Nebraska Nurse - August 2022

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Sent to all Nebraska Nurses courtesy of the

Nebraska Nurses Foundation in partnership

with the Nebraska Nurses Association

Quarterly circulation approximately 36,000 to all

RNs, LPNs, and Student Nurses in Nebraska.

Volume 55 • No. 3

August, September,

October 2022

Mindfulness Meditation

to Decrease Stress in

Pediatric Nurses

Page 5

Nebraska Nurses

on the Hill

Page 13

In This Issue


Lasting Legacy

Interview Series

Pages 6-7

Inside the NNA

President’s Column ............................1

NNA MIG Reports ............................3

NNA State Director ............................4

Nebraska Nurses Foundation

Nebraska Nurses Foundation –

Lasting Legacy Interview Series .................6-7

Apply today for an NNF Project Grant! .............7

Feature Articles

Project Firstline ....................................1

CALL FOR NNA LEADERS .............................2

Mindfulness Meditation to Decrease

Stress in Pediatric Nurses ............................5

How nurses can counter health misinformation ......... 9-11

Membership Assembly Update .......................12

Nebraska Nurses on the Hill ..........................13

Pearls and Pitfalls: The Journey of APRN Entrepreneurs .....14

Affiliate Organizations

Nebraska School Nurses Association ..................15

Where Do I Go From Here? .......................16-17

Courage in Everyday Nursing Practice .................17

Membership Activation Form .......................19

President’s Column

Kari Wade EdD, MSN, RN, CNE

Nebraska Nurses Association President

As my last President’s message

for Nebraska Nurse, I reflect on

the past two years since taking

on the role in 2020. The world

has changed. Our profession

has changed. And with it, the

Nebraska Nurses Association has

become more bold and stronger

than ever as a voice for Nebraska


Over the past two years, we

have had to advocate for nurses

Kari Wade

like never before to protect our profession, protect Nebraska

nurses, and advocate and innovate ways to build our

nursing workforce. We have had to participate in targeted

education to promote the health of our communities and

the patients we serve at the population health level. It

seems like every week brings another “charged” issue to

the forefront that NNA must monitor and/or address, often

which comes with division and controversy. Navigating



Nurses are the nation’s first line of defense against

infectious diseases such as COVID-19. That’s why ANA

has partnered with the CDC to present Project Firstline, an

interactive series of free online tools that give you the training

and information you need about infection prevention and

control (IPC). Comprehensive education includes best practices

addressing COVID-19 and other pathogens, as well as

evidence-based strategies to improve outcomes.

Project Firstline resources are designed to help you

understand and confidently apply IPC principles regardless of

previous training or background. New courses will be added

as information advances so you can stay prepared with the

latest knowledge. Together, we can stop the spread.

reporters, media, and law makers about the position of

NNA has become a frequent occurrence to ensure the voice

of nurses is being heard on these important matters.

Despite the rollercoaster ride these challenges provide,

NNA has worked hard to address issues head-on and

provide education to Nebraska nurses regarding critical

topics related to the pandemic, health disparities, civil

unrest, and diversity-equity-inclusivity. The “charged”

issues just keep coming, and NNA will continue to engage

to uphold the core values of the organization and nursing


At the 2022 Annual Convention, I will have the longawaited

opportunity to address NNA members in person

for the first time. It’s an opportunity I’ve been waiting for

since nearly my entire term has been virtual. Our incoming

NNA President, Dr. Linda Hardy, will also be addressing

membership and share insight toward the future of NNA

and the direction we are going.

Serving as NNA President has been one of the most

challenging and rewarding experiences of my life. I have

grown as a person, a leader, and as a nurse. Thank you

for the support shown to me as President, and to the

organization for this tremendous experience.

Featured topics this month include:

Environmental Cleaning and Disinfection Basics

• Episode 16: Cleaning? Disinfection? What’s the


• Episode 20: Why do Cleaning and Disinfection

Matter in Healthcare?

• Episode 22: Why Does Contact Time Matter for


Visit NNA’s Project Firstline Website for more!


current resident or

Non-Profit Org.

U.S. Postage Paid

Princeton, MN

Permit No. 14

Page 2 • Nebraska Nurse August, September, October 2022



Be Engaged in Nursing Leadership!

The Nominations Committee would like to extend

an invitation to all NNA members to submit your

name as a candidate for the offices of:


The president shall be elected to a four-year

term: the first year as president-elect, automatically

becomes president for two years, and serves as

immediate past-president for one year. The presidentelect

shall assume the duties assigned by the president

and/or the Board of Directors. Candidates must be a

full member of both NNA/ANA.


The Treasurer of NNA is responsible for monitoring

the fiscal affairs of the association and shall provide

reports and interpretation of NNA’s financial condition

to the NNA Annual Membership Meeting, the Board

of Directors, and the membership; and oversee the

development of the NNA budget by the Governance,

Finances, and Membership Committee; and assume

other duties as assigned by the Board of Directors.

This is a two-year term.



REGION 1, 2, 3, 4, At Large

The role of the LARC will be to plan and implement

activities related to professional security and nurse

advocacy and to represent NNA’s positions on state

and local concerns, as defined by NNA’s approved

legislative platform. The LARC is responsible to

develop and recommend to the NNA Membership a

state legislative platform which reflects professional

standards and social concerns; develop mechanisms

which are proactive and responsive to healthcare

advocacy issues; analyze the implications of federal,

state, and local legislation on nursing and health

care services for all people in accordance with the

approved NNA legislative platform; communicate

NNA’s position on legislative and healthcare advocacy

issues, through a variety of media; enlist the

expertise of members; and encourage individual and

organizational promotion to public officials who are

supportive/responsive to NNA’s legislative platform.

This is a two-year term.



Nursing Practice Member, Nursing Faculty Member

x2, and Nursing Professional Educator x2

The role of the NPDC will be to plan and implement

activities related to nursing professional development

and NNA events. Responsibilities include promoting

the understanding of nursing professional practice

responsibilities defined by the most recent versions of

the Nebraska Nurse Practice Act, the ANA Scope and

Standards of Practice, the ANA Social Policy Statement

and the ANA Code of Ethics for Nursing; develop

mechanisms to provide professional development, which

are proactive and responsive to healthcare issues; provide

input to the Annual Membership Meeting CE offerings

through the NPDC Chair/designee serving on the AMM

planning committee; coordinate the reference proposal

process and recommend to the NNA Membership those

proposals that meet reporting criteria; and coordinate

NNA award, scholarship, and recognition processes

(including the Nightingale Tribute) and recommend

to the Board of Directors those candidates to receive

recognition. This is a two-year term.



Staff Nurse Member, Nursing Faculty Member,

Urban Member

The GFMC shall provide infrastructure guidance

and recommendations to the Board of Directors

related to membership recruitment and retention,

recruitment of qualified candidates for NNA elected

and appointed positions, and oversight of financial

operations on behalf of the Board of Directors.

Responsibilities include Monitoring quarterly NNA

financial statements and advise the Board of Directors

in matters of finance; Develop the annual budget

for the association in collaboration with the state

director; Provide a plan for non-dues fundraising

for the association; Develop slate of nominees for

NNA elected and appointed offices; Develop, with

priority actions, an ongoing three-year membership

recruitment and retention plan and report outcomes

of the plan annually; and Evaluate proposed changes

to the bylaws, as presented by individual members,

constituents, other committees, the NNA Board of

Directors, or the ANA. This is a two-year term.


One representative shall be elected for a two-year

term to the ANA Membership Assembly. Representatives

are charged to act on behalf of the entire association

for the benefit of ANA and nursing as a whole. The

issues before the Membership Assembly may be new,

cutting-edge and politically complex. Attention should

be focused on the big picture—policy and standards

which determine the preferred future of the profession

and association. Must be able to commit annually to

participate in a three to four-day Membership Assembly

meeting, typically in Washington, DC.

Become a part of the decisionmaking

process, submit your name

as a candidate!

All participating leaders must complete the

leadership commitment form:



Should you have questions, please email Kim

Houtwed at director@nebraskanurses.org

Deadline for applications is

September 16, 2022

NNA’s Mission:

The mission of the Nebraska Nurses Association is advancing

our profession to improve health for all. The vision of the

Nebraska Nurses Association is to be a proactive voice for

nurses and an advocate for improved health for all.

NNA’s Core Priorities

C – Collaboration

A – Advocacy

R – Recognition

E – Education

NNA’s Official Publication:

The Nebraska Nurse is the official publication of the

Nebraska Nurses Association (NNA) (a constituent member

of the American Nurses Association), published quarterly

every February, May, August, and November. The NNA

provides education, networking opportunities, publications

and other products and services to its members and

extends its mission to all nurses in Nebraska.

Phone: (888) 885–7025

You can leave a message at any time!

Email: Director@NebraskaNurses.org

Web site: www.NebraskaNurses.org

Mail: c/o Midwest Multistate Division

3340 American Avenue, Suite F

Jefferson City, MO 65109

Questions about your nursing license?

Contact the Nebraska Board of Nursing at:

(402) 471–4376. The NBON is part of the Nebraska Health

and Human Services System Regulation and Licensure.

Questions about stories in the Nebraska Nurse?

Contact: NNA.

This newsletter is a service of the Nebraska Nurses

Association and your receipt of it does not mean

you are automatically a member. Your membership

in support of this work is encouraged; please visit


Writer’s Guidelines:

• Any topic related to nursing will be considered for

publication in the Nebraska Nurse.

• Authors are not required to be members of the NNA;

however, when space is limited, preference will be given

to NNA members.

• Photos are welcome, digital is preferred. NNA does not

assumes responsibility for lost or damaged photos.

• Use current APA formatting for any article requiring


• Provide a brief author biography indicating the author’s

nursing experience and/or expertise with the paper’s


o Limit the author’s biography to 4-sentences.

• Submitted material is due by the 2nd of the month in

January, April, July, and October of each year.

• The peer-review is blinded; submit the title page

separately from the article

• Submit the title page and article as Word documents to


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. NNA 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


Acceptance of advertising does not imply endorsement

or approval by the Nebraska Nurses Association of products

advertised, the advertisers, or the claims made. Rejection of an

advertisement does not imply a product offered for advertising

is without merit, or that the manufacturer lacks integrity, or that

this association disapproves of the product or its use. NNA 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 NNA or

those of the national or local associations.

