Colorado Nurse - August 2022

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
Volume 122 • No. 3 • August 2022
Quarterly publication distributed to approximately 42,200 RNs and LPNs in Colorado
NURSE
From the Desk of
the CNF President
Colorado Nurses
Association President...
Nurse License Plates Now Available
On behalf of the Colorado Nurses Foundation, I am pleased
to announce that the long-awaited Colorado Nurse License
Plate is now available. Building on work started by Jennifer
Allen-Thomas, RN, the Colorado Nurses Foundation (501c3
organization), along with the Colorado Nurses Association,
worked with House Representatives Kyle Mullica and Daneya
Esgar to bring a Colorado Nurses license plate to Colorado.
With the publics’ support, these license plates will result in
increased awareness and recognition of nurses in Colorado. Money
raised from the sale of license plates will allow several non-profits
to provide nursing scholarships for underrepresented populations.
The plate was designed by artist Melanie Simonet, who provided Margaret Mulhall
her services at no charge as a gift to nursing in Colorado.
For a $50.00 donation to the Colorado Nurses Foundation, you will receive a certificate
to take to the DMV. The certificate will allow you to purchase the plates. The $50.00
certificate donation fee will go support scholarships for underrepresented nurses and
nursing students via the Colorado Council of Black Nurses Inc., Hispanic Nurses Association,
Philippine Nurses Association of Colorado and the Colorado Nurses Foundation Jennifer
Allen-Thomas Scholarship. Go to coloradonursesfoundation.com to order your certificate.
Margaret Mulhall, RN, President
Colorado Nurses Foundation
What is Just Culture and
How Do We Cultivate It?
On March 25, 2022, a jury in Tennessee found former
nurse, RaDonda Vaught, guilty of criminally negligent homicide
and abuse of an impaired adult. Ms. Vaught, like all RNs,
was working in a busy, complicated environment when she
committed a medication error. Most unfortunately, the error
led to the death of a patient, Charlene Murphey. Health care
workers are human beings. The average human makes three
to six errors per hour. In a 12-hour shift, that could mean 72
errors PER PERSON, PER SHIFT, and that is just an average. This
is human nature. It is not intentional, it is not malicious, it is a
part of existence. We purposefully build systems that promote
safety through mechanisms like automation, technology, and Laura Rosenthal
check points but at the end of the day, those systems are still
operated by a human being.
Heath care is a complex system fraught with error. If errors, or more importantly- near
misses, are not reported, how do we know there is something to address? How will we
learn as a health care system if we are too frightened to discuss potential issues with our
colleagues, our leadership, and our patients? I dare go as far as to say that facilities and
entities that use punishment as a solution to medical error are the ones promoting further
error in the near future. Punitive actions such as criminal prosecution termination of an
employee do not prevent error. These solutions only serve to provide a scapegoat – to
provide “an answer” to the question, “Who is going to pay for this?” When talking to
victims of medical error and their families, many hold the hope that actions following error
will result in the error never occurring with another patient. Punishment of an employee
does not prevent the event from recurring. What does assist in prevention is taking a nonbiased,
non-punitive look at each of the system components that contributed to the error.
This is the concept of Just Culture.
Just Culture is the idea of encouraging the formal reporting of errors or near misses
in the context of learning from these situations and improving quality to avoid further
potential error. This process is not based on a punitive approach, but rather one that
fosters systems thinking and collaboration. This is a “what can we do better” or “how
CNA President continued on page 2
current resident or
Non-Profit Org.
U.S. Postage Paid
Princeton, MN
Permit No. 14
From the Desk of CNA Director of
Practice and Government Affairs .................3
District and Special Interest Group Reports .........4
Peer Assistance ...............................5
Government Affairs & Public Policy Committee .....7
In Memory ...................................8
2022 Nightingale Luminary Awards Gala ...........9
ANA 2022 Annual Membership Assembly .........10
The Fight for Healthy Environments ..............12
Faith Community Nursing ......................13
INSIDE
Adventures in Nursing –
From the Bedside to Behind the Scenes ........13
Former foster child earns PhD,
vows to help other vulnerable people ..........14
Virtual Simulation: Impact on Clinical Judgment ....15
CU Nursing Legends Credited for Developing
National Residency Model ....................16
Nurse License Protection Case Study .............17
How nurses can counter health misinformation ....18
We’ve Come a Long Way Baby”… or Have We? .....19

2 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
COLORADO NURSE (ISSN-8750-846X) is published 4 times annually, February,
May, August, and November, by the Arthur L. Davis Publishing Agency, Inc. for the
Colorado Nurses Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014;
Mailing: P.O. Box 3406, Englewood, CO 80155-3406.
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. CNF 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
Colorado Nurses Foundation 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. CNF 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 CNF or those of the
national or local associations.
Colorado Nurses Foundation wants to hear from you and welcomes letter to
the editors. Correspondence may be sent to Colorado Nurses Foundation,
2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406,
Englewood, CO 80155-3406; email, info@coloradonursesfoundation.com.
Colorado Nurse Publication Article Submission
CNA President continued from page 1
can we prevent this from happening in the future?” culture.
This is NOT a “who is responsible for this problem?”
culture. This is a culture that promotes patient safety. A
culture where the person/people that committed the error
are supported and educated.
How do we get there? The first step is acknowledging
that human error, although undesired, is inevitable
and an unavoidable part of health care. Second, once
this fact is accepted, leaders from all professions must
model behaviors consistent with Just Culture including
implementation of policies that support this work (or
de-implementation of policies contrary to this concept),
differentiating between human error, at-risk, and reckless
• September 13 for November Issue
Colorado Nurses Association in partnership with the Colorado Nurses Foundation seeks your
regular reports and any content you feel would be informative for Colorado Nurses.
Submit to: https://civicamanagement.wufoo.com/forms/m10eei4p1ds8okp/
behavior, and solidifying to commit to a culture of safety.
After promoting a culture of support and safety, engaging
every member to systematize the process of reporting and
reviewing from a stance of appreciative inquiry with the
ultimate goal of learning and improvement.
Nurses have the knowledge, understanding, and
experience to navigate these complex systems every day.
Nurses have the voice to improve patient safety through
changes in culture. If you are afraid to report an error or
near miss, please consider advancing patient safety through
advocating for a Just Culture environment. CNA is here to
support you in your efforts. For more information on Just
Culture, please refer to these resources.
– ANA Position Statement on Just Culture. https://
www.nursingworld.org/practice-policy/nursingexcellence/official-position-statements/id/just-culture/
– AHRQ Patient Safety Network. https://www.
nursingworld.org/practice-policy/nursing-excellence/
official-position-statements/id/just-culture/
– IHI. http://www.ihi.org/resources/Pages/Tools/
PrinciplesofaFairandJustCulture.aspx
Correction:
The May, 2022 issue of the Colorado Nurse
incorrectly identified Robin Bruce, President
of the Colorado Black Nurses Association , as
Robin Cook in the article “CNA Presents State
Level Awards.” Our apologies to Robin Bruce.
AMAZING
REMARKABLE
AWESOME
American Renal Associates
Our Staff Make the Difference!
Opportunities for dialysis nurses in the
Denver Metro Area in Colorado.
Please apply at americanrenal.com.
To submit an article for publication, consider the following guidelines.
1. Topic is current and relevant to RN practice.
2. 500 word limit
3. Individuals may submit articles for consideration by emailing
carolomeara@aol.com.
Material is copyrighted by the Colorado Nurses Foundation and may not be
reprinted without written permission from CNF.
Co-Editors: M. Colleen Casper, RN, MS, DNP (16)
Eve Hoygaard, MS, RN, WHNP (30)
Carol O’Meara, MS, RN, WHNP (20/30)
Sonja Hix
COLORADO NURSES FOUNDATION
EXECUTIVE COMMITTEE
President: Margaret Mulhall
Vice President: Sara Jarrett
Secretary: Carol O’Meara
Treasurer: Eve Hoygaard
BOARD MEMBERS
Jeanne Burnkrant, Colleen Casper, Lola Fehr,
Laura Rosenthal, Betsy Woolf, Lisa Zenoni
COLORADO NURSES ASSOCIATION
Region 1 Director:
Mavis Mesi
Region 2 Director
(DNA 3, 12, 16, 20, 23):
Amanda Cobb
Region 3 Director (DNA 4):
Mary Satre
Region 4 Director (DNA 6):
Glenda Jackson
EXECUTIVE COMMITTEE
President: Laura Rosenthal
Past President: Linda Stroup
Vice President: Angela Petkoff
Secretary: Nan Morgan
Treasurer: Carol OMeara
BOARD OF DIRECTORS
DNA PRESIDENTS
DNA #3: Anne Zobec DNA #12: Amanda Chappell
Colorado Springs
DNA #16: Vacant
DNA #4: Kathryn Carpenter
Model, CO
DNA #20: Jean Schroeder
DNA #5:
DNA #23: Colleen Casper
DNA #6: Charlotte LeDonne
Alamosa, CO
DNA #7: Nora Flucke
DNA #9: Brenda Tousley
Director of Practice
and Government Affairs: Colleen Casper, RN, MS, DNP
Chief Administrative Officer:
Region 5 Director (DNA 7):
Nora Flucke
Region 6 Director (DNA 5):
Deb Bailey
Director At Large (SIGs):
Patricia Abbott
Director At Large (SIGs):
V. Sean Mitchell (SIG 30)
Director at Large (Recent Graduate)
Jeanna Brewer
SIG #30: Meghan Abrams,
DNP, NP-C
SIG #31: Ruby Martinez,
PhD, RXN, CNS, PMHCNS-BC
Sonja Hix
To contact any person listed above, please use the
CNA/CNF office numbers/address/email address.
CNA Contact Information:
Ph: 720-457-1194 • Fax: 303-200-7099
Email: info@coloradonurses.org
CNF Contact Information: Ph: 720-457-1004
Email: info@coloradonursesfoundation.com
www.coloradonurses.org

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 3
From the Desk of CNA Director of
Practice and Government Affairs
Colorado Nurses Make Progress on Safe Nurse Staffing
Colleen Casper, DNP, MS, RN
Director of Practice & Government Affairs
Colorado Nurses Association
(CNA) Government Affairs and
Public Policy Committee (GAPP)
worked with many other nurses,
members and non-members,
Legislative leaders, and Governor
Polis’s staff to address the single,
most important health care crisis
that we continue to face, safe
nurse staffing.
Safe nurse staffing impacts
the safety and quality of care Colleen Casper
delivered in any clinical setting,
thereby reducing complications such as infections, bed
sores, patient falls, and many other outcomes, including
death, that lead to increased costs of care. Safe nurse
staffing impacts nurse safety and retention, thereby
reducing the costs of nurse turnover. Safe nurse staffing
seems common sense, but based on current payment
methodologies for patient care, nursing is seen as a “labor
cost to manage” rather than an investment to assure safe
and quality patient care.
I share this for individuals who may not understand
why CNA invested so much time and energy into
achieving successful passage of HB22-1401. We learned
many lessons through this work. Most significantly, we
learned that many Colorado legislators have very little, if
any, understanding of the importance of why nurses care
about staffing, the importance of nurses being able to
participate in nurse staffing decisions, and why regulation
of employers of health delivery systems must be done to
assure every person in Colorado access to safe and quality
nursing care.
HB22-1401 Concerning the Preparedness of Health to
Meet Patient Need, and in Connection Therewith, Making
an Appropriation was signed by Governor Polis, May 18th
at 12:42pm on the lawns at North Suburban Hospital.
HB22-1401 as signed is available at https://leg.colorado.
gov/bills/hb22-1401).
