirements for nurse staffing in
hospitals. Requires a written nurse services
staffing plan. Provides for the establishment
of nurse staffing committees. Provides for
anonymous reports and investigations of
unsafe staffing conditions. Establishes a state
safe staffing advisory commission. This Bill was
introduced in the House after Crossover Day
and was not eligible for passage
Important Upcoming Dates
• May 24, 2022 – Statewide Primary Election Day
• June 21, 2022- Statewide Primary Runoff Election
Day (If needed)
• November 8, 2022- Statewide General Election
Day
• December 6, 2022- Statewide General Runoff
Election Day (If needed)
GN-PAC
The purpose of the GN-PAC is to promote the
improvement of the health care of the citizens of
Georgia by raising funds from within the nursing
community and friends of nursing and contributing to
the support of worthy candidates for State office who
believe, and have demonstrated their belief, in the
legislative objectives of the Georgia Nurses Association.
The Georgia Nurses Association Political Action
Committee (GN-PAC) actively and carefully reviews
candidates for local, state, and federal office. This
consideration includes the candidate's record on
nursing issues and value as an advocate for the nursing
profession. Your contribution to GN-PAC today will
help GNA continue to protect your ability to practice
and earn a living in Georgia. Your contribution will also
support candidates for office who are strong advocates
on behalf of nursing. CONTRIBUTE TO THE GEORGIA
NURSES POLITICAL ACTION COMMITTEE TODAY!
GNA Legislative Committee
Stay engaged and abreast of all that is going
on under the Gold Dome to advance the nursing
profession by joining the Georgia Nurses Association
Legislative Committee.
Members only need to complete the Volunteer
Interest Form indicating their interest in joining, and
you will be added to the committee listserv.
STAY TUNED FOR MORE UPDATES FROM GNA!
For questions about our advocacy efforts or inquiries
about how to get involved, please contact GNA Sr.
Director of Membership & Government Affairs Tim
Davis at tim.davis@georgianurses.org.

July, August, September 2022 Georgia Nursing • Page 5
Nursing: A Profession of Care and Compassion
By Patricia Sarmiento
p.sarmiento@publichealthcorps.org
Nursing is one of the fastest-growing professions in
the country, and according to the U.S. Department of
Labor Occupational Outlook Handbook, the trend will
only continue. One of the best things about the field
is that there are multiple levels in nursing, and you
can pursue each level at your own pace. From there,
the Georgia Nurses Association can help you find the
perfect opportunity for your unique skill sets.
What Nurses Do
Nurses are positive, persistent people who work
in a wide variety of settings, including schools, skilled
nursing facilities, emergency clinics, doctor offices,
surgery centers, and hospitals. Some nurses specialize,
pursuing roles related to pediatrics, obstetrics,
oncology, or geriatrics. All levels of nursing require
a commitment to being a caring and compassionate
patient advocate, as well as being comfortable with
hands-on patient care, which can include things such
as trauma and wound care, assistance with medical
and surgical procedures, and physical examinations.
The type of duties nurses perform is based on their
individual levels of education and experience.
Entry-Level Nursing
Some nursing roles can be obtained with less than
a year of training. These are typically support roles
like certificated nursing assistant (CNA) or nursing
aide. These individuals report to nurses with advanced
education and training, and duties typically include
personal patient care, such as bathing, dressing,
feeding, moving, and transporting, along with other
hygiene and mobility measures. These roles are most
often found in nursing and assisted care centers,
hospices, and home health care. Education for these
roles is often accessible in community colleges and
technical or vocational training institutions.
Licensed Practical Nurse
A licensed practical nurse (LPN) is the next level
of nursing, and typically involves a one or two-year
training program at a community college or vocational
training institute. Clinicals, or hands-on experience,
take place in a variety of medical settings. Nurses at
this level must pass the National Council Licensure
Examination (NCLEX) to receive their nursing license.
LPNs provide more direct patient care and often
assist registered nurses and physicians in performing
medical procedures. They also draw blood, take
patient histories and vitals, and discharge patients with
instructions.
Registered Nurse
A registered nurse (RN) typically completes a twoyear
or four-year training program and receives an
associate’s or bachelor’s degree respectively. They
must also participate in clinicals and pass a higher-level
NCLEX exam to receive their license. Registered nurses
can provide a greater degree of care and are typically
charged with supervising LPNs and CNAs. They can
lead emergency responses using basic life support
and advanced cardiac life support procedures, as well
as start IVs and monitor medications. An RN with a
bachelor’s degree is known as a BSN. This advanced
level of education allows them to pursue management
roles.
Nurse Practitioner
A nurse practitioner often serves as a primary care
provider. These individuals have master’s degrees,
though some also hold doctorates in nursing. In
addition to traditional nursing responsibilities, nurse
practitioners can order tests, interpret results, and
make diagnoses. They create care plans, prescribe
treatments and medications, and help patients manage
chronic conditions. They often work in medical
practices with an attending physician. They also
supervise and mentor other nurses and help patients
and their families make informed healthcare decisions.
Continuing Nursing Education
Many people start out in the nursing field at an
entry-level and then continue their education over the
course of time. Online nursing education programs
make it easier than ever to do this. Many online
programs allow students to work at their own pace,
from the location of their choice. This allows students
to continue working in the field while pursuing their
next level of education, all while managing families and
other personal interests and responsibilities. Some even
pursue roles in nursing or healthcare administration as
a way to help ensure high-quality medical care for all
who need it.
The nursing profession can be personally and
professionally fulfilling, especially for individuals who
want to make their communities healthy places to
live. According to Incredible Health, networking, a
detailed resume, and solid interview skills are essential
to moving up in the nursing profession. Connections
made during clinicals and in school can help land the
all-important first job.
Photo courtesy of Pixabay

Page 6 • Georgia Nursing July, August, September 2022
How nurses can counter health misinformation
By Georgia Reiner,
MS, CPHRM, Risk
Analyst, Nurses Service
Organization (NSO)
The wealth of health
information available online
can be beneficial for patients,
but only if that information
is accurate. Although recent
issues on misinformation have
centered on the COVID-19
pandemic, misinformation has
been a problem in many other areas related to wellness
and healthcare, such as dieting, exercise, and vitamins
and supplements. Although misinformation isn’t new,
the internet and social media have supercharged the
ability for it to spread.
Nurses and nurse practitioners have the power
to counteract misinformation, but first, they need to
understand the nature of the problem and why people
may be inclined to believe information that is not
grounded in science.
Misinformation overview
Two definitions help better understand this issue.
Misinformation refers to claims that conflict with
the best available scientific evidence. Disinformation
refers to a coordinated or deliberate effort to spread
misinformation for personal benefit, such as to
gain money, power, or influence. An example of
misinformation is the false claim that sugar causes
hyperactivity in children. An example of disinformation
is a company that makes false scientific claims about
the efficacy of their product to boost sales. This article
focuses on misinformation.
People increasingly seek health information online
through sources such as search engines, health-related
websites, YouTube videos, and apps. Unfortunately,
misinformation can occur at all these points, as well as
via blogs, social media platforms, and user comments
on articles or posts. Even when not actively seeking
health information, people can be exposed to it
through media outlets such as print, TV, and streaming
networks.
Why do people believe misinformation?
Several factors can lead to people accepting
misinformation:
Health literacy. Health literacy refers not only to
the ability to read and understand health information,
but the appraisal and application of knowledge. People
with lower levels of health literacy may be less able
to critically assess the quality of online information,
leading to flawed decision-making. One particular
problem is that content is frequently written at a level
that is too high for most consumers.
Distrust in institutions. Past experiences with the
healthcare system can influence a person’s willingness
to trust the information provided. This includes not
only experiences as an individual but also experiences
of those in groups people affiliate with. Many people
of color and those with disabilities, for example, have
had experiences with healthcare providers where
they did not feel heard or received substandard care,
eroding trust. In some cases, healthcare providers have
lied, as was the case with the Tuskegee syphilis study
of Black men; the men were not told they had the
disease or offered treatment. In addition, some people
have an inherent distrust of government, leading them
to turn to alternative sources of information that state
government-provided facts are not correct.
Emotions. Emotions can play a role in both the
spread and acceptance of misinformation. For example,
false information tends to spread faster than true
information, possibly because of the emotions it elicits.
And Chou and colleagues note that during a crisis
when emotions are high, people feel more secure and
in control when they have information—even when
that information is incorrect.
Cognitive bias. This refers to the tendency to
seek out evidence that supports a person’s own point
of view while ignoring evidence that does not. If the
misinformation supports their view, they might accept
it even when it’s incorrect.
How to combat misinformation
Recommending resources, teaching consumers how
to evaluate resources, and communicating effectively
can help reduce the negative effects of misinformation.
Recommendations. In many cases, patients and
families feel they have a trusting relationship with
their healthcare providers. Nurses can leverage that
trust by recommending credible sources of health
information. Villarruel and James note that before
making a recommendation, nurses should consider the
appropriateness of the source. For example, a source
may be credible, but the vocabulary used may be at
too high a level for the patient to understand. And
someone who prefers visual learning will not appreciate
a website that is dense with text. Kington and
colleagues suggest using these foundational principles
when evaluating sources:
• Science-based: The source provides information
consistent with the best scientific evidence
available and meets standards for creation,
review, and presentation of scientific content.
• Objective: The source takes steps to reduce the
influence of financial and other forms of conflict
of interest or bias that could compromise or
be perceived to compromise the quality of the
information provided.
• Transparent and accountable: The source discloses
limitations of the provided information, conflicts
of interest, content errors, or procedural missteps.
• Each principle has specific attributes, which
are listed in the article available for download
A proactive approach
Villarruel and James provide the following
suggestions for talking with patients about
misinformation:
• Acknowledge the barrage of health
information that is available online and
through other sources and the difficulty of
“knowing who and what to trust.” (“I know
there’s a great deal of information about
COVID-19 and not all of it is the same.
Sometimes, it’s hard to sort it out and know
what to trust.”)
• Assess where patients and families obtain
their health information and what sources
they trust. Keep in mind that even when
a source is credible, a person may not trust
it, and a person may trust a site that is not
credible. (“Where do you get most of your
information about COVID-19? What makes
that a trusted source for you?”)
• Provide alternative and accurate sources
of information. (“I’m not familiar with that
website, but I’ll look at it and let you know
what I think. In the meantime, here’s where I
get information and why I trust it.”)
• When correcting misinformation be
nonjudgmental. (“I’ve heard similar
information about not getting vaccinated.
Here’s what I’ve learned from the science and
why I believe getting vaccinated is important
and safe.”)
Source: Villarruel AM, James R. Preventing the spread of
misinformation. Am Nurs J. 2022;17(2):22-26. https://
www.myamericannurse.com/preventing-the-spreadof-misinformation/
at https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC8486420/.
Another tool for evaluating sources of health
information is the CRAAP test (Currency, Relevance,
Authority, Accuracy, and Purpose), which focuses
on evaluating the accuracy of research. It consists
of multiple questions in each category (see https://
researchguides.ben.edu/source-evaluation). For a
more concise tool, nurses can turn to the algorithm,
developed by Kington and colleagues, for assessing the
credibility of online health information.
Although the tendency is to recommend government
sources such as the Centers for Disease Control and
Prevention and National Institutes of Health, as noted
earlier, some people do not trust the government.
In this case, sources such as MedlinePlus, World
Health Organization, and condition-specific nonprofit
organizations (e.g., the American Heart Association,
Public Health
RNs/NPs Needed
Infants to adult programs:
Assessments, Immunization,
Breast/Cervical Cancer,
Case Management
Apply:
http://dph.georgia.gov