August, September, October 2022 Nebraska Nurse • Page 3

NNA MIG Reports

Region 1 MIG Update

The Region 1 MIG met in May at the Steel Grill in

Scottsbluff. Donations to students for the State and

National Student Nurses Association conferences were

discussed. The students that attended the National

Convention, submitted a zoom presentation of the

event (this is available to those that would like to see

it). Upcoming dates including the NNA Convention in

Lincoln were discussed. Information on the Panhandle

Medical Reserve Corp and the NE Nurse Honor Guard

was distributed in the minutes. The next meeting is

scheduled for Monday, September 19, 2022, at the

Steel Grill in Scottsbluff. Please contact Wendy Wells if

questions: wwells@unmc.edu.

Omaha Metro Area

MIG Update

Lincoln Area MIG Update

Registered Nurses in the Lincoln area were joined

together for an inspirational morning, celebrating their

profession through a Mutual Interest Group fellowship

brunch at the Lincoln Children’s Zoo on April

30th. The one and only Dr. Marilyn Moore presented

pictures of her African safari and through her words,

she eloquently related the similarities between their

guides’ job in protecting the tourists as the nurse

protects and advocates for their patients. The morning

closed with distinguished RN guests receiving awards

for their contributions to the nursing profession… and

of course, feeding the giraffes their morning lettuce.

Next year’s Celebrate Nursing for the Lincoln Area

MIG will be on Saturday, April 29, 2023. We look

forward to another successful event!

Amy King, Leslie Cosgriff, and Stephanie Oie

Anna Mackevicius, BSN RN PMP

Chair, Omaha Metro Area Mutual Interest Group

Here’s an update regarding events planned by

the Omaha Metro Area Mutual Interest Group

this year. Remember, all area nurses are welcome

at any of our events; you do not need be a NNA

member but, of course, we hope you consider

becoming one.

Student Leaders Recognition

Our goal is to host this event in-person in

2023. Planning has started. We are hoping for

all schools/colleges of nursing to participate to

recognize their student leaders and our future

nursing leaders! Stay tuned for more details in

this newsletter. If you have any questions, please

contact Anna Mackevicius. Email address is at the

end of this article.

The Positive Image of Nursing Awards

We are going back to our previous format

and hosting a breakfast in 2023. More details to

come. Please plan ahead to identify someone who

portrays the Positive Image of Nursing at your

work or in your personal life. We hope to have

representation from every healthcare system and

college/school in Region 4 join us next spring.

Feel free to contact me with any questions. Email

address is at the end of this article.

Nurses Political Reception

A legislative reception will be held on August

23, 2022 at the Thompson Alumni Center on

UNO’s campus. Outreach to elected officials and

candidates to attend with encouraging positive

results. Join us to talk to those who make policy

and law in a casual environment. The Omaha MIG

is seeking corporate and individual sponsors for

this year’s event. Please consider contributing this

to worthwhile event. The online registration page

is open on NNA’s website at https://nna.salsalabs.

org/22legislativereception; there is an option for

credit card or check payment. Feel free to contact

me with any questions. Email address is at the end

of this article.

Marilyn Moore, speaker for the event, and

Kari Wade, NNA president

Brenda Jones, Katie Loughran,

and Patricia Prentice

Annual Dinner and Charitable Drive

The MIG is considering options for a dinner

or luncheon for 2022. Looking into a possible

outdoor venue early summer that we could

combine with chartable drive. We would love to

hear your ideas for a fun and safe gathering. More

to come on this event.

Feel free to contact me at annamackevicius@

gmail.com if you have any questions about the

Omaha Metro MIG events or membership to NNA.

Page 4 • Nebraska Nurse August, September, October 2022

NNA State Director

Kim Houtwed, MBA, BSN, RN

NNA State Director

NNA has numerous opportunities to be involved in your

profession, whether it is at the leadership level, recognizing

outstanding nurses or furthering your education with

scholarship opportunities. Annually elections are held in

November for leadership positions. Every NNA member in good

standing as of January 1, 2022, has to opportunity to cast their

vote. Awards and Scholarships are announced at the Annual

Membership Convention.

With so many wonderful members I encourage you to

consider sharing your talents and become involved on a state

and local level within NNA. If you are not a member, consider

joining and being a member of this important association where

you all share the title of nurse.


Kim Houtwed

Now is a great time to consider stepping into leadership with NNA! Board of Directors

and Committee members serve two-year terms that run from January 2023-December

2024. If you are interested in running for a leadership position on the 2022 NNA ballot,

please complete the ONLINE Leadership Profile at www.nebraskanurses.org. Please submit

your profile by September 16, 2022.

PRESIDENT ELECT: the role of the President Elect is to assume duties of the president

in the president’s absence or at the discretion of the president and serves as a non-voting

member of all four committees. Term of this office is: two years as President Elect, two

Years as President and one year as Immediate Past President.

TREASURER: the role of the Treasurer is to be responsible for monitoring the fiscal affairs

of the association and shall provide reports and interpretation of NNA’s financial condition to

the NNA Annual Membership Meeting, the Board of Directors, and the membership.

LARC (Legislative Advocacy Representation Committee): The role of the

Legislative Advocacy and Representation Committee works to develop NNA’s legislative

platform and submit it to the general membership for approval. The legislative platform

is used to guide the committee’s work during subsequent legislative sessions, and to

communicate NNA’s position on nursing issues to state legislators. The committee is also

involved in planning activities related to nurse advocacy. The LARC member must work or

reside within the region designated. The committee meets virtually.

NPDC (Nursing Professional Development Committee): The role of the Nursing

Professional Development Committee is to plan and implement activities related to nursing

professional development and oversee continuing education accreditation activities. The

candidate must currently be active in a staff, educator, or faculty role. The committee

meets virtually.

GFMC (Governance, Finance, and Membership Committee): The role of the

Governance, Finance, and Membership Committee is to provide infrastructure guidance

and recommendations to the Board of Directors related to membership recruitment and

retention, recruitment of qualified candidates for NNA elected and appointed positions,

and oversight of financial operations on behalf of the Board of Directors. The candidate

must be currently active in a staff or faculty role and live in an urban area. The committee

meets virtually.


to act on behalf of the entire association for the benefit of ANA and nursing as a

whole. The issues before the Membership Assembly may be new, cutting-edge and

politically complex. Attention should be focused on the big picture—policy and

standards which determine the preferred future of the profession and association.

Must be able to commit annually to participate in a three to four-day Membership

Assembly meeting, typically in Washington, DC.


NNA Awards serve as recognition tools for those member nurses who exemplify

passion and dedication to the nursing profession. Think of excellent nurses who

are making a difference in the lives of patients and their communities. We all

know nurses who fit that description! The Nebraska Nurses Association wants to

recognize members that are making a difference for their patients, practice, and

profession… but we need your help! We encourage all members to nominate

their peers and to recognize achievement within our profession. The nominations

deadline is September 1st. Award nominees must be NNA members in good

standing. NNA Award Nomination Forms may be found on the NNA website under

the membership section. There are awards for all areas of nursing practice:

NURSE OF THE YEAR: This award focuses on outstanding achievement in

nursing over a one-year period. The nominee must be directly involved in nursing

through clinical practice, education, administration, or research and have made a

positive impact on the quality of nursing care or the nursing profession.


achievement in nursing over a cumulative number of years. There must be evidence

of significant contributions to nursing at the local, state, or national level.

DISTINGUISHED SERVICE: This award focuses on the nominee’s service to the

NNA at the district or state level over the past year.

NOTABLE NEW NURSE: This award focuses on outstanding achievement in

nursing by an RN practicing for five years or less since graduation from an entry level

Registered Nursing program.

EXCELLENCE IN DIRECT PATIENT CARE: The focus of this award is on

achievement in nursing by a nurse providing direct patient care. The nominee is

recognized for nursing expertise provided in a caring, professional manner.

OUTSTANDING NURSE EDUCATOR: This award focuses on achievement by a

nurse whose primary role is as an educator. The nominee must be directly involved

in patient education, nursing education, continuing education or staff development.

The award recognizes innovation and expertise in the educator role.



offered in memory of Gail Graham, sister of NNA Member Jacy Henk. Recipient

must be a member in good standing of NNA/ANA. Must be pursuing a higher

degree in nursing: RN to BSN, MSN, DNP, PhD, EdD.

NNA SCHOLARSHIP: NNA embraces the belief that we, as members of our

professional organization, are committed to developing others in the continuing pursuit

of excellence in scholarship, clinical practice, research, and professional development. To

honor that commitment, a $1000 is made available to a member enrolled in a Bachelor,

Masters, or Doctoral program in nursing who possess the ability to assume or continue

a leadership role in nursing. The purpose of this scholarship is to assist a NNA member

with expenses related to advanced studies in nursing.

ARTHUR L. DAVIS SCHOLARSHIP: Through the generosity of the Arthur L.

Davis Publishing Agency, the Nebraska Nurses Association will grant two (2) $500

scholarships to Nebraska prelicensure nursing students. Applicants must be a

resident of Nebraska, enrolled in an accredited nursing program in Nebraska, 3.0

GPA and completed more than 50% of the nursing degree courses.

Join our Team!

RNs and LPNs

We thank our nurses for

their dedicated service!

575 Fallbrook Blvd., Suite 100

Lincoln, Nebraska 68521

(402) 438-2500

Nancy R. Wynner Attorney at Law

Straight talk and sound advice in

administrative license matters including:

• Defense Against Disciplinary Action

• License Reinstatement



Warm & Welcoming!

That’s who we are!

We care like family… Join us!

Megan Becklun,

402-887-4151, hr@amhne.org,

102 W 9th St, Neligh NE 68756

402-887-6397 (Fax)

Visit our website at amhne.org

for career opportunities

Making a difference in people’s lives

through excellent patient care

August, September, October 2022 Nebraska Nurse • Page 5


Mindfulness Meditation to Decrease Stress in Pediatric Nurses

Tara Hommelson, MSN, RN, CPNP, CNE

(Article originally published in the Missouri Nurse. Used

with permission from the Missouri Nurses Association.)