The bill builds on work done in 2019 to strengthen
rules and regulations via hospital licensure through the
Colorado Department of Public Health & Environment
(CDPHE). The bill strengthens the explicit requirements
for safe staffing and staff nurse’s participation in the
development and monitoring of staffing plans, the
metrics for tracking and reporting of safe staffing, and
addresses the accountability of employers to assure to
the people of Colorado that health care delivered in their
facilities meets minimum, acceptable standards.
I would be remiss to not address the overwhelming
requests from clinical nurses, (RNs, LPNs, & CNAs) for
mandated ratios rather than staffing committee process
requirements. After significant time and negotiations,
CNA agreed to trial the methods described in HB22-
1401. We are hopeful that safer staffing standards will
demonstrate that nurses will return to work amidst the
narrative of overall nurse staffing shortages. If HB22-
1401 is not effective for patients and nurses in health
delivery systems in Colorado, we will be back to pursue
more aggressive regulations.
Key components of HB22-1401 include:
• On or before, September 1, 2022 each hospital shall
establish a nurse staffing committee with at least 60%
or greater participation by clinical staff;
• The committee must include a designated leader of
workplace violence prevention and reduction efforts;
• The committee shall annually develop and oversee a
master nurse staffing plan for each inpatient unit and
emergency department that are aligned with national
standards;
• Must include guidance for adjusting nurse to patient
assignments based on acuity;
• Staffing plan will be submitted to senior nurse
and governing body for approval. If not approved
as submitted, senior nurse must provide staffing
committee with explanation for changes.
• If staffing committee does not believe the plan
from senior nurse does not meet safe nurse staffing
standards, the staffing committee may request CDPHE
review the plan for compliance with rules; and,
• Committee will establish, in writing, the process for
receiving, tracking and resolving complaints and/or
feedback on staffing plans from clinical staff and make
available to all staff.
• Language specific to hospital requirements include:
o Submit the final, approved nurse staffing plan to
CDPHE annually;
o Quarterly evaluate the staffing plan & prepare a
report to staffing committee;
o Provide the unit-based staffing plans to each
employee; Applicants and patients shall receive
staffing plans upon request; and,
o Shall not assign a clinical staff nurse, nurse aide or
EMS provider to a hospital unit unless personnel
records include documentation of training and
competency.
• CDPHE will establish a Colorado hospital report card for
the public via website to include:
NURSING
Peer Health Assistance Program
RNs and LPNs
Peer Assistance Services, Inc.
Encourage nurses to SEEK HELP EARLY
o Baseline number of beds staffed to provide patient
care;
o Nursing-sensitive quality measures include at a
minimum:
- Skill mix;
- Nursing hours per patient day;
- Voluntary turnover;
- Patient falls prevalence rate; and falls with injury;
and,
- Incidences of violence against staff and contract
staff;
Additional statutory requirements include that CDPHE
may enter, survey and investigate as necessary to ensure
compliance, which actually broadens the ability to survey
with or without complaint, and that hospitals with fewer
than 100 beds are exempt from these requirements at this
time.
Clearly, there is work ahead to align these statutory
changes with rules and regulations for health care
facility licensure through CDPHE. CNA is interested in
efforts to educate and empower clinical nurses as to the
opportunities these changes make in terms of workplace
decision making. Colorado Nurses Association is preparing
to assist in both areas of work.
Please watch our website for opportunities to contribute
to this work.
SAVE LIVES… both practitioners and patients
Help us to EDUCATE the profession
Bringing Love back to
healthcare using Watson’s
Caring Science Theory.
Events Calendar:
www.watsoncaringscience.org/home/events-calendar/
Connect with WCSI:
www.watsoncaringscience.org/contact-wcsi/
Become a Caritas Coach ®
accepting applications for November 2022
www.watsoncaringscience.org/ccep
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I am a better nurse because of the program; my
employer has been very supportive; I couldn’t have
stayed clean and sober without the program.
START BELIEVING.
303.369.0039
For confidential information: info@peerassist.org
www.PeerAssistanceServices.org

4 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
District and Special
Interest Group Reports
DNA 20 – West Metro Area
Colorado Rockies Health
Care Appreciation
Nights Raise Funds for
Nursing Scholarships
Nan Morgan, CNA Secretary
Norma Tubman MScN, RN
In lieu of a speaker at our May meeting, members
joined the May 18 five-hour ANA Live Virtual Nurses
Event “You Make A Difference” which celebrated
nurses. In the evening, we held our virtual business
meeting at which the DNA 20 election results for the
Board for 2022-23 were announced. Positions remain
unchanged thanks to members in open positions
rerunning. The Board is made up of Jean Schroeder,
President; Betsy Woolf, Vice-President; Irene Drabek,
Secretary; Allison Windes, Treasurer; and Annette
Cannon, Kathy Crisler, Susan Moyer and Norma
Tubman, Board Members at Large. The Nominating
Committee is Rita Beam, Irene Drabek, and Barbara
Pedersen. The Board will meet August 17 to plan for
2022-23.
Throughout the spring and summer members
remained active. Several members donated medical
supplies, back packs, clothing, personal items and
money to the “We Stand with Ukraine”. Collections
were taken to the Arvada West Family Medical Clinic
where Ellie Titarenko, APN, and staff sorted and boxed
donations and delivered three truck loads to Project
Cure for shipment to Ukraine. We hope to have Ellie,
who has family in Ukraine, at our September meeting
as a speaker.
Annette Cannon PhD, MA, RN, MSN, D-ABMDI,
participated in two videos that address Overdose
Prevention/Education and Fentanyl Overdose Prevention.
The videos are geared toward teens but have useful
Bent County Correctional and
Crowley County Correctional.
Now Hiring RNs and LPNs!
- FT, PT, and PRN
Apply today at jobs.corecivic.com
information for adults and parents. The videos can
be viewed at www.jeffcoteens.org/ODPreventon and
https://www.twelvetalks.com/overdose. Help Annette in
her efforts to prevent overdoses and overdose deaths by
sharing the links with everyone you know.
Susan Moyer MS, RN, CNSPH, presented “Building
Bench Strength by Increasing the Number and Scope of
RNs Working in Primary Care” at the National Forum of
State Nursing Workforce Centers Annual Conference at
the Bellagio Hotel in Las Vegas, NV on June 21. She also
presented “Future of Nursing: Charting the Path for the
Next Decade” at the 2022 Nurse Educator’s Conference
in the Rockies in Breckenridge, CO on July 20.
Jean Schroeder has been busy reaching out to
schools of nursing to share with them the benefits of
joining ANA/CNA/DNAs. Some of the schools she
talked to included Arapahoe Community College and
Platt College. Other schools were able to learn about
joining through a Zoom video Jean created and sent to
the schools.
Since all work and no play is not healthy, on May 13
DNA 20 members Annette Cannon and Susan Moyer
joined DNA 16 members to participate in Health Care
Appreciation Night at Coors Field to watch a Colorado
Rockies game. A good time was had by all as the photo
shows.
For information on DNA 20 meetings see the
CNA website or contact President Jean Schroeder at
nursingstrategies@gmail.com.
May 13th through the 18th were exciting days for
Nurses and Healthcare Professionals with fund raising
for the Colorado Nurses Foundation through ticket sales
to six Rockies home games. The Rockies expanded the
option for purchasing special nursing support tickets
as the Rockies took on both Kansas City and the
Giants. Each ticket sold through the Healthcare link
contributed $2.00 to the Colorado Nurses Foundation
for scholarships to be awarded in January 2023.
For twenty-five years, Mary Kershner, DNA 16,
has been connecting Colorado Nurses Association to a
Rockies game close to National Nurses Day (now National
Nurses Month). What was once one game under the
banner Nurses Night at the Rockies has expanded to
include all Healthcare Professionals. If you were one of
the lucky 1000 to purchase with the special rate to the
Kansas City game May 13th, you received a lovely pair
of winter socks with the Rockies emblem and the words
“Healthcare Rocks” with your ticket. There was also “On
Field” recognition with Mary Kershner, Judith Burke,
Christine Schmidt, Annette Cannon and Susan Moyer
as shown in the photo. Even though the Rockies only
came away with two wins through this home stand,
Colorado Nurses Foundation scored over $9,000.00 for
scholarships. Applications for scholarships will begin Sept
1, 2022. Thank you to all that attended and cheered for
nurses. Hope to see you again next year.

Your Dream
Find
Job Now!
Nursing
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 5
Re-Growing Our Own
Ingrid Johnson DNP, MPP, RN,FAAN
President and CEO – Colorado Center for Nursing Excellence
I am regularly receiving calls and emails from organizations and individuals
concerned with the “great resignation” and how that is creating an added
shortage of nurses. It is not unusual for the conversation to lean toward
questions such as, “Why aren’t the schools graduating more nurses?” and
“Should we lower educational requirements to educate RNs faster?” The
answer to the first question is not singular. First, we don’t have enough faculty
because, to be very direct, nursing faculty is poorly paid in relation to the rest
of our profession. Additionally, even if we did have more faculty available,
there would not be enough clinical placement opportunities to move everyone
through the clinical education process. The answer to the second question is:
“No.” Why? Because patients are getting sicker and living longer. Nursing is
a complex professional position and reports from employers is that the new
nurses come in with gaps in their knowledge. There is too much to learn to
create experts in every area of healthcare, and even a four-year BSN degree
seems to be too short to fill in all the gaps as new nurses enter the profession.
We are trying to transition nurses into practice successfully with post-licensure
nurse residencies and evidence indicates that this is a great way to mitigate
that need for experience and successfully onboard newly licensed nurses.
There is one population of nurses that we haven’t talked a lot about, and
I think we need to do so. What about those experienced nurses who have let
their license lapse for personal reasons and are out of the workforce? How
many nurses out there would be interested in jumping back into the workforce
but have been out for awhile and may need to update their skill set or reactivate
their license? Data isn’t strong enough to give us a good view of the
numbers of nurses in this group, but we suspect that there are many. It is not
easy for experienced nurses to figure out how to best update their knowledge
and skill set and over the years, as the state’s nursing workforce center, we
have repeatedly been contacted to help identify how a nurse can reactive his
or her license or refresh a clinical skillset.
There are only limited RN and LPN Refresher Courses. State courses that
we are aware of are Red Rocks Community College, UCCS, and THEARI
(formerly Colorado Central Area Health Education Center). Recently, THEARI
contacted The Center to request that we take over the RN and LPN Refresher
Courses. Kris Wenzel was the author of that original course at Colorado
Central AHEC and was also a founder of The Center. The transition of these
programs, therefore, feel natural. We have agreed and the THEARI RN and LPN
Refresher Courses are now under The Colorado Center for Nursing Excellence
programming.
We are hopeful that among the refresher courses in the state, we will
together be able to recruit and regrow our nursing profession from the
experienced workforce that is out there in Colorado. Combining the work of
our schools and opening the door for easy access to refresher programs for
Colorado nurses could serve to build our workforce more quickly while utilizing
all our nursing expertise that is not being used in the state. I encourage any
nurse considering returning to direct care nursing and hoping to re-enter
the workforce to do it. You can access The Center’s course at https://www.
cahec.org/rn-and-lpn-refresher-course. This is a 100% online course. If you
prefer an in-person option, please look at the programs at UCCS or Red Rocks
Community College. Our goal is to make education accessible, and we hope
that this is an opportunity to re-grow our nursing workforce.