July, August, September 2022 Georgia Nursing • Page 7
American Cancer Society, Alzheimer’s Association) might
be preferred.
Education. The sheer scope of the information
found online can make it difficult for even the most
astute consumer to determine what is accurate.
Nurses can help patients by providing tools they
can use to evaluate what they read. The website
Stronger suggests a four-step process for checking for
misinformation (https://stronger.org/resources/how-tospot-misinformation).
• Check the source. Is the website or person known
for conflating facts and opinions?
• Check the date. Is it implied that the information
is recent even though it’s not? Is there more
current information available elsewhere?
• Check the data and motive. What is the original
source of the information? Are they just looking
for anything that supports their own worldview?
• If still unsure, use a reputable, fact-checking site
such as Snopes.com or FactCheck.org.
UCSF Health (https://www.ucsfhealth.org/education/
evaluating-health-information) provides a useful short
overview for patients on how to evaluate the credibility
(e.g., authors’ credentials) and accuracy (e.g., whether
other sources support the information) of health
information and red flags to watch for (e.g., outdated
information, no evidence cites, poor grammar).
Communication. Communication is the best way
to correct misinformation and stop its spread. This
starts with the nurse clearly explaining the evidence
for recommended interventions. From the start, the
nurse should establish the principle of shared decisionmaking,
which encourages open discussion.
A toolkit from the U.S. Surgeon General on
misinformation (https://www.hhs.gov/sites/default/
files/health-misinformation-toolkit-english.pdf)
recommends that nurses take time to understand each
person’s knowledge, beliefs, and values and to listen
with empathy. It’s best to take a proactive approach
and create an environment that encourages patients
and families to share their thoughts and concerns (see
“A proactive approach”). Nurses should remain calm,
unemotional, and nonjudgmental.
Nurses also can prepare for conversations where
they know misinformation may occur such as
vaccination. For example, the CDC has a page on its
website that addresses infant vaccination (https://www.
cdc.gov/vaccines/hcp/conversations/conv-materials.
html). It includes resources such as responses to
possible questions.
Listening and providing information may not be
enough. In some cases, a patient may not want to
hear what the nurse is saying. When patients become
angry or frustrated, the nurse should remain calm. It
can be helpful to acknowledge the frustration (“I can
see that you are upset.”) Depending on the situation, it
may be possible to briefly summarize key points before
reinforcing the desire to provide information to support
the patient and then move on to another topic. The
goal is to maintain a positive nurse-patient relationship,
which leaves the door open to further conversation.
Documentation
As with any patient education, it’s important to
document discussions related to misinformation in
the patient’s health record. Nurses should objectively
record what occurred and include any education
material they provided. Should the patient experience
harm as a result of following misinformation instead of
the recommended treatment plan, this documentation
would demonstrate the nurse’s efforts and could help
avoid legal action.
A positive connection
Nurses can serve as a counterbalance to the
misinformation that is widely available online. Providing
useful resources, educating consumers, and engaging
in open dialogue will promote the ability of patients
to receive accurate information so they can make
informed decisions about their care.
References
CDC. How to address COVID-19 vaccine misinformation.
2021. https://www.cdc.gov/vaccines/covid-19/healthdepartments/addressing-vaccine-misinformation.html
CDC. Talking with parents about vaccines for infants. 2021.
https://www.cdc.gov/vaccines/hcp/conversations/convmaterials.html
CDC. The U.S. public health service syphilis study at
Tuskegee. 2021. https://www.cdc.gov/tuskegee/index.
html
Chou W-YS, Gaysynsky A, Vanderpool RC. The COVID-19
misinfodemic: Moving beyond fact-checking. Health Educ
Behav. 2020;1090198120980675:1-5.
Kington RS, Arnesen S, Chou W-YS, Curry SJ, Lazer D, and
Villarruel AM. Identifying credible sources of health
information in social media: Principles and attributes.
NAM Perspect. 2021:10.31478/202107a. https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC8486420/
Kurpiel S. Evaluating Sources: The CRAAP Test. Benedictine
University. 2022. https://researchguides.ben.edu/sourceevaluation
Office of the Surgeon General. A Community Toolkit for
Addressing Health Misinformation. US Department of
Health and Human Services. 2021. https://www.hhs.gov/
sites/default/files/health-misinformation-toolkit-english.pdf
Stronger. How to spot misinformation. n.d. https://stronger.
org/resources/how-to-spot-misinformation
Schulz PJ, Nakamoto K. The perils of misinformation: When
health literacy goes awry. Nat Rev Nephrol. 2022. https://
www.nature.com/articles/s41581-021-00534-z
Swire-Thompson B, Lazer D. Public health and online
misinformation: Challenges and recommendations. Annu
Rev Public Health. 2020;41:433-451.
UCSF Health. Evaluating health information. n.d. https://
www.ucsfhealth.org/education/evaluating-healthinformation
Villarruel AM, James R. Preventing the spread of
misinformation. Am Nurs J. 2022;17(2):22-26. https://
www.myamericannurse.com/preventing-the-spread-ofmisinformation/
Disclaimer: The information offered within this article
reflects general principles only and does not constitute legal
advice by Nurses Service Organization (NSO) or establish
appropriate or acceptable standards of professional conduct.
Readers should consult with an attorney if they have specific
concerns. Neither Affinity Insurance Services, Inc. nor NSO
assumes any liability for how this information is applied
in practice or for the accuracy of this information. Please
note that Internet hyperlinks cited herein are active as of
the date of publication but may be subject to change or
discontinuation.
This risk management information was provided by
Nurses Service Organization (NSO), the nation's largest
provider of nurses’ professional liability insurance coverage
for over 550,000 nurses since 1976. The individual
professional liability insurance policy administered through
NSO is underwritten by American Casualty Company of
Reading, Pennsylvania, a CNA company. Reproduction
without permission of the publisher is prohibited. For
questions, send an e-mail to service@nso.com or call 1-800-
247-1500. www.nso.com.

