Missouri Nurse News - July 2022

MISSOURI
NURSING NEWS
Volume 2 • No. 4
July, August, September 2022
The Official Publication of the Missouri Nurses Association with a quarterly circulation of approximately 72,000 to RNs and LPNs
Message from the President
Caryl Goodyear, PhD, RN,
NEA-BC, CCRN-K, FAAN
As I write this, I’m trying to
stay cool. We seem to jump
right from winter into summer
without the benefit of a nice
spring….welcome to Missouri!
I just returned from the
American Nurses Association
Membership Assembly where I
represented Missouri nurses in the official business of
the ANA. The discussions were meaningful and actions
were taken to address challenges. We unanimously
voted to adopt a racial reckoning statement which
was an outcome of the work ANA began in 2021 to
uncover the challenges of racism in our profession.
The Assembly called on ANA to identify, develop and
advance strategies about a culture of safety and a
zero-tolerance approach to verbal abuse and violence
in all care settings. Recognition that the pandemic
has exacerbated nurse staffing issues, the Assembly
approved a recommendation that ANA support safe
patient standards including ratios that are based on
acuity, are setting-specific, and enforceable. ANA will
be working directly with all state constituents, including
Missouri, to develop further details.
I would encourage each of you to reach out to us,
Missouri Nurses Association, for any questions you may
have about these specific areas of action.
Caryl Goodyear
Director’s Letter
Happy summer! We have
a lot of exciting updates
here at the association. First
we capped off a successful
legislative session this year.
In a session that didn’t have
very many bills passed, we
had several priorities that
made it through. Our states
APRNs are now able to order
home health, we also received
dollars to fund state nursing
programs, and stopped several
bills that were harmful to Heidi Lucas
nursing.
Another exciting development is that we were
awarded a large grant through the Missouri Foundation
for Health to help fund our APRN initiatives here in the
state. This additional funding allowed us to expand
our staff to include an outreach manager and an
administrative assistant. The outreach manager goal is
to organize the states APRNs into an unstoppable force
to gain ground towards full practice authority. With
Kansas opening the door, we hope that this influx of
funding and staff will allow us to step through that
door and follow suit. The money from the grant is a
great step so expect to hear more from our office on
these initiatives over the next few months.
We also are starting a new diversity equity and
inclusion task force here at the Association. The
Missouri Nurses Association is committed to promoting
diversity within our membership and leadership
and promoting access to quality nursing care for all
patients. We know that not only does discrimination
interfere with the ability of individuals to access
proper and equal medical care, it also represents a
pervasive barrier to educational, economic, and social
success. The Missouri Nurses Association is rolling out
a Diversity, Equity & Inclusion Taskforce to develop
and promote strategies and best practices within the
nursing community in the state of Missouri.
Our goal is twofold: To guide the MONA in
making internal changes with specific, actionable
steps to further address matters of diversity, equity,
and inclusion within our organization; and to make
recommendations for support and development
of equity and inclusion practices that will eliminate
discrimination and ignorance in our larger nursing
community. Look for application to be open this
Director’s Letter continued on page 2
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2
Missouri Nursing News July, August, September 2022
Missouri Nurses Leading the Way
Jane Kaiser, RN, BSN & Gina Bufe, APRN, PhD
Missouri Nurses Jane Kaiser & Gina Bufe led the way
as Flag Bearers for the Missouri Flag during the Parade
of States at the 2022 National Senior Games (NSG) in
Fort Lauderdale, Florida. It was fitting to have Nurses
lead the way in the first National Senior Games that
have been held since the pandemic. The NSG were
originally scheduled to occur in May of 2021 but due
to the pandemic were rescheduled to November 2021
and then rescheduled a second time to May 2022 in
an effort to ensure the safety of all Senior Athletes.
Both Jane and Gina have previously qualified and
participated in past NSG. Jane competes in Track &
Field as well as Swimming events and Gina competes
in Racewalking and Table Tennis. Both Missouri Nurses
find competition in the NSG motivating to maintain
health and well-being. During the pandemic, both
nurses continued to work as they trained for the
games. Jane works as a Case Investigator COVID
for the St. Louis County Department of Public Health
and Wellness, Flu and COVID clinics, Visiting Nurse
Association of Greater St. Louis. Gina continues to
work as an APRN in Child & Adolescent Mental Health
at Mercy Health System in St Louis. Upon their return
from the NSG, both began their qualifying journey to
the NSG to be held in Pittsburgh 2023. The journey
started with the St Louis Senior Olympics and then
participation in the Missouri State Senior Games
where both qualified for the National Senior Games in
Pittsburgh 2023. The benefits of exercise on healthy
aging through improved physical and mental health,
socialization, and perceived quality of life have been
well documented (Andrews, et. al, 2017; Kinnafick, et.
al., 2022.) Jane & Gina experienced first-hand that in
addition to the physical benefits, the camaraderie and
encouragement are nice mental health benefits from
participation in the games that support healthy aging.