Peer Assistance
Investing in Prevention Makes
Good Financial Sense
Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA)
at the National Institutes of Health
You can’t put a dollar value on the losses American families have suffered due
to the addiction and overdose crisis. A life lost to overdose is irreplaceable, and
the costs to happiness, success, and well-being of those living with addiction are
similarly overwhelming and incalculable. Yet, funds are finite, and public health
decisions do carry cost implications. When policymakers and community leaders can
translate the human benefits of effective treatment and prevention measures into
some quantifiable return on that investment, it can be a lever to shift public health
policies.
Recently in the journal Prevention Science, a group of researchers funded by
the National Institute on Drug Abuse (NIDA) published an analysis of the costs
to North Carolina healthcare payers for hospital charges potentially relating to
higher-risk behaviors in patients aged 9-18 (i.e., pre-adolescents and adolescents)
in 2012. Charges included care for injuries from violence, accidents, or poisoning;
care relating to sexual activity, substance use, or psychiatric disorders; and charges
related to suicide or self-inflicted injury.
The researchers found that these charges totaled more than $327 million,
accounting for more than 10 percent of all hospital-related charges. The higherrisk
behaviors associated with these costs are preventable with psychosocial
interventions, including family-based prevention programs. Pediatricians and family
therapists surveyed in the study supported screening and referral to prevention,
but cited possible challenges to reimbursement for these services as well as lack of
training and lack of referral networks to/from each other. Pediatricians also cited
concerns over patients not following through with referrals, suggesting that having
family therapists working in pediatric clinics could help.
Peer Assistance continued on page 6
ANNOUNCING ....
RN & LPN
Refresher Training
The Colorado Center for Nursing
Excellence is now offering RN & LPN
Refresher courses to help you get
back in the game.
RN RN LPN Virtually
Refresher Refresher Refresher Simulated
Lite
Clinicals
These courses are designed to provide
previously licensed Nurses with the opportunity
to update and enhance their nursing skills &
knowledge and build confidence to renew their
license and re-enter the workforce.
COLORADO CENTER FOR NURSING EXCELLENCE
pTransforming H
:;:; :
ug orkforce Innovation
refresher@coloradonursingcenter.org

6 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
Peer Assistance
Peer Assistance continued from page 5
Primary prevention—including screening and
intervention before negative health outcomes occur—
is relatively inexpensive, and the higher-risk behaviors
it is designed to reduce are so costly to the healthcare
system that it is staggeringly wasteful not to make
sure that screening and treatment referral are readily
implemented and faithfully reimbursed by insurers and
that interventions are convenient for parents and their
children.
Reducing higher-risk behaviors would lessen burden
across many sectors of society, not just healthcare,
which was the sole focus of the newly published
analysis. Greater investment in preventing such
behaviors in youth would yield savings across public
safety and the criminal justice system, behavioral
health, education, and so on.
This is a common theme in the research on the
benefits and costs of prevention. Some programs
designed to prevent teen substance use and other
behavioral problems have been found or estimated to
be stunningly good investments. For example, an early
childhood intervention called Nurse Family Partnership,
in which specially trained nurses periodically visit firsttime
mothers during their pregnancy and first two
years of their child’s life, was shown in an analysis by
the Washington State Institute for Public Policy to save
taxpayers $2.88 for each dollar invested; the same
analysis found that a component of an elementaryschool-based
intervention called the Good Behavior
Game saved taxpayers $25.92 for each dollar.
Another example is the Communities That Care
prevention system, developed three decades ago
and the subject of many randomized trials that follow
participants well into adulthood. Communities That
Care is not a single prevention intervention but a
structured approach that helps communities utilize
their resources most effectively to address identified
risk factors for substance use, aggression, and other
problems in youth. One recent analysis showed that an
approximately $602 investment in each child (adjusted
to 2017 dollars) had yielded an estimated $7754 in
savings by the time participants were age 23—a
$12.88 return for each dollar invested. The researchers
estimated that those savings were distributed among
individuals/families themselves, taxpayers, and other
stakeholders. The return was well over twice as
great when the downstream economic benefits of
completing college—more likely among those receiving
interventions—was factored in.
Prevention is needed now more than ever. Fentanyl
is permeating the illicit drug supply and causing evergreater
numbers of overdose deaths. It is increasingly
found in counterfeit prescription pills, which are
liable to be taken by youth and other people with no
previous exposure to opioids. In 2020, for the first
time, fentanyl overdose deaths in teens spiked to nearly
double the rate it had been in previous years.
Communities, schools, and healthcare systems
already have scientifically well-supported tools at
their disposal to help prevent substance use and
other related mental illnesses and risk behaviors in
adolescence, but sadly they are seldom implemented.
Even if an intervention can be shown in a trial to
produce benefits, it cannot be expected to make a
positive impact if it is not easily scaled up in a variety of
real-world settings adaptable to the needs of different
communities. For this reason, developing and testing
interventions that can be adopted and sustained is an
important part of NIDA’s prevention research portfolio.
While investment in prevention doesn’t show
immediate returns, playing the long game and investing
in prevention interventions can save lives and dollars.
This article was written by Dr. Nora Volkow, Director
of the National Institute on Drug Abuse (NIDA) at the
National Institutes of Health.
1. NIDA. 2022, April 28. Investing in Prevention Makes Good
Financial Sense. Retrieved from https://nida.nih.gov/
about-nida/noras-blog/2022/04/investing-in-preventionmakes-good-financial-sense
on 2022, June 17
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The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 7
Government Affairs & Public Policy Committee
Mary Satre, MSN, MBA, RN
CNA Board Member Region 3, District 4,
and Co-Chair of GAPP Committee
The Regular Session of the Seventy-third General
Assembly of the Colorado State Legislature concluded
on May 11th with the interests of nursing represented
to the end of the last day by CNA’s Director of Practice
and Government Affairs, Colleen Casper, and Contract
Lobbyist Gil Romero and his team. The regularly
scheduled GAPP meeting held on May 25th included a
review of the legislative session followed by discussion
led by Dr. Casper under the agenda heading: “What
Did We Learn?” The primary answer to this question
is that it is important to educate our legislators as to
what it is that nurses actually do. Regular and proactive
communication with our legislators is more important
than ever as we begin to make progress in the
protection of nurses in the workplace.
Throughout the 2022 session, GAPP maintained
a Hot List containing 49 bills, 13 of which were
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witnesses from the membership of CNA and
GAPP, twelve of these bills passed, including those
supporting modifications to civil commitment, health
facility visitation during the pandemic, a prescription
drug monitoring program, and measures to support
the Colorado Rural Healthcare Workforce.
Of particular import to Colorado nurses is
HB22-1401 – Hospital Safe Staffing & Hospital
Preparedness, which was introduced by
Representative Kyle Mullica and co-sponsored by
Senator Dominick Moreno. GAPP will continue
to follow the implementation of the bill with the
development of tool kits to educate nurses to the
protections it offers as well as how to most effectively
benefit from it.
A list of priority bills, along with CNA’s position
on them, can be reached through the “Bill Tracker”
link found under the Advocacy/Policy tab on the CNA
homepage (www.coloradonurses.org).
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GAPP’s meetings continue via Zoom on a
monthly basis during the legislative off-season,
meeting on the fourth Wednesday of the month
from 6:15 to 8:00 pm. Members and other
attendees will receive a look ahead at the priorities
to be addressed in the 2023 legislative season
as well as an analysis of the potential effects of
the redistricting of the electoral map in Colorado.
GAPP meetings are open to all CNA members
and students are encouraged to visit the website
(https://www.coloradonurses.org/gov-t-affairspublic-policy-gapp-)
to register to attend as guests.
CNA members interested in joining GAPP are
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8 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
In Memory
Eve Cook Hoygaard, MS,RN, WHNP
If you are a nurse who has read previous issues
of the Colorado Nurse, you have probably read this
column about nurses who have passed away that
you have worked with or otherwise known at some
time in your career. Did you wonder how we knew
about these losses? We depend upon receiving
from families and friends of these departed nurses.
We depend on other people... like you!
Our criteria for information to be included
requires it being about a RN or an LPN who has been
educated in, lived in and/or worked in Colorado plus
the date and, if available, of where they lived at the
time they passed away. We appreciate provision of
additional information as to where and when they
received their nursing education, degree(s), age,
where they were employed, special awards (such
as being a Nightingale Award or nominee) are
examples we consider including.
We Remember
Amey, Lynne, RN (73) passed away in
Lakewood CO on March 31, 2022. She moved
from Wisconsin to Colorado. She was a 1998
graduate of Front Range Community College
School of Nursing and worked at Hospice of St
John’s in Lakewood for nine years.
Gallagher, Constance Christianson, RN
passed away in 2022. Born in Budapest, Hungary
in 1935, she survived WWII (NAZI occupation and
a Soviet work camp.) She moved to Colorado in
1957 where she worked at the University Hospital
in Denver, Boulder Community Hospital and for
the American Diabetic Association.
Green, Barbara Brailsford, RN passed away
on May 28,2022. She was a graduate of Mercy
Medical Center SON in Philadelphia. Her 50 years
of Nursing practice included a variety of areas in
New York and Colorado.
Gross, Janet Barker, RN (69) passed away
in Lone Tree, CO on June 4, 2022. A graduate
of Youngstown State University with a degree in
Teaching and a Nursing degree from Kent State
University. She was an RN for 30 years.
Kruse, Helen RN (96) passed away in April 2022
in Aurora. She was a graduate of St Joseph’s Nursing
School in Concordia, KS. She worked as a nurse in
Kansas, Arizona, New Mexico, Alaska and Colorado.
She lived in Aurora, CO for many years.
Negri, Jennie Stella, RN, (96) passed away
in April 2022 in Wheat Ridge, CO. She was born in
1926 and graduated from the Nursing Program at
St Anthony’s Hospital, Denver in 1947. She later
attended a post-graduate program at Margaret
Hague Maternity Hospital in New Jersey. She was a
Head Nurse in Obstetrics at St Anthony’s.
Neid, Darlene Helen, RN (78), a graduate of
Abbott Hospital School of Nursing in Minneapolis
in 1964. She received a B.S. in Education from the
University of Nebraska in 1988. Her career included
both Nursing (Abbott, Lincoln General, St. Elizabeth’s
and Nebraska Methodist Hospitals) in addition, she
did teach (part-time) in Lincoln Public Schools.
Shaw, Karen Newberry RN (79) passed away
in April 2022. She was a 1965 graduate of Johns
Hopkins Hospital School of Nursing and in 1979
received a Bachelor of Arts in Biology at the University
of Colorado. She worked in Pediatrics at Vanderbilt
University Hospital. She moved to Switzerland in
1971 and in 1981 she moved to Colorado where she
worked at Porter Adventist Hospital in Denver until
her retirement in 2002.
Smith, Ann Noordenbos, PhD, RN (81) passed
away in Boulder, CO, April 29, 2022. She was born
in New Jersey where she received her early nursing
education. After moving to Colorado she earned her
BSN in 1964, MSN in 1965 and PhD at the University
of Colorado. She was one of the first graduates in
the Pediatric Nurse Practitioner program created
at the University of Colorado in 1966. Her career at
the University of Colorado included faculty member
in that program, and Director of the Continuing
Education Program at CU School of Nursing. There,
she was involved in a number of innovative programs.
In 2015, she was awarded the CU College of Nursing
Alumni Distinguished Service Award. She was active
in nursing charitable organizations and was a Lifetime
member of the Friends of Nursing.
Young, Mary Jo Leonard Young RN (86)
passed away in June 2022. She received a Diploma
Program at St. Rita’s SON in Lima, OH. In 1958 she
joined the Navy Nurse Corps. While in the Navy
Nurse Corps, she completed a BSN at the University
of Colorado School of Nursing and a Masters Degree
in Higher Education at George Washington University.