Page 8 • Georgia Nursing July, August, September 2022
Nurse License Protection Case Study:
Administering medication without an order
Nurses and License Protection Case Study with Risk Management Strategies, Presented by NSO
A State Board of Nursing (SBON) complaint may be filed against a nurse by
a patient, colleague, employer, and/or other regulatory agency, such as the
Department of Health. Complaints are subsequently investigated by the SBON
in order to ensure that licensed nurses are practicing safely, professionally, and
ethically. SBON investigations can lead to outcomes ranging from no action against
the nurse to revocation of the nurse’s license to practice. This case study involves
a registered nurse (RN) who was working as the clinical director of a small, rural
emergency care center.
Summary
The insured RN was employed as the clinical director of a small, rural emergency
care center when they responded to a Code Blue, arriving just as the patient was
being intubated. The patient was fighting the intubation, so a physician gave a
verbal order for propofol. The RN asked the pharmacy technician to withdraw a
100-cc bottle of propofol from the medication dispensing machine and asked
another nurse to administer the medication to the patient. Shortly after the other
nurse began administering the propofol, the patient’s blood pressure dropped, so
the nurse was ordered to stop the propofol infusion.
The patient continued to decompensate and suffered respiratory collapse/arrest.
Following some delay, the patient was eventually intubated, then emergently
transferred to a higher acuity hospital for further treatment. The patient ultimately
suffered anoxic encephalopathy while he was in respiratory arrest.
A recorder was present documenting the Code, and, afterwards, another nurse
transcribed the recorder’s notes into the patient’s healthcare information record. The
recorder noted that it was the insured RN who advised the pharmacy technician to
remove propofol from the medication dispensing machine and instructed a nurse to
administer the medication. However, the recorder failed to note that the physician
gave a verbal order for the propofol. The insured RN failed to review the notes that
the recorder and nurse entered into the patient’s healthcare information record and
failed to note this error. The physician who was present during the Code also failed
to catch this error in the record.
Approximately six months later, the patient’s family filed a lawsuit against
the emergency care center. During a review of the Code record in response to
the lawsuit, it was noted that, during the Code, the RN instructed another nurse
to administer propofol. However, there wasn’t any indication in the record that a
physician had ordered the medication. The emergency care center dismissed the
RN from employment and reported the incident to the SBON. The SBON opened its
own investigation into the RN’s conduct.
Resolution
While the insured RN denied ordering
another nurse to administer propofol
without a verbal order from the physician,
the RN could not deny failing to ensure
that the propofol administration was
documented in the patient's healthcare
information record.
The RN entered into a stipulation
agreement with the SBON, under which:
• the RN’s multi-state licensure
privileges were revoked;
• the RN was required to complete coursework on nursing jurisprudence
and ethics, medication administration, documentation, and professional
accountability; and
• the RN was required to work under direct supervision for one year and submit
quarterly nursing performance evaluations to the SBON.
The total incurred expenses to defend the insured RN in this case exceeded $16,600.
Risk Control Recommendations
• Know the parameters of your state’s nursing scope of practice act, and
your facility’s policies and procedures, related to medication administration.
• Only accept verbal drug orders from practitioners during emergencies
or sterile procedures. Before carrying out a verbal order, repeat it back to
the prescriber. During a Code Blue, be sure to communicate all procedures,
medications, treatments to the recorder.
• Review Code Blue records for completeness and process of care after
each Code. Report any concerns and provide feedback through proper channels
to ensure that any errors in the record or areas of improvement are identified and
addressed.
• Document simultaneously with medication administration, whenever
possible, in order to prevent critical gaps or oversights.
Disclaimers
These are illustrations of actual claims that were managed by the CNA insurance
companies. However, every claim arises out of its own unique set of facts which must
be considered within the context of applicable state and federal laws and regulations,
as well as the specific terms, conditions and exclusions of each insurance policy, their
forms, and optional coverages. The information contained herein is not intended to
establish any standard of care, serve as professional advice or address the circumstances
of any specific entity. These statements do not constitute a risk management directive
from CNA. No organization or individual should act upon this information without
appropriate professional advice, including advice of legal counsel, given after a thorough
examination of the individual situation, encompassing a review of relevant facts, laws
and regulations. CNA assumes no responsibility for the consequences of the use or
nonuse of this information.
This publication is intended to inform Affinity Insurance Services, Inc., customers of
potential liability in their practice. This information is provided for general informational
purposes only and is not intended to provide individualized guidance. All descriptions,
summaries or highlights of coverage are for general informational purposes only and do not
amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is
governed only by the terms and conditions of the relevant policy. Any references to non-
Aon, AIS, NSO, NSO websites are provided solely for convenience, and Aon, AIS, NSO
and NSO disclaims any responsibility with respect to such websites. This information is
not intended to offer legal advice or to establish appropriate or acceptable standards of
professional conduct. Readers should consult with a lawyer if they have specific concerns.
Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this
information is applied in practice or for the accuracy of this information.
Nurses Service Organization is a registered trade name of Affinity Insurance Services,
Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS
Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services,
Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance
Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.
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July, August, September 2022 Georgia Nursing • Page 9
Human-Centered Leadership in Action: One Turtle at a Time
By Susan Campis, MSN, RN, NE-BC; susan@uleadership.com,
Kay Kennedy, DNP, RN, NEA-BC, CPHQ; kay@uleadership.com, and
Lucy Leclerc, PhD, RN, NPD-BC, lucy@uleadership.com
A man went for a walk one sunny morning and happened to see an elderly woman
sitting by a lake with a small metal cage beside her. Being a curious person, he walked
up to the woman to see what she was doing. As he approached her, he noticed the
cage was actually a trap, and the trap had three small turtles slowly walking about.
One turtle was in the woman’s lap where she was carefully and gently cleaning the
algae off its shell. “What are you doing?” the man asked. “I’m cleaning the algae and
scum from the turtle’s shells,” she replied. “The algae on their shells prevents them
from absorbing heat and affects their ability to swim.” “That’s nice of you to do, but
don’t all turtles swim with algae on their shell?” he asked. “How is cleaning off the
shell of one turtle going to make a difference? After all, 99% of all freshwater turtles
don’t have someone as kind as you cleaning their shells.” The woman looked up at
the man and then back down at the turtle in her lap, and said “If this turtle could talk,
he would say it makes all the difference in the world.”
In his book, “Learned Optimism: How to Change Your Mind and Your Life,”
Dr. Martin Seligman (2006) explains that optimism is based on the beliefs we
have about ourselves and our situation. Our explanatory style reflects the way
we habitually make sense of and explain bad, stressful, or challenging events. For
instance, pessimists, according to Seligman, believe the causes of adverse events
are permanent, pervasive, and personal. Learned optimism, however, comes
from the belief that we can change our mindset by changing the way we explain
situations to ourselves. Learned optimism is the practice of viewing situations and
experiences in a more positive manner, and involves learning to challenge negative
thoughts, ban negative self-talk, and to show ourselves the same kindness and
compassion we show others. In thinking more optimistically, we believe we have
the power to change things for the better, no matter how big or how small. Just
picture this “turtle lady” thoughtfully and mindfully caring for each of those turtles.
She is outside, on a beautiful sunny day, doing something that brings her joy. Her
optimism and hope fuel her purpose, and her purpose is to make a difference.
Human-Centered Leaders are a lot like the wise, optimistic, and purposedriven
lady we’ve described. The Human-Centered leader embraces self-care, self-
awareness, self-compassion, and mindfulness to support a mindset of optimism and
hope (Kennedy, Leclerc, & Campis, 2021). When we focus on self, first, we not only
build resilience but strengthen the capacity to focus outward. The Human-Centered
Leader acknowledges the shared human experience, whether it’s the good, the bad,
or the ugly, by recognizing humanity in self and others. This means each of us, as a
nurse leader, meets every person in our sphere of influence, where they are, without
judgment, and with an awareness of what may lie behind and within. Human-
Centered Leadership is more than just a leadership style or approach, it is who you,
as a leader, choose to be.
In the story, the man asks the elderly woman how cleaning the shell of only
one turtle would make a difference. The wise woman knows that even though
her efforts won’t affect all turtles everywhere, she is optimistically hopeful that
her actions will make a difference, one turtle at a time. It’s all in the mindset.
Remember, it starts with you.
References:
Kennedy, K., Leclerc, L., & Campis, S. (2021) Human-Centered Leadership in Healthcare:
Evolution of a Revolution. Morgan James Publishing.
Seligman, M. (2006). Learned Optimism: How to Change your Mind and your Life. Vintage
Books.

Page 10 • Georgia Nursing July, August, September 2022
Advancing Health Equity in Georgia:
A Call for Health Policy Action
Mary Gullatte Matt Caseman Gaea Daniel Patricia Horton Rose Horton Wanda Jones
Joy King Richard Lamphier Lucy Marion Lisa Muirhead Lisa Thompson
Mary Gullatte, PhD, RN, ANP-BC, AOCN, FAAN; Matt Caseman;
Gaea Daniel, PhD, RN; Patricia Horton, RN, MN, MBA, CMC;
Rose L. Horton, MSM, RNC-OB, NEA-BC;
Wanda Jones, BSN, RN, MSN, FNP-BC; Joy King, DNP, MBA, APRN, NP-C;
Richard Lamphier, RN; Lucy Marion, PhD, RN;
Lisa Muirhead, DNP, APRN, ANP-BC, FAANP, FAAN; and
Lisa Thompson, PhD, MS, RN, FNP, FAAN
Abstract
Over the past 20 years Gallup poll has repeatedly recognized nurses as the
most honest and trusted among professionals (Saad, 2022). Therefore, nurses
have a higher charge to commit to recognizing and alleviating health inequities,
and promoting diversity, equity, and inclusivity in healthcare where nurses live and
practice, and advancing the health of all Georgians. Nurses have the opportunity to
heal the heart, mind, spirit and body of our patients, their families, students, and
ourselves. Nurses have long been in a position to champion wellness and promote
health equity not only in Georgia but across the Nation and World. One pathway
nurses have to advance health equity is through active engagement in health policy
and advocacy to advance diversity and inclusivity relative to all aspects of health and
healthcare.
“They may forget your name, but they will never forget how you made them
feel.” Maya Angelou, author, poet, and civil rights activist
“For there is always light, if only we’re brave enough to see it. If only we’re brave
enough to be it.” Amanda Gorman, National Youth Poet Laureate
Introduction
Overall, the United States has the highest health spending among developed
countries with GDP reported to be at 18% in 2020; yet, the United States has some
of the poorest health outcomes of industrialized countries (Yang, 2021).
Since March 2020, the CoV-2 pandemic in the United States has re-illuminated
the pervasive inequities in healthcare across the world and the nation. Georgia
COVID-19 morbidity and mortality rates among black and brown communities