A need for change exists

to assist nurses in cultivating

healthier mechanisms to

manage stress. Stress in nurses

can impact work performance,

including patient care,

productivity, and job satisfaction

(Jordan et al., 2016). Nurses

who work with ill children

are at high-risk for secondary

traumatic stress, resulting from

care of children during traumatic Tara Hommelson

experiences (Partlak Günüşen

et al., 2018). About 50% of certified pediatric nurses

describe moderate, high, or severe secondary traumatic

stress (Kellogg et al, 2018). Due to the risk of stress, nurses

must be supported with tools for effective coping (Partlak

Günüşen et al., 2018). Interventions, such as meditation,

are needed to support nurses in developing healthy

strategies to decrease the prevalence of stress. Meditation

has been shown to reduce anxiety, stress, and depression

(Van der Riet et al., 2018). Smartphone mindfulness

meditation application may be beneficial in reducing stress

while increasing mindfulness a self-compassion (Huberty

et al., 2019). To address reduction in pediatric nurses,

a mindfulness meditation smartphone application was

introduced at a children’s hospital in the Midwest.


All nurses at the hospital were invited to participate

in the quality improvement initiative. The mindfulness

meditation intervention was delivered via the free

Healthy Minds Program smartphone application.

The nurses were asked to use the app for at least

ten minutes, three times a week, over eight weeks.

The nurses received weekly emails to motivate them.

To measure the improvement in stress, the nurses

completed a pre and post-intervention Perceived

Stress Scale (PSS). The scale measures the extent that

someone appraises events in their life as stressful

(Cohen, 1994), including perception of overload in life.


Twenty-four nurses completed the pre-test. The

average age was 36.5 years. On the pre-test PSS,

23 participants had moderate stress, scoring 24-26

points out of 40 possible points. One nurse had high

perceived stress, and no nurses had low stress. Of the

four participants who completed the pre-test and posttest,

the pretest data revealed three participants had

moderate stress and one participant had high perceived

stress. The pre- to post-data did not change in stress


Although a decrease in stress in pediatric nurses was

not demonstrated in the limited nurses using the app,

the chief nursing office anecdotally reported that a few

nurses stated the mindfulness meditation strategy was

beneficial. This informal nurse feedback may support

the use of a smartphone app to reduce stress in nurses.


Interventions, such as meditation, are needed

to support nurses in developing healthy strategies

to decrease stress. A improvement initiative using

mindfulness app, which is easily accessible by

smartphone and free, may potentially reduce stress in

pediatric nurses.


Huberty, J., Green, J., Glissmann, C., Larkey, L., Puzia, M., & Lee,

C. (2019). Efficacy of the mindfulness meditation mobile app

“Calm” to reduce stress among college students: Randomized

controlled trial. JMIR MHealth and UHealth, 7(6), Article

e14273. https://doi.org/10.2196/14273

Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The

impact of perceived stress and coping adequacy on the health

of nurses: A pilot investigation. Nursing Research and Practice,

2016, Article 5843256. https://doi.org/10.1155/2016/5843256

Kellogg, M. B., Knight, M., Dowling, J. S., & Crawford, S. L.

(2018). Secondary traumatic stress in pediatric nurses. Journal

of Pediatric Nursing, 43, 97–103. https://doi.org/10.1016/j.


Partlak Günüşen, N., Üstün, B., Serçekuş Ak, P., & Büyükkaya

Besen, D. (2018). Secondary traumatic stress experiences

of nurses caring for cancer patients. International Journal

of Nursing Practice, 25(1), e12717. https://doi.org/10.1111/


van der Riet, P., Levett-Jones, T., & Aquino-Russell, C. (2018).

The effectiveness of mindfulness meditation for nurses and

nursing students: An integrated literature review. Nurse

Education Today, 65, 201–211. https://doi.org/10.1016/j.


Page 6 • Nebraska Nurse August, September, October 2022

Nebraska Nurses Foundation

Nebraska Nurses Foundation – Lasting Legacy Interview Series

Dr. Linda Lazure

The NNF is proud to launch our new Lasting Legacy

Interview Series. This series will feature interviews with

past and present leaders and contributors to the NNA,

NNF and the nursing profession within Nebraska. It

was my pleasure to recently visit with Linda Lazure,

PhD, RN, a member of the NNA Hall of Fame, past

Chair of the NE Board of Health, and active political

advocate for nursing and health. It was a lively

discussion, as those who know Linda would expect!

Here are excerpts from my interview with her.

TA: How did you select nursing as your career path?

LL: My mother had always wanted to be a nurse

and didn’t have the chance, but my three older

sisters were nurses too and had gone to Mercy in

Council Bluffs. I really wanted to go to Creighton,

but my mom wouldn’t let me because we had to run

the farm. I didn’t want to go where my sisters went,

so I chose St Catherine’s. I was in the last class there,

graduating in 1970, but I just kept going to school.

I started out at Bergan in the ICU and I had such

nurturing nurses there, one was Judy Quinn. They

encouraged me, and I knew I had to get my degree.

I started in September at University of Nebraska

with only 10 credits that would transfer from St

Catherine’s since we weren’t on a college campus. I

took chemistry across 72nd Street at College of St.

Mary and I remember getting sandburs in my socks

crossing the field and open sewer since there was

nothing else there at the time. Our nursing dorm was

right east of Bergan. I also always knew I wanted to

be a teacher.

TA: How did you get involved in ANA/NNA?

LL: This is a funny story. Since we were the last

class at St Catherine’s, there was an anonymous

donor, we suspect it was one of the doctors, who

decided to send the entire class to Miami, Florida,

to the ANA Convention. Some of the others spent

the time on the beach but my roommate and I went

to the meetings since someone had paid to send

us to the convention. It was really odd because

nobody said anything good about the ANA at

that time. They had just put out the 1965 position

paper on baccalaureate degrees as the entry into

practice and the folks at St Catherine’s felt it was

a ‘sellout’ of diploma programs. There were 20-30

in our class and for someone to pay for us to go,

that was pretty amazing. I remember going back to

the auditorium and seeing the ANA Board members

and they were debating different things. And I

thought, ‘Oh my Lord, this is where the decisions

are made. These were people making decisions

about the career I’m in. Oh my gosh this is a pretty

decent organization.’ And I just remember that so

distinctly, I thought ‘Man, I do need to join this.’ I

Dr. Lazure graduated from St Catherine’s

School of Nursing in 1971 and thanks to a

generous donor, who paid for her entire class

to attend the ANA national meeting that year

in Florida, joined the ANA/NNA organizations

immediately following graduation. Her 12 years

(including several as Chair) on the Nebraska

Board of Health, induction into the NNA Nurses

Hall of Fame, and celebrating her ’50 Year

Member’ milestone in 2020, reflects just part

of her legacy to nursing in Nebraska and to

the NNA. After receiving her BSN she quickly

followed with her MSN and a PhD. Her clinical

experiences in critical care at Bergan Mercy

Medical Center led to her 37-year career at

the Creighton University School of Nursing

and her lifetime status as Professor Emeritus.

By following her three older sisters into the

profession, she honored her mother’s unfulfilled

dream to become a nurse. With her daughter

and niece also nurses prepared with doctoral

degrees, the family legacy continues.

reached my 50 years as a continuous member in

2020, which unfortunately, along with my 50-year

class reunion, wasn’t celebrated because of the




Undetectable = Untransmittable

Educating patients about the value of treatment as prevention can help them manage their HIV. Engaging

patients in routine, brief conversations about treatment as prevention can also help health care providers

become more familiar with each patient, including their adherence and transmission risk.

Tools from CDC can help foster discussions between providers and patients about HIV treatment, care, and


Learn more at: dhhs.ne.gov/Pages/HIV-Prevention.aspx| cdc.gov/preventioniscare

Health care providers who treat patients with HIV have an important role in supporting HIV prevention. Because a

patient’s needs may change over time, health care providers should engage patients in brief conversations at every visit

to discuss the prevention steps the patient is taking.

Taking antiretroviral therapy (ART) to achieve and maintain an undetectable viral load enables patients with HIV to stay

healthy. It also helps prevent transmission to others, which is known as treatment as prevention.

Three landmark studies have shown that treatment

prevents sexual transmission of HIV.

Across all three studies, there were no linked HIV transmissions observed between mixed-HIV-status partners when the

partner with HIV was virally suppressed (defined in these studies as having a plasma HIV RNA viral load less than either

200 or 400 copies/mL).

1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. Aug 11 2011;365(6):493-505.

2. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830-9.

3. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIVpositive

partner is using suppressive antiretroviral therapy. JAMA 2016;316(2):171-81.

4. Bavinton B, Grinsztejh B, Phanuphak N, et al. HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and

Brazil. Presented at the 9th IAS Conference on HIV Science (IAS 2017), Paris, France; July 25, 2017.


TA: Linda, when you think of all those years in NNA

and involvement with NNF what are the top three

memories that come to your mind?

LL: When I was in my BSN, I attended the NNA

Convention and there was a panel, and of course they

were still discussing the 1965 position paper. I was in

the middle of my degree, feeling disenfranchised as a

diploma nurse, being asked to pay full tuition for the

chance to ‘test out’ of courses. I spoke up about that

and it was acknowledged that it was a barrier. They

soon changed that policy and I thought ‘wow, this is a

good organization!’ Maybe it was just the Holy Spirit

like where you know what you are supposed to know.

Another time was when I was the only staff nurse

on the NNA District 2 Board. I felt that I was bringing

in a different perspective to that work. I had a lot of

opportunities from there and I believe that ‘every job I

got’ was because people knew what I did in the NNA,

and that if I said I would do something I would follow

up and I would do it.

Another great memory was running for a position

on the national ANA board. Anne Oertwich was

my campaign manager. We had “Lazure for Sure”

cards made, and I gave a cute speech. They kind of

outlawed some speeches after that, but I did get the

most votes. I was on the Reference Committee and

had a role in introducing the topics for discussion and

approval and that was very interesting too.

TA: What does the NNA/NNF bring today to nurses

or the public in the state?

LL: The recognitions and identifying people

bringing service to the profession and organization

and then being role models. That is important. I

think it is important for those who have been in

nursing and the organization to be mentors and

prepare people to follow through on the needs of the

profession. I am a Fellow in the American Academy

of Nursing and I feel the same way about that. For

example, this year, I was able to help nominate two

Nebraska nurses. One of them is Anne Boatright,

recognized for her work with human trafficking

and support for sexual assault victims. Such a great

example of what one person can accomplish. That

recognition is important.