Jane & Gina encourage other nurses over 50 years old
to consider participation.
References
Andrews RM, Tan EJ, Varma VR, Rebok GW, Romani WA,
Seeman TE, Gruenewald TL, Tanner EK, Carlson MC
(2017). Positive Aging Expectations Are Associated
With Physical Activity Among Urban-Dwelling Older
Adults.Gerontologist. Aug 1;57(suppl_2):S178-S186. doi:
10.1093/geront/gnx060.PMID: 28854610 Downloaded
June 16, 2022
Kinnafick FE, Brinkley AJ, Bailey SJ, Adams EJ (2021)Is walking
netball an effective, acceptable and feasible method to
increase physical activity and improve health in middleto
older age women?: A RE-AIM evaluation. Int J Behav
Nutr Phys Act. 2021 Oct 19;18(1):136. doi: 10.1186/
s12966-021-01204-w.PMID: 34666782. Downloaded
June 16, 2022
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Gina Bufe (Left) & Jane Kaiser (Right)
Biographical Information:
Jane Kaiser, RN, BSN
Senior Olympics, Local, State, National, Medals,
Ribbons and Awards 2001 to present
1971, ADS, RN St. Louis Community College at
Meramec, St. Louis, MO
BSN, St. Louis University, St. Louis, MO
Surgical Intensive Care Unit, St. Mary's Hospital, St.
Louis, MO
Medical/Surgical Nursing Instructor, Jefferson
College, Hillsboro, MO
Wife, Mother of four, Grandmother of three
Presently working
Wellness, Flu and COVID clinics, Visiting Nurse
Association of Greater St. Louis, MO
Case Investigator for COVID, St. Louis County
Department of Public Health
Gina Bufe, APRN, PhD
Senior Olympics, Local, State, National, Medals,
Ribbons and Awards 2016 to present
PhD in Nursing, Saint Louis University, St. Louis, MO,
1996
MSN(R) in Psychiatric/Mental Health Nursing-CNS
option, Saint Louis University, St. Louis, MO, 1991.
BSN, Southeast Missouri State University, Cape
Girardeau, MO, 1987
Presently working
MERCY HOSPITAL/HEALTH SYSTEM St. Louis, MO
April 2013-Present
Advanced Practice Registered Nurse, PMHCNS-
BC: Collaborative Intensive Outpatient Program (IOP)
practice and Psychiatric Hospitalist Team member.
Director’s Letter continued from page 1
summer! The application is open to all nurses in the
state of Missouri, regardless of MONA membership
status.
I hope that if you are not a member of MONA,
that you will consider it. If every nurse was a member
of the association, we would have incredible power at
the Missouri Capitol and there would be nothing we
couldn’t accomplish. Membership is only $15/month
or $174/year and it gives you membership to the
Missouri Nurses Association and the American Nurses
Association. And if you are a member, thank you for
your membership into the Missouri Nurses Association
we are excited to have you and we hope that these
changes will help to move the Association into the
future.
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MONA’s Mission, Vision, Purpose
Our Mission
Advancing the nursing profession by uniting as one strong
voice with Missouri nurses
Our Vision
A healthy Missouri through the power of Nursing
Our Purpose
To act and speak for the nursing profession and Missouri’s
professional nurses and to promote and enhance safe and
accountable professional nursing practice.
MONA’s Official Publication:
The Missouri Nursing News is an official publication of the
Missouri Nurses Association (MONA) (a constituent member
of the American Nurses Association), published quarterly
every January, April, July and October. The MONA provides
education, networking opportunities, publications and
other products and services to its members and extends its
mission to all nurses in Missouri.
Phone: (573) 636-4623
Email: director@missourinursess.org
Web site: www.MissouriNurses.org
Mail: c/o Midwest Multistate Division
3340 American Avenue, Suite F
Jefferson City, MO 65109
Questions about your nursing license?
Contact the Missouri State Board of Nursing at:
(573) 751-0681.
This newsletter is a service of the Missouri Nurses
Association and your receipt of it does not mean
you are automatically a member. Your membership
in support of this work is encouraged; please visit
www.missourinurses.org.
Writer’s Guidelines:
• Any topic related to nursing will be considered for
publication in the Missouri Nursing News.
• Authors are not required to be members of the MONA;
however, when space is limited, preference will be given
to MONA members.
• Photos are welcome, digital is preferred. MONA does not
assume responsibility for lost or damaged photos.