July, August, September 2022 Georgia Nursing • Page 11
and all Georgians mirror those of the nation.
Health inequities are socially constructed and have
existed since the origin of this country but are more
pronounced in the Southern United States. In addition,
Georgia has one of the highest maternal mortality rates
in the nation. Health inequities in access to care are
worsening where health services are lacking, including
access to mental health care among rural Georgians
compared to those in urban areas. These inequities are
played out in aspects of age, race, ethnicity, gender
identity, geographical location (rural or urban), as well
as lack of health insurance throughout Georgia.
Relevance to the Actual Problem
America spends more money on health care than
any other industrialized country, yet we rank among
the highest in terms of poverty rates and income
inequity. Georgia has some of the poorest health
outcomes in the United States and relative to other
developed countries (National Academy of Medicine
[NAM], 2021). Overall, the United States has the
highest health care spending among developed
countries with GDP reported to be at 18% in 2020;
yet, the United States has some of the poorest health
outcomes of industrialized countries (Yang, 2021).
US Census Bureau indicates that in 2018 a total of
27.5 million Americans had no health insurance, a
problem that has been compounded by the COV-2
Pandemic effect in the US (https://www.statista.com/
statistics/184968/us-health-expenditure-as-percent-ofgdp-since-1960/).
Many Americans choose to postpone
seeking medical treatment because of lack of insurance
and expendable cash to pay for health care access
(https://policyadvice.net/insurance/insights/how-manyuninsured-americans/?nowprocket=1).
It is reported that around 44 million adults in the
US do not have health insurance, while 38 million do
not have adequate health coverage (https://www.
statista.com/statistics/184968/us-health-expenditureas-percent-of-gdp-since-1960/).
This is not just an
issue of uninsured elderly across the nation. Figure 1
depicts the uninsured rates among the nonelderly US
population.
The intersectionality of longstanding health
inequities and deep social injustices has gained global
and national attention during the COVID-19 pandemic.
The disproportionate higher disease burden and
increased risk exposure are closely associated with
social, economic, or environmental disadvantages that
adversely affect certain groups. These health disparity
trends are seen in a wide range of diseases and
health conditions among racial, ethnic, geographic,
socioeconomic, and other groups (CDC, 2020; CDC,
2013). Recognizing the role of social and structural
factors on health and health outcomes is critical in
developing multi-prong solutions to achieve health
equity nation-wide. There is increasing evidence that
conditions where people are born, live, learn, work,
play and age are major underlying determinants of
health that contribute to multi-generational variances in
health impact and outcomes These social and structural
forces include quality of education, socioeconomic
status, housing, employment, neighborhood and
environment, social capital, and access to health
care. All are strong influencers in health and health
consequences that extend beyond health systems'
recognition as the single driver in shaping health
(Artiga & Hinton, 2018).
Georgia by the Numbers
Georgia has 1.4 million that are uninsured, making
Georgia’s uninsured rate 13.7%, the third highest in
the United States. In rural Georgia, the uninsured rate
could be as high as 25 percent by 2026 (GA Waiver.
Georgia Environmental Scan Report_07082019.pdf )
and (Cover Georgia coverga.org).
The profile of Georgia’s uninsured generally reflects
national trends for education and income:
• 27% of the uninsured population have not
graduated high school
• 31% of the uninsured population has an annual
household income less than $25,000
Georgia also ranks among the bottom five states
for women’s health insurance coverage. About 36% of
Georgians in the coverage gap are black and 22% are
Latinx. Only 41% of Georgia employers offer employersponsored
health insurance.
Additionally, access to mental health treatment
is lacking for both children and adults due to lack of
mental health care options, scarce resources, and
inadequate or no insurance, especially in rural Georgia.
This also includes lack of mental health support for
Georgia’s Opioid abuse prevention and treatment.
• In 2020, Georgia ranks last in the country for
access to mental health care, resources, and
insurance (Mental Health America, 2021)
• Those with a serious mental illness is 20% more
likely to end up in prison instead of a hospital
(Mental Health America of Georgia, 2021a)
• Two in five children who need mental health
treatment have trouble accessing it (Mental
Health America of Georgia, 2021a)
• Although mental illnesses are biological
disorders of the brain, they are not treated
as seriously and urgently as physical illnesses
(Mental Health America of Georgia, 2021b)
• All rural counties in Georgia have a shortage
of mental health care providers (Rural Health
Information Hub, 2021)
Georgia has an opportunity to move from one of
the worst states in the nation, in terms of important
health outcomes, to FIRST by advancing health
equity for all people of Georgia (GA Waiver. Georgia
Environmental Scan Report_07082019.pdf ) and (Cover
Georgia coverga.org).
Social Determinants of Health
To fully understand the adverse effects of social
determinants of health (SDOH), it is important to
recognize the role structural racism and discrimination
play in achieving optimal health outcomes and safety.
The systemic effects of racism have been baked into
American society, and healthcare systems are not
exempt from these historical roots. The Institute of
Medicine (2003) landmark report “Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health
Advancing Health Equity in Georgia continued on page 12

Page 12 • Georgia Nursing July, August, September 2022
Advancing Health Equity in Georgia continued from page 11
Care” describes the disturbing health care experiences
of individuals from underrepresented groups and
the impact of racial, ethnic, and other forms of
discrimination have on quality of health care. Little
sustained change has occurred in reducing health
disparities since this report 19 years ago.
Social, economic, and environmental inequities,
and psychosocial trauma, and residential segregation
have been examined and provide pathways to
understanding the interconnectedness of structural
racism and poor health (Bailey et al, 2017; Yearby,
2020). Although these issues are complex, they
add a contextual framework in understanding the
relationships among these concepts and help to
organize approaches to achieve health equity.
To address health inequities imposed by the
social determinants of health and other barriers it is
important to have some common evidence supported
definitions (see Table 1). Additionally, it is important to
engage people across multiple disciplines and sectors.
One important sector is nursing. Nursing has been
recognized as a key player not only in the health care
workforce, but also for the central role nurses play in
building healthier communities and achieving health
equity where everyone has a fair opportunity for
quality health care (Robert Wood Johnson Foundation,
2020). The National League of Nursing (2019)
highlights the impact Social Determinants of Health
(SDOH) has on health equity, social justice, and health
outcomes, and recommends that SDOH integration in
nursing education curricula is critical to advance the
health of national and global communities. American
Association of Colleges of Nursing’s (AACN) newly
released Essentials for professional nursing education
calls for competencies that reflect an understanding
of the interrelatedness of SDOH, systemic racism, bias,
and health equity (AACN, 2021). AACN acknowledges
how imperative it is for a prepared nursing workforce
to address the persistent and pervasive health
inequities in urban and rural areas where there are
unequal distribution of resources and access to
healthcare services (AACN, 2021).
Although, there are many drivers of health
disparities and the magnitude and complexity of
these problems cannot rely on one discipline alone for
solutions, nursing is key to any organized health system
approach to advance health equity among Georgians.
For 20 consecutive years the Gallup Poll reports
nurses rated highest among a list of professionals in
honesty and ethics (Saad, 2022). The first principle in
the American Nurses Association (ANA) Code of Ethics
for Nurses reads that, “the nurse, in all professional
relationships, practices with compassion and respect
for the inherent dignity, worth, and uniqueness of
every individual unrestricted by consideration of social
or economic status, personal attributes, or the nature
of the health problems.” p.1.
The Healthy People 2020 declaration placed an
emphasis on eliminating health disparities as cited:
Health disparities adversely affect groups of people
who have systematically experienced greater social or
To access electronic copies of
Georgia Nursing, please visit
http://www.NursingALD.com/publications
Table 1 Socialization to Health Inequity Definitions
Topic Definition Source of Evidence
Health Disparity
Racial/ethnic inequities
Implicit Bias
Racism
Structural Racism
Cultural Racism
Institutional Racism
Social Determinants of
Health (SDOH)
SDOH-from Healthy
People 2030 and
National Academies of
Medicine –Future of
Nursing 2020-2030
An increased burden of an adverse health
outcome or health determinant within a specific
subset of the population
Racial differences in health date back to some of
our earliest health records in the United States
with blacks (or African Americans) having poorer
health than whites across a broad range of health
status indicators.
Cultural stereotypes may not be consciously
endorsed, but their mere existence influences how
information about an individual is processed and
leads to unintended biases in decision-making.
Prejudice (differential assumptions about the
abilities, motives, and intentions of others
according to their race) and discrimination
(differential actions toward others according to
their race
The biased societal approach to housing,
education, employment, healthcare, and criminal
justice.
Is a process whereby people who are strongly
identified with certain ‘language groups, religion,
group habits, norms and customs, including
typical style of dress, behavior, cuisine, music
and literature, are treated in a prejudicial and
discriminatory way based on these characteristics
(Goldberg, 1993, p.70).
A system that categorizes people based on
race, color, ethnicity, and culture to differentially
allocate societal goods and resources in a way
that unfairly disadvantages some, while without
merit, rewards others. As a system, racism has
been institutionalized in a way that permits the
establishment of patterns, procedures, practices,
and policies within organizations that consistently
penalizes and exploits people because of their
race, color, culture or ethnic origin.
The conditions in the environments where people
are born, live, learn, work, play, worship, and age
that affect a wide range of health, functioning,
and quality-of-life outcomes and risks.
Social determinants of health (SDOH) have a
major impact on people’s health, well-being, and
quality of life and contribute to health disparities
and inequities. They affect everyone at some level
or at some time. Examples of SDOH include:
• Safe housing, transportation, and
neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical
activity opportunities
• Polluted air and water
• Language and literacy skills
• Income and wealth
• Public safety
• Transportation
• Social Environment
Wheeler & Bryant (2017) Obstet Gynecol Clin
North Am. Mar;44(1):1-11
Williams, D. & Sternthal, M. (2010).
Understanding Racial/ethnic Disparities in
Health: Sociological Contributions. J Health
Soc Behav.; 51(Suppl): S15–S27.
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3468327/
Chapman, E., Kaatz, A. & Carnes, M. (2013).
Physicians and implicit bias: how doctors may
unwittingly perpetuate health care disparities.
J Gen Intern Med 28(11):1504-10.
https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3244674/
https://www.medpagetoday.com/blogs/
kevinmd/84362
Goldberg D (1993) Racist Culture: philosophy
and the politics of meaning. Oxford: Blackwell.
Hamel J (1993) Case Study Methods. Newbury
Park: Sage Publications.
Shepherd,SM, Willis-Esqueda,C, Paradies,
Y., Sivasubramaniam, D., Sherwood, J. &
Brockie, T. (2018). Racial and cultural minority
experiences and perceptions of health
care provision in a mid-western region.
International Journal for Equity in Health
volume 17, Article number: 33.
https://www.aafp.org/about/policies/all/
institutional-racism.html
Williams, D., Lawrence, J & Davis, B. Racism
and Health: Evidence and Needed Research
Annual Rev Public Health. 2019 April
01; 40: 105–125. doi:10.1146/annurevpublhealth-040218-043750
https://health.gov/healthypeople/objectivesand-data/social-determinants-health
https://www.ncbi.nlm.nih.gov/books/
NBK573923/#pz64-2
Bharmal N, Derose KP, Felician M, Weden
MM. Understanding the upstream social
determinants of health. Santa Monica, CA:
RAND Corporation; 2015
NASEM. Vibrant and healthy kids: Aligning
science, practice, and policy to advance
health equity. Washington, DC: The National
Academies Press; 2019b.
Social and Health
Policy Decisions
Economic inequities
Political and Moral
Determinants of
Health
Racism is a fundamental cause of health inequities
and disease, which requires policy solutions
that address this cause directly rather than only
targeting mechanisms.
Wage and employment gaps
Federal poverty level 2021: Annual income
1 person household= $12,880
2 person Household =$17,420
4 person Household =$26,500
Political determinants of health lie even further
upstream than the social determinants of health –
Looking further upstream through the lens of the
political determinants of health, one can see how
the placement of the bus depot and interstate
stemmed from redlining policies, displacement of
minorities, and zoning decisions. If the minority
community had had political power, those
decisions would have been made differently.
The political determinants of health shape the
social drivers of health equity.
Cogburn, CD (2019). Culture, Race, and
Health: Implications for Racial Inequities and
Population Health Milbank Q.97(3):736-761.
Columbia University School of Social Work
US Department Health and Human Services
Poverty Guidelines: Jan 15,2021.
https://aspe.hhs.gov/poverty-guidelines
Dawes DE. Health inequities: a look at the
political determinants of health during the
COVID-19 pandemic. American Journal of
Health Studies. 2020;35 (2):77-82
Berwick DM. The moral determinants of
health. JAMA. 2020;324(3):225-226
Pepin D, Winig BD, Carr D, Jacobson PD.
Collaborating for health: health in all policies
and the law. The Journal of Law, Medicine &
Ethics. 2017;45(1)
Advancing Health Equity in Georgia continued on page 14