August, September, October 2022 Nebraska Nurse • Page 7

Nebraska Nurses Foundation

The NNF is also important as a way to give back to the profession. You will be

proud of this, that I have included them in my will. I also dedicated a scholarship

for transfer students at Creighton as a gift to my folks on their 75th wedding

anniversary, long before I left Creighton. Everyone should plan, in even a small

way, to give back what and where they can.

TA: Linda, this has been a terrific conversation, is there anything else you

would like to add?

LL: Maybe it’s as you get older, but as you pass through these developmental

stages, succession becomes a big thing. I don’t want to do anything if it doesn’t

lead to succession. That’s why I help with the FAAN nominations and also mentor

several faculty. You don’t need to do these things for your own glory, but if you

can help someone else to do it, that’s being a professional. I had so many people

in my life and my career, that’s what I need to do for others. Succession is a big


TA: As a nurse who personally has benefited from your mentoring and

guidance, I can verify that you are leaving a strong legacy behind, maybe more

than you will ever know! Thank you for all you do and have done for nursing

in Nebraska!

Sign Up To Give to Nebraska

Nurses Foundation on

AmazonSmile Today!

The Nebraska Nurses Foundation has signed up with Amazon to participate in

the AmazonSmile program. How it works is when you shop at, on your computer

or through the Amazon mobile app with AmazonSmile enabled, with Nebraska

Nurses Foundation as your selected charitable organization, for eligible purchases

the AmazonSmile Foundation will donate 0.5% of the purchase price to the

Nebraska Nurses Foundation.

To sign up on your computer, visit smile.amazon.com and select Nebraska

Nurses Foundation as your charitable organization. If you shop through the

Amazon app on your phone, you can ensure that you are shopping with

AmazonSmile by going to the Settings menu then click on AmazonSmile and

follow the prompts to generate donations on the mobile app and select Nebraska

Nurses Foundation. This is an easy and indirect way to contribute to our mission

while shopping as normal through Amazon.

Apply today for an NNF

Project Grant!

The NNF Board is happy to announce updated guidelines and application

materials for their Nursing Project Grants. The grants are designed to

provide funding to NNA members for evidence-based practice, quality

improvement or innovation projects conducted within clinical nursing or

education settings.

Applications for the 2023 calendar year grants are being accepted from

now until November 1, 2022.

Visit https://nebraskanursesfoundation.org/practice-clinical-grantprogram/

for more information.

For questions contact Teresa Anderson, NNF Board 2nd Vice President and

Secretary at teresa@tlandersonconsulting.com or call/text 402-679-1551.

We want to help you to be successful with your application and your project.

Dr. Linda Lazure with her daughter, Dr. Lori Rusch - nursing excellence

legacy continues. Photo by T Anderson, 2017.

Thank You,


Thank you to the 26 nurses who completed

the Medications for Opioid Use Disorder

(MOUD) training.

We appreciate you taking time out of your busy schedule to improve your

knowledge and skills on this topic. Thank you Marcia Mueting for bringing

this training to our attention.

Learn more: DHHS.NE.GOV/PDMP

If you are interested in taking this training in the future

please reach out to DHHS.PDMP@nebraska.gov .

Page 8 • Nebraska Nurse August, September, October 2022

Rest, Relax, Laugh: Spending Time with Yourself

Dr. Phyllis Lawrence, DNP, RN, NEA-BC

Reprinted with permission from Tennessee Nurse

February 2022 issue

Rest and Relax

How many times have you been told that you need

to get plenty of sleep for good physical health? Sleep

is also instrumental in maintaining sound mental and

emotional health. Rest is not only the act of sleeping,

but you can rest your body, mind, and tap into your

spirit simply by feeling renewed. Waking up and

feeling that you have run a marathon is a sign of

significant activity during your rest period. Either the

mind continues to cycle, or you may be suffering from

a sleep disorder. In either case, you are not at rest.

To rest the mind, you must relax. Relaxation is

defined as the state of being free from tension and

anxiety (Google dictionary, 2022). The Cambridge

Dictionary defines relaxation as a pleasant activity

that makes you become calm and less worried. This

definition supports the concept of complementary

and alternative interventions and modalities.

Relaxation can really be a state of mind. One of

the most effective holistic modalities that promotes

relaxation is meditation. Meditation is reflected in

many forms, including guided imaginary, mindfulness,

Zen meditation, Mantra meditation, Transcendental

meditation, and Yoga meditation, just to name a

few. Mindfulness has become popular over the last

few years. Being mindful is the basic human ability

to be fully present in the moment, aware of your

surroundings, feelings, and emotions. Try it, sit still in

a quiet place. Place your hands in your lap. Now close

your eyes. What do you hear? What do you smell?

Breathe slow and steady while maintaining the rhythm.

Continue this practice for approximately 10-15 minutes.

Notice the change in your stress level or anxiety. This

simple exercise can alleviate stress and anxiety, and if

engaged in regularly, lead to an optimistic outlook.

Laugh for a Healthier You

Have you noticed that when you laugh, you feel

better? It is harder to cry while you are laughing.

Research has found that laughing triggers the release

of endorphins (nature’s feel-good chemicals). It has

also been reported that laughter decreases stress

hormones and increases immune cells. We have a

natural response to infection, which helps produce

antibodies, improving our resistance to disease

and promoting our overall well-being. What makes

you laugh? Is it a funny commercial, your loved

one(s), maybe your co-workers? Laughter is the best

medicine. In an article by Robinson, Smith, & Segal

(July 2021), learn to create opportunities to laugh,

watch a funny movie, TV show, or YouTube video,

check out a comedy club, read the funny pages, check

out the humor section in your bookstore, play with a

pet, better yet host a game night with friends.

I would like to share with you some of the things

that make me laugh. Watching my favorite comedy

movies, even though I know the punch line, dancing

to my favorite 80’s jam on YouTube, and serving

with a grateful heart. When I see someone smile, I

smile! During hard times, laughter has been a saving

grace for many. Whitman (2017) A new study reveals

how laughter affects the brain, which may be an

explanation why giggles play an important role in

social bonding.

When you take time for yourself, you validate your

worthiness and value. Make it a point to celebrate

your life. Buy that neat sweater, go to the movies with

your spouse, family, or friends. Do something that

you enjoy, and that makes you feel good. How about

butter pecan ice cream? Take care of yourself so that

you can take care of others. The first step to self-care

is accepting that you are worthy of that care. The care

you require may need to come from a professional

source, and that’s okay. There are services available

through most healthcare facilities and organizations.

Sometimes you just might need to talk. It may be a

good time to phone a friend.

Take a moment and plan to rest, relax, and laugh.

Try to include at least one activity to cover each one of

the components. Start with resting and relaxing, then

let the laughter begin. Remember, you are worthy,

valuable, and appreciated. Self-worth can only be

measured by you. So make every moment count, and

be mindful of your value. I can sum it up in one word,



L. Robinson, M. Smith & J. Segal (2021). Laughter is the Best

Medicine. https://www.helpguide.org/articles/mentalhealth/laughter-is-the-best-medicine.htm

Mindful: healthy mind, healthy life (2022). https://www.


Whiteman, H. (2017). Laughter releases ‘feel good

hormones’ to promote social bonding. https://www.


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August, September, October 2022 Nebraska Nurse • Page 9


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


Nurses and nurse practitioners have the power

to counteract misinformation, but first, they need

to understand the nature of the problem and why

people may be inclined to believe information that

is not grounded in science.

Misinformation overview

Two definitions help better understand this issue.

Misinformation refers to claims that conflict with the best

available scientific evidence. Disinformation refers to a

coordinated or deliberate effort to spread misinformation

for personal benefit, such as to gain money, power, or

influence. An example of misinformation is the false

claim that sugar causes hyperactivity in children. An

example of disinformation is a company that makes false

scientific claims about the efficacy of their product to

boost sales. This article focuses on misinformation.

People increasingly seek health information online

through sources such as search engines, health-related

websites, YouTube videos, and apps. Unfortunately,

misinformation can occur at all these points, as well as

via blogs, social media platforms, and user comments on

articles or posts. Even when not actively seeking health

information, people can be exposed to it through media

outlets such as print, TV, and streaming networks.

Why do people believe misinformation?

Several factors can lead to people accepting


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


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

Health Misinformation continued on page 10

Page 10 • Nebraska Nurse August, September, October 2022


Health Misinformation continued from page 9

with healthcare providers where they did not feel heard

or received substandard care, eroding trust. In some

cases, healthcare providers have lied, as was the case

with the Tuskegee syphilis study of Black men; the men

were not told they had the disease or offered treatment.

In addition, some people have an inherent distrust of

government, leading them to turn to alternative sources of

information that state government-provided facts are not


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


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


How to combat misinformation

Recommending resources, teaching consumers how

to evaluate resources, and communicating effectively can

help reduce the negative effects of misinformation.

Recommendations. In many cases, patients and

families feel they have a trusting relationship with

their healthcare providers. Nurses can leverage that

trust by recommending credible sources of health

information. Villarruel and James note that before

making a recommendation, nurses should consider the

appropriateness of the source. For example, a source may

be credible, but the vocabulary used may be at too high

a level for the patient to understand. And someone who

prefers visual learning will not appreciate a website that

is dense with text. Kington and colleagues suggest using

these foundational principles when evaluating sources:

• Science-based: The source provides information

consistent with the best scientific evidence available

and meets standards for creation, review, and

presentation of scientific content.

• Objective: The source takes steps to reduce the

influence of financial and other forms of conflict

of interest or bias that could compromise or

be perceived to compromise the quality of the

information provided.

Transparent and accountable: The source discloses

limitations of the provided information, conflicts of

interest, content errors, or procedural missteps.

• Each principle has specific attributes, which are

listed in the article available for download at https://


Another tool for evaluating sources of health

information is the CRAAP test (Currency, Relevance,

Authority, Accuracy, and Purpose), which focuses on

evaluating the accuracy of research. It consists of multiple

questions in each category (see https://researchguides.

ben.edu/source-evaluation). For a more concise tool,

nurses can turn to the algorithm, developed by Kington

and colleagues, for assessing the credibility of online

health information.