• Use current APA formatting for any article requiring
citation.
• Provide a brief author biography indicating the author’s
nursing experience and/or expertise with the paper’s
content.
o Limit the author’s biography to 4-sentences.
• Submitted material is due by the 10th of the month in
March, June, September and December of each year.
• The peer-review is blinded; submit the title page
separately from the article
• Submit the title page and article as Word documents to
info@missourinurses.org
For advertising rates and information, please contact Arthur
L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626–4081, sales@aldpub.com. MONA and the
Arthur L. Davis Publishing Agency, Inc. reserve the right to
reject any advertisement. Responsibility for errors in advertising
is limited to corrections in the next issue or refund of price of
advertisement.
Acceptance of advertising does not imply endorsement
or approval by the Missouri Nurses Association of products
advertised, the advertisers, or the claims made. Rejection of an
advertisement does not imply a product offered for advertising
is without merit, or that the manufacturer lacks integrity, or that
this association disapproves of the product or its use. MONA
and the Arthur L. Davis Publishing Agency, Inc. shall not be held
liable for any consequences resulting from purchase or use of
an advertiser’s product. Articles appearing in this publication
express the opinions of the authors; they do not necessarily
reflect views of the staff, board, or membership of MONA or
those of the national or local associations.

July, August, September 2022 Missouri Nursing News 3
Bringing More Home Health Care RNs to
Medicaid Patients in Missouri
Sarah Oerther, Ph.D., RN, ANEF
Margaret R Benz MSN(R), APRN, ANP-BC,
FAANP
Season 1 of the Netflix hit series, “Call the Midwife,”
begins in 1950s England with Jenny Lee providing
nursing care to mothers and their families by riding her
bicycle to families’ homes in London. The show follows
the nurses, midwives, and nuns from Nonnatus House,
who visit families in their homes, providing them with
extraordinary healthcare. Fast forward to 2022, and
amendments to Bills HB2331, HB2149 and SB710
will help to bring more Home Health Care RNs to the
residences of Medicaid patients in Missouri.
Currently, in Missouri, a Nurse Practitioner must
have a physician document that a face-to-face
assessment has been performed and sign the order for
Home Health Care verifying the patient’s eligibility for
Home Health Care services to be provided to them in
their place of residence. Nurse Practitioners in Missouri
are not currently able to initiate or make necessary
adjustments to medication or treatment for Home
Health Care patients without obtaining a physician
signature (American Association of Nurse Practitioners,
2019). This outdated process in Missouri generally
results in delays in care, especially when physicians
are busy, in addition to more costly care or potentially
causing further health complications.
Missouri Nurses have long been vocal about
Missouri’s physician-certification policy, an antiquated
and overly rigid law. A priority for the Missouri Nurses
Association this year has been elimination of Missouri’s
strict physician-certification policy because this policy
creates roadblocks that make it more difficult for
patients to gain access to Home Health Care services
and RNs, resulting in some patients needing to go
to long term care facilities. Nurse Practitioners are
qualified to certify patient eligibility for Home Health
Care by RNs without a physician signature and are
already one of the largest home-based primary care
providers for Medicaid patients nationwide (American
Association of Nurse Practitioners, 2019). The current
laws in Missouri put patients at risk for avoidable
complications and delay access to treatment. Delays
in care are particularly challenging for Home Health
Care Medicare and Medicaid beneficiary populations
patients in Missouri who suffer from more chronic
conditions and report more limitations on activities of
daily living than the non-Home Health Care Medicare
and Medicaid beneficiary populations (American
Association of Nurse Practitioners, 2019). When
patients can’t get access to a Home Health Care RN in
a timely manner, those delays drive up costs in Missouri
and result in negative health outcomes for vulnerable
patients in Missouri.
It is important to note that the Cares Act
(Coronavirus Aid, Relief, and Economic Security Act)
legislation that was passed in March 2020, included
a provision authorizing a Nurse Practitioner to certify
and recertify their patients for Home Health Care,
permanently retiring the federal barrier to Nurse
Practitioner practice for patients requiring Home Health
Care services (Centers for Medicare and Medicaid
Services, 2021). This legislation made it possible on
the federal level for Nurse Practitioners to be able
to provide necessary quality care services for their
patients requiring Home Health Care. Because of this
federal legislation, in most states, Nurse Practitioners
were immediately able to activate this legislation and
begin certifying and recertifying their patients for
Home Health Care. Unfortunately, in Missouri, Nurse
Practitioners are not able to implement this federal
legislation because of an outdated law that specifically
required a physician to sign Home Health Care orders.