When she retired from the USN in 1984, she was
the Director of Nursing at the Charleston Navy
Hospital. She was a member of the Navy Nurse Corps
Association and many volunteer organizations.
We reserve the right to edit material submitted
and endeavor to verify all information included in this
column. If you notice an error, please advise us and a
correction will be published in the next available issue.
We always appreciate our readers assistance with
providing information for this column. Please submit
the information to Eve Hoygaard at hoygaard@msn.
com or CNF@civicamanagement.zendesk.com. If
you would like to donate to the Colorado Nurses
Foundation Scholarship Fund in honor of a departed
nurse or to honor a nurse friend or colleague, there are
several options. To donate by check, send to Colorado
Nurses Foundation, P.O. Box 3406, Englewood, CO
80155. For credit card donations, please visit the
ColoradoNursesFoundation.com/donate Questions:
CNF@civicamanagement.zendesk.com
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The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 9
2022 Nightingale Luminary Awards Gala
Join us on this special evening to honor the following 47 nurses from across the state who will
be presented a Luminary Award for excellence in their profession. 12 of these 47 Luminaries
will receive the Nightingale Award which will be announced during the evening’s celebration.
Hannah Antista
Renee Demontreux
Andrea Himmelberger
Marissa Maxwell-Kaime
Sean Reed
Melanie Schwindt
Marsha Bagby
Michelle Deuto
Sonya Hirsch
Emily McGarvey
Megan Rentel
Brooke Sixta
Diane Banta
Katrina Einhellig
Meredith Jones
Kathleen McInnis
Lindsey Rettke
Beverly Strnad
Kristin Bentley
Susan Fisk
Dana Justus
Maria Milagros
Jesus Rivera
Jennifer Thistle
Allison Boerner
Bryan Garcia
Lindsay Kidd
Kneusel
Jennifer Roth
Lori Trego
Arlene Bravo
Debra Gardiner
Cassie Lang
Jennifer Miller
Jill Rozynski
Joelle Valdez
Khrystynn Cano
Shannon Goldsberry
Figaro Loresto
Andrea Mondragon
Denise Rush
Mark Vickers
Deborah Clarke
Lucy Graham
Dana Martin
Angela Pal
Rachel Sabolish
Jordan Widmer
Saturday, Aug. 13, 2022, at 6:00 p.m.
Hilton Denver Inverness | 200 Inverness Drive West | Englewood, CO, 80112
Master of Ceremonies
The Colorado Nurses
Foundation is excited to
announce that Kim Christiansen
of 9NEWS is returning as
master of ceremonies. Kim
has emceed the event in
previous years and has been
a big supporter of nurses and
the Foundation. She has won
seven Heartland regional Emmy
awards for spot news, news
writing and news reporting. Kim is also devoted to the fight
against breast cancer and she serves as the spokesperson
for the Buddy Check9 program and speaks to dozens of
community groups about the importance of self-exam and
mammography. Kim’s sister Keri was diagnosed with breast
cancer in 2005 and has taken an active role in efforts to
raise awareness about the importance of early detection.
Kim grew up in Colorado and graduated with a degree in
journalism from the University of Colorado at Boulder.
The Nightingale Luminary theme of “Excellence
in Nursing Professional Engagement & Citizenship”
reflects the CNF Strategic Initiative to reframe the
profession of nursing and the professional engagement
of nurses.
The dress code will be a more formal “black-tie
preferred” this year to emphasize the celebration’s
prestige.
Evening schedule:
6:00 PM
- Reception, Cash Bar
7:00 PM
- Welcome, Luminaries Presentation & Dinner Served
8:15 PM
- Nightingales Presentation
Table Sponsorships
Tables of 10 can be purchased for $1,800. Table
sponsorships include your organization recognized
via signage at your table and recognition as a Table
Sponsor in the Event Program.
Additional Sponsor & Advertising Opportunities
You or your organization can support this event
through many other sponsor opportunities. Please
review these on the CNF website.
Join us on August 13, 2022
for this exciting event!

10 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
ANA 2022 Annual Membership Assembly
June 10-11, 2022, Washington DC
Synopsis of Dialogue Forum on Nurse Staffing
Submitted Mary Satre, MSN, MBA, RN
CNA Board Member Region 3, District 4, and
Co-Chair of GAPP Committee
I was privileged to attend the 2022 Membership
Assembly of the ANA in June as an observer on behalf
of CNA. The program included a discussion forum on
three issues, the most robust of which was that focusing
on nurse staffing, including ANA’s current policy and
approach to nurse staffing along with several other state
and specialty-level strategies. Introductory video statements
were provided ahead of the Assembly by four panelists,
who attended the session and provided additional
comments following the general debate.
Members called for ANA to take a strong stance
on this issue and provide leadership and guidance to
the state organizations. Concerns were raised about
insufficient supply of nurses in certain areas and the
ensuing difficulty of implementing and/or enforcing
staffing recommendations. It was recognized that multiple
approaches may be effective, but that action is necessary
to mitigate the current state of burnout and moral distress
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experienced by many nurses. Above all, the membership
recognized that emphasis must be on patient safety.
An overview of the comments of individuals
representing their home states, in the order of the
discussion, yields the following highlights:
Ohio – Eliminate mandatory overtime – leads to fatigue.
Oregon – Staffing Law (2001) subject to misinterpretation
or is ignored. Be careful of the word “Minimum.”
Arizona (ASU) – clinical site shutdown has affected
nursing education; can students partner with RNs as “extra
hands?”
California – “Staffing works!” Helps with mental health.
But nurses have to fight every day to make sure ratios stay
in place.
Association of Men in Nursing – Pay disparity exists
with travelers. Consider tenure versus new staff to address
staffing shortage. Adopt VA public pay scales – they start
with a reasonable rate and never top off.
California – COVID overflow happened despite staffing
ratios. An example included 102 patients in a facility, 99 of
which tested positive for COVID and were cared by one RN
with only three CNAs. Hospital acuity metrics are tied to
EPIC (charting) system and care needs indicators.
Tennessee – Interest in policy making with consideration
of feasibility with regard to politics, implementation, and
monitoring over time.
Washington (NP in Urgent Care) – Staff nurses need to
be the leading voice (with ANA). “Ratios” could be called
“Standards.” Rural and urban deserve same standards of
care.
New Jersey – Continuum of care should be considered,
not just acute care. Include School nursing and home care.
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Pennsylvania – Dr. Linda Aiken (U of Penn) has provided
a rich body of research and statistics that support staffing
and outcomes. Use that research.
Pediatric Oncology Nurses – Language matters. The
acuity tool should be the nursing needs. Consider growth
and development.
Montana – ICU has maintained a 2:1 cap. Some places
have got it right.
Minnesota – School secretary with no training gives
insulin to students at school because there is no school
nurse.
Virginia – Would like adequate auxiliary staff (unit clerks,
et al.) to save nurses from doing all the jobs. Hospitals are
focused on profit.
Georgia– Emphasized the toll on new graduates and
provided examples of shifting patients around helping to
accommodate short staffing.
Vermont – “Speak even if your voice shakes.” We need
to help other nurses realize this.
Dialogue Forum Panelist Comments:
• Look to the literature and research to make these
decisions.
• One-sided collaboration doesn’t work. Language
should be: “safe staffing standards.”
“We need national guidance and a clear voice from
ANA.” But every state will be in a different place.
• Literature Review of more than 1000 articles has
been done – reference made to executive summary.
• Illinois has built a “line in the sand” with the
hospital association. They will negotiate once
more and then will head for ratios if the current
committee approach doesn’t work.
ANA’s Professional Policy Committee recognizes the
ongoing controversy and complexity surrounding this
issue but also recognizes that the current ANA position
does not meet the needs of the current environment. To
that end, the Committee recommends that ANA:
• Engage with state organization (C/SNA) leaders to
revise ANA’s current position on nurse-to-patient
ratios/standards.
• Consider the outcome of the engagement with
these leaders at the Leadership Council in December
2022.
Please refer to GAPP information in this issue of
the Colorado Nurse regarding the steps underway in
Colorado to address the issue of nurse staffing.
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The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 11
News from American
Association Nurse
Practitioners® (AANP)
Constance McMenamin. AANP State
Representative
The 2022 AANP National Conference was held in
Orlando Florida, June 21-26. It was a great week filled with
continuing education, exclusive keynote speakers, legislative
and policy updates, and workshops and exhibitors. It was
also a great time to connect with colleagues across the US
and beyond. AANP celebrated the 2022 State Award for
excellence winners with a reception honoring our Colorado
award winners. Again, congratulations to Sarah Schaefer,
NP-BC, CNRN, MSCN, who was selected as Colorado’s
AANP NP State Award for Excellence recipient and Colleen
Casper, RN, MS, DNP, who was selected as Colorado’s
AANP Advocate State Award for Excellence recipient.
This is a reminder for nominations for the 2023 AANP
State Awards for Excellence, with two awards per state
recognizing clinical excellence or advocacy, which will
launched in late July. Nominations must be submitted
online by early September. Please start thinking about
worthy colleagues now; we should have a flood of worthy
candidates. (Nominators need to be AANP members, but
nominees do not).
In addition, AANP Colorado State Representative selfnominations
are due in October 2022 to be considered
for the election slate and assume the role of state
representative in July 2023. This is a great opportunity
to participate in the largest professional membership
organization for nurse practitioners (NPs), acting as a liaison
between state and national leaders on behalf of NPs.
For more information on AANP activities in Colorado
or how you can get involved with the association, please
reach out to constance.mcmenamin.np@gmail.com.
ANA Membership Assembly Addresses
Verbal Abuse and Workplace Violence
Carol OMeara, ANA Membership
Assembly Representative
At the 20022 ANA Membership Assembly, a report
on Advancing Solutions to Address Verbal Abuse and
Workplace Violence Across the Continuum of Care
was discussed. As pointed out in the report, healthcare
stakeholders’ approach to workplace violence in health
care often focuses on responses to, and prevention of,
ANA Adopts
Racial Reckoning
Statement
Carol OMeara, CNA Voting Representative to
the ANA Membership Assembly
On June 11, 2022 the voting representatives of the
American Nurses Association’s (ANA) Membership
Assembly voted by unanimous consent to adopt a Racial
Reckoning statement which will be the starting point for
the association to embark on a racial reckoning journey
to acknowledge its past actions that have caused
irreparable harm to nurses of color as well as ethnicminority
nursing organizations, and that persist today,
ANA intends to take full accountability for its actions.
The statement as well as the plans for the journey will
be released later this summer and will be reported in the
November Issue of Colorado Nurse.
physical assaults in hospitals. These approaches overlook
verbal abuse, which can be a risk factor for physical
violence. In addition, recommendations developed for
inpatient settings may not be appropriate for or helpful in
community settings, such as schools, community health
centers, public health facilities, and similar places where
workplace violence can occur.
Assembly representatives called on ANA to engage key
stakeholders to identify, develop and advance strategies
resulting in a comprehensive culture of safety and zerotolerance
approach to verbal abuse and violence in all care
settings, advance workplace violence prevention priorities
in nursing practice and public policy, and advocate for
better data collection to inform policy development.
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12 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
The Fight for Healthy Environments:
Nurses Drawdown empowers nurses
to make a difference
Katheren Koehn, MA, RN, FAAN
Executive Director, Minnesota Organization
of Registered Nurses
This article originally appeared in
Texas Nursing 2021, Issue 3
Reprinted from New Mexico Nurse, August, 2021
While the political debate continues about climate
change, its impact, and what governments can do,
nurses do not have to wait to take action. The Nurses
Drawdown initiative helps individual nurses and nurse
organizations to collectively work to decrease the
impact of climate change.