Although the tendency is to recommend government

sources such as the Centers for Disease Control and

Prevention and National Institutes of Health, as noted

earlier, some people do not trust the government.

In this case, sources such as MedlinePlus, World

Health Organization, and condition-specific nonprofit

organizations (e.g., the American Heart Association,

American Cancer Society, Alzheimer’s Association) might

be preferred.

Education. The sheer scope of the information found

online can make it difficult for even the most astute

consumer to determine what is accurate. Nurses can help

A proactive approach

Villarruel and James provide the following

suggestions for talking with patients about


• Acknowledge the barrage of health

information that is available online and

through other sources and the difficulty

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

know there’s a great deal of information

about COVID-19 and not all of it is the

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

and know what to trust.”)

• Assess where patients and families obtain

their health information and what sources

they trust. Keep in mind that even when a

source is credible, a person may not trust

it, and a person may trust a site that is

not credible. (“Where do you get most of

your information about COVID-19? What

makes that a trusted source for you?”)

• Provide alternative and accurate sources

of information. (“I’m not familiar with

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

you know what I think. In the meantime,

here’s where I get information and why I

trust it.”)

• When correcting misinformation be

nonjudgmental. (“I’ve heard similar

information about not getting vaccinated.

Here’s what I’ve learned from the science

and why I believe getting vaccinated is

important and safe.”)

Source: Villarruel AM, James R. Preventing

the spread of misinformation. Am Nurs J.

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


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.


• Check the source. Is the website or person known

for conflating facts and opinions?

• Check the date. Is it implied that the information is

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

information available elsewhere?

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• Check the data and motive. What is the original source of the information? Are

they just looking for anything that supports their own worldview?

• If still unsure, use a reputable, fact-checking site such as Snopes.com or FactCheck.


UCSF Health (https://www.ucsfhealth.org/education/evaluating-health-information)

provides a useful short overview for patients on how to evaluate the credibility

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

the information) of health information and red flags to watch for (e.g., outdated

information, no evidence cites, poor grammar).

Communication. Communication is the best way to correct misinformation

and stop its spread. This starts with the nurse clearly explaining the evidence for

recommended interventions. From the start, the nurse should establish the principle of

shared decision-making, which encourages open discussion.

A toolkit from the U.S. Surgeon General on misinformation (https://www.hhs.

gov/sites/default/files/health-misinformation-toolkit-english.pdf) recommends that

nurses take time to understand each person’s knowledge, beliefs, and values and to

listen with empathy. It’s best to take a proactive approach and create an environment

that encourages patients and families to share their thoughts and concerns (see “A

proactive approach”). Nurses should remain calm, unemotional, and nonjudgmental.

Nurses also can prepare for conversations where they know misinformation may

occur such as vaccination. For example, the CDC has a page on its website that

addresses infant vaccination (https://www.cdc.gov/vaccines/hcp/conversations/convmaterials.html).

It includes resources such as responses to possible questions.

Listening and providing information may not be enough. In some cases, a

patient may not want to hear what the nurse is saying. When patients become

angry or frustrated, the nurse should remain calm. It can be helpful to acknowledge

the frustration (“I can see that you are upset.”) Depending on the situation, it may

be possible to briefly summarize key points before reinforcing the desire to provide

information to support the patient and then move on to another topic. The goal is to

maintain a positive nurse-patient relationship, which leaves the door open to further



As with any patient education, it’s important to document discussions related to

misinformation in the patient’s health record. Nurses should objectively record what

occurred and include any education material they provided. Should the patient

experience harm as a result of following misinformation instead of the recommended

treatment plan, this documentation would demonstrate the nurse’s efforts and could

help avoid legal action.

Dear NNA Members,

Your NNA/MW MSD Office Depot® Member Benefits Program, previously

Office Depot Business Solutions Division, has been rebranded to ODP Business

Solutions. Now a B2B-focused company serving small and medium level

businesses like yours. You’ll receive savings of up to 75% on the Best Value List of

preferred products with free next-business-day delivery* or in-store and curbside

pickup.** To continue to receive your member discounts, you’ll need to re-enroll

or register for an account through our dedicated ODP site.

Please visit: https://nebraskanurses.org/members-only-benefits/ for full

details and registration link.

*Free Delivery: Minimum purchase required after discounts and before taxes. Orders outside our local

delivery area and most furniture, oversized, bulk items, cases of bottled water and other beverages

and special-order items do not qualify. Non-qualifying orders incur a delivery charge (minimum charge

of $9.99). Many orders can be delivered next business day (between 8:30 AM and 5:00 PM) if placed

online or via phone by 3:00 PM or via fax by 1:00 PM, local time (In most locations). Other restrictions

apply. **Curbside pickup is available in most stores, subject to state and local regulations. Orders

must be placed 1 hour before store closing. See odpbusiness.com, call 888.2.OFFICE or ask your

Account Manager for details.

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.


CDC. How to address COVID-19 vaccine misinformation. 2021. https://www.cdc.gov/vaccines/


CDC. Talking with parents about vaccines for infants. 2021. https://www.cdc.gov/vaccines/hcp/


CDC. The U.S. public health service syphilis study at Tuskegee. 2021. https://www.cdc.gov/


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/

Kurpiel S. Evaluating Sources: The CRAAP Test. Benedictine University. 2022. https://


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/


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/


Villarruel AM, James R. Preventing the spread of misinformation. Am Nurs J. 2022;17(2):22-26.


Disclaimer: The information offered within this article reflects general principles only and does

not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or

acceptable standards of professional conduct. Readers should consult with an attorney if they

have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for

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

that Internet hyperlinks cited herein are active as of the date of publication but may be subject

to change or discontinuation.

This risk management information was provided by Nurses Service Organization (NSO), the

nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000

nurses since 1976. The individual professional liability insurance policy administered through

NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA

company. Reproduction without permission of the publisher is prohibited. For questions, send

an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.

Page 12 • Nebraska Nurse August, September, October 2022

Finally Back Together –

Discussing Violence, Staffing, Racism and Climate

Linda Stones, RN,

Membership Assembly Representative

First, thank you for allowing me to represent

Nebraska at the American Nurses Association

Membership Assembly, June 10th and 11th in

Washington DC.

The American Nurses Association was finally able

to meet in person for Membership Assembly. It had

been several years where we met virtually due to

COVID and finally, in 2022, we were able to bring

together nurses from all over the US and territories

to talk nursing. The House of Delegates passed three

resolutions and a position statement on racism in

nursing. The unintended product of the assembly

was the power of togetherness. I want to start with

togetherness and then I will share the resolutions on

Climate and Health, Violence in the Workplace, Nurse

Staffing and Racism.

Togetherness: Since I have had the opportunity to

experience both forms of meetings, I can tell you that

the sense of belonging, the sense of togetherness,

the feeling of empowerment is much greater when

we meet in person. So one of the big take-aways

that I want to share from Membership Assembly, is

the importance of being present with each other.

While zoom meetings can bring us together to make

operational decisions, the intangibles are missing.

Being present with one another adds a significant

value to the psyche.

As I was flying back to Nebraska, I reflected on

this. The majority of communication is through

the non-verbal interaction; I think literature says

about 85% of what we communicate is non verbal.

So much of non verbal is in the face and, for many

of our members working in clinical areas, this is still

disrupted with masks. I highly encourage all of you

to take time to reconnect with colleagues and peers

in person with masks aside. It is safe to meet outside

several feet apart without masks. Connection at this

level is important for us to move past this pandemic,

to move to our new reality but more importantly to

reinforce that sense of belonging, togetherness and

empowerment. As nurses we are part of the most

trusted profession, the largest sector of Healthcare

Professionals. Now more than any time in our history,

we need to stand together with one voice to advocate

for necessary changes to our health delivery systems.

We need to address the issues that are driving

nurses out of the profession. The time is now! Our

communities, our neighbors and our peers need us to

stand up.

Climate and Health: During the Membership

Assembly, we took action on three different reference

proposals. The first was on climate change and the

impact that this has on health. This focused on how

drought and extreme heat, air pollution, severe

weather can impact health such as heat related

illnesses, malnutrition, asthma exacerbation and

mental health issues. The final outcome was to direct

ANA to include climate issues in their policy platform

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Theresa Rizzo, CEO


and to educate members on how climate impacts

health. This resolution was passed by the House of


Workplace Violence: The second resolution was

on workplace violence across the continuum of care.

Members from the New Jersey Nurses Association

as well as the National Association of School Nurses

brought forward this reference proposal. The group

highlighted that one of the biggest issues surrounding

this topic is the lack of data available. There is no

central data base to collect incidence of violence, a

standard definition of violence does not exist and

there is significant under reporting. This topic brought

forward significant discussion and ideas on how the

American Nurses Association can support members.

The general consensus is that violence is a big issue

that needs to be addressed urgently. It is probably one

of the factors driving nurses out of healthcare. The

final reference proposal will be published soon on the

ANA website but some of the ideas included creating

a standard definition of violence, require mandatory

reporting of violence through OHSA, worker’s

compensation coverage for the mental recovery for

victims of violence. Watch for more to come on this

topic. The House of Delegates also had widespread

support of this reference proposal.

Staffing: The final discussion was around nurse

staffing. It was another topic that sparked a spirited

discussion. We heard from colleagues in California

that spoke in support of mandatory ratios. Principles

for appropriate nursing staffing were shared as part of

this reference proposal. The overall consensus of the

House of Delegates was something needs to occur

and it needs to occur now. There was a real sense of

urgency was shared by the members on this topic. We

debated the benefits of standards versus ratios, we

discussed how level of care and location, as well as

the physical structure of the facility and the amount

of support services can impact what is considered

“adequate staffing.” Members from Oregon shared

that they hired staff to teach staff how to advocate

for appropriate staffing in their environments. The

overall consensus of the House of Delegates was that

staffing is an extremely important topic that needs

to be addressed in all healthcare settings. However,

whatever solution that is proposed needs to be

flexible to the type of facility and the ever changing

acuity of patients and consideration should be made

to enforcement. Watch the ANA website for future

actions and focus on this topic.

Racism in Nursing: The final big topic for

Membership Assembly was related to racism

in Nursing. A Racial Reckoning statement was

developed, shared and discussed. The Reckoning

statement is an admittance to racism in our

profession, an acknowledgement that it exists and

that it is not accepted by the organization and that

steps need to be put in place to address racism. Please

watch for ANA release of additional information later

this summer on this topic.