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Advancing Health Equity in Georgia continued from page 12
economic obstacles to health based on their racial or
ethnic group, religion, socioeconomic-status, gender,
age, or mental health; cognitive, sensory, or physical
disability; sexual orientation or gender identity;
geographic location; or other characteristics historically
linked to discrimination or exclusion (http://www.
healthypeople.gov/2020/about/disparitiesAbout.aspx).
The newly released National Academy of Medicine
(NAM) report (May 2021 http://nap.edu/25982): Future
of Nursing 2020-2030: Charting a Path to Achieve
Health Equity addresses equity issues across research,
practice, and academia. Specifically, the report asserts
that:
A nation cannot fully thrive until everyone - no
matter who they are, where they live, or how much
money they make - can live their healthiest possible
life, and helping people live their healthiest life is
and has always been the essential role of nurses.
Nurses have a critical role to play in achieving
the goal of health equity, but they need robust
education, supportive work environments, and
autonomy.
The report calls upon nurses to take a more active
leadership role in promoting health equity and cited the
following:
Conclusion 9-1: Nurse Leaders at every level and
across all settings can strengthen the profession’s
long-standing focus on social determinants of health
and health equity to meet the needs of underserved
individuals, neighborhoods, and communities and to
prioritize the elimination of health inequities.
Given that social determinants that affect health
exist largely outside of the health care system (e.g.,
poverty, literacy, housing, transportation, and food
security), addressing SDOH and eliminating health
disparities will require collaboration and partnership
among a broad group of stakeholders. Public health
nurses have a long history of working collaboratively
to meet social needs and address SDOH, and their
experiences can be used as models for other nurses
seeking to work collaboratively across sectors.
Conclusion 9-2: Achieving health equity will require
multisector collaboration, and nurse leaders can
participate in and lead these efforts. The Future
of Nursing 2020-2030: Charting a Path to Achieve
Health Equity p. 295.
The dynamic evolution of the health care landscape
and transitioning profile of the US Population is
changing health care delivery systems including
where, and how, care is delivered (e.g., increased
focus on rural health equity, disparities related to race,
age, mental health, ethnicity, increase in telehealth
programs). The Department of Health and Human
Services [DHHS] identified one of the five overarching
goals in the Healthy People 2030 specifically related
to Social Determinants of Health “Create social,
physical, and economic environments that promote
attaining the full potential for health and well-being for
all” (https://health.gov/healthypeople/objectives-anddata/social-determinants-health).
Table 1 outlines key topic definitions included in
discussions about Health Equity and Inequity with
accompanying sources of evidence that provide a link
for socialization to the issues.
Relevance to the Health of Georgians
‣ 122 of the 159 counties in Georgia are designated
as rural and these counties have lower access to
hospitals and providers, including a robust nurse
workforce, leading to rural health care disparities
in Georgia.
‣ Georgia has the second-highest rate of maternal
mortality at 48.4 per 100,000 in the United
States.
‣ There is unequal access to healthcare services in
designated rural vs non-rural counties.
‣ The current environment needs to be reconfigured.
Food deserts (limited access to
affordable, nutritious food) and food swamps
(abundance of fast food, junk food, convenience,
and liquor stores) abound in low-income
communities. These same communities also need
safe and affordable housing.
Georgia Health Needs
‣ Increase access to pharmacy services and
eliminate pharmacy deserts in rural and lowincome
communities.
‣ Increase public awareness about healthcare issues
and services in Georgia.
‣ Expand Medicaid
‣ Expansion programs to prevent and treat Opioid
abuse
‣ Expansion of mental health services for children
and adults and active and retired military veterans
and their family
Georgia Health Policy Recommendations
In order to achieve the goal of HEALTH EQUITY
FOR GEORIGANS: EVERY PERSON, EVERY
COUNTY, and EVERY DAY, we recommend the
following items for action:
‣ Increase access to comprehensive, quality health
care services throughout the state of Georgia
• Identify and close the gaps in health care
access across the 122 rural counties
• Invest in fast speed internet for the entire
state-specially with focus on rural counties
• Expand and reimburse for Telehealth visits
equally for physicians and advance practice
providers (APPs: Nurse Practitioners and
Physician Assistants)
• Enact legislation to support top of license
practice for APPs
• Provide access to pre- and post-natal health
care to all women in Georgia to eliminate
preventable maternal morbidity and mortality
• Reduce cancer disparities through equal
access to screenings and cancer clinical trials
• Assure Georgians equal access to healthcare
and prescription medications.
• Increase Medicaid expansion in the state
• Provide school nurse or licensed health care
provider resource in all primary & secondary
schools throughout the state
• Improve behavioral health resources directed
to those in need including Opioid abuse
prevention and treatment and for Georgia
veterans and their family
Advancing Health Equity in Georgia continued on page 16

Page 16 • Georgia Nursing July, August, September 2022
Advancing Health Equity in Georgia continued from page 14
‣ Strengthen public health infrastructure
immediately and plan for the future
• Increase awareness about public health and
healthcare services
• Prepare for disasters, such as extreme
weather and pandemics, through public
health measures
‣ Develop and maintain a robust healthcare
workforce that involves academia, research, and
practice
• Champion Diversity, Equity, and Inclusivity
[DEI] in the workplace and community
• Ensure workforce demographics reflect
population served
• Advance legislation to reduce practice
restrictions among Advanced Practice
Registered Nurses (APRNs)
• Provide community outreach practicums and
integrate public/community health material in
Schools of Nursing in their curriculum
• Support HB430 to mandate collect workforce
data and survey part of re-licensure, including
separate APRN license
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• Support initiatives that increase pipelines that
allow high school students to understand the
role of the nurse
• Build financial incentive programs that
support nurses to advance their degrees
• Expand the workplace violence legislation to
include all healthcare providers and workers
including first responders.
‣ Address implicit biases and enhance cultural
humility across academia, research, and practice
• Develop programs that train students, staff,
and faculty across Georgia Schools of Nursing
Education. Ensure accountability measures to
foster sustainability
• Prepare our healthcare workforce to work
with diverse populations in Georgia
• Increase patient access to clinical trials to
advance care outcomes among diverse
populations, especially those who live in rural
areas in Georgia
‣ Build political will to address and eliminate health
disparities in Georgia
• Eliminate preventable maternal morbidity and
mortality
• Decrease infant mortality in Blacks by 10% by
2030
• Support & fund home visits (nurse family
partnership)
• Initiate policies to promote legislation for
compassionate immigration reform
• Promote legislation to end hunger and
homelessness in Georgia
• Restore order, dignity, and equity to
democratic institutions and ensure every
person’s right to vote is protected and
counted equally
‣ Implement strategies to intentionally focus on
mental health
• Support non-profit organizations focused on
the treatment and/or management of mental
illnesses, as well as the promotion of mental
health and wellness
• Incentivize health care professional students
who focus on becoming mental health
providers with scholarships and loan
repayment options
• Build digital and policy infrastructures to
support telehealth for mental health care
• Require law enforcement offices to hire a
proportionate number of mental health
providers to receive specialized training to
assist, support, and lead (when necessary)
de-escalate encounters between police/
sheriff’s officers and civilians
• Incentivize health care organizations that
focus on the treatment of mental illness
• Incentivize health care organizations to
expand telemedicine to support rural health
care needs
A call for all Georgia nurses to support your
professional nurses associations, personally contact
your state legislators (get to know them and them to
know you), and exercise your right to VOTE in every
election: local, state, and national. Nurses will have a
pivotal role in transforming health care as we vision
a post pandemic future. Remember to exercise your
VOICE with your VOTE.
Evidentiary Support and References
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HIRING
RNs & LPNs
Join the Crisp Regional Team!
crispregional.org
Contact: Ashley Purvis, Human Resource Recruiter at
229-276-3113 • apurvis@crispregional.org