Nurses must act now to make a difference into
the future. While each action may seem small within
the scope of the enormity of the challenge, everyone
will make a difference. As Florence Nightingale
famously said, “So never lose an opportunity of
urging a practical beginning, however small, for it is
wonderful how often in such matters the mustard-seed
germinates and roots itself.”
Nurses Drawdown is just this—a practical beginning.
Origins and Goals
In atmospheric terms, drawdown is that point in time
at which greenhouse gases peak and begin to decline
on a year-to-year basis. The goal of Project Drawdown
would be to identify, measure, and model one hundred
substantive solutions to determine how much we could
accomplish within three decades to towards that end.
Nurses Drawdown is based Drawdown, the work
of Paul Hawkins, over 70 Drawdown Fellows from 22
countries, and a 120-member advisory board of scientists,
engineers, climatologists, botanists, economists, and
others. Their resulting book, Drawdown: The Most
Comprehensive Plan Ever Proposed to Reverse Global
Warming organizes a growing list of practical solutions for
energy; food; women and girls; buildings and cities; land
use; transport; and materials. 1
To access electronic copies
of the Colorado Nurse,
please visit
http://www.NursingALD.com/
publications
Nurses Drawdown selected five key Drawdown
areas to focus on:
• ENERGY: Supporting a clean energy future by
promoting energy efficiency and advocating for a
transition to renewable energy
• FOOD: Commit to a plant-based diet, use of clean
cook stoves, and reduced food waste
• MOBILITY: Bike infrastructure, walkable cities,
and mass transit
• GENDER EQUITY: Educating girls and family
planning
• NATURE-BASED SOLUTIONS: Planting trees,
protecting tropical forests and forest protection
These goals relate closely to the UN Sustainable
Development Goals and the Social Determinants of
Health. 2,3
Expertise and Trust
Why nurses? As nurses, we know the impact of the
environment on health. We know that health depends
on good nutrition, clean air, the ability to get exercise
safely. As nurses, we are called to take action to
protect the environment.
The Code of Ethics for Nurses says, in part,
“Nursing must also advocate for policies, programs,
and practices within the health care environment that
maintain, sustain, and repair the natural world. As
nursing seeks to promote and restore health, prevent
illness and injury, and alleviate pain and suffering,
it does so within the holistic context of healing the
world.” 4
The power of nurses to implement change is based
on three essential assets: 5
• Nurses comprise about 60% of worldwide health
care professionals, working in clinical and public
health sectors.
• Nurses are trusted, as evidenced year-after-year in
Gallop Poll findings.
• Nurses are close to the people most vulnerable
to climate change, including people who are
underserved, marginalized, or both.
Action and Change
Nurses Drawdown believes that nurses are
in the right place and at the right time to make
a significant contribution to drawing down
greenhouse gases. A project of the Alliance of
Nurses for Healthy Environments and Project
Drawdown, Nurse Drawdown involves nurses from
around the globe. The website, Nurses Drawdown,
has a list of current organizational partners,
including the ICN, the Irish Nurses and Midwives
and several state nurses’ associations of the
American Nurses Association.
A first step for individual nurses is to join Nurses
Drawdown. Nursing organizations can also become
Nurses Drawdown Partners. There is no charge for
individuals or organizations to become involved. On
the website, nurses can learn about several actions they
can take and access media, including YouTube videos,
of how other nurses have gotten involved. Learn more
at nursesdrawdown.org.
1.Hawken, Paul. Drawdown: the Most Comprehensive Plan
Ever Proposed to Reverse Global Warming. Penguin
Books, 2017. 2 Department of Economic and Social
Affairs. (2015).
2. Sustainable Development: The 17 Goals. United
Nations. https://sdgs.un.org/goals
3. Healthy People 2030. (n.d.). Social Determinants of
Health. U.S. Department of Health and Human
Services.
https://health.gov/healthypeople/
objectivesand-data/social-determinants-health
4. American Nurses Association. (2015) Code of Ethics for
Nurses with Interpretative Statements.
5. Butterfield, P., Leffers, J., Vásquez, M.D.. (2021).
Nursing’s pivotal role in global climate action. BMJ
373: n 1049
CJ Cullinan, RN
DNA 16, NPAC Secretary
NPAC, Nurses for Political Action in
Colorado, is an active advocacy group that
collects money from nurses, friends and
family of nurses to make a difference in our
work in Colorado.
We, as nurses, know that our
organizations, agencies, clients and their
families and friends respect us for what we
do. The reality is that our work is affected
by the rules and regulations created at our
State Capitol. We need to stay vigilant. We
need Legislators who understand that our
work is not just in the hospital, community,
or home, but also in the State. We need
leaders that understand that our ability to
care for each person in Colorado must be
a priority. We need all voters to join us in
support of leaders that know the true value
and contribution of nurses.
With re-districting in 2021, the
2022 elections include all our State
Representatives, half of our State Senators,
State Governor and Lieutenant Governor,
Attorney General, Secretary of State, and
State Treasurer; State Board of Education,
University of Colorado Regent, RTD
(Regional Transportation District), County
based elected, including Coroner, Sheriff,
County Clerk & Recorder, Surveyor,
Treasurer, Coroners, and Commissioners, as
well as various City Councils across the state.
We have five Nurses running for office
and all are CNA members: Rosanna Reyes
CD 8 CU Regent, Kyle Mullica SD 24 Adams
County, Ruby Martinez HD 45 Castle Rock;
Alice Marie Slaven-Emond HD 54 Delta, and
Annette Cannon Jefferson County Coroner.
Your voluntary contributions (not taxdeductible)
work to elect leaders who will be
steadfast in their support of Nurses and their
patients. Your NPAC (Colorado) contribution
is maxed out at $625 every election cycle
(two years). For this year, our goal is $10,000
to have the funds to financially support
Nurse- informed candidates. You may
make your donation online at https://www.
coloradonurses.org/nurses-for-politicalaction-in-colorado-npac-.
As a NPAC donor of any amount, you
may join us in the discussions and vote for
candidates we choose to endorse and fund.
We’re supplemented by the experiences and
information by our Lobbyist Gil Romero and
CNA’s own Colleen Casper active at the
Capitol throughout the session. We meet
on the 2nd Wednesday’s of the month at
615p and you may register on the Colorado
Nurses Association website (coloradonures.
org).
As our healthcare environment becomes
increasingly politically and economically
driven, we want to elect leaders who are
capable of understanding the importance
of nurse led care. We want to invest our
endorsements, time and money to highlight
those candidates who have spoken and
supported Nurses in their care of everyone in
Colorado.
As an addendum, our national
representatives for Congress and the
Senate are endorsed and funded by the
American Nurses Association Political Action
Committee (ANA-PAC). Your ANA-PAC
(National) donation is maxed out at $5000
for the two-year election cycle and can
be completed through the ANA website
(nursingworld.org).

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 13
Adventures in Nursing – From the Bedside to Behind the Scenes
MS in informatics graduate loves helping nurses provide
the best patient care in the most efficient way
Dana Brandorff
Emily Reyes has been working in nursing
informatics for several years but knew she needed to
earn her master’s degree if she wanted to advance
in her career. “Even though I was already doing the
work, I needed more theory and evidence behind
what I was doing to take on higher leadership roles,”
says Reyes.
For 20 years, she has worked at Children’s Hospital
Colorado. First as a bedside nurse, then a Clinical Nurse
IV focusing on documentation. Because of that role, she
became a superuser within the hospital’s electronic record
system. “I was the go-to person for the other nurses
when they would have problems inputting or using the
system. I like troubleshooting and problem-solving.”
Opportunity to Analyze and Improve Systems
Appeals to Her
In 2005, the hospital was looking for a nurse to
help implement Epic EHR (Electronic Health Record)
software. “The opportunity was really a ‘no brainer’
as the analyst role fit my brain. I love applying the
clinical side to technology. And helping our nurses
provide the best patient care in the most efficient
way is right up my alley.” The job was anticipated
to last for two years, then she would return to her
superuser position. Because of her innate abilities,
Reyes has continued in the technology role at the
hospital and officially received the title of analyst in
2006. In 2019 after years in clinical applications as
an analyst and manager, Reyes became the Director
of Clinical Informatics/CNIO, which required a
master’s degree.
Why CU Nursing for her Master’s Degree?
So, when Reyes was looking for a master’s program
specializing in informatics, she knew she wanted
something innovative and one that had a long history
of embracing change. “There are a ton of online
schools. But none like CU Nursing. What drew me to
the program was Dr. Diane Skiba. She is so well-known
in the field and is considered the mother of healthcare
informatics. She was what sold me,” says Reyes. It also
didn’t hurt that Children’s Hospital Colorado is located
on the Anschutz Medical Campus – the same campus as
CU Nursing – providing greater access to resources.
“Doing it all online was a challenge to get used to.
It was very different than my undergraduate years at
the University of Pennsylvania. Because of the excellent
curriculum and access to legends in the profession, I
couldn’t think of a better place to earn my degree. It was
the only place I considered.”
She started in the program in 2019 and graduated in
December 2021.
Why Informatics?
“Informatics isn’t for everyone. I miss the bedside.
There are so many paths nurses can follow. I know
that I contribute to the profession and this specialty in
different ways. I’m making different kinds of changes for
more patients –.”
One of the advantages of the informaticist role is the
hours. She doesn’t work weekends and, “I’m around for
my kids and can attend their extracurricular programs.”
For Reyes, informatics is where she can make the
most impact on the most people – from nurses to
patients, and she loves it. “It’s what I was born to do. I
love it!”
Faith Community Nursing
Melanie Huibregtse, MS,BSN, RN, Faith
Community Nurse
Plymouth United Church of Christ Fort Collins,
Colorado
What is a Faith Community Nurse?
Faith community nursing is a growing nursing practice
specialty recognized by the American Nurses Association
and according to their scope and standards, Faith
Community Nursing focuses on the intentional care of the
spirit, the promotion of an integrative model of health,
and the prevention and minimization of illness within the
context of a faith community.
The Faith Community Nurse (FCN) is a licensed,
registered nurse with two to five years of experience,
who has received special training through the
Foundations of Faith Community Nursing Course
(36.5 contact hours) and uses his or her professional
skills to assist those who are underserved or need
help to negotiate the health care maze. They serve
congregants from cradle to old age and provide
confidential counseling, advocacy, referral, spiritual
support, and education.
FCN’s also assist with referral to clergy and
organization of faith community volunteers to support
those in need. They may help by interpreting medical
“jargon”, finding healthcare resources, and walking
alongside someone who has a life-threatening diagnosis.
They might help those coping with injury, illness, or
chronic disease, and can also promote health through
immunization clinics, screenings, support groups, and
education programs.
Wait, how is this different from Home Health
Services?
FCNS are not a home health service and cannot
provide physician directed care such as dispensing
medications, changing dressings, or giving injections, etc.,
but do serve as a knowledgeable health care professional
in advising and supporting congregants who may have
questions, or are having difficulty navigating the health
care system.
Sometimes a story helps people understand…
Supporting the Homeless
One of the major health issues for homeless persons
is problems with their feet. Recognizing this, one FCN
in Boulder helped with an event that invited homeless
persons off the streets for foot washing and foot care by
registered nurses. The Health Ministry (with coordination
by the FCN) provided blood pressure screening and
health and nutrition counseling for people without access
to a kitchen. Hair stylists volunteered to give haircuts
and others gave manicures. Clean socks and samples
of shampoo, soap, lotion, and dental products were
available. Other volunteers came with coffee, donuts and
conversation as a way to welcome the homeless.