As you can see by my report, some very significant

and relevant topics were discussed that are impacting

our profession. All are very complex issues with

no outright, single solution but yet all need to

be addressed. The American Nurses Association

represents you as a nurse and your nursing profession.

The power of ANA does not come through their

staff, it comes through the togetherness of all of our

members. The power comes in our numbers as the

largest group of health professionals and through the

recognition our the public that we are the #1 most

trusted profession. To make significant changes, we

must do this together. If you belong to your state

nurses association, lean in and ask how you can help.

If you don’t belong, get your membership started and

then lean in. It is in working together that we can

make significant changes to better our profession.

“Be the Change you wish to see in the World”

- Gandhi

Note from Dr. Linda Hardy, President Elect,

NNA: I had the distinct privilege of attending the

Membership Assembly for our President, Dr. Kari

Wade who was unable to attend. This was the first

time that I attended this meeting. What an amazing

feeling to be in a room with hundreds of nurses from

across our country. As Linda mentioned, being faceto-face

was so very powerful.

August, September, October 2022 Nebraska Nurse • Page 13

Nebraska Nurses on the Hill

decline in licensed nurses and that this is

the first time in over 20 years we have seen a

decline. These statistics helped us talk about

RN staffing, impacts on patient outcomes, the

need for financial support for tuition and faculty

development and a general focus on nursing


Linda Stones, RN

This June, Kim Houtwed, Linda Hardy, and I

represented the Nebraska nurses on Capitol Hill. We

all participated in the American Nurses Association Hill

Day on June 9th, in Washington DC.

The day kicked off with a breakfast that brought

together almost three hundred nurses from fifty states

and territories that were spending the day talking with

their House of Representatives and Senators on issues

related to nursing. Sharing the issues with our elected

representatives and including our own personalized

stories from Nebraska is key to gaining their support.

It was good to be able to visit the representatives

in DC but due to COVID, some aspects of Hill Day

were limited. Our delegation was able to meet in

person with Senator Deb Fischer and her Health Aide.

We greatly appreciated Senator Fischer’s time and

presence as we discussed issues for Nebraska Nurses.

Senator Ben Sasse’s aide was able to meet with us

virtually. Since our House of Representative seat was

empty, that was the extent of our planned visits. In

other years, we were able to drop into offices but due

to COVID protocols, staffers had to escort you into the

buildings and into their offices.

There were three main topics that we shared.

1. Improving Senior’s Timely Access to Care Act

of 2021 (S 3018/HR 3173): This bill highlights

some of the burdens of Medicare Advantage

programs. Unnecessary burdens of the

authorization process and delays in accessing

care. This bill allowed us to share the challenges

of nurse staffing and resources such as beds

and nursing care are being tied up due to the

lengthy authorization processes.

2. Advanced Practice Registered Nurses (APRNs)

We shared how nurses should be utilized to

the fullest extent of their skills and training to

help address access to care issues and how the

pandemic highlighted gaps in our systems. We

shared how access to specialized care could be

addressed by utilizing APRNs to their fullest.

3. Valuing the Nursing Workforce. We shared the

stories of nurses who stepped up during the

COVID pandemic and met the needs of their

communities. We also shared the results of a

recent survey that highlighted the impact that

this pandemic had on the health of our RN

workforce. We shared statistics that 60% of

acute care nurses reported being burned out,

and that only 19% of nurses under the age of

thirty-five feel that their organizations care

about them or their well-being. We also shared

that the US Bureau of Labor Statistics estimates

that over a half million RNs will retire by the end

of 2022, creating a worse shortage of RNs. We

also shared the Nebraska Center for Nursing

fact sheet about how Nebraska saw a significant

Nurses - Want to use your

knowledge in a new way?

Public Health needs your creativity

and expertise!

This is an opportunity to work with people in local communities

and develop new programs to help people be healthier. Northeast

Nebraska Public Health Department (NNPHD) is looking for a Public

Health Nurse (BSN preferred) to work in a variety of public health

programs such as:

• Disease Surveillance, Investigations and Response,

• Immunizations,

• Chronic Disease Prevention, and

• Health Coaching & Case Management.

NNPHD offers:

• Paid Employee Health Insurance,

• Generous PTO and Holiday Package,

• State Retirement Benefits, and

• Numerous Additional Benefits

Position will remain open until qualified candidate is hired. Salary

commensurate with experience and skill level.

For more information email julie@nnphd.org . Send resume and cover

letter to the email listed or send via USPS mail to

Northeast Nebraska Public Health Department, ATTN: Health Director,

215 N Pearl Street, Wayne, NE 68787.

NNPHD serves Cedar Dixon, Thurston and Wayne Counties.

While the meetings with our representatives were

short, the representatives heard our stories firsthand.

They heard from Nebraskans. They heard from Nurses.

It is the start of developing a relationship with the

representatives and their staff so when issues related

to nursing come up, they have a contact in Nebraska

to call. It is through these personal connections that

we can make a difference. We hope that our presence

in Washington will open the door for you to have

continued conversations with these representatives.

Consider it the invitation to approach them in their

home office or at a county parade to share your

stories about being a nurse in Nebraska.

For additional information about these topics

or others, please do not hesitate to contact me at



Glenwood Resource Center (GRC) is seeking

applicants for RNs and LPNs caring for those with

Intellectual Disabilities and Physical Disabilities.

RN hourly rates starting at: $26.53 - $41.17*

LPN hourly rates starting at: $22.48 - $34.14*



RNs & LPNs

Apply online: https://das.iowa.gov

Click on Human Resources

Click on State employment

*based on


Page 14 • Nebraska Nurse August, September, October 2022

Pearls and Pitfalls: The Journey of APRN Entrepreneurs

Nurse Practitioners are experts in clinical care, but

most are often novices when it comes to business,

marketing, financial management and working

outside mainstream healthcare settings. There is little

focus on the business side within the curriculum of

current nurse practitioner education. However, these

skills are essential for nurse practitioners who want

to grow, innovate and work in independent practice.

Whether you are ready to open your own practice or

enhance your current business capabilities and skills,

join us for this day-long webinar and learn from Dr.

Wendy Wright’s experience building her business

over the last 15 years. She will share tips for effective

and accurate billing and coding, mistakes to avoid in

contract negotiation, and documentation that stands

up against malpractice claims, and much more!

The live, virtual event will begin at 8:45 am and will

adjourn at 4:45 pm. Within the schedule for the day,

we have incorporated three fifteen-minute breaks for

those watching to stretch, grab a drink, etc., as well

as a 45-minute lunch break. During the time set aside

for breaks and lunch, Wendy will be monitoring the

ZOOM Q&A feature to address your questions. It will

be a fun, full day of learning for everyone participating

and we hope you will choose to join us!


8:30 am Registrants begin logging into the

virtual platform to participate in the

event – individualized login details

provided after registering for the event

8:45 am Session 1

10:15 am Session 2

11:30 am Lunch Break

12:15 pm Session 3

1:45 pm Session 4

3:15 pm Session 5

4:30 pm Complete Evaluation

4:45 pm Event Adjourns


1. Coding and Reimbursement: Essentials for

Successful Practice

2. APRN Contract Negotiation and Much More…

3. Malpractice Prevention & Documentation: Everything

the APRN Needs to Know

4. Starting a Business/Independent Practice

5. Pearls of Business: What I Wish Someone Had

Told Me


Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP,


Registration Fees:

• $129.00 – Member

• $169.00 – Non Member

Pre-registration is required for access to live, virtual




Registration Deadline:

September 19, 2022 at 12:00 pm CST


• Successful Completion – Attendees must

register, participate in all of the educational

sessions and complete the online conference

evaluation to receive a certificate of completion.

The link to the online evaluation will be emailed

to participants (to the email address provided at

registration) upon conclusion of the activity.

• Relevant Financial Relationships – Dr.

Wendy Wright serves as a consultant for

Gilead, GlaxoSmithKline, Merck, Pfizer & Sanofi

and is on the speakers’ bureau for AbbVie,

Biohaven, Merck, Pfizer & Sanofi. All relevant

financial relationships for the presenter have

been mitigated. No other relevant financial

relationships were identified for any member of

the planning committee or presenter/author.


6.5 contact hours are available to those who meet

the successful completion requirements.

The Midwest Multistate Division is accredited

as a provider of nursing continuing professional

development by the American Nurses Credentialing

Center’s Commission on Accreditation.

Tuition Assistance up to 100% and the Children of

State Teammate Tuition Reimbursement Program

What is the Midwest Multistate Division? The Arkansas Nurses

Association, Kansas State Nurses Association, Missouri Nurses

Association and Nebraska Nurses Association formed a

collaborative, namely the Midwest Multistate Division (Midwest

MSD), with the goal of promoting efficiencies and growth. As part

of this collaborative, the Midwest MSD Professional Development

Unit (PD Unit) was formed, which is accredited as an ANCC

approver and provider of NCPD, to address the educational needs

of nurses in the Midwest region.

Those certified through AANP – Contact

hours received through participation in this event

are acceptable toward certification/recertification

through the American Academy of Nurse Practitioners

(AANP). Per the AANP guidelines, the American

Nurses Credentialing Center (ANCC) is an acceptable,

accredited and independent organization that

provides advanced nursing CE content for NPs seeking

renewal using continuing education credit. (https://

www.aanpcert.org/recert/ce_opps; Recertification


Questions? Please contact Sara Fry at (573) 636-4623

x102 or sara@midwestnurses.org with any questions.

August, September, October 2022 Nebraska Nurse • Page 15



School Nurses


The Nebraska School Nurses Association, the official

affiliate of the National Association of School Nurses, in

collaboration with the Central Nebraska School Nurses

Association, hosted the 38th Annual School Nurse

Conference June 5-7th, 2022.

The conference was held in Kearney, Nebraska and was

attended by over 200 school nurses across the state of


The Keynote speaker, Dr. Erin Maughan, presented on

Overcoming, Moving Forward, and Leading Out the New

Normal. Other speakers addressed topics specifically for the

practice of school nursing.

Additionally, the Nebraska School Nurses Association

held its annual all members meeting and installed newly

elected NSNA board of director positions.