July, August, September 2022 Georgia Nursing • Page 17
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Page 18 • Georgia Nursing July, August, September 2022
Advancing Health Equity in Georgia continued from page 17
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Apr;26(4):458. doi: 10.1038/s41591-020-0823-6. PMID: 32284617.Weil AR.(2017).
Pursuing Health Equity. Health Affairs (Millwood). Jun 1;36(6):975. doi: 10.1377/
hlthaff.2017.0583. PMID: 28583952 (Retrieved December 2019)
Wheeler SM, Bryant AS. Racial and Ethnic Disparities in Health and Health Care.
Obstet Gynecol Clin North Am. 2017 Mar;44(1):1-11. doi: 10.1016/j.ogc.2016.10.001.
PMID: 28160887.
Williams DR, Lawrence JA, Davis BA. Racism and Health: Evidence and Needed
Research. Annu Rev Public Health. 2019 Apr 1;40:105-125. doi: 10.1146/annurevpublhealth-040218-043750.
Epub 2019 Feb 2. PMID: 30601726; PMCID:
PMC6532402.
Williams DR, Cooper LA. Reducing Racial Inequities in Health: Using What We
Already Know to Take Action. Int J Environ Res Public Health. 2019 Feb 19;16(4):606.
doi: 10.3390/ijerph16040606. PMID: 30791452; PMCID: PMC6406315.
Williams DR, Purdie-Vaughns V. Needed Interventions to Reduce Racial/
Ethnic Disparities in Health. J Health Polit Policy Law. 2016 Aug;41(4):627-51. doi:
10.1215/03616878-3620857. Epub 2016 Apr 28. PMID: 27127267
Yang, J. (2021). U.S. health expenditure as percent of GDP 1960-2020. https://
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1960/#:~:text=The%20United%20States%20has%20the%20highest%20health%20
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Yearby, R. (2020). Structural racism and health disparities: Reconfiguring the
social determinants of health framework to include the root cause. The Journal of
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Zimmerman FJ.(2019). A robust health equity metric. Public Health. Oct;175:68-
78. doi: 10.1016/j.puhe.2019.06.008. Epub 2019 Aug 9. PMID: 31404717.

July, August, September 2022 Georgia Nursing • Page 19
Meet some of the 2022 GNA Conference exhibitors!
Getting Clear on Bullying Versus Incivility
Reprinted with permission from
The Florida Nurse February 2022 issue
Renee Thompson, DNP,
RN, CSP
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 Dr. Renee Thompson
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
al., 2021).
• 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., 2019).
• 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,
2017).
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.
BULLYING
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 ethnic
background.
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
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
Congratulates
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
culture.
References
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), 828–834. doi:10.1001/
jamasurg.2019.1738
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
Bio:
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
bullying.
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by location and credentials.
Browse our online database of articles and content.
Find events for nursing professionals in your area.
Your always-on resource for nursing jobs, research, and events.
LaDonia Patterson, EdD, RN,
on receiving the Health eCareers
Nursing Diversity, Equity, and
Inclusion Award
Georgia Baptist College of Nursing
Celebrates its 120th Anniversary | 1902-2022
mercer.edu | nursing.mercer.edu

Page 20 • Georgia Nursing July, August, September 2022
Where Do I Go From Here?
Sharon Broscious, PhD, RN
Program Director South University RN-BSN
Online Program
Reprinted with permission from Virginia Nurses
Today, August 2021 issue
As the COVID-19 pandemic winds down, you
may be asking yourself questions about your
professional future. What’s my next career step?
What does my professional future hold for me? The
stress of the COVID-19 pandemic may have created
these nagging questions for you, and you might
be unsure what steps you should take to answer
them. The physical, emotional, psychological, and
financial impact of the pandemic on nurses has
been well documented. A plethora of publications
in professional journals and on websites as well as
newspaper and television reports have discussed the
impact of the COVID-19 pandemic on nurses. Terms
such as burnout, compassion fatigue, moral injury,
PTSD, and healthcare worker exhaustion are used to
describe the physical and mental effects of COVID-19
on healthcare providers (Chan, 2021; ICN, 2021). In
an interview on NPR, the phrase “crushing stress” of
the COVID-19 pandemic was used (Fortier, 2020).
Not only did the nursing workload change –
increased number of patients per assignment,
increased number of shifts, increased length of
workday due to insufficient staff – but also other
factors compounded the stress on staff. Lack of
equipment such as PPE, the unknowns about the
disease itself with policies changing almost daily,
and perceived lack of support from leadership have
also contributed to the COVID effect (ICN, 2021) on
nurses. Some facilities attempted to prepare and
support staff for the pandemic surges, to varying
levels of successful impact. While providing meals to
nurses who could not take time for a meal break was
helpful, as the pandemic persisted, nurses needed
more support from their leadership teams.
The recent COVID-19 report released by the
International Council of Nurses (ICN) (2021) describes
the exacerbation of burnout and exhaustion of
nurses during 2020. National nursing associations
reported approximately 80% of their members
identified as feeling stressed. In a survey of
healthcare workers conducted by Mental Health
America (Lagasse, 2020), 93% indicated feeling
stressed, and 76% reported feeling burned out
with 55% questioning their career focus. Similar
results were found in a survey from Brexi (2020) with
84% of responding healthcare workers identifying
some burnout and 18% reporting total burnout. In
addition, almost half had considered quitting their
job, retiring, or changing their career focus. The
top five stressors that respondents identified, in
order, were “fear of getting COVID-19, long hours/
shifts, general state of the world, fear of spreading
COVID-19, and family responsibilities/issues” (Berxi,
2020, para 2). Additional stressors identified by
Shun (2021) include physical, emotional and moral
distress related to ethical issues faced by nurses such
as dealing with patient deaths, scarce resources, and
forced changes in practice.
The 2021 Frontline Nurse Mental Health and
Well Being Survey (Trusted Health, 2021) revealed
for nurses under age 40, 22% indicated they were
less committed to nursing. Ninety-five percent of
the nurses responding indicated their physical and
mental health were not a priority in their workplace
or the support received from leadership was
inadequate. Finally, 66% of respondents indicated
they were experiencing depression and a decline in
their physical health. A poll by the Washington Post-
Kaiser Family Foundation (2021) indicated 62% of
healthcare workers felt mentally stressed from the
pandemic with their greatest fears of them getting
infected, infecting their families, or other patients.
Another challenge identified was working while
wearing PPE (Kirzinger et al., 2021).
Prior to the pandemic, Shah, et al. (2021) reported
burnout was the third leading cause of nurses
leaving their jobs. However, the pandemic intensified
levels of stress and burnout. From the perspective
of Maslow’s hierarchy, Virkstis (2021) described the
need for leadership to focus on basic needs of staff,
not high level self-actualization. The basic needs
were identified as: a safe working environment, clear
mission, time to reflect on what was happening, and
time to connect with peers.
Considering the factors identified here, it is no
surprise that you may be asking what is the next
step for you in handling stress, burnout, and career
questions.
Step 1 – Do I stay where I am?
You may be asking the following: Do I leave my
job as other nurses have? Do I want to, or can I
continue working where I am? Do I just need some
time off?
The first step to take is self-reflection or selfevaluation.
If you are unsure about a change, pause
and take some time to think about it. Consider
staying where you are to determine how your
workday has changed after COVID-19 and whether
factors such as workload, staffing, and equipment,
for example, have improved. Remember wherever
you go, everyone will be rebuilding after the
pandemic and trying to return to a previous level
of normalcy, or an improved level based on lessons
learned from the pandemic.
Before making a decision, reflect on your job prior
to the pandemic. Was this job a good fit for you?
Were you happy with your job? Answers to these
questions can guide you to remain in your current
job to see if those same positive feelings come
back after the pandemic. The area you work in may
not be exactly the same as it was, but it could be
even better. Other reasons leading you to consider
a change may include the work environment,
the leadership of your current unit, or lack of
potential for growth in your current position. This
introspective evaluation provides time to think about
other opportunities or make plans for change if that
is your final decision.
Step 2 – Do I change my career path?
There are numerous websites that provide steps to
take when changing your specialty or your role, but
the first step should be:
1. Identify your passion. What makes you happy?
Self-reflection and serious thought can help
provide this answer.
Additional steps to consider include:
2. Complete a SWOT analysis. Guidelines for
completing a SWOT analysis can be found on
the internet.
• Identify your strengths: skills, experiences,
education, support from peers/family.
• Identify weaknesses: communication skills,
leadership skills, skills needed for a new path.
• Identify opportunities: What specialty areas
might be of interest? Do you want to be in a
hospital or in the community? Do you want
to move to administration or education and
have less direct patient contact? What works
for your family? The Johnson & Johnson
Campaign for Nursing’s Future, provides
information about 96 nursing specialties; this
might be a good place to start looking for new
opportunities as it may present some potential
employment ideas you had not previously
considered. A list of more than 100 nursing
organizations is available at https://nurse.org/
orgs.shtml In addition, the Illinois Nursing
Workforce Center web page includes a list
of professional nursing organizations (http://
nursing.illinois.gov/nursingspeciality.asp).
• Identify threats. What barriers exist that might
keep you from making this change – family
responsibilities, work hours desired, access to
a new role in your geographic area, skills or
specific educational background needed. A
threat such as educational level may turn into
an opportunity to return to school.
3. What are your goals in five or ten years?
4. When you have decided on a new role –
develop an action plan or timeline to establish
your transition to the new role. What steps do
you need to take to make this change?
5. Refresh your resume. While you may consider
that a move from pediatrics to geriatrics would
not provide you with appropriate skills, there
are many skills you have that are transferable
– your assessment skills for example,
understanding lab results, providing care to
someone who may be unable to describe how
they feel, or organization skills.
6. Network. Talk to someone who currently
works in the specialty you are considering. If
the specialty has a professional organization,
peruse their website, attend a local meeting, or
read their journals and social media networks
to help you connect with nurses in the specialty
you are considering.
7. Draw on your support system and mentors to
overcome any barriers/challenges that may be
keeping you from making a change.
8. Resources on the VNA/ANA websites provide
information about available jobs, resume
writing, and interviewing. Scheduling a live
meeting with a career coach is also available.
9. After you have made a specialty change, give
yourself a chance to get acclimated to the new
path you have chosen.
10. Consider staying on good terms with your
current employer. A reference will be needed
when applying for a new position. Staying on
good terms may also be beneficial if the new
specialty or organization change does not work
out.
Step 3 – Do I leave nursing and change my
profession?
Your reflection may lead you to leaving the
nursing profession. Many of the steps in this
process are the same or similar to the steps above in
changing your career path.
1. Begin again with self-reflection/evaluation.
What makes you feel fulfilled? What would you
like to do? What are your interests?
2. Identify areas of interest. There are a number
of free aptitude tests available on the internet
that can guide you in identifying a new career
or attend a career fair. New careers could be
with pharmaceutical companies, insurance
companies, the government, or in education for
example.
3. Complete a SWOT analysis
4. What are your goals?
5. Identify the skills/education needed for the new
career
6. Develop action plan
7. Network
8. Career counseling – obtain a career coach, see
the VNA/ANA websites
9. Connect with your support system
10. Keep your license current, you may decide
at some point in time you want to return to
nursing.
The COVID-19 pandemic has likely changed you
personally and professionally, has certainly changed
healthcare, and has without a doubt changed the
world. What you do to fulfill your life is a priority, so
take time to carefully consider what you want to do
and where you want to be.
As Steve Jobs (2005) said, “Your work is going to
fill a large part of your life, and the only way to be
truly satisfied is to do what you believe is great work.
And the only way to do great work is to love what
you do. If you haven’t found it yet, keep looking.
Don’t settle. As with all matters of the heart, you’ll
know when you find it.”
References
Berxi. (December 8, 2020). State of healthcare workers in
2020. Business Wire. https://www.businesswire.com/
news/home/20201208005303/en/
Chan, G.K., Bitton, J.R., Allgeyer, R.L., Elliott, D.,
Hudson, L.R., Moulton Burwell, P. (May 31, 2021)
The impact of COVID-19 on the nursing workforce: A
national overview OJIN: The Online Journal of Issues
in Nursing 26 (2), Manuscript 2. DOI:10.3912/OJIN.
Vol26No02Man02
Fortier, J. (December 16, 2020). ICU Workers are quitting
due to crushing stress from COVID-19 surge. (Radio
broadcast) Morning Edition – NPR.
International Council of Nurses. (January 13, 2021). The
COVID-19 Effect: World’s nurses facing mass trauma,
an immediate danger to the profession and future of
our health systems.