Babies! Babies!
One FCN in Fort Collins does well baby visits as
part of her ministry. It is a joy to bring a small gift
from the church to the parents and to meet the
newest member of a family. The visit is designed to
offer the new parents a resource in case of questions
or concerns, and to link them to services in the
community.
Juniper Village at the Spearly Center
Come join our amazing team!
We are hiring
RNs • LPNs • CNAs
For more information, contact the regional non-profit,
non-denominational group Faith Community Nursing
in the Rockies which supports and educates FCNs. The
website has information on upcoming Foundations
of Faith Community Nursing classes and educational
events at www.fcnrockies.org. You can also find more
information on this topic at the national Faith Community
Nursing site www.westberginstitute.org.
Citations
1. American Nurses Association. (2017). Faith Community Nursing
: scope and standards of practice. Co-published with the
American Nurses Association and the Health Ministries
Association
If you are excited to make an impact on the lives of
those around you, we want to hear from you!
We offer Great Benefits!
We are certified as
A Great Place To Work from Forbes.
Please visit us and apply at
junipercommunities.com/find-juniper-communities-jobs/
2205 W. 29th Ave. Denver, CO 80211 • 303-458-1112

14 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
COVID-19 sparks professors to create virtual medical
emergencies for students
Restricted from clinics, CU College of Nursing grad
students treated patients in virtual simulations
The emergency room was overflowing with sick
patients. The graduate nursing student had 15 minutes to
figure out what was wrong with the deathly ill woman,
consult with his colleagues, and get her help. With the
clock ticking, he asked questions about her medical history
and examined her. Was she suffering from sepsis, bacterial
meningitis, gastrointestinal bleeding, or a number of other
life-threatening conditions? Minutes later, everything froze.
Time was up. The patient and emergency room dissipated
as the program shut down.
Advanced practice registered nurse students at the
University of Colorado College of Nursing immersed
themselves into virtual medical emergencies to simulate
what they could not initially get in the spring of 2020–
real world clinical training and experience. The pandemic
restricted many of them from practicing in actual clinics
with real patients because of limited physical clinical
workspace, and less preceptor availability. Yet, the students
were still required to earn clinical hours for indirect patient
care to graduate. That prompted the faculty to get creative.
As an alternative to traditional clinical experiences, CU
Nursing faculty Angela D. Pal, PhD, ACNP-BC, CHSE; Fara
Bowler, DNP, APRN, CHSE; Mary Beth Flynn Makic, PHD,
CCNS; and Krista R. Estes, DNP, FNP-C introduced an
established, computer-based virtual simulation for grad
students. In an article just released, the faculty says the
virtual simulation training kept the students engaged and
taught them how to handle emergency situations almost as
well as the real thing.
According to the faculty, while research is limited, a
systematic review found this mode of education improved
nursing student skill-base, cognitive and affective
knowledge. It provides an opportunity to improve
patient safety, work effectively as an interprofessional
team, develop communication skills, and critically think.
Simulation facilitates autonomous learning because the
student can repeat the scenario for a more deliberate,
focused experience.
Faculty used the Oxford Medical Simulation (OMS)
platform, which follows best practices in simulations.
Students had 15 minutes to assess, diagnose, offer
empathy, collaborate with other providers, analyze the
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results and the patients’ medical records, and treat the
patient.
OMS uses artificial intelligence to adapt to the virtual
patients’ conversations, behavior and physiologic responses
to the students’ interventions and questions. After the
simulation, students completed a worksheet about the
scenario and received feedback about their encounter.
During the year-long program evaluation, 144
graduate students volunteered to participate in the
virtual clinical education. According to a survey, 86%
Former foster child earns PhD,
vows to help other vulnerable people
Deborah Sherman
From foster child to doctor
of philosophy. Dawn Taylor
is about to earn the highest
academic degree despite the
lowest possible start in life. Even
as she graduated this past May
from the University of Colorado
College of Nursing with a
PhD in Caring Science, she’s
remembering where she began
and how far she still wants to go.
“The likes of me and my Dawn Taylor
family were not encouraged to
go to the university. For me to be the first in my family to
graduate college, let alone with a doctorate degree, speaks
volume,s, says Taylor, PhD class of 2022, RN, BSN, MSN.
“Also, I have been a nurse for 30 years. It blows my mind as
to where I’m at now.”
Rocky Start to Life
Taylor was born in Cambridge, England. Her dad could
barely read. Her mom was a gamekeeper’s daughter. By
the time Taylor was 11, they were both dead. Without
parents, she landed in foster care. First, with some relatives
who made it clear she wasn’t wanted. Then, she went
to a second foster home where she learned life skills like
laundry, cooking, and budgeting. It was hard and lonely.
“I didn’t have a TV. I would literally come home from
school and stare at four blank walls. There was no noise
which was overwhelming. I felt like even being around bad
crowds was better than sitting and being alone. The silence
was deafening,” says Taylor.
Giving Voice to Others Who Feel Invisible
The solitude of her childhood led Taylor as an adult to
give a voice to others who feel invisible: victims of physical,
mental and emotional abuse, alcoholics, drug addicts, and
gender diverse women and men. She calls herself an ally.
Taylor worked in the United Kingdom as a nurse for
several years, then moved to the United States in 1998 and
had to retake the licensing exam to establish competence
of the students said it accurately reflected clinical
practice.
“I found this to be of value to our program… This
simulation includes all the components to complete a
full history and physical, order labs, diagnostics and treat
the patient effectively in a given time,” said one student
participant.
With the successful simulation, faculty plan to continue
using virtual reality to enhance student learning and clinical
experience.
to practice as a registered nurse in the U.S. She worked as a
nephrology nurse specializing in diseases of the kidney, and
was certified in nephrology in 2001-2017. Then in 2008,
Taylor earned a bachelor’s degree in nursing and in 2010,
completed a Master of Science in Nursing degree.
She has been living in Las Vegas, Nevada teaching
undergraduate students health assessment, fundamentals
of nursing and community/public health nursing – all the
while going to school at CU Nursing in Denver for her PhD.
Tough Teacher who Espouses Work Smarter
Philosophy
Taylor says she’s a tough teacher and expects her
students to work hard.
“The only person who helped me back then is me. I’ve
had to push to get where I am, and that translates to my
students. As long as they’re giving me everything they
have, then I respect that. But I get frustrated if someone
does barely enough to get by and I know they have more
in them,” says Taylor. “I tell them ‘You don’t have to work
harder to get there, you have to work smarter and not
be afraid. The professors will help. If you make yourself
vulnerable and trust them to help you, they will help you.’”
The focus of Taylor’s PhD is Caring Science, a type
of nursing theory for students to integrate caring and
healing into their lives and to provide deeper meaning,
purpose and dignity to patients. Her dissertation is based
on exposing healing after violence among LGBTQ partners.
Taylor has also volunteered for several years as a yoga and
meditation instructor for victims of domestic violence and
gender diverse people.
Never Give Up
After Taylor earns her doctorate, she plans to continue
teaching at the graduate level and obtain a tenure position
at Nevada State College. She also wants to continue her
research working in public health with invisibility and healing
journeys with vulnerable populations. Above all, she wants
foster kids and other people who feel alone to never give up.
“Things are not going to go as you expect, ever. The
best-laid plans are going to go awry. So, seek help early,
and don’t shut down. If you find yourself struggling, never
give up. You can change your life.”

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 15
Virtual Simulation: Impact on Clinical Judgment
Amber Kool, MSN, RN
Reprinted from Oklahoma Nurse May June July 2022
The need for newly licensed nurses to safely manage
multiple complex patients requires strong clinical
judgment skills to appropriately prioritize and delegate
(Bittner & Gravlin, 2009). Direct patient care experiences
in acute care settings are the typical way nursing
students learn clinical judgment. However, these clinical
experiences do not always provide an opportunity to
collaborate, critical think, or make independent decisions
that will improve patient outcomes (Lippincott Nursing
Education, 2018). The most recent data from the
American Association of Colleges of Nursing suggests
that 80,407 qualified applicants were not admitted
to baccalaureate and graduate nursing programs with
insufficient clinical sites a contributing factor (2020).
The COVID-19 pandemic has significantly limited direct
patient care clinical experiences for nursing students
throughout the U.S. (Logue et al., 2021). There is an
urgent need to develop teaching-learning practices that
will support the development of clinical judgment as
both an augment and substitution for direct care clinicals
(Thobaity & Alshammari, 2020).
This study investigated the impact of a virtual
simulation (VS) (Sentinel U’s Patient Management
and Delegation and Prioritization of Care) on clinical
judgment in a sample of pre-licensure BSN students.
VS utilizes experiential learning as identified by Kolb’s
Experiential Learning Theory (1984) to expose the
learner to a new experience and requires the student
to reflect, thereby integrating the learning into their
knowledge bank (McLeod, 2017). As learners reflect
on their decisions and reasoning, they integrate their
previous experiences and the new knowledge gained
through the VS.
Design
Using a one-group, repeated measures design,
a paired-samples t-test was used to measure the
change in perceived clinical judgment pre- to post-
VS intervention. The Skalsky Clinical Judgment Scale
measures the construct using a four-point Likert
Scale, with ten questions, which include assessing
perceived abilities in prioritization, delegation, and
communication.
Major Findings
There was a statistically significant increase in perceived
clinical judgment scores from pre- intervention (VS) (M =
32.17, SD = 4.178) to post- intervention (VS) (M = 34.10,
SD = 4.992), t (41) = 2.832, p < .007 (two-tailed). The
mean increased in perceived clinical judgment scores was
1.929 with a 95%.
Discussion
The positive results suggest that VS may be useful
to support teaching-learning practices related to
clinical judgment development. Perceived increases in
clinical judgment may make students more confident
and encourage them to practice skills further. Further
research is needed to objectively measure clinical
reasoning and resultant patient outcomes that result
from the use of VS as a teaching-learning strategy.
Implications for Nursing the Nursing Profession
Recent evidence suggests that only 10% of newly
licensed nurses score within an acceptable competency
range using a performance-based (Kavanagh & Sharpnack,
2021). The most recent practice analyses by the National
Council of States Boards of Nursing suggest that newly
licensed RNs are increasingly required to make more
complex clinical decisions (2015, 2018). COVID-19
exacerbated existing pre-licensure nursing education
challenges by further limiting already scarce clinical
practicum sites (Dewart et al., 2020). VS may be a useful
addition to direct patient care and high-fidelity human
patient simulation to learn clinical reasoning skills. VS may
be helpful as an additional strategy in addressing the critical
nationwide shortage of clinical practicum sites. Also, VS
may bridge the gap in clinical learning experiences during
times when other opportunities may not exist, such as
experienced during the COVID-19 pandemic and in times
of emergencies and natural disasters.
VS may likewise prove beneficial for skill
development or assessment within clinical agency
orientation and continuing competency efforts. Similar
to its use in the academic environment, VS within
practice and continuing education provides a safe
environment to make decisions without potential harm
to patients (Verkuyl et al., 2019). In conclusion, given
the evolving technology that underpins VS and its
increasing fidelity, the interest in and application of
VS in academic and practice environments will likely
increase. Nurse leaders will be challenged to implement
VS in evidence-based ways and monitor and measure
outcomes to assure its value.
References
American Association of Colleges of Nursing. (2019). Nursing
shortage. Retrieved from https://www.aacnnursing.org/
news-information/fact-sheets/ nursing-shortage
Bittner, N. P., & Gravlin, G. (2009). Critical thinking,
delegation, and missed care in nursing practice. JONA:
The Journal of Nursing Administration, 39(3), 142-146.
doi:10.1097/ nna.0b013e31819894b7
Dewart, G., Corcoran, L., Thirsk, L., & Petrovic, K. (2020).