Now — thanks to amendments to Bills HB2331,
HB2149 and SB710 — Nurse Practitioners will be
able certify patient eligibility for Home Health Care
by RNs. Consistent with the Future of Nursing report
2030, amendments to Bills HB2331, HB2149 and
SB710 update laws in Missouri to authorize Nurse
Practitioners to perform admission assessments, as well
as certification of patients for Home Health Care RNs
(Institute of Medicine, 2020). Expanding the role of
Nurse Practitioners to certify patients should improve
patient access to RNs who are qualified to identify
new health problems or needs, such as medication
education, prevention services, or nutrition counseling
(American Association of Nurse Practitioners, 2019).
This also makes Missouri consistent with federal
legislation allowing Nurse Practitioners to certify Home
Health Care for their patients.
Moving ahead, advocacy will continue to be
important to help get more of Missouri’s antiquated
and overly rigid state laws that restrict Nurse
Practitioner practice to catch up with federal law. For
instance, Missouri is one of only three (3) states with
mileage restrictions for Nurse Practitioners. With a
variety of communication methods now available
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that are timelier and more efficient, and with the
Governor’s expansion of broadband, the mileage
barriers are outdated. Though the rules have been
modified, all Nurse Practitioners in the state of
Missouri are still held to a 75-mile radius unless they
are working in a Department of Corrections Facility,
in which case, they have a 200-mile radius for a four
to six month period, which can be renewed upon
review. Additionally, over the last two (2) years
Missouri implemented waivers to allow telehealth
to be provided across the state in all settings by all
providers if Nurse Practitioners were within the 75-mile
radius. This allowed timely and safe access to care to all
Missourians no matter where they reside. This allowed
many people to receive ongoing care and preventative
screening, even when movement was restricted.
With the end of the waivers December 31, 2021, that
included elimination of mileage restrictions, telehealth
flexibility, chart review and the one-month supervisory
rule came to an end. Missouri Nurses will continue to
pursue elimination of these barriers in future legislative
sessions, so our patients have access to safe and
affordable care.
References
American Association of Nurse Practitioners. (2019). Improve
Medicare patient access to home health services.
Retrieved from https://www.aanp.org/advocacy/federal/
federal-issue-briefs/improve-medicare-patients-accessto-home-health-care
Centers for Medicare and Medicaid Services. (2021).
Home health PPS. Retrieved from https://www.cms.
gov/Medicare/Medicare-Fee-for-Service-Payment/
HomeHealthPPS
Institute of Medicine. (2020). The Future of Nursing 2020-
2030: Charting a Path to Achieve Health Equity.
Washington, DC: The National Academies Press. https://
doi.org/10.17226/25982.
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Missouri Nursing News July, August, September 2022
This position has a seat on the MONA Board of Directors
and serves as Chair of the MONA Practice Committee. The
Practice Director will influence nursing professional practice
issues and nursing policy covering a broad range of health care
settings, specialties, nursing roles and practice challenges. The
Practice Director will be the chair of the Practice Committee and
expected to meet 6-10 times a year as a committee. Must be able
to commit annually to participate in four MONA board meetings
at the MONA office.
This position is responsible for the business of the region
including, but not limited to, organizing regional meetings,
chairing a regional committee to help plan meetings, serving as
the regional representative on the Nominations Committee, and
acting as the liaison between the membership and the Board of
Directors. There are three Regional Chair positions, one from
the East, West, and South MONA regions.
To be considered for the position of Regional Director, you must
be a MONA member residing within the region you would like
to serve. Must be able to commit annually to participate in four
MONA board meetings at the MONA office. You also commit
to holding at least 4 in person meetings in your region and two
virtual events.
(1 of 2 open positions)
This position has a seat on the MONA Board of Directors in a
non-voting capacity. The Board Leadership Fellow is for nurses
who are interested in Board Leadership and would like to
develop those skills and abilities. The Fellow will be available
to fill unexpected vacancies in the board or other leadership
roles. This position would be able to run for the role of MONA
President. Must be able to commit annually to participate in four
MONA board meetings at the MONA office.
The VP of Communication will ensure that an ongoing
comprehensive communication plan is developed, implemented,
and evaluated for the purpose of maintaining open and
consistent communication with the MONA membership. The
VP of Communications will be the chair of the Communications
Committee and expected to meet 6-10 times a year as a
committee. This position has a seat on the MONA Board of
Directors and is responsible for keeping minutes of all MONA
meetings in which the President presides. Must be able to
commit annually to participate in four MONA board meetings at
the MONA office.