July, August, September 2022 Georgia Nursing • Page 21
ICN, https://www.icn.ch/news/covid-19-effect-worldsnurses-facing-mass-trauma-immediate-dangerprofession-and-future-our
Jobs, S. (June 12, 2005), Stanford Commencement
Address. https://news.stanford.edu/2005/06/14/jobs-
061505/
Kirzinger, A, Kearney, A, Hamel, L., & Brodie M. (April 6,
2021). KFF/The Washington Post Frontline Health Care
Workers Survey. https://www.kff.org/report-section/
kff-the-washington-post-frontline-health-care-workers-
survey-toll-of-the-pandemic/?utm_campaign=KFF-
2021-polling-surveys&utm_medium=email&_hsmi=2&_
hsenc=p2ANqtz--iaCcoAuZ0CZUTZn7HHpdxV5L9Fu
ps2XQo2KMt8EYKKP_J3ppmXnSGWTPlbCKV22LE_
QkSI0MO__BEFpHKrtaZ9CXF8w&utm_
content=2&utm_source=hs_email
Lagasse, J. ed (December 8, 2020) Healthcare workers
experiencing burnout, stress due to COVID-19
pandemic. Healthcare Finance News https://www.
healthcarefinancenews.com/news/healthcare-workersexperiencing-burnout-stress-due-covid-19-pandemic
Shun, S.C. (2021). COVID-19 Pandemic: The challenge
to the professional identity or nurses and nursing
education. The Journal of Nursing Research 29(2), e138.
doi: 10.1097/JNR.0000000000000431
Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N.,
Moore, M., & Ali, M. (2021). Prevalence of and
factors associated with nurse burnout in the US.
JAMA Network Open 4(2), e2036469 doi:10.1001/
jamanetworkopen.2020.36469
Trusted Health. (2021). 2021 Frontline Nurse Mental
Health & Well- Being Survey https://www.
trustedhealth.com/notahero
Virkstis, K. (March 11, 2021). Nurse burnout didn’t start
with Covid-19. (And it won’t end with Covid-19,
either.). Advisory Board https://www.advisory.com/
daily-briefing/2021/03/11/nurse-burnout