Nebraska Nursing

Students and NNA


The Nebraska Nurses Association has several awards

and scholarship opportunities available this year and

are now open for application submission. The following

scholarships are open for application submissions:

• NNA Member Scholarship – one $1000 scholarship

per NNA membership liaison region to an NNA

member seeking higher education

• Arthur L Davis – two $500 scholarships for prelicensure

nursing students

• Gail Graham Memorial – one $500 scholarship for

nurses furthering their education.

More information on the awards and scholarship

applications can be found at http://www.nebraskanurses.

org/awards-scholarships/. The deadline for all applications is

AUGUST 26, 2022. Submit your applications today!

Page 16 • Nebraska Nurse August, September, October 2022

Where Do I Go From Here?

Sharon Broscious, PhD, RN

Program Director South University RN-BSN

Online Program

Reprinted with permission from Virginia Nurses Today,

August 2021 issue

As the COVID-19 pandemic winds down, you may

be asking yourself questions about your professional

future. What’s my next career step? What does my

professional future hold for me? The stress of the

COVID-19 pandemic may have created these nagging

questions for you, and you might be unsure what

steps you should take to answer them. The physical,

emotional, psychological, and financial impact of the

pandemic on nurses has been well documented. A

plethora of publications in professional journals and on

websites as well as newspaper and television reports

have discussed the impact of the COVID-19 pandemic

on nurses. Terms such as burnout, compassion fatigue,

moral injury, PTSD, and healthcare worker exhaustion

are used to describe the physical and mental effects of

COVID-19 on healthcare providers (Chan, 2021; ICN,

2021). In an interview on NPR, the phrase “crushing

stress” of the COVID-19 pandemic was used (Fortier,


Not only did the nursing workload change –

increased number of patients per assignment, increased

number of shifts, increased length of workday due to

insufficient staff – but also other factors compounded

the stress on staff. Lack of equipment such as PPE,

the unknowns about the disease itself with policies

changing almost daily, and perceived lack of support

from leadership have also contributed to the COVID

effect (ICN, 2021) on nurses. Some facilities attempted

to prepare and support staff for the pandemic surges,

to varying levels of successful impact. While providing

meals to nurses who could not take time for a meal

break was helpful, as the pandemic persisted, nurses

needed more support from their leadership teams.

The recent COVID-19 report released by the

International Council of Nurses (ICN) (2021) describes

the exacerbation of burnout and exhaustion of nurses

during 2020. National nursing associations reported

approximately 80% of their members identified as

feeling stressed. In a survey of healthcare workers

conducted by Mental Health America (Lagasse, 2020),

93% indicated feeling stressed, and 76% reported

feeling burned out with 55% questioning their career

focus. Similar results were found in a survey from

Brexi (2020) with 84% of responding healthcare

workers identifying some burnout and 18% reporting

total burnout. In addition, almost half had considered

quitting their job, retiring, or changing their career

focus. The top five stressors that respondents

identified, in order, were “fear of getting COVID-19,

long hours/shifts, general state of the world, fear of

spreading COVID-19, and family responsibilities/issues”

(Berxi, 2020, para 2). Additional stressors identified

by Shun (2021) include physical, emotional and moral

distress related to ethical issues faced by nurses such

as dealing with patient deaths, scarce resources, and

forced changes in practice.

The 2021 Frontline Nurse Mental Health and Well

Being Survey (Trusted Health, 2021) revealed for

nurses under age 40, 22% indicated they were less

committed to nursing. Ninety-five percent of the

nurses responding indicated their physical and mental

health were not a priority in their workplace or the

support received from leadership was inadequate.

Finally, 66% of respondents indicated they were

experiencing depression and a decline in their physical

health. A poll by the Washington Post-Kaiser Family

Foundation (2021) indicated 62% of healthcare workers

felt mentally stressed from the pandemic with their

greatest fears of them getting infected, infecting their

families, or other patients. Another challenge identified

was working while wearing PPE (Kirzinger et al., 2021).

Prior to the pandemic, Shah, et al. (2021) reported

burnout was the third leading cause of nurses leaving

their jobs. However, the pandemic intensified levels of

stress and burnout. From the perspective of Maslow’s

hierarchy, Virkstis (2021) described the need for

leadership to focus on basic needs of staff, not high

level self-actualization. The basic needs were identified

as: a safe working environment, clear mission, time to

reflect on what was happening, and time to connect

with peers.

Considering the factors identified here, it is no

surprise that you may be asking what is the next

step for you in handling stress, burnout, and career


Step 1 – Do I stay where I am?

You may be asking the following: Do I leave my job

as other nurses have? Do I want to, or can I continue

working where I am? Do I just need some time off?

The first step to take is self-reflection or selfevaluation.

If you are unsure about a change, pause

and take some time to think about it. Consider staying

where you are to determine how your workday has

changed after COVID-19 and whether factors such as

workload, staffing, and equipment, for example, have

improved. Remember wherever you go, everyone will

be rebuilding after the pandemic and trying to return

to a previous level of normalcy, or an improved level

based on lessons learned from the pandemic.

Before making a decision, reflect on your job prior

to the pandemic. Was this job a good fit for you? Were

you happy with your job? Answers to these questions

can guide you to remain in your current job to see if

those same positive feelings come back after the

pandemic. The area you work in may not be exactly

the same as it was, but it could be even better. Other

reasons leading you to consider a change may include

the work environment, the leadership of your current

unit, or lack of potential for growth in your current

position. This introspective evaluation provides time

to think about other opportunities or make plans for

change if that is your final decision.

Step 2 – Do I change my career path?

There are numerous websites that provide steps to

take when changing your specialty or your role, but the

first step should be:

1. Identify your passion. What makes you happy?

Self-reflection and serious thought can help

provide this answer.

Additional steps to consider include:

2. Complete a SWOT analysis. Guidelines for

completing a SWOT analysis can be found on the


• Identify your strengths: skills, experiences,

education, support from peers/family.

• Identify weaknesses: communication skills,

leadership skills, skills needed for a new path.

• Identify opportunities: What specialty areas

might be of interest? Do you want to be in a

hospital or in the community? Do you want

to move to administration or education and

have less direct patient contact? What works

for your family? The Johnson & Johnson

Campaign for Nursing’s Future, provides

information about 96 nursing specialties;

this might be a good place to start looking

for new opportunities as it may present

some potential employment ideas you had

not previously considered. A list of more

than 100 nursing organizations is available

at https://nurse.org/orgs.shtml In addition,

the Illinois Nursing Workforce Center web

page includes a list of professional nursing

organizations (http://nursing.illinois.gov/


• Identify threats. What barriers exist that might

keep you from making this change – family

responsibilities, work hours desired, access to

a new role in your geographic area, skills or

specific educational background needed. A

threat such as educational level may turn into

an opportunity to return to school.

3. What are your goals in five or ten years?

4. When you have decided on a new role – develop

an action plan or timeline to establish your

transition to the new role. What steps do you

need to take to make this change?

5. Refresh your resume. While you may consider

that a move from pediatrics to geriatrics would

not provide you with appropriate skills, there are

many skills you have that are transferable – your

assessment skills for example, understanding lab

results, providing care to someone who may be

unable to describe how they feel, or organization


6. Network. Talk to someone who currently works

in the specialty you are considering. If the

specialty has a professional organization, peruse

their website, attend a local meeting, or read

their journals and social media networks to help

you connect with nurses in the specialty you are


7. Draw on your support system and mentors to

overcome any barriers/challenges that may be

keeping you from making a change.

8. Resources on the VNA/ANA websites provide

information about available jobs, resume writing,

and interviewing. Scheduling a live meeting with

a career coach is also available.

9. After you have made a specialty change, give

yourself a chance to get acclimated to the new

path you have chosen.

10. Consider staying on good terms with your

current employer. A reference will be needed when

applying for a new position. Staying on good

terms may also be beneficial if the new specialty or

organization change does not work out.

Step 3 – Do I leave nursing and change my


Your reflection may lead you to leaving the nursing

profession. Many of the steps in this process are the same

or similar to the steps above in changing your career path.

1. Begin again with self-reflection/evaluation. What

makes you feel fulfilled? What would you like to

do? What are your interests?

2. Identify areas of interest. There are a number of

free aptitude tests available on the internet that

can guide you in identifying a new career or

attend a career fair. New careers could be with

pharmaceutical companies, insurance companies,

the government, or in education for example.

3. Complete a SWOT analysis

4. What are your goals?

5. Identify the skills/education needed for the new


6. Develop action plan

7. Network

8. Career counseling – obtain a career coach, see

the VNA/ANA websites

9. Connect with your support system

10. Keep your license current, you may decide at

some point in time you want to return to nursing.

The COVID-19 pandemic has likely changed you

personally and professionally, has certainly changed

healthcare, and has without a doubt changed the

world. What you do to fulfill your life is a priority, so

take time to carefully consider what you want to do

and where you want to be.

As Steve Jobs (2005) said, “Your work is going to fill

a large part of your life, and the only way to be truly

satisfied is to do what you believe is great work. And

the only way to do great work is to love what you do.

If you haven’t found it yet, keep looking. Don’t settle.

As with all matters of the heart, you’ll know when you

find it.”


Berxi. (December 8, 2020). State of healthcare workers in

2020. Business Wire. https://www.businesswire.com/news/


Chan, G.K., Bitton, J.R., Allgeyer, R.L., Elliott, D., Hudson, L.R.,

Moulton Burwell, P. (May 31, 2021) The impact of COVID-19

on the nursing workforce: A national overview OJIN: The

Online Journal of Issues in Nursing 26 (2), Manuscript 2.


Fortier, J. (December 16, 2020). ICU Workers are quitting due

to crushing stress from COVID-19 surge. (Radio broadcast)

Morning Edition – NPR.

International Council of Nurses. (January 13, 2021). The COVID-19

Effect: World’s nurses facing mass trauma, an immediate

danger to the profession and future of our health systems.

References continued on page 17

August, September, October 2022 Nebraska Nurse • Page 17

Courage in Everyday Nursing Practice

Carol Dobos PhD, RN-BC, NEA-BC

Reprinted with permission from Arizona Nurse,

July 2021 issue

Courage is an important attribute in life and in your

nursing practice. As Helen Keller said,

“Security is mostly a superstition. It does not exist

in nature nor do the children of men as a whole

experience it. Avoiding danger is no safer in the long run

than outright exposure. Life is either a daring adventure,

or nothing.”