As a committee of the Assembly, the Bylaws committee
shall consist of an elected Chair, and shall be accountable to
the membership. This committee shall suggest and receive
all proposed amendments or revisions to these bylaws. Such
proposed amendments, including those required for Missouri
Nurses Association to be in harmony with the American
Nurses Association bylaws, shall be submitted to the Missouri
Nurses Association Membership Assembly for action at the
Biennial or Special Meeting of the Missouri Nurses Association
Membership Assembly. The work of the Bylaws Committee will
be in 2023 before the 2023 Membership Assembly. This is an
elected position, however this position will not sit on the MONA
Board of Directors. The Chair shall commit to holding meetings
with the committee in 2023 and explain the bylaws changes and
the process before the Membership Assembly in the Fall of 2023.

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July, August, September 2022 Missouri Nursing News 5
MONA DEI TASK
FORCE
The Missouri Nurses Association is committed
to promoting diversity within our membership and
leadership and promoting access to quality nursing
care for all patients. We know that not only does
discrimination interfere with the ability of individuals to
access proper and equal medical care, it also represents
a pervasive barrier to educational, economic, and social
success. The Missouri Nurses Association is rolling out
a Diversity, Equity & Inclusion Taskforce to develop
and promote strategies and best practices within the
nursing community in the state of Missouri.
Nurses are the nation’s first line of defense against
infectious diseases such as COVID-19. That’s why ANA
has partnered with the CDC to present Project Firstline,
an interactive series of free online tools that give you
the training and information you need about infection
prevention and control (IPC). Comprehensive education
includes best practices addressing COVID-19 and other
pathogens, as well as evidence-based strategies to
improve outcomes.
Project Firstline resources are designed to help
you understand and confidently apply IPC principles
regardless of previous training or background. New
courses will be added as information advances so you
PROJECT FIRSTLINE
can stay prepared with the latest knowledge. Together,
we can stop the spread.
Featured course/topics this month include:
Ventilation, Source Control, and Hand Hygiene
• Episode 17: What is Ventilation?
• Episode 18: Why Does Ventilation Matter?
• Episode 23: What is Source Control?
• Episode 21: Do We Really Have to Talk About
Hand Hygiene? Again? Yes!
Visit https://missourinurses.org/firstline for
more!
Our goal is twofold:
• To guide the MONA in making internal changes
with specific, actionable steps to further address
matters of diversity, equity, and inclusion within
our organization.
• Make recommendations for support and
development of equity and inclusion practices
that will eliminate discrimination and ignorance
in our larger nursing community.
Full Details & Sign-Up Form At:
https://missourinurses.org/dei/
Hermann Area District Hospital, located in one of
the most beautiful towns in the state of Missouri,
is looking to hire Full Time RNs for the
Night Shift with a $10,000 Sign-On Bonus.
Join the “People Who Care.”
Contact Sue Daller, RN, Director of Nursing
Email: don@hadh.org | Phone: 573-486-2158
Fax: 573-486-3743 | www.hadh.org
509 W. 18th St., PO Box 470, Hermann, MO 65041
To access electronic copies of the
Missouri Nursing News, please visit
http://www.NursingALD.com/publications

6
Missouri Nursing News July, August, September 2022
Victor Hugo is credited with the observation that
there is nothing so powerful as an idea whose time
has come. Unfortunately, until their time arrives, the
best ideas can repeatedly fail to launch for decades.
You may be familiar with the case of James Lancaster,
an English sea captain who suspected that citrus juices
prevented scurvy in his sailors (this idea occurred to him
at a time when scurvy killed more sailors than warfare
or sea accidents). Today, we know he was correct. As
early as 1601, he proved his theory with real sailors and
a control group. Even so, his innovation failed to catch
on.
Finally, in 1747 (150 years later), a British Navy
physician, James Lind, read about Lancaster’s
experiments & began some of his own. Lind’s
experiments also proved the theory. It was so
undeniable, the British Navy ultimately required
oranges, lemons & limes for sailors on its entire fleet
of ships, to prevent scurvy among its sailors… in
1795, nearly 50 years after this re-discovery of James
Lancaster’s original experiments.
You may wonder why, in the face of so many
deaths, when the answer was so simple, it took two
centuries for this medical innovation to catch on. In
short, bureaucratic inertia was a major barrier. There
was evidence that citrus prevented scurvy, but not
everyone agreed it was a cure. Further, Dr. Lind may
have been correct, but he was not a prominent figure
in Navy medicine, so his message was slow to gain
traction. One thing we know for sure: During the
intervening 200 years, the Navy adopted numerous
innovations in shipbuilding & weaponry. It was simply
not the case that the Navy was averse to innovation in
general.
In his seminal work, Diffusion of Innovations,
Everett Rogers found that for a new idea to be widely
adopted, it has to meet four basic criteria:
1. It has to be innovative.
2. It has to be communicated through certain
channels.