Page 22 • Georgia Nursing July, August, September 2022
Courage in Everyday Nursing Practice
Carol Dobos PhD, RN-BC, NEA-BC
Reprinted with permission from
Arizona Nurse, July 2021 issue
Courage is an important attribute in life and in
your nursing practice. As Helen Keller said,
“Security is mostly a superstition. It does not exist
in nature nor do the children of men as a whole
experience it. Avoiding danger is no safer in the long
run than outright exposure. Life is either a daring
adventure, or nothing.”
Nursing is a noble profession that is not for the
faint of heart. Opportunities to choose courageous
acts present themselves on a regular basis because
risk is everywhere. You can attempt to minimize the
risks by playing it safe. However, there are risks to
yourself, your colleagues, your profession, and those
you serve when you don’t take risks in showing up,
speaking up, or practicing according to the highest
standards of evidence-based practice.
Choosing to practice courageously, consistent
with your personal and professional values, will
cause some discomfort, bumps, and bruises to you
and your career. It will also bring professional and
personal fulfillment, strengthen the profession, and
improve patient outcomes. You will know that you
are making a difference in your daily practice and
throughout your nursing career.
One way to cultivate courageous behavior is
through personal risk-taking (PRT), but first you
need to understand the nature of risk and its related
concept, positive deviance.
What is Risk?
Risk is defined as the possibility of losing
something of value, which could be physical,
psychological, or economic. Common risks include
falling out of favor with others in authority, losing
support, or damaging essential relationships.
Any of these events could lead to losing status or
influence at work, or even losing one’s position or
employment.
A related concept called “positive deviance” refers
to an intentional act of breaking the rules to serve
the greater good. Positive deviance is intentional and
honorable behavior that departs or differs from an
established norm. It contains elements of innovation,
creativity, adaptability, or a combination thereof; and
it involves risk for the nurse.
For most nurses, whether a particular action
is right or wrong will often be judged by others in
charge of rules enforcement. The decision to engage
in positive deviance, however, lies entirely with the
nurse.
Personal Risk-Taking
PRT is behavior that is consciously and freely
chosen among available alternatives, some of which
are known to incur less risk than the chosen action.
It is supported by the strength and belief of personal
convictions. Courageous action upholds principles.
Calculated inaction due to fear leaves one powerless,
with values compromised.
Nurses promote courageous action by sharing
courageous behavior, also called hero stories. This
can be done formally and informally, verbally and
in writing, one on one or in groups, during staff
meetings, during change of shift report, or rounds.
We create a culture based on what we talk about,
what we value, and what we support and reward.
Sometimes we stand alone, and sometimes we
influence others to follow our lead and take their
own personal risks. In one study, risk taking was
found to be one of the key elements in attaining
expert nursing practice, which supports effective
and quality-based healthcare outcomes. Risk taking
also was found to enhance clinical and professional
development.
Rather than sitting on the sidelines and hurling
judgment or advice at others (for example,
“Someone needs to do something about this.”), we
must dare to show up and let ourselves be seen,
which can result in change. (See Success story.)
Success story
When residents were not interacting appropriately
with pediatric patients, risking psychological harm, I
discussed this with the chief and arranged education.
I advised our team that in identifying this issue,
relationships might become strained, but we had an
obligation to our patients to address this problem. I
often used the mantra “I am doing the right thing
for the right reason” stating it over and over in my
head to help me stay the course and follow through
with my convictions. As feared, the residents and
even an attending physician demonstrated passive
aggressive behavior towards us. The care of the
children did improve, however, and we knew we had
made the right call.
We pay a price when we shut down and
disengage, failing to take action. I have heard
nurses talk about “staying under the radar.” In
doing so they pay a dear price. Their talents,
wisdom, knowledge, and values are not being
shared to positively influence care and support the
development of new nurse graduates and other
colleagues through courageous role modeling.
Vulnerability occurs in sharing an unpopular opinion,
standing up for oneself or others such as a colleague
who is being bullied, being accountable, asking for
help, trying something new, admitting uncertainty,
and asking for forgiveness. When courage and fear
meet, it often feels awkward and scary; however,
“being all in” is to be alive. To act in alignment
with your values is key to personal and professional
happiness.
PRT and Promoting Patient Safety
Failing to take risks and practice courageously
can lead to threats to patient safety. Focusing on
my obligation to “First do no harm,” I made the
decision not to deploy a transport team until all
the team members demonstrated competency.
I was transparent in discussing my concern and
contingency plan to send another team with my
medical and administrative colleagues. I was told
that this was a “career-limiting move.” I simply
stated, “I have to be able to sleep at night.”
In another organization, I disagreed with a
plan to move critically ill patients multiple times
to accommodate unit renovation. I identified an
alternative that required only one move. Although
my plan was successfully implemented, my action
caused me to fall out of favor with the administrator
and eventually resulted in my having to move on to
another position. In both instances, I had to put my
patients first because when I became a member of
the nursing profession, I made a promise to protect
them.
Why We May Not Take Personal Risks
Understanding scarcity is key to understanding
why nurses may not take justified risks. The three
components of scarcity are shame, comparison, and
disengagement.
Shame is the fear of ridicule and belittling often
used to control people and to keep them in line.
Shame-based cultures are very unhealthy for nurses
and patients. The killer of innovation is shame. In
these cultures, covert or sometimes overt messages
are common, such as to dare not, you’re not good
enough, who do you think you are, don’t you dare
get too big for your britches.” Shame becomes
fear, fear leads to risk aversion, and risk aversion
kills innovation and can lead to unsafe patient care.
Shame is the intensely painful feeling or experience
of believing that we are flawed and therefore
unworthy of belonging. Shame makes us feel
unworthy of connection. Resilience to shame occurs
when recognizing and speaking openly about shame,
practicing critical awareness, and reaching out to
others.
Healthy competition can be beneficial, but
constant overt or covert comparing and ranking
suffocates creativity and risk taking. If nurses are
held to one narrow standard, they may not question
the relevance of a course of action to a specific
situation and embrace evidence- based practice.
Disengagement occurs when people are afraid to
take risks and try new things. Too often it is easier
to stay quiet than to share stories, experiences, and
ideas. It is important to do what is right, not what
is easy. The best way through a difficult situation is
to address the situation directly with honesty and
integrity, sharing your story and asking for what you
need. An excellent resource for nurses is the book
Crucial Conversations. Often what we fear does not
happen, but even if it does, we have retained our
self-respect and commitment to professional values.
Courageous Practice
I hope you choose to practice courageously, doing
the right things for the right reasons. As Theodore
Roosevelt said,
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“Far better it is to dare mighty things, to win
glorious triumphs, even though checkered by failure,
than to take rank with those poor spirits who neither
enjoy much nor suffer much, because they live in the
gray twilight that knows not victory nor defeat.”
Selected references
Dobos C. Defining risk from the perspective of nurses in
clinical roles. J Adv Nur. 1992;17:1303-9.
Dobos C. Understanding personal risk taking among staff
nurses: critical information for nurse executives. J Nurs
Adm. 1997;27(1):1-2.
Gary JC, Exploring the concept and use of positive
deviance in nursing. Am J Nurs. 2013;113(8):26-
34. Haag-Heitman B. The development of expert
performance in nursing. J Nurses Staff Dev.
2008;24(5):203-11.
Brown B. Daring Greatly: How the Courage to be
Vulnerable Transforms the Way We Live, Love, Parent,
and Lead. Gotham Books; 2012.
Patterson K, Grenny J, McMillan R, et al. Crucial
Conversations: Tools for Talking When Stakes are High,
2nd ed. New York, NY: McGraw-Hill; 2011.
Carol Dobos lives in Phoenix Arizona and is the
past-president of the Arizona Association for Nursing
Professional Development, a state affiliate of the
Association for Nursing Professional Development.

July, August, September 2022 Georgia Nursing • Page 23
MEMBERSHIP
As a GNA Member, you have …
• The opportunity to serve as a GNA Board and/or Committee
Member*
• Access to shared interest and local chapters, and avenues to
connect with leaders in the profession
• Access to free and discounted educational opportunities
• A free subscription to The American Nurse Today - the official
journal of the American Nurses Association (ANA)
• Member-only access to ANA’s Nurse Space
• Free access to The Online Journal of Issues in Nursing (OJIN)
• Access to free and discounted webinars at Navigate Nursing
Webinars
• The LARGEST discount on initial ANCC certification ($120/full
members only)
• The LARGEST discount on ANCC re- certification ($150/full
members only)
• Discounts at NursesBook.Org
* Serving as a GNA Board Member is subject to running in and winning the GNA
Board of Directors’ Election for the position of interest.
Become a GNA Member today! GeorgiaNurses.org
I Want to Get Involved:
Joining and Creating a GNA Chapter
Are you interested in Palliative Care? Nurse
Navigation? Informatics?
Whatever your nursing passion may be, Georgia
Nurses Association (GNA) can help you connect with
your peers locally and across the state. Becoming
involved in your professional association is the first step
towards creating your personal career satisfaction and
connecting with your peers. Now, GNA has made it
easy for you to become involved according to your own
preferences.
Through GNA’s new member-driven chapter
structure, you can join multiple chapters and also
create your own chapter based on shared interests
where you can reap the benefits of energizing
experiences, empowering insight and essential
resources.
Visit http://www.georgianurses.org/?page=
Chapter Chairs to view a list of current GNA Chapters
and Chapters Chair contact information. Connect with
Chapter Chairs to find out when they will hold their
next Chapter meeting!
The steps you should follow to create a NEW GNA
chapter are below. If you have any questions, contact
the membership development committee or GNA
headquarters; specific contact information and more
details may be found at www.georgianurses.org.
1. Obtain a copy of GNA bylaws, policies and
procedures from www.georgianurses.org.
2. Gather together a minimum of 10 GNA
members who share similar interests.
3. Select a chapter chair.
4. Chapter chair forms a roster to verify roster
as current GNA members. This is done by
contacting headquarters at (404) 325-5536.
5. Identify and agree upon chapter purpose.
6. Decide on chapter name.
Member Lifestyle Benefits
In addition, GNA Members
receive special rates at:
• Mutual of Omaha
Insurance
• Nurses Service
Organization
• Matchwell
• Education Loan Finance
• Commerce Bank
• Grand Canyon University
• Snazzy Traveler, and more!
7. Submit information for application to become a
chapter to GNA Headquarters. Information to be
submitted includes the following:
Chapter chair name and chapter contact
information including an email,
Chapter name, Chapter purpose, and Chapter
roster.
8. The application will then go to the Membership
Development Committee who will forward it to
the Board of Directors. The Board will approve or
decline the application and notify the applicant
of its decision.
Georgia Nurses Association
Political Action Committee
(GN-PAC)
About GN-PAC:
The Georgia Nurses Association Political Action
Committee (GN-PAC) actively and carefully reviews
candidates for local, state and federal office. This
consideration includes the candidate’s record on
nursing issues and value as an advocate for the nursing
profession. Your contribution to GN-PAC today will
help GNA continue to protect your ability to practice
and earn a living in Georgia. Your contribution will
also support candidates for office who are strong
advocates on behalf of nursing. By contributing $25
or more, you’ll become a supporting member of GN-
PAC. By contributing $100 or more, you’ll become a
full member of GN-PAC! The purpose of the GN-PAC
shall be to promote the improvement of the health
care of the citizens of Georgia by raising funds from
within the nursing community and friends of nursing
and contributing to the support of worthy candidates
for State office who believe, and have demonstrated
their belief, in the legislative objectives of the Georgia
Nurses Association.
TO DONATE VISIT:
https://georgianurses.nursingnetwork.
com/page/75371-gn-pac
Nurses We Want Your
Opinion!
On March 25, 2022, RaDonda Vaught, former Neuro
ICU Nurse at Vanderbilt, was convicted of criminally
negligent homicide and gross neglect of an impaired
adult. Vaught mistakenly administered Vecuronium
instead of the intended medication, Midazolam
(Versed). Vaught recognized her mistake immediately,
and took necessary steps to report the error to her
superiors. Unfortunately, the patient succumbed to
the paralytic effects and suffered an anoxic brain
injury and ultimately death. In the end, she has lost
her nursing license, and will serve 3 years of probation
for mistaking two similar worded medications and
neglecting to identify it before administering it to the
patient. Below you will be able to take a 14 question
survey asking your thoughts and opinions concerning
this case.
Passcode: CARE
To become a member of GNA please review and
submit our membership application located on the
homepage of our website at www.georgianurses.org
Url: https://form.jotform.com/221177084102042

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