Nursing education in a pandemic: Academic challenges
in response to COVID-19. Nurse education today, 92,
104471. https://doi. org/10.1016/j.nedt.2020.104471
Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in
Competency: A Defining Moment in Nursing Education”
OJIN: The Online Journal of Issues in Nursing Vol. 26, No.
1, Manuscript 2. DOI: 10.3912/OJIN.Vol26No01Man02
Lippincott Nursing Education. (2018, June 7). Turning new
nurses into critical thinkers. Combining Domain Expertise
With Advanced Technology
| Wolters Kluwer. https://www.wolterskluwer. com/en/expertinsights/turning-new-nurses-
into critical-thinkers
Logue, M., Olson, C., Mercado, M., McCormies, C.J., (January
31, 2021) “Innovative Solutions for Clinical Education
during a Global Health Crisis” OJIN: The Online Journal
of Issues in Nursing Vol. 26, No. 1, Manuscript 6. DOI:
10.3912/OJIN.Vol26No01Man06
National Council of States Boards of Nursing. (2015). 2014 RN
Practice Analysis: Linking the NCLEX-RN Examination
to Practice - U.S. and Canada. 62. https://www.ncsbn.
org/15_RN_ Practice_Analysis_Vol62_web.pdf
National Council of States Boards of Nursing. (2018). 2017 RN
Practice Analysis: Linking the NCLEX-RN Examination to
Practice - US & Canada 72. https://www.ncsbn.org/17_
RN_ US_Canada_Practice_Analysis.pdf
McLeod, S. (2017, February 5). Kolb’s learning styles and
experiential learning cycle. Retrieved from https://www.
simplypsychology.org/learning- kolb.html
Sentinel U. (2020, November 30). Nursing prioritization
exercises. https://www.sentinelu.com/solutions/
prioritization-and-delegation/
Skalsky, K. (n.d.). Skalsky Clinical Judgment Scale validity.
American Sentinel University
Thobaity, A., & Alshammari, F. (2020). Nurses on the Frontline
against the COVID-19 Pandemic: An Integrative Review.
Dubai Medical, 1-6. https:// doi.org/10.1159/000509361
Verkuyl, M., Hughes, M., Tsui, J., Betts, L., St-Amant, O., &
Lapum, J. L. (2017). Virtual gaming simulation in nursing
education: A focus group study. Journal of Nursing
Education, 56(5), 274-280. doi:10.3928/01484834-
20170421-04
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16 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
CU Nursing Legends Credited for Developing
National Residency Model
How Dr. Colleen Goode and Dr. Mary Krugman built a program that helps nurses succeed nationwide
Bob Mook
Two highly regarded nursing leaders with ties
to the University of Colorado College of Nursing
are credited with pioneering the widespread
adoption of nurse residency programs (NRPs). An
article in the Journal of Continuing Education in
Nursing paid tribute to the groundbreaking work
of Colleen Goode, PhD, RN, FAAN, NEA-BC, and
Mary Krugman, PhD, FAAN, NEA-BC, for building
what has become a national model that has helped
nursing graduates segue to their chosen profession.
More than 500 clinical sites nationwide are
now using the residency program’s evidencebased
curriculum. UCHealth University of Colorado
Hospital was among six institutions that tested the
initial program.
The article highlighted how NRPs reduced
attrition in nursing over the years by providing
retention strategies that are just as effective now as
when they were first introduced.
Careers crossed paths
Drs. Goode and Krugman began their nursing
careers in the 1960s before relocating to Colorado
in the 1990s. Goode received a nursing degree
from the University of Iowa in 1961 and held
numerous leadership positions throughout the
Midwest before moving to Colorado to become
the chief nursing officer of what is now UCHealth
University of Colorado Hospital. She also served as
associate dean for CU Nursing.
As someone who spent abundant time
interacting with health care professionals in myriad
settings, Goode noticed high levels of stress and
high turnover rates among the newly recruited
nurses. She questioned why nursing did not require
a residency program like other health care practices.
“If you are in medicine, pharmacy, physical
therapy or a hospital chaplain, you were required to
obtain a residency before entering ‘the real world,’”
Goode said. “It didn’t make sense to me that nurses
– who are so critical in the delivery of health care
– weren’t getting the level of professional and
emotional support they needed to prepare for their
careers.”
Krugman gained valuable insights about patients’
needs as a nurse at the psychiatric unit of a New
York hospital in the mid-1960s and while earning a
master of psychiatric mental health nursing degree
from New York University.
“Faculty were very involved and they provided
support and empathy as we gained confidence in
ourselves as part of a team,” Krugman said. “Those
experiences were so formative and important in my
career – as they are for every nurse.”
For 23 years, Krugman was director of
professional resources and development at
University of Colorado Hospital, where she oversaw
clinical employee orientation and education,
nursing and continuing education. In 1997, over an
introductory “business lunch,” Krugman and Goode
quickly bonded over their similar philosophy and
collaborative work style.
“It was the beginning of a great partnership,”
Krugman recalled. “We were lucky that we both were
part of a system that allowed us to explore our vision.”
NRP timeline
Reaching out to colleagues nationally, Goode and
Krugman began to collaborate on an idea to form
an alliance of academic hospitals and deans to build
a pilot NRP with specific objectives and measures.
This group prepared a graduate nurse residency
curriculum and discussed how nurse data would be
collected and analyzed. They also drafted multiple
manuscripts and presentations making the case for
the adoption of the program.
In March 2000, nursing officers and deans
from several hospitals and universities in the U.S.
convened a task force to identify ways to increase
participation in post-baccalaureate graduate
nursing programs. After demonstrating there was
little to no uniformity in orientation programs and
curriculum offered by hospitals, the partnership
developed what is now called the Vizient/AACN
Nurse Residency Program, credited by the American
Association of Colleges of Nursing (AACN).
Your Next Move Before Starting Your Career?
Nurse residency programs provide a bridge
between school and ‘the real world’
Let’s face it: These are scary times and nursing
can be a scary profession. The thought of leaving
the safe nest of academia can be quite daunting –
especially now.
“The recent pandemic restricted many students
from practicing in actual clinics,” said Allison Boyrer,
MS, MA, BSN, RN, a CU Nursing alumna and manager
of the Post-Baccalaureate Registered Nurse Program
(PBRNR), in a recent news item. “So, a residency
program that provides more protected, mentored time
with real-life experiences is extremely valuable.”
Fortunately, new or soon-to-be graduates have
plenty of options that provide the practical experience
of a real job (and a paycheck) along with support,
training and additional curriculum to help them
succeed. UCHealth offers several residency programs
with trained preceptors and other clinical experts who
share your commitment to learn and grow.
Protect yourself against burnout
Though burnout among clinicians has garnered
recent headlines amid a global pandemic, it is
nothing new. Indeed, the very concept of nurse
Bob Mook | June 9, 2022
residency programs (NRPs) has its genesis at CU
Nursing. Two trailblazers of nurse residencies (Drs.
Colleen Goode and Mary Krugman) developed a
pilot program that was implemented at UCHealth
University of Colorado Hospital nearly 20 years ago
-- in part, to address early burnout among recent
nursing grads.
As a young nurse at the start of what would
become long and successful career, Krugman
participated in a similar program firsthand. As an
associate dean for CU Nursing and a chief nursing
officer, Goode maintained that residencies gave
nurses a safe haven to learn and grow. Findings and
analyses over the years have strongly supported that
thesis. Nurse Residency programs are considered an
investment in your long-term success in a field that
you were called to serve.
The benefit of a residency is that “you’re not
just stuck in one unit,” said Alexis Ricamonte, a
2021 graduate of CU Nursing, who entered the
PBRNR program at VA Eastern Colorado Health
Care System. “I’m getting a new perspective and I
appreciate it in a way I didn’t expect.”
By 2003, six hospital-college partnerships
joined the pilot program. Findings overwhelmingly
supported the benefits of a 12-month NPR,
with nurses having more confidence to work
independently while collaborating with those in
other disciplines. The data show the program also
improved retention rates among newly graduated
nurses.
In 2010, the National Academy of Medicine
called for the implementation of nurse residencies
for all new graduates. While this endorsement
was a big step forward, Goode pushed for wider
adoption of the NRP curriculum. That persistence
paid off. In 2013, the Commission on Collegiate
Nursing Education (CCNE) approved accreditation
standards for post-baccalaureate NRPs. UCHealth
University of Colorado Hospital was the first
accredited NRP.
Today, NRPs are considered essential by many
nursing professionals. As the article authors noted,
“the momentum and successes associated with these
programs are becoming more widely accepted.”
However, dedicated funding continues to be a
challenge to implementing NRPs. Both Goode and
Krugman still hold out hope that the Centers for
Medicare & Medicaid Services (CMS) would provide
more financial support for the programs just as they
do with similar professionals in health care.
A lasting legacy
Over the years, Goode and Krugman earned
respect within their employment settings and
nationally with numerous published articles and
awards.
Goode was recognized for her leadership by
receiving the Edge Runner Award in 2010. She is
also a recipient of the distinguishedNightingale
Award in Colorado as well as the Lifetime
Achievement Award from the American
Organization of Nurse Executives in 2011. She is
the namesake of the Dr. Colleen Goode Fund for
Nursing Research and Evidence-Based Practice
Projects and has served as a professor for CU
Nursing since 2009 and characterizes herself as
“happily retired” on her Facebook page.
Krugman also received the Nightingale Award for
leadership in Administrator, Educator, Researcher
and Other Nontraditional Roles. In 2020, she
received a University Medal from the University of
Colorado Board of Regents. “Her contributions
have a positive impact on professional entry into
practice and nurse retention at UHC and across the
country,” according to remarks citing the honor.
Like Goode, she remains involved with CU Nursing
during retirement.
Published earlier this month in the Journal of
Continuing Education in Nursing, the oral history
was written by four CU Nursing professors who
worked closely with Goode and Krugman: Dr.
Mary Beth Flynn Makic, PhD, RN, CCNS, FAAN,
FNAP, FCNS; Dr. Kathy Casey, PhD, RN, NPD-BC; Dr.
Kathleen S. Oman, PhD, RN, FAAN; and Dr. Regina
M. Fink, PhD, APRN, AOCN, CHPN, FAAN. All four
are accomplished leaders in nursing and strong
advocates of post-graduate residencies.
“Dr. Goode and Dr. Krugman deserve significant
credit for their vision and work developing a
national model for NRPs,” the article said in
closing. “Their leadership, remarkable contributions
and coloration with other hospitals early in the
development of NRPs paved the way for the current
presence and ongoing development of NRPs to
help nurses transition to professional practice more
successfully.”
The Vizient/AACN Nurse Residency Program at
UCHealth serves 12 hospitals throughout the Front
Range. The program includes specialty courses
designed for your specific unit throughout the
year and monthly residency seminars providing
additional curriculum and residency support.
Applications are accepted year-round.

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 17
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.
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.
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

18 • Colorado Nurse | August 2022
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association
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 why people may be inclined to believe information
that is not grounded in science.
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 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.
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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 (https://
www.myamericannurse.com/preventing-the-spread-of-misinformation/) 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. Before making a recommendation,
nurses should consider the appropriateness of the source for the patient’s health
literacy level. Kington and colleagues (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC8486420/) explain the importance of evaluating sources to ensure the
information provided is science-based, objective, transparent, and accountable.