3. It has to occur over time.
4. It has to happen among the members of a social
system.
One of the most important roles of the Missouri
Nurses Association is our promotion of innovation in
the field of Nursing. One way we do this is by offering
an Early Career Nurse Innovator Award – an annual
cash prize for a creative new nurse, who looks at the
profession with fresh eyes, whose innovative approach
accomplishes something noteworthy & respectable that
advances the profession of Nursing & the health of
Missourians.
This year, we are using a somewhat innovative
approach to fundraising for the grant. We are asking
100 people to donate $100 to support the Early Career
Nurse Innovator Award. As leaders in the social system
of Nursing, we believe that by communicating these
innovative acts to & through our members & our
colleagues over time, we’re well-positioned to help
these innovations diffuse in the time-tested manner
supported by research. We are asking you to visit our
website & make a $100 donation to our effort, and to
send this letter to a couple of your friends, encouraging
them to consider doing the same.
To give, please visit: https://missourinurses
foundation.org/100for100/
With your help, as always, we hope to connect the
past, improve the present & anticipate the future of
Nursing in Missouri.
Thank you,
Matt Younger, M.S., LNHA
President, Missouri Nurses Foundation

July, August, September 2022 Missouri Nursing News 7
Latest in the Management of Post Acute COVID Syndrome
(Long-Hauler Syndrome)
COVID-19 has infected millions of Americans, many
of whom continue to suffer with long-term sequelae
months and years after the infection. As the evidence
and our understanding of the virus and COVID-19
continues to evolve, so will our clinical approach to
those COVID long-haulers, those living with post-
COVID conditions.
During this webinar, Dr. Wendy Wright will focus
on the most current recommendations regarding the
diagnosis of post-covid syndrome and the various
treatment and management options available. We
hope you will choose to participate!
Speaker
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP,
FAAN, FNAP
Registration Fees:
• Members: $29.00
• Non Members: $49.00
Pre-registration is required for access to live, virtual
activity.
REGISTER NOW: https://cvent.me/42xdzd
Registration Deadline: August 8, 2022 at 12:00 pm
CST
Disclosures
• Successful Completion – Attendees must
register, participate in the entire educational
session and complete the online conference
evaluation to receive a certificate of completion.
The link to the online evaluation will be emailed
to participants (to the email address provided at
registration) upon conclusion of the activity.
• Relevant Financial Relationships – Dr.
Wendy Wright serves as a consultant for
Gilead, GlaxoSmithKline, Merck, Pfizer & Sanofi
and is on the speakers’ bureau for AbbVie,
Biohaven, Merck, Pfizer & Sanofi. All relevant
financial relationships for the presenter have
been mitigated. No other relevant financial
relationships were identified for any member of
the planning committee or presenter/author.
Accreditation
1.25 contact hours are available to those who
meet the successful completion requirements, 1.0
contact hours of which is pharmacology focused.
The Midwest Multistate Division is accredited
as a provider of nursing continuing professional
development by the American Nurses Credentialing
Center’s Commission on Accreditation.
What is the Midwest Multistate Division? The
Arkansas Nurses Association, Kansas State Nurses
Association, Missouri Nurses Association and Nebraska
Nurses Association formed a collaborative, namely the
Midwest Multistate Division (Midwest MSD), with the
goal of promoting efficiencies and growth. As part
of this collaborative, the Midwest MSD Professional
Development Unit (PD Unit) was formed, which is
accredited as an ANCC approver and provider of NCPD,
to address the educational needs of nurses in the
Midwest region.
Those certified through AANP – Contact
hours received through participation in this event
are acceptable toward certification/recertification
through the American Academy of Nurse Practitioners
(AANP). Per the AANP guidelines, the American
Nurses Credentialing Center (ANCC) is an acceptable,
accredited and independent organization that provides
advanced nursing CE content for NPs seeking renewal
using continuing education credit. (https://www.
aanpcert.org/recert/ce_opps; Recertification Handbook)
Questions? Please contact Sara Fry at (573) 636-
4623 x102 or sara@midwestnurses.org with any
questions.

8
Missouri Nursing News July, August, September 2022
Pearls and Pitfalls: The Journey of APRN Entrepreneurs
Nurse Practitioners are experts in clinical care, but
most are often novices when it comes to business,
marketing, financial management and working outside
mainstream healthcare settings. There is little focus
on the business side within the curriculum of current
nurse practitioner education. However, these skills are
essential for nurse practitioners who want to grow,
innovate and work in independent practice. Whether
you are ready to open your own practice or enhance
your current business capabilities and skills, join us
for this day-long webinar and learn from Dr. Wendy
Wright’s experience building her business over the last
15 years. She will share tips for effective and accurate
billing and coding, mistakes to avoid in contract
negotiation, and documentation that stands up against
malpractice claims, and much more!