Nursing is a noble profession that is not for the

faint of heart. Opportunities to choose courageous

acts present themselves on a regular basis because risk

is everywhere. You can attempt to minimize the risks

by playing it safe. However, there are risks to yourself,

your colleagues, your profession, and those you serve

when you don’t take risks in showing up, speaking

up, or practicing according to the highest standards of

evidence-based practice.

Choosing to practice courageously, consistent

with your personal and professional values, will cause

some discomfort, bumps, and bruises to you and your

career. It will also bring professional and personal

fulfillment, strengthen the profession, and improve

patient outcomes. You will know that you are making

a difference in your daily practice and throughout your

nursing career.

One way to cultivate courageous behavior is

through personal risk-taking (PRT), but first you need to

understand the nature of risk and its related concept,

positive deviance.

What is Risk?

Risk is defined as the possibility of losing something

of value, which could be physical, psychological, or

economic. Common risks include falling out of favor

with others in authority, losing support, or damaging

essential relationships. Any of these events could lead

to losing status or influence at work, or even losing

one’s position or employment.

A related concept called “positive deviance” refers

to an intentional act of breaking the rules to serve

the greater good. Positive deviance is intentional and

honorable behavior that departs or differs from an

established norm. It contains elements of innovation,

creativity, adaptability, or a combination thereof; and it

involves risk for the nurse.

References continued from page 16

ICN, https://www.icn.ch/news/covid-19-effect-worlds-nursesfacing-mass-trauma-immediate-danger-profession-andfuture-our

Jobs, S. (June 12, 2005), Stanford Commencement Address.


Kirzinger, A, Kearney, A, Hamel, L., & Brodie M. (April 6,

2021). KFF/The Washington Post Frontline Health Care

Workers Survey. https://www.kff.org/report-section/







Lagasse, J. ed (December 8, 2020) Healthcare workers

experiencing burnout, stress due to COVID-19

pandemic. Healthcare Finance News https://www.


Shun, S.C. (2021). COVID-19 Pandemic: The challenge to the

professional identity or nurses and nursing education. The

Journal of Nursing Research 29(2), e138. doi: 10.1097/


Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N., Moore,

M., & Ali, M. (2021). Prevalence of and factors associated

with nurse burnout in the US. JAMA Network Open 4(2),

e2036469 doi:10.1001/jamanetworkopen.2020.36469

Trusted Health. (2021). 2021 Frontline Nurse Mental Health &

Well- Being Survey https://www.trustedhealth.com/notahero

Virkstis, K. (March 11, 2021). Nurse burnout didn’t start with

Covid-19. (And it won’t end with Covid-19, either.). Advisory

Board https://www.advisory.com/daily-briefing/2021/03/11/


For most nurses, whether a particular action is right

or wrong will often be judged by others in charge of

rules enforcement. The decision to engage in positive

deviance, however, lies entirely with the nurse.

Personal Risk-Taking

PRT is behavior that is consciously and freely

chosen among available alternatives, some of which

are known to incur less risk than the chosen action.

It is supported by the strength and belief of personal

convictions. Courageous action upholds principles.

Calculated inaction due to fear leaves one powerless,

with values compromised.

Nurses promote courageous action by sharing

courageous behavior, also called hero stories. This

can be done formally and informally, verbally and

in writing, one on one or in groups, during staff

meetings, during change of shift report, or rounds.

We create a culture based on what we talk about,

what we value, and what we support and reward.

Sometimes we stand alone, and sometimes we

influence others to follow our lead and take their own

personal risks. In one study, risk taking was found to

be one of the key elements in attaining expert nursing

practice, which supports effective and quality-based

healthcare outcomes. Risk taking also was found to

enhance clinical and professional development.

Rather than sitting on the sidelines and hurling

judgment or advice at others (for example, “Someone

needs to do something about this.”), we must dare to

show up and let ourselves be seen, which can result in

change. (See Success story.)

Success story

When residents were not interacting

appropriately with pediatric patients, risking

psychological harm, I discussed this with

the chief and arranged education. I advised

our team that in identifying this issue,

relationships might become strained, but we

had an obligation to our patients to address

this problem. I often used the mantra “I am

doing the right thing for the right reason”

stating it over and over in my head to help

me stay the course and follow through with

my convictions. As feared, the residents and

even an attending physician demonstrated

passive aggressive behavior towards us. The

care of the children did improve, however,

and we knew we had made the right call.

We pay a price when we shut down and

disengage, failing to take action. I have heard nurses

talk about “staying under the radar.” In doing so they

pay a dear price. Their talents, wisdom, knowledge,

and values are not being shared to positively influence

care and support the development of new nurse

graduates and other colleagues through courageous

role modeling. Vulnerability occurs in sharing an

unpopular opinion, standing up for oneself or others

such as a colleague who is being bullied, being

accountable, asking for help, trying something new,

admitting uncertainty, and asking for forgiveness.

When courage and fear meet, it often feels awkward

and scary; however, “being all in” is to be alive. To act

in alignment with your values is key to personal and

professional happiness.

PRT and Promoting Patient Safety

Failing to take risks and practice courageously

can lead to threats to patient safety. Focusing on

my obligation to “First do no harm,” I made the

decision not to deploy a transport team until all the

team members demonstrated competency. I was

transparent in discussing my concern and contingency

plan to send another team with my medical and

administrative colleagues. I was told that this was a

“career-limiting move.” I simply stated, “I have to be

able to sleep at night.”

In another organization, I disagreed with a

plan to move critically ill patients multiple times

to accommodate unit renovation. I identified an

alternative that required only one move. Although

my plan was successfully implemented, my action

caused me to fall out of favor with the administrator

and eventually resulted in my having to move on to

another position. In both instances, I had to put my

patients first because when I became a member of

the nursing profession, I made a promise to protect


Why We May Not Take Personal Risks

Understanding scarcity is key to understanding

why nurses may not take justified risks. The three

components of scarcity are shame, comparison, and


Shame is the fear of ridicule and belittling often

used to control people and to keep them in line.

Shame-based cultures are very unhealthy for nurses

and patients. The killer of innovation is shame. In

these cultures, covert or sometimes overt messages

are common, such as to dare not, you’re not good

enough, who do you think you are, don’t you dare get

too big for your britches.” Shame becomes fear, fear

leads to risk aversion, and risk aversion kills innovation

and can lead to unsafe patient care. Shame is the

intensely painful feeling or experience of believing that

we are flawed and therefore unworthy of belonging.

Shame makes us feel unworthy of connection.

Resilience to shame occurs when recognizing and

speaking openly about shame, practicing critical

awareness, and reaching out to others.

Healthy competition can be beneficial, but constant

overt or covert comparing and ranking suffocates

creativity and risk taking. If nurses are held to one

narrow standard, they may not question the relevance

of a course of action to a specific situation and

embrace evidence- based practice.

Disengagement occurs when people are afraid to

take risks and try new things. Too often it is easier

to stay quiet than to share stories, experiences, and

ideas. It is important to do what is right, not what

is easy. The best way through a difficult situation is

to address the situation directly with honesty and

integrity, sharing your story and asking for what you

need. An excellent resource for nurses is the book

Crucial Conversations. Often what we fear does not

happen, but even if it does, we have retained our selfrespect

and commitment to professional values.

Courageous Practice

I hope you choose to practice courageously, doing

the right things for the right reasons. As Theodore

Roosevelt said,

“Far better it is to dare mighty things, to win

glorious triumphs, even though checkered by

failure, than to take rank with those poor spirits

who neither enjoy much nor suffer much, because

they live in the gray twilight that knows not victory

nor defeat.”

Selected references

Dobos C. Defining risk from the perspective of nurses in

clinical roles. J Adv Nur. 1992;17:1303-9.

Dobos C. Understanding personal risk taking among staff

nurses: critical information for nurse executives. J Nurs

Adm. 1997;27(1):1-2.

Gary JC, Exploring the concept and use of positive deviance

in nursing. Am J Nurs. 2013;113(8):26-34. Haag-Heitman

B. The development of expert performance in nursing. J

Nurses Staff Dev. 2008;24(5):203-11.

Brown B. Daring Greatly: How the Courage to be Vulnerable

Transforms the Way We Live, Love, Parent, and Lead.

Gotham Books; 2012.

Patterson K, Grenny J, McMillan R, et al. Crucial

Conversations: Tools for Talking When Stakes are High,

2nd ed. New York, NY: McGraw-Hill; 2011.

Carol Dobos lives in Phoenix Arizona and is

the past-president of the Arizona Association

for Nursing Professional Development, a

state affiliate of the Association for Nursing

Professional Development.

Page 18 • Nebraska Nurse August, September, October 2022

What is the Success Pays Program?

NNA partners with the American Nurses Credentialing Center (ANCC) using the Success Pays Program

to support professional development of nurses, increase the number of certified nurses in the workforce,

decrease test-taking anxiety and reduce financial burden for our members.

NNA members can apply to take the exam up to two times and pay the reduced rate of $260 only if they

pass the exam. This saves time, money and anxiety. Certifications with ANCC can also be renewed through

NNA at a reduced price of $250.

How it works:

• If the nurse passes the exam, the nurse is charged for the exam fees

• If the nurse is unsuccessful, they can take the exam an additional time before the contract expiration date

• If the nurse passes the second time around, then the nurse is charged the exam fee

• If the nurse does not pass, no one pays if within the contract date

Benefits of the program:

• Reduced test stress for nurses: Fear of failure is eased (FailSafe) and confidence increases

• Better care: Certified nurses provide the best nursing care to patients and families

Information concerning registering for the exam:

Applying for the ANCC Success Pays Program does not register you for the exam. To be eligible to take a

certification exam, you must meet all eligibility criteria at the time of the application.

• For more information concerning the exam and criteria, please visit the NNA Success Pays webpage.


Full-Time Day and Night RN positions available

Competitive Salary • Sign-on Bonus

Tuition Reimbursement

300 East 12th Street Cozad, NE


Apply online at cozadhealthcare.com or send

resume to hbrennan@cozadhealthcare.com

August, September, October 2022 Nebraska Nurse • Page 19









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