Although the tendency is to recommend government sources such as the Centers
for Disease Control and Prevention and National Institutes of Health, as noted earlier,
some people do not trust the government. In this case, sources such as MedlinePlus,
World Health Organization, and condition-specific nonprofit organizations (e.g., the
American Heart Association, American Cancer Society, Alzheimer’s Association) might
be preferred.
Education. The sheer scope of the information found online can make it difficult
for even the most astute consumer to determine what is accurate. Nurses can help
patients by providing tools they can use to evaluate what they read. The website
Stronger suggests a four-step process for checking for misinformation (https://stronger.
org/resources/how-to-spot-misinformation), and MedlinePlus offers additional resources
for evaluating health information (https://medlineplus.gov/evaluatinghealthinformation.
html). UCSF Health (https://www.ucsfhealth.org/education/evaluating-healthinformation)
provides a useful short overview for patients on how to evaluate the
credibility and accuracy of health information and red flags to watch for.
Communication. From the start, the nurse should establish the principle of
shared decision-making, which encourages open discussion. A toolkit from the U.S.
Surgeon General on misinformation (https://www.hhs.gov/sites/default/files/healthmisinformation-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.
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 because 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/health-departments/addressing-vaccine-misinformation.html
Chou W-YS, Gaysynsky A, Vanderpool RC The COVID-19 misinfodemic: Moving beyond factchecking.
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/
MedlinePlus. Evaluating Health Information. National Library of Medicine. 2022. https://
medlineplus.gov/evaluatinghealthinformation.html
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-spotmisinformation
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-health-information
Villarruel AM, James R. Preventing the spread of misinformation. Am Nurs J. 2022;17(2):22-26.
https://www.myamericannurse.com/preventing-the-spread-of-misinformation/
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.

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association August 2022 | Colorado Nurse • 19
We’ve Come a Long Way Baby”… or Have We?
A Brief Review of Recent Nursing Literature Comparing the Lessons
Learned from the 1918 Pandemic and the COVID-19 Pandemic
Reprinted from ANA-New York Nurse, April 2022
Kennedee Blanchard, BA, Communications
Manager, Center for Nursing at the Foundation
of NYS Nurses, Inc.
Susan Birkhead, DNS, MPH, RN, CNE, Nursing
Education Consultant
Martin Dornbaum, MS, FAAN, Director Health
Professions Education Center, Hunter-Bellevue
School of Nursing
Deborah Elliott, MBA, BSN, Executive Director,
Center for Nursing at the Foundation of NYS
Nurses, Inc.
Joan Madden Wilson, MS, BS, RN, President,
Center for Nursing at the Foundation of NYS
Nurses, Inc. and President, Bellevue School of
Nursing Alumnae Association
Nurses often look to the past to inform our
present and future. We learn from our history
and from those who went before us. We value
nurse theorists, research, and evidence to guide
our practice. Many of the original principles of the
American Nurses Association (ANA), back when it
was first founded as the Nurses Associated Alumnae
of the United States and Canada in 1896, still hold
true today. However, when it comes to preparing for
and providing care during a pandemic, how much
have we learned and how much has improved?
A few nurse leaders and researchers have
pondered this question in light of the challenges
and issues revealed during the current COVID-19
pandemic. The authors of this article reviewed recent
articles that highlight some of the similarities and
differences between the 1918 influenza pandemic
and the ongoing COVID-19 pandemic.
Pandemic Preparation and Taking Precautions
In attempt to minimize fear and panic among
the public, as well as to maintain a positive morale
during wartime, little acknowledgement of the
severity of the disease behind the 1918 pandemic
or details about its impact were openly shared. This
led to misunderstandings and delayed responses
when attempting to prevent the spread of infection
(Gordon et al., 2020). Robinson (2021) noted that
little has changed since then; despite the known
results of the devastating 1918 pandemic and
outbreaks of various other pathogens, nurses
today are still not being provided the necessary
preparation and resources to protect themselves
and their patients during a pandemic. Reports from
nurses indicate of lack of information, or inaccurate
information, during the recent pandemic—just as it
was in the early 1900’s.
“Effective preparation and planning must occur
with public health, healthcare, and emergency
management partners working together to
develop new approaches to provide protection,
both nationally and globally against the next
influenza pandemic.” (Robinson, 2021, p.354)
Nursing Care
Most patients during the 1918 pandemic received
care in their homes, whereas most patients during
the earliest phase of the COVID-19 pandemic were
hospitalized. However, despite the difference
in settings, nurses demonstrated their power in
both pandemics to provide excellent care despite
challenges (Robinson, 2021). According to Gordon et
al. (2020), priority nursing care of infected patients in
both 1918 and 2020 required constant attention to
“breathing, positioning, nutritional and hydrational
status, and mental and emotional morale” (p. 29),
even though today’s nurses are aided by advanced
technologies.
In both pandemics, those with preexisting
conditions have been more vulnerable. In 1918,
nothing beyond expert nursing care could be offered
to the sick, and this was generally true at the onset
of the current pandemic. In the absence of curative
treatments, quality care has remained crucial to
the survival and recovery of acutely ill patients. In
the case of the COVID-19 pandemic, nurses are
administering novel treatments to patients in need,
even as “nursing care has become increasingly more
complex and significantly more technical in nature”
(Talbot et al., p. 29).
Supplies and equipment
Johnson (2021) shares the accounts of her
grandmother, Kathryn (Katie) Ann Darmody, RN, who
worked at St. Lawrence Hospital in Ogdensburg, New
York during the 1918 pandemic. Katie recounted
how “fellow nurses were overwhelmed by the influx
of patients and experienced a severe shortage of
protective equipment. As the pandemic progressed,
supplies such as gauze, sheets, and towels were
repurposed and turned into masks, protective
coverings for nurses, and compresses for patients” (p.
63). Similarly, during COVID-19, a nationwide survey
of nurses reported that the lack of personal protective
equipment (PPE) was a concern of nine out of ten
frontline nurses, and many admitted they created
their own masks at times (Robinson, 2021). While
there were reports of limited supply of masks and
other protective equipment during the early phases of
the COVID-19 pandemic, it didn’t deter nurses from
providing care. In troubling times, they found ways to
improvise or reuse items as safely as possible. This is
indicative of the spirit of the nursing profession, which
remains as true today as it was a century ago.
Nursing shortages , staffing, and training
Talbot et al. (2021) comment on the similarities
in circumstances of the two pandemics: a shortage
of nurses; overcrowded hospitals; a new and lethal
respiratory virus; few treatment options; and limited
approaches to infection prevention and control.
They also point out one significant difference
in the two pandemics: in the 1918 pandemic, a
high number of severe cases occurred in healthy,
younger adults. These patients faced a crisis when
presented with a pressing nursing shortage, as not
enough nurses were available to treat them. During
the 1918 pandemic, many nurses were deployed
overseas supporting the armed forces in World
War I, resulting in a shortage in the United States.
While that was not the case in 2020, communities
nationwide were impacted due to nurses traveling
to the cities to treat patients living in COVID-19
epicenters, such as New York City. The fact that
many nurses fell ill and had to quarantine themselves
also contributed to shortages; many have died as
a result of frontline exposure. However, in both
pandemics 100 years apart, nurses came out of
retirement, or delayed retirement, to answer the
call (Robinson, 2021). Others learned new skills
in order to work temporarily in different areas of
specialization, such as critical care areas. In both
pandemics, student nurses were put to work. While
there are limited reports of on-the-job training of
nurses during WWI, the use of just-in-time training
for military nurses in war or pandemic situations has
been described. Throughout the current pandemic,
many civilian nurses have also received just-in-time
training, assuming their responsibilities after getting
redeployed to unfamiliar work settings.
“While the number of [nurses] available was
altogether inadequate to meet the needs
of this unprecedented situation, the response
of the rank and file of the great nursing body
was so splendid that we now have an enlarged
vision of the courage [and] the self-sacrificing
spirit…of nurses.” (Palmer, 1919, p. 83-84)
Nurse Wellbeing
In both pandemics, nurses endured working
long, arduous hours with significant physical and
emotional stress. This results from the nature of the
work, uncertainty, fear of becoming ill or carrying
the illness to loved ones, unremitting exposure to
death, and lingering grief in those who survive.
Isolation is also a stress factor impacting nurses’
health. The use of PPE in and of itself can be an
isolating experience. Gordon et al. (2020) state that
donning PPE “can be traumatising [sic]. It is an act
that preludes the day’s hard work and its attendant
emotional and physical stresses. PPE highlights risk
and is symbolically akin to battledress of a soldier or
a medic” (p. 30). Isolation also occurs when nurses
who work in a COVID unit are separated from
colleagues and may be shunned by them. Nurses
may continue isolation even outside of work hours,
in order to protect their family and friends from
infection through self-imposed separation.
Talbot et al. point out that “crises … remove
barriers [and generate] rapid innovation to meet
the nation’s needs” (p. 27). This has always been
a hallmark of military nursing. They state that
the military nurses in WWI “advanced nursing
science and practice in practical ways through the
management of the ill and the wounded” (p. 29).
They suggest that the current pandemic has revealed
areas where additional research is needed: exploring
the effects of the psychological and physical distress
experienced by nurses who care for COVID patients.
They further postulate that enough staffing, access
to adequate PPE, and education on the spread of
disease could help mitigate nurses’ suffering.
“My grandmother was one nurse among
thousands who responded to the 1918
pandemic. But her story helps connect the
nurses of a century ago to those of today,
displaying the continuous courage and selfsacrificing
spirit of nurses throughout time.”
(Johnson, 2021, p. 65)
How the Past Informs the Future
The lessons of the 1918 influenza pandemic
are particularly pertinent today, as the COVID-19
pandemic rages on and nursing care is forever
altered in response. Examining both pandemics in
tandem provides an opportunity to examine current
crises from a different perspective, allowing us to
draw conclusions to better inform clinical care and
provide a solid foundation for nurses today. Through
studying the history of pandemics and incorporating
necessary changes, front line nurses can become
better prepared to deal with similar situations in the
future.
“Now, as we move forward, it is worth
noting that by documenting and preserving
nurses’ experiences in the COVID-19 pandemic,
we can provide valuable lessons for future
nurses dealing with future pandemics.”
(Keeling, 2021, p.5)
References:
Gordon, O., Gwinnop, A., & Hallet, C. (2020). Learning
from the past? Spanish influenza and the lessons for
Covid-19. Nursing Times [online] (116)10, 27 – 31.
Keeling, A.W. (2021). Nurses on the front line: The 1918
influenza and COVID-19 pandemics. Nursing2021
(51)8, 32-37.
Johnson, D. (2021). The flu pandemic of 1918: A nurse’s
story.
AJN (121)11, 61-65.
Palmer, S.F. (1918). The epidemic of influenza. American
Journal of Nursing (19)2, p. 83.
Robinson, K.R. (2021). Comparing the Spanish flu and
COVID-19 pandemics: Lessons to carry forward.
Nursing Forum 2021(56), 350-357.
Sage, M.W. (1995). Pittsburgh plague – 1918. Home
Healthcare Nurse (13)1, 49-54.
Talbot, L.A., Metter, E. J., & King, H. (2021). History of
the military nurse corps and the 1918 influenza
pandemic: Lessons for the 2019 coronavirus
pandemic. Military Medicine (186)1/2, 27-32.
Post note: The Center for Nursing History
at the Foundation of NYS Nurses is interested
in collecting oral histories from nurses on the
front lines, in management, or academia during
the COVID-19 pandemic in order to document
and preserve nurse experiences to inform
future generations. If interested, please contact
Kennedee Blanchard at kblanchard@cfnny.org

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