The live, virtual event will begin at 8:45 am and
will adjourn at 4:45 pm. Within the schedule for the
day, we have incorporated three 15-minute breaks for
those wanting to stretch, grab a drink, etc., as well as
a 45-minute lunch break. During the time set aside for
breaks and lunch, Wendy will be monitoring the ZOOM
Q&A feature to address your questions. It will be a fun,
full day of learning for everyone participating and we
hope you will choose to join us!
Agenda
8:30 am Registrants begin logging into the virtual
platform to participate in the event –
individualized login details provided after
registering for the event
8:45 am Session 1
10:15 am Session 2
11:30 am Lunch Break
12:15 pm Session 3
1:45 pm Session 4
3:15 pm Session 5
4:30 pm Complete Evaluation
4:45 pm Event Adjourns
Sessions:
1. Coding and Reimbursement: Essentials for
Successful Practice
2. APRN Contract Negotiation and Much More…
3. Malpractice Prevention & Documentation:
Everything the APRN Needs to Know
4. Starting a Business/Independent Practice
5. Pearls of Business: What I Wish Someone Had
Told Me
Speaker
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP,
FAAN, FNAP
Registration Fees:
• $129.00 Member
• $169.00 Non-Member
Pre-registration is required for access to live, virtual
activity.
REGISTER NOW: https://cvent.me/1O7PQ2
Registration Deadline: September 19, 2022 at
12:00 pm CST
Disclosures
• Successful Completion – Attendees must
register, participate in all of the educational
sessions and complete the online conference
evaluation to receive a certificate of completion.
The link to the online evaluation will be emailed
to participants (to the email address provided at
registration) upon conclusion of the activity.
• Relevant Financial Relationships – Dr.
Wendy Wright serves as a consultant for
Gilead, GlaxoSmithKline, Merck, Pfizer & Sanofi
and is on the speakers’ bureau for AbbVie,
Biohaven, Merck, Pfizer & Sanofi. All relevant
financial relationships for the presenter have
been mitigated. No other relevant financial
relationships were identified for any member of
the planning committee or presenter/author.
Accreditation
6.5 contact hours are available to those who meet
the successful completion requirements.
The Midwest Multistate Division is accredited
as a provider of nursing continuing professional
development by the American Nurses Credentialing
Center’s Commission on Accreditation.
What is the Midwest Multistate Division? The
Arkansas Nurses Association, Kansas State Nurses
Association, Missouri Nurses Association and Nebraska
Nurses Association formed a collaborative, namely the
Midwest Multistate Division (Midwest MSD), with the
goal of promoting efficiencies and growth. As part
of this collaborative, the Midwest MSD Professional
Development Unit (PD Unit) was formed, which is
accredited as an ANCC approver and provider of NCPD,
to address the educational needs of nurses in the
Midwest region.
Those certified through AANP – Contact
hours received through participation in this event
are acceptable toward certification/recertification
through the American Academy of Nurse Practitioners
(AANP). Per the AANP guidelines, the American
Nurses Credentialing Center (ANCC) is an acceptable,
accredited and independent organization that provides
advanced nursing CE content for NPs seeking renewal
using continuing education credit. (https://www.
aanpcert.org/recert/ce_opps; Recertification Handbook)
Questions? Please contact Sara Fry at (573) 636-
4623 x102 or sara@midwestnurses.org with any
questions.

July, August, September 2022 Missouri Nursing News 9
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10
Missouri Nursing News July, August, September 2022
MONA Member Benefit for
ANCC Certification
Success Pays is a way to assist healthcare professionals in achieving certification
while eliminating test-taking anxiety and financial barriers. Clinicians are given
two opportunities to test for a certification specialty, and ONLY PAY IF YOU PASS!
Members of the Missouri Nurses Association also receive a reduced rate
of $260. Certification renewals with ANCC are also available through MONA at a
reduced price of $250.
For a list of qualifying certifications and full details, please visit: https://
missourinurses.org/success-pays/
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12
Missouri Nursing News July, August, September 2022
Rest, Relax, Laugh:
Spending Time with Yourself
Dr. Phyllis Lawrence, DNP, RN, NEA-BC
Reprinted with permission from
Tennessee Nurse February 2022 issue
Rest and Relax
How many times have you been told that you
need to get plenty of sleep for good physical health?
Sleep is also instrumental in maintaining sound
mental and emotional health. Rest is not only the
act of sleeping, but you can rest your body, mind,
and tap into your spirit simply by feeling renewed.
Waking up and feeling that you have run a marathon
is a sign of significant activity during your rest
period. Either the mind continues to cycle, or you
may be suffering from a sleep disorder. In either
case, you are not at rest.
To rest the mind, you must relax. Relaxation is
defined as the state of being free from tension and
anxiety (Google dictionary, 2022). The Cambridge
Dictionary defines relaxation as a pleasant activity
that makes you become calm and less worried. This
definition supports the concept of complementary
and alternative interventions and modalities.
Relaxation can really be a state of mind. One of
the most effective holistic modalities that promotes
relaxation is meditation. Meditation is reflected
in many forms, including guided imaginary,
mindfulness, Zen meditation, Mantra meditation,
Transcendental meditation, and Yoga meditation,
just to name a few. Mindfulness has become popular
over the last few years. Being mindful is the basic
human ability to be fully present in the moment,
aware of your surroundings, feelings, and emotions.
Try it, sit still in a quiet place. Place your hands in
your lap. Now close your eyes. What do you hear?
What do you smell? Breathe slow and steady while
maintaining the rhythm. Continue this practice for
approximately 10-15 minutes. Notice the change
in your stress level or anxiety. This simple exercise
can alleviate stress and anxiety, and if engaged in
regularly, lead to an optimistic outlook.
Laugh for a Healthier You
Have you noticed that when you laugh, you feel
better? It is harder to cry while you are laughing.
Research has found that laughing triggers the release
of endorphins (nature’s feel-good chemicals). It has
also been reported that laughter decreases stress
hormones and increases immune cells. We have a
natural response to infection, which helps produce
antibodies, improving our resistance to disease and
promoting our overall well-being. What makes you
laugh? Is it a funny commercial, your loved one(s),
maybe your co-workers? Laughter is the best
medicine. In an article by Robinson, Smith, & Segal
(July 2021), learn to create opportunities to laugh,
watch a funny movie, TV show, or YouTube video,
check out a comedy club, read the funny pages,
check out the humor section in your bookstore, play
with a pet, better yet host a game night with friends.
I would like to share with you some of the things
that make me laugh. Watching my favorite comedy
movies, even though I know the punch line, dancing
to my favorite 80’s jam on YouTube, and serving
with a grateful heart. When I see someone smile, I
smile! During hard times, laughter has been a saving
grace for many. Whitman (2017) A new study reveals
how laughter affects the brain, which may be an
explanation why giggles play an important role in
social bonding.
When you take time for yourself, you validate your
worthiness and value. Make it a point to celebrate
your life. Buy that neat sweater, go to the movies
with your spouse, family, or friends. Do something
that you enjoy, and that makes you feel good. How
about butter pecan ice cream? Take care of yourself
so that you can take care of others. The first step
to self-care is accepting that you are worthy of that
care. The care you require may need to come from
a professional source, and that’s okay. There are
services available through most healthcare facilities
and organizations. Sometimes you just might need to
talk. It may be a good time to phone a friend.
Take a moment and plan to rest, relax, and laugh.
Try to include at least one activity to cover each one
of the components. Start with resting and relaxing,
then let the laughter begin. Remember, you are
worthy, valuable, and appreciated. Self-worth can
only be measured by you. So make every moment
count, and be mindful of your value. I can sum it up
in one word, priceless!!
References
L. Robinson, M. Smith & J. Segal (2021). Laughter is the
Best Medicine. https://www.helpguide.org/articles/
mental-health/laughter-is-the-best-medicine.htm
Mindful: healthy mind, healthy life (2022). https://www.
mindful.org/meditation/mindfulness-getting-started/
Whiteman, H. (2017). Laughter releases ‘feel good
hormones’ to promote social bonding. https://www.
medicalnewstoday.com/articles/317756
Getting Clear on Bullying Versus Incivility
Renee Thompson, DNP, RN, CSP
Reprinted with permission from The Florida
Nurse, February 2022 issue
Numerous studies
show the prevalence
and devastating impact
disruptive behaviors have
on nurse retention and
satisfaction, patient safety
and the financial health of
an organization. Today, more
than ever, the unpredictable,
life-and-death nature of
the pandemic has created
an environment that is
ripe for an increase in Dr. Renee Thompson
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 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.

14
Missouri Nursing News 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
Disasters call for heroes.
Answer the Call.
In 2021, over 1,000 volunteers Answered the Call through
Show-Me Response to serve in COVID-19 Lifesaving Missions!
Register to volunteer at
ShowMeResponse.org
573-522-8637 | Missouri State
Emergency Management Agency

July, August, September 2022 Missouri Nursing News 15
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,
“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.
To learn more, contact Kelli Holland
kelli@teamcenturion.com
314.640.2285

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